• Archives of Plastic Surgery
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• v.42 no.6
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• pp.761-768
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• 2015

Background Surgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire. Methods A total of 40 patients (17 men and 23 women) with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS) and the Wake Forest University rating scale. Results The total patient score was 8.59 (range, 6-15) in the two-step incision group and 9.62 (range, 7-18) in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034) but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03). Conclusions Compared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

• Journal of the Korean Arthroscopy Society
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• v.2 no.1
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• pp.33-39
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• 1998

This study was done to compare the results of the one-incision technique and the conventional two incision technique for the arthroscopic treatment of the posterior cruciate ligament injury. Fifty-five patients with the posterior cruciate ligament injury underwent the arthroscopic posterior cruciate ligament reconstruction using bone-patellar tendon-bone(BTB) graft. Patients with combined ligament injuries requiring concomitant operative treatment were excluded in this study. The conventional two-incision technique was performed in ten patients(Group I) and the one-incision technique in forty-five patients(Group II). The average duration of follow-up was 45 months in Group I(range, 40 to 50 months) and 36 months in Group II(range, 24 to 68 months). Auto BTB grafts were utilized for all patients in Group I. In Group II, 34 BTB autografts and 11 BTB allografts were utilized. The functional results were evaluated according to the Lysholm Knee Scoring scale and the Hospital for Special Surgery(HSS) knee ligament rating form. The postoperative posterior laxity was measured with a KT 1000 or 2000 arthrometer. Lysholm postoperative mean values were 90.0 in Group I and 90.6 in Group II. HSS mean values were 87.7 in Group I and 92.6 in Group II. HSS postoperative mean value showed better results in Group II(p=0.037). The average side-to-side difference of the posterior translation measured by the KT 2000 arthrometer were 2.10 mm(range, 1 to 4 mm) in Group I and 2.38 mm(range, 0 to 5 mm) in Group II. But there was no statistically significant difference. In Group II, the results of the autograft and allograft showed no significant difference. The arthroscopic posterior cruciate ligament reconstruction using one-incision technique showed good results comparable to the conventional two-incision technique. This technique minimizes potential injury to the extensor mechanism, especially vastus medialis obliquus, and scar formation over the medial femoral condyle. The operation can be finished within one tourniquet time by using only one-incision.

• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.131-137
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• 2005

The extensor digitorum brevis (EDB) muscle island flap is a reliable, safe method for coverage of foot and ankle. There are many variation in approach such as curvilinear, zigzag, L-shaped or vertical longitudinal incision for exposure of the EDB muscle. These approaches use only single incision excluding the distal incision for exposure of the distal tendon. Since dorsalis pedis artery vascular bundle and sinus tarsi branch of the lateral tarsal artery both requires careful dissection, single incision alone may cause not only difficulty in exposure but also skin sloughing at donor site. So we tried to modify the approach into two parallel longitudinal incision, one for dorsalis pedis vascular bundle and the other for sinus tarsi branch exposure. The author treated 9 patient with EDB muscle flap. We used single incision in six patients, and two parallel incision in three patients. All the flap survived. In two parallel incision group, dissection was more easy and rapid. So we would like to suggest that two parallel longitudinal incision approach is better method than the single incision technique for exposure of the EDB muscle flap.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.271-276
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• 2010

Purpose: The purpose is to present an useful and simple surgical method to improve the aging of upper third face in patients with high frontal hairline as well as low frontal hairline. Methods: Forty eight female patients were treated with subcutaneous forehead lift using an anterior hairline incision over 14 years. This surgical technique is performed under direct vision utilizing a beveled incision made 4 to 5 mm into the anterior hairline with subcutaneous dissection, which is continued near to eyebrow, sometimes extended to supraorbital rim to remove corrugator and procerus muscles. In patients with high frontal hairline, excess forehead skin anterior to incision line is removed. On the contrary in the patients with low frontal hairline, scalp posterior to incision line is removed. Results: This technique provided constant and good results with the forty six patients, who were satisfied with eyebrow elevation and removal of wrinkles in forehead and glabellar region. However two patients were undercorrected, and focal alopecia developed in another two patients. One patient complained of pruritus over one year, but subsided spontaneously without any treatment. Temporary paresthesia developed in the forehead and frontal scalp of all cases after operation but permanent sensory loss never occurred in all the patients. Conclusion: Subcutaneous forehead lift using an anterior hairline incision is suggested to be one of the effective surgical methods to improve the aging of upper third face in the patients with high frontal hairline as well as low frontal hairline.

• Archives of Craniofacial Surgery
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• v.20 no.3
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• pp.203-206
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• 2019

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroectodermal carcinoma arising from mechanoreceptor Merkel cells. Multiple MCCs are even rarer. We report a case of two independent MCCs simultaneously present in the cheek of a patient, which were effectively and esthetically treated using a cheek flap. Punch biopsy performed in a 60-year-old woman admitted with a chief complaint of two skin-colored hard nodules in her left cheek, accompanied by an itching sensation, was suggestive of MCC. Accordingly, we performed sentinel lymph node biopsy through the modified Blair incision under general anesthesia, in cooperation with the head and neck surgery department. The defect was covered with a cheek flap by slightly extending the existing incision following wide excision with a safety margin of 1 cm. This paper is significant in that it introduces an effective reconstruction technique that maintains function using a cheek flap for the management of this rare case. In addition, this paper is the first to classify multiple MCCs according to the time of onset. We believe that this paper presents an effective alternative reconstruction technique with sentinel node biopsy through the modified Blair incision.

• Journal of Veterinary Clinics
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• v.39 no.6
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• pp.319-325
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• 2022

Two-port laparoscopic ovariectomy (Lap-OVE) has been performed in small dogs, using 3-mm and 5-mm portal sites, and is associated with reduced surgical stress and postoperative pain. However, extension of the incision is often needed to extract the ovaries. In this study, we aimed to minimize invasiveness by using smaller-sized cannulas as well as a novel technique for ovary extraction. Lap-OVE was performed on six, healthy female dogs (range, 3 to 7.2 kg) using two 3-mm midline portals. The middle finger of a size M nitrile glove was cut at its base and sterilized preoperatively. The ovary was suspended at the body wall using a 1-0 blue nylon needle, and the ovarian pedicle and ligaments were transected using a 3-mm bipolar forceps. To facilitate the glove passing through the 3.9-mm port, it was turned inside out to expose the smooth inner surface, before being inserted into the abdominal cavity with an applicator. Both ovaries were placed inside, and the mouth of the glove was exteriorized through the port with a laparoscopic grasping forceps. The ovaries were morcellated inside the glove, using Adison-Brown tissue forceps and iris scissors, which enabled safe extraction without incision enlargement. Median incision lengths were 4.3 mm (3.5-mm cranial cannula) and 4.8 mm (3.9-mm caudal cannula). An advantage of this procedure was that there was no need for skin sutures. In conclusion, using our novel technique, sutureless Lap-OVE was possible in small dogs using two 3-mm portal sites without additional incision.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.173-178
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• 2005

Propose: There have been many debates about the ideal surgical technique for acute Achilles tendon rupture. The purpose of this study is to review and analyze the clinical outcome of the acute Achilles tendon ruptures that had been repaired by indirect suture technique with minimal incision that utilized an instrument called Achillon (Newdeal, France). Materials and Methods: This study is based on the 14 cases (14 patients) of acute Achilles tendon total ruptures that have been repaired by minimal incision technique utilizing Achillon instrument from June 2003 to December 2004. Two cases were reruptured before 8 weeks and repaired again using Krackow suture which left 12 feet for postoperative functional evaluation with at least 6 months of follow-up. Ten cases were men and average age at time of injury was 34.4 (26-49) years. The time from injury to surgery was an average of 4.5 (1-9) days and the postoperative evaluations were done by an Arner-Lindholm scale and AOFAS score. The ability to return to original work and sports activities as well as patient satisfaction were also evaluated. Results: The follow-up period was averaged for 13.2 (6-24) months. Seventy-one percent of cases were ruptured during sports activities. The ruptured level was the average of 5.1 cm (3.2-8 cm) above calcaneal attachment and the skin incision was averaged for 2.7 cm (2.5-3.0 cm) long. At final follow-up, standing on tip-toe was possible in all cases while the heel-floor height on ruptured side was shorter by 0.7 cm (0-2 cm). By Arner-Lindholm evaluation scale, 9 cases were excellent, and 3 cases were good. Overall AOFAS score was an average of 96.1 (94-100), and all patients were satisfied with the result. Patients returned to work at an average of 1.3 months after the surgery and pre-injury sports activities were all possible from at 6 months after operation. Conclusion: Since we have treated acute Achilles tendon ruptures with minimal incision technique utilizing the Achillon and gained encouraging functional results with all patients returning to previous work with high patient satisfaction, this technique could be recommended as one of the ideal surgical options for the Achilles tendon ruptures.

• Archives of Craniofacial Surgery
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• v.17 no.3
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• pp.119-127
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• 2016

Background: Conventional correction of malunioned zygoma requires complete regional exposure through a bicoronal flap combined with a lower eyelid incision and an upper buccal sulcus incision. However, there are many potential complications following bicoronal incisions, such as infection, hematoma, alopecia, scarring and nerve injury. We have adopted a zygomaticofrontal suture osteotomy technique using transconjunctival incision with lateral paracanthal extension. We performed a retrospective review of clinical cases underwent correction of malunioned zygoma with the approach to evaluate outcomes following this method. Methods: Between June 2009 and September 2015, corrective osteotomies were performed in 14 patients with malunioned zygoma by a single surgeon. All 14 patients received both upper gingivobuccal and transconjunctival incisions with lateral paracanthal extension. The mean interval from injury to operation was 16 months (range, 12 months to 4 years), and the mean follow-up was 1 year (range, 4 months to 3 years). Results: Our surgical approach technique allowed excellent access to the infraorbital rim, orbital floor, zygomaticofrontal suture and anterior surface of the maxilla. Of the 14 patients, only 1 patient suffered a complication-oral wound dehiscence. Among the 6 patients who received infraorbital nerve decompression, numbness was gradually relieved in 4 patients. Two patients continued to experience persistent numbness. Conclusion: Transconjunctival incision with lateral paracanthal extension combined with upper gingivobuccal sulcus incision offers excellent exposure of the zygoma-orbit complex, and could be a valid alternative to the bicoronal approach for osteotomy of malunioned zygoma.

• Proceedings of the KOSOMBE Conference
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• v.1995 no.05
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• pp.95-100
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• 1995

This study investigated the effects of mechanical factors involved in several corneal refractive surgeries on the surgical outcomes. Then we proposed possible new techniques from the mechanical point of a view utilizing finite element method. The models studied are: circumferential keratetomy, combination of excimer laser photorefractive keratectomy and circumferential keratotomy for myopia treatment, arcuate keratotomy for astigmatism treatment. The cornea was assumed to be nonlinear elastic and almost incompressible material as the most soft tissue in the human body. In the circumferential keratotomy the effect of the incision location was investigated. The angle and location of the incision were varied to predict the surgical outcomes in the arcuate keratotomy. The finite element analysis results showed that the location of incision was a critical factor affecting the surgical outcomes in the circumferential keratotomy. In the combination of the excimer laser photorefractive keratectomy and circumferential keratotomy, it was predicted that the circumferential can increase or decrease the refractive power depending on the incision location or it can be used to adjust the overcorrection of undercorrection. In the arcuate keratotomy for astigmatism, the most diopter changes were predicted when the location and the angle of the incision were 3.0mm from the apex and $90^{\circ}$, respectively. In the arcuate keratotomy, the effects of an incision were studied within the incision area as well as outside the incision area. Also, the arcuate keratotomy with two incisions located on the opposite area of the cornea was also studied. As a conclusion, the finite element method is a useful technique in the area of corneal refractive surgeries to develop new techinques.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.2
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• pp.157-161
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• 2004

The eyes, the saying goes, are the windows of the soul. It's the first thing you notice about a person. Therefore, many people want to possess beautiful eyelids. Surgical formation of a palpebral fold and sulcus divides the lid into two well-defined segments (palpebral and pretarsal), producing the double eyelid desired by many Oriental women as well as an increasing number of man recently. Upper lid blepharoplasty is the Oriental eye is one of the variations of standard upper lid blepharoplasty. In Oriental double eyelid surgery, there have been two approaches to form a superior palpebral fold: the buried suture(nonincision) method and the full external incision method. Conventionally, the nonincision technique has been shown to produce little postoperative edema. However, the probability of the fold disappearing is high, and this technique cannot be performed in patients with fatty eyelids. Conversely, the incision technique has contrary characteristics. Recently, partial incision(or semi-open) technique which is combination of mentioned methods is used, this technique is removal of pretarsal tissue, muscle, and/or orbital fat around 2 or 3 incision site to facilitate tarsus-dermal adhesion. Our method is on the basis of this technique, furthermore, compared with conventional semi-open method, Y(Yang's) needle assisted double eyelid operation is more easy, convenient, saving-time method and provide satisfactory results.