PURPOSE: The ischial area is by far the most common site of pressure sores found in wheel chair bound paraplegic patients, because greatest pressure is exerted from the body on this area in a sitting position. Even after a series of successful pressure sore treatments, the site is very prone to relapse by the simplest ordinary tasks of everyday life. Therefore, it is crucial to preserve the main pedicle during primary surgery. Various surgical procedures employed to treat pressure sores such as myocutaneous flap and perforator flap have been introduced. After introduction of ischial sore treatment using the inferior gluteal artery perforator (IGAP) has been made, the authors experienced favorable clinical results of patients who have undergone IGAP flap procedure in a three year time period. METHODS: A total of 17 patients received IGAP flap surgery in our hospital from January 2003 to May 2006, among which 14 of them being males and 3 females. Surgery was performed on the same site again in 6(35%) patients who had originally relapsed after receiving the conventional method of pressure sore surgery. Patients' average age was 49.4(27-71) years old. Most of the patients were paraplegic(11 cases, 65%) and others were either quadriplegic(4 cases, 23%) or ambulatory(2 cases, 12%). Based on hospital records and clinical photographs, we have attempted to assess the feasibility and practicability of the IGAP flap procedure through comparative analysis of several parameters: size of defective area, treatment modalities, occurrence of relapses, complications, and postoperative treatments. RESULTS: The average follow-up duration of 17 subjects was 25.4 months(5-42 months). All flaps survived without any necrosis. Six cases were relapsed cases from conventional surgical procedures. All of them healed well during our follow-up study. Postoperative complications such as wound dehiscence and fistula developed in some subjects, but all were well healed through secondary treatment. A total of 2 cases relapsed after surgery. CONCLUSION: The inferior gluteal artery perforator flap is an effective method that can be primarily applied in replacement to the conventional ischial pressure sore reconstructive surgery owing to its many advantages: ability to preserve peripheral muscle tissue, numerous possible flap designs, relatively good durability, and the low donor site morbidity rate.
Arteries* ; Female ; Fistula ; Follow-Up Studies ; Hospital Records ; Humans ; Ischium ; Male ; Myocutaneous Flap ; Necrosis ; Perforator Flap* ; Postoperative Complications ; Pressure Ulcer* ; Recurrence ; Tissue Donors ; Wheelchairs ; Wounds and Injuries

PURPOSE: Botulinum toxin type A(BoTA) can block the release of vasoconstriction cotransmitters as well as acetylcholine in nerve terminal. The authors observed that BoTA increases flap survival by preventing sympathetic collapse of peripheral vessels. METHODS: 10 Sprague Dawley rats were divided into control(n=5), and BoTA group(n=5). 3x10cm sized random pattern cutaneous flaps were elevated on the dorsal side in both groups. In BoTA group, BoTA was injected into the flap via intradermal to subdermal route, 7 days before the flap elevation. Flap survival rates (survival area/total area) were measured 7 days after the elevation. Cutaneous blood flow was measured in proximal, middle and distal compartments of the flap using laser Doppler flowmetry initially, preoperatively, at immediate postoperation, and 7 days after flap elevation, respectively. Histological examination was performed 7 days after the flap elevation. The number and shape of the vessels were evaluated under microscope. RESULTS: Mean flap survival was 53.18+/-6.58% in control group and 93.79+/-6.06% in BoTA group, displaying statistically significant difference(p=0.0008, p< 0.05). In the control group, blood flow to the middle and distal compartments of the flap decreased significantly immediately after flap elevation. In the BoTA group, blood flow to the middle compartment did not decrease(p=0.002) and slightly decreased in the distal compartment(p=0.001). Cutaneous blood flow was significantly higher in all compartments of the flap in BoTA group than in control group, 7 days after the flap elevation. In histopathologic examination, greater number of vessels were noted in the BoTA group than in the control group. CONCLUSION: Botulinum toxin A can increase the survival of the random pattern cutaneous flap in rats by preventing the sympathetic collapse of peripheral vessels.
Acetylcholine ; Animals ; Botulinum Toxins ; Laser-Doppler Flowmetry ; Rats ; Rats, Sprague-Dawley ; Survival Rate ; Vasoconstriction

PURPOSE: Autologous fat injection into the facial area is a frequently used technique in aesthetic plastic surgery for augmentation of the soft tissue. Fat injection is a very safe procedure because of the advantage of being autologous tissue. Minimal foreign body reaction or infections are noted after fat injection. However, there may be some complications including those as severe as blindness. There have been some case reports on visual disturbances after autologous fat injection reported in the literature. METHODS: A 21-year-old female patient underwent autologous fat injection into left eyebrow area to correct depression of soft tissue. Immediately after injection of autologous fat, she complained sudden visual loss on the left eye. She had come to our emergency room and ophthalmologic evaluation showed that the patient could only recognize hand motion. There was no abnormality of the optic nerve on magnetic resonance imaging. Suspecting an ischemic optic neuritis from fat embolism of the central retinal artery, the patient was treated conservatively with occular massage, antiglaucomatic agent, anti-inflammatory drugs and antibiotics. Visual field examination showed visual defect of half the lower hemisphere. RESULTS: While maintaining antiglaucomatic agents and non steroidal anti inflammatory drugs, fundoscopic examination showed no abnormalities on the second day of admission. Visual field examination showed an improvement on the fourth day along with decreased eyeball pain. Significant improvement of vision was noted and the patient was discharged on the fifth day of admission. The patient was followed-up 2 days afterwards with improved vision and visual field defect. CONCLUSION: We describe an unusual case of sudden unilateral visual disturbance following autologous fat injection into periorbital area.
Anti-Bacterial Agents ; Blindness ; Depression ; Embolism, Fat ; Emergency Service, Hospital ; Eyebrows ; Female ; Foreign-Body Reaction ; Hand ; Humans ; Magnetic Resonance Imaging ; Massage ; Optic Nerve ; Optic Neuritis ; Retinal Artery ; Surgery, Plastic ; Visual Fields ; Young Adult

PURPOSE: Multiple symmetric lipomatosis (MSL) is a relatively rare disorder characterized by presence of multiple, symmetric, nonencapsulated fat masses in face, neck, shoulder and other areas. There has been only a few cases reported in Korea. The main purpose of this research is to examine the Korean patients to see what kinds of special characteristics occurred due to this disease and to decide the proper treatment. METHODS: A total of 16 patients were evaluated retrospectively. 5 patients were treated at our hospital. The other patients were reviewed from literature. We analyzed the biological characters of patients, location of fat deposit, morphologic characters of patients, clinical evidence of neuropathy, associated metabolic disorders and treatment modality. RESULTS: All cases were male patient. The mean age of onset was 47.43 years. All patients were moderate to heavy alcoholics. The most common location of fat deposition was posterior neck and abdomen. In neurologic exam of 9 patients, 5 patients showed muscle weakness, tremor, pain and autonomic nerve dysfunction. In metabolic studies of 9 patients, total cholesterol values were higher in 1 patient. A glucose tolerance test was abnormal in 1 patient. In treatment modality, 14 patients were treated with surgical resection, 1 patient was treated with liposuction and surgical excision, 1 patient was treated only with liposuction. CONCLUSION: To treat MSL patients successfully, we should concentrate not only on the removal of the fatty tissue but also on neurologic abnormities, metabolic disorders and associated diseases.
Abdomen ; Adipose Tissue ; Age of Onset ; Alcoholics ; Autonomic Pathways ; Cholesterol ; Glucose Tolerance Test ; Humans ; Korea ; Lipectomy ; Lipomatosis, Multiple Symmetrical* ; Male ; Muscle Weakness ; Neck ; Retrospective Studies ; Shoulder ; Tremor

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low-to-intermediate malignant tumor of endothelial origin. Computed tomography (CT) findings of PEH demonstrate multiple small bilateral nodules; however, to the best of our knowledge, there were no reports on PEH coexisting with other malignancies. Here, we reported on a case involving PEH in a patient with colon cancer and breast cancer which was misconceived as pulmonary meta-stasis. A 63-year-old woman who suffered from constipation for 2 weeks visited our hospital. Colonoscopy showed a large mass with obstruction on hepatic flexure. The histological diagnosis was adenocarcinoma of the ascending colon. Multiple nodules in both lungs and breast were observed on a chest CT scan. A core biopsy of a breast nodule was performed and a diagnosis of invasive ductal carcinoma of the left breast was made. Pulmonary nodules observed on the chest CT scan was considered as pulmonary metastasis from colon or breast cancer. Laparoscopic right hemicolectomy was performed. At the same time, wedge resection of the lung was performed and pathological diagnosis was PEH. Radiologic features of PEH were difficult to distinguish from lung metastasis. Therefore the author reported a rare case involving PEH in a patient with primary malignancy of colon and breast.
Adenocarcinoma ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Constipation ; Diagnosis ; Female ; Hemangioendothelioma ; Hemangioendothelioma, Epithelioid* ; Humans ; Lung ; Middle Aged ; Neoplasm Metastasis* ; Tomography, X-Ray Computed

It is possible to compare three-dimensional image of patterned injury in virtual space with object using 3D/CAD supported photogrammetry(FPHG). this method make it possible to examine patterned injuries of skin, soft tissue and bone for matching instruments in shape, size and angle without altering. Generally, 3D measuring of objects require 3D digitizer or series of photographs taking by metric camera. We developed program which calibrate pictures taken by non-calibrated commercial camera and un distorted image. This image and objet model n can be examined with respect to matching shapes using 3D/CAD system.
Imaging, Three-Dimensional ; Photogrammetry ; Skin ; United Nations

PURPOSE: There have been limited reports on breast reconstruction after excision of phyllodes tumor. This paper reports four patients who had immediate reconstruction of the breast following excision of phyllodes tumor. METHODS: We retrospectively reviewed the medical records of 14 patients from March 2000 to March 2008. Clinical data were analyzed including age, presenting symptoms and signs, type of surgery and metastasis. RESULTS: The mean age was 38.6 years. The mean follow-up period was 40.6 months. Reconstruction was performed with latissimus dorsi musculocutaneous flap in 3 patients and transverse rectus abdominis musculocutaneous flap in 1 patient. Other cases were covered with skin graft or primary repair. 2 local recurrent cases were noted. CONCLUSION: The breast affected by phyllodes tumor must undergo complete excision. Followed by mastectomy, immediate reconstruction of breast improved cosmetic results, and allowed a wider surgical excision margin of tumor.
Breast ; Cosmetics ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Medical Records ; Phyllodes Tumor ; Rectus Abdominis ; Retrospective Studies ; Skin ; Transplants

By means of microsurgical free-tissue transfer providing a large amount of required tissue, the surgeon can resect tumoral tissue more safely, which allows tumor-free margins and enhances the reliability of the ablative surgery that otherwise could not be performed radically. The morbidity of elective free-tissue transfer seems to be quite low, carrying acceptable risks for most patients. But the elderly patients are at risk for cardiac and respiratory problems, deep vein thrombosis, pulmonary emboli and infection merely as a function of age. This study was undertaken to define further risks of the elderly population with regards to free-tissue transfer. We retrospectively reviewed our experience with 110 microsurgical free-tissue transfers for head and neck reconstruction in patients greater than 60 years of age. Microsurgical procedures in all cases were preformed by the plastic and reconstructive department at Yonsei medical center. The investigated parameters were patient demographics, past medical history, American Society of Anesthesiologists(ASA) status, site and cause of defect, the free tissue transferred and postoperative complication including free-flap success or failure. There were 46 patients in the age group from 60 to 64 years, 34 patients from 65 to 70 years, and 30 patients 70 years or older. There happened 3 flap losses, resulting in a flap viability rate of 97%. Patients with a higher ASA designation experienced more medical complication(p=0.05, 0.01, 0.03 in each age group I, II, III) but not surgical complication p=0.17, 0.11, 0.54 in each age group I, II, III). And the relationship between postoperative complication and age groups was not significant. These observations suggest that major determinant for postoperative medical complication be the patient's American Society of Anesthesiologists score, and chronologic age alone should not be an exclusion criterion when selecting patients for free-tissue transfer.
Aged* ; Demography ; Head* ; Humans ; Neck* ; Plastics ; Postoperative Complications ; Retrospective Studies ; Venous Thrombosis

No abstract available.
Chronic Disease ; Hepatitis B, Chronic/economics ; Humans ; Insurance, Health, Reimbursement/*economics ; Korea ; Liver Diseases/*economics ; *Prejudice ; Social Support ; Social Welfare/*economics ; *Societies, Medical ; Socioeconomic Factors

Background: Attenuated Salmonella strain can be used as a vector to transport immunogens to the host antigen-binding sites. Objectives: The study aimed to determine the protective efficacy of attenuated Salmonellastrain expressing highly conserved Brucella immunogens in goats. Methods: Goats were vaccinated with Salmonella vector expressing individually lipoprotein outer-membrane protein 19 (Omp19), Brucella lumazine synthase (BLS), proline racemase subunit A (PrpA), Cu/Zn superoxide dismutase (SOD) at 5 × 10 9 CFU/mL and challenge of all groups was done at 6 weeks after vaccination. Results: Among these vaccines inoculated at 5 × 10 9 CFU/mL in 1 mL, Omp19 or SOD showed significantly higher serum immunoglobulin G titers at (2, 4, and 6) weeks post-vaccination, compared to the vector control. Interferon-γ production in response to individual antigens was significantly higher in SOD, Omp19, PrpA, and BLS individual groups, compared to that in the vector control (all p < 0.05). Brucella colonization rate at 8 weeks post-challenge showed that most vaccine-treated groups exhibited significantly increased protection by demonstrating reduced numbers of Brucella in tissues collected from vaccinated groups. Realtime polymerase chain reaction revealed that Brucella antigen expression levels were reduced in the spleen, kidney, and parotid lymph node of vaccinated goats, compared to the nonvaccinated goats. Besides, treatment with vaccine expressing individual antigens ameliorated brucellosis-related histopathological lesions. Conclusions These results delineated that BLS, Omp19, PrpA, and SOD proteins achieved a definite level of protection, indicating that Salmonella Typhimurium successfully delivered Brucella antigens, and that individual vaccines could differentially elicit an antigen-specific immune response.