The clinical applications of free have been extended tremendously in head and neck reconstruction. In a nine-year period, 92 microvascular free flaps were performed to repair the defects following major head and neck ablative surgery. Twenty-one transverse rectus abdominis myocutaneous flaps, 18 radial foream flaps, 15 latissimus dorsi muscle flaps, 12 jejunal flaps, 8 fibular osteocutaneous flaps, 6 rectus abdominis muscle flaps, 6 iliac osteomyocutaneous flaps, 2 groin fasciocutaneous flaps, 1 scapular fasciocutaneous flap, 1 parascapular osteocutaneous flap, 1 tensor fascia lata muscle flap and 1 serratus anterior muscle flap were used for reconstruction. Twenty-five maxillary defects including the orbit or skull base, 16 pharyngoesophageal defects, 15 intraoral defects, 15 mandibular defects, 13 scalp defects, 1 cervical region and 7 other facial region were covered with various free flaps. The overall success rate of the flaps was 95.6%. The complications included total flap loss (3 cases), partial flap loss (1 case), recurrence of primary tumors (15 cases), cerebrospinal fluid leakage (3 cases), fistula formation (3 cases) and infection (5 cases). Superficial temporal artery, facial artery, superior thyroidal artery, lingual artery, occipital artery, transverse cervical artery were commonly used recipient arteries and 7 cases of vein grafts were used if indicated. End to end anastomosis was performed in 84 cases and end to side anastomosis in 8 cases. The average follow-up period was 42 months, ranging from 6 months to 8 years. One patent died during postoperative intensive care due to sepsis and 19 patients died because of recurrence of tumors and underlying medical diseases during the follow-up period. Although free flaps may appear to be riskier than traditional forms of reconstruction, they offer the surgeon a greater spectrum of reconstructive options. Free flap reconstruction also improves the quality of life and minimizes the loss of function. Limitations of the use of free flaps result only from a lack of technical skills and specialized equipment.
Arteries ; Cerebrospinal Fluid ; Fascia Lata ; Fistula ; Follow-Up Studies ; Free Tissue Flaps* ; Groin ; Head* ; Humans ; Critical Care ; Myocutaneous Flap ; Neck* ; Orbit ; Quality of Life ; Rectus Abdominis ; Recurrence ; Scalp ; Sepsis ; Skull Base ; Superficial Back Muscles ; Temporal Arteries ; Thyroid Gland ; Transplants ; Veins

Until recently, cranial base tumors or midfacial tumors were deemed unresectable due to an inability to accurately diagnose the extent of the involvement and to approach and excise the tumor safely. With refinements in CT and NMR scanning, as well as the development of craniofacial technique, reconstruction has become absolutely crucial in allowing successful resection of these tumors. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amendable to local tissue closure. In such cases, free tissue transfer was an effective alternative because it can provide a large amount of well-vascularized tissues arts reliable separation of the intracranial space from bacterial flora of the upper airway. Microvascular free tissue transfer was used in 15 patients at our center to reconstruct the cranial base and/or midfacial defects. Of these 12 were free rectus muscle flaps, 2 were free latissimus dorsi muscle flaps, 1 was a free scapular osteocutaneous flap and 1 was a free scapular fasciocutanegus flap. There were 2 cases of total flap loss. In those cases, revisions were performed using latissimus dorsi muscle free flap in one case and STSG in the other. One patient had a postoperative cerebrospinal fluid leak which was spontaneously resolved by conservative management. The large complex defects were successfully reconstructed by one-stage operation and the functional and esthetic results wee satisfactory with acceptable complication rates.
Cerebrospinal Fluid ; Free Tissue Flaps ; Humans ; Skull Base* ; Superficial Back Muscles

No abstract available.
Female ; Hysterectomy, Vaginal*

We report a case of lupus vulgaris following BCG vaccination in a 12-year-old male. The patient was vaccinated against tuberculosis on right shoulder 6 months ago. The erythemstous papular eruptions began to develop on the BCG vaccinated site 2 weeks after vaccination. The eruptions progressed to be pruritic, erythematous plaque which was flat, crescent shaped, and centrally covered by adherent scales for 6 months. Histopathological findings revealed tubercles and tuberculoid structures composed of epitheloid cells and Langhans giant, cells in the dermis. Caseation necrosis within the tubercles was slight or absent. In addition, there was an infiltrate of mononuclear cells around the tubercles. The skin lesions cleared after 6 months of treatment with oral isoniazid 300mg daily.
Child ; Dermis ; Humans ; Isoniazid ; Lupus Vulgaris* ; Male ; Mycobacterium bovis* ; Necrosis ; Shoulder ; Skin ; Tuberculosis ; Vaccination* ; Weights and Measures

Sclerosing lymphangitis of the penis is a rare disorder characterized by painless. firm. cord-like lesion in the coronary sulcus of the penis. Although sexual trauma may be causative factor the etiology is unknown. Histologic findings reveal hypertrophy and sclerosis of lymphatic vessel wells, and some cases show thrombus formation within dilated vessels. Most cases are self-limited and conservative management is indicated. We report two cases of sclerosing lymphangitis of the penis in a 37-year-old man and a 28-year-old man.
Adult ; Humans ; Hypertrophy ; Lymphangitis* ; Lymphatic Vessels ; Male ; Penis* ; Sclerosis ; Thrombosis

No abstract available.
Fetal Macrosomia*

Congenital dyserythropoietic anemia Type II (herditary erythroblatic multinuclearity with positive acidified serum test; HEMPAS) is characterized by binuclearity, multinuclearity, pluripolar mitoses, karyorrhexis of normoblasts, and the presence of abnormal antigens on the red cells. We experienced a case of HEMPAS in a 2 month old girl patient who had an intermittent fever, abdominal distention with palpable liver & spleen, and generalized jaundice. The blood analysis revealed anemia, and thrombocytopenia. Peripheral blood smear showed an averge of 6 mature normoblast per 100 leukocyte count. The red cells showed moderate anisocytosis, poikilocytosis, irregularly crenated, contracted cells and occasional spherocytes. The leukocytes showed relative lymphocytosis, and there were occasional villous lymphocytes. The marrow smear showed abnormality in erythroid series. About ten percent of the erythroblasts showed 2~7 nuclei or lobulated nuclei. The mitotic forms of the erythroid precursors were also increased in frequency. The M:E ratio was 1:3.2. Blood culture on this patient showed a pure growth of Coxiella burnetti. Medical treatment with Doxycycline and Rifampin was performed. After treatment, she became afebrile showing improved general condition with decreased size of liver & spleen. In spite of clinical improvement, she died suddenly 3 weeks after initial treatment.
Anemia ; Anemia, Dyserythropoietic, Congenital* ; Bone Marrow ; Coxiella ; Doxycycline ; Erythroblasts ; Female ; Fever ; Hempa ; Humans ; Infant ; Jaundice ; Leukocyte Count ; Leukocytes ; Liver ; Lymphocytes ; Lymphocytosis ; Mitosis ; Rifampin ; Spherocytes ; Spleen ; Thrombocytopenia

Microvascular surgery can provide the necessary soft tissue coverage from the remote donor areas by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Recently, vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde for flaps are well established in island flaps. Purpose of this study is to report our clinical experiences with lower extremity reconstruction in 9 patients. 9 patients with soft tissue defect below the knee underwent lower extremity reconstruction with distally based free flaps using retrograde arterial flow. For assessment of the retrograde flow, intraoperative retrograde arterial pressure was quantified and compared with systolic blood pressure taken at the same time. Suitable candidates had ben chosen with pulsatile retrograde flow and a diastolic retrograde arterial pressure of 60 mmHg. Three different free flaps were used. All flaps were successful. Retrograde flow anastomosis could not interrupting the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. In cases wherein arteriography demostrates significant vascular flow interruption within the zone of injury, those are also candidate for retrograde arterial anastomosis.
Angiography ; Arterial Pressure ; Blood Pressure ; Blood Vessels ; Extremities ; Free Tissue Flaps* ; Humans ; Knee ; Lower Extremity ; Surgical Flaps ; Tissue Donors ; Wound Healing

Microsurgical free-tissue transfer has allowed surgeons to salvage injured limbs but choosing appropriate healthy recipient vessels has proved to be a difficult problem. Retrograde flow flaps are established in island flaps. Retrograde flow anastomosis could prevent the possible kinking and twisting of the arterial anastomosis. By not interrupting the proximal blood flow to the fracture or soft tissue defect site, the compromise of fracture or wound healing might be prevented. We wished to establish an animal model in rat for a retrograde arterial flow based free flap. Nembutal-anesthetized male rats, weighing 250 to 300 gm, were used. The femoral artery and common carotid artery exposed and divided. The systemic and retrograde arterial pressure were quantified by utilizing a paralle tubing system connected with peripheral arterial line. In this study, the retrograde flow was not pulsatile and the retrograde arterial pressure was 64-65 mmHg, with a mean arterial pressure of 106-109 mmHg. An epigastric skin flap, measuring 3x3 cm, was raised with its vascular pedicle. The epigastric free flap was transferred in the same rat from femoral vessels to carotid vessels in end to end fashion. We anastomosed the donor ateries to the distal parts of the divided recipient arteries and the donor veins to the proximal parts of the recipient veins. Twelve experiments were performed and the transplantations succeeded in 75 percent of them. In the remaining 25 percent, the experiments failed due to thrombosis at the site of anastomosis, or other causes. This animal model represents an excellent example of retrograde arterial flow free flap transfer that is reliable.
Animals ; Arterial Pressure ; Arteries ; Carotid Artery, Common ; Extremities ; Femoral Artery ; Free Tissue Flaps* ; Humans ; Male ; Models, Animal ; Rats ; Skin ; Surgical Flaps ; Thrombosis ; Tissue Donors ; Vascular Access Devices ; Veins ; Wound Healing

BACKGROUND: Insulin resistance syndrome shows extreme insulin resistance and is associated with acanthosis nigricans. We can differentiate it into type A insulin resistance that has insulin receptor defect, and type B insulin resistance due to insulin receptor autoantibody. Type B insulin resistance was firstly described by Kahn in 1976. It was often found in adult female and showed autoimmune characteristics. As clinical characteristics, there are hyperglycemia, hypoglycemia, hyperinsulinemia, extreme insulin resistance and acanthosis nigricans. METHODS: We investigated 17 insulin receptor autoantibody positive cases and 8 cases of normal control who had visited Wonju Christian Hospital from October 1994 to December 1995. Among insulin receptor autoantibody positive subject, male was 4 cases and female 13 cases. Their mean age was 42.2. We compared patients who had insulin receptor antibody positive acanthosis nigricans(IRA) with normal controls. IRA patients were 6 cases(35.3%) of nomal glucose tolerance, 11 cases(64.7%) of abnormal glucose tolerance including overt diabetes mellitus. RESULTS: The 11 cases(64.7%) among IRA patrents were obese and 13 cases(76.5%) had hyperininsulinemia. In IRA patients, mean serum insulin concentration during oral glucose tolerance test was 202.1mU/mL and it was greater than 46.3 of normal controls. Insulin sensitivity in 1.79mg/L * mM * xmU * min normal controls was higher than 0.74mg/L * mM * min of IRA patients. CONCLUSION: IRA patients showed abnormal glucose tolerance including overt diabetes millitus, severe insulin resistance, hyperinsulinemia and obesity.
Acanthosis Nigricans* ; Adult ; Diabetes Mellitus ; Female ; Gangwon-do ; Glucose ; Glucose Tolerance Test ; Humans ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemia ; Insulin Resistance ; Insulin* ; Male ; Obesity ; Receptor, Insulin*