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ABSTRACT: BACKGROUND: Telecanthus occurs because of the disruption of the medial canthal tendon (MCT). The deformity of medial canthus can result from nasoorbitoethmoid fractures, tumor resection, craniofacial exposure, congenital malposition, or aging. Repair of the MCT using transnasal wiring is regarded as a method of choice to treat telecanthus. We have introduced an oblique transnasal wiring using Y-V epicanthoplasty incision rather than the well-known classical bicoronal approach. METHODS: Eight patients with telecanthus were treated with this method. Through the medial canthal horizontal and periciliary incision, we could have an access to the medial orbital wall and the MCT. An oblique transnasal wiring was performed with the following steps: (1) after slit skin incision on the nasal recession of the contralateral frontoglabella area, 2 drill holes were made from this point to the superior and posterior region of the lacrimal fossa of the affected orbit; (2) a 2-0 wire was passed through the MCT and the holes; (3) the wire was pulled and tightened until the MCT was ensured and was twisted in the contralateral side. After the repositioning of the MCT, the skin was simply sutured. The excess skin was trimmed, and then the skin was sutured with nylon 7-0. The remaining "dog ear" in the lateral portion can be removed by additional periciliary skin incision and excision. RESULTS: All the patients achieved an improvement and a prompt recovery. The interepicanthal distance was decreased by 6.3 mm on average compared with that in the preoperative condition. All patients had no complication associated with surgeries. Of posttraumatic telecanthus, 5 patients were much satisfied with the outcomes, and 1 patient had recurrence on postoperative month 3. In cases of congenital anomaly or neoplasm, the telecanthus was also improved. CONCLUSIONS: An oblique transnasal wiring using Y-V epicanthoplasty incision could be a simple, safe method to correct the telecanthus with the following advantages: first, we could fix the MCT to the appropriate position with oblique transnasal wiring; second, a horizontal incision and a periciliary incision could be acquired with enough operative fields; third, Y-V epicanthoplasty incision is an effective method for minimizing unsightly scar formation.
Annals of plastic surgery 02/2013; · 1.29 Impact Factor
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ABSTRACT: Given the variability of the timing and order of surgeries, it is difficult to choose the best treatment for patients with complex facial fractures. Based on the clinical experiences, the authors have reviewed their experience with the timing and order of operations depending on the sites of complex facial fractures and their concurrent injuries. The current study was based on a total of 105 patients with complex facial fractures from the year 2002 to 2011. After assessing the patients' clinical records, radiological data, and clinical photographs, the following data were analyzed: patients' age and sex, causes of injury, concurrent injuries, sites of fractures, the interval between trauma and the operations, the presence of additional surgeries, and the aesthetic and functional outcomes.For most of the patients, early operation was performed (within 2 weeks in 95.2%). Additional surgeries within 1 month after injuries were performed in 22 patients. Usually, a top-to-bottom direction repair was applied when head injuries were involved, and bottom-to-top direction repair was applied when occlusal problems were involved. Of 105 patients whom we were able to follow up, 49 patients showed complications or were dissatisfied with the outcomes. However, except them, most of the patients were satisfied with the outcomes of surgical treatments. There were 14 cases of cheek asymmetry, 9 enophthalmos, 30 paresthesia, 4 malocclusion, and a single case of persistent trismus.In the current study, satisfactory results could be achievable under the following principles: a repair should be done in the early stage after the onset of the injury; supportive surgeries should be done, if necessary, within 2 weeks (no later than 4 weeks); and the order of surgical treatment should be determined by the severity of bone fracture and the systemic status.
The Journal of craniofacial surgery 01/2013; 24(1):216-20. · 0.81 Impact Factor
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ABSTRACT: BACKGROUND: Gynecomastia is a benign, excessive development of the male breast that occurs at an overall incidence of 32-36 %. The authors effectively removed peripheral fat tissues with power-assisted liposuction (PAL) and periareolar glandular tissues with a cartilage shaver in a series of patients. The small periareolar incisions were not easily recognized. METHODS: Between February 2010 and April 2012, the charts of 15 patients (28 breasts) treated with PAL and a cartilage shaver were retrospectively reviewed. RESULTS: The mean volume of fat tissue removed with liposuction was 319 mL, and the mean volume of glandular tissue removed with the cartilage shaver was 70 mL. The mean follow-up period was 11.2 months. No infection, nipple-areola complex necrosis, nipple retraction, or saucer deformity was encountered in this series. Intraoperative bleeding occurred in one patient. Mild asymmetries developed in three patients. CONCLUSIONS: Use of PAL and a cartilage shaver for the treatment of gynecomastia allows for effective removal of both the fat and the glandular tissue of the breast through a minimal periareolar incision. This technique can achieve excellent aesthetic results with inconspicuous scarring. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Aesthetic Plastic Surgery 09/2012; · 1.41 Impact Factor
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ABSTRACT: Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation.
This study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 µg/mL remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 µg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects.
Intraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally.
Our results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast augmentation surgery.
Archives of plastic surgery. 09/2012; 39(5):540-5.
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ABSTRACT: In this report, the authors present the experience on the reconstruction of the totally degloved foot and extremely long soft tissue defect of a lower limb with the combined free tissue transfer using the anterolateral thigh flap as a link in two male patients between October 2009 and December 2010. The anterolateral thigh flap has been commonly used as a link between the recipient site and the distal flap. The anterolateral thigh flap and latissimus dorsi muscle flap were selected for the distal flap, according to their reconstructive needs. Two combined free flaps survived without major complication. The authors could salvage of the lower extremity through the reconstruction of complex wound with the combined free tissue transfer using the anterolateral thigh flap as a link. This combined flap may be an alternative for reconstruction of complex soft tissue defect in the lower extremity. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.
Microsurgery 07/2012; 32(7):575-9. · 1.61 Impact Factor
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ABSTRACT: The purpose of this study was to retrospectively evaluate the patients who had undergone delayed correction of posttraumatic enophthalmos.
The medical charts of 85 patients with posttraumatic enophthalmos and who underwent surgical correction at the authors' medical center were reviewed. The outcomes were analyzed in relation to various factors such as the period of delayed correction, the causes of delayed correction, the type of initial injury, the pathologic site of the orbital wall, the operative methods, and the aesthetic and functional results.
With regard to posttraumatic enophthalmos, good aesthetic and functional results were seen in most patients. The period from the initial injury up to the delayed correction ranged from 1 to 144 months (average, 20.9 months). The most common cause of posttraumatic enophthalmos was initial inadequate repair. A zygomatico-orbital fracture was initially the most frequent facial bone fracture. The most common defect site of the orbital wall was the inferior wall. Enophthalmos was significantly improved from a preoperative average of 3.16 mm to a postoperative average of 1.29 mm.
Better functional results were achieved for the cases of mild to moderate enophthalmos with a single defect site of the orbital wall for the patients without associated facial bone fracture. We conclude that most cases of posttraumatic enophthalmos could be prevented through careful reconstruction during the first operation. Delayed correction of posttraumatic enophthalmos could be a possible reparative procedure if sufficient release of scar tissue, accurate repositioning of the dislocated orbital bones, and proper intraorbital grafting are performed.
The Journal of craniofacial surgery 07/2012; 23(4):1005-9. · 0.81 Impact Factor
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Archives of plastic surgery. 07/2012; 39(4):433-4.
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Archives of plastic surgery. 05/2012; 39(3):262-4.
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ABSTRACT: The publication rate of presentations at medical international meetings has ranged from 11% to 78% with an average of 45%. To date, there are no studies about the final rate of publications at scientific meetings associated with plastic surgery from Korea. The present authors investigated the publication rate among the presentations at meetings associated with plastic surgery.
The titles and authors of the abstracts from oral and poster presentations were collected from the program books of the Congress of the Korean Society of Plastic and Reconstructive Surgeons (CKSPRS) for 2005 to 2007 (58th-63rd). All of the abstracts presented were searched for using PubMed, KoreaMed, KMbase, and Google Scholar. The titles, key words from the titles, and the authors' names were then entered in database programs. The parameters reviewed included the publication rate, type of presentation including running time, affiliation, subspecialty, time to publication, and publication journal.
A total of 1,176 abstracts presented at the CKSPRS from 2005 to 2007 were evaluated. 38.7% of the abstracts, of which oral presentations accounted for 41.0% and poster presentations 34.8%, were published as full papers. The mean time to publication was 15.04 months. Among journals of publication, the Journal of the Korean Society of Plastic and Reconstructive Surgeons was most used.
Brilliant ideas and innovative approaches are being discussed at CKSPRS. The 38.7% publication rate found from this research appeared a bit lower than the average rate of medical meetings. If these valuable presentations are not available as full papers, the research would be a waste of time and effort.
Archives of plastic surgery. 05/2012; 39(3):238-43.
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ABSTRACT: For blowout fractures of the medial orbital wall, the goals of treatment are complete reduction of the herniated soft tissue and anatomical restoration of the orbital wall without surgical complications. Surgeons frequently worry about damage to the optic nerve caused by dissection when the part over the posterior ethmoidal foramen is fractured. The authors performed small incision and inlay implantation of porous polyethylene for reconstruction of medial orbital wall fractures.
Between January of 2007 and December of 2009, 55 patients were included in an analysis of the outcome of corrected medial orbital wall fractures. For 55 patients with posterior comminuted fractures of the medial orbital wall, insertion of porous polyethylene into the ethmoid sinus was performed in multiple layers, through the transconjunctival approach.
In all cases, the orbital cavity was restored to its normal anatomical shape. The associated ocular problems disappeared except for mild enophthalmos in three patients and diplopia in one patient. There were no serious surgical complications associated with inlay implantation.
The advantages of the inlay technique include the anatomical reconstruction of the orbital wall, the avoidance of optic nerve injury, the simplicity of the procedure, and consequently the absence of surgery-related complications. This technique is presented as one of the preferred treatments for posterior comminuted fractures of the medial orbital wall.
Plastic and reconstructive surgery 01/2011; 127(1):321-6. · 2.74 Impact Factor
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Plastic and reconstructive surgery 09/2010; 126(3):144e-6e. · 2.74 Impact Factor
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ABSTRACT: Many studies have been published on the clinical importance and attractiveness of a face. On the other hand, Asian faces give an impression that is not polished owing to their pronounced cheekbone and mandible. There have already been many studies in progress pertaining to measurements and analyses of Asian facial structure; however, the authors would like to contribute to such research by providing practical analytical data and distributional patterns of the widths of their faces showing how wide their faces are.
The facial golden mask was applied to 1000 facial photographs of Korean college students, of whom 500 were males and 500 were females.The horizontal ratios (HR) of the mid- and lower faces of each student were calculated against the facial golden mask. The results were divided into 3 groups according the degrees of the HR for further analyses: group 1 (HR = 1.0), group 2 (HR > 1.0), and group 3 (HR < 1.0).
We obtained an S-shaped cumulative frequency distribution graph for young Koreans per sex, per midface, and per lower face. The graph is dense at the center and is shifted to the right, signifying that the Koreans' midfaces and lower faces are wider than that of the facial golden mask.
Conclusion reached in this study is that the faces of Koreans are wider than those of the facial golden mask as commonly perceived; thus, it is expected that graphs for the cumulative frequency of the distribution will be used extensively in the future.
The Journal of craniofacial surgery 09/2009; 20(5):1378-82. · 0.81 Impact Factor
