The world's first face transplantation was performed in France, in 2005. Since then, 21 cases of face transplantation have been performed. Face transplantation is one of the most prominent part of composite tissue allotransplantation (CTA) along with hand transplantation. Since these fields are not deal with life-saving organs, there are many arguments about immunosuppression therapy. Recent paradigm of face transplantation shows that surgical ranges are expanded from partial face transplantation to full face transplantation. Most immunosuppression protocols are triple therapy, which consists of tacrolimus (FK-506), mycophenolate mofetil and prednisolone. Anatomical researches, immunosuppression, and immunotolerance take great parts in the researches of CTA. The medical fields directly related to face transplantation are microsurgery, immunology, and transplantation. Nowadays, each field is performed widely. Therefore people, even medical teams think face transplantation could be easily realized, sooner or later. But there are lots of things that should be prepared for not only practice and immunosuppression therapy but also for the cooperation with relevant fields. That's the reason why only 21 cases of face transplantation have been done, while more than 70 cases of hand transplantation have been done in the past years. Especially in Korea, brain death patients are not enough even for organ transplantation and furthermore there are some troubles in taking part in the society of transplantation. Face transplantation has lots of problems concerning variable medical fields, administration, society, ethics, and laws. Therefore, for the realization of face transplantation in Korea, not only medical skills but also political powers are needed.
Brain Death ; Facial Transplantation ; France ; Hand ; Humans ; Immune Tolerance ; Immunosuppression ; Jurisprudence ; Korea ; Microsurgery ; Mycophenolic Acid ; Organ Transplantation ; Prednisolone ; Tacrolimus ; Transplants

PURPOSE: The purpose of this study is to evaluate the remodeling process of the various skin substitutes in 4th and 6th weeks following the transplantation when transplanted onto nude mice. METHODS: Three types of artificial skin substitutes, such as PLGA scaffold with keratinocyte sheets(group 1), acellular human dermis(Surederm(TM)) and keratinocyte sheet(group 2), bioengineered skin(Neoderm(TM))(group 3), were applied to the wound on nude mice. All mice were killed in 2, 4 weeks and/or 6 weeks after grafting and tissue samples were harvested from the back of mice. The changes in wound size, degree of angiogenesis, formation of basement membrane and epidermis, density of collagen fibers and neural restoration were examined. RESULTS: There was no significant changes in wound size among the three groups. However, the size of wound decreased in the non-substituted group due to contracture. Degree of angiogenesis and systhesis of collagen or neurofilaments were mostly increased in bioengineered skin(Neoderm(TM))(group 3), followed by acellular human dermis(Surederm(TM)) and keratinocyte sheet(group 2), PLGA scaffold with keratinocyte sheets (group 1). However, group 3 and group 2 showed similar thickness of basement membrane and epidermis. CONCLUSION: We found that degree of angiogenesis, formation of basement membrane and skin appendages, density of collagen fibers and neurofilaments can be the categories to evaluate the success of artificial skin substitution in early stages.
Animals ; Basement Membrane ; Collagen ; Contracture ; Epidermis ; Humans ; Keratinocytes ; Lactic Acid ; Mice ; Mice, Nude ; Polyglycolic Acid ; Skin ; Skin, Artificial ; Transplants

PURPOSE: Rigid external distraction(RED) is a highly effective technique for correction of maxillary hypoplasia in patients with cleft or syndromic craniosynostosis. Despite many advantages of RED, it also has the problem of relapse as the conventional advancement surgery. Bicoronal approach, that is the common approach to gain access to the craniofacial skeleton, had some morbidity, such as hair loss, sensory loss, wide scar and temporal hollowing. We present our clinical experience of RED distraction with minimal invasive approach and early rigid fixation to overcome these disadvantages. METHODS: A 27-year-old female patient with Crouzon's disease underwent Le Fort III osteotomy and RED device application through the minimal invasive direct skin incisions. After the latent period of 5 days, distraction was undertaken until proper convexity and advancement were obtained. During the rigid retention period, inflammation occurred on the right cheek, and proper conservative managements were done including continuous irrigation. To maintain the stability of distraction, early rigid fixation was undertaken on the osteotomy sites through another skin incisions. Preoperative and postoperative orthodontic treatments were performed. Serial photographs and cephalometric radiographs were obtained preoperatively, after distraction and 6 months after distraction. RESULTS: The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla and improvement of facial convexity. After 6-month follow-up period, the maxilla was stable in the sagittal plane and no relapse was found. Facial scars were not noticeable and other deformity and morbidity did not occur. CONCLUSION: This effective and stable technique will be a good alternative for the patients who need large amount of distraction and for adult patients with severe maxillary hypoplasia or syndromic craniosynostosis.
Adult ; Cheek ; Cicatrix ; Congenital Abnormalities ; Craniofacial Dysostosis* ; Craniosynostoses ; Female ; Follow-Up Studies ; Hair ; Humans ; Inflammation ; Maxilla ; Osteogenesis, Distraction* ; Osteotomy* ; Recurrence ; Skeleton ; Skin

PURPOSE: Rigid external distraction(RED) is a highly effective technique for correction of maxillary hypoplasia in patients with cleft or syndromic craniosynostosis. Despite many advantages of RED, it also has the problem of relapse as the conventional advancement surgery. Bicoronal approach, that is the common approach to gain access to the craniofacial skeleton, had some morbidity, such as hair loss, sensory loss, wide scar and temporal hollowing. We present our clinical experience of RED distraction with minimal invasive approach and early rigid fixation to overcome these disadvantages. METHODS: A 27-year-old female patient with Crouzon's disease underwent Le Fort III osteotomy and RED device application through the minimal invasive direct skin incisions. After the latent period of 5 days, distraction was undertaken until proper convexity and advancement were obtained. During the rigid retention period, inflammation occurred on the right cheek, and proper conservative managements were done including continuous irrigation. To maintain the stability of distraction, early rigid fixation was undertaken on the osteotomy sites through another skin incisions. Preoperative and postoperative orthodontic treatments were performed. Serial photographs and cephalometric radiographs were obtained preoperatively, after distraction and 6 months after distraction. RESULTS: The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla and improvement of facial convexity. After 6-month follow-up period, the maxilla was stable in the sagittal plane and no relapse was found. Facial scars were not noticeable and other deformity and morbidity did not occur. CONCLUSION: This effective and stable technique will be a good alternative for the patients who need large amount of distraction and for adult patients with severe maxillary hypoplasia or syndromic craniosynostosis.
Adult ; Cheek ; Cicatrix ; Congenital Abnormalities ; Craniofacial Dysostosis* ; Craniosynostoses ; Female ; Follow-Up Studies ; Hair ; Humans ; Inflammation ; Maxilla ; Osteogenesis, Distraction* ; Osteotomy* ; Recurrence ; Skeleton ; Skin

Patency of the radial artery plays an important role in the survival of radial forearm fasciocutaneous free flap and artery conduit of coronary artery bypass graft procedure. Even though Allens' test has been used for evaluating the patency of radial artery, the studies on the correlations between risk factors for atherosclerosis and histopathologic findings of radial arteries are rare, until now. Therefore, the authors investigated the correlations between these two factors, and tried to estimate the feasibility of the radial artery in high-risk groups for artherosclerosis. The risk factors for atherosclerosis and lipid profiles were investigated in 38 patients by history taking, physical examinations and blood analysis. And 38 cases of segments of vessel were harvested during the elevation of the flap. The degrees of vessel medial sclerosis were estimated by R values(by Kobayashi and colleagues) that is the median value between the thickness of the intima and that of the media. The measured mean R value was 0.210+/-0.05. Thirty one cases belonged to Grade I(R<0.25), 7 cases belong to Grade II(0.25 Age Factors ; Arteries ; Atherosclerosis* ; Coronary Artery Bypass ; Forearm ; Free Tissue Flaps ; Humans ; Physical Examination ; Radial Artery* ; Risk Factors* ; Sclerosis ; Transplants

Cell migration is essential for many important biological events, including embryonic development, wound healing, inflammatory response, and tumor metastasis. As a result of endothelial cell migration, angiogenesis is very important factor in embryogenesis, wound healing, tumor development and flap survival. Angiogenesis is dependent on endothelial cell proliferation, migration and motility is one of the most essential for many important biological events. The speed of cell migration is regulated by extension, attachment, detachment of cell membrane and adhesiveness of cell to extracellular matrix. Growth factors such as FGF, TGF, VEGF is well known to play a major roles in the migration of endothealial cells. This study was designed to compare the motilities of human dermal microvascular endothelial cell(HDMEC) in growth factors such as bFGF, TGF-beta1 and VEGF. The motility of cultured HDMEC was compared using a video-microscopy system that was developed in combination with a self-designed CO2 mini- incubator. To determine migration speed, cells were viewed with a 4 phase-contrast lens and video recored. Images were captured using a color CCD camera and saved in 8-bit full-color mode. Experimental groups were divided into four groups: group I(with a Control, HDMEC only), group II(HDMEC with bFGF), group III (HDMEC with TGF-beta1), group IV(HDMEC with VEGF). At the concentration of 1ng/ml(bFGF), 1ng/ml(TGF-beta1), and 10ng/ml(VEGF) as the most effective dose for cell migration through preliminary study, the speed of migration are 8.736+/-0.948micrometer/hr, 9.869+/-1.904micrometer/ hr, 10.293+/-1.612micrometer/hr, respectively. These data shows that groups with growth factor accelerate the HDMEC migration than a control group, and the VEGF is most effective growth factor in the HDMEC migration than bFGF and TGF-beta1.
Adhesiveness ; Cell Membrane ; Cell Movement ; Embryonic Development ; Endothelial Cells* ; Extracellular Matrix ; Female ; Humans* ; Incubators ; Intercellular Signaling Peptides and Proteins* ; Neoplasm Metastasis ; Pregnancy ; Transforming Growth Factor beta1 ; Vascular Endothelial Growth Factor A ; Wound Healing

The computer imaging process is becoming a popular procedure in the research of the craniofacial skeleton. In acquisition of the digital data of computer tomography (CT), the position of the head is likely to vary each time. The difference in head position results in different orientations on actual images, which in turn may result in misinterpretation of the image. The purpose of this study is to point out the importance of position alignment between CT databases before pursuing research by comparing the images of different position alignment To show the significance of the alignment of CT scan, eleven target points were selected from CT scan and the coordinates were obtained from the different position of the aligned CT scan by the nasion, basion, and bilateral external auditory meatus. The target points were divided into three groups-the central points, the lateral points, and the mid points groups, depending on their positional configuration from the mid- sagittal plane. The alignment of CT scan was processed by volume rendering method and the coordinates of target points were taken from the three dimensional images with different position. The aligned CT images rotated by 10 degrees with respect to the X-axis, the (X- and Y-axes), and the (X-, Y-, and Z axes), respectively. Eleven target points were measured from these rotated images one per day, for 10 days, by a plastic surgeon. The mean coordinates from the 10 trials were defined as the gold standard values for the other 10 times measurement. The measurement error(ME) of the central points group was lower than that of the mid points group, and the ME of the mid points group was lower than that of the lateral points group. The ME increased as the distance from the center to target point increased. However the ME of aligned CT images was the lowest of all the rotated cases. For the mean ME of the 11 points, aligned image, the X-axis(X- and Y-axes), and (X-, Y-, and Z-axes) rotation were 0.97, 1.53, 1.62 and 1.77 mm, respectively. Among three rotated cases, ME of the(X-, Y-, and Z-axes) rotation had the highest one. Above results mean that the chance of incorrectly localizing the target points could be significantly reduced if the skull CT images were aligned, in the research of the measurement of craniofacial skeleton from CT scan.
Head ; Skeleton ; Skull ; Tomography, X-Ray Computed

Three unilateral craniosynostosis (plagiocephaly) patients who had undergone the cranial vault surgery in 4,9,18 months after birth were evaluated. The CT scans were obtained with high resolution. The CT scan data were reconstructed three dimensionally via Analyze AVW software, and visualized as volume rendering mode. The reconstructed volume data was realigned using 4 anatomical landmarks, nasion, basion, left and right external auditory meatus. After all data sets were realigned with same orientation, the target axial slice was obtained. The target slices are determined that is passing the center of the sellar trucica. The anterior, posterior and lateral distances were measured and the midsagittal angles were measured on the selected target slices. The pre- and post-operative data of measurement were compared. As results, the growth of affected side was seemed to be more rapid than that of normal side in patients who had undergone surgery at the time of 4 and 9 months old. Midsagittal angle was also increased up to about 180 degrees. However it was not definite in the 18month old patient. These results can be an evidence of the compensatory growth of the synostotic cranial base of synostosed side as same as other previous reports, however, much more cases should be examined to make the results to be more objective.
Craniosynostoses* ; Dataset ; Humans ; Infant ; Parturition ; Skull Base* ; Tomography, X-Ray Computed*

Patients with secondary cleft lip nose deformity usually complain not only aesthetic problems but also functional problems such as nasal obstruction. However, there have been few studies on nasal airway problem in secondary cleft lip nose deformity patients and no reports for the correlation between degree of the deformity and nasal airway obstruction. The authors selected 34 patients with secondary cleft lip nose deformity and measured the degree of morphological deformity by photo analysis and the degree of nasal airway obstruction by VAS score and acoustic rhinometry. Almost all patients complained of more obstructive symptom on the affected side. Functional anatomic structure and volume of the nasal airway examined by acoustic rhinometry showed that narrowest point was located above the nostril and pathological obstruction was more significant in patient group in both side and the area of the narrowest point and the total nasal volume was smaller in patient group. The result that alar contour difference has correlation with total nasal volume but not with objective symptom shows that there may be other factors affecting the nasal obstruction. Therefore the authors conclude that not only the correction of the external morphologic deformity but also the consideration of nasal airway obstruction is essential when performing operation on the secondary cleft lip nose deformity patients.
Acoustics* ; Airway Obstruction* ; Cleft Lip* ; Congenital Abnormalities* ; Humans ; Nasal Obstruction ; Nose* ; Rhinometry, Acoustic

PURPOSE: To evaluate the usefulness of ultrasound guided confirm this change; the symbol has been corrupted in my version placement of tunneled hemodialysis catheters via internal jugular vein (IJV). METHOD: The outcomes of 52 hemodialysis catheters placed from January 2000 through December 2002 were retrospectively analyzed. Of 50 patients, 2 received two catheters. Initially, the patency of the IJV was evaluated with ultrasonography, after which the IJV puncturehe was performed under the guidance of ultrasonography. Under fluoroscopy, a 12.5 F double lumen hemodialysis catheter was placed at the caval atrial junction through a subcutaneous tunnel in the neck. To prevent initial failure we performed a flow test using a 50 cc syringe through the catheters in 47 patients. RESULT: Catheter placements were successful in all patients. Early complication was poorly functioning catheters immediately after placement (initial failure) in two cases (4%). However, no patients developed initial failure after we performed flow test using the 50 cc syringe through the catheters. There were no instances of pneumothorax or hemothorax. Nevertheless, late complications included injured catheters in two cases (4%), bacteremia in five (9.5%), and tunnel infection in 2 (4%). Mean duration of catheter use before removal was 86 days (3~55 days). The blood flow rate at first hemodialysis after catheter placement was 230+/-35.5 ml/min and after 1 month was 248+/-18.6 ml/min. Catheters were removed because of matured arteriovenous fistula in 36 cases (69%), bacteremia in five (9.5%), patient death in 7 (13.5%), injured catheters in two (4%) and tunnel infection in 2 (4%). Symptomatic central venous stenosis was not developed during the study period. CONCLUSION: Ultrasound guided placement of tunneled hemodialysis catheters via IJV is a safe method, and is useful for patients requiring long-term hemodialysis.
Arteriovenous Fistula ; Bacteremia ; Catheters* ; Constriction, Pathologic ; Fluoroscopy ; Hemothorax ; Humans ; Jugular Veins ; Neck ; Pneumothorax ; Renal Dialysis* ; Retrospective Studies ; Syringes ; Ultrasonography*