Jung Hyun Seul

New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications.

Background: Many studies have revealed facts about the anatomy of the medial sural artery perforator. The exact locations or areas where the perforators pierce through the fascia, however, have not been clearly identified. Methods: Based on cadaver dissections performed on 40 legs from 20 cadavers, the authors identified the location of the first and second perforators of the medial sural artery. The passages of the medial sural artery perforators were also confirmed by means of duplex-Doppler scanning, three-dimensional computed tomography, and angiography. Results: The authors found that the main perforators of the medial sural artery were located on a line drawn from the midpoint of the popliteal crease to the midpoint of the medial malleolus. The hip joint was flexed in supine position and the knee joint was flexed into a 90-degree angle, thus making it possible to observe the first perforator, which was approximately 8 cm from the midpoint of the popliteal crease, and the second perforator, which was approximately 15 cm from the popliteal crease. A series of 21 clinical cases with soft-tissue defects were successfully treated using the medial sural artery perforator flap, including 18 free flaps and three pedicled flaps. There were seven cases of hand reconstruction and 14 cases of lower extremity reconstruction. Conclusions: Until now, it has been a general belief that the exact location of a perforator cannot be predicted. The authors, however, have found that the first perforator was located almost 8 cm from the midpoint of the popliteal crease within the distal half circle drawn with a radius of 2 cm. Because this study made it possible to prepare a diagram of the exact location of the medial sural perforators, it is expected that more professionals will use this method for hand and facial reconstructions in the future.

A new repair technique for penile paraffinoma : Bilateral scrotal flaps

Although worldwide incidence is not well known, foreign-body injection is often attempted in order to increase the circumference of the penile shaft. Paraffin, Vaseline, and other materials are injected into the penile skin by the patient himself or by untrained persons who practice medicine fraudulently. Complications usually follow, such as penile deformity, skin necrosis, limited erectile function, and the inability to have intercourse. Definitive treatment of these patients includes the complete removal of skin and subcutaneous tissue infiltrated by the foreign material. Sometimes, complete removal of the foreign material may not be possible and may leave permanent foreign-body granuloma on the corpus cavernosum and/or corpus spongiosum. The remaining foreign material does not permit skin-graft coverage, which is a simple and effective method of resurfacing. In such cases, we tried a new technique comprised of bilateral scrotal flaps to provide for reliable and stable coverage. The scrotal skin, which has high elasticity, seems to be a good material for penile coverage, despite its hairy nature. In our experience, exclusively with Korean males, the scrotal hair has a low density and does not seem to cause serious problems, but patients with hirsute scrota may be contraindicated. Since 1993, 17 patients with penile paraffinoma have been treated using the bilateral scrotal flap method. All 34 flaps survived completely and the reconstructed penis had immediate postoperative tactile sensibility. The results were successful and without any major complications.

Central Lip Lift as Aesthetic and Physiognomic Plastic Surgery: The Effect on Lower Facial Profile

BACKGROUND A central lip lift was introduced to Westerners in 1980s. However, no studies have been conducted on the facial aesthetic and physiognomic perspectives of a central lip lift in the Asian population. OBJECTIVES The authors presented the central lip lift as aesthetic and physiognomic treatment in Asians and explained its effect on lower facial profile. METHODS A retrospective chart review was performed in 202 cases of asians. The authors analyzed patient age, cause of long philtrum, purpose of the treatment, and postoperative satisfaction. The authors then performed an anthropometric assessment and a photographic analysis. RESULTS The vertical disproportion of the lower face was improved after the treatment, and there was significant shortening of the philtrum length (P < .001) and an increase in a visible upper vermilion (P < .001). In Westerners, a long philtrum was mainly caused by the aging process. Aging patients (range, 40-59 years) underwent the central lip lift for upper lip rejuvenation. In contrast, in Asia, a long philtrum was primarily caused by bone retraction after an orthognathic surgery or orthodontic procedure. Young patients (range, 20-39 years old) underwent the central lip lift to correct a relatively lengthened philtrum after 2-jaw surgery. Furthermore, about half of the patients (52.0%) underwent the central lip lift for facial physiognomic improvement. CONCLUSIONS In todays multiracial society, plastic surgeons planning a central lip lift in Asian patients should consider both aesthetic and physiognomic perspectives. Regardless of the aesthetic outcome, the surgeon should strive to maximize patient satisfaction. LEVEL OF EVIDENCE 4 Therapeutic.

Reconstruction of Midface Defect with Latissimus Dorsi Myocutaneous Free Flap

We report 2 cases of midface defect reconstructed with latissimus dorsi myocutaneous free flap. In these cases, the main points to cover the defects were as follows ; 1. For the contour of zygoma and maxilla, it was well preserved without bone graft which was not used for second stage reconstruction. In first case, for application of artificial eye and in second case, for, operation after full development. 2. For the drainage of paranasal sinuses, we made the nostril with skin graft, and it was well preserved without any complications during follow up. 3. It was sufficient to cover the defect with latissimus dorsi muscle well designed before surgery and thick enough to fill the defect. 4. In second case, the remained defect of palate and maxilla was not covered for the appropriate reconstructions after full development. In conclusions, we experienced two cases of midface defect reconstructed with latissimus dorsi myocutaneous free flap without any complication and with good results.

Augumentation Rhinoplasty Using Autogenous Cranial Bone Graft

Augumentation rhinoplasty using autogenous cranial bone graft(outer table)can be used more successfully than other methods. In patients with congenital or posttraumatic severe saddle nose deformity and lateral deviation, cranial bone graft is an excellent method of augumentation. The adventages of cranial bone graft compaired with traditional method of bone graft are summarized as follows ; 1. easy to reach donor site 2. abundance of materal 3. little pain and functional disability 4. shorter hospitalization period 5. unconspicuous donor scar 6. no secondary deformity of donor site 7. appropriate curvature can be obtained by proper selection of donor site. With the above advantages, we conclude that augumentation rhinoplasty using split cranial bone graft is a good method in correction of congenital or posttraumatic deformity of nose.