Kihwan Han

Reduction mandibuloplasty: ostectomy of the lateral cortex around the mandibular angle.

Many surgical techniques have been applied toward correcting the prominent mandibular angle. One of the most popular methods is mandibular angle ostectomy. However, gross asymmetry, mandibular condylar fracture, and unnatural contouring of the mandibular angle are frequent consequences. Therefore, we perform ostectomy of the lateral cortex around the mandibular angle in patients with wide and squared lower faces. Seventeen female patients with ages ranging from 23 to 35 years underwent surgery. Ostectomy of the lateral cortex of the mandible and mandible angle ostectomy were performed in five patients (group I). Ostectomy of the lateral cortex only was performed in the remaining 12 patients (group II). The follow-up period ranged from 1 to 5 years. Postoperatively, the bigonial distance was effectively reduced in both groups (group I, mean 13 mm; group II, mean 12 mm). Compared with group I, the gonial angle and mandibular plane-sella-nasion angle were within normal ranges in group II. We therefore conclude that the ostectomy of the lateral cortex alone allows the reduction to be achieved without changing the angle of the mandible itself. Moreover, although the resection of the mandibular angle was not performed, the contour of mandibular angle became soft, giving a more natural appearance.

Comparison of anthropometry with photogrammetry based on a standardized clinical photographic technique using a cephalostat and chair

OBJECTIVES The aim of this study was to standardize clinical photogrammetric techniques, and to compare anthropometry with photogrammetry. MATERIAL AND METHODS To standardize clinical photography, we have developed a photographic cephalostat and chair. We investigated the repeatability of the standardized clinical photogrammetric technique. Then, with 40 landmarks, a total of 96 anthropometric measurement items was obtained from 100 Koreans. Ninety six photogrammetric measurements from the same subjects were also obtained from standardized clinical photographs using Adobe Photoshop version 7.0 (Adobe Systems Corporation, San Jose, CA, USA). The photogrammetric and anthropometric measurement data (mm, degree) were then compared. A coefficient was obtained by dividing the anthropometric measurements by the photogrammetric measurements. RESULTS The repeatability of the standardized photography was statistically significantly high (p=0.463). Among the 96 measurement items, 44 items were reliable; for these items the photogrammetric measurements were not different to the anthropometric measurements. The remaining 52 items must be classified as unreliable. CONCLUSIONS By developing a photographic cephalostat and chair, we have standardized clinical photogrammetric techniques. The reliable set of measurement items can be used as anthropometric measurements. For unreliable measurement items, applying a suitable coefficient to the photogrammetric measurement allows the anthropometric measurement to be obtained indirectly.

Viability of fat cells over time after syringe suction lipectomy: the effects of cryopreservation.

The purpose of this study was to determine the late decline in viability of fat cells over time for fat tissue stored at −15°C and −70°C after harvest from abdominal liposuction. A total of 16 females were recruited for this study. The viability of fat cell specimens was measured after freezing for 1, 3, 7, 14, 28, and 56 days. A number of viable mature adipocytes were evaluated by fluorescence microscopy after staining with fluorescein diacetate and propidium iodide. The glycerol-3-phosphate dehydrogenase activity was measured in lipoaspirates before digestion and the XTT reduction assay was performed. In addition, the XTT reduction assay was also performed on isolated lipocytes and preadipocytes.The viability of mature adipocytes was very low for both the −15°C and −70°C samples after 1 day of freezing (13.3% ± 7.4% and 12.6% ± 6.3%, respectively). There was no statistically significant difference between the samples stored at the 2 temperatures. The GPDH activity of the lipoaspirates frozen, for 1 day, at −15°C and −70°C was 25.1% ± 10% and 28.7% ± 11%, respectively. For the XTT test, the fractional enzyme activity of the lipoaspirates frozen, for 1 day, at −15°C and −70°C was 30.0% ± 10.9% and 36.1% ± 12.3%, respectively. In addition, the adipocytes had low activity from day one: 15.4% ± 7.2% at −15°C and 11.5% ± 5.6% at −70°C. Furthermore, the preadipocytes had a low activity of 8.0% ± 6.0% at −15°C and 8.6% ± 3.8% at −70°C. At 8 weeks, there were few viable mature adipocytes and the activity of the cells was very low by XTT and GPDH testing.The results of this study showed that the viability of adipocytes declined rapidly after frozen storage for 1 day at both −15°C and −70°C, and decreased gradually in storage after 8 weeks; at which time only approximately 5% of the fat cells were alive. These findings suggest that the present fat preservation storage techniques using a −15°C freezer or a −70°C deep freezer are both inadequate to maintain the viability of fat cells.

Large Auricular Chondrocutaneous Composite Graft for Nasal Alar and Columellar Reconstruction

Background Among the various methods for correcting nasal deformity, the composite graft is suitable for the inner and outer reconstruction of the nose in a single stage. In this article, we present our technique for reconstructing the ala and columella using the auricular chondrocutaneous composite graft. Methods From 2004 to 2011, 15 cases of alar and 2 cases of columellar reconstruction employing the chondrocutaneous composite graft were studied, all followed up for 3 to 24 months (average, 13.5 months). All of the patients were reviewed retrospectively for the demographics, graft size, selection of the donor site and outcomes including morbidity and complications. Results The reasons for the deformity were burn scar (n=7), traumatic scar (n=4), smallpox scar (n=4), basal cell carcinoma defect (n=1), and scar contracture (n=1) from implant induced infection. In 5 cases of nostril stricture and 6 cases of alar defect and notching, composite grafts from the helix were used (8.9×12.5 mm). In 4 cases of retracted ala, grafts from the posterior surface of the concha were matched (5×15 mm). For the reconstruction of the columella, we harvested the graft from the posterior scapha (9×13.5 mm). Except one case with partial necrosis and delayed healing due to smoking, the grafts were successful in all of the cases and there was no deformity of the donor site. Conclusions An alar and columellar defect can be reconstructed successfully with a relatively large composite graft without donor site morbidity. The selection of the donor site should be individualized according to the 3-dimensional configuration of the defect.

Treatment of Diabetic Foot Ulcer Using Matriderm In Comparison with a Skin Graft

Background For patients with neuropathy, vasculopathy, and impairment of wound healing, treatment of a diabetic foot ulcer poses many challenges. A large number of dermal analogues have been invented in an effort to overcome these challenges. Matriderm, a dermal analogue, is made from bovine collagen and elastin. This study was conducted in order to evaluate the effectiveness of Matriderm for treatment of diabetic foot ulcers, in comparison with skin grafting. Methods Sixty patients with diabetic foot ulcer were included in this prospective study. The average age of the patients, who had type II diabetes mellitus, was 58 years old. The patients were allocated to an experimental or control group with their consents. The patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a Matriderm appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft. Results A shorter hospitalization period (7.52 weeks) was observed in the experimental group than in the control group (9.22 weeks), and a shorter period of time (8.61 weeks) was required for complete healing, compared with the control group (12.94 weeks), with statistical significance (P<0.05). A higher elasticity ratio of the affected side to the non-affected side was observed in the experimental group, compared with the control group (P<0.01). Conclusions Matriderm enables effective healing and improves elasticity in treatment of patients with diabetic foot ulcer.

Statistical analysis of surgical dog-ear regression.

BACKGROUND Several methods have been developed to prevent or correct dog-ears. Most of these methods, however, result in prolonged scars and operative times. OBJECTIVE We observed dog-ears without correction to examine the regression of dog-ears with time. METHODS The study was performed on 43 cases of dog-ears in 26 patients. Linear regression analysis was performed to examine the correlation between various factors and the height of the dog-ears (%). We produced a regression equation to allow prediction of the height of the dog-ears (%). In addition, we estimated the initial height of the dog-ears that should be removed during surgery. RESULTS The height of dog-ears regressed with time, and this response was better in younger and female patients. It was predicted that the time taken for a dog-ear to reduce to 50% of its original height was 20.697 days; the median time at which dog-ears completely regressed was 132 days. The odds of regression of dog-ears with an initial height of ≤8 mm was 4.667 times greater than that of larger dog-ears. CONCLUSIONS If the height of a dog-ear is ≤8 mm, we recommend observation rather than immediate surgical removal.

Complete septal extension grafts using porous high-density polyethylene sheets for the westernization of the Asian nose.

Background: In Asian rhinoplasty, most patients need correction of the nasal tip and columella along with dorsal augmentation. A complete septal extension graft can effectively and concomitantly correct less projected tips, retracted columellar bases, and acute columella-labial angles. However, the amount of septal cartilage is not sufficient as a source for the graft; therefore, the authors used porous high-density polyethylene sheets as their graft material. Methods: Fifty-eight patients were enrolled in the study between April of 1994 and July of 2001. The authors evaluated a total of 11 measurement items (three for nasal tip, three for columella, two for alar shape or flaring, one for nostril shape, and two for symmetry of the alae and columella) by photogrammetry using standardized clinical photogrammetric techniques. Results: Nasal tip projection, nasal bridge length, height of nose, and columella-labial angle increased significantly during an average follow-up period of 21 months, but nostril axis inclination, columellar length (Rt-Lt), and alar length (Rt-Lt) decreased significantly during the same study period. Implant exposure was noted in two cases, which was resolved by trimming the implants. Minor complications were stiffness of the columella (12 patients), buckling of the implant (nine patients), and excessive columellar show (two patients). Conclusions: A complete septal extension graft resulted in a more projected and caudally lengthened nasal tip; in addition, retracted columella and the acute columella-labial angle were improved aesthetically. Most complications were lower risk and preventable. Therefore, with careful use of porous high-density polyethylene, the authors could modify Asian noses into more Westernized noses. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Evaluation of an Amniotic Membrane-Collagen Dermal Substitute in the Management of Full-Thickness Skin Defects in a Pig

Background To minimize the inflammatory reaction and improve healing, a new modified dermal substitute composed of an atelocollagen, chondroitin-6-sulfate, and amniotic membrane (AM) was applied to full-thickness skin defects in a pig. Atelocollagen was extracted from bovine skin, and two modified dermal substitutes were generated according to the cross-linking type. Methods The AM-collagen dermal substitutes were characterized and compared with currently used dermal substitutes in a pig skin defect model. There were five experimental groups: dehydrothermal (DHT) cross-linking atelocollagen with the AM on the top (AM-DHT), DHT and chemical cross-linking atelocollagen with the AM on the top (AM-DHT/chemical), Terudermis, Integra, and AlloDerm. After 3×3 cm full-thickness skin defects on the back of a pig were created, each dermal substitutes dermal substitutes was randomly grafted on the defects. Two weeks after grafting, autologous partial-thickness skin was over-grafted on the neodermis. The take rate of the dermal substitutes, skin, and histological sections were all assessed at 1, 2, and 4 weeks postoperatively. Results More rapid healing and a higher take rate were evident in the AM-DHT and Terudermis groups. Histological examination revealed fewer inflammatory cells and more fibroblast hyperplasia in these two groups. Four weeks after surgery, the amount of newly formed collagen was significantly more appropriate in the AM-DHT group. Conclusions These observations provide supporting evidence that a newly developed amniotic-collagen dermal substitute may inhibit inflammatory reactions and promote wound healing.

Treatment of Axillary Osmidrosis Using a Subcutaneous Pulsed Nd-YAG Laser

Background Axillary osmidrosis is characterized by an unpleasant odor, profuse sweating, and in some instances, staining of clothes that may socially and psychologically impair affected individuals. Various types of surgical procedures have been developed for the treatment of axillary osmidrosis. This study was undertaken to evaluate the effectiveness of subcutaneous pulsed neodymium: yttrium-aluminum-garnet (Nd-YAG) laser treatment for the treatment of axillary osmidrosis. Methods Twenty-nine patients with axillary osmidrosis were included in this study. Patients were categorized according to the results of an axillary malodor grading system, and a subcutaneous pulsed Nd-YAG laser was applied to all patients. The treatment area for the appropriate distribution of laser energy was determined using the iodine starch test (Minors test) against a grid pattern composed of 2×2 cm squares. The endpoint of exposure was 300 to 500 J for each grid, depending on the preoperative evaluation results. The results were evaluated by measurement of axillary malodor both pre- and postoperatively using the grading system and iodine starch test. Results The average follow-up period was 12.8 months. Nineteen patients had a fair-to-good result and ten patients had poor results. The postoperative Minors test demonstrated that there were remarkable improvements for patients with mild to moderate symptoms. Complications including superficial second degree burns (n=3) were treated in a conservative manner. A deep second degree burn (n=1) was treated by a surgical procedure. Conclusions Subcutaneous pulsed Nd-YAG laser has many advantages and is an effective noninvasive treatment for mild to moderate axillary osmidrosis.

Comparison of endoscopic endonasal reduction and transcaruncular reduction for the treatment of medial orbital wall fractures.

Currently, endoscopic endonasal reduction and transcaruncular reduction are frequently used as surgical treatments for medial orbital wall fractures. However, these 2 surgical techniques have not been comprehensively compared using objective criteria. Therefore, the results of these 2 techniques were compared retrospectively using 8 objective criteria in patients with medial orbital wall fracture. This study included 48 medial orbital wall fracture patients treated from June 1993 to July 2006: 29 had endoscopic endonasal reduction and 19 had transcaruncular reduction. Computed tomographic scans, double vision field testing for diplopia using Goldmann perimetry, and Hertel exophthalmometer (Richmond Products, Albuquerque, NM) were done pre- and postsurgery. The average follow-up period was 70.8 months. Among patients with pure medial orbital wall fractures, the average reduction rate was 89.2% for the endoscopic endonasal reduction group and 90.7% for the transcaruncular reduction group. One case in the endoscopic endonasal reduction group had a more than 2-mm enophthalmos after surgery. The diplopia correction rate was 1.8% in the endoscopic endonasal reduction group and 2.7% in the transcaruncular reduction group. None of the above differences was statistically significant. However, among patients with pure medial orbital wall fractures compared with the transcaruncular reduction group, the average operation time, the average hospital stay, and the average cost were significantly greater in the endoscopic endonasal reduction group. The 2 surgical methods had a similar effectiveness; however, transcaruncular reduction seemed to be more advantageous with respect to the operation time, the length of hospital stay, and cost.