PURPOSE: Owing to the improvement of microscope, microsurgery implements, and microsuture, finger replantation has made a considerable development. With high success rate of microsurgery in children, positive results have been reported from distal amputation. We report the patients demographics, methods, and results of the microsurgery performed in children in our hospital for the last 8 years. METHODS: From the medical records of 21 patients who had given the treatment in our hospital from January 2000 to December 2007, we analyzed patients' sex, age, operative method, and complication retrospectively. RESULTS: The number of male patients was twice as many as female, where most patients belong to the ages of five to ten years. Operative methods performed in this study included end-to-end anastomosis of artery and vein, vein graft, and epineurial suture. As a result, 19 out of 21 cases were successfully accomplished, and four of them went through the debridement of necrotic tissue due to the partial necrosis of the lesion. A one-year follow-up observation was made after surgery and most of them were almost fully recovered as in their previous state. CONCLUSION: The success rate of finger replantaion in children is continuously improving despite the difficulty of vessel anastomotic procedure, rehabilitation treatment and management after surgery. We report the satisfactory results of pediatric finger replantation technically and aesthetically.
Amputation ; Arteries ; Child ; Debridement ; Demography ; Female ; Fingers ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Male ; Medical Records ; Microsurgery ; Necrosis ; Replantation ; Retrospective Studies ; Sutures ; Transplants ; Veins

PURPOSE: Self-inflicted wrist laceration is a common injury in the department of hand surgery. The aim of this study was to investigate the clinical characteristics and psychiatric features of self-inflicted wrist laceration using categorization according to wound severity. METHODS: We reviewed 71 patients from 2002 through 2012. All of the patients were grouped into four groups. Data regarding the following characteristics were collected: age, gender, size, structure involved, instruments used, history of previous self-inflicted injury, comorbidities in psychiatric and presentation of follow-up outpatient appointment to the department of plastic surgery and psychiatry. RESULTS: In these patients, approximately 64% of patients were female. About 80% of patients cut their wrist using a knife. And in grade 3-4 injury, percentage of glass injury was relatively high (22%), compared with other grades (3%). Unlike previous studies, patients in grade 3-4 tended to cut their wrist repeatedly. Focusing on psychiatric problems, approximately one quarter of patients had a previous history of self-infliction. In all patient groups, mood disorder was the most common disorder in patients who had a previous psychiatric disorder. But after operation, more than two thirds of patients had not visited department of psychiatry again. CONCLUSION: We identified some other differences among their characteristics. All patients in group also should be evaluated and surgically treated properly. A multidisciplinary approach is required for patients with wrist laceration due to self-injury in comparison to those with laceration due to other causes. Because many of them have previous self-injury experiences and psychiatric disease.
Comorbidity ; Female ; Follow-Up Studies ; Glass ; Hand ; Humans ; Lacerations* ; Mood Disorders ; Outpatients ; Retrospective Studies* ; Self Mutilation ; Suicide ; Surgery, Plastic ; Wounds and Injuries ; Wrist*

No abstract available.
Lower Extremity*

PURPOSE: Incidence of radiographic contrast media extravasation has increased owing to the escalating availability of contrast enhanced imaging. Potential complications of extravasation include localized swelling, itching sensation, hypesthesia, erythema, limitation of finger movement, compartment syndrome, skin sloughing, and necrosis. We describe clinical characteristics and treatment of computed tomography contrast media extravasation. METHODS: A retrospective chart review was performed on 26 consulted patients experiencing contrast extravasation, between January 2005 and December 2011. Age, signs, symptoms, types of contrast administered, volume of extravasation, treatment and patient outcomes were documented and evaluated, retrospectively. RESULTS: Extravasation of less than 100 mL occurred in 85%. Immediate surgical therapy was necessary in 23% of cases. There were no postoperative complications and it rendered excellent cosmetic outcomes. In 77% of cases, conservative management was recommended, such as elevation and immobilization of extremity, application of ice pack, and careful monitoring. CONCLUSION: Prevention is the most important for extravasation injuries. Diagnosis and treatment must be made on the spot in order to avoid severe soft tissue damage. Hand surgeons' decision on the necessity of surgical treatment within 6 hours is important in the prognosis of patients.
Compartment Syndromes ; Contrast Media ; Cosmetics ; Erythema ; Extravasation of Diagnostic and Therapeutic Materials ; Extremities ; Fingers ; Hand ; Humans ; Hypesthesia ; Ice ; Immobilization ; Incidence ; Necrosis ; Postoperative Complications ; Prognosis ; Pruritus ; Retrospective Studies ; Sensation ; Skin ; Upper Extremity

PURPOSE: Marjolin's ulcer is rare but highly aggressive malignant cancer that is associated with chronic, nonhealing wounds such as burn wound. There are no confirmed effective protocols for treatment of this disease. This study was conducted to describe the clinical presentation and treatment modalities of Marjolin's ulcer in our hospital. METHODS: This was a retrospective study of Marjolin's ulcer. 20 cases were histologically confirmed malignant skin cancer seen at Chonbuk National University Hospital from January 2000 to December 2011. Data were retrieved from patients' medical records and photographs. RESULTS: The total 20 cases of Marjolin's ulcer were studied. Squamous cell carcinoma was the most common pathological type in 20 patients (100%). Lymph node metastasis at the time of diagnosis was recorded in 3 patient (15%). Wide excision was the most common surgical procedure performed in 17 patients (85%) of cases. The reconstruction modalities were various as free flap 3 patients (15%), skin graft 13 patients (65%), local advancement flap 2 patients (10%) and regional flap 1 patient (5%). Local recurrence was noted in 3 patients (15%) who had surgical treatment. And one patient (5%) expired in hospital. CONCLUSION: Marjolin's ulcer is an infrequent lesion. Unfortunately the diagnosis and treatment are often delayed. If the wound was histologically confirmed, aggressive excision and reconstruction is warranted in these highly malignant skin cancer. Early recognition and aggressive treatment of Marjolin's ulcers are essential to improve outcomes.
Burns ; Carcinoma, Squamous Cell ; Free Tissue Flaps ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Skin ; Skin Neoplasms ; Transplants ; Ulcer

BACKGROUND: A recent advancement in microsurgery, the free flap is widely used in the reconstruction of the lower leg and foot. The simple and effective methods of local flaps, including transposition and advancement flaps, have been considered for patients with chronic debilitation who are unable to endure long surgical procedures or general anesthesia. However, the location and size of the wound may restrict the clinical application of a local flap. Under these circumstances, a sural flap can be an excellent alternative, rendering satisfying clinical outcomes in chronically debilitated patients. METHODS: Between 2008 and 2012, 39 patients underwent soft tissue defect treatment by sural artery flap as a final method. All of the patients had at least one chronic disease or more (diabetes, hypertension, vascular disease, etc.). Also, all of the patients had a history of chronic lower extremity ulceration, which revealed no response to several months of conservative treatment. RESULTS: The results of the 39 cases had a success rate of 100% with 39 complete recoveries. Nine cases suffered complications: partial necrosis (n=4), wound dehiscence without necrosis (n=3), hematoma (n=1), and infection (n=1). CONCLUSIONS: The sural artery flap is not only useful for the lower leg but also for the heel, and other various parts. Furthermore, it is a relatively simple surgical technique for reconstructing the defect area for patients with various chronic conditions with a high surgical risk or contraindications to surgery.
Anesthesia, General ; Arteries ; Chronic Disease ; Foot ; Free Tissue Flaps ; Heel ; Hematoma ; Humans ; Hypertension ; Leg ; Lower Extremity ; Microsurgery ; Necrosis ; Organic Chemicals ; Soft Tissue Injuries ; Surgical Flaps ; Ulcer ; Vascular Diseases

Thermal injury to free flap site can be severe and distressing injuries both for the patients and the surgeon. Thermal injuries to insensate free flaps are known complications often reported. But thermal injuries to free flaps are also occurred in the perioperative period. This study focused on the various factors associated with these injuries. We reported a 36-years old male patient with scalding burn in using warmed saline irrigation who underwent anterolateral thigh perforator free flap due to diabetic foot ulcer on dorsum of left foot. The clinical characteristics of thermal injuries during the free tissue transters are 1) Warmed saline irrigation is often too hot and a temperature excess 48degrees C should be considered very hot saline during the operation. 2) The direct exposure of the microscope light often causes iatrogenic burn, so copiously irrigating the surgical field and readjusting the light source's position or its output intensity are important. Surgeon must be aware that warmed saline irrigation & surgical microscope can cause thermal injury to free flap during the free tissue transfer.
Burns ; Diabetic Foot ; Foot ; Free Tissue Flaps* ; Humans ; Male ; Perioperative Period ; Thigh ; Ulcer

PURPOSE: To assess the width of the labial alveolar bone of the incisive canal and the width of the incisive canal on spiral computed tomographic images of the anterior portion of the maxilla. MATERIALS AND METHODS: Study materials included 38 CT scans taken for preoperative planning of implant placement. Axial cross-sectioned image entirely showing the incisive canal was selected and scanned with 600 DPI resolution. The width of the labial alveolar bone of the incisive canal at an orifice to the oral cavity, middle portion, and an orifice to the nasal cavity and the diameter of the incisive canal at the middle portion were determined by two specialist using Digora for Windows 2.1. The statistical analyses were carried out using SPSS 12.0.1. RESULTS: When the maxillary central incisors remained, the mean labial alveolar bone width were 6.81+/-1.41 mm, 6.46+/-1.33 mm, and 7.91+/-1.33 mm. When the maxillary central incisors were missed the mean width were 5.42+/- 2.20 mm, 6.23+/-2.29 mm, and 7.89+/-2.13 mm. CONCLUSIONS: The labial alveolar bone width at middle portion and an orifice to the nasal cavity were of no statistical significant difference according to presence of the maxillary central incisors (P>0.05). The width between oral cavity and nasal cavity, middle portion and to nasal cavity revealed statistically significant difference (P<0.05).
Alveolar Process ; Dental Implants ; Incisor ; Maxilla ; Mouth ; Nasal Cavity ; Radiography, Dental, Digital ; Specialization ; Tomography, X-Ray Computed

PURPOSE: Neurofibromas of neuroectodermal origin are commonly found in Von Recklinghausens disease or neurofibormatosis type 1. It is an autosomal dominant disease caused by mutation of the long arm of chromosome 17. It can present from small nodules to disfiguring giant tumor. Plexiform neurofibroma is benign in most cases, but it could be transformed into malignant tumor, which requires surgical excision. To cover the defects after the excision, a number of surgical correction methods are available. This study is to report a surgical correction of disfiguring plexiform neurofibroma using anterolateral thigh free flap for extensive defects after surgical excision of neurofibrona. METHODS: Data of five neurofibroma patients with an average age of 39 including medical history, physical examination, computed tomography, and magnetic resonance imaging were checked. No disease other than neurofibroma were detected. Biopsy on the excised tissues was performed. The follow-up period was 7 to 27 months. RESULTS: The average size of defects after complete excision of neurofibroma was 13x10~25x15cm. Defects were covered by anterolateral thigh free flap, while donor sites were covered by local flap, split thickness skin graft and regional flap. Throughout follow-up, there were no complication, relapse, or any abnormalities. CONCLUSION: Despite various surgical correction methods are applicable to defects after excision on disfiguring plexiform neurofibroma, coverage of massive defects is still challenging in plastic and reconstructive surgeon. We have made five successful cases of surgical correction of disfiguring plexiform neurofibroma using anterolateral thigh free flap.
Arm ; Biopsy ; Chromosomes, Human, Pair 17 ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Magnetic Resonance Imaging ; Neural Plate ; Neurofibroma ; Neurofibroma, Plexiform ; Neurofibromatosis 1 ; Physical Examination ; Plastics ; Recurrence ; Skin ; Thigh ; Tissue Donors ; Transplants

No abstract available.