Won Min Yoo

Medial epicanthoplasty using the skin redraping method.

Background: The presence of epicanthal folds and the absence of supratarsal folds are unique features in the eyelids of Asians. The resulting appearance leads many to seek cosmetic improvement in the medial canthal area. Although many techniques have been described for the elimination of epicanthal folds, scarring and design complexity are barriers that must still be overcome by surgeons. Methods: From December of 2002 to December of 2004, the authors performed medial epicanthoplasties using the skin redraping method (tension-free epicanthoplasty) to correct epicanthal folds in the eyelids of 215 Asian patients. The authors’ method is very simple to design and easy to perform. The procedure requires only the elevation of skin, eliminating volume of muscle, and trimming of skin. Other ancillary procedures, such as flap design, anchoring, plication, or subdermal fixation, are not required. Results: Most of the patients obtained satisfactory results. No patients complained about visible scarring and none required revision surgery. Scarring can be avoided on the noticeable medial canthal region because the only incisions needed are supratarsal and subciliary incisions. The ability to avoid tension resulting from skin redraping is another important factor contributing to the minimization of scarring. Conclusions: The skin redraping method is simple to design and easy to perform. It does not create tension or visible scars on the medial canthal region.

The effect of botulinum toxin A on skin flap survival in rats.

This study examines the role of botulinum toxin type A (BoTA) in preventing the collapse of the peripheral vessels in the cutaneous flap and in increasing the survival of the flap. Because BoTA cleaves the SNAP‐25 protein, the release of vasoconstriction cotransmitters as well as acetylcholine would be blocked. Dorsal skin flaps in rats were elevated and returned to the original position. In the BoTA and the control group, either BoTA or saline was injected into the entire flap. The flap survival rate measurement and a histopathological examination were performed 1 week after flap elevation. The cutaneous blood flow was measured in three different areas of each flap, serially. In BoTA group, there was a significant increase in the survival rate (93.79 ± 6.06%, p=0.042). In the control group, the blood flow was decreased significantly immediately after flap elevation. The blood flow was high in all areas in the BoTA group in a week, and also most of the vessels maintained their shape without collapsing. In conclusion, pretreatment with BoTA increases the dorsal skin flap survival in rats by increased perfusion, and further studies should be performed to determine the possible mechanism by which BoTA attenuates the sympathetic vasoconstriction effect in skin flaps.

Inferior gluteal artery perforator flap: a viable alternative for ischial pressure sores

The ischial area is by far the most common site for pressure sores in wheelchair-bound paraplegic patients, because most of the pressure of the body is exerted on this area in the seated position. Even after a series of successful pressure sore treatments, the site is very prone to relapse from the simplest everyday tasks. Therefore, it is crucial to preserve the main pedicle during primary surgery. Several surgical procedures, such as myocutaneous flap and perforator flap, have been introduced for the treatment of pressure sores. During a 4-year time period at our institute, we found favourable clinical results using the inferior gluteal artery perforator (IGAP) procedure for ischial sore treatment. A total of 23 patients (20 males and three females) received IGAP flap surgery in our hospital from January 2003 to January 2007. Surgery was performed on the same site again in 10 (43%) patients who had originally relapsed after undergoing the conventional method of pressure sore surgery. The average age of patients was 47.4 years (range 26-71 years). Most of the patients were paraplegic (16 cases, 70%) and others were either quadriplegic (four cases, 17%) or ambulatory (three cases, 13%). Based on hospital records and clinical photographs, we attempted to assess the feasibility and practicability of the IGAP flap procedure through comparative analysis of several parameters including the size of the defective area, treatment modalities, relapses, complications, and postoperative treatments. The average follow-up duration for 23 subjects was 25.4 months (range 5-42 months). All flaps survived without major complications. Partial flap necrosis developed in one case but secondary healing was achieved and the final outcome was not impaired. Most of the cases healed well during the follow-up period. Postoperative complications such as wound dehiscence and fistula developed in some subjects, but all healed well with a secondary treatment. A total of five cases relapsed after surgery due to tissue deficit and these were treated with bursectomy and muscle transposition flap to fill the dead space. We propose that the IGAP flap should be considered a viable alternative to other methods of ischial pressure sore surgery owing to its many advantages, which include the ability to preserve peripheral muscle tissue, the variability of flap designs, relatively good durability, and the low donor site morbidity rate.

Development of DNA microarray for pathogen detection

Pathogens pose a significant threat to humans, animals, and plants. Consequently, a considerable effort has been devoted to developing rapid, convenient, and accurate assays for the detection of these unfavorable organisms. Recently, DNA-microarray based technology is receiving much attention as a powerful tool for pathogen detection. After the target gene is first selected for the unique identification of microorganisms, species-specific probes are designed through bioinformatic analysis of the sequences, which uses the information present in the databases. DNA samples, which were obtained from reference and/or clinical isolates, are properly processed and hybridized with species-specific probes that are immobilized on the surface of the microarray for fluorescent detection. In this study, we review the methods and strategies for the development of DNA microarray for pathogen detection, with the focus on probe design.

High-throughput identification of clinically important bacterial pathogens using DNA microarray.

Rapid and accurate detection of pathogenic bacteria is important for the treatment of patients with suitable antibiotics. Here we report the development of a diagnostic DNA microarray for the high-throughput identification of 39 pathogenic bacteria selected based on their high prevalence rate and/or difficulty of cultivation. The 23S ribosomal DNA and 16S-23S rDNA intergenic spacer region were used as target DNAs for pathogen detection. Universal- and species-specific probes were designed based on the unique and common sites within the target DNA sequences. New target DNA sequences were determined for the detection of 19 bacterial pathogens. The usefulness of the designed probes was validated using 39 reference bacteria and also with 515 clinical isolates from various clinical samples including blood, stool, pus, sputum, urine and cerebrospinal fluid. The DNA microarray developed in this study allowed efficient detection of bacterial pathogens with the specificities of 100%. The sensitivities were 100% as well except for the two pathogens, Enterobacter cloacae (75%) and Enterococcus faecium (85%). These results suggest that the DNA microarray-based assay developed in this study outperforms current diagnostic systems with respect to sensitivity, specificity, and high-throughput detection, and thus should be useful in pathogen diagnosis in the clinical setting.

Development of a DNA chip for the diagnosis of the most common corneal dystrophies caused by mutations in the βigh3 gene

Aim: To develop a diagnostic DNA chip to detect mutations in the βigh3 gene causing the most common corneal dystrophies (CDs). Methods: Samples from 98 people, including patients with βigh3-associated CDs (β-aCDs), were examined. Specific primer and probe sets were designed to examine exons 4 and 12 of the βigh3 gene, in order to identify mutant and wild-type alleles. Mutations were then identified by hybridisation signals of sequence-specific probes immobilised on the slide glass. Results: Direct sequencing of exons 4 and 12 of the βigh3 gene in the patients’ genome showed that β-aCDs could be mainly classified into five types: homozygotic Avellino corneal dystrophy (ACD), heterozygotic ACD, heterozygotic lattice CD I, heterozygotic Reis–Bucklers CD and heterozygotic granular CD. Blind tests were performed by applying the target DNA amplified from the genomic DNA isolated from the peripheral blood of the participants onto a DNA chip. The results obtained by DNA chip hybridisation matched well with the direct DNA sequencing results. Conclusions: The DNA chip developed in this study allowed successful detection of β-aCDs with a sensitivity of 100%. Mutational analysis of exons 4 and 12 of the βigh3 gene, which are the mutational hot spots causing β-aCDs, can be successfully performed with the DNA chip. Thus, this DNA chip-based method should allow a convenient, yet highly accurate, diagnosis of β-aCDs, and can be further applied to diagnose other types of CDs.

Gossypiboma after mandibular contouring surgery.

Background: Gossypiboma is derived from the Latin word gossypium, meaning cotton, and it means a postoperatively retained foreign body used in operations. Several cases of gossypiboma have been reported especially after abdominal surgery, but there has not been any reported case in plastic surgery. Mandibular contouring surgery cannot ensure a view wide enough to avoid injury to surrounding structures such as a facial artery and a retromandibular vein. In addition, many surgeons pack the sponge into the operative field to prevent bleeding, and surgeons may neglect remnant surgical materials. Recognition of gossypiboma is essential but is often considerably delayed and cause medicolegal problems. Therefore, it is important to ensure that every effort is made to prevent such occurrences. We had a chance to evaluate and treat gossypiboma, and in this paper, we want to share our experiences. Materials and Methods: In circa 1999 to 2007, there were 3 cases diagnosed as gossypiboma after a mandible angle surgery. All patients were female, and some had signs of fever, swelling, tenderness, and purulent discharge of an oral wound. We performed a computed tomographic scan and blood test, and foreign body removal was done under general anesthesia. Intraoperatively, the diagnosis of gossypiboma was confirmed. Results: All symptoms were reduced or subsided after surgery. It was noted that no postoperative infection remained. Conclusions: Gossypiboma must be considered when fever, unilateral swelling, tenderness, or unhealed oral wound is sustained despite an antibiotics therapy and a drainage procedure after a mandible angle surgery. In that case, a computed tomographic scan can be recommended as an effective method for detection of gossypiboma.

A Simple DNA Chip for Diagnosis of Most Common Corneal Dystrophies Caused by ßigh3 Gene Mutations

The aim of this study is to develop and evaluate a rapid diagnostic DNA chip to detect most common betaigh3 mutations which cause corneal dystrophies (CDs). Recent studies have shown that LASIK can worsen the CDs, and thus initial screening of betaigh3 gene mutation is urgently needed before LASIK. Direct sequencing of the exons 4 and 12 of the relevant gene showed that CDs could be mostly divided into homozygous Avellino CD and heterozygous Avellino CD, Heterozygous Lattice Type I, heterozygous Reis-Buckers CD and heterozygous Granular CD. In our previous study, suitable primer and probe sets were designed and DNA chip diagnosing these CDs was successfully developed. Mutations were then identified by signals of the probes immobilized on DNA chip developed and evaluated based on the DNA sequencing results. 327 participants volunteered for this test. Diagnosis was firstly performed by slit-lamp eye examination which is common medical diagnostic method and each DNA sample from peripheral blood was analyzed by DNA chip developed. All the tests were performed as blind tests. The evaluation was finally done by comparing with the DNA sequencing results. We concluded that this rapid genotyping using DNA chip allowed successful detection of CDs with 100% sensitivity and specificity. We thus expect that this simple DNA chip can be a perfect substitute for the routine clinical diagnosis, which will help in making precise diagnoses of patients.