No Abstract Available.
Humans ; Poliomyelitis*

The orbital floor fracture of trapdoor subtype is a pure orbital fracture, linear in form and hinged medially, which allows herniation of orbital fat and ocular muscles and then entraps these contents. The goals of the reconstruction of the orbital fracture are to restore the continuity and to avoid a relapse the orbital tissue. If the reconstruction is incomplete, it may result in enophthalmos with diplopia. The indications for surgical reconstruction are the imitation of ocular muscles, the persisting diplopia, enophthalmos, large size of bony defect. There are no uniformly guidelines for the materials for orbital reconstruction. The ideal material should be biocompatible, non-carcinogenic, easily kept in position and free of any potential for disease transmission. Among the materials, the absorbable mesh is used for the orbital reconstruction recently. We used the 0.8mm thickness absorbable mesh in 11 patients with orbital floor trapdoor fracture. The displaced bony fragment was reducted and the absorbable mesh was inserted below the reducted fragment. The absorbable mesh was fixated with absorbable screw, so the mesh can support the bony fragment with cantilever effect. The results were satisfactory and no significant problem was not happened during the follow up period. Absorbable meshes are gradually resorbed and the scar that formed after resorption provides the support of the globe. Our results suggest that the orbital floor trapdoor fracture with small to moderate defects is the advisable indication of orbital reconstruction with absorbable mesh.
Cicatrix ; Diplopia ; Enophthalmos ; Follow-Up Studies ; Humans ; Muscles ; Orbit* ; Orbital Fractures ; Recurrence

Deficiency of upper lip tissue is a difficult problem in cleft lip repair. Various kinds of operation technique such as triangular flap and Millard method has been developed. but, when the severe vertical tissue deficiency is present, there are limitations in making a symmetric lip contour. We defined the short lateral lip when the vertical distance from alar base to the imaginary peak of cupid bow pont is less than vertical distance from alar base to noncleft cupid bow peak. Rareoperation techniques to solve the short lateral lip has been suggested until nowadays. So, we classified the short lateral lip as mild, moderate and severe cases. And we tried the following 3 methods for correction of short lateral lip. In mild cases, we used the C-flap and small triangular flap which can lengthen the short lateral lip about 2 to 3 mm just above the white line. And the moderate cases, it can corrected with lattis method. For the lengthening of very short lateral lip in cleft side, full thickness skin from the posterior auricular area is grafted onto the redrapped muscle of cleft side muscle bulge.
Cleft Lip* ; Lip* ; Skin ; Transplants

Despite on-going efforts to control malaria, the rate of malaria has not decreased throughout the world. It was believed that endemic malaria had been eradicated in Korea since the end of the 1970s, however it reemerged from 1993 and has been increasing ever since. Besides endemic malaria, imported malaria is also increasing in Korea as the number of overseas travellers and foreign workers increases. We discovered malaria in a two-year-old child who visited Sierra Leone with his missionary father. The patient contracted malaria despite chemo-prophylaxis with chloroquine and was diagnosed as falciparum malaria by blood smear examination and IFAT. He successfully recovered after administraion of quinine and clindamycin without complication. However, the malaria did not respond quickly to chloroqine and Fansidar but a drug resistence test was not performed.
Child* ; Chloroquine ; Clindamycin ; Fathers ; Humans ; Korea ; Malaria* ; Missions and Missionaries ; Quinine ; Sierra Leone

Axillary osmidrosis is caused by excessive secretion of apocrine sweat gland and can cause extreme difficulty in social activities. The surgical removal of apocrine glands has been thought as an effective method. But this classical treatment results in many complications such as scarring, hematoma, skin necrosis and these complications have not been solved yet. Recently radiofrequency surgery as a minimally invasive technique is used for the treatment of snoring, benign prostate hypertrophy, hepatoma, reduction of masseter muscle and gastrocnemius muscle. From June, 2004 to March, 2005, 10 patients with axillary osmidrosis were treated by radiofrequency thermal ablation(PMC-1000). The generator was set to level 6-8 and the duration of time was 1.0 seconds. The maximum number of treatment sessions were two. The mean postoperative follow-up period was about average 6 month ranged from 2 to 9 month. The skin necrosis was developed in 2 patients. All patients were satisfied or partially satisfied with the results. Although suitable radiofrequency power and heating duration have not been defined yet, which is mandatory in order to obtain the best results, the radiofrequecy could be a safe and effective treatment modality for axillary osmidrosis with a good clinical outcome and few complications.
Apocrine Glands ; Carcinoma, Hepatocellular ; Cicatrix ; Follow-Up Studies ; Heating ; Hematoma ; Hot Temperature ; Humans ; Hypertrophy ; Masseter Muscle ; Muscle, Skeletal ; Necrosis ; Prostate ; Skin ; Snoring ; Sweat Glands

Pachydermodactyly is a rare distinct form of fibromatosis characterized by acquired, asymptomatic dense fibrosis and fibroblastic proliferation around one or more proximal interphalangeal joints. Intralesional triamcinolone injection may be helpful in improving the clinical appearance. A 20-year-old unemployed female patient gave a four years history of progressive swelling of the fingers affecting predominantly the proximal interphalangeal joints of index fingers of left hand and index, middle fingers of right hand. There was no pain and tenderness. Physical examination, complete blood count, antinuclear antibody, rheumatoid factor were unremarkable and radiograph of both hands showed soft tissue swelling only without bony abnormality. We excised the redundant soft tissue from the both sides of proximal interphalangeal joint with longitudinal elliptical fashion. After operation, the fingers of the patient showed marked improvement cosmetically. There were no motor or sensory changes. Pachydermodactyly was first reported in 1996 in Korea. Histologic features include an increased dermal accumulation of collagen and occasionally an increased number of fibroblast. We report for one patient with pachydermodactyly treated with longitudinal elliptical excision and obtained an improvement of clinical appearance.
Antibodies, Antinuclear ; Blood Cell Count ; Collagen ; Female ; Fibroblasts ; Fibroma ; Fibrosis ; Fingers ; Hand ; Humans ; Joints ; Korea ; Physical Examination ; Rheumatoid Factor ; Triamcinolone ; Young Adult

Perineal area is composed of compact structures of urogenital organs and anus requiring a more sophisticated selection of flap and reconstruction. For achieving better outcome then conventional flap surgery, we use the perineal perforator based island flap for its reconstruction. After locating the perforator by Doppler, the flaps were designed according to the defect or expected vaginal orifice. The flaps were elevated bilaterally as island pattern. Finally defect or neovagina was reconstructed with inconspicious linear scar hidden in the inguinal crease. Five cases were performed with the perineal perforator based island flap. There were 3 cases of vulvar cancer, 1 case of transsexualism, and 1 case of ambiguous genitalia because of congenital adrenal hyperplasia. Operative results were satisfactory with good contouring and less prominent donor scar, when they were compared with other flap reconstructions such as latissimus dorsi perforator flap, groin flap, gracilis myocutaneous flap etc. The perineal perforator based island flap is highly recommended with the advantages of easy flap elevation, good rotation arc, and appropriate flap thickness for contouring. Compared with other conventional flaps, it can be selected as a good option for moderate defect of perineal area.
Adrenal Hyperplasia, Congenital ; Anal Canal ; Cicatrix ; Disorders of Sex Development ; Groin ; Humans ; Myocutaneous Flap ; Perforator Flap ; Superficial Back Muscles ; Tissue Donors ; Transsexualism ; Vulvar Neoplasms

A soft tissue defect of the lower leg or foot presents a challenging problem. Reconstructive surgeon should be armed at all points of wound site, tendon and bone exposure, injury of major vessel and so on in the lower limb. We reconstructed the defects of lower legs and feet of 25 patients between February, 1997 and December, 2003. Applying reversed adipofascial flap with skin graft on a soft tissue defect of the lower leg or foot is challenging. We did a comparative study of 25 reversed adipofascial flaps with 51 free flaps. All 25 cases of reverse adpofascial flap reconstruction were successful except for a partial loss of skin graft in 3 occasions. The reversed adipofascial flap had a merit of a short operation time and hositalization, a high success rate and minimum complications. Besides major vessels in the lower leg are better preserved and donor morbidity is minimal. However, the flap is unmerited in reconstructing a hug hallowed defect and in the leg with poor blood circulation and once previous surgery. The operators may consider the feasible substitution of reversed adipofascial flap for free flap before applying in the lower leg.
Arm ; Blood Circulation ; Foot ; Free Tissue Flaps* ; Humans ; Leg* ; Lower Extremity ; Skin ; Tendons ; Tissue Donors ; Transplants ; Wounds and Injuries

Immediate breast reconstruction in breast cancer patients is universalized and now with a wide variety of methods to choose from, we can select a breast reconstruction method according to the patient's condition. Among these methods, immediate breast reconstruction with TRAM free flap is the most commonly used. Nipple reconstruction is usually performed as a secondary procedure, reconstructed. Nipple is reconstructed with contralateral nipple composite graft or with local flap. Areola is reconstructed with skin graft and tattooing. Therefore, to reconstruct complete breast, two or more staged operations are needed and are troublesome to both the surgeon and the patient. If we could reconstruct breast mound and nipple at same time, we would reduce the operative stages and heighten the patient's satisfaction. The author performed delayed or immediate breast reconstruction with TRAM free flap and nipple reconstruction at the same time. If the TRAM flap was to situate in the whole of the breast or at the center of the breast mound, nipple was reconstructed with a local flap from the TRAM flap. If the TRAM flap was not situated in center of breast mound, nipple was reconstructed with a local flap from remnant breast skin. Immediate nipple reconstructions in breast reconstruction consisted total of 22 cases. Among these, delayed breast reconstruction were 5 cases and immediate breast reconstruction were 17 cases. According to patient's condition and mastectomy method, nipple reconstruction method was selected; nipple reconstruction with contralateral nipple composite graft(3 cases); nipple reconstruction with remnant breast skin(6 cases); nipple reconstruction from flap margin(10 cases); nipple reconstruction with prefabricated nipple on flap(3 cases). Malposition of the reconstructed nipple was the most common and serious complication(6 cases). The other complications were atrophy of the nipple(1 case), and necrosis(1 case). Reconstruction of the breast and nipple at the same time can reduce the need of a secondary operation and use remnant skin or redundant flap tissue maximally. On the other hand, it must be considered that position and shape of nipple could be deformed, because the nipple reconstruction is performed before the shape of reconstructed breast settles completely. Prudent attention is needed, because the danger of complication is higher than delayed nipple reconstruction.
Atrophy ; Breast Neoplasms ; Breast* ; Female ; Free Tissue Flaps* ; Hand ; Humans ; Mammaplasty* ; Mastectomy ; Nipples* ; Skin ; Tattooing ; Transplants

Free TRAM flap is considered as the first choice of the breast reconstruction after mastectomy deformity. Complications such as partial flap loss and fat necrosis in reconstructed breasts are less common with free TRAM flap than conventional pedicled TRAM flap or deep inferior epigastric perforator flap(DIEP flap), because free TRAM flap has a robust blood supply by deep inferior epigastric artery. We evaluated the incidence, causes, diagnosis, and treatment of fat necrosis in reconstructed breast using free TRAM flap. A retrospective study was performed in all patients who had undergone free TRAM flap breast reconstruction between 1990 and 2002. Fat necrosis is a clinical diagnosis, usually made by physical examination alone. However we performed mammography and ultrasonography in all patients to rule out the recurrence of tumor, and get the objective and unbiased data. We performed needle biopsy for exclusion of cancer recurrence in selected cases. Of the 92 breasts reconstructed with free TRAM flap, 7 patients(7.6%) had clinically evident fat necrosis, and 2 patients(2.1%) had fat necrosis that was found only by mammography and ultrasonography. The size of fat necrosis in our study was various from 1.0 x 0.7 x 0.5 to 8 x 4 x 3 cm. The lesions of the fat necrosis were usually placed on superomedial and medial part of the reconstructed breast. In case of the fat necrosis, anchoring suture of flap which had been applied for the preservation of flap drooping and ptosis seemed to be related with the location. In addition, use of zone IV of TRAM flap would be associated the occurrence of fat necrosis. We suggest that fixation suture of flap, intraoperative injury of perforator vessel, extensive use of flap (including Zone IV), smoking and obesity, postoperative radiation therapy can be the causes of fat necrosis in the reconstructed breast with free TRAM flap. Fat necrosis is said to be relatively common in patients who were obese or had a history of smoking in literature, but it did not show any significant differences in our study. Five patients underwent excision during nipple-areolar complex reconstruction after 6 months of free TRAM flap breast reconstruction, and 4 patients did not undergo any treatment due to relatively small size. Hardness of fat necrosis became smaller in size, and softened with time. We conclude that the fat necrosis would be decreased if free TRAM flap breast reconstruction was performed with well organized design of flap, sensible assessment of perforators in the flap, careful use of zone IV in thin patient, and careful suture fixation of flap to chest wall.
Biopsy, Needle ; Breast* ; Congenital Abnormalities ; Diagnosis ; Epigastric Arteries ; Fat Necrosis* ; Female ; Hardness ; Humans ; Incidence ; Mammaplasty ; Mammography ; Mastectomy ; Obesity ; Physical Examination ; Recurrence ; Retrospective Studies ; Smoke ; Smoking ; Sutures ; Thoracic Wall ; Ultrasonography