• Archives of Craniofacial Surgery
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• v.9 no.1
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• pp.17-22
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• 2008

Purpose: For several decades, open reduction has been a controversial issue in mandibular condyle fracture. The authors have successfully used the open reduction and internal fixation with retromandibular approach and have found it to be satisfactory for mandibular condyle fracture. Methods: A total of 10 patients with mandibular condyle fracture underwent open surgical treatment using retromandibular approach. The incision for the retromandibular approach was carried below the ear lobe and the facial nerve branches were identified. Dissection was continued until the fracture site was exposed and internal fixation was performed with miniplate following intermaxillary fixation. The average period of joint immobilization was 1 weeks and the arch bars were removed in 3 weeks on average. The preoperative and postoperative panoramic view and three-dimensional computed tomography were compared. During the follow up period, we evaluated the presence of malocclusion, chin deviation, trismus, pain, click sound, facial nerve palsy, hypertrophic scar and skin fistula. Results: According to the radiographic findings, the fractured condyle was reducted satisfactorily in all patients without any symptoms of facial palsy. During the follow up period ranged form 6 to 12 months, all clinical symptoms were improved except in one case with chin deviation and malocclusion. Conclusion: Using open reduction and internal fixation of mandibular condyle fracture with retromandibular approach, all results were satisfactory with good functional outcomes and minimal complication. We concluded that the open surgical treatment should be considered as the first choice for mandibular condyle fracture management.

• Archives of Plastic Surgery
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• v.40 no.4
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• pp.414-424
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• 2013

Background In esthetic surgery, understanding the factors that influence patient satisfaction is important for successful practice. We hypothesize that the factors that influence patient satisfaction include not only aesthetic and functional outcomes, but also personal factors such as the level of familiarity with factors affecting wound healing and expectations regarding aesthetic outcome. Methods One hundred patients who underwent esthetic closure after thyroidectomy were included in this study. In order to evaluate the individual characteristics of the patients, a preoperative survey was administered to the patients. We estimated the patient satisfaction six months postoperatively and assessed the aesthetic and functional outcomes using the Patient and Observer Scar Assessment Scale. Results According to the results of correlation analysis, level of familiarity with wound healing factors had a positive correlation with satisfaction. High expectations, pain, itching, and high observer scale score had negative correlations with satisfaction. The factors that were correlated with satisfaction were included in the multiple regression analysis. Level of familiarity with wound healing factors was found to have a positive relationship with satisfaction, while itching and observer scale were found to have a negative relationship with satisfaction. After excluding 10 patients who had hypertrophic scars, only level of familiarity with wound healing factors and expectations affected satisfaction. Conclusions The level of familiarity with factors affecting wound healing and expectations were found to independently affect satisfaction. Improving patients' level of familiarity with wound healing factors and reducing their expectations by providing suitable preoperative education has the potential to improve patient satisfaction.

• Archives of Plastic Surgery
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• v.39 no.5
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• pp.463-468
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• 2012

Background In the extremities of premature infants, the skin and subcutaneous tissue are very pliable due to immaturity and have a greater degree of skin laxity and mobility. Thus, we can expect wounds to heal rapidly by wound contraction. This study investigates wound healing of full-thickness defects in premature infant extremities. Methods The study consisted of 13 premature infants who had a total of 14 cases of full-thickness skin defects of the extremities due to extravasation after total parenteral nutrition. The wound was managed with intensive moist dressings with antibiotic and anti-inflammatory agents. After wound closure, moisturization and mild compression were performed. Results Most of the full-thickness defects in the premature infants were closed by wound contraction without granulation tissue formation on the wound bed. The defects resulted in 3 pinpoint scars, 9 linear scars, and 2 round hypertrophic scars. The wounds with less granulation tissue were healed by contraction and resulted in linear scars parallel to the relaxed skin tension line. The wounds with more granulation tissue resulted in round scars. There was mild contracture without functional abnormality in 3 cases with a defect over two thirds of the longitudinal length of the dorsum of the hand or foot. The patients' parents were satisfied with the outcomes in 12 of 14 cases. Conclusions Full-thickness skin defects in premature infants typically heal by wound contraction with minimal granulation tissue and scar formation probably due to excellent skin mobility.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.601-605
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• 2012

Background Cryptotia is a congenital ear deformity in which the upper pole appears buried beneath the mastoid skin. Cryptotia is a common auricular malformation among Asians. The aim of this paper is to examine the surgical techniques for and complications of 34 cryptotic patients. Methods Surgery was performed for 34 cryptotic deformities (January 2005 to January 2012). Twenty-two patients (64.7%) were classified as having type I cryptotia, and 12 patients (37.5%) type II cryptotia. Among the type I cryptotia patients, 8 patients had mild deformity and 14 severe deformity. Among the type II cryptotia patients, 10 patients had mild deformity and 2 severe deformity. Results The mild deformities were corrected via Z-plasty, V-Y plasty, full-thickness skin graft, and transposition flap, while the severe deformities were corrected via cartilage graft or Medporfor the spread of cartilage adhesion of antihelix. There were two cases of reinvagination in the autologous cartilage graft group. Implant exposure occurred with Medpor (two cases). There were two cases of hypertrophic scar on the previous surgical wound with Medpor. There were no complications in the 18 patients who had mild deformities. Conclusions The type I cryptotia patients had more severe deformities than the type II cryptotia patients. As most of the type II cryptotia patients had only mild deformities, their deformities were corrected without using autologous conchal cartilage graft or Medpor, except for two patients. Through more case analyses, researchers should make an effort to identify methods for recurrence and prevention of complication.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.330-335
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• 2007

Purpose: The purpose of this study is to evaluate the functional outcome and donor site morbidity of anterolateral thigh free flap(ALT) compared to Radial forearm free flap(RFFF) for the reconstruction of partial glossectomy defect. Methods: 5 ALT free flap (group I) were attempted for partial glossectomy patients. We compared patients undergone ALT flap with those(n=11) of similar size defect reconstructed with RFFF (Group II). Rating scales for articulation and swallowing function were applied and donor site morbidity have been evaluated. Results: The scales for speech function showed no difference between the two groups (average score; group I - 6.4, group II - 6.45). Swallowing function also showed no difference between the two groups(average score; Group I - 6.6, Group II - 6.27). ALT group had one patient with donor site morbidity(numbness). All of the RFFF patients(11/11) complained and suffered from hypertrophic scar, retraction, numbness or hyperpigmentation on forearm donor site. Based on our study, ALT free flap is comparable to that of RFFF in terms of functional assessment in tongue reconstruction. Conclusion: Considering the donor site morbidity, ALT flap is to be valuable to reconstruct partial glossectomy defect.

• Archives of Plastic Surgery
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• v.41 no.4
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• pp.379-386
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• 2014

Background Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction. Methods From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps. Results The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis. Conclusions We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.

• Archives of Plastic Surgery
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• v.40 no.3
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• pp.209-213
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• 2013

Background A cartilage wedge block and covering flap are standard procedures for firm elevation of the ear in microtia correction. However, using costal cartilage for elevation of the reconstructed auricle can be insufficient, and the fixed cartilage wedge block may be absorbed or may slip out. Furthermore, elevating covering flaps is time-consuming and uses up fascia, a potential source of reconstruction material. Therefore, we propose an innovative method using autologous onlay rib bone graft for auricular elevation of microtia. Methods From February 1995 to August 2012, 77 patients received a first stage operation with a rib cartilage framework graft. In the second stage operation, a small full thickness of rib bone was harvested through the previous donor scar. The bihalved rib bone was inserted into the subperiosteal pocket beneath the cartilage framework. Results The follow-up time ranged from 1 month to 17 years, with a mean of 3 years. All of the patients sustained the elevation of their ears very well during the follow-up period. Donor site problems, except for hypertrophic scars, were not observed. Surgery-related complications, specifically skin necrosis, infection, or hematoma, occurred in 4 cases. Conclusions Onlay rib bone graft used to elevate the reconstructed auricle is a more anatomically appropriate material than cartilage, due to the bone-to-bone contact between the bone graft and the temporal bone. Postoperative minor correction of the elevation degree is straightforward and the skin graft survives better. Therefore, reconstructed auricle elevation using onlay rib bone graft is a useful and valuable method.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.773-778
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• 2009

Purpose: The authors propose the new classification of fatty - type gynecomastia(lipomastia) which can serve as a guide for modifying the periareolar technique. Methods: A retrospective analysis was made of 1000 cases of lipomastia operated on in the last 17 months. The extent of the clinical result, the technique employed, and the complications were observed. On the basis of this review the authors observed that at grade I(fat component < 50 ml, fibroglandular component < 3 g each breast), flattening of the thorax can be achieved by means of stab incision, ultrasound - assisted lipectomy(UAL), scavenging suction - assisted lipectomy(SAL) and tissue shaving. At grade II(50 < < 150 ml, 3 < < 5 g), stab incision, UAL, SAL and pull - out method(POM) using small curved scissors. At grade III(150 < < 300 ml, 5 < < 15 g and prominent inframammary fold(IMF)), minimal incision (5 - 6 mm), UAL, SAL and POM using small angulated scissors, and blunting IMF. At grade IV (300 < < 500 ml, 15 < < 30 g, and glandular ptosis), minimal incision (5 - 6 mm), UAL, SAL, fibroglandular excision using small angulated scissors, cutting IMF and fixation of nipple - areola complex(NAC) becomes necessary. At grade V (> 500 ml, > 30 g and ptosis), small incision (7 - 8 mm), UAL, SAL, fibroglandular excision using large angulated scissors, cutting IMF, upper repositioning of NAC and delayed circumareolar skin reduction or chest lifting becomes necessary. Results: The complications were minimal but there were hematoma (n = 7), infection (n = 3) and hypertrophic scar (n =13). Almost patients were satisfied with the outcome. Conclusion: This simple classification may help in choosing the most suitable treatment, thus avoiding insufficient or invasive treatments and undesirable scars.

• Archives of Craniofacial Surgery
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• v.15 no.1
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• pp.7-13
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• 2014

Background: Cryptotia correction by V-Y advancement of a temporal triangular flap was introduced in 2005. However, despite the several advantages of V-Y advancement, visible scars at the donor site are problematic. As a result, a Z-plasty technique was considered for skin deficiency in mild cases. Therefore, we introduce a new surgical scheme for cryptotia correction based on considerations of techniques and complications that arose in our clinic. Methods: Between 2000 and 2013, 26 patients (35 cases) of cryptotia were treated. Seventeen patients had unilateral cryptotia and nine had bilateral cryptotia. Two corrective methods were used, Z-plasty or V-Y advancement, based on the severity. In mild cases, Z-plasty was used for correction and in severe cases, V-Y flap advancement was used for more skin supplement. Results: Follow-up periods ranged from 6 months to 1.5 years. The results obtained were relatively favorable. Nine cases of mild deformity were corrected by Z-plasty, and the other 26 cases with mild or severe deformities were corrected by V-Y advancement. In Z-plasty cases, there was one hypertrophic scar and in V-Y advancement cases, seven resulted in visible scarring and three in skin sloughing. Conclusion: The main advantage of Z-plasty is a lower likelihood of visible scarring at the donor site. In mild cases, Z-plasty may be a good alternative, but in severe cases, V-Y advancement is probably the best option for more skin supplement.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.158-162
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• 2007

Background: After burn patients are discharged from the hospital, they may continue to feel pain and paresthetic sensations at the site of a healed burn and these problems may persist for years. This study was designed to describe the characteristics of these symptoms in terms of intensity, frequency, and influencing factors. Methods: Patients that developed paresthetic sensations at sites of a healed burn were recruited from the pain management center from January 2003 to April 2006. Data was collected using a structured interview protocol. Results: Fifty one adults, with a total body surface area burned (TBSA) of $21.1{\pm}16.3%$ aged $42.0{\pm}12.9$ years were studied. A paresthetic sensation was reported to be present every day in 52.9% (27/51) of the subjects. A variation in the intensity was most commonly related to changes in the weather. A tight sensation and itching types of sensations were significantly more frequent in patients with more extensive injuries. Conclusions: Recognition and understanding of the chronic paresthetic sensation that many burn patients continue to experience at sites of a healed burn deserve further attention. Not only do clinicians need to be aware of these problems but also strategies for prevention and alleviation shou\d be explored.