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ABSTRACT: 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.
Journal of Reconstructive Microsurgery 02/2013; · 1.43 Impact Factor
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ABSTRACT: 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.
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.
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.
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.
The Journal of craniofacial surgery 01/2013; 24(1):221-5. · 0.81 Impact Factor
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ABSTRACT: 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.
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.
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.
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.
Archives of plastic surgery. 09/2012; 39(5):504-8.
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ABSTRACT: 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.
The Journal of craniofacial surgery 07/2011; 22(4):1479-82. · 0.81 Impact Factor
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ABSTRACT: 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.
The Journal of craniofacial surgery 05/2011; 22(3):978-81. · 0.81 Impact Factor
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ABSTRACT: In scaphocephaly, traditional distraction osteogenesis increases only the bitemporal width. We describe distraction osteogenesis with a pivot plate for scaphocephaly, which not only increases the bitemporal width but also decreases the anteroposterior length. Three patients with scaphocephaly were treated using distraction osteogenesis with a pivot plate between January 2005 and June 2006. These children underwent cranial reshaping by gradual distraction using an external distraction device and pivot plate. The distraction rate was 1 mm/d, and the latency period was 5 days. The follow-up period after distraction osteogenesis ranged from 16 to 24 months. No specific complications, such as accidental removal of the distraction devices, infection, or neurologic problems in any patient, occurred. The mean distraction was 45 mm. The mean cranial index was 73.6. Distraction osteogenesis for scaphocephaly is still in the development stage, but it is becoming accepted as a useful method because of its many advantages. Distraction osteogenesis with a pivot plate for scaphocephaly is better than other distraction osteogenesis techniques because it induces increased bitemporal width and decreased anteroposterior length synchronously.
The Journal of craniofacial surgery 01/2011; 22(1):96-9. · 0.81 Impact Factor
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ABSTRACT: 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.
The Journal of hand surgery 08/2010; 35(8):1282-5. · 1.33 Impact Factor
