• Steel and Composite Structures
• /
• v.15 no.3
• /
• pp.323-342
• /
• 2013

In the case of seismic-resistant composite dual moment resisting and eccentrically braced frames, the current design practice is to avoid the disposition of shear connectors in the expected plastic zones, and consequently to consider a symmetric moment or shear plastic hinges, which occur only in the steel beam or link. Even without connectors, the real behavior of the hinge may be different from the symmetric assumption since the reinforced concrete slab is connected to the steel element close to the hinge locations, and also due to contact friction between the concrete slab and the steel element. At a larger level, the structural response in the case of important seismic motions depends directly on the elasto-plastic behavior of elements and hinges. The numerical investigation presented in this study summarizes the results of elasto-plastic analyses of several steel frames, considering the interaction of the steel beam with the concrete slab. Several parameters, such as the inter-story drift, plastic rotation requirements and behavior factors q were monitored. In order to obtain accurate results, adequate models of plastic hinges are proposed for both the composite short link and composite reduced beam sections.

• Archives of Plastic Surgery
• /
• v.36 no.3
• /
• pp.341-343
• /
• 2009

Purpose: Morel - Lavallee lesions is post - traumatic effusion at subcutaneous layer. Early management of Morel - Lavallee lesion is percutaneous drainage and compression. Surgical excision is recommended for cases that are chronic. Method: 41 - year old male patient had slow growing, painful mass on left thigh, which has been present for 3 years. He had a history of blunt trauma 3 years ago. Computed tomography presented $10{\times}10{\times}5cm$ sized cystic mass on left thigh, between subcutaneous fat layer and muscle fascia layer. The mass was surgically removed and biopsy was performed. Result: Histopathological examination shows chronic inflammation and fibrotic change. After 6 month follow - up period, postoperative course was uneventful. Conclusion: We performed surgical excision of Morel - Lavalle lesion in a patient who had trauma 3 years ago. We report a case of Morel - Lavallee lesion with the review of the literatures.

• Archives of Plastic Surgery
• /
• v.32 no.3
• /
• pp.381-384
• /
• 2005

Rhabdomyosarcoma is a rare malignancy of head and neck region. When rhabdomyosarcoma occurs in maxillary area, total maxillectomy is necessary. Total maxillectomy causes defects of orbital floor, palate, gingiva, and alveolar bone, causing severe facial deformity and functional impairment. Immediate maxillary reconstruction has to cover both bone and soft tissue to minimize cosmetic and functional problems. The fibular osteocutaneous free flap can provide paranasal, gingiva, oral mucosal lining and foundation for dental prosthesis, thus ensuring good cosmetic results and mastication, phonation function. We have experienced a reconstruction case of a 19-year-old man with rhabdomyosarcoma of the left maxillary sinus. The patient underwent total maxillectomy and neck dissection. We designed a fibular free flap that had a vascularized bone segment and a double skin paddle. Surgical outcomes were excellent in cosmetic and functional aspects.

• Archives of Plastic Surgery
• /
• v.35 no.6
• /
• pp.692-697
• /
• 2008

Purpose: Gluteal perforator flap has evolved to one of the standard tools for coverage of pressure sore. We used this flap to cover the defect adjacent to the buttock. Methods: From September 2004 to August 2006, gluteal perforator flaps were performed in 3 patients with sore and 9 patients with tumor. We made the rule for free style design of the flap. First, the defect should be covered fully regardless of the shape or area. Second, the location of perforators was decided to maximize flap mobility. Third, the donor-site should be closed directly. Results: Successful reconstruction was fulfilled. In 2 cases, initial flap congestion was observed but medical leech was applied and it was resolved. Partial flap loss occurred in one case. Infection was observed in one case. But there were no major complications. Conclusion: Gluteal perforator flap is very good option for the reconstruction of the defects adjacent to the buttock.

• Archives of Plastic Surgery
• /
• v.39 no.1
• /
• pp.59-62
• /
• 2012

Sweet's syndrome is characterized by clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions, and a diffuse infiltrate of mature neutrophils. This is a report of our experience of Sweet's syndrome with parotitis. A 57-year-old man initially presented with tender swelling on the right cheek similar to parotitis. His symptoms relapsed despite the use of an oral antibiotic agent for 3 weeks. He additionally presented with erythematous papules and plaques on the periocular area and dorsum of both hands. Histiopathologic findings on punch biopsy of the right dorsum of the hand showed superficial perivenular histiocytic infiltration without vasculitis. We confirmed this as histiocytoid Sweet's syndrome and used systemic corticosteroid. After initiation of treatment with systemic corticosteroids, there was a prompt recovery from both the dermatosis-releated symptoms and skin lesions. Sweet's syndrome should be considered in patients with therapy-refractory parotitis and unclear infiltrated nodules. We present a confusing case who initially appeared to have parotitis but turned out to have histiocytoid Sweet's syndrome.

• Archives of Plastic Surgery
• /
• v.32 no.5
• /
• pp.663-666
• /
• 2005

Mandible angle ostectomy is the most widely-operated facial contour surgery. We experienced a rare case of necrotizing fasciitis of the lower leg following mandible angle ostectomy. A 20 years old female visited our department 5 days after mandible angle ostectomy. At the time, she was diagnosed as sepsis and on her 2nd admission day, she was diagnosed as necrotizing fasciitis on her left leg. She was treated by fasciotomy and necrotized tissue removal. Necrotizing fasciitis is a rare complication of any kinds of operation but once it develops, it causes fatal results, especially to cosmetic surgeries. Early diagnosis and aggressive operation is known as only treatment for the disease.

• Archives of Craniofacial Surgery
• /
• v.12 no.2
• /
• pp.121-124
• /
• 2011

Purpose: The congenital epulis is a rare, benign tumor. It can protrude out of the newborn's mouth to prevent normal closure of the mouth and it can interfere with respiration or feeding. Methods: An 11-day old female neonate presented with a $1.5\;{\times}\;1.5\;{\times}\;2.3cm$ sized mass in the gingival and anterior alveolar ridge of the mandible. We performed a simple excision. Results: In our case, histologically, there was no pseudoepitheliomatous hyperplasia. The staining for S-100 protein, and actin was negative. After 8 months, the patient had normal teeth eruption and no recurrence of the tumor. Conclusion: With early detection and appropriate treatment, we were able to help the baby avoid developing any dyspnea. Nursing was possible after the mass had been removed.

• Archives of Craniofacial Surgery
• /
• v.22 no.2
• /
• pp.119-121
• /
• 2021

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation for facial laceration in pediatric patients. The major benefits are its rapid onset of effects, relatively short half-life, and lack of respiratory depression. The known side effects of ketamine are hallucinations, dizziness, nausea, and vomiting. Seizure is not a known side effect of ketamine in patients without a seizure history. Here, we present the case of a patient in whom ketamine likely induced a generalized tonic-clonic seizure when used as a single agent in procedural sedation for facial laceration repair. The aim of this article is to report a rare and unexpected side effect of ketamine used at the regular dose for procedural sedation. This novel case should be of interest to not only emergency physicians but also plastic surgeons.

• Archives of Plastic Surgery
• /
• v.46 no.1
• /
• pp.75-78
• /
• 2019

It is difficult to differentiate acute skin failure (ASF) from pressure ulcer (PU). ASF is defined as unavoidable injury resulting from hypoperfusion caused by severe dysfunction of another organ system. We describe a case of ASF mistaken as PU that resulted in a legal dispute. A 74-year-old male patient was admitted to our intensive care unit with sepsis due to bacterial pneumonia. Despite the use of air cushions and regular position changes, skin ulcerations occurred over his occiput, back, buttock, elbow, and ankle. After improvement in his general condition, he was transferred to the department of plastic and reconstructive surgery. Debridement was performed immediately, followed by conservative treatment (including a vacuum-assisted closure device) for 6 weeks. The buttock and occiput wounds were treated surgically. Despite complete healing, his caregivers sued the hospital for failing to prevent PU formation. ASF is a pressure-related injury resulting from hemodynamic instability due to organ system failure. Unlike PU, ASF may occur despite the implementation of all appropriate preventive measures. Furthermore, misdiagnosis of ASF as PU can lead to litigation. Therefore, it is critical for the proper diagnosis to be made quickly, and for physicians to explain that ASF occurs despite proper preventative treatment.

• Archives of Craniofacial Surgery
• /
• v.22 no.1
• /
• pp.66-70
• /
• 2021

Isolated head and neck metastasis of renal cell carcinoma (RCC) is relatively rare and metastasis to the temple area is very rare. Here, we present the case of a 51-year-old man who was diagnosed with RCC 2 years earlier and had a contralateral metastatic temple area lesion. The patient who was diagnosed with renal cell cancer and underwent a nephrectomy 2 years ago was referred to the plastic surgery department for a temple mass on the contralateral side. In the operative field, the mass was located in the temporalis muscle with a red-to-purple protruding shape. Biopsy of the mass revealed a metastatic RCC lesion. Computed tomography imaging showed a lobulated, contoured enhancing lesion. Positron emission tomography/computed tomography imaging showed high-fluorodeoxyglucose uptake in the right temporalis muscle. The patient underwent wide excision of the metastatic RCC including the temporalis muscle at the plastic surgery department. Skeletal muscle metastasis of head and neck lesions is extremely rare in RCC. Isolated contralateral temporalis muscle metastasis in RCC has not been previously reported in the literature. If a patient has a history of malignant cancer, plastic surgeons should always consider metastatic lesions of head and neck tumors. Because of its high metastatic ability and poor prognosis, it is very important to keep this case in mind.