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Calcification on the Surface of Silicone Nasal Implants: Regional Properties of Calcification Deposits.

Min Jae LEE ; Hyun Ji KIM ; Ki Hwan HAN ; Jun Hyung KIM ; Dae Gu SON

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):324-329.

The silicone rubber implants are widely used in plastic surgery because of various advantages; however, calcification in surface of implant(as a chemical resistance) may transform or destroy the high molecular biomaterial when it stays too long within the human body. The purpose of this study is to determine the relationship between calcification and the histological disparities of the tissues surrounding the area adjoining the silicone nasal implant by examining the regional characteristics of calcium deposits in the silicone nasal implant via elemental analyses using EDX(energy-dispersive X-ray analysis) and ultrastructural analyses using SEM(scanning electron microscopy). The subjects of the study were 19 silicone nasal implants removed by revision rhinoplasty, all displaying calcification. According to the tissue characters, the implant surface was divided into 4 zones with the rhinion as the basis. For each zone, elemental and ultrastructural analyses were performed. Elemental analysis revealed that the calcium deposits consisted of Ca and P only. There were no statistically significant disparities among the ratios between Ca and P according to the zones. Ultrastructural analysis showed acellular mineral-like deposits coalesced to create amorphous deposits in all zones; however, in zones 1 and 3(more pressurized zones by periosteum or nasal bone), additional flaky cylinder-shaped calcium deposits were detected. Thus, it seems that the histological disparities in the surrounding tissues do not affect the components and their proportions in the calcification process. However, it can be inferred that the physical environment due to the histological disparities in the surrounding tissues affects the ultrastructures of calcium deposits.
Calcium ; Human Body ; Periosteum ; Rhinoplasty ; Silicone Elastomers ; Surgery, Plastic

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A Clinical Experience of Frontal Periosteal Osteoma: 20 Cases.

Jae Hak JUNG ; Young Hwan KIM ; Hook SUN ; So Min HWANG ; Chul Sun KANG

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):319-323.

Osteoma is benign tumor composed of mature compact or cancellous bone. Generally it is classified as periosteal(or peripheral) osteoma and endosteal(or central) osteoma by its origin. Clinically, periosteal osteoma on forehead is usually asymptomatic. From March 2002 to February 2005, We experienced 20 patients(23 cases) of histologically confirmed frontal osteoma. 20 patients are classified as sex, age, the number of osteoma, size, location and shape. Out of 20 patients, 16 were female and 4 were male in sex and mean age was 46. 18 patients have only one lesion but one patient has two lesions and another patient has three lesions. The size of osteoma varied from 7 x 5 x 3 mm to 16 x 14 x 6 mm and mean size is 12 x 10 x 5 mm. All osteomas were located at midline of forehead and shape of attachment was all sessile type. Surgical excision was superficial ostectomy through direct cutaneous incision or endoscopic approach. we obtained satisfactory result without specific complication.
Female ; Forehead ; Humans ; Male ; Osteoma*

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The Clinical Experiences of Congenital Preauricular Fistulectomy including Cartilage Excision.

Jang Woo PARK ; Mi Sun KIM ; Ho Kil KIM ; Hwan Jun CHOI ; Young Mann LEE

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):313-318.

The preauricular fistula is a congenital malformation of the ear with a small opening in the preauricular area. In general, this malformation should be treated by excision after its infection is brought under control with antibiotics. For cosmetic consideration, we performed a elliptic incision around opening, and then we dissected along the fistula tract to the cyst without sacrificing too much soft tissues. From March 2001 to March 2005, 90 patients with 102 cases of fistulas were excised including a small portion of auricular perichondrium and cartilage, where they adhered closely. Then, histologic findings of preauricular fistula were studied. The histologic findings reveal that the fistular tract is very close to auricular cartilage, and the thickness of fistular epithelium and perichondrium are about the same. There was no specific complications related to this procedure. The recurrence rate for the excision with cartilage was 2 out of 102(2%). Results of surgery in all cases were satisfactory. It is important, in preauricular fistular excision, perichondrium and auricular cartilage should be excised to prevent recurrence.
Anti-Bacterial Agents ; Cartilage* ; Ear ; Ear Cartilage ; Epithelium ; Fistula ; Humans ; Recurrence

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Speech Improvement of the Patients Performed Primary Palatal Repair over 4 Years Old.

Cheol Uk KANG ; Yong Chan BAE ; Su Bong NAM ; Young Seok KANG ; Soon Bok KWON

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):308-312.

Time to time, we face patients who missed the proper time for primary palatal repair. Although we do not have enough available documents, it is important to establish efficacy of palatal repair in patients more than 4 years old. From May 1995 to March 2005, we selected 14 patients who underwent palatal repair in more than 4 years old patients and they are able to tolerate speech articulation tests. Out of 14 patients 5 males an 9 females in sex, aged form 4 to 50 years old. 6 patients with incomplete cleft palate and 8 patients with submucous cleft palate. Double reversing Z-plasty(n=5), pushback palatoplasty(n=4), two flap palatoplasty(n=2), von Langenbeck palatoplasty(n=2), and intravelar veloplasty(n=1) were performed. Preoperative and postoperative speech articulation test, "Simple method of speech evaluation in Korean patients with cleft palate", were conducted. Satisfaction rate was sorted into 5 levels. There is no significant statistical correlation in the speech improvement, satisfaction rate, patients sex, cleft type and operative method. But there is significant statistical correlation between the speech improvement and patienet's age. There were better result in younger patient group than aged patients group.
Child, Preschool* ; Cleft Palate ; Female ; Humans ; Male ; Middle Aged ; Speech Articulation Tests

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Experiences of Abdominoplasty without Undermining.

Hyung Bo SIM ; Sang Yub YOON

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):303-307.

No one technique provides an optimal outcome for all body contouring patients. There are many surgical options for abdominoplasty. Among these, this abdominoplasty without undermining consists of liposuction around abdominal subcutaneous fatty tissue, excision of lower abdominal flap. The procedure allows aggressive thinning and sculpting of abdominal flap. This operation minimizes the dead space, which often leads to postoperative complications, and preserves neurovascular supply to the abdominal skin. From 1999 to 2004, 18 patients underwent the abdominoplasty without undermining, resulting in high satisfaction rates with no significant complications, such as, pulmonary embolism and deep vein thrombosis. Patients could return to normal activity within a week. This abdominoplasty without undermining is an effective and safe alternative with low complication rate and enhances aesthetic results compared to traditional abdominal surgery.
Abdomen ; Abdominoplasty* ; Adipose Tissue ; Humans ; Lipectomy ; Postoperative Complications ; Pulmonary Embolism ; Skin ; Venous Thrombosis

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Simplified Insetting Strategy in Pedicled TRAM Flap Breast Reconstruction.

Taik Jong LEE ; Sang Yub YOON

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):298-302.

Various method of insetting the transverse rectus abdominis myocutaneous flap for breast reconstruction has been reported in literature. The Bostwick's principle is commonly applied, which utilizes contralateral pedicle in a vertical or oblique flap inset position and ipsilateral pedicle in the transverse position. But it is relatively a complex and difficult technique, thus requires a more simplified strategy. We have formulated a new insetting method, in which the contralateral pedicled TRAM flap with an oblique(0 degree - 90 degrees) flap inset was carried out. We used this method in 100 cases from July 2001 to June 2003. This maneuver places Hartrampf's zones I and III with good vascularity in the medial side, and zone II in lateral side of breast. Fat necrosis was observed in 14 patients(14%) and of these, only three cases needed surgical excision. This simplified method is easy to learn. Specifically, fat necrosis removal is easy with more tolerable aesthetic results, especially in Asian patients with smaller breasts.
Asian Continental Ancestry Group ; Breast* ; Fat Necrosis ; Female ; Humans ; Mammaplasty* ; Myocutaneous Flap ; Rectus Abdominis

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The Effects of Breast Reconstruction Using Latissimus Dorsi Myocutaneous Pedicled Flap for Lymphedema.

Jung Min PARK ; Jung HEO ; Jae Sung HA ; Keun Cheol LEE ; Seok Kwun KIM ; Se Heon JO ; Kyung Woo LEE

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):294-287.

Lymphedema is one of the most common complications of mastectomy. It decreases quality of life and causes functional or aesthetical problems in post-mastectomy patients. Axillary lymph needs dissection (ALND), and radiation therapy(RTx) is known as the representative factor of lymphedema. Authors discovered that breast reconstructions using latissimus dorsi(LD) myocutaneous flap decrease the incidence of lymphedema in spite of these risk factors. Therefore we compared the incidence of lymphedema between the patients who underwent breast reconstructoins by LD pedicled flap, and the patients who did not undergo breast reconstructions from January 2002 to December 2004. Lymphedema was diagnosed when difference of arm circumference was over 2cm or limitation of joint movement was greater than 20 degrees. Overall incidence of lymphedema was 14.0%, and it was 18.9% in case of ALND, and 21.1% in case of RTx, respectively. But the incidence of breast-reconstructed patients using LD pedicled flap was 3.3%. This result reveals that LD pedicled flap decreases incidence of lymphedema significantly. In the future, it is recommended to identify the causes of decrease in the incidence of lymphedema in case of breast reconstructed by LD myocutaneous pedicled flap, for example lymphoscintigraphy and so on.
Arm ; Breast* ; Female ; Humans ; Incidence ; Joints ; Lymphedema* ; Lymphoscintigraphy ; Mammaplasty* ; Mastectomy ; Myocutaneous Flap ; Quality of Life ; Risk Factors ; Superficial Back Muscles* ; Surgical Flaps*

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The Safety of Microsurgical Head and Neck Reconstruction in the Elderly Patients.

Bong Kyoon CHOI ; Young Seok KIM ; Won Jai LEE ; Dae Hyun LEW ; Kwan Chul TARK

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):289-293.

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

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Reconstruction of Midfacial Defect Using Various Free Flap.

Jae Hyun CHO ; Won Jai LEE ; Dae Hyun LEW ; Dong Kun RAH ; Kwan Chul TARK

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):283-288.

Various vascularized free flaps have been used for midfacial reconstruction after ablative head and neck cancer surgery. The most common donor sites for free flap include latissimus dorsi, rectus abdominis, and radial forearm. Between 1994 and 2004, 14 patients underwent free flap operation after head and neck cancer ablation, and were reviewed retrospectively. Among 14 free flaps, 8 were latissimus dorsi myocutaneous flaps, 3 rectus abdominis myocutaneous flaps and 3 radial forearm flaps, respectively. The overall survival rate of the flap was 100%. Complications were wound dehiscence(5 cases) and ptosis(1 case). We designed multiple dimensionally folded free flap for midfacial reconstruction. For 3-dimensional flap needs, we used latissimus dorsi myocutaneous flap. 2-Dimensional flap was latissimus dorsi or rectus abdominis myocutaneous flap and 1-dimensional flap was radial forearm flap. In this study we produced an algorithm for midfacial reconstruction. Large volume with many skin paddle defects were best reconstructed with latissimus dorsi myocutaneous flap or rectus abdominis myocutaneous flap. Radial forearm flap was used for reconstruction of small volume and little skin paddle defects.
Forearm ; Free Tissue Flaps* ; Head and Neck Neoplasms ; Humans ; Myocutaneous Flap ; Rectus Abdominis ; Retrospective Studies ; Skin ; Superficial Back Muscles ; Survival Rate ; Tissue Donors ; Wounds and Injuries

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Anterolateral Thigh Flap: Our Experiences in Head and Neck Reconstruction.

Byeng June JEON ; So Young LIM ; Won Sok HYON ; Sa Ik BANG ; Kap Sung OH ; Goo Hyun MUN

Journal of the Korean Society of Plastic and Reconstructive Surgeons.2006;33(3):276-282.

The anterolateral thigh(ALT) flap has been known as a very versatile and reliable flap. We report our experiences with the anterolateral thigh flap for the postoncologic reconstruction of head and neck region from April 2002 to March 2005. A total of 38 subjects (M: F=30:8, mean age:53.8 years) were taken. We reviewed primary site of tumors, size and thickness of flaps, location and number of perforators, course of perforators, length of pedicle, and postoperative complications. The mean flap size, thickness and pedicle length were 11.8 x 6.4 cm, 1.1 cm and 12.2 cm, respectively. We classified the pedicles based on the authors' criteria. Type I, pedicle with short intramuscular course, was with 29 cases(72.5%), type II, pedicle with long intramuscular course, with 6 cases(15%), type III, pedicle with septocutaneous course, with 3 cases(7.5%), and type IV, clinically unavailable pedicle, with 2 cases (5%). We experienced 1 case of partial and 1 case of total flap loss. There was 1 case of donor site wound dehiscence, which was treated by debridement and closure. According to the defect, efficient adjustment of the size and thickness of flap was possible, and favorable functional and aesthetic results have been obtained in our study. Our experience confirmed the versatility and usefulness of the anterolateral thigh flap for various reconstructions in head and neck region.
Debridement ; Head* ; Humans ; Neck* ; Postoperative Complications ; Reconstructive Surgical Procedures ; Surgical Flaps ; Thigh* ; Tissue Donors ; Wounds and Injuries

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