No Abstract Available.
Chondrocytes* ; Phenotype*

Late results of microvascular patency after crush or crush avulsion injury have been relatively poor. A key factor in the poor results may relate to the presence of damaged tissue, but the mechanism of this thrombus formation is still imcompletely understood. One current theory about the origin of thrombus after vessel trauma involves increased exposure of the subendothelial tissue to platelets that adhere and aggregate at the injury site, initiating thrombus formation. Most surgeons have usually used several anticoagulant drugs to prevent thrombosis for 2-3 weeks after trauma or microvascular repair. We thought that Ginkgo biloba extract (EGb 761), which has a number of pharmacologic actions, could promote microvasculature healing and prevent thrombosis. The femoral arteries of rats were dissected. Each group was as follows:-1. group A (n=10): intact group (not crushed vessel),2. group B (n=10); crushing injury (not EGb 761-treated group),3. group C (n=10); crushing injury (EGb 761-treated group). Group B and C underwent crush injury with the energy of 0.07J. We compared patency rate and histological examination. All arteries were patent at postoperative 14 days, and in histologic finding, group C (group with EGb 761 treatment among the crushed injury group) showed significant improvement of vascular endothelial and medial regeneration.
Animals ; Anticoagulants ; Arteries ; Femoral Artery ; Ginkgo biloba* ; Microvessels ; Pharmacologic Actions ; Rats ; Regeneration ; Thrombosis

Replantation after crush amputation has a relatively low success rate. Thrombus formation due to vessel and tissue trauma is considered as the principal cause of failure. In the laboratory and clinically, we have been tried to improve the post-anastomosis patency rate in crushed microvasculature. To accomplish this, we have usually used several anticoagulant drugs. Extracts from the leaves of Ginkgo biloba (EGb) have been used therapeutically for centuries. EGb exerts a number of pharmacologic actions. Eighty rats were control group and another 80 rats were treated with EGb 761. The femoral arteries underwent crush injury with an energy of 0.4J, and the vessles in each group were divided and anastomosed by a standard microsurgical technique. Each group was comprised as follows: (1) control group(A1,A2): group A1(n=40); intraluminal saline irrigation, group A2(n=40); intraluminal saline irrigation+heparin 40 u/ml(IV). (2) EGb 761 treated group(B1, B2): groupB1(n=40); intraluminal saline irrigation, group B2(n=40); intraluminal saline irrigation + heparin 40 u/ml(IV). At postoperative 14 days, the patency rates were; group A1 20%, group A2 77.5%, group B1 47.5%, group B2 92.5%. These results were interpreted as follows: the patency rate was significantly increased in the EGb 761-only treated group(p>0.01), the heparin-only treated group(p>0.01), and the EGb 761 and heparin-combined at crushed microvessel surgery. However the patency rate of the EGb-only treated group was significantly lower than that of the heparin-only treated group(p>0.01). And in the EGb 761 and heparin-combined treated group compared to the heparin-only treated group, there was some patency rate increase in the combined treated group, but there was no significant difference between them(p=0.060).
Amputation ; Animals ; Anticoagulants ; Femoral Artery ; Ginkgo biloba* ; Heparin ; Microvessels* ; Pharmacologic Actions ; Rats* ; Replantation ; Thrombosis

For the successful autologous chondrocyte transplantation, it is important to maximize the number of chondrocyte and maintain its original morphology and phenotypic change of the chondrocyte in the culture. In this study, the effect of ascorbic acid and human serum which are known to promote cell proliferation and collagen synthesis was observed in the culture of human chondrocyte. Media were prepared with the conditions of fetal bovine Serum(FBS) treated group, FBS +ascorbic acid(asc) treated group, human serum(HuS) treated group, and HuS+asc treated group, respectively. Proliferation was measured by cell counting using trypan-blue staining method. We used to determine the degree of expression of aggrecan of mRNA and type II collagen using RT-PCR. Type II collagen in cultured cell and medium was measured by western blot analysis and proteoglycan synthesis by DMB (Dimethylene Blue) assay. Under all conditions, aggrecan on mRNA level was well expressed. On the other hand, expression of type II collagen was reduced on HuS treated group than FBS treated group, and ascorbic acid treated groups showed decreased expression of type II collagen. Western blot analysis showed increased expression of type II collagen on HuS treated group than FBS treated group, and ascorbic acid treated groups showed increased level. HuS+asc treated group showed the most significant effect than the other groups. The increased effects of ascorbic acid on the proliferation and collagen synthesis were more prominent in the culture with human serum. It might be due to the synergic effect with some growth factors which were present in human serum.
Aggrecans ; Ascorbic Acid* ; Blotting, Western ; Cell Count ; Cell Proliferation ; Cells, Cultured ; Chondrocytes* ; Collagen ; Collagen Type II ; Hand ; Humans* ; Intercellular Signaling Peptides and Proteins ; Phenotype* ; Proteoglycans ; RNA, Messenger

PURPOSE: In most cases of nasal bone fracture, closed reduction with internal or external splint fixation approach is selected. However, because of indiscriminate insertion of the internal splint without considering of anatomical difference or deformity, insufficient fixation happens frequently that need additional fixation. Therefore, we suggest a new method for providing adequate support in reduced nasal bone by carving Merocel(R) that is fixed for the anatomical structure. METHODS: Closed reduction and internal fixation with carved Merocel(R) was performed in 15 nasal bone fracture patients from March, 2010 to July, 2010. Each patient was evaluated by physical examination, facial photographic check, simple X-ray, and computerized tomography. On the first day post-operation, location of packing and amount of reduction were checked by follow up X-ray and computerized tomography. In addition, patients' symptoms were evaluated. During the 3-month post-op follow up at out-patient clinic, operator, 2 doctors in training and one assistant performed the objective evaluations by physical examination on nasal dorsal hump, nasal deviation, nasal depression, nasal breath difficulty, and nasal airway obstruction. A survey of subjective patients' satisfaction in 4-stages was also performed. RESULTS: The results of follow-up computerized tomography of the 15 patients revealed that 11 patients had good reduced state. Three patients with combined maxillary frontal process fracture had over reductions. A survey performed on the first day post-operation showed that 14 of 15 patients answered that their current symptoms were more than tolerable. At the 3-month follow-up physical exam, one case had a dorsal hump. However, there were no nasal deviations, nasal depressions, nasal breath difficulties, or nasal airway obstructions. Twelve of the 15 patients answered more than moderate on the 3-month survey. CONCLUSION: Intranasal packing after carving the Merocel(R) considering anatomical structure is a new effective method to promote proper-reduction, maintain stability, and minimize patients' symptoms by addition of a simple procedure.
Airway Obstruction ; Congenital Abnormalities ; Depression ; Follow-Up Studies ; Fractures, Closed ; Humans ; Nasal Bone ; Nasal Obstruction ; Outpatients ; Physical Examination ; Splints

BACKGROUND: Autologous fat grafts have been widely used for cosmetic purposes and for soft tissue contour reconstruction. Because diabetes mellitus is one of the major chronic diseases in nearly every country, the requirement for fat grafts in diabetes patients is expected to increase continuously. However, the circulation complications of diabetes are serious and have been shown to involve microvascular problems, impairing ischemia-driven neovascularization in particular. After injection, revascularization is vital to the survival of the grafted fat. In this study, the authors attempted to determine whether the diabetic condition inhibits the survival of injected fat due to impaired neovascularization. METHODS: The rat scalp was used for testing fat graft survival. Forty-four seven-week-old male Sprague-Dawley rats were allocated to a diabetic group or a control group. 1.0 mL of processed fat was injected subcutaneously into the scalp of each rat. The effect of diabetes was evaluated by calculating the volume and the weight of the grafted fat and by histologically analyzing the fat sections. RESULTS: The surviving fat graft volume and weight were considerably smaller in the diabetic group than in the control group (P<0.05), and histological evaluations showed less vascularity, and more cysts, vacuoles, and fibrosis in the diabetic group (P<0.05). Cellular integrity and inflammation were not considerably different in the two groups. CONCLUSIONS: As the final outcome, we found that the presence of diabetes might impair the survival and the quality of fat grafts, as evidenced by lower fat graft weights and volumes and poor histologic graft quality.
Adipose Tissue ; Animals ; Chronic Disease ; Diabetes Mellitus ; Diabetic Angiopathies ; Fibrosis ; Graft Survival ; Humans ; Inflammation ; Male ; Rats* ; Rats, Sprague-Dawley ; Scalp ; Streptozocin ; Transplants* ; Vacuoles ; Weights and Measures

BACKGROUND: Settlements between doctors and patients provide a solution to complicated disputes. However, some disputes may be renewed as a result of negligence by both parties. The purpose of this study was to review the legal issues that may potentially arise during the preparation of settlement agreements and to propose a list of requirements for ensuring the effectiveness of these settlement agreements. METHODS: Data from 287 civil cases concerning aesthetic surgery that took place between 2000 and 2015 were collected from a court database in South Korea. Factors that influenced the effectiveness of settlement agreements were analyzed. RESULTS: Among the 287 court precedents, there were 68 cases of covenant not to sue. Eighteen cases were dismissed because the settlement agreements were recognized as effective, and 50 cases were sent forward for judgment on their merits because the agreements were not recognized as effective. The types of surgery and types of complications were classified by frequency. We evaluated the geographical distribution of the precedents, the settlement timing, and the effectiveness and economic impact of the settlements. We found that there was no statistically significant relationship among these factors. Four major factors that made a settlement agreement legally effective were identified, and the data showed that fee-free reoperations were not considered by the court in determining the compensation amount. CONCLUSIONS: When preparing a settlement agreement, it is advisable to review the contents of the agreement rather than to take the preparation of a settlement agreement per se to be legally meaningful.
Compensation and Redress ; Dissent and Disputes ; Humans ; Judgment ; Jurisprudence* ; Korea* ; Malpractice ; Plastics* ; Surgery, Plastic*

Postoperative infections are rare after plastic surgery; however, when present, they can affect the aesthetic outcome. Currently, many malpractice lawsuits are associated with surgical site infection. The present study aimed to analyze malpractice claims associated with surgical site infection in the field of plastic surgery through a review of Korean precedents. We analyzed the type of procedure, associated complications, and legal judgment in these cases. Most claimants were women, and claims were most often related to breast surgery. The common complications related to surgical site infection were deformity, scar, and asymmetry. Among the 40 cases, 34 were won by the plaintiff, and the mean claim settlement was 2,832,654 KRW (USD 2,636.6). The reasons for these judgements were as follows: 1) immediate bacterial culture tests were not performed and appropriate antibiotics were not used; 2) patients were not transferred to a high-level hospital or the infection control department was not consulted; 3) surgical site infection control measures were not appropriate; and 4) surgical procedures were performed without preoperative explanation about surgical site infection. The number of claims owing to surgical site infection after surgery is increasing. Infection handling was one of the key factors that influenced the judgement, and preoperative explanation about the possibility of infection is important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns.
Anti-Bacterial Agents ; Breast ; Cicatrix ; Congenital Abnormalities ; Cross Infection ; Female ; Humans ; Infection Control ; Judgment ; Malpractice* ; Patient Satisfaction ; Plastics* ; Surgeons ; Surgery, Plastic* ; Surgical Wound Infection*

PURPOSE: Squamous cell carcinoma(SCC) of the lower lip is the most common malignant tumor comprising 90% of all lip SCC. The typical picture of SCC of the lower lip is of an ulcerated lesion with raised margins. Surgery is the treatment of choice for SCC of lower lip. Depending on the location and size of the tumor, different types of flaps are used. We used new method ? 'both buccal mucosa transposition flap' for the reconstruction of the near total mucosal defect of the lower lip. METHODS: This 67-year-old men presented with the crusted 1x1cm sized ulceration of the lower lip that was arised 30 years ago. There were no size or color change, except the bleeding and ulceration. At first, We diagnosed the SCC through the incisional biopsy. Then We performed the wide excision of the tumor and reconstruction of the lower lip. After the excision of the whole tumor, the defect was measured at 8x3.5cm. We designed the buccal mucosa transposition flap taking care to avoid the parotid duct. The flap was made in a triangular shape for the reconstruction of defected lower lip. The donor site defect can be sutured primarily. RESULTS: A patient in this study had no postoperative complications such as necrosis, dehiscence, infection of the flap or donor site. Reconstructed lower lip is relatively close to that of the natural lip; More satisfactory aesthetic and functional results can be obtained by using this technique rather than other techniques. CONCLUSION: 'Both buccal mucosa transposition flap' is reliable method for the reconstruction of the large lower lip mucosal defect. The operation is simple and performed in one stage, with no postoperative complications. This technique can offer consistently good functional and esthetic outcomes after reconstruction of lower lip mucosal defect.
Aged ; Biopsy ; Hemorrhage ; Humans ; Lip ; Male ; Mouth Mucosa ; Necrosis ; Postoperative Complications ; Tissue Donors ; Ulcer

Articular cartilage is a unique tissue devoid of blood and nerve tissue and so its regeneration is very limited. Recently a clinical trial on transplantation using autologous chondrocyte with periosteal flap has drawn a great deal of attention. Chondrocytes cultured in a plastic flask in monolayer can rapidly dedifferentiate appearing fibroblastic, and exhibit a change in matrix gene expression characterized by a decrease in type II collagen synthesis. It is uncertain whether phenotypic change of dedifferentiated chondrocytes in vitro can be reversible to their original status alter long term culture. It is important to verify tile maintenance of the phenotype and determine the optimum period for culturing chondrocytes to be used in autologous chondrocyte transplantation. This study will be set up to confirm the reversibility of once-dedifferentiated chondrocytes with matrix-producing capability. The phenotype of cultured human chondrocyte is analysed by Northern blot and Western blot analysis for collagen type I and II. Chondrocytes appeared fibroblast right after adhering to the flask buttom at first week of culture. The proliferating rates of chondrocyte in a monolayer culture were maximum at 3rd and 4th week of culture. And thereafter, proliferation rate flowed down or stops as confluence rose. On Northern and Western blot analysis, collagen type II was well expressed by 3th to 4th week culture, thereafter progressively decreased its density with time. On the other hand, collagen type I m-RNA has not expressed until 3rd week of the culture, showing progressive increment of density thereafter. On Northern blot analysis in pellet culture, type II collagen m-RNA is apparantly reexpressed. This study indicates chat in the monolayor culture, the chondrocytic phenotype was lost with regards to morphology and mRNA expression and cartilage specific protein. However, these cells seemed to haute the potential to redifferentiate to well-differentiated chondrocytes in densely packed culture, such as pellet.
Blotting, Northern ; Blotting, Western ; Cartilage ; Cartilage, Articular ; Chondrocytes* ; Collagen Type I ; Collagen Type II ; Fibroblasts ; Gene Expression ; Hand ; Humans* ; Nerve Tissue ; Phenotype ; Plastics ; Regeneration ; RNA, Messenger