• Archives of Plastic Surgery
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• v.33 no.5
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• pp.659-662
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• 2006

Purpose: Alloplastic implants, such as methylmethacrylate, Teflon, silicone, Supramid are commonly used to cover the floor defect and to prevent reherniation of the displaced orbital tissue in orbital floor fracture. Silicone implant has been used for reconstruction of orbital wall defects because of pliability, advantage of carving and chemically inert nature. However, silicone implant also has complications including infection, extrusion, pain, dystopia and tissue reaction. Cyst formation around the silicone implant is a very rare complication. According to many reports, cysts around alloplastic implant in an orbital area are mostly hemorrhagic cysts consisted of blood breakdown product with fibrous capsule cell in histologic examination. Methods: The authors report atypical case and successful treatment of intraorbital hemorrhagic cyst around silicone implant of a 37-year-old male patient. Results: Preoperative symptoms of diplopia, exophthalmos, proptosis, vertical dystopia and ectropion of lower eyelid were resolved after surgical removal of implants with surrounding capsule. Conclusion: Clinical suspicion of plastic surgeon is important in diagnosis of intraorbital cyst of patients who have history of silicone implantation and computed tomography is the standard tool of diagnosis. During the operation, caution must be taken on delivering the whole capsule of intraorbital cyst along with silicone implant to prevent recurrence of the cyst.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.748-752
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• 2006

Purpose:Circular skin lesions between 10 and 35 mm in diameter generate problems often. Direct closure of the lesion risks excessive wound tension or wound dehiscence. Skin grafts heal slowly and often remain unsightly. Traditional skin flaps have a limited role. We treated this circular medium-sized skin lesion(10 - 35 mm sized) by reducing opposed multilobed(ROM) flap. Methods: ROM flap involves a series of semicircular lobes extending both cephalic and caudal from the defect. Direction of the semicircular multilobed flap is set parallel to relaxed skin tension line(RSTL) to minimize scar formation. First semicircle is drawn 60% in diameter of the defect. Second semicircles are drawn at the cephalic and caudal aspects of the original semicircles. These semicircles are 60% in diameter of the first semicircle. Additional semicircles are repeatedly drawn until the tension of skin flaps becomes free. ROM flap has a length-to-base ratio of 0.5 resulting in lower theoretical risk of end flap necrosis than a random pattern flap with a large ratio. The technique involves lobes most distant from the primary defect being transposed in turn closer to the defect. Results: The ROM flap reduces skin tension concerns, lowers the risk of flap necrosis and allows for quicker and more aesthetic healing. Results were generally good and major complications, such as dehiscence, infection, or delayed healing, did not occur. Conclusion: ROM flap repair allows the plastic surgeon an additional option when faced with a circular medium-sized skin lesion.

• Archives of Plastic Surgery
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• v.43 no.2
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• pp.160-171
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• 2016

Background The objective of this study was to assess the attractive facial features of the Indian population. We tried to evaluate subjective ratings of facial attractiveness and identify which facial aesthetic subunits were important for facial attractiveness. Methods A cross-sectional study was conducted of 150 samples (referred to as candidates). Frontal photographs were analyzed. An orthodontist, a prosthodontist, an oral surgeon, a dentist, an artist, a photographer and two laymen (estimators) subjectively evaluated candidates' faces using visual analog scale (VAS) scores. As an objective method for facial analysis, we used balanced angular proportional analysis (BAPA). Using SAS 10.1 (SAS Institute Inc.), the Turkey's studentized range test and Pearson correlation analysis were performed to detect between-group differences in VAS scores (Experiment 1), to identify correlations between VAS scores and BAPA scores (Experiment 2), and to analyze the characteristic features of facial attractiveness and gender differences (Experiment 3); the significance level was set at P=0.05. Results Experiment 1 revealed some differences in VAS scores according to professional characteristics. In Experiment 2, BAPA scores were found to behave similarly to subjective ratings of facial beauty, but showed a relatively weak correlation coefficient with the VAS scores. Experiment 3 found that the decisive factors for facial attractiveness were different for men and women. Composite images of attractive Indian male and female faces were constructed. Conclusions Our photogrammetric study, statistical analysis, and average composite faces of an Indian population provide valuable information about subjective perceptions of facial beauty and attractive facial structures in the Indian population.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.803-807
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• 2011

Purpose: The safety of radiation therapy after breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap is still being debated, and few studies exist on the outcome of irradiation after immediate TRAM breast reconstruction. Some authors presented satisfactory outcomes after adjuvant radiation therapy on reconstructed breast with pedicled TRAM flap, while others reported significant post radiation changes of the flap. Effect of radiation therapy on TRAM flap was evaluated to see whether adjuvant radiation therapy was tolerable. Methods: 1000 immediate TRAM breast reconstruction was done by a single surgeon from July, 2001 to December, 2009. Among them 105 patients required adjuvant radiation therapy because of advanced disease or locoregional recurrence. Fat necrosis, radiation fibrosis, mastectomy skin flap necrosis, need for secondary touch up procedures, patient satisfaction were evaluated. Results: The incidence of fat necrosis was 10.5% and significant radiation fibrosis occurred in only one patient. Delayed wound problem did not occur during or after irradiation. Secondary touch-up procedures were performed in 12.3%, the most common being fat graft (8.6%). Average patient satisfaction score was 8.62/10, which was not significantly different from the authors' previous report involving all the TRAM patients (8.50). Conclusion: Radiation therapy did not increase the complication rate significantly. Aesthetic result was affected but was tolerated in most cases. The fear of adjuvant radiation is not a negative factor in selecting immediate breast reconstruction with TRAM flap.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.499-503
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• 1995

Since the insertion of self expandable metalic stent[SEMS has became popular method for hollow organ stenosis, many attempts for further apply the stent to airway stenosis as an simple procedure has been made, but intrabronchial migration of stent or occurrence of inflammatory granuloma around stent develop occasionally and sometimes it worsen bronchial stenosis further more. This report describes 2 case of surgically treated bronchial restenosis in whom intrabronchial stent were applied for release of bronchial stenosis. Our surgical option was pneumonectomy and bronchoplasty with sleeve right middle and upper lobectomy respectively. During the operation we found the SEMSs were tightly impacted in restenotic bronchial lumen with overgrowth of granulation tissues. The bronchial obstructions occupied more than 90% of lumens in both cases, and needed much complicated procedure to be relieved. Therefore, even though the insertion of SEMS remains as a prcedure determined by the physician`s preference, it has to be considered prudently that the use of SEMS can cause severe restenosis and the surgeon has more difficulties in performing segmental resection of restenotic bronchus in patient with SEMS previously inserted. Throughout these experiences we can conclude that the insertion of SEMS must be performed only in very selected cases of bronchial stenosis.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.210-215
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• 2001

Objectives: Salivary gland neoplasms are a diverse group of benign and malignant tumors with a wide range of biologic behaviors. The surgeon must understand the pathologic behavior of each tumor type to develop an appropriate treatment plan. The authors planned this study to evaluate our clinical experiences and establish a new treatment strategy. Materials and Methods: From Sep. 1997 to June 2001, 25 cases of major salivary gland tumors which were underwent surgery were evaluated retrospectively. Results: 20 cases were benign and 5 were malignant. Most(17) of benign cases were pleomorphic adenoma and they showed wide distribution in age. Also we experienced other benign such as warthin's tumor, oncocytoma. In malignant, there were 2 cases of carcinoma ex-pleomorphic adenoma, 2 cases of adenoid cystic carcinoma, and one lymphoma. In carcinoma ex-pleomorphic adenoma, one showed dismal prognosis in spite of multimodality and the other were recurrent to be salvaged. Conclusion: We concluded that salivary gland neoplasms are challenging because of their relative infrequency, inconsistent classification, and highly variable biologic behavior. We need to establish new effective strategies with the regard of factors influencing survival.

• Journal of Yeungnam Medical Science
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• v.37 no.1
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• pp.32-39
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• 2020

Background: Rhinoplasty is one of the most commonly performed cosmetic surgery procedures. Most Asians desire elevation of their relatively flat nasal dorsum and tip to make them appear more prominent. This study introduces a simple method of nasal tip plasty using three-dimensional (3D)-printed polycaprolactone (PCL) (Smart Ball^®), which provides the required length and volume for this purpose and enables the creation of a nasal tip of the desired shape in a safe and simple manner. Methods: Between September 2014 and May 2017, 22 patients participated in a survey to assess postoperative satisfaction levels. Additionally, three plastic surgeons compared patients' pre- and 1-year postoperative photographs to evaluate the results. All patients underwent 2- to 4-year postoperative follow-up. Results: Levels of subjective satisfaction among patients were 3.59, 3.50, 3.82, 3.73, 3.55, and 3.82 for each of the 6 categories evaluated, with a mean of 3.67/4 points, indicating high satisfaction levels. The mean plastic surgeon-reported score for the 22 patients was 4.47/5 points, which also indicates highly successful outcomes. Postoperative nasal tip rotation and tip projection were ideal in most patients. Conclusion: Our novel method using 3D-printed PCL (Smart Ball^®) provides the optimal length and volume required for nasal tip plasty and enables the creation of a nasal tip of the desired shape, in a safe and simple manner. An advantage of our method is that it retains the original nasal structure in contrast to structural changes observed with the use of conventional methods.

• Quality Improvement in Health Care
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• v.2 no.2
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• pp.32-45
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• 1996

Background : A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment. Methods: For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy. Result : Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education. Conclusion : From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.388-391
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• 2007

Objective : The focus of aneurysm surgery is eliminating unnecessary operative manipulations and preparing the surgeon for any crises that might arise. With this concept in mind, we have tried resection of the gyrus rectus without routine sylvian fissure dissection in selected patients with anterior communicating artery (ACom) aneurysms, and compared these results with those from the conventional transsylvian approach. Methods : This retrospective study included 231 surgically treated patients with ACom aneurysms from March, 1997 to May, 2005. The patients were divided into two groups : Group A (96 with sylvian fissure dissection, March, 1997-December, 2000) and Group B (135 without sylvian fissure dissection, January, 2001-May, 2005). Overall surgical outcomes were compared, and operative times have been prospectively recorded since January, 04 to evaluate how this maneuver affected the length of surgical procedures. Results : All aneurysms were satisfactorily clipped, and there was no evidence of increased number of procedure-related retraction injuries in group B. Overall outcome was good in 186 (80.5%); 76 (79.2%) in group A, and 110 (815%) in group B ($x^2$ test, p=0.79). In good clinical grade of group A, good outcome was observed in 60 patients (89.6%) and in group B, 97 patients (94.2%) (Fisher's exact test, p=0.38) (Fig. 2). Conclusion : In this study, eliminating the step of sylvian fissure dissection by gentle lateral basal-frontal retraction to the side of the sylvian fissure did not increase morbidity and mortality. However, we do not intend to modify the standard approach to the ACom aneurysm that is familiar to and has been mastered by many others. Rather, we report our experience on the basis of our anatomic understanding of the technique and its results.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.179-183
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• 1986

The frozen section technique is a means of intraoperative pathological diagnosis, and a procedure of great value to the surgeon. This method should be accurate, rapid and reliable. This method serves useful purposes, such as determining the presence of tumor, its type(especially whether it is benign or malignant), the adequacy of a biopsy of a suspected lesion, and the conditions of the surgical margins. But, it bears many disadvantages, the most of which is the danger of incorrect diagnosis. We studied the indications, the limitations, and the accuracy of the frozen section method and the materials studies was total of frozen section during recent 3 years. The overall accuracy of the frozen section diagnosis of 809 cases was 98.1% with 0.5% of false negative, 0% of false positive, 0.5% of incorrect histological diagnosis or grading errors, and 0.9% of deferred cases. The tissues submitted were lymph node, gastrointestinal tract, skin subcutaneous tissues in decreasing oder of frequency. The false positive case is not present, while the false negative cases were 4.