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Plastic and reconstructive surgery 08/2008; 122(1):140-2. · 2.74 Impact Factor
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ABSTRACT: The goals of reduction mammoplasty are to reduce the volume of a breast, to create an aesthetic shape that is stable over time, to maintain blood supply and innervation to the areolar complex, and to make fine limited scars. The present authors used periareolar reduction mammoplasty using an inferior dermal pedicle or a central pedicle. To minimise the scar, periareolar incision was performed. To reduce the volume of breast and to preserve blood supply and innervation to the nipple-areolar complex, a central or an inferior pedicle technique was used. To prevent areolar widening, a purse-string suture was used. A total of 82 breasts in 41 patients with very large breasts were operated on between July 1998 and June 2004. The mean age was 39, and the mean resection amount was 389 g per breast (right 413 g, left 364 g) with an average follow up of 28 months. Most of the patients were satisfied with the fine periareolar scar, the size of the breasts and the sensation of the nipple-areolar complex. The present authors have applied this procedure to all kinds of macromastia. Although the advantages of the periareolar reduction mammoplasty are an inconspicuous limited scar, a preservation of sensation to the nipple-areolar complex and a short operation time, 24 breasts (29%) showed areolar widening. There were persistent periareolar wrinkles in eight breasts (10%) and poor sensation to the nipple-areolar complex in 12 breasts (15%), in which more than 500 g of breast tissue was removed per breast. In conclusion, the periareolar reduction mammoplasty is optimal for patients who require a reduction of less than 500 g per breast. In severe macromastia with or without ptosis, the inverted T-incision is more preferable to periareolar incision, and periareolar incision can be modified by adding a wedge resection of the outer excess in skin flap inferiorly, which results in periareolar and vertical scars below the nipple-areolar complex.
Journal of Plastic Reconstructive & Aesthetic Surgery 02/2008; 61(3):275-81. · 1.49 Impact Factor
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ABSTRACT: Cephalhematoma is a collection of blood beneath the periosteum of the bones in the cranial vault. The treatment strategy of most cephalhematoma is conservative. However, in cases of ossified cephalhematoma causing deformities of skull, surgical management is indicated. From 1996 to 2002, the authors treated three cases of ossified cephalhematoma with the suggested pathogenesis of ossification, which cephalhematoma goes to ossification process, rather than calcification. Surgical treatment, which is bony shaving with a burr on the irregular margin site, was performed in one case in which the thickness of the skull in the bulging area was the same as in the normal area in preoperative computed tomography (CT) scan, and a depression did not exist in the operative field. In two cases in which there was any difference in bony density in the preoperative CT scan and depression after removal of cephalhematoma, the bony cap was remodeled into multiple pieces and the depressed region was reconstructed with a remodeled bone cap as an onlay bone graft. There was no evidence of complications and recurrence, and there was good reconstitution of the skull contour in all cases.
Journal of Craniofacial Surgery 10/2004; 15(5):774-9. · 0.82 Impact Factor
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ABSTRACT: The purpose of this project was to study the effect of hyaluronic acid, calcium sulfate, and chitosan on early bony consolidation in distraction osteogenesis of a canine model. Sixteen dogs were used for this study. The lateral surface of the mandibular body was exposed in the subperiosteal plane, and the vertical osteotomy on the mandibular body was extended downward. An external distraction device was applied to the mandibular body, and the mandibular distraction was started 5 days after the operation at a rate of 1 mm/d up to a 10-mm distraction. The experimental group was then divided into a control group, chitosan group, hyaluronic acid group, calcium sulfate combined with hyaluronic acid group, and calcium sulfate combined with chitosan group, depending on the type of implantation material in the distracted area. After completing the distraction, implantation material was injected into the distracted area, although no material was implanted into the distracted area of the control group. After implanting the materials, the distraction device was left in place for 6 weeks to allow for bony consolidation. Four dogs were allocated to each group. Two dogs in each group (total of 8 dogs) were killed 3 weeks after implantation of the material, and the other 8 dogs were killed after 6 weeks. New bone was generated in the distracted zone of all groups. In the calcium sulfate combined with chitosan group and calcium sulfate combined with hyaluronic acid group, the formation of active woven bone was observed throughout the distracted zone. Moreover, the new bone seemed to be nearly normal cortical bone at 6 weeks after implantation. In the chitosan group and hyaluronic acid group, the development of new bone was observed in the distracted zone at 6 weeks. The amount was less than that in the calcium sulfate combined with hyaluronic acid group and calcium sulfate combined with chitosan group. These findings suggest that calcium sulfate and its combined materials seem to be quite effective in early bony consolidation in distraction osteogenesis.
Journal of Craniofacial Surgery 12/2002; 13(6):783-93. · 0.82 Impact Factor
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ABSTRACT: To improve the success rate of microsurgical flap transfers into a buried area, it is important to monitor the circulation of the flap during the early stage. A monitoring flap includes such advantages as simplicity, reliability, noninvasiveness, and the ability to continuously monitor the vascular status of various buried flaps. This article describes experiences related to the importance and reliability of a monitoring flap. A total of 109 flaps in 99 patients were treated with buried free flaps, including a monitoring flap, between 1990 and 1999. Forty-nine patients received a tubed free radial forearm flap with a skin-monitoring flap, and six received a free jejunal flap with a jejunal segment monitoring flap for the reconstruction of the esophagus. Vascularized fibular grafts with a skin monitoring flap or peroneus longus muscle monitoring flap were used for reconstructing the mandible in six patients and for treating osteonecrosis of the femoral head in 48 flaps in 38 patients. Monitoring flap abnormalities were indicated in 14 flaps; therefore, immediate revisions were performed on the pedicle of the monitoring flap and microanastomosis site. Among these 14 flaps, nine showed true thrombosis and five showed false-positive thrombosis. Among the nine flaps that showed true thrombosis, five were salvaged and four were finally lost. The false-positive thrombosis in the five flaps was attributed to torsion or tension of the perforator of the monitoring flap in three flaps, an unclear determination in one flap because the monitoring flap size was too small, and damage to the perforator in the last flap. The total thrombosis rate was 8.3 percent (nine of 109), and the failure rate of the free tissue transfer was 3.7 percent (four of 109). The overall sensitivity of the monitoring flap was 100 percent, the predictive value of a positive test was 64 percent (nine of 14), and false-positive results occurred in 36 percent (five of 14). The salvage rate was 55.6 percent. To improve the reliability of a monitoring flap, it is recommended that the size of the flap be larger than 1 x 2 cm to assess the arterial status, and that a perforator with the appropriate caliber be selected. When a monitoring flap is fixed to a previous incision line or a newly created wound, any torsion or tension of the perforator should be avoided. In conclusion, the current results suggest that a monitoring flap is a simple, extremely useful, and reliable method for assessing the vascular status of a buried free flap.
Plastic & Reconstructive Surgery 11/2002; 110(5):1249-58. · 3.38 Impact Factor
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ABSTRACT: The purpose of this investigation was to study the effect of bone morphogenetic protein (BMP), transforming growth factor beta-induced gene h3 (betaig-h3), and chitosan on early bony consolidation in distraction osteogenesis in a dog model. Sixteen dogs were used for this study. The lateral surface of the mandibular body was exposed in the subperiosteal plane and the vertical osteotomy on the mandibular body was extended downward. An external distraction device was applied to the mandibular body, and the mandibular distraction was started 5 days after the operation at a rate of 2 mm/day up to a 10-mm distraction after 5 days. The experimental group was then divided into a control group, a BMP group, a betaig-h3 group, and a chitosan group, depending on the type of implantation material used in the distracted area. On the same day after completing the distraction, BMP, betaig-h3, or chitosan was implanted into the distracted area. No material was implanted into the distracted area in the control group. After implanting the materials, the distraction device was left in place for 7 weeks to allow for bony consolidation. Four dogs were allocated to each group. Two dogs in each group, a total of eight dogs, were killed 4 weeks after completing the distraction and the other eight dogs were killed after 7 weeks. Serial radiographs were obtained every week after completing the distraction. New bone was generated in the distracted zone in all groups. In the BMP group, the formation of active woven bone was observed throughout the distracted zone, and the new bone appeared to be nearly normal cortical bone 7 weeks after implantation. In the betaig-h3 and chitosan groups, the development of new bone was observed in the distracted zone after 7 weeks; however, the amount was less than that in the BMP group. In the control group, the new bone was observed at the edges of the distracted zone. These findings suggest that BMP seems to be very effective in early bony consolidation in distraction osteogenesis.
Plastic & Reconstructive Surgery 06/2002; 109(6):1966-77. · 3.38 Impact Factor
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ABSTRACT: The purpose of this project was to study the effect of calcium sulfate on early bony consolidation in distraction osteogenesis. A total of eight patients with craniofacial microsomia were treated between April 2000 and February 2001. The age of the patients ranged from 2 to 40 years, and all were male. The follow-up period was 1 to 15 months. The operative procedure in adults was based on Ortiz Monasterio's simultaneous mandibular and maxillary distraction technique. In children, osteotomy of the mandible was performed for distraction. On the fifth day after the operation, distraction was performed at a rate of 1 mm/d in three adults. In children, distraction was performed at a rate of 1 mm/d in one patient and 2 mm/d in four patients without a latent period. On the day of completion of distraction, calcium sulfate was implanted into the distracted zone. Radiographs showed bony consolidation at 4 weeks in one child at a rate of 1 mm/d, at 5 to 7 weeks in four children at a rate of 2 mm/d, and at 5 weeks in three adults after implantation of the calcium sulfate. In conclusion, these findings suggest that calcium sulfate is effective for early bony consolidation in distraction osteogenesis and that it would shorten the whole treatment period.
Journal of Craniofacial Surgery 06/2002; 13(3):465-75; discussion 475-7. · 0.82 Impact Factor
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ABSTRACT: The purpose of this investigation was to study the effect of bone morphogenetic protein (BMP), transforming growth factor beta–induced gene h3 (βig-h3), and chitosan on early bony consolidation in distraction osteogenesis in a dog model. Sixteen dogs were used for this study. The lateral surface of the mandibular body was exposed in the subperiosteal plane and the vertical osteotomy on the mandibular body was extended downward. An external distraction device was applied to the mandibular body, and the mandibular distraction was started 5 days after the operation at a rate of 2 mm/day up to a 10-mm distraction after 5 days. The experimental group was then divided into a control group, a BMP group, a βig-h3 group, and a chitosan group, depending on the type of implantation material used in the distracted area. On the same day after completing the distraction, BMP, βig-h3, or chitosan was implanted into the distracted area. No material was implanted into the distracted area in the control group. After implanting the materials, the distraction device was left in place for 7 weeks to allow for bony consolidation. Four dogs were allocated to each group. Two dogs in each group, a total of eight dogs, were killed 4 weeks after completing the distraction and the other eight dogs were killed after 7 weeks. Serial radiographs were obtained every week after completing the distraction. New bone was generated in the distracted zone in all groups. In the BMP group, the formation of active woven bone was observed throughout the distracted zone, and the new bone appeared to be nearly normal cortical bone 7 weeks after implantation. In the βig-h3 and chitosan groups, the development of new bone was observed in the distracted zone after 7 weeks; however, the amount was less than that in the BMP group. In the control group, the new bone was observed at the edges of the distracted zone. These findings suggest that BMP seems to be very effective in early bony consolidation in distraction osteogenesis.
Plastic & Reconstructive Surgery 04/2002; 109(6):1966-1977. · 3.38 Impact Factor
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ABSTRACT: The early revascularization of a membranous inlay bone graft in a canine mandible was investigated using bone scans and histological examinations. Eight 5-month-old mongrel dogs were used as the subjects. The inlay bone graft, a 1- x 2-cm critically sized bone, was completely separated from the lower border of the canine mandible and then refixed to the original site. Bone scans and histological examinations were performed in the first, second, third, and fourth postoperative weeks. The bone scan in the first postoperative week revealed radioisotope uptake on the margin of the grafted bone with an isotope count that was 21% of the normal bone uptake. In the second postoperative week, the radioisotope uptake in the grafted bone increased to 52% of the normal bone uptake. In the third and fourth postoperative weeks, the isotope uptakes were 111% and 124%, respectively. The histological findings in the first postoperative week showed an absence of osteoblastic activity and 6 viable blood vessels in a field magnified x 200, which was the equivalent of 25% of the vessels of the normal bone. In the second postoperative week, osteoblastic activity was noted, and the number of viable blood vessels increased to 15, that is, 63% of the vessels of the normal bone. In the third postoperative week, there was an increase in osteoblastic activity, and the number of viable blood vessels was 21, that is, 88% of the vessels of the normal bone. In the fourth postoperative week, there was a marked increase in osteoblastic activity with the number of vessels reaching 23, that is, 96% of the normal bone. In summary, revascularization of the membranous inlay bone graft began within the first week after the bone graft and thereafter gradually increased. In the third postoperative week, revascularization returned to a near-normal value compared with the value of the adjacent normal mandibular bone.
Journal of Craniofacial Surgery 04/2002; 13(2):251-7. · 0.82 Impact Factor
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ABSTRACT: In the case of a severe tissue deficiency with a secondary cleft lip nasal deformity, a composite graft can be useful for columellar lengthening or to create symmetrical nostrils. The current study used composite grafts to correct secondary cleft lip nasal deformities with a severe tissue deficiency or severe nostril asymmetry. A total of 19 patients who were born with complete cleft type were operated between 1995 and 1999. Of these patients, 10 were men and 9 were women, and the age distribution was 7 to 35 years old. In 9 patients with unilateral cleft lip nasal deformities and in 6 patients with bilateral cleft lip nasal deformities, columellar lengthening was performed using a composite graft taken from the helix in 14 patients and the contralateral alar rim in 1 patient. In 4 patients with severely asymmetrical nostrils resulting from a short alar rim in unilateral cleft lip nasal deformities, the ear helix was used in 2 patients, whereas in the other two patients, the alar rim of the unaffected side was transferred to the affected side to create a symmetrical nostril by reducing the length of the ala on the unaffected side. The follow-up period ranged from 1 to 3 years, and results were as follows: Four days after the graft, the composite tissue exhibited a pinkish color, and complete survival was confirmed after 7 days. The absorption rate was approximately 10% and the color mismatch became minimal with time. Composite tissue from the ear was found to be useful for full-layer reconstruction of the ala and columella because of its stiffness, thin nature, and similarity. Composite tissue from the alar rim on the contralateral side was also determined to be a good material for full-layer reconstruction of the deficient ala.
Annals of Plastic Surgery 03/2002; 48(2):131-7. · 1.32 Impact Factor
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ABSTRACT: A prominent malar complex results in a triangular facial shape. When combined with a prominent mandibular angle, the face appear to be aggressive and masculine. Surgical procedures to correct these features are commonly requested by Asian women. Baek introduced reduction malarplasty by underpositioning of the "osteotomized" zygoma. We modified Baek's procedure by sliding the osteotomized zygoma superoposteriorly. The posterior surface is not separated from the soft tissue to preserve the blood supply to the zygoma. Ten patients with prominent zygomas underwent reduction malarplasty from March 1994 through July 1996. Seven patients were female and 3 patients were male. All patients were satisfied with their results. A symmetrical appearance was achieved in all patients. This method provides for precise malar reduction under good exposure. Symmetry of the zygoma is easily achieved. There is no effect on the survival of the malar bone after the procedure because the osteotomized zygoma has its own blood supply on the posterior surface. The masseteric origin is preserved, which ensures minimal cheek drooping after reduction.
(C) 1998 Mutaz B. Habal, MD
Journal of Craniofacial Surgery 04/1998; 9(3). · 0.82 Impact Factor
