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ABSTRACT: When used to cover facial skin defects, skin grafts and local flaps have limitations such as color mismatch, volume depletion, and long scar. We used skin-fat composite grafts harvested with enough fat tissue over the whole plane to cover full-thickness facial skin defects. This study enrolled 15 composite grafts, and the results were rated by 2 investigators on a scale of 1 to 5 based on skin texture, color, and volume. Skin color analysis using a spectrophotometer was performed on 9 grafts using the L*a*b* score. There were no major complications, but 1 partial loss. The clinical assessment score ranged from good to excellent. Color assessment using a spectrophotometer showed that there were no significant statistical differences in the L* and a* scores between the grafts and the adjacent skin. Skin and fat composite tissue grafts can be a good option for covering full-thickness facial skin defects.
Annals of plastic surgery 02/2013; · 1.29 Impact Factor
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ABSTRACT: BACKGROUND: We performed robot-assisted neck dissection (RAND) via a modified face-lift (MFLA) or retroauricular approach for neck management and carried out free flap reconstruction via these approaches in patients with head and neck cancer. We assessed the feasibility of free flap reconstruction in patients who had undergone transoral resection of a primary lesion and RAND via these approaches. METHODS: In this prospective study, seven patients with head and neck squamous cell carcinoma were enrolled between August 2011 and May 2012. Approval was obtained from the institutional review board of Yonsei University. A radial forearm free flap was used for reconstruction because of its thin structure and pliability. Microvascular anastomosis was performed via an MFLA or retroauricular approach using a microscope and microvascular instrument set. RESULTS: Pathology reports showed a negative margin in all patients. On the basis of pathologic information for the primary lesion and neck specimens, 5 patients underwent surgery alone and two received adjuvant radiotherapy. At the last outpatient department visit, all patients were alive without locoregional recurrence. All patients were extremely satisfied with the invisible postoperative scar. On average, patients tolerated an oral diet after 1-2 weeks. The status of the free flap was viable and functioning in all patients. CONCLUSIONS: Although long-term follow-up of oncologic safety is required to establish these approaches as valid treatment methods, our study has demonstrated the feasibility of free flap reconstruction and RAND via an MFLA or retroauricular approach.
Annals of Surgical Oncology 11/2012; · 4.17 Impact Factor
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ABSTRACT: The extended latissimus dorsi flap is important for breast reconstruction. Unfortunately, donor site seroma is the most common complication of extended latissimus dorsi flap for breast reconstruction. Although using fibrin sealant in the donor site reduces the rate of seroma formation, donor site seroma remains a troublesome complication. The purpose of this study was to analyze the effectiveness of the combination of quilting sutures and fibrin sealant in the latissimus dorsi donor site for the prevention of seroma.
Forty-six patients who underwent breast reconstruction with extended latissimus flap were enrolled in the study. The patients received either fibrin sealant (group 1, n=25) or a combination of fibrin sealant and quilting sutures (group 2, n=21) in the extended latissimus dorsi donor site. Outcome measures were obtained from the incidence, volume of postoperative seroma, total drainage amount, indwelling period of drainage, and duration of hospital stay.
The incidence of seroma was 76% in group 1 and 42.9% in group 2 (P=0.022). We also found significant reductions in seroma volume (P=0.043), total drainage amount (P=0.002), indwelling period of drainage (P=0.01), and frequency of aspiration (P=0.043). The quilting sutures did not affect the rate of drainage, tube reinsertion, or hospital stay.
The use of quilting sutures combined with fibrin sealant on the latissimus dorsi flap donor site is helpful for reducing the overall seroma volume, frequency of aspiration, and total drainage amount.
Archives of plastic surgery. 09/2012; 39(5):509-13.
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ABSTRACT: Improvement of flap survival represents an ongoing challenge in reconstructive surgery. The angiogenic potential of adipose-derived stem cells (ASCs) offers a promising approach to improve the viability of random pattern flaps. Recently, to maximize the therapeutic effects of ASCs, increasing focus is being placed on how to deliver the stem cells to target lesions. The purpose of the present study was to compare the effectiveness of different administration routes of ASCs to improve the viability of the random pattern skin flap. ASCs labelled with PKH26 were applied via four methods to the cranially-based random pattern skin flaps of rats: (a) intravenous injection; (b) subcutaneous injection; (c) application with collagen sponge seeding; and (d) application with fibrin glue seeding. ASCs led to a significant increase in flap viability in the subcutaneous injection group and the collagen sponge group. Cutaneous blood flow was increased in the intravenous injection, subcutaneous injection and collagen sponge groups. Capillary density in the intravenous injection group and collagen sponge group was significantly greater than in the control group (no treatment). PKH26-positive cells via the collagen sponge were distributed more densely within the flap than in other groups. This study demonstrated that the collagen sponge method delivered ASCs most effectively within the flap and increased flap vascularity. The clinical therapeutic effects of ASCs can therefore be maximized when the optimal delivery route is chosen. Copyright © 2012 John Wiley & Sons, Ltd.
Journal of Tissue Engineering and Regenerative Medicine 07/2012; · 3.28 Impact Factor
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ABSTRACT: Coverage of defects of the pretibial area remains a challenge for surgeons. The difficulty comes from the limited mobility and availability of the overlying skin and soft tissue. We applied variable pedicled perforator flaps to overcome the disadvantages of local flaps and free flaps on the pretibial area.
Eight patients who had the defects in the anterior tibial area were enrolled. Retrospective data were obtained on patient demographics, cause, defect location, defect size, flap dimension, originating artery, pedicle length, pedicle rotation, complication, and postoperative result. The raw surface created following the flap elevation was covered with a split thickness skin graft.
Posterior tibial artery-based perforator flaps were used in five cases and peroneal artery-based perforator flaps in three cases. The mean age was 54.3 and the mean period of follow-up was 6 months. The average size of the flaps was 63.8 cm(2), with a range of 18 to 135 cm(2). There were no major complications. No patients had any newly developed functional deficit of the lower leg.
We suggest that pedicled perforator flaps can be an alternative treatment modality for covering pretibial defects as a simple, safe and versatile procedure.
Archives of plastic surgery. 07/2012; 39(4):360-6.
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ABSTRACT: In secondary cleft lip deformities, repetitive surgeries lead to increased tension and deformities in the upper lip, ultimately resulting in new deformities such as wide scars and a tight lip. The simultaneous correction of a wide scar and tissue deficiency in the upper lip is paradoxical unless sufficient tissue is supplied to the scant upper lip. The authors describe a method to transfer composite tissue for the improvement of secondary cleft lip deformities and present an analysis of the outcomes.
Ninety-one patients with secondary cleft lip, a wide scar, and tight lip were enrolled. After complete excision of the scar, the defect was covered with a composite graft that included skin and subcutaneous fat. The results were rated by 2 investigators blinded to the image of the scar and the morphology of the upper lip. The skin color of the 25 grafts was analyzed using a narrowband spectrophotometer using the Commission International d'Eclairage L*a*b* color coordinates.
All grafts survived without sequelae. The scores of the scar images and general morphology were 8.3/10 and 8.2/10, respectively. Spectrophotometric analysis displayed no differences between the composite tissues and normal upper lip skin in each color coordinate, indicating that the composite tissue had a good color match with a normal upper lip.
The use of a composite graft on the upper lip can be a reliable option to correct a wide hypertrophic scar and tight lip simultaneously, resulting in a satisfactory scar image and an improvement of upper lip morphology.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 07/2012; 70(7):e419-27. · 1.58 Impact Factor
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ABSTRACT: Rigid external distraction osteogenesis is regarded as a standard treatment for congenital midfacial hypoplasia. However, external distraction for the upper portion of the midface is not as effective and tends to rotate the midfacial segment in a counterclockwise direction. Moreover, patients poorly tolerate it because of the device's bulkiness. To prevent such drawbacks of an external distractor, both external and internal distractors were synchronously applied to patients with Crouzon syndrome.
In 6 patients with Crouzon syndrome in whom a dual-distraction technique was applied, distraction of the midfacial region was performed for up to a mean length of 15.3 mm. The external distractor was removed after a 1-month consolidation period, but the internal distractor was maintained for more than 6 months. The degree of advancement of the midface and ossification was measured with lateral cephalometry and 3-dimensional computed tomography imaging, respectively.
At long-term follow-up (mean, 4.6 years), the facial contours retained the initial distraction geometry with almost no relapse, showing that the ideal facial contour and occlusion could be obtained. Bone deposition was found to be continually progressing even 6 months postoperatively, and more than 6 months of consolidation was required for complete ossification that mainly occurred in the pterygomaxillary junction and lateral orbital wall.
The dual-distraction technique can induce balanced growth without the recurrence of hypoplasia, and it may eventually yield satisfactory outcomes in Crouzon syndrome.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 03/2012; 70(3):e242-51. · 1.58 Impact Factor
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ABSTRACT: The soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate.
Six patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation.
Mean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function.
The large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.
Archives of plastic surgery. 01/2012; 39(1):25-30.
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ABSTRACT: To evaluate and compare the effect of the coronal thread size on the marginal bone loss around the fixtures, when both implants were provided with threads to the top of fixture.
Two groups of implants, one with a macro-thread to the top of the fixture (A) and the other with a micro-thread to the top of the fixture (B), were placed adjacent to each other in the partially edentulous areas of 20 patients. Bone loss around each implant was analyzed after 1 year of functional loading. The bone losses after loading were compared using Wilcoxon's signed-rank test.
The mean marginal bone losses (A, 0.154 ± 0.144 mm; B, 0.125 ± 0.136 mm) were not statistically significant between the two groups (P = 0.669).
There was no significant difference between implant with macro- and micro-neck thread in terms of marginal bone loss after 1 year of loading.
Clinical Oral Implants Research 09/2011; 23(10):1147-51. · 2.51 Impact Factor
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ABSTRACT: It is accepted that patients who undergo appropriate primary repair for cleft lip will have secondary deformities. Because these deformities are caused by complex and diverse patterns, the deformities were categorized to provide a standardized treatment for each category.
Pathologic characteristics of 1,170 patients were classified into 7 categories. Corrections were performed using 7 fundamental procedures corresponding to the surgical resolution of each deformity: 1) transposition of the caudal septum; 2) release of the septal-cartilaginous junction; 3) medial crus elevation; 4) lateral crus elevation; 5) release of the orbicularis oris muscle from the lip elevators; 6) anchoring of the orbicularis oris muscle to the anterior nasal spine; and 7) philtral column formation. A satisfaction survey was performed to evaluate the overall outcomes in 171 patients and an anthropometric analysis was performed in 38 patients.
Satisfactory scores obtained through postoperative follow-up were higher than preoperative scores, and there was no difference between postoperative scores obtained over the short and long term. All preoperative anthropometric measurements were different from the postoperative measurements, indicating that the fundamental procedure achieved effective outcomes.
These proposed 7 fundamental procedures can be used as guidelines that can always be applied for the correction of any secondary cleft lip nasal deformity to obtain ideal treatment outcomes.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 08/2011; 69(11):e420-30. · 1.58 Impact Factor
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Periodontology 2000 06/2011; 56(1):209-26. · 3.96 Impact Factor
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ABSTRACT: To test the plaque-removal efficacy of a single-tufted toothbrush on the posterior molars compared with a flat-trimmed toothbrush.
Forty-nine subjects were selected. Professional instruction and written brushing instructions were given. After thorough supra-gingival scaling and polishing, all subjects were asked to abstain from oral hygiene procedures for 24 hours prior to the first experiment. The subjects were randomized to a treatment sequence. The modified Quigley and Hein plaque index was recorded pre- and post-tooth brushing, at 6 surfaces of the posterior molars. After a wash-out period, all the remaining plaque was removed professionally. Twenty-four hours of brushing abstinence was again performed. The plaque index was recorded pre- and post-tooth brushing after the subjects were given the second toothbrush in the cross-over sequence.
The percentage reductions in plaque scores achieved with the single-tufted brushes were significantly higher than those of the flat-trimmed brush at the maxillary buccal interproximal, marginal and mandibular lingual interproximal site. The other locations showed no significant difference.
The results of the present study implied that the single-tufted brush could be an effective tool for the removal of plaque at some, but not all, sites of the posterior molars.
Journal of periodontal & implant science 06/2011; 41(3):131-4.
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ABSTRACT: A port-wine stain begins with thin macular lesions and eventually becomes hypertrophic and forms nodules. Although laser therapy for port-wine stain is a safe treatment modality that has been well-established, the long-standing port-wine stain has a tendency to respond less well to laser treatment. The authors performed total surgical resections of long-standing port-wine stain in the facial region, and attempted to clarify the histomorphologic changes.
The records of 15 patients with long-standing port-wine stain were reviewed for nodules and associated characteristics. After removal of the vascular lesions, the affected area was reconstructed with a radial forearm free flap or a skin graft depending on cosmetic considerations. All specimens obtained from resection were stained with hematoxylin and eosin and Victoria blue for elastic fibers for histomorphologic analysis. After a mean follow-up period of 12 years, the outcomes of surgical management were assessed.
The nodules developed in 13 patients, and the mean age for nodule onset was 30 years. Victoria blue staining of the nodular lesions showed an intermingling of thick-walled vessels with abundant elastic fibers and thin-walled vessels without elastic fibers, which are findings typical of arteriovenous malformations. After surgical management, most of the outcomes were satisfactory, without complications or recurrence at long-term follow-up.
A long-standing nodular port-wine stain can convert to a high-flow malformation with an arterial component, and these lesions are different from early-stage port-wine stains. For the treatment of long-standing port-wine stain that is resistant to laser therapy, surgical methods will bring more satisfactory outcomes than traditional laser therapy.
Plastic and reconstructive surgery 02/2011; 127(2):784-91. · 2.74 Impact Factor
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Dong Won Lee
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ABSTRACT: Pubmed, Cochrane and Lilac databases, Google, Google Scholar, hand searching of websites of major dental journals. The reference list of five recently published systematic reviews on peri-implantitis treatment were also screened for potential studies.
Randomised controlled trials and non-randomised studies in English, German, French, Spanish and Italian on peri-implantitis treatment in humans were included. Case series, case reports and cross sectional or non-therapy studies were excluded from the assessment of endpoints. No minimum follow up time was set for studies that were included.
Data were extracted in duplicate by two reviewers and disagreements were resolved by consensus. True endpoints for peri-implantitis treatment were considered only if they provided evidence of tangible benefit to the patient. The outcome variables regarded as true endpoints were implant failure, aesthetic assessment and variables related to quality of life, but these were only considered if they were clearly identified as an objective of the research, not as an outcome of treatment. Surrogate endpoints were considered as those measurements of clinical outcomes such as probing pocket depth and clinical attachment level.
Fourteen studies were included in this review with data on implant failure presented solely as consequence of peri-implantitis therapy. No true endpoint was described for any study on peri-implantitis. Mean pocket probing depth, clinical attachment level and bleeding on probing were the three surrogate endpoints cited most often in the literature.
All endpoints used in the trials reviewed are surrogates of clinical events, such as implant failure. Clinical surrogate endpoints should be validated to assess the real effect of these measures on true endpoints.
Evidence-based dentistry 01/2011; 12(1):7.
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ABSTRACT: Pharyngocutaneous fistula is one of the fatal complications occurring after head and neck reconstruction with neck node dissection. Even minor salivary leakage from the fistula could cause serious infection and threaten the viability of the transferred flap or even lead to the rupture of jugular vein. In such cases, proper management is difficult, and the chances for recurrence rise. We used a collagen patch (TachoComb) for fistula prevention and treatment. TachoComb, a collagen patch integrated with activated thrombin and fibrinogen, was used to prevent postoperative fistula formation in the initial reconstruction by applying them on sites with a high risk of salivary leakage. The patch was applied to 16 patients who had hypopharyngeal reconstruction, and the results were evaluated and compared with patients who had reconstruction without a collagen patch. A fistula occurred in 1 (6%) of 16 patients who received the collagen patch, whereas it occurred in 6 (14%) of 43 patients who underwent reconstruction without the collagen patch. In addition, the collagen patch was also used to treat postoperative fistula in 2 patients, and the results were successful after a single revision. Our results suggest that the collagen patch can be effective in the prevention and treatment of postoperative fistula after head and neck reconstruction, especially pharynx and cervical esophagus.
The Journal of craniofacial surgery 11/2010; 21(6):1674-6. · 0.81 Impact Factor
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ABSTRACT: In head and neck cancer reconstruction, the transverse cervical artery is a good alternative vessel when the appropriate recipient vessels cannot be identified because of preoperative radiation and radical neck dissection. Selecting the appropriate recipient vein is essential for a successful intraoral reconstruction. We attempted to determine which veins are candidate partners of the transverse cervical artery by anatomically examining 10 necks (2 sides of the neck in 5 cadavers) in a cadaver study. Three types of veins (suprascapular vein, transverse cervical vein, and descending vein from the trapezius muscle) were selected as recipient vein candidates, and the characteristics of each vein were analyzed. Clinically, we also examined which vessels were chosen as recipient veins in 13 patients in whom intraoral reconstruction with bare neck was performed using the transverse cervical artery as recipient. The descending vein from the trapezius muscles (trapezius vein) was used most frequently, followed by the transverse cervical vein. The transverse cervical vein could be considered an appropriate recipient vein, but it is prone to damage from neck dissection in some cases. Therefore, the use of the trapezius vein can aid in the successful reconstruction in such patients.
The Journal of craniofacial surgery 09/2010; 21(5):1423-7. · 0.81 Impact Factor
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ABSTRACT: We have introduced a less invasive, simple, and effective method for zygomatic fractures using percutaneous reduction with a Steinmann pin (S-pin) and temporary external suspension with a Kirschner wire (K-wire).For 2 years, 51 patients underwent first percutaneous reductions and then fixations, which is a method that we developed. After the S-pin no. 1 was percutaneously inserted at the most prominent point of the zygoma, closed reduction was first attempted using lever movement and temporary external suspension with a K-wire. If required, 1-site rigid fixation was performed on the zygomaticomaxillary buttresses via gingivobuccal incisions. Only 13 patients received K-wire suspensions and 38 patients received K-wire suspensions and lateral buttress fixations. We evaluated the postoperative result in 4 aspects (flattening, symmetry, scar, and paresthesia) using the 4-point visual analog score after at least 6 months.The mean maintenance period of the S-pin and K-wire was 12.3 days, and the mean operation time was 33 minutes. No serious complications, such as infections or external wire instability, were observed. Excellent or good results were achieved in more than 95% of patients in all 4 aspects mentioned.We believe that our method, which is the first percutaneous reduction using S-pin and temporary external suspensions with a K-wire with or without a lateral buttress rigid fixation, is a simple and effective method for noncomminuted zygomatic fractures.
The Journal of craniofacial surgery 07/2010; 21(4):1060-5. · 0.81 Impact Factor
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ABSTRACT: Hydroxyapatite cement is an ideal alloplastic material to replace the autogenous bone grafts in craniofacial surgery. Hydroxyapatite cement is advantageous because it can be easily molded by hand unlike other alloplastic materials such as silicone and high-density polyethylene. For aesthetic applications of hydroxyapatite cement, we evaluated the efficacy and safety of the rapidly hardening hydroxyapatite cement used in facial contour augmentation, especially for the forehead and the malar area. A total of 18 cases of facial skeleton augmentation or contouring surgery using rapidly hardening hydroxyapatite cement (Mimix; Biomet, Warsaw, IN) were examined, and the long-term cosmetic results and any complications were also analyzed. The aims of facial contouring surgeries were to correct the following conditions: hemifacial microsomia, craniosynostosis, posttraumatic facial deformity, deformity after tumor resection, dentofacial deformity, and Romberg disease. The application sites of hydroxyapatite cement were the forehead, malar area, chin, and paranasal area. A mean of 16 g (range, 5-50 g) of the hydroxyapatite cement was used. Postoperative infection, seroma, and migration of the implant were not observed during the follow-up period of 23 months. Rapidly hardening hydroxyapatite cement, Mimix, is easy to manipulate, promptly sclerotized, and can be replaced by living bone tissue, with a low complication rate. Therefore, it can be an optimal treatment that can be used instead of other conventional types of alloplastic materials used in facial contouring surgery.
The Journal of craniofacial surgery 07/2010; 21(4):1084-8. · 0.81 Impact Factor
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ABSTRACT: Scars on exposed areas are a major concern among Asian populations because of their conspicuousness. Size, color, or whether the scar is hypopigmented or hyperpigmented matters little. Silicone gel is well known for the prevention and induction of better maturation of hypertrophic and keloid scars. However, its aesthetic effect on normal surgical scars has not been considered.
Clinical evaluation of scars was performed in 40 patients. All the 40 patients underwent clean and minor surgery of the exposed area, such as scar revision, by 1 plastic surgeon. Twenty of the 40 patients did not apply any adjunctive material for scar management and were grouped as the control. The other 20 patients applied a silicone gel sheet for 12 hours a day for 3 months. Three assessment criteria, pigmentation, vascularity, and height, were evaluated by photographic assessment of the scars at 2 weeks, 1 month, and 3 months postoperatively and scored by 3 plastic surgeons. The Wilcoxon rank sum test was used to verify any significant differences in the previously mentioned 3 parameters between the 2 groups and parameter scores at each follow-up period.
Two patients were excluded from the study because of the development of rashes on the areas covered by the silicone gel sheet. There was no statistical significance between the groups at postoperative 2 weeks and 1 month in pigmentation and redness. For evaluation of height, there was statistical significance (P = 0.024) at postoperative 1 month. However, there were statistically significant differences in all the assessment criteria at postoperative 3 months between the groups: pigmentation, P = 0.0002; vascularity, P = 0.0002; and height, P < 0.0001.
The silicone gel sheet has a favorable aesthetical effect for normally created surgical scars in the Asians. Its application can reduce the conspicuousness of scars more rapidly than without.
The Journal of craniofacial surgery 05/2010; 21(3):706-10. · 0.81 Impact Factor
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ABSTRACT: To evaluate and to compare the effect of the conical neck design on marginal bone loss around the fixtures, when both implants were provided with micro-threads to the top of the fixture.
Two types of implant, one with a straight shape (S) and the other with a conical neck design (C) provided with a retentive element to the top of the fixture, were placed adjacent to each other in the partially edentulous areas of 12 patients. Bone loss around each implant was analyzed after 1 year of functional loading. The bone losses after loading were compared using Wilcoxon's signed-rank test.
The mean marginal bone losses (S, 0.05 + or - 0.09 mm; C, 0.07 + or - 0.14 mm) were not statistically significant between the two groups (P=0.578).
There was no significant difference between conical and straight neck implants in terms of marginal bone loss after 1 year of loading.
Clinical Oral Implants Research 04/2010; 21(4):439-44. · 2.51 Impact Factor
