• Anatomy and Cell Biology
• /
• v.56 no.4
• /
• pp.584-587
• /
• 2023

Polymelia is an extremely rare congenital anomaly where an individual is born with an abnormally developed extra or supernumerary limb which is generally shrunken and functionless. A case of thoracomelia (a type of polymelia) was observed macroscopically and confirmed radiologically in 1.5 years old boy born in Nepal with an abnormal supernumerary upper limb attached to his back in the thoracic region. The limb was successfully amputated, and the boy had a favorable outcome after surgical treatment, without any adverse effects or impairment. Understanding the embryogenesis of thoracomelia is essential for unraveling the complex mechanisms underlying this condition and potentially aiding in early diagnosis and intervention. This case report and review aims to shed light on the intricate processes governing forelimb formation and their perturbations leading to thoracomelia.

• Archives of Plastic Surgery
• /
• v.43 no.6
• /
• pp.512-517
• /
• 2016

Background Studies of the ear-molding technique have emphasized the importance of initiating molding early to achieve the best results. In the present study, we describe the immediate effects and long-term outcomes of this technique, focusing on children who were older than the ideal age of treatment initiation. Methods Patients who visited our institution from July 2014 to November 2015 were included. Medical charts were reviewed to collect data on demographics, the duration of treatment, the types of deformities, and the manner of recognition of the deformity and referral to our institution. Parents were surveyed to assess the degree of improvement, the level of procedural discomfort at the end of treatment, any changes in the shape of the molded auricle, and overall satisfaction 12 months after their last follow-up visits. Results A review of 28 ears in 18 patients was conducted, including the following types of deformities: constricted ear (64.2%), Stahl ear (21.4%), prominent ear (7.1%), and cryptotia (7.1%). The average score for the degree of improvement, rated on a 5-point scale (1, very poor; 5, excellent), was 3.5 at the end of treatment, with a score of 2.6 for procedural discomfort (1, very mild; 5, very severe). After 12 months, the shapes of all ears were well maintained. The average overall satisfaction score was 3.6 (1, very dissatisfied; 5, very satisfied). Conclusions We had reasonable outcomes in older patients. After 1 year of follow-up, these outcomes were well maintained. Patients past the ideal age at presentation can still be candidates for the molding technique.

• Archives of Craniofacial Surgery
• /
• v.21 no.2
• /
• pp.92-98
• /
• 2020

Background: Posttraumatic acquired facial deformities require surgical treatment, with options including scar revision, fat grafts, implant insertion, and flap coverage. However, each technique has specific advantages and disadvantages. Methods: From 2016 to 2018, 13 patients (eight with scar contracture and five with a depressed scar) were treated using dermofat grafts from the groin. The harvested dermofat was then inserted into the undermined dead space after the contracture was released, and a bolster suture was done for fixation considering the patient's contour and asymmetry. A modified version of the Vancouver Scar Scale and satisfaction survey were used to compare deformity improvements before and after surgery. Results: In most cases, effective volume correction and an aesthetically satisfactory contour were maintained well after dermofat grafting, without any major complications. In some cases, however, lipolysis proceeded rapidly when inflammation and infection were not completely eliminated. A significant difference was found in the modified Vancouver Scar Scale before and after surgery, with a p-value of 0.001. The average score on the satisfaction survey was 17.07 out of 20 points. Conclusion: A dermofat graft with the groin as the donor site can be considered as an effective surgical option that is the simplest and most cost-effective method for the treatment of acquired facial deformities with scar contracture.

• Archives of Craniofacial Surgery
• /
• v.11 no.2
• /
• pp.77-84
• /
• 2010

Purpose: The nasal bones are the most common fracture sites of the facial bones, and a careful reduction may still result in secondary deformities, such as saddle nose, deviated nose, hump nose etc, requiring secondary cosmetic rhinoplasty. Therefore, this study examined the clinical characteristics of nasal bone fractures to propose guidelines for patient selection and surgical procedures to achieve more satisfactory results and to prevent secondary deformities with simultaneous augmentation rhinoplasty and bony reduction. Methods: The study was based on 26 out of 149 nasal bone fracture patients who underwent simultaneous augmentation rhinoplasty with bony reduction between May 2008 and April 2009. Retrospective analysis was performed according to the clinical data, surgical techniques and postoperative results. Results: Of the 26 patients, there were 15 males and 11 females. The incidence according to the Stranc's classification revealed that 62% of patients were injured by a frontal impact and 38% by a lateral impact. Frontal impact plane I (50%) was the most frequent type. At the follow up, 18 (81.2%) out of 22 patients were satisfied with their postoperative outcome, and the remaining 4 patients were fair. No one was dissatisfied. However, 5 cases in 3 patients (23%) had some complications; minimal implant deviation in 2 cases, minor irregularity on the nasal dorsum in 2 cases and palpable implant movement under palpation in 1 case. None of these cases required surgical correction. Conclusion: With the proper guidance, simultaneous augmentation rhinoplasty with bony reduction can prevent secondary deformities and satisfy the cosmetic outcomes.

• Journal of Korean Foot and Ankle Society
• /
• v.16 no.2
• /
• pp.123-127
• /
• 2012

Purpose: The purpose of this study was to evaluate the clinical and radiographic results of the parallel-shaped modified Scarf osteotomy which is performed the Scarf osteotomy parallel to the shaft of the 1st metatarsal bone for hallux valgus deformities. Materials and Methods: We retrospectively reviewed 43 patients who had been treated by the parallel-shaped modified Scarf osteotomy for hallux valgus deformities between January 2006 and March 2011. We evaluated the results after this Scarf osteotomy with respect American Orthopaedic Foot & Ankle Society (AOFAS) scores, radiologic results by comparing intermetatarsal angle between 1stand 2nd metatarsal bones and hallux valgus angle. Results: We checked out the pre-operational and post-operational radiologic evaluation of intermetatarsal angle and hallux valgus angle between 1st and 2nd metatarsal bones. The mean AOFAS scores improved from 63.5 to 88.5. At final follow up, The hallux valgus angle improved from $31.4^{\circ}$ (16-52) to $9.0^{\circ}$ (3-13) and the intermetatarsal angle improved from $18.6^{\circ}$ (12-30) to $9.3^{\circ}$ (6-12) postoperatively. There was no case of major complications included recurrence of valgus deformity, correction or fixation failure and stress fractures. Conclusion: Our results suggest the our parallel-shaped modified Scarf osteotomy produces improved AOFAS scores, and effective correction of hallux valgus deformities. Our Scarf technique of osteotomy which is performed in parallel to the metatarsal bone minimizes the need for skill while more reliable and obtaining good correction and avoids associated complications.

• The Journal of the Korean bone and joint tumor society
• /
• v.17 no.2
• /
• pp.100-105
• /
• 2011

Vascular malformations may typically present with palpable mass that can be either asymptomatic or can present with symptoms including swelling and pain. On rare occasions, vascular malformation of muscle may produce joint deformities caused by contracture of the involved muscle. When vascular malformation involves the flexor muscle of the leg, ankle equinus deformity may occur. However, there are no reports of toe deformities secondary to intermuscular or intramuscular vascular malformations of flexor muscles of toe. Thus, we report a case of vascular malformation of flexor hallucis longus muscle with flexion contracture of toes in a 40-years-old woman who was treated with surgical excision.

• Journal of Korean Foot and Ankle Society
• /
• v.19 no.2
• /
• pp.63-68
• /
• 2015

Purpose: The purpose of this study was to report impacts of the amount of displacement of percutaneous osteotomy on the clinical and radiologic results in the treatment of bunionette deformities. Materials and Methods: We retrospectively reviewed 36 cases of bunionette deformities treated with percutaneous modified Kramer osteotomies from 2009 to 2013. We measured amounts of displacement on anteroposterior and lateral plain radiographs as well as multiple parameters which represent degrees of the bunionette deformities. We also recorded radiological healing time, clinical healing time, residual symptoms, and the time of returning to daily activity. Results: No meaningful correlation was found between severity of preoperative deformity and amount of displacement of the osteotomy. The amount of displacement on a horizontal plane did not affect the healing time, duration of symptoms, or time of returning to daily activity. However, large sagittal displacement was related to duration of postoperative symptoms. Conclusion: Findings of this study suggest that the displacement in percutaneous osteotomy for bunionette deformity does not affect clinical results and healing time. We believe that we do not need to be excessively cautious about how large the displacement we make during the percutaneous modified Kramer osteotomy for the bunionette deformity.

• Archives of Plastic Surgery
• /
• v.38 no.6
• /
• pp.775-782
• /
• 2011

Purpose: Nasal bone fracture is most common facial bone fracture. The cause of fractures is mainly trauma such as fighting, automobile accident and fall down, and it commonly involves young males. Very frequently nasal bone fractures are associated with other facial injuries such as orbital bone fracture, maxillary bone fracture and nasal septal deformities. Because of various dynamic directions of power are involved, phenomenon of fractures are also various and treatment cannot be simple. Methods: We studied and analyzed retrospectively 452 cases nasal bone fractures from January 2008 to December 2010. Diagnosis were made with physical examination, Nasal bone X-rays, Facial bone CT and 3D facial bone CT. Four surgeons are involved in treatments of these patients and applied different procedure along patient's condition and deformity. We analyzed the cause of nasal bone fractures, deformities, associate injuries and applied surgical technique, and patient's satisfaction rate. In this study, old nasal bone fractures were excluded. Results: Young male group was most commonly sustained nasal bone fracture and physical violence was most common cause of injury. 64 of 452 patient was involved associate injuries of face. Closed reduction were applied 246 cases and C-arm quide reduction were 167 cases and in 20 cases lateral osteotomy were applied. Approximately, more than 80% of the Patients were satisfied with the outcomes. Conclusion: Diagnosis and treatment of nasal bone fractures are considered simple but because of various deformity and associate injuries, treatment is not always simple and universal. Time to time, we face unsatisfied patient after treatment of nasal bone fractures. For obtaining satisfactory result, cause of injury and state of deformities and associate injuries such as nasal septal deformity should be evaluated properly and proper treatment should be applied.

• Archives of Plastic Surgery
• /
• v.39 no.2
• /
• pp.113-117
• /
• 2012

Background : Nasal pyramid fractures accompanied by saddle nose deformities are not easily corrected by closed reduction. We used an absorbable plate as a perpendicular strut to support the collapsed "keystone area" and obtained good results. Methods : Between September 2008 and June 2011, 18 patients who had nasal pyramid fractures with saddle nose deformities underwent surgery. Pre- and postoperative facial computed tomographic images and photographs were taken to estimate outcomes. The operative technique included the mucoperichondrial dissection of the nasal septum, insertion of an absorbable plate prepared to an appropriate length to support the "keystone area", and fixation of the absorbable plate strut to the cartilaginous septum. Results : Functional and esthetic outcomes were satisfactory in all patients. Eleven patients assessed the postoperative appearance of the external nose as 'markedly improved' and 7 patients as 'improved'. The 5 surgeons scored the results as a mean of 4.5 on a 5-point scale. Conclusions : The use of an absorbable plate as a perpendicular strut requires no additional procedures because the plate is gradually absorbed. The mechanical strength provided by a buttress between the "keystone area" and the maxillary crest lasts for a long time before the strut is absorbed.

• Korean Journal of Cleft Lip And Palate
• /
• v.8 no.1
• /
• pp.11-22
• /
• 2005

There ate anteroposterior$\cdot$vertical maxillary underdevelopment, transverse maxillary deficiency and wide cleft alveolus$\cdot$oroanual fistula among cleft lip ant palate related maxillary deformities. For treatment of these deformities, ones have used conventional treatment methods, there were often unsatisfactory results to patients and operators both. Since llizarov introduced effective technique of bone lengthening and augmentation for a variety of limb defotmities, application of distraction osteogenesis on maxillofacial area has been used to solve those disadvantages of conventional methods. Authors introduced following three cases about use of distraction osteogenesis. The first case is the application of RED(rigid external distraction) II system for the treatment of the anteroposterior$\cdot$vertical maxillary hypoplasia after several times of surgery and end of development in bilateral cleft lip and palate patient. The second case is the application of the USPD(unilateral segmental palatal distraction) for the resolution of the unilateral posterior crossbite and transverse dental arch asymmetry after alveolorraphy in growing unilateral cleft lip and palate patient. The third case is the application of transport distraction osteogenesis far closure of the wide clef alveolus and oroantral fistula in growing bilateral cleft lip and palate patient. There were satisfactory results in these cases. Particularly, in comparison with the decreases of relapse rates, the reduction of the hospitalization time and post-operative discomfort owing to minimal surgical intervention.