• Archives of Plastic Surgery
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• v.32 no.3
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• pp.293-298
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• 2005

Osseointegrated prosthetic auricular reconstruction can be classified as either direct or indirect. In the $Br{\aa}nemark $ system of direct osseointegration, implants are placed into the mastoid process of the temporal bone. In the Epitec system of indirect osseointegration, implants are inserted into a three-dimensional carrier plate that is fixed to the mastoid by means of screws. We experienced forty-four cases using the indirect system and seventeen cases using the direct system. We compared with two systems by complications, such as skin reaction, implant loosening, implant loss. There were no specific differences in the skin reaction around the implants and abutments in relation to age or system used. The degree of skin reaction was different according to the conditions around the implant: in cases of virgin microtia, a skin flap was used to cover the implant, in contrast to grafted skin coverage for failed autogenous reconstruction. In both systems, the skin reaction was more severe and frequent in skin flap than in grafted skin. Loosening of the implant was more frequent in the direct system; however, accidental detachment of the implant from the abutment was more frequent in the indirect system. To reduce complications of skin reaction in osseointegrated prosthetic auricular reconstruction, it is important for soft tissue around implant to immobilize. Therefore, grafted skin is better than skin flap as soft tissue around implant. And immobilization of soft tissue around implant by wound dressing is major facter.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.749-757
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• 2010

Purpose: Since skin sparing mastectomy removes the mammary gland and the nipple-areolar complex preserving all mammary skin, it makes the widespread use of implants in immediate reconstruction. This article reports our experience in immediate breast reconstruction after skin sparing mastectomy by using the silicone implants in patients especially who have small to moderate sized and minimal ptotic breast. Methods: From September of 2007 to July of 2009, we performed breast reconstruction for 44 breasts of 40 women with silicone implant after mastectomy. Tumors were divided into 5 malignant types (21 IDC, 18 DCIS, 2 ILC, 2 phylloides tumor, 1 mucinous carcinoma). The implant is placed in a submuscular pocket or in a submuscularsubfascial pocket depending upon the condition of the muscles and skin flaps after mastectomy. Results: The mean age was 47 years and the average follow-up period was 11 months. Cosmetic outcome was assessed by evaluation of photographs and assessment of breast volume and shape, breast symmetry, and overall outcome. About 80% of each of these parameters was scored as good or excellent. Breast complication was developed in a total of 6 cases including 2 capsular contracture, 2 partial skin necrosis due to blue dye injection and 2 implant infection. Conclusion: The use of definitive implants in a skin sparing mastectomy is a one-stage immediate breast reconstruction with low morbidity and acceptable result. This method is considered reliable with favorable aesthetic result.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.767-772
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• 2009

Purpose: Among reasons for reoperations in augmentation mammoplasty, palpable implant, due to thin skin is relatively common, but not easy to correct, especially if thin skin area is wide. The capsule around the implant is a physiologic response to foreign body, naturally formed, and suitable for use as a flap because of its high vascularity. Authors report that capsular flap is very effective and successful method for correction of implant palpability in secondary breast augmentation. Methods: From September 2007 to September 2008, the capular flaps were performed on 5 patients having palpable and wrinkling breast implants due to very thin skin among the cases on whom secondary augmentation mammaplasty had been performed. After the capsular flap was elevated according to thin skin area, the capsular flap was turned down or over to cover the thin skin area and made the thin skin area thick. Results: Post - implant palpable breast wrinkling had been successfully corrected by capsular flaps and breast implants were not palpable any more during the follow - up period(average 9.2 months). All patients who suffered from deformed breast were satisfied. Conclusion: Authors suggest that the capsular flap is a ideal, effective and useful method in management of implant palpability.

• Archives of Plastic Surgery
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• v.41 no.3
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• pp.258-263
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• 2014

Background For early breast cancer patients, skin-sparing mastectomy or nipple-sparing mastectomy with sentinel lymph node biopsy has become the mainstream treatment for immediate breast reconstruction in possible cases. However, a few cases of skin necrosis caused by methylene blue dye (MBD) used for sentinel lymph node localization have been reported. Methods Immediate breast reconstruction using a silicone implant was performed on 35 breasts of 34 patients after mastectomy. For sentinel lymph node localization, 1% MBD (3 mL) was injected into the subareolar area. The operation site was inspected in the postoperative evaluation. Results Six cases of immediate breast reconstruction using implants were complicated by methylene blue dye. One case of local infection was improved by conservative treatment. In two cases, partial necrosis and wound dehiscence of the incision areas were observed; thus, debridement and closure were performed. Of the three cases of wide skin necrosis, two cases underwent removal of the dead tissue and implants, followed by primary closure. In the other case, the breast implant was salvaged using latissimus dorsi musculocutaneous flap reconstruction. Conclusions The complications were caused by MBD toxicity, which aggravated blood disturbance and skin tension after implant insertion. When planning immediate breast reconstruction using silicone implants, complications of MBD should be discussed in detail prior to surgery, and appropriate management in the event of complications is required.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.529-534
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• 2014

Background In 2012, a new anatomic breast implant of form-stable silicone gel was introduced onto the Korean market. The intended use of this implant is in the area of aesthetic breast surgery, and many reports are promising. Thus far, however, there have been no reports on the use of this implant for breast reconstruction in Korea. We used this breast implant in breast reconstruction surgery and report our early experience. Methods From November 2012 to April 2013, the Natrelle Style 410 form-stable anatomically shaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients for implant breast reconstruction with an acellular dermal matrix. Patients were treated with skin-sparing mastectomies followed by immediate breast reconstruction. Results The mean breast resection volume was 240 mL (range, 83-540 mL). The mean size of the breast implants was 217 mL (range, 125-395 mL). Breast shape outcomes were considered acceptable. Infection and skin thinning occurred in one patient each, and hematoma and seroma did not occur. Three cases of wound dehiscence occurred, one requiring surgical intervention, while the others healed with conservative treatment in one month. Rippling did not occur. So far, complications such as capsular contracture and malrotation of breast implant have not yet arisen. Conclusions By using anatomic breast implants in breast reconstruction, we achieved satisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction.

• Archives of Plastic Surgery
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• v.43 no.1
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• pp.84-87
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• 2016

Titanium micro-mesh implants are widely used in orbital wall reconstructions because they have several advantageous characteristics. However, the rough and irregular marginal spurs of the cut edges of the titanium mesh sheet impede the efficacious and minimally traumatic insertion of the implant, because these spurs may catch or hook the orbital soft tissue, skin, or conjunctiva during the insertion procedure. In order to prevent this problem, we developed an easy method of inserting a titanium micro-mesh, in which it is wrapped with the aseptic transparent plastic film that is used to pack surgical instruments or is attached to one side of the inner suture package. Fifty-four patients underwent orbital wall reconstruction using a transconjunctival or transcutaneous approach. The wrapped implant was easily inserted without catching or injuring the orbital soft tissue, skin, or conjunctiva. In most cases, the implant was inserted in one attempt. Postoperative computed tomographic scans showed excellent placement of the titanium micro-mesh and adequate anatomic reconstruction of the orbital walls. This wrapping insertion method may be useful for making the insertion of titanium micro-mesh implants in the reconstruction of orbital wall fractures easier and less traumatic.

• Archives of Craniofacial Surgery
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• v.20 no.5
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• pp.319-323
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• 2019

Cochlear implant extrusion, which is a common complication of cochlear implants, is generally repaired by a well visualized soft-tissue flap. A 61-year-old female patient with a medical history of schizophrenia who had a skin ulcer that caused cochlear implant extrusion, but that would be a stronger statement was referred to our department for removal of the implant and reconstruction of the resultant scalp defect. Accordingly, the broad defect was covered via rotation of a temporoparietal fascia flap (TPFF) using the superficial temporal artery, with the pedicle in the preauricular region as the pivot point. Coverage of TPFF was achieved with a split-thickness skin graft using the scalp as the donor site, which led to a quick recovery after the operation and satisfactory results in terms of aesthetics. This case suggests that a TPFF might be used as a flexible flap with low donor site morbidity for reconstructing cases of cochlear implant extrusion accompanied by a large full-layer scalp defect.

• The Journal of Advanced Prosthodontics
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• v.5 no.1
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• pp.67-72
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• 2013

Traumatic defects are mostly accompanied by hard and soft tissue loss. This report describes the surgical and prosthetic treatment of a patient with post-traumatic mandibular defect. A split-thickness skin graft was performed prior to implant placement and prefabricated acrylic stent was placed to hold the graft in place. The esthetic and functional demands of the patient were fulfilled by implant-supported screw-retained fixed prosthesis using CAD-CAM technology.

• Journal of Yeungnam Medical Science
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• v.36 no.3
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• pp.201-207
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• 2019

Implant-based breast reconstruction is the most commonly used reconstruction technique after mastectomy. This is because skin-sparing mastectomy has become possible with advancements in oncology. In addition, the development of breast implants and the advent of acellular dermal matrices have reduced postoperative complications and resulted in superior cosmetic results. The most frequently performed surgical breast reconstruction procedure for the past 20 years was the insertion of an implant under the pectoralis major muscle by means of the dual plane approach. However, some patients suffered from pain and animation deformity caused by muscle manipulation. Recently, a prepectoral approach has been used to solve the above problems in select patients, and the results are similar to subpectoral results. However, this technique is not always chosen due to the number of considerations for successful surgery. In this article, we will discuss the emergence of prepectoral breast reconstruction, indications and contraindications, surgical procedures, and outcomes.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.458-464
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• 2011

Purpose: Metacarpal fractures are common hand injury that may require operative intervention to ensure adequate reduction and stabilization. Traditionally, titanium miniplate was used for rigid fixation of bone fractures. However, the use of permanent plate lends itself to multiple complications such as infection, exposure of the hardware, tendon adhesions, tendon rupture, prolonged pain, bony atrophy and osteoporosis (stress shielding), metal sensitization, and palpation under the skin. This study evaluated the usefulness and stability of biodegradable plates and screws for treatment of metacarpal bone fractures. Methods: There was 17 patients who had surgery for metacarpal bone fracture from April 2007 to June 2010. All patients had open reduction and internal fixation. We used absorbable plates and screws (Inion CPS$^{(R)}$) for internal fixation. Postoperative results were assessed with x-ray. Stability of plates and screws, healing process and its complications were observed by clinical and radiographic assessment. Results: All patients were successfully reduced of bone fracture, and fixations with absorbable plates and screws were stable. The mean follow up period was 7.1 months. 2 patients complained postoperative pain, but they were relieved with analgesics. All patients experienced transient stiffness, but they were relieved with active assistive range of motion after removal of splint. No patients suffered complications which could be occurred by using metallic plate. Conclusion: There was no critical complications such as re-fracture or nonunion among patients. No patients suffered side effects related with metallic implants. Biodegradable implants can offer clinically stable and attractive alternative to metallic implants to stabilize metacarpal bone fractures in the hand.