Rong-Min Baek

A new surgical treatment of keloid : Keloid core excision

Keloids and hypertrophic scars result from excessive collagen deposition, the cause of which is not yet known. Unlike hypertrophic scars, keloids frequently persist at the site of injury, often recur after excision and always overgrow the boundaries of the original wound. There have been many trials to control keloids, but most of them have been unsuccessful. The authors propose a new surgical technique to treat keloids and name it keloid core extirpation. They excise the inner fibrous core from the keloid and cover the defect with a keloid rind flap, which is arterialized by the subcapsular vascular plexus. The authors treated 24 keloids of the ear, trunk, face, and genitalia with keloid core excision. Four cases of partial rind flap congestion or necrosis occurred. Those patients who healed primarily after surgery showed no evidence of keloid recurrence as long as they were followed. The authors have found the keloid core extirpation technique to be excellent in preventing keloid recurrence, with no adjuvant therapy after surgery.

Effect of platelet-rich plasma on ultraviolet b-induced skin wrinkles in nude mice

BACKGROUND Platelet-rich plasma (PRP) is researched and used in many clinical fields as it contains an abundance of various growth factors. Recently, a topical injection of PRP has been clinically tried for treatment of photoageing-related skin wrinkles. Nevertheless, there have been only a few studies including objective data or explaining the mechanisms of PRP. Therefore, the authors performed animal experiments to collect laboratory data and to infer the basal mechanism of the effect of PRP on skin rejuvenation. METHODS Mice photoaged by ultraviolet B (UVB) irradiation for 8 weeks were divided into three groups (no-treatment group, saline injected group and PRP-injected group) with 10 mice in each group. After 4 weeks, the degree of wrinkle formation was compared among three groups by replica analysis, and skin biopsies were performed. An additional in vitro assay with growth-factor-neutralising antibodies was performed to evaluate whether growth factors contained in PRP could accelerate fibroblast proliferation and collagen production, which may play a major role in skin rejuvenation. RESULTS The wrinkles in the PRP-injected group were significantly reduced than in the other groups. Biopsy results indicated that the dermal layer was remarkably thicker in the PRP-injection group. In in vitro assay, fibroblast proliferation and collagen production were increased in the experimental group through growth factors in the PRP. CONCLUSION Although more in vivo studies and research about the mechanism of PRP are required, the results of this study indicate that PRP is effective in the rejuvenation of photoaged skin.

Peripheral arterial- bypass grafts in the hand or foot in systemic sclerosis

Although the literature suggests that sympathectomy alone may improve ischaemic digital pain, fingertip ulceration and cold intolerance in vaso-occlusive patients, questions regarding long-term efficacy remain. Two adult patients, aged 42 and 49 years, had severe digital ischaemia and ulceration in a finger and a toe, respectively, and arteriograms confirmed the occlusions of the superficial palmar arch and tarsal arch, respectively. Microsurgical re-vascularisation of the hand and foot and arch reconstruction were performed by using the greater saphenous vein for reconstruction. Following successful vascular reconstruction, digital temperatures, pain and cold sensitivity and health-related quality of life improved significantly. No recurrence has been encountered after X and Y months of follow-up.

Prolongation of the Rat Composite Tissue Allograft Survival by the Combination of Tolerogenic Immature Dendritic Cells and Short-Term Treatment With FK506

OBJECTIVE Prevention of rejection in composite tissue allotransplantation without continuous immunosuppression is of paramount importance in the field of transplantation. Recently dendritic cells (DCs) have gained considerable attention as antigen-presenting cells that are also capable of tolerance induction. This study assessed the effect of interleukin (IL)-10-supplemented, alloantigen-pulsed immature tolerogenic DC to increase survival of orthotopic hind limb transplantations in rats. MATERIALS AND METHODS Hind limbs from Sprague-Dawley (SD) hosts were transplanted to Fischer 344 (F344) rats. Peripheral blood mononuclear cells (PBMC) isolated from F344 were cultured to generate immature DCs (imDCs); IL-10 was added for tolerogenic DC induction. Flow cytometric analysis were performed to characterize the DC phenotype. IL-10-imDCs cocultured with donor mononuclear cells for 24 hours were reinjected into recipients subcutaneously 1 day before transplantation. Recipient animals were divided into 4 groups, each comprising 6 rats (n = 6): group I (untreated controls), group II (IL-10-imDCs alone), group III (FK-506 [Tacrolimus, 2 mg/kg] for 2 weeks postoperative), and group IV (recipient origin IL-10-imDCs combined with FK-506 for 2 weeks postoperative). Observation of graft appearance, cytokine production assays, and confocal immunofluorescence were performed at postoperative 1 week. RESULTS The combination of IL-10-treated imDCs and FK-506 produced a significantly prolonged median allograft survival (46.7 days) compared with groups I (4.7), II (5.3), or III (26.3). Splenocytes isolated from rats treated with IL-10-imDCs plus and FK-506 produced significant amounts of IL-10 and IL-4 cytokines upon alloantigen stimulation, as confirmed using ELISPOT and ELISA. CONCLUSIONS We demonstrated that IL-10-treated imDCs induced T-cell hyporesponsiveness, skewing the immune response to Th2 elements, resulting in long-term survival of composite tissue allografts.

Rhinoplasty using rib chondro-osseous graft in Asian patients.

Corrective rhinoplasty for functional and aesthetic recovery relies much on the use of grafts. This may be effectively accomplished with alloplastic materials; however, certain circumstances mandate the use of autologous grafts. Septal and auricular cartilages are inadequate for dorsal augmentation of the Asian nose. Here, we present our experiences with the correction of nasal deformities using chondro-osseous rib grafts, aiming at anatomic and functional reconstruction of the nose dorsum, especially the keystone area. The deformity was the result of trauma in 16 patients, postrhinoplastic deformities in 7, and congenital deformities in 5 patients. All the patients underwent reconstructive rhinoplasty using the sixth or seventh rib complex graft. Overall, functional and aesthetic outcome was satisfactory in all patients. Rigid bony union, good nasal projection, and symmetry were obtained. Graft exposure, displacement, warping, and significant bone absorption were not observed. The seventh or sixth rib provided not only the greatest overall available length and thickness, but also less donor-site morbidity. In conclusion, using rib bone and cartilage combination graft as a single unit allowed more predictable and reliable reconstruction of the nose deformity than did the conventional dorsal grafts.

Internal carotid artery variations in velocardiofacial syndrome patients and its implications for surgery.

Background: Medially displaced internal carotid arteries in velocardiofacial syndrome carry a risk during pharyngeal flap surgery. This study was designed to evaluate the frequency of medially deviated internal carotid arteries in both velocardiofacial syndrome patients and the general pediatric population and to assess the minimum distance to the pharyngeal walls to define the potential risk of internal carotid artery injury during pharyngeal surgery. Methods: Twenty-three consecutive patients with velocardiofacial syndrome who underwent posterior pharyngeal flap surgery and 21 control subjects who did not have velocardiofacial syndrome but who underwent oropharynx magnetic resonance imaging were reviewed. Results: Medial deviation of at least one internal carotid artery was documented in 10 velocardiofacial syndrome patients (43.5 percent), compared with three patients (14.3 percent) in the control group (p = 0.034). The mean ± SD minimum distance to the posterior pharyngeal wall was 3.78 ± 1.86 mm in velocardiofacial syndrome patients and 9.17 ± 2.94 mm in the control group (p = 0.014). Only one patient had significant medial dislocation of the internal carotid artery, and the closest distance from the pharyngeal wall was 0.86 mm. Conclusions: In velocardiofacial syndrome patients, medial dislocation of the internal carotid artery was common, and the minimum distance to the pharyngeal wall was short compared with the control group. However, in most of the authors’ patients, the course of the cervical portion of the internal carotid artery is irrelevant to pharyngeal flap surgery. The authors conclude that preoperative vascular imaging study is not cost-effective in velocardiofacial syndrome patients but that intraoperative use of ultrasound imaging is still valuable for the purpose of planning pharyngeal flap surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Use of various free flaps in progressive hemifacial atrophy.

ObjectiveRomberg disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue, and bone. Facial asymmetry with soft tissue deficiency in Romberg disease causes a significant disability affecting the social life and can bring about many psychological problems. MethodsThe aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, filler injections, cartilage and bone grafts, and pedicled and free flaps. We report our experiences with 11 patients involving 11 free flaps with a minimum 1-year follow-up. All patients were classified as having moderate to severe atrophy. The average age at disease onset was 4.5 years; the average duration of atrophy was 5.2 years. No patients were operated on with a quiescent interval of less than 1 year. The average age at operation was 20.1 years, ranging from 10 to 55 years. Reconstruction was performed using 4 groin dermofat free flaps, 4 latissimus dorsi muscle free flaps, and 3 other perforator flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le Fort I leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angle plasty, rib and calvarial bone graft, correction of alopecia, and additional fat graft. ResultsAll patients were satisfied with the results. ConclusionsWe believe that a free flap transfer is the requisite treatment modality for severe degree of facial asymmetry in Romberg disease.

The Perilobule Approach to Subcondylar Fractures

Several approaches to the management of subcondylar fractures have been used, including the submandibular approach, the preauricular approach, and the retromandibular approach. Although they provide excellent access to repair fractures of body, ramus, and condyle, we have found it difficult to manage subcondylar fractures using either of these approaches. We describe a novel approach for subcondylar fractures that provides direct access to the fracture site. A total of 17 consecutive patients underwent open reduction and internal fixation of their subcondylar fractures using this technique. The incision line is located just anterior and posterior to the ear lobe, and is comprised of lower part preauricular and upper retroauricular incisions. Intraoperatively, the method applied shortened the time necessary for and simplified the procedure of reduction and osteosynthesis. The postoperative course was uneventful in most patients. Radiologic follow-up revealed correct reduction and fixation in all the cases. There were no occlusal disturbances, no trismus, no lateral deviations of the mandible, and no nerve lesions. Our findings indicate that the short perilobe approach is an easy and safe technique for displaced subcondylar fractures.

An Intermaxillary Fixation Screw Traction Wire: An Aid for Facial Bone Fracture Repair

We have devised a new technique to improve stabilization of fractured facial bone fractures (frontal sinus fractures, zygomatic fractures, mandibular condyle fractures) by intermaxillary fixation screw traction wires (stainless steel wires through intermaxillary fixation screws). A retrospective study evaluating intermaxillary fixation screw traction wires was performed. We have used this technique for 3 cases of frontal sinus fractures, 9 cases of zygomatic fractures, and 7 cases of mandibular condyle fractures. After dissection of a fractured site, a hole is drilled on the fractured bone where it does not interfere with positioning the plate across the fracture line. After an intermaxillary fixation screw is inserted, a stainless steel wire is tied through a hole in the screw head. By the aid of wire for traction, the displaced fractured bone is easily aligned to the proper position. Plates and screws are applied readily on the predetermined area. A retrospective study on 19 patients using intermaxillary fixation screw traction wires was performed. The diagnoses and associated complications of the cases were recorded. No associated complication as a result of using this technique was identified. The use of intermaxillary fixation screw traction wire enhances stabilization and visualization without possible risk for surrounding soft tissue injury using, a sharp traction device like a bone hook. An intermaxillary fixation screw traction wire is an useful aid for visualization and stabilization during facial bone fracture reduction, particularly where exposure is difficult such as in the condylar region of the mandible. And unlike a classic traction wire, the intermaxillary fixation screw traction wire has almost no risk of having it loosened from the screw.

The use of bioabsorbable plate fixation for nasal fractures under local anaesthesia through open lacerations

Nasal fractures are the most common facial fractures. The majority of nasal fractures have been discussed as minor injuries and managed by closed reduction and intranasal packing. However, in cases of a nasal fracture with open laceration on fracture site, the plates fixation may be accomplished with definite reduction through the open laceration. But, metallic reconstruction plates can sometimes produce palpable irregularity at the site of fixation in nasal bone fractures. We performed rigid fixation through open laceration wound with bioabsorbable plate and screws under local anesthesia. Satisfactory result was obtained in both functional and aesthetic aspect. Open reduction through external laceration and bioabsorbable fixation under local anesthesia is a reliable and useful method for the treatment of extensive and comminuted nasal fractures.