No abstract available.

The search for a new flap with minimal donor morbidity has been pursued by many plastic surgeons. Numerous donor sites available for microsurgical composite tissue transplantation have been described owing to the tremendous advances made in the field of microsurgery. To be suifable for use as a free flap, a sizable vessel must be included within the tissue, leading to significant donor morbidity. There have been studies for prefabrication of an axial pattern flap in an effort to create a new flap, but most of these methods relied solely on revascularization of a preexisting composite tissue. Our experiment, using an isolated femoral artery and vein as the main pedicle, led to formation of a capsule flap through a normal foreign body reaction between 2 silastic sheet implants. On this induced capsule flap, a skin graft was performed and a total of 40 axial pattern capsulo-cutaneous flaps from 20 Sprague-Dawley rats were successfully obtained after nearly 12 weeks through 4 stages of experiment, including a delay procedure at the second stage. Pathology revealed neovascularization, and abundantly impregnated vascular structures near the pedicle were observed along with random pattern collagen fibers. The skin graft took 100% on this newlyformed axial pattern capsular flap and thus implied that the capsule structure was able to survive on it`s own and was able to support skin grafts. This new flap using only the isolated artery and vein structure can be induced according to various needs with minimal donor morbidity.
Arteries ; Collagen ; Femoral Artery ; Foreign-Body Reaction ; Free Tissue Flaps ; Humans ; Microsurgery ; Pathology ; Rats, Sprague-Dawley ; Skin ; Tissue Donors ; Tissue Transplantation ; Transplants ; Veins

The evaluation of pigmentary skin lesions by clinical doctors has been based on subjective and qualitative judgements. Observations have mostly relied on visual inspection, making the effects of treatment difficult to evaluate with any precision. For this reason there is a real need for an objective method to evaluate prognosis after treatment. Recent scientific measurements such as reflectance spectrophotometry and reflectance colorimetry have provided accurate quantitative color information about skin lesions, but these techniques are costly and difficult to apply in the clinical field. The purpose of this study was to develop a simple and cost-effective way of evaluating treatment results. We have developed a software program using the L*a*b* color coordinate system to quantify the effect of treatment and have successfully demonstrated its clinical usefulness. Our method compares the relative color difference between normal skin and skin lesions before and after treatment, instead of measuring the absolute color of skin lesions. The accuracy of our quantitative color analysis was confirmed by the simulated images of hemangioma and ota nevus. Clinical efficacy was also confirmed through a blind test involving 3 clinicians who were asked to grade the treatment effects of 13 cases of hemangioma and 7 cases of ota nevus. These subjective clinical grades correlated well with the treatment results obtained using the proposed color analysis system (Correlation coefficient = 0.84).
Color* ; Female ; Hemangioma/therapy ; Hemangioma/pathology ; Human ; Nevus of Ota/therapy ; Nevus of Ota/pathology ; Outcome Assessment (Health Care)/methods* ; Pigmentation Disorders/therapy* ; Pigmentation Disorders/pathology* ; Skin Neoplasms/therapy ; Skin Neoplasms/pathology ; Skin Pigmentation* ; Software*

Major peripheral arterial graft infection is a potentially devastating complication of vascular surgery, associated with significant mortality and high amputation rates. Autologous saphenous veins are considered optimal arterial conduits for lower extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients. This study describes two patients with major peripheral graft infection, but without available autologous veins, who underwent graft excision and cryopreserved cadaveric arterial allograft reconstruction. Although long-term graft durability is unclear because of gradual deterioration and degeneration, these findings suggest that cadaveric allografts may be good options for patients with major peripheral graft infection.
Allografts* ; Amputation ; Blood Vessel Prosthesis ; Cadaver* ; Humans ; Lower Extremity ; Mortality ; Saphenous Vein ; Tissue Preservation ; Transplants* ; Veins

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient’s pathology, the treatment plan should be carefully decided and individualized. At the authors’ institution, the treatment plan is made individually based on each patient’s symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient’s pathophysiology, optimal outcomes can be achieved. Depending on each patient’s pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient’s pathology, the treatment plan should be carefully decided and individualized. At the authors’ institution, the treatment plan is made individually based on each patient’s symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient’s pathophysiology, optimal outcomes can be achieved. Depending on each patient’s pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

The heat shock response is an important homeostatic mechanism that enables cells of animals, plants, and bacteria to survive a variety of environmental stresses. In all organisms a small set of proteins(heat shock proteins, hsps) is preferentially synthesized in response to stress. By seeking the expression of mRNA of hsps to tissue ischemia-reperfusion injury, a guideline can be provided in its application. A total of 100 Sprague-Dawley rats weighing about 200 to 300 gm were used. The rats were divided into three groups; group1: sham operation group, group 2: ischemia induced only, and group 3: ischemia-reperfusion group. The ischemia group(group 2) was subdivided according to the duration of ischemia. 1, 2, 4, 8, and 12 hours each. Ischemia-reperfusion group(group 3) was subdivided according to the duration of ischemic insult lasting 1, 2, and 4 hours each(group 3-1, 2, 3). Samples were taken from both subgroups 15 min, 30 min, 1, 2, 4, 8 hours after reperfusion. Creatine phosphokinase levels were measured and mRNA expression was observed using in situ hydridization histochemistry. The elevation of creatine phosphokinase was correlated to the duration of ischemic insult and to the duration of reperfusion time. This postulated the fact that the amount of muscle injury had direct connection with time of ischemia and the injury continued even after reperfusion. The overall mRNA of hsp in the ischemia-reperfusion group showed faster and stronger expression compared to that of the ischemia-only group. Among the ischemia-reperfusion subgroups, as the ischemic time was increased, the mRNA expression demonstrated faster but with decreased amount. This findings suggest that there can be a limit in expression of hsp based on the extent of ischemic insult. This can be helpful in clinical applications. When the gastrocnemius and soleus muscle are compared, white muscle group(gastrocnemius) revealed faster and stronger expression of mRNA of hsps. This is most likely due to the fact that red muscle group has abundant blood supply and mitochondria, and implies decreased injury after ischemia-reperfusion. Although the precisive mechanism of hsp is not yet known, heat shock induced protection increases flap survival dramatically. But by demonstrating the pattern of expression based on ischemia time and reperfusion, this paper suggests a possible limit of hsp against ischemia- reperfusion injury.
Animals ; Bacteria ; Creatine Kinase ; Heat-Shock Proteins* ; Heat-Shock Response ; Hot Temperature* ; Ischemia ; Mitochondria ; Muscle, Skeletal* ; Rats ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; RNA, Messenger* ; Shock

PURPOSE: The jejunal free flap has the shorter ischemic time than other flap and requires a laparotomy to harvest it. As the evaluation of the perfusion the buried flap is very important, the perfusion of the buried jejunal free flap requires monitoring for its salvage. We tried to improve the monitoring flap method in the jejunal free flap and examined its usefulness. METHODS: From March 2002 to March 2006, the monitoring flap method was applied to 4 cases in 8 jejunal free flaps for the pharyngeal and cervical esophageal reconstructions. The distal part of the jejunal flap was exposed without suture fixation through cervical wound for monitoring its perfusion. The status of perfusion was judged by the color change of jejunal mucosa and mesentery. If necessary, pin prick test was performed. Doppler sonography was applied to mesenteric pedicle of the monitoring flap in case of suspicious abnormal circulation. RESULTS: The monitoring flap shows no change in 3 cases, but the congestion happened in one case at the 12 hours after the operation. This congestion was caused by the twisting or kinking of the mesenteric pedicle of the monitoring flap. So, we fixed up the monitoring flap close to adjacent cervical skin for prevention of rotation. Finally, the main part of transferred jejunal flap was intact. CONCLUSION: The success of a jejunal free flap depends on close postoperative monitoring and early detection of vascular compromise. So, various monitoring methods have been tried, for instance, direct visualization using a fiberoptic pharyngoscope, through a Silastic window placed in the neck flap, or external surface monitoring with an Doppler sonography, use of a buried monitoring probe. But, all of the above have their own shortcomings of simplicity, non-invasiveness, reliability and etc. In our experience, monitoring flap can be a accurate and reliable method.
Estrogens, Conjugated (USP) ; Free Tissue Flaps* ; Laparotomy ; Mesentery ; Mucous Membrane ; Neck ; Perfusion ; Skin ; Sutures ; Wounds and Injuries

Open structure rhinoplasty combines the open(external) approach to rhinoplasty with innovative nasal restructuring techniques especially for the lower third of the nose. It involves minimal resection of the nasal structure, dome-dividing maneuvers with reconstitution of the lateral crural strip, and columellar strut and tip-grafting methods. A total of 14 patients are presented, 1 with congenital flat nose, 1 with congenital nasal deformity, 1 with congenital bulbous tip and deviation, and 11 with posttraumatic nasal deformities, with age between 14 and 41 years old and a follow-up period of 2 years. These patients underwent humpectomy, septal cartilage shield graft, corrective rhinoplasty, and augmentation rhinoplasty through a transverse midcolumellar incision with bilateral marginal incisions. These incisions provide the exposure necessary to precisely assemble a structurally sound nasal skeleton. The nasal tip graft and alar cartilage realignment are essential for determining nasal tip projection. We used sutured-in-place tip graft in 3 patients. The aesthetic results were excellent with improved nasal dorsal profile including nasal tip projection. The open structure rhinoplasty, however, has its disadvantages. The procedure is more time consuming, mainly because the nasal restructuring maneuvers and transcolumellar incision require meticulous execution. Nevertheless if proper techniques are used, columellar scar is rarely noticed and almost disappears with the lapse of time. In conclusion, unlike all closed techniques, the open approach to rhinoplasty permits accurate diagnosis and precise realignment of deformed nasal structures(both cartilage and bone) during the operation.
Adult ; Cartilage ; Cicatrix ; Congenital Abnormalities ; Diagnosis ; Follow-Up Studies ; Humans ; Nose* ; Rhinoplasty* ; Skeleton ; Transplants

No abstract available.
Acne Vulgaris ; Allergens ; Dermatitis, Allergic Contact* ; Dermatitis, Contact ; Hospitals, University ; Incidence ; Korea* ; Mass Screening ; Merbromin ; Patch Tests ; Potassium ; Povidone ; Povidone-Iodine