• Archives of Plastic Surgery
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• v.44 no.1
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• pp.59-64
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• 2017

Background Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed. Methods Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV. Results Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes. Conclusions It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.

• Journal of Pharmacopuncture
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• v.16 no.2
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• pp.23-27
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• 2013

Objective: This research was performed to investigate the efficacy of complex rehabilitation combined with pharmacopuncture treatment for the children with neuromotor system diseases. Methods: Fifty (50) patients aged from 5 to 15 yr old were compared. Twenty (20) patients received conventional treatments and complex rehabilitation as a control group, and fifty (50) patients received complex rehabilitation with pharmacopuncture. At their first visits, the patients had checkups and neurological scales, and after 10 days of pharmacopuncture treatments and 55 days of rehabilitation, they also took neurological scales. We studied the pre and post effects of the treatment group. Results: The number of patients with ankle joint disorder and contracture, knee joint contracture, steppage, horsey hoof, shoulder weakness and contracture, radio-carpal joint disorder and contracture, arm hypotrophia, arm atrophia, leg hypotrophia and total atrophia decreased after treatments. Conclusion: This study showed the efficacy of pharmacopuncture combined with complex rehabilitation for the treatment of neuromotor system diseases.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.4 no.2
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• pp.84-87
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• 2011

We had applied Doppler ultrasound guided modified Allen's test for a Volkmann's ischemic contracture patient who had ulnar artery constriction which was not detected with acoustic Doppler and CT-angiogram preoperatively. We report this case of Volkmann's ischemic contracture with brief review of literatures for awareness of the Doppler-ultrasound guided modified Allen's test.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.147-152
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• 2009

Purpose: First web space contracture of the hand has been treated with various surgical techniques such as Z - plasty, local flap, pedicled flap, distant free flap, and anterolateral thigh free flap. Among those surgical techniques, anterolateral thigh free flap provide a thin and pliable flap, which is a useful method for correction of first web space contracture. Methods: From August 2003 to September 2007, authors selected 9 patients who had first web space contracture with limitation of thumb abduction within 30 degrees. All of patients had received first web contracture release with anterolateral thigh free flap. Age ranged from 24 to 51, and all the patients were male. Average follow up period was 12 months and authors performed photographic analysis of the thumb abduction angle of postoperative increase. Result: All the flaps were survived. Donor site was closed with primary closure in 8 cases and covered with split - thickness skin graft in 1 case. Average flap size was $8{\times}9cm$ and average thickness was 0.6 cm in suprafascial flap. The procedure resulted in increased thumb abduction angle of $34.7^{\circ}$ in average and showed concave shape of first web space in suprafascial flap. Additional operations were performed with Z - plasty in 3 cases, local flap in 5 cases, and opponensplasty in 3 cases. Conclusion: In suprafascial flap, we obtained relatively thin flap thickness and were able to make natural concave shape of first web space. In releasing severe contracture of the first web space, anterolateral thigh free flap provided a good coverage of appropriate thickness and pliable soft tissue and allowed limited donor site morbidity.

• The Korean Journal of Physiology
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• v.23 no.2
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• pp.291-299
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• 1989

Na and Ca effects on contracture were studied in order to estimate Na/Ca exchange ratio in the isolated atrial muscle of the rabbit. All experiments were performed in tris-buffered Tyrode solution which was being aerated with 100% $O_2\;and\;kept\;at\;37^{circ}C$. To load intracellular $Na^+,\;10{-6}M$ ouabain or K-free solution were used. Contractures were induced by brier exposure of atrial muscle to Tyrode solution containing various concentrations of Ca or of Na. The results obtained were as follows: 1 ) Increasing the extracellular Ca concentration, the amplitude of contracture also increased and was maximum at 8 mM Ca-Tyrode solution. 2) The relationship between extracellular Ca concentrations and relative amplitude of the contractures showed hyperbolic pattern. By using Hill plot, the line has the slope of 1 12 which means the number of Ca binding sites of the carrier in the cell membrane. 3) The amplitude of the contracture was maximum in 0 mM Na-Tyrode solution and decreased in dose dependent manner when the Na concentration increased. 4) When the relationship between extracellular Na concentrations and the amplitude of contractures was expressed as dose-response curve, the curve showed sigmoid pattern. The line with the slope of 2.82 was obtained by using Hill plot. 5) From above all the results, it is suggested that exchange ratio of Na and Ca via Na/ca exchange system in the atrial muscle of rabbit could be 3:1 approximately.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.46-51
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• 2010

Purpose: The loss of web space is caused by congenital syndactyly or acquired burn injury, trauma or surgery. Numerous surgical procedures have been described for restoration of the web space. Local flaps are usually preferred because of the easiness to perform and tolerable postoperative outcome. Among the various local flaps, the authors introduce V-M plasty for correction of web space contracture and syndactyly. Method: From March 2007 to Jun 2008, 4 patients underwent V-M plasty for correction of web space contracture and syndactyly. V-M plasty consists of 3 distinct triangular flaps. One triangular flap is designed next to the web region on the dorsal site of the hand, whereas the remaining 2 triangular flaps are placed on the volar site. The dorsal triangular flap is then placed between the volar adjacent triangular flaps. At the end of the operation, the involved fingers or toes are positioned in abduction to avoid kinking of the triangular flaps. Result: All the patients gained web functions with good esthetic appearance without any recurrence or complications. Mean follow-up was 8 months. Conclusion: V-M plasty is a safe, easy and rapid procedure to design and apply by using local tissues without the needs for a skin graft or risk of linear scarring and recurrence. The authors advise this versatile technique both in primary and recurrent cases of web space contracture and syndactyly.

• The Korean Journal of Physiology
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• v.21 no.2
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• pp.179-189
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• 1987

Since it has been known that ryanodine has a potent negative inotropic effect on the cardiac muscle contractility (Jenden and Fairhurst, 1968), ryanodine has been a subject of intensive research (Frank and Sleator, 1975; Jones et al, 1978; Sutko et al, 1985). However, the underlying mechanism for the ryanodine dependent negative inotropic effect is still uncertain. In this study, the effects of ryanodine on the generation and relaxation of contracture due to Na-withdrawal and on the force-frequency relationship of heart muscles isolated from rats and guinea pigs were measured in an effort to understand the underlying mechanism of the ryanodine-induced negative inotropy. Results are summerized as follows: 1 ) Ryanodine significantly reduced the contractility of heart muscles produced at low frequency of stimulation, but showed a little effect on the contractility at high frequency stimulation. 2) Ryanodine, at the concentrations ranging from $10^{-6}\;M$ to $10^{-8}\;M$, had no significant effect on the Na-dependent relaxation of Na-withdrawl contracture. 3) Ryandoine significantly reduced the amplitude of the Na-withdrawl contracture, and this inhibitory effect was reinforced by procaine, antiagonized by caffeine and high potassium. From these results, it may be concluded that the negative inotropic effect of ryanodine is mainly due to an inhibition of calcium release from sarcoplasmic reticulum.

• Archives of Plastic Surgery
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• v.45 no.2
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• pp.158-164
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• 2018

Background During breast augmentation, the transaxillary approach provides the advantage of allowing the mammary prosthesis to be placed through incisions that are remote from the breast itself, thereby reducing the visibility of postoperative scars. For patients experiencing capsular contracture who do not want additional scars, the previous transaxillary scar can be used for site change and implant exchange. Methods This study analyzed 17 patients (34 breasts) with submuscular breast implants with grade III-IV capsular contracture who received treatment from 2010 to 2015. The mean age of the patients was 29 years (range, 20-38 years). The inclusion criterion was a pinch test of more than 3 cm at the upper pole of the breast. Previous axillary scars were used to expose the pectoralis fascia, and submuscular breast implants were removed carefully. The dissection underneath the pectoralis fascia was performed with endoscopic assistance, using electrocautery under direct visualization. Results The mean follow-up period was 14 months (range, 6-24 months). The entire dissection plane was changed from the submuscular plane to the subfascial plane. Round textured gel implants were used, with a mean implant size of 220 mL (range, 160-300 mL). Two patients developed grade II capsular contracture. There were no cases of malposition or asymmetry. Three patients complained of minor implant palpability. None of the patients required additional surgery. Conclusions Endoscopic subfascial conversion may be an effective technique for treating capsular contracture and avoiding scarring of the breast in selected patients.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.80-87
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• 2000

Acute high speed accidents that results in full thickness skin defect and exposure of tendon, nerve, vessel and periosteum over denuded bone demands soft tissue coverage. Exposed bone often ensues chronic infection and requires free flap transplantation which surely covers defects in one stage operation and enhances transport of oxygen-rich blood and converts a non-osteogenic or partially osteogenic site into a highly osteogenic site, but exposed bone which had performed free flap transplantation sometimes necroses and needs secondary bone procedure. Scar contracture limits joint motion should be excised and covered with normal soft tissue to restore normal range of motion. Authors have performed the large latissimus dorsi myocutaneous free flap in 8 cases of extensive soft tissue defect and exposed bone lesion in the leg and 1 case of the flap was failed. The secondary ilizarov bone procedure was performed in 3 of 8 cases. 2 cases of large burn scar contracture and 1 case of posttraumatic scar contracture in lower extremity were restored with the large latissimus dorsi myocutaneous free flap. Authors concluded that large latissimus dorsi myocutaneous free flap is the most acceptable microvascular procedure in large soft tissue defect combined with exposed periosteum and bone requiring secondary bone procedure and in large burn scar contracture limiting knee joint motion.

• The Korean Journal of Physiology
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• v.23 no.2
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• pp.263-275
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• 1989

Mechanical contractions and electrical activities of the fundic longitudinal and antral circular muscle fibers were investigated in order to elucidate topical differences of gastric motility. K-induced contracture was produced by exposure of muscle strips to high K Tyrode solution. Membrane potential and mechanical contraction were simultaneously recorded by conventional glass microelectrode method and single sucrose-gap technique. All experiments were performed in tris-buffered Tyrode solution which was aerated with $100%\;O_2\;and\;kept\;35^{\circ}C$. The results obtained were as follows: 1) The resting membrane potential of circular muscle cells in the antral region was about 10 mV more negative than that in the fundic region. 2) The membrane potentials decreased almost linearly as the extracellular KCI concentration was increased both in antral circular muscle cells and in fundic longitudinal muscle cells. 3) The thresholdal K concentration of K-contracture was 15 mM (membrane potential, -48 mV) for the antral circular muscle strip and 20 mM for the fundic longitudinal muscle cells. 4) The ratio of membrane permeability coefficient for $Na^+\;and\;K^+,\;P_{Na}/P_K\;({\alpha})$ was 0.065 for antral circular muscle cells and was 0.108 for fundic longitudinal muscle cells. 5) K-contracture of antral and fundic smooth muscle strips showed the contracture composed of phasic and tonic components. The amplitude of the phasic component increased sigmoidally in a dose-dependent manner, whereas that of the tonic component was maximal at a concentration of 40 mM KCI and at the concentrations above or below 40 mM KCI the amplitude was reduced. 6) The inverse relationship between the amplitude of tonic component and extracellular KCI concentration in the range of 40 to 150 mM KCI was more prominent in the antral circular muscle strip than in the fundic longitudinal muscle strip, where the amplitude of the tonic component decreased less steeply and was maintained higher at the same high K concentrations. 7) The tonic component was totally dependent on the external $Ca^{2+}$ and completely abolished by verapamil, while tile phasic component was far less dependent on the external $Ca^{2+}$ and partially suppressed by verapamil. From the above results, the following conclusions could be made. 1) The phasic component of K-contracture is produced both by intracellular $Ca^{2+}$ mobilization and by $Ca^{2+}$-influx from outside, while the tonic component is generated and maintained by the $Ca^{2+}-influx$ through the potential-dependent $Ca^{2+}$ channel. 2) The mechanism of reducing the free $Ca^{2+}$ concentration in the myoplasm seems to be more developed in the antral circular muscle than in the fundic longitudinal muscle. 3) The lower resting membrane potential of the fundic longitudinal muscle cell reflects a relatively high $P_{Na}/P_K$ ratio of about 0.108.