• 대한두개안면성형외과학회지
• /
• 제23권6호
• /
• pp.269-273
• /
• 2022

Naso-orbito-ethmoidal (NOE) fractures are complicated fractures of the mid-face. The treatment of NOE fractures is challenging and a comprehensive treatment strategy is required. We introduce a case of NOE fracture treated with open reduction and suspension sutures. A 28-year-old woman presented with a unilateral NOE fracture. To reduce the frontal process of the maxilla, a suspension suture was made by pulling the fragment using a double arm suture via a transcaruncular incision. The suture thread was placed in the horizontal plane. Another suspension suture on the inferior orbital rim assisted reduction procedure, and they passed through the overlying skin. The reduction alignment could be finely adjusted by tightening the transcutaneous suture threads while checking the degree of bone alignment through the subciliary incision. The two suture threads were suspended using a thermoplastic nasal splint. An additional skin incision on the medial canthal area, which would have resulted in a scar, could be avoided. Four months postoperatively, computed tomography showed an accurate and stable reduction. The patient was satisfied with her aesthetic appearance, and functional deficits were not present.

• Archives of Plastic Surgery
• /
• 제38권4호
• /
• pp.472-476
• /
• 2011

Purpose: Traditional transcutaneous incision and transconjunctival incision methods are commonly used in the lower blepharoplasty. The transconjunctival method leaves no visible scars nor does it change the shape of lower eyelid contour and the surgical technique is not difficult. However removal of excess baggy skin is not possible through this method. Therefore, the transconjunctival incision method is useful only for patients who still have normal elasticity of the lower eyelids and fat that is protruding only anterocaudally. The Author will introduce a technique, which complements the limitations of these two methods mentioned above. Methods: The author combined the transconjunctival approach and lower blepharoplasty with only the excised skin flap method. This method does not go beyond the previous methods but does apply the advantages of them. Results: From March 2007 to October 2010, this new technique was performed in a total of 62 patients. Fat was removed and repositioned through transconjunctival incision. Drooped skin was excised as in the traditional blepharoplasty but only the skin flap was elevated. This prevents post-operative complications such as ectropion, sclera show, and deformation of the shape of the lower eyelids or under-resection of fat. All patients were satisfied with the post-operative appearance. Conclusion: The author was able to get satisfactory results while avoiding complications of traditional transcutaneous technique with this combined technique of the transconjunctival approach and the lower blepharoplasty method of skin flaps only.

• Archives of Plastic Surgery
• /
• 제37권3호
• /
• pp.271-276
• /
• 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 Plastic Surgery
• /
• 제37권2호
• /
• pp.169-174
• /
• 2010

Purpose: Reduction mammaplasty is a procedure with a relatively high patient satisfaction rate, however, associated scarring around the areola can be a serious problem. This study proposes a new modification of the breast reduction procedure by means of an inframammary incision alone. Methods: The breast is marked out preoperatively with standing position. Under the general anesthesia, an inframammary incision of approximately 7 - 8 cm is done. The subcutaneous plane is made in the lower pole of the breast, then the subglandular plane is entered and a sharp dissection is made up to 2 cm below the areola. The breast is mobilized from the chest wall and a cone-shaped parenchyme is removed in en-block except from the retroareolar central part. The remaining both pillars are gathered together with absorbable sutures and the base of the gland is narrowed to project the breast forward. The wound is closed in a layered fashion and taping of the breast mound is applied to redistribute the breast skin. Results: 21 patients (36 breasts) underwent this procedure from December 2004 to December 2009. Average follow up was 9 months (ranged from 6 months to 12 months). No major complication occurred. Most patients were pleased with the breast size, shape, and scars. However, 2 patients complained their hypertrophic scars which were corrected by revision. Conclusion: This technique is a simple approach to mild to moderate breast reduction through an inframammary incision alone. And, this technique provides an option with minimal complications and invisible scarring, which is especially important in the young patient group.

• 대한두개안면성형외과학회지
• /
• 제22권1호
• /
• pp.52-55
• /
• 2021

Complete surgical excision within a margin of normal healthy bone is the treatment of choice for intraosseous hemangioma. A 56-year-old man visited with complaints of a firm, mildly tender, immovable, and palpable mass on the right forehead (size: 1.5×1.5 cm). Non-contrast brain computed tomography performed preoperatively revealed a 1.5 cm heterogenous osteolytic lesion with suspected internal trabeculation in the right frontal bone. Under general anesthesia, a 2 cm transverse incision was made on the forehead skin rather than bicoronal incision. Full-thickness en bloc resection of the frontal bone including the mass was performed. The frontal bone was removed with care taken not to damage the frontal sinus mucosa. The frontal sinus was sealed with a collagen patch (Tachocomb) and a cranioplasty was performed using bone cement. At 6 months postoperative, a clean wound was confirmed without any complications, and there was no local recurrence. Surgical excision of intraosseous hemangioma in the frontal sinus bone can be performed via direct incision or the bicoronal approach. In this case, the direct incision approach was used to achieve smaller scars and faster recovery than the bicoronal approach.

• 대한견주관절학회:학술대회논문집
• /
• 대한견주관절학회 2002년도 아시아견관절학술대회
• /
• pp.413-415
• /
• 2002

Properly selected pts Advantages : Limited skin incision & soft tissue dissection Better definition of pathology Tolerable aggressive P.T. Technically Demanding

• Archives of Plastic Surgery
• /
• 제46권5호
• /
• pp.433-440
• /
• 2019

Background Mastectomy in male transgender patients is an important (and often the first) step toward physical manhood. At our department, mastectomies in transgender patients have been performed for several decades. Methods Recorded data were collected and analyzed for all male transgender patients undergoing mastectomy over a period of 24 years at our department. Results In total, 268 gender-reassigning mastectomies were performed. Several different mastectomy techniques (areolar incision, n=172; sub-mammary incision, n=96) were used according to patients' habitus and breast features. Corresponding to algorithms presented in the current literature, certain breast qualities were matched with a particular mastectomy technique. Overall, small breasts with marginal ptosis and good skin elasticity allowed small areolar incisions as a method of access for glandular removal. In contrast, large breasts and those with heavy ptosis or poor skin elasticity often required larger incisions for breast amputation. The secondary correction rate (38%) was high for gender reassignment mastectomy, as is also reflected by data in the current literature. Secondary correction frequently involved revision of chest wall recontouring, suggesting inadequate removal of the mammary tissue, as well as scar revision, which may reflect intense traction during wound healing (36%). Secondary corrections were performed more often after using small areolar incision techniques (48%) than after using large sub-mammary incisions (21%). Conclusions Choosing the suitable mastectomy technique for each patient requires careful individual evaluation of breast features such as size, degree of ptosis, and skin elasticity in order to maximize patient satisfaction and minimize secondary revisions.

• Archives of Plastic Surgery
• /
• 제44권3호
• /
• pp.210-216
• /
• 2017

Background In treating minor-form or microform cleft lip, obtaining an optimal result is a challenge because of the visible scarring caused by traditional surgery. We present a refined method using muscle overlapping with a minimal skin incision in patients younger than 3 years, a group characterized by thin muscle. Methods The surgical technique involves restoration of the notched vermillion using Z-plasty, formation of the philtral column using overlapping of an orbicularis oris muscle flap through an intraoral incision, and correction of the cleft lip nasal deformity using a reverse-U incision and V-Y plasty. A single radiologist evaluated ultrasonographic images of the upper lip. Results Sixty patients were treated between September 2008 and June 2014. The age at the time of operation ranged from 6 to 36 months (mean, 26 months). The follow-up period ranged from 8 to 38 months (mean, 20 months) in minor-form cases and from 14 to 64 months (mean, 37 months) in microform cases. A notched cupid's bow was corrected in 10 minor-form cases and 50 microform cases. Ultrasonographic images were obtained from 3 patients with minor-form cleft lip and 9 patients with microform cleft lip 12 months after surgery. The average muscle thickness was 4.5 mm on the affected side and 4.1 mm on the unaffected side. Conclusions The advantages of the proposed procedure include the creation of an anatomically natural philtrum with minimal scarring. This method also preserves the continuity and function of the muscle and provides sufficient augmentation of the philtral column and nostril sill.

• Archives of Plastic Surgery
• /
• 제34권6호
• /
• pp.724-728
• /
• 2007

Purpose: The objective of this study is to prevent postoperative lower eyelid retraction and scleral show. There are several approaches for orbital rim reconstruction. But these techniques are sometimes difficult to perform, and have some merits and faults. Maybe most common unwanted and unpleasant result that we have experienced by subciliary incision preseptal approach is the lower eyelid retraction and the scleral show. Therefore, I want to find out the causes and the solutions for such complication. We must know the mechanics for those unpleasant result first of all. Methods: We conducted a comparison of postoperative photographs between retroseptal approach group and preseptal approach group, both with subciliary incision. In experimental retroseptal group, incision was applied at subciliary region. After elevating skin flap to preserve pretarsal muscle, not with muscle flap elevation, but direct oblique incision through the muscle, retroseptal dissection was applied to the ROOF and the septum. Fixating fracture line, periosteal and septal repair was followed by skin repair. The light compressive dressings and protection were kept in place for 7 days. The effectiveness of this operative method was made comparison with control group which the preseptal approach was applied to, by postoperative 2nd week and 2nd month. Results: Author's technique had been used in 20 patients and control group was composed of 50 patients over 19months period. There were better results in experimental group than in control group and all of experimental group had no complaint about the lower eyelid retraction and the scleral show. Conclusion: It must be known about the reason of the lower eyelid retraction and the scleral show induced by subciliary and preseptal approach. Mechanically it can be easily proved. And the solution maybe will be easier if we get more information about the mechanics. I recommend the retroseptal subciliary approach

• 한국전문물리치료학회지
• /
• 제10권2호
• /
• pp.61-70
• /
• 2003

The purposes of this study was to evaluate the effect of low power GaAsAl laser on tissue contraction in a linear incision wound on rat skin. The linear incision wound was made on the midline of the backside in the experimental animals. Low power laser applications with different intensities such as 3, 6, or 10 mW were applied to the experimental animals twice a day for 10 days. On either the seventh or tenth postoperative day, the quantitative analysis of the inflammatory reaction surrounding the linear incision wounds on the rats were performed using enzymatical analysis of myeloperoxidase (MPO) activity. The number of neutrophil was $.07-1.0{\times}106/m{\ell}$ from a normal blood sample that was obtained from the normal experimental animals. Each concentration of neutrophil showed .04-.62 unit activity of MPO. Therefore, the 6 unit activity of MPO per neutrophil was $.57{\pm}.014{\times}10^{-6}$ unit. On the 7th and 10th post operative day, non treated tissues demonstrated increased MPO activity as compared to that of normal tissue. These data indicated that the inflammatory reaction of tissue was induced after wound induction and the MPO activity were increased in the inflammed tissues. While both 3 mW or 6 mW intensity of laser treatments did not affect the tissue MPO activity, 10 mW intensity of laser treatment significantly decreased the tissue MPO activity on the 7th and 10th post operative day. These data demonstrated that only 10 mW intensity of laser treatment successfully suppressed tissue inflammatory reaction after wound induction. In conclusion, these findings suggested that 10 mW of GaAIAs laser treatments effectively suppressed the inflammatory reaction of tissue that was induced during the wound healing process.