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Application of Local Axial Flaps to Scalp Reconstruction.

Yolanda ZAYAKOVA ; Anton STANEV ; Hristo MIHAILOV ; Nicolai PASHALIEV

Archives of Plastic Surgery.2013;40(5):564-569. doi:10.5999/aps.2013.40.5.564

BACKGROUND: Scalp defects may be caused by various etiological factors, and they represent a significant surgical and aesthetic concern. Various surgical techniques can be applied for reconstructive work such as primary closure, skin grafting, pedicled or free flaps. In this article, the authors share their clinical experience with scalp operations using the technique of local flaps and discuss the application of this method from the perspective of not only the size of the defect, but also in relation to the anatomical area, quality of surrounding tissue, and patient's condition. METHODS: During the period from December 2007 to December 2012, 13 patients with various scalp defects, aged 11 to 86 years, underwent reconstruction with local pedicle flaps. The indications were based on the patients' condition (age, sex, quality of surrounding tissue, and comorbidities) and wound parameters. Depending on the size of the defects, they were classified into three groups as follows: large, 20 to 50 cm2; very large, 50 to 100 cm2; extremely large, 100 cm2. The location was defined as peripheral (frontal, temporal, occipital), central, or combined (more than one area). We performed reconstruction with 11 single transposition flaps and 1 bipedicle with a skin graft on the donor area, and 2 advancement flaps in 1 patient. RESULTS: In all of the patients, complete tissue coverage was achieved. The recovery was relatively quick, without hematoma, seroma, or infections. The flaps survived entirely. CONCLUSIONS: Local flaps are widely used in scalp reconstruction since they provide healthy, stable, hair-bearing tissue and require a short healing time for the patients.
Aged ; Burns ; Carcinoma, Basal Cell ; Free Tissue Flaps ; Hematoma ; Humans ; Reconstructive Surgical Procedures ; Scalp ; Seroma ; Skin ; Skin Transplantation ; Surgical Flaps ; Tissue Donors ; Transplants

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The Effect of Breast Hypertrophy on Patient Posture.

Oren LAPID ; E Joline DE GROOF ; Leonard U M C CORION ; Mark J C SMEULDERS ; Chantal M A M VAN DER HORST

Archives of Plastic Surgery.2013;40(5):559-563. doi:10.5999/aps.2013.40.5.559

BACKGROUND: One of the reasons women with macromastia chose to undergo a breast reduction is to relieve their complaints of back, neck, and shoulder pain. We hypothesized that changes in posture after surgery may be the reason for the pain relief and that patient posture may correlate with symptomatic macromastia and may serve as an objective measure for complaints. The purpose of our study was to evaluate the effect of reduction mammaplasty on the posture of women with macromastia. METHODS: A prospective controlled study at a university medical center. Forty-two patients that underwent breast reduction were studied before surgery and an average of 4.3 years following surgery. Thirty-seven healthy women served as controls. Standardized lateral photos were taken. The inclination angle of the back was measured. Regression analysis was performed for the inclination angle. RESULTS: Preoperatively, the mean inclination angle was 1.61 degrees ventrally; this diminished postoperatively to 0.72 degrees ventrally. This change was not significant (P-value=0.104). In the control group that angle was 0.28 degrees dorsally. Univariate regression analysis revealed that the inclination was dependent on body mass index (BMI) and having symptomatic macromastia; on multiple regression it was only dependent on BMI. CONCLUSIONS: The inclination angle of the back in breast reduction candidates is significantly different from that of controls; however, this difference is small and probably does not account for the symptoms associated with macromastia. Back inclination should not be used as a surrogate "objective" measure for symptomatic macromastia.
Academic Medical Centers ; Back Pain ; Body Mass Index ; Breast ; Female ; Humans ; Hypertrophy ; Kyphosis ; Mammaplasty ; Neck ; Posture ; Prospective Studies ; Shoulder Pain

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One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy.

Hye Ri KIM ; Jin Soo LIM ; Sue Min KIM ; Sung No JUNG ; Gyeol YOO ; Eun Young RHA

Archives of Plastic Surgery.2013;40(5):553-558. doi:10.5999/aps.2013.40.5.553

BACKGROUND: Skin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM) has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM. METHODS: Among the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview. RESULTS: During the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur. CONCLUSIONS: Since one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.
Bandages ; Breast ; Breast Neoplasms ; Cosmetics ; Depression ; Fat Necrosis ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Mammaplasty ; Mastectomy ; Necrosis ; Nipples ; Recurrence ; Self-Assessment ; Seroma ; Skin ; Telephone

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Clinical Follow-up on Sagittal Fracture at the Temporal Root of the Zygomatic Arch: Does It Need Open Reduction?.

Ji Seon CHEON ; Bin Na SEO ; Jeong Yeol YANG ; Kyung Min SON

Archives of Plastic Surgery.2013;40(5):546-552. doi:10.5999/aps.2013.40.5.546

BACKGROUND: The zygoma is a major portion of the midfacial contour. When deformity occurs in this area, a reduction should be conducted to correct it. If a sagittal fracture at the temporal root of the zygomatic arch occurs, this also requires reduction, but it is difficult to approach due to its anatomical location, and the possibility of fixation is also limited. Thus, the authors attempted the reduction of sagittal fracture by two- or three-point fixation and the Gillies approach without direct manipulation. The preoperative and postoperative results of the patients were evaluated. Follow-up was performed to establish a treatment guideline. METHODS: A retrospective study was done with 40 patients who had sagittal fractures at the temporal root of the zygomatic arch from March 2009 to June 2012. Only two- or three-point fixation was performed for the accompanying zygomatic-orbital-maxillary fracture. The Gillies approach was used for complex fractures of the zygomatic arch, while the temporal root of the zygomatic arch was only observed without reduction. Preoperative and postoperative computed tomography and X-ray scans were performed to examine the results. RESULTS: The result of the paired t-test on preoperative and postoperative bone gap differences, the depression level, and the degree of temporal protrusion showed a marked decrease in the mean difference at a 95% confidence interval. The results were acceptable. CONCLUSIONS: In the treatment of sagittal fractures at the temporal root of the zygomatic arch, it is acceptable to use indirect reduction and non-fixation methods. This leads to a satisfactory aesthetic and functional outcome.
Congenital Abnormalities ; Depression ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Retrospective Studies ; Zygoma ; Zygomatic Fractures

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Nostril Base Augmentation Effect of Alveolar Bone Graft.

Woojin LEE ; Hyung Joon PARK ; Hyun Gon CHOI ; Dong Hyeok SHIN ; Ki Il UHM

Archives of Plastic Surgery.2013;40(5):542-545. doi:10.5999/aps.2013.40.5.542

BACKGROUND: The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft. METHODS: Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT. RESULTS: Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001). CONCLUSIONS: An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.
Alveolar Process ; Alveoloplasty ; Bias (Epidemiology) ; Bone Transplantation ; Child ; Cleft Palate ; Depression ; Fistula ; Humans ; Lip ; Photogrammetry ; Tooth ; Transplants

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Nasal Carriage of 200 Patients with Nasal Bone Fracture in Korea.

Jun Wook LEE ; Young Joon KIM ; Hoon KIM ; Sang Hyun NAM ; Bo Moon SHIN ; Young Woong CHOI

Archives of Plastic Surgery.2013;40(5):536-541. doi:10.5999/aps.2013.40.5.536

BACKGROUND: Pathogens in the nasal cavity during nasal surgery could lead to a systemic infectious condition, such as bacteremia, nosocomial infection, or toxic shock syndrome. However, there is no research about the prevalence of nasal carriage in patients with nasal bone fracture. METHODS: This was a prospective, double-blind, randomized study about the rate of nasal carriage in 200 patients with nasal bone fracture in Korea. Nasal secretions were taken from both the middle nasal meatus and colonized. All analyses were carried out using SPSS software. RESULTS: Pathogens were identified in 178 of the 200 cases. Coagulase-negative staphylococci (CNS) were the most cultured bacteria in 127 (66.84%) of the 190 total patients after excluding 10 cases of contaminated samples, and methicillin-resistant coagulase-negative staphylococci (MRCNS) were found in 48 (25.26%). Staphylococcus aureus was the second most identified pathogen, found in 36 (18.95%), followed by 7 cases (3.68%) of methicillin-resistant Staphylococcus aureus (MRSA). The prevalence rate of MRSA in the females was higher than that in the males (RR=4.70; 95% CI, 1.09-20.18), but other demographic factors had no effect on the prevalence rate of MRSA and MRCNS. CONCLUSIONS: The prevalence rate of these pathogens in patients with nasal bone fracture in Korea was similar to other reports. However, few studies have addressed the prevalence rate of CNS and MRCNS in accordance with risk factors or the change in prevalence according to specific prophylaxis against infectious complications. Additional research is needed on the potential connections between clinical factors and microbiological data.
Bacteremia ; Bacteria ; Colon ; Cross Infection ; Demography ; Female ; Humans ; Korea ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Nasal Bone ; Nasal Cavity ; Nasal Surgical Procedures ; Prevalence ; Prospective Studies ; Risk Factors ; Shock, Septic ; Staphylococcus aureus

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Platelet-Rich Plasma: Quantitative Assessment of Growth Factor Levels and Comparative Analysis of Activated and Inactivated Groups.

Jeong Woo LEE ; O Hyun KWON ; Taek Kyun KIM ; Young Kyoo CHO ; Kang Young CHOI ; Ho Yun CHUNG ; Byung Chae CHO ; Jung Dug YANG ; Jun Ho SHIN

Archives of Plastic Surgery.2013;40(5):530-535. doi:10.5999/aps.2013.40.5.530

BACKGROUND: Platelet-rich plasma (PRP) has more concentrated platelets than normal plasma (approximately 150-400x10(3) cell/dL). Platelets excrete several growth factors and cytokines that are associated with the healing and regeneration process. However, even though PRP is widely used, the mechanism or actual effect is presently unclear. Therefore, this study was performed to investigate the levels of growth factors and platelet concentration rate. METHODS: Autologous blood for preparing PRP was obtained from healthy subjects aged 25 to 35 years. The samples were divided into 4 experimental groups (inactivated whole blood, inactivated PRP, activated whole blood with thrombin and calcium chloride, and activated PRP). The platelet counts in the blood were analyzed and the growth factors were quantitatively measured. A statistical analysis was performed by using Dunn's multiple comparison test. RESULTS: In the blood cell analysis, the platelet count of the PRP group was approximately 4.25 times higher than that of the whole blood group. In the quantitative analysis of growth factors, the platelet-derived growth factor (PDGF)-AB, PDGF-BB, and transforming growth factor-beta of the inactivated and activated PRP groups were higher than those of the inactivated and activated whole blood groups (P<0.05). CONCLUSIONS: In this study, the platelet count and the levels of PDGF-AB and PDGF-BB in the PRP were determined. Further, more research is required on the bioactivity level of the growth factors secreted during the process of PRP preparation and the potency of growth factors that can be exerted physiologically in vivo.
Aged ; Blood Cells ; Blood Group Antigens ; Blood Platelets ; Calcium Chloride ; Cytokines ; Humans ; Intercellular Signaling Peptides and Proteins ; Plasma ; Platelet Count ; Platelet-Derived Growth Factor ; Platelet-Rich Plasma ; Proto-Oncogene Proteins c-sis ; Regeneration ; Thrombin ; Transforming Growth Factors

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The Relationship between Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional Analysis of 15,289 Patients.

Lauren M MIOTON ; Sumanas W JORDAN ; Philip J HANWRIGHT ; Karl Y BILIMORIA ; John Y S KIM

Archives of Plastic Surgery.2013;40(5):522-529. doi:10.5999/aps.2013.40.5.522

BACKGROUND: Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery. METHODS: We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. RESULTS: A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. CONCLUSIONS: Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.
Demography ; Humans ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Surgery, Plastic ; Wound Infection

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Expression of Extracellular Superoxide Dismutase Protein in Diabetes.

Chul Han KIM

Archives of Plastic Surgery.2013;40(5):517-521. doi:10.5999/aps.2013.40.5.517

BACKGROUND: Diabetes is characterized by chronic hyperglycemia, which can increase reactive oxygen species (ROS) production by the mitochondrial electron transport chain. The formation of ROS induces oxidative stress and activates oxidative damage-inducing genes in cells. No research has been published on oxidative damage-related extracellular superoxide dismutase (EC-SOD) protein levels in human diabetic skin. We investigated the expression of EC-SOD in diabetic skin compared with normal skin tissue in vivo. METHODS: The expression of EC-SOD protein was evaluated by western blotting in 6 diabetic skin tissue samples and 6 normal skin samples. Immunohistochemical staining was also carried out to confirm the EC-SOD expression level in the 6 diabetic skin tissue samples. RESULTS: The western blotting showed significantly lower EC-SOD protein expression in the diabetic skin tissue than in the normal tissue. Immunohistochemical examination of EC-SOD protein expression supported the western blotting analysis. CONCLUSIONS: Diabetic skin tissues express a relatively small amount of EC-SOD protein and may not be protected against oxidative stress. We believe that EC-SOD is related to the altered metabolic state in diabetic skin, which elevates ROS production.
Blotting, Western ; Diabetes Mellitus ; Electron Transport ; Humans ; Hyperglycemia ; Oxidative Stress ; Reactive Oxygen Species ; Skin ; Superoxide Dismutase ; Superoxides

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Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience.

Eun Kyung WOO ; Jong Wook LEE ; Gi Yeun HUR ; Jang Hyu KOH ; Dong Kook SEO ; Jai Ku CHOI ; Young Chul JANG

Archives of Plastic Surgery.2013;40(5):510-516. doi:10.5999/aps.2013.40.5.510

BACKGROUND: This paper discusses the treatment protocol for patients with frostbite. METHODS: We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012. RESULTS: Our clinical series of patients (n=17) included 13 men and four women, whose mean age was 42.4+/-11.6 years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of 12.7+/-3.3 days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of 35+/-4.3 days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation. CONCLUSIONS: With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.
Clinical Protocols ; Cold Temperature ; Debridement ; Female ; Foot ; Frostbite ; Hand ; Humans ; Male ; Patient Education as Topic ; Retrospective Studies ; Skin Transplantation ; Surgical Procedures, Operative

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