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Median Nerve Entrapment Syndrome Due to Adhesion of Laceration Wound by Suicidal Attempt -A Case Report.

In Soo BAEK ; Sang Hoon ROH ; Hyung Bin SOHN ; In Pyo HONG

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):676-680.

PURPOSE: Median nerve entrapment syndrome within carpal tunnel is usually called carpal tunnel syndrome and it is the most common form of peripheral nerve entrapment syndrome. Many factors such as diabetes mellitus, hypothyroidism, hormonal replacement theraphy, corticosteroid use, rhematoid arthritis and wrist fractures may cause carpal tunnel syndrome. To the best of our knowledge, this is the first case report of median nerve entrapment syndrome due to adhesion of laceration wound after suicidal attempt. METHODS: A 28-year-old woman presented with a sensory change and thenar hypotrophy on her left hand. On her history, she attempted suicide by slashing her wrist. Initial electromyography (EMG) showed that the nerve conduction velocities of median nerve was delayed. Therefore, we performed surgical procedures. When exploration, Fibrous scar tissue observed around the median nerve but nerve had not been injured. Transcarpal ligament was completely released and adjacent fibrous tissue was removed to decompress the median nerve. RESULTS: The postoperative course was uneventful until the first year. Opposition difficulty and thenar hypotrophy were improved progressively after the surgery. Sensory abnormality was slowly improved over one year. CONCLUSION: We report a case of median nerve entrapment syndrome that was caused by adhesion of laceration wound after suicidal attempt. This is an unusual cause of median nerve entrapment syndrome, the symptoms were relieved after transcarpal ligament release and fibrous scar tissue removal.
Adult ; Arthritis ; Carpal Tunnel Syndrome ; Cicatrix ; Diabetes Mellitus ; Electromyography ; Female ; Hand ; Humans ; Hypothyroidism ; Lacerations ; Ligaments ; Median Nerve ; Neural Conduction ; Peripheral Nerves ; Suicide, Attempted ; Wrist

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The Fate of Calvarial Bone Graft in Nasal Tip Plasty Patients Followed Up for Over 10 Years.

Deok Jung KIM ; Soo Hyang LEE ; Eun A HWANG ; Hyun Gon CHOI ; Soon Heum KIM ; Dong Hyeok SHIN ; Ki Il UHM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):671-675.

PURPOSE: In order to maintain corrected nasal tip projection, strong support is important. Authors used calvarial bone graft method for this purpose. Patients were followed up about permanency of the bone graft for a long time. METHODS: From 1995 to 1998, author performed calvarial bone graft on 30 adult patients with secondary cleft lip and nose deformity. Patients were observed for 34 months. There were no specific complications, and results were satisfactory. We could confirm the permanence of the calvarial bone graft in 3 patients by photography and radiologic studies for 10 years follow-up. RESULTS: None of the patients showed size change or displacement. But the portion of graft facing the tip was absorbed resulting in loss of tip projection and short nose in two patients. One patient had fracture on the middle of the graft. This caused depression from lower portion of the dorsum to the tip. CONCLUSION: Despite of autogenous grafts such as calvarial bone, absorption of the bone may occur when compressed with tension for a long period. And the graft in the nasal tip not having any contact with the nasal bone may cause absorption of the graft.
Absorption ; Adult ; Cleft Lip ; Congenital Abnormalities ; Depression ; Displacement (Psychology) ; Follow-Up Studies ; Humans ; Nasal Bone ; Nose ; Photography ; Transplants

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Urethroplasty of Urethral Defect with Longitudinal Tubed Flap of Scrotal Skin after Fournier's Gangrene (Necrotizing Fascitis).

Hee Joon MIN ; Tai Suk ROH ; Ji Ye KIM ; Sug Won KIM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):667-670.

PURPOSE: The management of urethral defect represents one of the most challenging clinical problems in uroplastic surgery. Especially for defect after Fournier's Gangrene, optimal management is still a hard problem. During extensive urethral reconstruction, to overcome the poor vascularity due to periurethral scarred tissue and limitation of the choice of local flap, we report our experience with one-stage reconstruction of urethral defect using a longitudinal tubed flap of scrotal skin. METHODS: A 72-year-old man with several years of diabetes mellitus history visited for swelling and pain of scrotal area. After diagnosis of Fournier's Gangrene, radical debridement was performed and 6 cm of urethral defect on border of penile-scrotal ventral area was made. Rectangular scrotal skin flap (6 x 2.5 cm) based on external spermatic fascia was elevated and tubed longitudinally. After transfer the flap to the defect area, end-to-end anastomosis was performed bilaterally. RESULTS: 4 weeks after the operation, the patient started voiding him-self and urethrography showed good fluence of contrast agent. Long term evaluation reveals stable performance characteristics without any complications. CONCLUSION: We suggest a one-stage reconstruction of extensive urethral defect using a longitudinal tubed flap of scrotal skin. Advantages of this procedures are simple, one-stage reconstruction with the reliable scrotal skin flap based on external spermatic fascial vasculature, and no donor morbidity.
Aged ; Cicatrix ; Debridement ; Diabetes Mellitus ; Fascia ; Fournier Gangrene ; Humans ; Skin ; Tissue Donors

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Septal Approach on Upper Blepharoplasty in Elderly Person.

Eui Sun OH ; In Sik YUN ; Beyoung Yun PARK

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):659-666.

PURPOSE: Blepharoplasty plays a vital role in facial rejuvenation. Aging eyelids are the result of relaxation of lid structures as the skin, the orbicularis muscle, and mainly the septum, with subsequent protrusion or pseudoherniation of intraorbital fat contents. Traditional blepharoplasty has often involved the excision of excessive lax skin and muscle and removal of fat, leaving the eyelid unnatural and even causing the brow ptosis. The authors propose the septal approach through which the amount of skin excision can be decreased and solid fixation can be achieved in the upper blepharoplasty. METHODS: From November 2007 to February 2010, total of 15 patients underwent upper blepharoplasty with septal approach. In 9 patients, orbital septum anchored into the orbital periosteum only. But in 6 patients, the attenuated septum was strengthened through shortening and fixing into orbital periosteum with non-absorbable suture. RESULTS: Pleasing results were obtained from most of the patients. But one patient who had septum anchoring procedure complained of slight undercorrection, therefore secondary operation with septum shortening procedure was followed. CONCLUSION: We found that the method using orbital septum fixation into orbital periosteum has several advantages: less amount of skin excision, less recurrence rate, and more natural appearance. And the results were reliable and satisfactory.
Aged ; Aging ; Blepharoplasty ; Eyelids ; Humans ; Muscles ; Orbit ; Periosteum ; Recurrence ; Rejuvenation ; Relaxation ; Skin ; Sutures

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Loop Suture Technique for Flexor Digitorum Profundus Tendon Repair in the Insertion Site.

Kyu Cheol LEE ; Dong Chul LEE ; Jin Soo KIM ; Sae Hwi KI ; Si Young ROH ; Jae Won YANG

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):650-658.

PURPOSE: In the case of repair for far distal parts of FDP (Flexor digitorum profundus) division, the method of either pull-out suture or fixation of tendon to the distal phalanx is preferred. In this paper, the results of a modified loop suture technique used for the complete division of FDP from both zone 1a and distal parts of zone 1b in Moiemen classification are presented. METHODS: From July 2006 to July 2009, the modified loop suture technique was used for the 10 cases of FDP in complete division from zone 1a and distal parts of zone 1b, especially where insertion sites were less than 1 cm apart from a tendon of a stump. In a suture technique, a loop is applied to each distal and proximal parts of tendon respectively. Core suture of 2-strand and epitendinous suture are done with PDS 4-0. Out of 10 patients, the study was done on 6 patients who were available for the follow-up. The average age of the patients was 49.1 years (in the range from 26 to 67). 5 males and 1 female patients were involved in this study. There were 3 cases with zone 1a and distal parts of zone 1b. The average distance to the distal tendon end was 0.6 cm. There were 5 cases underwent microsurgical repair where both artery and nerve divided. One case of only tendon displacement was presented. The dorsal protective splint was kept for 5 weeks on average. The results of the following tests were measured: active & passive range of motion, grip strength test, key pinch and pulp pinch test. RESULTS: The follow-up period on average was 11 months, in the range from 2 to 20 months. There was no case of re-rupture, but tenolysis was performed in 1 cases. In all 6 cases, the average active range of motion of distal interphalangeal joint was 50.8 degree. The grip strength (ipsilateral/contralateral) was measured as 88.7% and the pulp pinch test was 79.2% as those of contralateral side. Flexion contracture was presented in 2 cases (15 degree on average) and there was no quadrigia effect found. CONCLUSION: Despite short length of tendon from the insertion site in FDS rupture in zone 1a and distal parts of zone 1b, sufficient functional recovery could be expected with the tendon to tendon repair using the modified loop suture technique.
Arteries ; Contracture ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Formycins ; Hand Strength ; Humans ; Joints ; Male ; Range of Motion, Articular ; Ribonucleotides ; Rupture ; Splints ; Suture Techniques ; Sutures ; Tendons

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Replantation of Amputated Digits in Elderly Patients.

Soon Il CHUNG ; Jin Soo KIM ; Dong Chul LEE ; Sae Hwi KI ; Si Young ROH ; Jae Won YANG

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):644-649.

PURPOSE: As the mean life expectancy of people has been prolonged, and the elderly people who participate in the production activities has been increasing, it is expected that the demand on the replantation of amputated digits in elderly patients would increase. But, there are few studies about the replantation of amputated digits in elderly patients. Therefore, we report treatment outcomes of replantation of amputated digits in elderly patients. METHODS: From 1998 to 2008, the replantation was performed in 51 completely amputated digits of 33 patients aged 60 years or older. We performed the replantation in the usual manner. Under the brachial plexus block, the surgical procedures carried out in the following sequence: internal fixation using Kirschner wire, tenorrhaphy, arteriorrhaphy, neurorrhaphy and venorrhaphy. If the arterial ends could not be approximated without tension, a vein graft was performed. RESULTS: Of a total of 51 digits, 46 digits (90%) survived. 13 patients (40%) had underlying medical problem preoperatively. But, in all the patients, there were no postoperative medical complications. As the postoperative surgical complications, excluding five cases of the total necrosis of digit, there were three cases of venous congestion, two cases of arterial insufficiency, seven cases of infection and 16 cases of partial necrosis. CONCLUSION: Age alone does not affect the survival of replanted digits. Type of injury is the most important factor that affects the survival of replanted digits.
Aged ; Amputation, Traumatic ; Brachial Plexus ; Humans ; Hyperemia ; Life Expectancy ; Necrosis ; Replantation ; Transplants ; Veins

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Correction of Cryptotia by Triangular V-Y Advancement Flap and Rhomboid Flap.

Joon Moon LEE ; Dong Lin SEO ; Eun Sang DHONG ; Eul Sik YOON

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):639-643.

PURPOSE: Cryptotia is a congenital deformity in which the upper third of the auricle is buried under the temporal skin. It is rare in Caucasians, yet it is more common in Asians. Although a variety of methods to treat cryptotia have been introduced, there is still no acceptable single procedure that can successfully manage this deformity in its entity. We present a triangular V-Y advancement flap and rhomboid flap for correcting cryptotia that can overcome the diverse shortcomings of the conventional methods. METHODS: This operative method was used to correct 18 auricles in patients ranging in age from 4 to 33 years. A triangular flap was prepared over the auricle by making a skin incision according to Ohmori's method. Then a rhomboid flap with a side length of about 8 to 10 mm that sets the lower portion as a pedicle in the anterior region was prepared to supplement the contracted portion of the helix. The cartilage deformity was corrected by the banner flap or the radiating cartilage incisions with cartilage graft or high density polyethylene graft. RESULTS: We have treated 16 patients with severe cryptotia using this method and have obtained good aesthetic results. All cases showed widened scaphoid fossa and smooth triangular fossa of antihelix. There were no major postoperative complications, such as necrosis or infection of the flaps. CONCLUSION: Correction of cryptotia using the triangular V-Y advancement flap and rhomboid flap is useful a method for certain conditions, when a severe contraction of the helix is present.
Asian Continental Ancestry Group ; Cartilage ; Congenital Abnormalities ; Contracts ; Humans ; Necrosis ; Polyethylene ; Postoperative Complications ; Skin ; Transplants

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Effective Reconstruction of Extensive Orbital Floor Fractures Using Rapid Prototyping Model.

Hye Young KIM ; Deuk Young OH ; Woo Sung LEE ; Suk Ho MOON ; Je Won SEO ; Jung Ho LEE ; Jong Won RHIE ; Sang Tae AHN

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):633-638.

PURPOSE: Orbital bone is one of the most complex bones in the human body. When the patient has a fracture of the orbital bone, it is difficult for the surgeon to restore the fractured orbital bone to normal anatomic curvature because the orbital bone has complex curvature. We developed a rapid prototyping model based on a mirror image of the patient's 3D-CT (3 dimensional computed tomography) for accurate reduction of the fractured orbital wall. METHODS: A total of 7 cases of large orbital wall fracture recieved absorbable plate prefabrication using rapid prototyping model during surgery and had the manufactured plate inserted in the fracture site. RESULTS: There was no significant postoperative complication. One patient had persistent diplopia, but it was resolved completely after 5 weeks. Enophthalmos was improved in all patients. CONCLUSION: With long term follow-up, this new method of orbital wall reduction proved to be accurate, efficient and cost-effective, and we recommend this method for difficult large orbital wall fracture operations.
Absorbable Implants ; Computer Simulation ; Computer-Aided Design ; Diplopia ; Enophthalmos ; Floors and Floorcoverings ; Follow-Up Studies ; Human Body ; Humans ; Orbit ; Orbital Fractures ; Postoperative Complications

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The Importance of Septoplasty in The Treatment of Nasal Bone and Grade I Septal Fracture: Estimation with Acoustic Rhinometry.

Jun Hyung KIM ; Dong Woo SHIN ; Tae Hyun CHOI ; Dae Gu SON ; Ki Hwan HAN

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):626-632.

PURPOSE: Nasal bone fractures are often classified as minor injury. However, the incidence of posttraumatic nasal deformity remains alarmingly high. It is because of unnoticed septal fracture. This study was conducted to determine the necessity of septoplasty for patients with nasal bone fracture accompanying grade I septal fractures. METHODS: Among 105 patients with nasal bone fractures, 52 who had grade I septal fracture were diagnosed based on physical examination and computed tomography. Patients' age ranged from 14 to 65 years (mean 29.25 years), and 35 were male and 17 female. Patients were divided into 2 groups according to surgical treatment METHODS: patients who underwent closed reduction only (group 1, n=28) and those who underwent simultaneous closed reduction and septoplasty (group 2, n=24). The treatment outcomes were evaluated by comparing changes in nasal airway volume measured by acoustic rhinometry before the surgery, 3 months and 6 months after the surgery according to the timing of surgical repair and surgical treatment methods. RESULTS: Nasal airway volume increased after the surgery by 17.8% in 3 months after the surgery, 25.2% in 6 months in group 1 and by 22.7% in 3 months, 35.8% in 6 months in group 2. The increase in airway volume after the surgery by 26.3% in 3 months after the surgery, 34.2% in 6 months after the surgery in operation within 1 week after trauma and by 12.1% in 3 months, 22.2% in 6 months after the operation later 1 week after trauma. The difference was statistically significant. Three patients in group 1 complained of intermittent nasal obstruction, two of whom showed a decrease in nasal airway volume by acoustic rhinometry. CONCLUSION: Most patients with nasal bone fractures accompanying grade I septal fractures have been treated with closed reduction in clinical settings. However, the results of this study suggest that septoplasty be performed after a correct diagnosis of septal fracture is made through comprehensive physical examination and computed tomography. Septoplasty is important to obtain more favorable outcomes and reduce complication.
Acoustics ; Congenital Abnormalities ; Female ; Humans ; Incidence ; Male ; Nasal Bone ; Nasal Obstruction ; Physical Examination ; Rhinometry, Acoustic

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Open Reduction and Internal Fixation (ORIF) of Trapdoor Orbital Floor Blowout Fracture with Absorbable Mesh Plate.

Yu Jin KWON ; Ji Hoon KIM ; Jae Ha HWANG ; Kwang Seog KIM ; Sam Yong LEE

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2010;37(5):619-625.

PURPOSE: Trapdoor orbital blowout fracture is most common in orbital blowout fracture. Various materials have been used to reconstruct orbital floor blowout fracture. Absorbable alloplastic implants are needed because of disadvantages of nonabsorbable alloplastic materials and donor morbidity of autogenous tissue. The aim of the study is to evaluate usefulness of absorbable mesh plate as a reconstructive material for orbital blowout fractures. METHODS: From December 2008 to October 2009, 18 trapdoor orbital floor blowout fracture patients were treated using elevator fixation, depressor fixation, or elevator-depressor fixation techniques with absorbable mesh plates and screw, depending on degree of orbital floor reduction, because absorbable mesh plates are less rigid than titanium plates and other artificial substitutes. RESULTS: Among 18 patients, 5 elevator fixation, 4 depressor fixation, and 9 elevator and depressor fixation technique were performed. In all patients, postoperative computed tomographic (CT) scan showed complete reduction of orbital contents and orbital floor, and no displacement of bony fragment and mesh plate. Mean follow-up was 10 months. There were no significant intraoperative or postoperative complications. CONCLUSION: Three different techniques depending on the degree of orbital floor reduction are useful for open reduction and internal fixation of trapdoor orbital floor blowout fracture with absorbable mesh plates.
Displacement (Psychology) ; Elevators and Escalators ; Floors and Floorcoverings ; Follow-Up Studies ; Humans ; Orbit ; Postoperative Complications ; Tissue Donors ; Titanium

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