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ABSTRACT: Wound healing is a dynamic and complex process of tissue repair that involves a number of cellular and molecular events. It proceeds from inflammatory response to reepithelialization and finally to formation of a permanent scar. Alginate is a polymer of guluronic and mannuronic acid that is used as a scaffolding material in biomedical applications. For the purpose of studying wound healing, full-thickness skin defects were produced on the dorsal area in rats. We measured the relative sizes of the wounds on days 3, 5, 7, 14, and 28. The wound sizes were decreased in the alginate-treated group compared with the control group and the vaseline-treated group. The expressions of transforming growth factor-beta1, fibronectin, and vascular endothelial growth factor were significantly decreased in the alginate-treated group compared with the control group, while the expression of collagen-I was increased in the alginate-treated group, as indicated by Western blotting and immunohistochemical staining. These data suggest that alginate has significant wound healing promoting activity. The results from the present study indicate that the effect of alginate on wound healing may involve biological mechanisms associated with the expression of transforming growth factor-beta1, fibronectin, vascular endothelial growth factor, and collagen-I.
Wound Repair and Regeneration 07/2009; 17(4):505-10. · 2.91 Impact Factor
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Plastic and reconstructive surgery 08/2008; 122(1):140-2. · 2.74 Impact Factor
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ABSTRACT: Marcus Gunn described for the first time a syndrome consisting of unilateral, congenital ptosis, and rapid exaggerated elevation of the ptotic eyelid during movement of the mandible to the contralateral side.
Here, clinical findings from the management of 20 patients with jaw-winking syndrome have been reviewed. Preoperative measurement of the ptotic degree and the levator function by Berke's method, and marginal limbal distance were all evaluated. Moreover, the amount of winking found in the upper eyelid on primary gaze was graded on a scale from I to III. The operation was performed on 20 patients under local anesthesia: 10 by unilateral levator resection and the other 10 by the frontalis muscle falp or orbicularis oculi muscle flap.
The correction of blepharoptosis was possible without encountering severe complications. However, a moderated degree of jaw-winking, slight undercorrection, and transient lagophthalmos were all inevitable.
The management of patients with jaw-winking syndrome is a challenging endeavor. Therefore, a comprehensive medical and ophthalmologic evaluation and a detailed history are mandatory before undertaking the successful treatment of patients with this syndrome.
Annals of Plastic Surgery 05/2008; 60(4):404-9. · 1.32 Impact Factor
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ABSTRACT: The normal morphologic and functional values of eyelids and orbits vary according to race, sex, and age. Unfortunately, there is a paucity of information related to these values in Asians, leading Asian surgeons to use statistical data from Caucasians.
The authors quantified and statistically analyzed nine morphologic and functional values in 234 Asian male and 264 Asian female subjects.
Among adults, the mean value for the palpebral fissure was 27.0 +/- 1.8 mm in males and 26.8 +/- 1.7 mm in females in the horizontal dimension and 8.0 +/- 1.0 mm in males and 8.2 +/- 1.1 mm in females in the vertical dimension. The average slant of the palpebral fissure was 7.9 +/- 2.4 degrees in males and 8.8 +/- 2.3 degrees in females, and the average height of the opened upper eyelid was 12.4 +/- 2.4 mm in males and 12.0 +/- 1.9 mm in females. The average height of the double fold in the closed eye was 6.6 mm in males and 6.5 mm in females, and the average intercanthal distance was 38.4 +/- 3.0 mm in males and 38.2 +/- 2.8 mm in females. The average interpupillary distance was 64.6 +/- 2.9 mm in males and 63.6 +/- 2.9 mm in females.
The peak level of growth in the vertical dimension of the palpebral fissure was reached between ages 10 and 13 years, that of the intercanthal distance between ages 14 and 16 years, and that of the horizontal dimension of the palpebral fissure between ages 17 and 19 years.
Plastic and reconstructive surgery 05/2008; 121(4):1405-13. · 2.74 Impact Factor
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ABSTRACT: Measurement of levator muscle function is very important in the evaluation and choice of surgical methods for blepharoptosis. In addition, the functional values of levator muscles are very helpful in cases of bilateral ptosis surgery. The normal values of levator muscle function vary according to race, sex, and age. Unfortunately, there are few articles concerning this function in Asians, so the authors have been forced to use Caucasian statistical data in conducting blepharoptosis surgery, until now.
There are two commonly used methods for measuring levator muscle function: Berke's method and margin limbal distance. The authors have measured levator muscle function by both of these methods, and have statistically analyzed the function of 498 individuals (234 males and 264 females).
The mean levator muscle function values were 11.9 +/- 1.6 mm in males and 11.9 +/- 1.6 mm in females through Berke's method, and 6.5 +/- 1.0 mm in males and 6.6 +/- 1.0 mm in females by margin limbal distance. There was no statistical difference between male and female subjects in left and right levator muscle function. Levator function reached a peak level during the high teen years and twenties among a large percentage of subjects. After peaking, the pattern of change in levator function became stationary or decreased gradually.
The results are very different from the reports of Putterman on his Caucasian subjects. Therefore, they should be applied as the standard in cosmetic surgery on Asian eyelids.
Plastic and reconstructive surgery 05/2008; 121(4):1181-7. · 2.74 Impact Factor
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ABSTRACT: Most patients with blepharoptosis prefer to undergo a double eyelid operation and a ptosis repair simultaneously to achieve the optimal cosmetic and functional result. However, it is difficult to achieve symmetry in patients with blepharoptosis.
Surgery was performed on the levator aponeurosis or frontalis muscle to correct blepharoptosis while double eyelid surgery was simultaneously performed to correct blephroptosis in 264 patients over the past 15 years. This report describes 39 representative cases of unilateral congenital blepharoptosis and 30 representative cases of bilateral congenital blepharoptosis. In cases of unilateral ptosis with good or fair levator function, a levator resection or plication was performed, and the position of the lid margin was adjusted to 1 to 2 mm below the upper limbus. Cases of severe unilateral blepharoptosis were corrected by frontalis muscle flap, orbicularis oculi muscle flap, or frontalis myofacial flap, and the height of the double eyelid was created to be 1 to 2 mm less than the height on the normal side. The position of the lid margin was adjusted to the level of the superior limbus, and the height of the lid crease of the ptotic eye was determined to be according to that on the nonptotic side. For bilateral ptosis patients with equal levator function, the height of the double eyelid was designed symmetrically. Bilateral blepharoptosis patients with unequal levator muscle function should have the double eyelids on both sides created the same as in normal cases, and they must be grafted in proportion to the severity of the blepharoptosis. If the results are unpredictable, the two-stage operation should be performed.
Only 30% of the eyelids in this study were perfectly symmetric after the blepharoptosis operation, with 70% asymmetric. These 70% showed good symmetry immediately after surgery, but asymmetry occurred 6 months after the operation.
In blepharoptosis surgery, different techniques for double eyelids must be applied according to the method of ptosis correction used. Usually, the height of the double eyelid on the ptotic side should be a little less than the normal double eyelid height on the nonptotic side. However, it is difficult to achieve symmetric double eyelids in blepharoptosis patients.
Aesthetic Plastic Surgery 02/2008; 32(1):66-71. · 1.41 Impact Factor
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ABSTRACT: The optimal surgical approach for blepharoptosis is dependent upon many factors, the most important being levator function. However, the preferred approach in severe blepharoptosis remains a matter of contention.
We investigated 130 patients with levator function between 2 and 4 mm who underwent corrective surgery for blepharoptosis between January 1990 and December 2004. There were 65 eyelids of levator resection performed in 50 patients and 105 eyelids of frontalis transfer performed in 80 patients. Postoperative results were evaluated, with an average follow-up period of 27 months.
The average preoperative degree of ptosis was approximately 2.7 mm in cases treated with levator resection and 4.0 mm in cases treated with frontalis muscle transfer. The average postoperative level of ptosis was approximately 1.7 mm in levator resection and 2.1 mm in frontalis muscle transfer. The average degree of postoperative ptosis improvement was approximately 1.0 mm in levator resection and approximately 1.86 mm in frontalis muscle transfer. The most frequent complication of levator resection was undercorrection. Eyelid deformity due to excessive traction was more frequent in the frontalis muscle flap technique.
Levator resection and frontalis transfer can effectively treat blepharoptosis patients with poor levator function. Frontalis muscle transfer should be performed more carefully in operation to avoid complications which too excessive contraction could cause for blepharoptosis patients with 2 approximately 4 mm of levator function. Also, some accessorial methods were regarded as necessary to prevent undercorrection in performing levator resection.
Annals of Plastic Surgery 11/2007; 59(4):388-92. · 1.32 Impact Factor
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Dae Hwan Park
Plastic and reconstructive surgery 05/2007; 119(5):1624-6. · 2.74 Impact Factor
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ABSTRACT: The challenge of accurately predicting eyelid height after blepharoptosis surgery is a well-known problem even in competent hands. From May 1988 to December 2004, the authors reviewed 182 cases (240 eyes) of blepharoptosis corrected by frontalis muscle transfer or levator resection and had experienced 10 cases (15 eyelids) of early adjustment around 1 week. The period from initial operation to adjustment is between 6 and 8 days, and the mean period is 7 days. Initial operative procedures were frontalis muscle transfer in 3 cases (4 eyelids) and levator resection in 7 cases (11 eyelids). Follow-up period ranged from 6 months to 16 years. Early postoperative adjustment was performed in accordance with the preoperative and postoperative degree of ptosis of the patient and considering previous operative technique. The results are evaluated according to the criteria of an ideal correction by Souther and Jordan. Seven patients had good or satisfactory results (less than 1 mm asymmetry, good in 5 cases and satisfactory in 2 cases). Three patients (5 eyelids) were recorded as poor results (more than 2 mm asymmetry). Even if early or late reoperation can be effective in correcting unsatisfactory results after correction of blepharoptosis, early reoperation is better than later reoperation because early reoperation can offer a reduction in time to final result, the ease with which it is performed, potential cost savings. The experience of the surgeon is also an important factor for the treatment of recurred blepharoptosis.
Annals of Plastic Surgery 11/2006; 57(4):376-80. · 1.32 Impact Factor
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Plastic and reconstructive surgery 01/2006; 116(7):1954-9. · 2.74 Impact Factor
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ABSTRACT: Thirteen patients underwent reoperation for recurrent blepharoptosis using the orbicularis oculi muscle flap or the frontalis musculofascial flap. The orbicularis oculi muscle flap and the frontalis musculofascial flap are a modification of direct transplantation of the frontalis muscle to the tarsal plate. This is based on an anatomic study showing that the frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the eyebrow region. The patients' previous blepharoptosis operations were frontalis muscle suspension with autogenous or alloplastic material. Their follow-up period ranged from 6 months to 10 years. The average interval between the patient's first frontalis suspension to their reoperation was 8.09 years. The selection of the muscle flaps was based on the extent of levator function of the patient. When the eyelid excursion was moderate (>4 mm), the orbicularis oculi muscle flap was used. For patients with minimal or weak eyelid excursion (<3 mm), the frontalis musculofascial flap was used. Eleven patients (91.6%) gained levator excursion of more than 7 mm and reduced the height difference of both palpebral fissures by less than 2 mm after the reoperation. After an average follow-up of 20 months, 11 patients (14 eyelids) recorded satisfactory results. This is based on the criteria of Souther, and Jordan and Anderson. The overall results were more than satisfactory. Even though 2 patients reported poor results, there was no complete failure in this series. The authors' technique offers several advantages over conventional frontalis muscle suspension: it is a simple technique that has a good operative field, there is no donor morbidity and less complications, and asymmetrical supratarsal folding, eyelid notching, lagophthalmus, and abnormal eyebrow position that can occur after a frontalis muscle suspension can be avoided. In summary, the orbicularis oculi muscle flap or the frontalis musculofascial flap are considered for patients with recurrent blepharoptosis after frontalis muscle suspension.
Annals of Plastic Surgery 01/2003; 49(6):604-11. · 1.32 Impact Factor
