Seung Min Nam

Does Fibrin Sealant Reduce Seroma after Immediate Breast Reconstruction Utilizing a Latissimus Dorsi Myocutaneous Flap

Background The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation. We investigated any statistically significant differences in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of the latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction after skin-sparing partial mastectomy. Methods A total of 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedure without fibrin sealant and the other 23 were administered the fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed to evaluate the potential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U test were used for analyzing the drainage volume according to age, weight of the breast specimen, and body mass index. Results Although not statistically significant, the cumulative drainage fluid volume was higher in the control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage beginning on postoperative day 3. The donor site comparisons showed the fibrin sealant group had more drainage beginning on postoperative day 3 and the drain was removed 1 day earlier in the control group. Conclusions The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with patients before its use as a part of informed consent.

Real-time navigation-assisted orthognathic surgery.

Background One limitation of orthognathic surgery is the narrow surgical field, which makes it difficult to view the operative site directly. Thus, many perioperative complications can occur. In this study, we evaluated the usefulness of computer-aided navigation techniques in orthognathic surgery. Methods We enrolled 10 patients (3 men and 7 women) with facial deformities who were treated between July 2010 and February 2011. A Le Fort I osteotomy, sagittal split ramus osteotomy, and reduction malarplasty were performed with guided navigation. Results All 10 patients were treated successfully using the computer-assisted navigation surgery. Using the navigation system, instruments were visualized on a monitor in real time and all maneuvers were performed safely. Conclusions Orthognathic surgery, such as a Le Fort 1 osteotomy, sagittal split ramus osteotomy, and reduction malarplasty, can be performed safely under the guidance of a surgical navigation system. Navigation systems enable surgeons to carry out preoperative plans accurately without injuring important anatomic structures because the positions of the instruments can be visualized on site in real time.

Microsurgical training with porcine thigh infusion model.

We herein present our experience with microsurgical training using a porcine thigh infusion model, which resembles living animal models. The main femoral artery was cannulated with a 24G angioneedle and fixed with 4-0 black silk sutures. Microanastomoses were performed on the femoral vessels of porcine thighs using end-to-end and end-to-side techniques. During the microanastomoses, dyed 0.9% isotonic sodium chloride was infused at 200 to 850 mL/min using an infusion pump. No anastomosis site leakage was observed and the patency of the anastomosis site was maintained. We consider the porcine thigh infusion model to be appropriate for the beginner trainee because the large vessel size enables him or her to practice. In addition, our model provides a circulation environment similar to the in vivo human environment. We believe that our model is more convenient than living animal models and more accurate than models that do not provide a circulation environment.

Transoral Open Reduction for Subcondylar Fractures of the Mandible Using an Angulated Screwdriver System.

BackgroundThe management of subcondylar mandibular fractures has been a matter of controversy. Although closed reduction is the most useful method, it can be difficult to achieve anatomical reduction with this technique compared with open reduction and internal fixation (ORIF). Most surgeons prefer to treat subcondylar fractures by extraoral approaches rather than intraoral approaches because extraoral approaches provide good visualization of the operative field. The retromandibular, submandibular, and perilobular approaches are commonly performed in the treatment of displaced condylar or subcondylar fractures and that the functional results of these treatments are good. However, extraoral approaches have a high rate of surgical complications such as salivary fistula formation, visible scarring, and facial nerve injury, compared with intraoral approaches. Therefore, this clinical study evaluated the clinical results of ORIF for mandibular subcondylar fractures through a transoral approach using an angulated screwdriver system without endoscopic assistance. MethodsA study was conducted between March 2011 and October 2012. Eleven patients with subcondylar fractures of the mandible were treated through a transoral approach using an angulated screwdriver. There were 10 male patients and 1 female patient aged 21 to 72 years (mean, 38 years). Nine patients had a symphyseal or parasymphyseal fracture, and 2 patients had isolated subcondylar fractures of the mandible. ResultsEleven patients with subcondylar fractures of the mandible were treated with a transoral approach using an angulated screwdriver. The subcondylar fracture was on the left side in 6 patients and on the right in 5. All patients achieved satisfactory ranges of temporomandibular joint movement with an interincisal distance of more than 40 mm without deviation and stable individual centric occlusion. The maximum operation duration was 165 minutes, and the average duration of ORIF was 97 minutes. The association between the operation duration and the number of operations was statistically significant. ConclusionsOur clinical study shows that subcondylar fractures of the mandible can be treated using an angulated screwdriver system through a transoral approach and that this technique provides reliable, satisfactory, and safe clinical outcomes.

Orbital floor reconstruction considering orbital floor slope.

Orbital floor fractures are among the more challenging injuries faced by plastic surgeons. Enophthalmos is defined as backward, usually downward, displacement of the globe into the bony orbit. We describe reconstruction of the orbital floor slope in orbital floor fractures that prevents postoperative complications, especially posttraumatic enophthalmos. Thirty-three patients with orbital floor fractures were treated using reconstruction of the orbital floor slope between April 2009 and July 2010. The patients ranged in age from 12 to 54 years. There were 31 males and 2 females. All patients were operated on using a transconjunctival approach under general anesthesia. The orbital floor was reconstructed with poly-l/d-lactide sheets in all cases. Preoperatively, 23 [Float1]patients (69%) had enophthalmos, and 12 patients (36%) had symptomatic diplopia. The enophthalmos was corrected in 20 patients (86%), and the diplopia resolved in 10 (83%). Extrinsic ocular movement was impaired preoperatively in 1 patient (3%), but resolved after surgery. No patient had impaired visual acuity preoperatively or postoperatively. The results suggest that orbital floor reconstruction considering the orbital floor slope is a safe, reliable method with fewer complications that is more effective at preventing posttraumatic enophthalmos.

Blepharoptosis correction with buried suture method.

BackgroundMany surgical techniques have been developed to correct blepharoptosis, including the anterior levator resection or advancement, tarsoaponeurectomy, and Fasanella-Servat Müllerectomy. However, to minimize surgical scarring and reduce the postoperative recovery time, the procedure has been developed from a complete incision to a partial incision, which is appealing to patients. To aid the procedural development, this study describes a surgical technique in which the correction of blepharoptosis and a double eyelid fold operation are performed using a buried suture technique during the same operation. MethodsA retrospective review was conducted using the medical records and preoperative and postoperative photography of 121 patients who underwent simultaneous correction of blepharoptosis and had a double eyelid fold created between October 2010 and July 2011. All of the patients had mild (1–2 mm) or moderate (3–4 mm) bilateral blepharoptosis and excellent or good levator function (>8 mm). ResultsThe average preoperative marginal reflex distance (MRD1) measured 1.174 (0.3) mm. No intraoperative complications occurred. The average postoperative MRD1 measured 3.968 (0.2) mm. There was statistical significance improvement between preoperative MRD1 and postoperative MRD1 (P < 0.05). No symptomatic dry eye and exposure keratopathy were noted. ConclusionsBlepharoptosis correction using the buried suture technique is an effective technique for young patients experiencing mild to moderate blepharoptosis who want to have the double eyelid fold operation using the buried suture technique.

Interphalangeal Traction for Comminuted Fracture of Middle Phalanx Fingers: Case Report

We report an interphalangeal traction system through capsuloligamentotaxis for the treatment of comminuted fracture of the middle phalanx. The interphalangeal (IP) traction system inserts a K-wire at the proximal and distal phalanx. The difference between our IP traction system compared with the modified Suzuki frame method is that distal IP and proximal IP joints are synchronously distracted in the fixator, and bony continuity and articular integrity are restored.

Real Time Navigation-Assisted Orbital Wall Reconstruction in Blowout Fractures.

Background:Limitation in performing restoration of orbital structures is the narrow, deep, and dark surgical field, which makes it difficult to view the operative site directly. To avoid perioperative complications from this limitation, the authors have evaluated the usefulness of computer-assisted navigation techniques in surgical treatment of blowout fracture. Methods:Total 37 patients (14 medial orbital wall fractures and 23 inferior orbital wall fractures) with facial deformities had surgical treatment under the guide of navigation system between September 2012 and January 2015. Results:All 37 patients were treated successfully and safely with navigation-assisted surgery without any complications, including diplopia, retrobulbar hematoma, globe injury, implant migration, and blindness. Conclusions:Blowout fracture can be treated safely under guidance of a surgical navigation system. In orbital surgery, navigation-assisted technology could give rise to improvements in the functional and aesthetic outcome and checking the position of the instruments on the surgical site in real time, without injuring important anatomic structures.

Microscope-assisted reconstruction of canalicular laceration using Mini-Monoka.

Abstract A canalicular laceration is the most common injury of the lacrimal drainage system and can result from direct or indirect injury to the canalicular system. If the wounds are not managed properly, they can lead to scarring, stenosis, and inflammation, which may lead to symptomatic epiphora. We successfully reconstructed canalicular lacerations using Mini-Monoka tubes (FCI Ophthalmics, Marshfield Hills, MA) under microscopic magnification. We treated 14 patients for canalicular lacerations at the Soonchunhyang University Bucheon Hospital between August 2009 and October 2012. All patients underwent placement of a Mini-Monoka tube and a mucosal canalicular anastomosis microscopically to reconstruct monocanalicular lacerations. The tubes were removed at 6 to 8 months postoperatively, and follow-up was 8 to 12 months. No complications related to the Mini-Monoka tube, such as punctual plug migration, eye irritation, inflammation, granuloma formation, or erosion, occurred during the follow-up period. The goal of reconstructing a lacerated canaliculus is accurate approximation of the injured end of the canaliculus to facilitate mucosal healing and to prevent a canalicular obstruction. We believe that microscopic canalicular reconstruction with a Mini-Monoka tube is a safe, reliable, and straightforward method with fewer complications and is more effective for preventing iatrogenic injury in the unaffected canaliculus and minimizing patient discomfort.

Surgical correction of pneumosinus dilatans of maxillary sinus.

Pneumosinus dilatans is a rare disease in which 1 or more paranasal sinuses are dilated without functional alteration. The frontal sinus is the most commonly affected site, with involvement of the maxillary sinus being rare. Asymmetrical facial contour is the most common sign, and nasal obstruction and pain may also be present. We describe 6 cases of maxillary pneumosinus dilatans with histories of protrusion of the malar region. Plane radiography and computed tomography revealed abnormal expansion of the maxillary sinus without thinning of the bony wall, leading to a diagnosis of maxillary pneumosinus dilatans. Surgical decompression and maxilloplasty were achieved by electrical burring, greenstick downward fracture, or ostectomy of the anterior wall of the maxillary sinus and subsequent repositioning of the removed bony fragments with miniplates. The postoperative course was uneventful, and facial contours were improved on physical and radiologic examination. No recurrence was detected in any case, and good cosmetic results were achieved. In this article, the authors present surgical options for the treatment of pneumosinus dilatans of the maxillary sinus, including a review of the literature.