Keun-Cheol Lee

Mesenchymal stem cells overexpressing GCP-2 improve heart function through enhanced angiogenic properties in a myocardial infarction model

AIMS In this study, our aim was to evaluate the angio-vasculogenic properties of human adipose tissue-derived mesenchymal stem cells overexpressing the granulocyte chemotactic protein (GCP)-2 (hASCs/GCP-2) and to determine possible therapeutic effects in an experimental ischaemic heart model. METHODS AND RESULTS Quantitative real-time (qRT)-PCR results revealed that hASCs/GCP-2 expressed significantly higher levels of pro-angiogenic genes, including vascular endothelial growth factor (VEGF)-A, hepatocyte growth factor (HGF), and interleukin (IL)-8, when compared with control-vector transduced hASCs or human umbilical vascular endothelial cells (HUVECs). In addition, the anti-apoptotic insulin-like growth factor (IGF)-1 and Akt-1 were also highly up-regulated in the hASCs/GCP-2 cells. In vitro cell migration and proliferation assays showed that hASCs/GCP-2-derived conditioned media (CM) significantly accelerated the migration and proliferation of fibroblast cells. Examination of in vitro endothelial differentiation showed that hASCs/GCP-2 cells spontaneously formed vascular-like structures and highly expressed endothelial-specific genes and proteins. In vivo study results of our mouse myocardial infarction (MI) model revealed that hASCs/GCP-2 implantation improved the cardiac function and reduced the infarct size. Finally, transplanted hASCs/GCP-2 cells unexpectedly differentiated into endothelial cells and the engraftment rate was significantly higher than control groups. CONCLUSION We suggest that overexpression of GCP-2 in stem cells has the potential to enhance their angiogenic and survival properties.

Primary correction of unilateral cleft lip nasal deformity in Asian patients: anthropometric evaluation.

Previously it was thought that primary correction of nasal deformity in cleft lip patients would cause developmental impairment of the nose. It is now widely accepted that simultaneous correction of the cleft lip nasal deformity has no adverse effect on nasal growth. Thus, the authors tried to evaluate the results of primary correction of cleft lip in Asian patients. Of 412 cases of cleft lip, 195 cases were corrected by means of the conventional method from June of 1992 to June of 1997, and 217 cases were corrected by simultaneous rhinoplasty from July of 1997 to October of 2001. The average patient age was 3 months. Photographs and anthropometric evaluation were used to evaluate the results. Nasal tip projection, columellar length, and nasal width were measured in 60 randomized normal children, 30 randomized children treated with the conventional method, and 30 randomized children with primary nasal repair. Data were analyzed using t tests, and the level of significance was 5 percent (p < 0.05). In cases of simultaneous repair, nasal tip projection and columellar length were increased 24.8 percent and 28.8 percent, respectively. Nasal width was increased 12.3 percent in the cases of simultaneous repair and 12.6 percent in the cases without primary rhinoplasty. Simultaneous repair of cleft lip and nasal deformity in Asian patients showed that more symmetry of nostril and nasal dome projection and better correction of buckling and alar flaring were achieved. More balanced growth and development of the alar complex was achieved, and no interference with nasal growth was encountered.

Reduction malarplasty by 3-mm percutaneous osteotomy

Oriental people usually have a wide midface and a prominent malar curve. The zygomatic bone forms the prominence of the cheek, and it is the most important part in determining the ideal oval shape of the face on the frontal view and the character of the oblique profile. Therefore, zygoma contouring is commonly performed. Women with a prominent zygoma have an inferiority complex associated with unattractive facial features resembling aged, melancholic, and strong characters in oriental culture. Zygoma is the highlighted area of the midface and a major determinant of midfacial shape, but harmony with the adjacent area is very important. Therefore, to obtain the optimal outcome of reduction malarplasty, various ancillary procedures must be performed simultaneously. The authors performed 30 reduction malarplasties during the past 2 years. The amount of bone to be removed was determined by the preoperative interview, physical examination, and x-rays. Intraoral incisions provided access to the zygomatic body and lateral orbital rim. After the L-shaped osteotomy, two parallel vertical and transverse osteotomies in the medial part of the zygomatic body, the midsegment was removed. The posterior portion of the zygomatic arch was approached through a stab incision in the preauricular area. A 3-mm osteotome was used. After completion of the osteotomy, the movable zygomatic complex was reduced medially and superiorly, then fixed with miniplates and screws on the zygmaticomaxillary buttress. The combined operations with reduction malarplasty were as follows: reduction of the mandibular angle in 15 cases, rhinoplasty in 14 cases, and double-fold operation in 11 cases. The follow-up period was 2 months to 2 years, and all the patients were satisfied with the results. In conclusion, this method is a very simple, easy, and safe method that reduces the operating time to 1 h and minimizes postoperative edema and swelling. Consequently, recovery time is relatively short, and no conspicuous scars in the preauricular area are left. The authors also performed many ancillary procedures, thereby obtaining optimal satisfaction with their results, including decreased facial width and superior mobilization of the prominent area. They were able to prevent postoperative cheek drooping, and to give the patients a more youthful, charming look.

Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals

Gender reassignment operations in female-to-male transsexuals are increasing in number as the skill of phalloplasty develops. The authors are performing phalloplasty 1 year after undergoing mastectomy, reduction of nipples, oophrectomy and hysterectomy in female-to-male transsexuals. The ideal penile reconstruction should be a single-stage procedure, creating a phallus with both tactile and erogenous sensibility, water-tight neourethra allowing for voiding in the standing position, enough bulk with stiffness, and an aesthetically acceptable appearance. We performed phalloplasty with radial forearm osteocutaneous free flaps on 40 female-to-male transsexual patients from March 1991 to December 2005. We investigated the results with regard to aesthetic and functional status and complications through physical examinations and interviews over a period of 14 years. The results are as follows: In conclusion, we have been able to construct a good phallus with radial forearm osteocutaneous free flaps that is aesthetically and functionally acceptable. In addition, complications have been minimal.

Nasal tip plasty using various techniques in rhinoplasty.

Rhinoplasty is one of the most common aesthetic surgical procedures in Korea today. However, simple augmentation rhinoplasty results often failed to satisfy the high expectations of patients. As a result, many procedures have been developed to improve the appearance of the nasal tip and nasal projection. However, the characteristics of Korean nasal tips including the bulbous appearance (attributable to the thickness of the skin), flared nostrils, and restriction of the nasal tip attributable to an underdeveloped medical crus of the alar cartilage and a short columella have made such procedures difficult. Currently, most plastic surgeons perform rhinoplasty simultaneously with various nasal tip plasty techniques to improve the surgical results. An important part of an aesthetically pleasing result is to ensure an adequate nasal tip positioned slightly higher than the proper dorsum, with the two tip defining points in close proximity to each other, giving the nose a triangular shape from the caudal view. From June 2002 to November 2003, the authors performed rhinoplasty with simultaneous nasal tip plasty using various techniques according to the tip status of 55 patients (25 deviated noses, 9 broad noses, 15 low noses, and 6 secondary cleft lip and nose deformities). The surgery included realignment of alar cartilage by resection and suture, fibroareolar and subcutaneous tissue resection, tip graft, and columellar strut. The postoperative results over an average period of 10 months were entirely satisfactory. There were no patient complaints, nor complications resulting from the procedures. Good nasal tip projection, natural columellar appearance, and improvement of the nasolabial angle were achieved for most patients. In conclusion, rhinoplasty with simultaneous nasal tip plasty, achieved by a variety of techniques according to patients’ tip status, is an effective method for improving the appearance of the nose and satisfying the desires of the patients.

A new method of urethroplasty for prevention of fistula in female-to-male gender reassignment surgery.

One of the primary goals of the phalloplasty for female-to-male transsexuals is to gain the voiding ability in the standing position. However, achieving the competence of urethra, sensation and rigidity of the neophallus is still a significant challenge. Serious complications such as urethral fistula, obstruction and stricture were encountered in this surgery. In experienced hands, this seems to be associated with urethroplasty technique. The authors performed phalloplasty with radial forearm osteocutaneous free flap method in 70 patients of female-to-male transsexuals. In 38 cases which were enrolled before 2001, we had carried out the urethroplasty by our own method, but since 2001, we have applied the modified method of urethroplasty to reduce the incidence of urethrocutaneous fistula. Thirty-four cases have undergone a new modified method of ours. For construction of the urethra, an anteriorly based vaginal wall flap and labium minoral flaps were used in this technique. In our new method series, 1 case (1.4%) of flap loss occurred after phalloplasty. The incidence of urethrocutaneous fistula was 30%. Before the year 2001, of 38 patients, there were 14 cases (36.8%) who developed urethrocutaneous fistula. On the other hand, 7 of 32 patients (21.9%) who underwent urethroplasty by the modified labium minoral flap and anteriorly based vaginal flap had urethrocutaneous fistula after 2001. One-stage total phalloplasty and urethroplasty is associated with a significant increase of urethral fistula and obstruction. However, the urethrocutaneous fistula at the level of the female external urethral orifice can be successfully reduced using this new method.

Mulliken method of bilateral cleft lip repair: anthropometric evaluation.

Background: Simultaneous surgical correction of bilateral cleft lip and nasal deformity is becoming more common. This is a major change from the conventional strategy of secondary nasal correction. Methods: Thirty patients with bilateral cleft lip and nasal deformity were repaired using the Mulliken method between July of 1997 and December of 2002. This series was composed of 10 infants with bilateral complete cleft lip, 12 with bilateral incomplete cleft lip, and eight with bilateral asymmetric cleft lip, defined as complete on one side and incomplete on the other. A preoperative orthopedic appliance was employed in five infants who had severe collapse of the lateral maxillary segments. Mean age at the time of repair was 3.8 months. Result: Postoperative results were evaluated anthropometrically. The mean follow-up period was 3.8 years (range, 1.2 to 5.5 years). Nasal tip protrusion was low; interalar dimension was wide; columellar length was slightly short; upper cutaneous labial height was short; and vermilion-mucosal height was near normal. All anthropometric values approached controls by 5 years. Conclusion: Our modified Mullikenmethod is effective in correction of all forms of bilateral cleft lip and nasal deformity. Further evaluation is needed for possible differences in outcome based on race and age at the time of operation.

Problems Associated with Alloplastic Materials in Rhinoplasty

Purpose Augmentation rhinoplasty using alloplastic materials is a relatively common procedure among Asians. Silicon, expanded polytetrafluoroethylene (Gore-tex®), and porous high density polyethylene (Medpor®) are most frequently used materials. This study was conducted to analyze revisional rhinoplasty cases with alloplastic materials, and to investigate the usage of alloplastic materials and their complications. We also reviewed complications caused by various materials used in plastic surgery while operating rhinoplasty. Materials and Methods We report 581 cases of complications rhinoplasty with alloplastic implants and review of the literature available to offer plastic surgeons an overview on alloplastic implant-related complications. Results Among a total 581 revisional rhinoplasty cases reviewed, the alloplastic materials used were silicone implants in 376, Gore-tex® in 183, and Medpor® in 22 cases. Revision cases and complications differed according to each alloplastic implant. Conclusion Optimal alloplastic implants should be used in nasal structure by taking into account the properties of the materials for the goal of minimizing their complications and revision rates. A thorough understanding of the mechanism involved in alloplastic material interaction and wound healing is the top priority in successfully overcoming alloplastic-related complications.

Foreign Body Removal and Immediate Nasal Reconstruction with Superficial Temporal Fascia

For nasal augmentation, various materials have been used for many years. The injection of foreign body has been carried on, although it is performed mostly by laymen. Because many complications arise after augmentation rhinoplasty by foreign body injection, secondary correction has been needed. These complications have included headaches, swelling, redness, palpable mass, skin discoloration, telangiectasia and fear of cancer. The authors treated 10 patients who had undergone injection of foreign body to the nose. After the foreign body was removed, we immediately reconstructed nasal deformity by silicone implant wrapping with superficial temporal fascia. This method has many advantages including easy contouring of nasal shape and fixation, absence of foreign body reaction, reduced inflammatory reaction, no or minimal concerns regarding the migration or extrusion of the implants, and nonvisible donor scar. The mean follow-up period was 8 months, and no complications occurred. The authors conclude that nasal deformity can be successfully reconstructed immediately using silicone implant wrapping with superficial temporal fascia after foreign body is removed from the nose. In the authors’ experience, this procedure has improved aesthetic appearance and met patients’ expectations.

Perceptual Speech Assessment after Maxillary Advancement Osteotomy in Patients with a Repaired Cleft Lip and Palate

Background Maxillary hypoplasia refers to a deficiency in the growth of the maxilla commonly seen in patients with a repaired cleft palate. Those who develop maxillary hypoplasia can be offered a repositioning of the maxilla to a functional and esthetic position. Velopharyngeal dysfunction is one of the important problems affecting speech after maxillary advancement surgery. The aim of this study was to investigate the impact of maxillary advancement on repaired cleft palate patients without preoperative deterioration in speech compared with non-cleft palate patients. Methods Eighteen patients underwent Le Fort I osteotomy between 2005 and 2011. One patient was excluded due to preoperative deterioration in speech. Eight repaired cleft palate patients belonged to group A, and 9 non-cleft palate patients belonged to group B. Speech assessments were performed preoperatively and postoperatively by using a speech screening protocol that consisted of a list of single words designed by Ok-Ran Jung. Wilcoxon signed rank test was used to determine if there were significant differences between the preoperative and postoperative outcomes in each group A and B. And Mann-Whitney U test was used to determine if there were significant differences in the change of score between groups A and B. Results No patients had any noticeable change in speech production on perceptual assessment after maxillary advancement in our study. Furthermore, there were no significant differences between groups A and B. Conclusions Repaired cleft palate patients without preoperative velopharyngeal dysfunction would not have greater risk of deterioration of velopharyngeal function after maxillary advancement compared to non-cleft palate patients.