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Heterotopic Ossification in Pressure Sore: A Case Report.

Yun Seok CHOI ; Gyeol YOO ; Sung Shin WEE

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(2):313-317.

There are many complications related to paralyzed patients. Heterotopic ossification in pressure sore patients is reported to be rarely developed, but once it occurs, it frequently causes joint stiffness which may aggrevate the pressure sore wound. This paper was based on a clinical study of heterotrophic ossification in 6 quadriplegic and paraplegic patients from 1988 to 1997 at St. Paul's Hospital. All were males aged between 22 and 58 years (mean age, 45.5 years). The sites of pressure sore were in the ischial and trochanteric areas. Heterotopic ossification had developed around the hip joint and the ischial area. The mean onset time was 3.6 years (minimum 10 months maximum 8 years) after trauma. Plain X-ray, bone scan CT and pathological examination were helpful in confirming the diagnosis of heterotopic ossification. The mechanism of heterotopic ossification is not exactly known, but chronic trauma or inflammation could be one etiology. There are still many difficulties in management of heterotopic ossification, but prevention is the most important treatment.
Diagnosis ; Femur ; Hip Joint ; Humans ; Inflammation ; Joints ; Male ; Ossification, Heterotopic* ; Pressure Ulcer* ; Wounds and Injuries

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An Experimental Study on the Functional Assessment of End-to-side Neurorrhaphy Using Walking Track Analysis in Rats.

Jee Hyeok CHUNG ; Kyung Won MINN

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(2):306-312.

The purpose of this study was to investigate the functional recovery of end-to-side neurorrhaphy in rats. There have been several studies about the results of end-to-side neurorrhaphy from a histologic or eletrophysiologic view point. However, histologic or electrophysiologic parameters may not correlate with the actual nerve function. In this study we assessed the results of end-to-side neurorrhaphy functionally using walking track analysis. Forty-eight male Sprague-Dawley rats were randomly divided into 4 group, with 12 rats in each group. Group 1 was the sham-operation group. Group 2 was the peroneal nerve transection group. In group 3, the peroneal nerve was severed and end-to-end neurorrhaphy was carried out. In group 4, the peroneal nerve was severed and coapted end-to-side to the lateral face of the tibial nerve after removal of the epineurium arid perineurium. Walking track analysis was done every 2 weeks up to 16 weeks. Group 3 recovered 80.4% in peroneal function at postoperative 16 weeks, whereas group 4 recovered only 46.0%. In group 2, it was impossible to measure the peroneal function by walking track analysis because of plantar flexion contracture after 6 weeks. We concluded that the end-to-side neurorrhaphy group showed better results compared with the nerve transection group. However, the end-to-end neurorrhaphy group showed still better results in the walking track analysis of rats.
Animals ; Contracture ; Humans ; Male ; Peripheral Nerves ; Peroneal Nerve ; Rats* ; Rats, Sprague-Dawley ; Tibial Nerve ; Walking*

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Two Case Reports of Bone-invading Basal Cell Carcinoma.

Kwang Choul LEE ; Dong Jin CHOI ; Ki Taek HAN ; Ik Soo CHANG ; Chong Kun LEE

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(2):300-305.

Basal cell carcinoma is the most common skin cancer, especially on the eyelid and nose. As it rarely invades to a underlying bone or metastasizes an distant site, and is usually found at an early stage, it is regarded as a curative disease. However, basal cell carcinoma on the eyelid and nose may be resected incompletely due to efforts to preserve important structures or as a result of esthetic considerations. We experienced two cases of basal cell carcinoma with local invasion to underlying bone. One was a recurred case on the nasal area extending to the nasal bone arts medial wall of the ethmoid sinus. The lesion was widely resected and covered with a radial forearm free flap. The other was on the eyelid extending to the orbit. It was treated with orbital exenteration and resection of the involved eyelid. The defect was reconstructed with the temporalis muscle flap with split-thickness skin graft. These patients were followed up for 7 months with no evidence of recurrence. Since basal cell carcinoma can invade to the bone and metastasize to a distance site, it should be resected radically in the regions of the eyelid and nose.
Carcinoma, Basal Cell* ; Ethmoid Sinus ; Eyelids ; Forearm ; Free Tissue Flaps ; Humans ; Nasal Bone ; Nose ; Orbit ; Recurrence ; Skin ; Skin Neoplasms ; Transplants

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Malignant Epithelial Edontogenic Ghost Cell Tumor in the Mandible and Tongue : A Case Report.

Minn Seok GIL ; Choong Jae LEE ; Se Il LEE

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(2):296-299.

Benign odontogenic neoplasms are rare, but malignant odontogenic neoplasms are extremely rare. The majority of malignant epithelial neoplasms occurring in the jaws are the result of metastasis from distant primary neoplasms of direct invasion from contiguous carcinoma of the oral mucosa, sinus mucosa, salivary gland or skin. A few remaining primary intraosseous carcinoma of the jaw are presumed to be of mostly odontogenic origin since epithelial remnants of odontogenesis are numerous in the maxilla arts mandible. Although calcifying odontogenic cyst(COC) is a well-established pathologic entity, it has been recognized that there is an odontogenic neoplasm with histologic features similar to the COC(malignant epithelial odontogenic host cell tumor; EOGCT) that has been diagnosed as COC. Some authors have reported previously in the literature describing malignant EOGCT. We experienced one case of malignant EOGCT with aggressive growth pattern and histologic features strongly implying its malignant potential. The lesion was excised by anterior mandibular resection, total 1 resection of the tongue and bilateral functional neck dissection. The tongue was reconstructed by using the infrahyoid muscle neurovascular island flap and neurovascular radial forearm free flap. The mandible was reconstructed by using the osteocutaneous fibular free flap.
Carcinoma ; Forearm ; Free Tissue Flaps ; Jaw ; Mandible* ; Maxilla ; Mouth Mucosa ; Mucous Membrane ; Neck Dissection ; Neoplasm Metastasis ; Odontogenesis ; Salivary Glands ; Skin ; Tongue*

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Leiomyosarcoma Arising in Marjolin's Ulcer: A Case Report.

Moo Seog KANG ; Sang Hyun WOO ; Jung Hyun SEUL ; Joon Hyuk CHOI

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(2):292-295.

Leiomyosarcoma is a malignant tumor showing smooth muscle differentiation, and it accounts for 2% to 8% of soft tissue sarcoma. Clinically, substantial mortality and morbidity are related to the propensity for distant metastasis and local recurrence, respectively. Microscopic findings characteristically reveal intersecting bundles of spindle-shaped cells having fibrillar cytoplasm and blunt-ended nuclei. Immunohistochemistry for intermediate filaments is helpful in establishing a definitive diagnosis. We experienced a case of large protruding leiomyosarcoma that developed on an old burn scar of the medial calf of a 45-year-old man. On preoperative evaluation, we recommended amputation due to a distant metastasis to the lung(stage IV). As the patient refused amputation of his lower leg, the tumor was radically excised and immediate reconstruction was done using free latissimus dorsi muscle flap and skin graft. Four months after excision despite adjuvant chemotherapy, amputation was performed due to local recurrence.
Amputation ; Burns ; Chemotherapy, Adjuvant ; Cicatrix ; Cytoplasm ; Diagnosis ; Humans ; Immunohistochemistry ; Intermediate Filaments ; Leg ; Leiomyosarcoma* ; Middle Aged ; Mortality ; Muscle, Smooth ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Skin ; Superficial Back Muscles ; Transplants ; Ulcer*

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Surgical Correction for Minimal Cleft Lip.

Yong Bae KIM ; Hyok Sue OH ; Young Mann LEE ; Soon Jae YANG

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(5):827-833.

Minimal cleft lip has been defined as a cleft which does not extend over the vermilion. Minimal cleft lip has no specific classification and few methods for its correction. Based on our operative experience with secondary cleft lipnose deformities, we have developed principles of operation for minimal cleft lip: minimal incision, nostril and alar reconstruction, philtrum reconstruction. alignment of cupid's bow, and vermilial notching correction. Nine patients of minimal cleft lip were operated on from March 1992 to June 1998 in our department. Each partients was evaluated for lip and nose deformities presurgically: the nasal tip, columella, ala, scar, cupid's bow, lip pout and lip length. Every patients required a different technique for repair. Satisfactory results were obtained by treating the cleft following the principles.
Cicatrix ; Classification ; Cleft Lip* ; Congenital Abnormalities ; Humans ; Lip ; Nose

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Endoscopec Assisted Ultrasonic Aspiration for Axillary osmidrosis.

Yun Gyu PARK ; Seum CHUNG ; Won Min YOO ; Beyoung Yun PARK

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(5):822-826.

Surgical excision of the subcutaneous tissues, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice for Treating axillary a osmidrosis for the several decades. However, long periods of postoperative immobilization of a shoulder joint, partial necrosis of skin flaps or hematoma and the possibility of unsightly scars are frequent complications. For the purpose of reducing these complications, we performed ultrasonic aspiration of subcutaneous fat of the axilla, including the apocrine gland, using ultrasonic liposuction technique under confirmation of endoscopy via one small skin incision. From November 1997 to December 1998, a total of 134 patients (93 women and 41 men) received surgery for bilateral axillary osmidrosis on an outpatient basis. Sixty patients were evaluated more than 6 months after surgery. Among these patients, 6patients complained of a persistent foul odor(10%). Five patients received secondary ultrasonic aspiration for persistent foul odor and were then cured. We concluded that our method has several advantages such as 1) preservation of skin flap vascularity for the prevention of flap necrosis and axillary hair, 2) minimal scarring and bleeding, 3) shorter operation time and postoperative immobilization of the shoulder joint, 4) increased patient comfort, and 5) a safer operative method for recurred cases as a secondary method.
Apocrine Glands ; Axilla ; Cicatrix ; Endoscopy ; Female ; Hair ; Hematoma ; Hemorrhage ; Humans ; Immobilization ; Lipectomy ; Necrosis ; Odors ; Outpatients ; Shoulder Joint ; Skin ; Subcutaneous Fat ; Subcutaneous Tissue ; Ultrasonics*

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A Study of Partial Excision and Suvdermal Exicision in Surgical Treatment of Axillary Osmidrosis.

Young Dae KWEON ; Jin Gyu LEE ; Hyeon Ho SEO ; Chang Sik KIM ; Ji Woon HA

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(5):816-821.

There are 3 basic methods for surgical treatment of axillary osmidrosis; 1) method that removes only subcutaneous cellular tissue without removing skin 2) method that removes skin and subcutaneous cellular tissue en bloc, and 3) method that partially removes skin and subcutaneous cellular en bloc as well as removing the subcutaneous cellular tissue of the adjacent region. We studied the results of partial removal of the skin and subcutaneous cellular tissue en bloc, as well as the removal of subcutaneous cellular tissue of the adjacent region to compare the results of the bipedicled flap with the graft conversion method. There was no difference between two methods in results and complication rates. There are 3 advantage to this procedure. First, about 70-80% of apocrine glands were centrally distributed among the axillary hairbearing region therefore, resection of the central portion of axillary hair distribution area is important for good result. Second, the preservation of the subdermal plexus with careful excision of adjacent underlying subcutaneous tissue under the aid of the magnifying surgical loupe, is important for good wound healing. Third, the central excision of the axillary hair distribution area provides good exploration for undermining and defatting of the undersurface of the adjacent area, therefore it tooks a shorter operation time.
Apocrine Glands ; Hair ; Skin ; Subcutaneous Tissue ; Transplants ; Wound Healing

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Treatment of OTA'sNeves and Acquired Bilateral Nevus of OTA-like Macule(abnom)with Q-switched Alexandrite Laser.

Byoung Joo YOUN ; In Pyo HONG ; Jong Hwan KIM ; Nam Ho KIM ; Young Ki SHIM

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(5):810-815.

The nevus of Ota is a benign dermal melanocytic lesion that most commonly occurs unilaterally in areas innervated by the first and second division of the trigeminal nerve. Acquired bilateral nevus of Ota-like macules(ABNOM) are located bilaterally on the forehead, temples, eyelids, cheeks, and/or nose. They usually occur in the fourth or fifth decade of life in women(rarely in men). In contrast to the nevus of Ota, ABNOM have not been observed in the mucous membranes of the oral cavity, nose, or eyes. Traditional treatments were palliative, risky electrocautery, or cryotherapy. These methods resulted in permanent pigmentary changes and/or scarring. Recently utilizing the principle of selective photothermolysis, the Q-switched Alexandrite laser has been reported to be successful in treating benign pigmentary lesions and tattoos. Our study evaluated the treatment of 127 patients with nevus of Ota and ABNOM with the Q-switched Alexandrite laser(755 nm, 100 nsec). Nevi were treated up to 7 times with 7-8 J/cm2 at a minimum of 6 weeks interval. Good therapeutic effects were gained (up to 50% improvement was seen in 89% of patients.) and our patients were very satisfied. No patients had permanent textural change or scarring. Treatment with on Alexandrite laser for nevus of Ota & ABNOM is considered to be a safe and effective method.
Cheek ; Cicatrix ; Cryotherapy ; Electrocoagulation ; Eyelids ; Forehead ; Humans ; Lasers, Solid-State* ; Mouth ; Mucous Membrane ; Nevus of Ota ; Nevus* ; Nose ; Trigeminal Nerve

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Rhinoplasty with Green-stick Osteotomy.

Won Min YOO ; Won Jai LEE ; Chang Woo RYU ; Beyong Yun PARK

Journal of the Korean Society of Plastic and Reconstructive Surgeons.1999;26(5):804-809.

Lateral osteotomy has been chosen as a part of rhinoplasty for modification of the nasal bony vault, alteration of the base width of the lateral walls, establishment of a new profile line of the nasal dorsum and lateral profile line, and closure of the open roof. Various methods of lateral osteotomy may be employed, however Orientals have characteristically broad and flat noses Compared to caucasians and for an esthetically satisfactory result, it is important to correct both in rhinoplasty. In this study, the authors performed their devised method of lateral osteotomy in 12 patients for the correction of broad, flat nasal dorsum and deviated noses. The operations could be broadly categorized into two groups: 1) short lateral osteotomy in which the lateral osteotomy line was incomplete and short, extending to the infraorbital rim; and 2) green-stick transverse osteotomy which was induced by in-siturotation fracture by osteotomy and, if considered necessary, augmentation rhinoplasty and nasal tip plasty were also performed simultaneously. Our nasal osteotomy has limited mobilization, where as the previous method has total mobilization, and it has the advantages of repositioning the broad and deviated nose in a preferable direction and shape, as well as the capability of narrowing the preferable area selectively. Especially if there is a necessity to correct both broad and flat noses such as in Orientals, our osteotomy methods have a synergistic effect in esthetic outcome when performed with augmentation rhinoplasty with a silastic implant. There were no complications such as relapse or air-way obstruction during the 4.5-month follow-up period. However, a long-term follow-up period is needed to evaluate the complications considering the physiologic aspect of the nose.
Follow-Up Studies ; Humans ; Nose ; Osteotomy* ; Recurrence ; Rhinoplasty*

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