PURPOSE: In treatment of facial bone fracture, occurred in children, we generally use wires, miniplate, absorbable plate or their combination. These foreign bodies can be palpable, and sometimes may cause infections, and need reoperation for removing. When bone fragments are multiple, small or thin, they are hard to handle and make accurate reduction of all fragments. In these cases, a biodegradable tissue adhesive, Histoacryl(R) (n-butyl-2-cyanoacrylate), can be used as fixation technique for small, multiple, and thin fracture fragments. METHODS: 3 years old and 6 years old children, who has comminuted fracture on frontal sinus, we used Histoacryl(R) for fixation of multiple bone fragments. After approaching by coronal incision, we pulled out all bone fragments and reconstructed bone fragments by Histoacryl(R) and fixed those on frontal sinus by absorbable plates. RESULTS: Photographs and 3-dimensional CT obtained preoperatively and postoperatively. And we compared them each other in terms of accuracy of reconstructed bony contour. We could reconstruct almost all bone fragments easily along 3-dimensional structure and get excellent aesthetic results. There was no complication such as infection. CONCLUSION: In treatment of comminuted facial bone fracture, occurred in children, Histoacryl(R) is an excellent method for accurate reconstruction in small and thin bone fragments which cannot be fixed by wire, miniplate or absorbable plate without complication.
Child ; Enbucrilate ; Facial Bones ; Foreign Bodies ; Fractures, Comminuted ; Frontal Sinus ; Humans ; Reoperation ; Tissue Adhesives

PURPOSE: Compression of the ulnar nerve in the ulnar tunnel is a relatively uncommon condition. Many authors have described several etiologies of ulnar nerve compression. We experienced two cases of ulnar nerve compression in the ulnar tunnel due to an anomalous pulsatile S-shaped ulnar artery. METHODS: Case 1: A 51-year-old man was referred with numbness and paroxysmal tingling sensation along the volar side of the ring and little fingers of his right hand for 6 months. When exploration, the ulnar artery was pulsatile S-shaped and was impinging on the ulnar nerve. To decompress the ulnar nerve, the tortuous ulnar artery was mobilized and translocated radially onto the adjacent fibrous tissue. Case 2: A 41-year-old man was referred with tingling sensation on the 4th, 5th finger of the right hand for 4 months. Sensory nerve conduction velocities of the ulnar nerve was delayed. Preoperative 3D angio CT scan showed an anomalous S-shaped ulnar artery. Same operation was done. RESULTS: The postoperative course was uneventful. After decompression, paroxysmal tingling sensation decreased to less than 1 minute per episode, occurring 1 or 2 times a day. After 4 months, they had no more episodes of numbness and tingling sensation. Examination demonstrated good sensation to pinprick and touch on the ulnar aspect of the hand. CONCLUSION: We report two cases of ulnar nerve compressive neuropathy that was caused by an anomalous pulsatile S-shaped ulnar artery in the ulnar tunnel. Although this is an unusual cause of ulnar nerve compression, the symptoms will not spontaneously resolve. The prompt relief of compressive neuropathic symptoms following the translocation of the impinging ulnar artery from the affected ulnar nerve onto adjacent tissue proved that the ulnar nerve compression is due to the anomalous vessel.
Adult ; Decompression ; Fingers ; Hand ; Humans ; Hypesthesia ; Middle Aged ; Neural Conduction ; Sensation ; Ulnar Artery ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes

PURPOSE: Substantial tissue necrosis after snake bites requiring coverage with flap surgery is extremely rare. In this article, we report 7 cases of soft tissue defects in the upper and the lower extremities caused by snake bites, which needed to be covered with flaps. Among the vast mass of publications on snake bites there has been no report that focuses on flap coverage of soft tissue defects due to snake bite sequelae. METHODS: Seven cases of soft tissue defects in tendon, ligament, or bone exposure after snake bites were included. All patients were males without comorbidities, the average age was 35 years. All of them required coverage with a flap. In 6 cases, the defects were localized on the upper extremity, in one case the lesion was on the lower extremity. Local flaps were used in 6 cases, one case was covered with a free flap. The surgical procedures included one kite flap, one cross finger flap and digital nerve reconstruction with a sural nerve graft, one reverse proximal phalanx island flap, one groin flap, one adipofascial flap, one neurovascular island flap, and one anterolateral thigh free flap. The average interval from injury to flap surgery was 23.7 days. RESULTS: All flaps survived without complication. All patients regained a good range of motion in the affected extremity. Donor site morbidities were not observed. The case with digital nerve reconstruction recovered a static two point discrimination of 7mm. The patient with foot reconstruction can wear normal shoes without a debulking procedure. CONCLUSION: The majority of soft tissue affection after snake bites can be treated conservatively. Some severe cases, however, may require the coverage with flap surgery after radical debridement, especially, if there is exposure of tendon, bone or neurovascular structures. There is no doubt that definite coverage should be performed as soon as possible. But we also want to point out that this principle must not lead to a premature coverage. If the surgeon is not certain that the wound is free of necrotic tissue or remnants of venom, it is better to take enough time to get a proper wound before flap surgery in order to obtain a good functional and cosmetic result.
Comorbidity ; Cosmetics ; Debridement ; Discrimination (Psychology) ; Extremities ; Fingers ; Foot ; Free Tissue Flaps ; Groin ; Humans ; Ligaments ; Lower Extremity ; Male ; Necrosis ; Organic Chemicals ; Range of Motion, Articular ; Shoes ; Snake Bites ; Snakes ; Sural Nerve ; Tendons ; Thigh ; Tissue Donors ; Transplants ; Upper Extremity ; Venoms

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.
Jurisprudence ; Organization and Administration ; Skin ; Skin Care ; Skin Diseases ; Social Control, Formal

PURPOSE: Eccrine porocarcinoma is a very rare, potentially fatal tumor which arises from the intraepidermal portion of the eccrine sweat ductal apparatus. It does not have a characteristic clinical feature but does have a high incidence of metastasis. It may be developed de novo or in a preexisting benign eccrine poroma. It usually affects older people and is located most commonly on lower extremities. We report a rare case of eccrine porocarcinoma which developed on the back without metastasis. METHODS: The patient was a 94-year-old woman who showed a painful, ulcerated, dark brown colored polypoid 3.5x3.0cm sized mass on the back for 3 years. We totally excised the lesion including normal tissue. RESULTS: After wide excision of the lesion, pathologist reported an eccrine porocarcinoma. Histopathologic findings reveal that the classic type of eccrine gland carcinoma, eccrine porocarcinoma. Immunocytochemical studies showed a positive reactivity to anti-EMA antibody and anti-CEA antibody. CONCLUSION: Authors experienced a rare case of primary eccrine porocarcinoma on the back. Because of the propensity to develop local recurrence, wide excision of the primary tumor with histologic confirmation of negative margins represents the only curative treatment regimen for eccrine porocarcinoma.
Eccrine Glands ; Eccrine Porocarcinoma ; Female ; Humans ; Incidence ; Lower Extremity ; Neoplasm Metastasis ; Poroma ; Recurrence ; Sweat ; Ulcer

PURPOSE: Presently, silicone rubber is chosen most frequently for nasal augmentation. However, there is a possibility of extrusion with this material. Sometimes, noses are prone to be traumatized, and then silicone rubber has a possibility of deformity or deviation resulting in trauma. We experienced cases with complications and traumatic deformities after the augmentation rhinoplasty. METHODS: A retrospective review was performed to determine the characteristics of the implanted nasal silicone prosthesis after trauma. The patients' data such as deviation of implant, shape of fracture, age and sex of the patient, time of treatment, operative methods were reviewed. From March 2001 to March 2008, this study was performed in 30 patients. The patients were 25 females and 5 males, from 24 to 60 years of age, with an average of 42. All patients had previous augmentation rhinoplasty with silicone implant. RESULTS: All of the 30 patients were confirmed as deviation of silicone and nasal bone fractures in the facial bone CT scan. The most common cause of fracture was traffic accident. The classification of nasal trauma after augmentation was done by facial bone CT. Class I: Deviation of silicone without nasal bone fracture without extrusion(12 cases, 40%), Class II: Deviation of silicone without nasal bone fracture and with extrusion(4 cases, 13%), Class III: Deviation of silicone with nasal bone fracture and without extrusion(8 cases, 27%), Class IV: Deviation of silicone with nasal bone fracture and with extrusion(3 cases, 10%), Class V: Mild deviation of silicone with nasal bone fracture(3cases, 3%). Specially, the comminuted or trapezoid nasal fracture was confirmed in 11 cases(Class III, IV). CONCLUSION: The problems of silicone implant have generally been related to foreign body reactions, rigidity of the material, encapsulation, infections, and extrusion. We experienced 11 cases of comminuted or comminuted trapezoid shaped fracture below nasal implant. So, we think this phenomenon could be used in late problem of silicone implant.
Accidents, Traffic ; Congenital Abnormalities ; Facial Bones ; Female ; Foreign Bodies ; Humans ; Male ; Nasal Bone ; Nose ; Prostheses and Implants ; Retrospective Studies ; Rhinoplasty ; Silicone Elastomers

PURPOSE: Various types of flaps, with their own advantages and disadvantages, have been described for reconstruction of soft tissue defect with exposure of tendons, bones, or joints in the hand or foot. Local flaps with random vascularity have a limitation by their length. Free flaps are time-consuming procedure that may require the sacrifice of some major vessels. The ideal flap for covering soft tissue defects of the hand or foot must provide subcutaneous tissue that tendons can glide through which, supply enough subcutaneous tissue for cover of vital neural, bony, vascular and joint structures, and it has to be aesthetically pleasing. The adipofascial flap fulfills these criteria. It allows immediate or early closure of difficult wound of hand and foot in an easy way, and is especially indicated for small to medium-sized defects. METHODS: From October 2005 to December 2006, seven cases underwent this procedure to reconstruct soft tissue defect on hand or foot. RESULTS: All flaps survived completely, and no complications were observed. CONCLUSION: The adipofascial flap is a convenient flap for coverage of soft tissue with exposure of vital structure in the hand or foot, and provide several advantages, as following; easy and safe, short operating time, one stage procedure, thinness and good pliability of the flap, preservation of the major vascular pedicles, skin preservation at the donor site, thus preserve the shape of the limb and minimize donor site scar.
Cicatrix ; Extremities ; Foot* ; Free Tissue Flaps ; Hand* ; Humans ; Joints ; Pliability ; Skin ; Subcutaneous Tissue ; Tendons ; Thinness ; Tissue Donors ; Wounds and Injuries

PURPOSE: The goal of palatoplasty is focused on two points. One is to close the palatal defect completely, and the other to create a velopharyngeal system for normal speech. While established methods such as pushback palatoplasty or double opposing Z palatoplasty are used in wide cleft palate repair, sequelae such as maxillary hypoplasia or oronasal fistula may result. Therefore, when palatoplasty with buccinator myomucosal flap is used in the case of wide cleft palates, maxillary hypoplasia and oronasal fistula is reduced and optimal results are obtained. METHODS: From October 2005 to December 2006, four children with wide complete cleft palate underwent unilateral buccinator myomucosal flap and intravelar veloplaty. Mean age at cleft repair was 15 months, and mean cleft size was 2.15cm. The patients underwent intravelar veloplasty and palatoplasty was done using unilateral buccinator myomucosal flap. RESULTS: The patients, after mean 10 months of follow- up observation, showed no signs of oronasal fistula resulting from flap tension. The shape and color similar to normal oral mucosa was obtained, and velopharyngeal function was acquired. CONCLUSION: When intravelar veloplasty and palatoplasty with unilateral buccinator myomucosal flap is done on wide cleft palates, postoperative speech function is optimal, velopharyngeal incompetence is effectively corrected, and sequelae resulting from pushback palatoplasty and double opposing Z-plasty, such as maxillary hypoplasia and oronasal fistula, is reduced.
Child ; Cleft Palate* ; Fistula ; Humans ; Mouth Mucosa ; Velopharyngeal Insufficiency

PURPOSE: The mandibular ramus sagittal split osteotomy is a common procedure in cosmetic surgery. A late complication of this procedure, pseudoaneurysm rarely happens. The purpose of this case is to present our experience that is rare late vascular complication after mandibular ramus sagittal split osteotomy. METHODS: A 21-year-old male was operated by local plastic surgeon for treatment of mandibular prognathism. After 9 days, the man was transferred to our hospital with persistent bleeding and swelling on the mandibular area. We operated the man three times and failed to control hemorrhage. Therefore, we did angiography and found the pseudoaneurysm on the buccal and pterygoid branches of internal maxillary artery. Then we did selective embolization for removal of the pseudoaneurysm. RESULTS: The man was operated using the therapeutic embolization, and the pseudoaneurysm was removed. The results were successful, and we couldn't find any bleeding and the pseudoaneurysm during the follow-up of 12 months. CONCLUSION: The selective embolization is the good therapeutic method of late vascular complication after mandibular ramus sagittal split osteotomy.
Aneurysm, False ; Angiography ; Embolization, Therapeutic ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Maxillary Artery ; Osteotomy* ; Prognathism ; Surgery, Plastic ; Young Adult

PURPOSE: The mandibular ramus sagittal split osteotomy is a common procedure in cosmetic surgery. A late complication of this procedure, pseudoaneurysm rarely happens. The purpose of this case is to present our experience that is rare late vascular complication after mandibular ramus sagittal split osteotomy. METHODS: A 21-year-old male was operated by local plastic surgeon for treatment of mandibular prognathism. After 9 days, the man was transferred to our hospital with persistent bleeding and swelling on the mandibular area. We operated the man three times and failed to control hemorrhage. Therefore, we did angiography and found the pseudoaneurysm on the buccal and pterygoid branches of internal maxillary artery. Then we did selective embolization for removal of the pseudoaneurysm. RESULTS: The man was operated using the therapeutic embolization, and the pseudoaneurysm was removed. The results were successful, and we couldn't find any bleeding and the pseudoaneurysm during the follow-up of 12 months. CONCLUSION: The selective embolization is the good therapeutic method of late vascular complication after mandibular ramus sagittal split osteotomy.
Aneurysm, False ; Angiography ; Embolization, Therapeutic ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Maxillary Artery ; Osteotomy* ; Prognathism ; Surgery, Plastic ; Young Adult