• Archives of Plastic Surgery
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• v.39 no.2
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• pp.130-136
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• 2012

Background : Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner. Methods : A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study. Results : We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from $4{\times}9cm$ ($36cm^2$) to $15{\times}30cm$ ($450cm^2$) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was $102^{\circ}$ (range, $45^{\circ}$ to $140^{\circ}$). Conclusions : In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.

• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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• pp.37-54
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• 1987

The aim of surgery for all parotid masses is directed toward total removal of the tumor with adequate safe margins of adjacent normal tissue and preservation of the facial nerve whenever possible. Reconstructive procedures following parotidectomy for benign or low grade malignant lesions are most commonly necessary if soft tissue deficits appear at the angle of the mandible below the earlobe as a major cosmetic deformity. This is a report of Z4 cases with a diagnosis of parotid tumor who were treated using various surgical procedures at Department of Plastic and Reconstructive Surgery, Hanyang University Hospital over the period of 4 years from January, 1983 to December, 1986. Among 24 cases, 11 cases were reconstructed by Sternocleidomastoid muscle flap at the same time that extirpative surgery is outlined. The advantage of Sternocleidomastoid muscle flap is the coverage of the facial nerve, so adhesion between the facial nerve and skin was prevented. Absorption and loss of bulk was not found such as dermofat graft. It was a simple method. Neither donor site defect nor sternocleidomastoid muscle deformity was developed. Sternocleidomastoid muscle flap have been found satisfactory in maintaining filled-out soft tissue hollows with good result cosmetically and functionally.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.63-67
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• 2012

Purpose: Lipogranuloma is the reaction of adipose tissue to various oils, paraffin, and other hydrocarbons injected into subcutaneous tissue for cosmetic or other reasons. The authors experienced a case of sclerosing lipogranuloma on the nasal dorsum. Methods: A 42-year-old female, without a history of the injection of any foreign materials, was admitted on our hospital for a painless, irregular, and firm mass located on her nasal dorsum with step-off deformity. It was considered that the mass had developed after augmentation rhinoplasty. The size of mass had been increased after closed reduction of nasal bone fracture. On April 2011, under general anesthesia, the mass was removed by open rhinoplasty technique. In addition, a pathologic examination was performed. After the mass extirpation, dermofat graft was performed for the correction of depression deformity. Results: The histopathological findings demonstrated a Swiss cheese pattern with variably-sized vacuoles, which corresponded to lipid removed with tissue processing, and variable foreign body giant cell reaction, fat necrosis, and hyalinized fibrous tissue. The pathologic diagnosis is lipogranuloma replacing nasalis muscle. It has been considered that sclerosing lipogranuloma is caused by nerve injury during augmentation rhinoplasty and the ointment used after the closed reduction of nasal bone fracture, which infiltrated through the injured mucosa. Conclusion: During the treatment of rhinoplasty or nasal bone fracture, the nerve injury or the ointment use can lead to lipogranuloma. Therefore, careful dissection for avoidance of the nerve injury and limited use of ointment seems to be helpful in decreasing incidence of lipogranuloma.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.886-889
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• 2011

Purpose: Malignant peripheral nerve sheath tumor without neurofibromatosis type 1 is very rare neoplasm. Development in the superficial soft tissue is exremely rare. Authors experienced one rare case of primary malignant peripheral nerve sheath tumor developed on abdomen. The clinical and histologic findings were described. Methods: An 83-year-old man visited hospital with an $11{\times}6.5{\times}4.5$ cm sized ulcerated and hemorrhagic mass on abdomen. The tumor was localized in abdominal skin and started growing 3 years ago. Results: Wide excision with safety margin of 2 cm and limberg flap was done. The postoperative biopsy revealed a malignant peripheral nerve sheath tumor. There was no evidence of recurrence of tumor for 16 months. Conclusion: Malignant peripheral nerve sheath tumor is an aggressive malignant tumor. An abrupt enlargement of size, ulceration and bleeding are suggestive of malignant chnages of the tumor. We recommand early wide excision with enough safety margin as treatment of malignant peripheral nerve sheath tumor.

• Archives of Plastic Surgery
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• v.47 no.2
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• pp.187-193
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• 2020

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.

• Applied Microscopy
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• v.36 no.3
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• pp.183-194
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• 2006

The threadlike structures of fascia were examined by tight and electron microscopy. In order to distinguish its tissue organization, we used staining methods including hematoxylin-eosin, Masson's trichrome, Van Gieson's collagen fiber stain and Kluver-Barrera's luxol fast blue for nerve stain. Under the light microscope, the threadlike structures were composed of many collagen fibers and nerve. In higher magnification, they looked like as the bundle of tubular structures. Many myoid cell-spindle nuclei were observed in the tissue, which were taken from the fascia. It was identical with Bonghan duct known as one of meridian network theory. In the early 1960's the North Korean Bong-Han Kim showed the anatomical structures of the acupuncture points, and explained the meridian system as the concrete duct network system. According to Bonghan theory the Bonghan ducts spread throughout the body Because it is believed that the duct could have the role of signal pathway, the theory was reinvestigated in these days. All of the threadlike structures isolated from fascia shows the abundance of collagen fibers. The electron microscope examination (TEM) could confirm the well arranged collagen fiber and nerve. This investigation reveals that superficial Bohghan duct are nerve fiber parallel running with collagen fibers. We conjectured that the intermingled structure of collagen fiber, blood vessel and nerve fiber might have the role of meridian system. And the more, regardless of histological research, the study on collagen fiber as response transmitter in acupuncture treatment are in need.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.276-280
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• 2011

BSSRO (bilateral sagittal split ramus osteotomy) is an effective surgical method for maxillofacial deformities. Rigid fixation using a plate and screws can stabilize bony segments and induce early mouth opening. Though this procedure has a low complication rate, normal function and esthetic recovery is achieved through proper and early management of the complications. Complications consisting of temporomandibular disorders, sensory disturbances due to inferior alveolar nerve damage, open bite, malunion or nonunion, and facial nerve palsy occur, but these rarely develop. Facial nerve palsy causes the muscles involved in facial expression to depress, which results in ocular dryness or retinal damage. When facial nerve palsy develops, early management involving steroid medication and physical therapy is effective. In the case of severe damage, surgical intervention should be considered. A 20-year-male patient came to the oral and maxillofacial surgery department for orthognathic surgery. The mandible was set back by BSSRO under general anesthesia. Facial nerve palsy was observed on the left side of the face: steroid and vitamins were administered early and physical therapy was performed daily. These forms of management can aid in function and allow for gradual esthetic recovery. Presumed causes were excessive soft tissue retraction or soft tissue injury by the osteotome at the horizontal osteotomy of the ramus. Careful dissection, retraction and a precise osteotomy are needed for protection of the facial nerve. If nerve damage is observed, early management can help in the recovery of facial nerve function and esthetics.

• Journal of the korean academy of Pediatric Dentistry
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• v.21 no.2
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• pp.439-455
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• 1994

The purpose of this study was to investigate the distribution of nerves in the periodontal ligament of a dog's primary teeth by each developing stage. The distribution of nerves in the periodontal ligament were investigated by means of immunohistochemistry for detection of neurofilament protein (NFP). The results were as follows: The NFP-immunoreactive nerve fibers were found to be densely distributed in the apical third of the periodontal ligament, while they were sparse in the coronal two third, in both primary and permanent teeth. In generally the density of distribution and degree of arborization of nerve fibers in periodontal ligament of primary teeth revealed a poor appearance compared with that of permanent teeth. Periodontal ligament in anterior teeth showed more abundant nerve innervation than posterior teeth, and the periodontal ligament of the bifurcation area in posterior teeth roots were not observed to have nerve fiber. The density of nerve distribution in the periodontal ligament of primary teeth was reduced according to the physiological root resorption and nerve fibers were not observed in the surrounding area on the root of the exfoliation stage in primary teeth. The distribution of nerve fibers in mucogingival tissue, was poor innervated according to the aging of the dogs. A more abundant distribution of nerve fiber was represented in the lingual mucogingival tissue than in the labial side. Most of the nerve endings in the periodontal ligament of primary teeth showed a tree-like appearance. However, the typical Ruffini-like nerve endings were not observed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.74-77
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• 2015

Objectives: Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. Materials and Methods: In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. Results: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. Conclusion: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.839-842
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• 2010

Purpose: Ganglion cysts of peripheral nerve are uncommon. Ganglion cysts located within the nerve and extraneural ganglia that cause symptomatic nerve compression have been reported. We report an unusual case of epineural ganglion cyst confined to the epineurium of the sural nerve at the foot. Methods: A 45-year-old woman was referred because of a mass on the foot. She had six months' history of pain and numbness in the right small toe. During the examination of the lesion, multinodular cystic mass was identified arising from the epineurium of the sural nerve. The nerve fascicles were compressed by the cyst, but the cyst wall clearly did not invade the fascicle. With the aid of surgical microscope, the epineural cyst was completely excised along with epineural tissue to which it was attached, and the sural nerve was decompressed. There was no relationship between the cyst and either the joint capsule or tendon sheath. Since the cyst was on the periphery of the nerve it was possible to remove the cyst intact without damaging the underlying fascicles. Results: The postoperative course was uneventful. Pathologic examination showed a ganglion cyst with a degenerated collagen fibers and contained a yellowish, jelly-like mucinous substance. No neural elements were identified within the cystic wall. Her sensory impairment improved progressively. At the 15 months follow-up, she was asymptomatic with no neurological deficits. Conclusion: Rarely, ganglion cysts can involve peripheral nerves, leading to varing degrees of neurological deficits. Intraneural intrafascicular ganglion may be difficult to separate from the neural elements without nerve injury. Epineural ganglion, subcategorized as intraneural extrafascicular ganglion, can be removed without damage to the underlying nerve.