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A Simple, Reliable, and Inexpensive Intraoperative External Expansion System for Enhanced Autologous Structural Fat Grafting

  • Oranges, Carlo M.;Tremp, Mathias;Ling, Barbara;Wettstein, Reto;Largo, Rene D.;Schaefer, Dirk J.
    • Archives of Plastic Surgery
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    • v.43 no.5
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    • pp.466-469
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    • 2016
  • External volume expansion of the recipient site by suction has been proposed as a way of improving fat graft survival. The objective of this study was to present an innovative and simple intraoperative external expansion system to enhance small-volume autologous fat grafting (40-80 mL) and to discuss its background and its mechanism of action. In this system, expansion is performed using a complete vacuum delivery system known as the Kiwi VAC-6000M with a PalmPump (Clinical Innovations). The recipient site is rapidly expanded intraoperatively 10 times for 30 seconds each with a negative pressure of up to 550 mm Hg before autologous fat injection. During this repetitive stimulation, the tissues become grossly expanded, developing macroscopic swelling that regresses slowly over the course of hours following the cessation of the stimulus. The system sets various mechanisms in motion, including scar release, mechanical stimulation, edema, ischemia, and inflammation, which provide an environment conducive for cell proliferation and angiogenesis. In order to maintain the graft construct in its expansive state, all patients are encouraged postoperatively to use the Kiwi three times daily for one minute per session over the course of three days. The handling of this system is simple for both the patients and the surgeon. Satisfactory clinical outcomes have been achieved without significant complications.

Application of Lateral Osteotomy in Nasal Bone Fracture (비골 골절에서 외측 비골 절골술의 적용)

  • Lim, Kwang Ryeol;Song, Jennifer K.;Hwang, So Min;Jung, Yong Hui;Cho, Ka Hyung
    • Archives of Craniofacial Surgery
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    • v.13 no.2
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    • pp.104-110
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    • 2012
  • Purpose: Who may dare to state that optimal choice of treating nasal bone fracture is closed reduction? Few decades of authors' experience in nasal bone fracture has lead to believe that more active and assertive approach in nasal bone fracture by performing simultaneous lateral osteotomy may be applied in proper indications to acquire more accurate reduction and cosmetically satisfying result. Methods: From May 2008 to October 2009, among 241 nasal bone fracture patients, 20 patients underwent simultaneous lateral osteotomy with nasal bone fracture reduction. Followed by rigid septal correction, nasal cavity is packed to stabilize the fracture segment for safer osteotomy. Through intranasal incision, in selected cases of difficult reduction or for cosmetic purposes, various types of lateral osteotomy was performed corresponding to the fracture anatomy, conditions of the nasal cavity. Postoperative nasal packing was retained for one week and nasal dorsum splint for 3 weeks. Results: Lateral osteotomy was utilized for difficult cases of closed reduction, for correction of wide nose, hump and deviation in 9, 5, 2, and 4 cases, respectively. Patient satisfaction was scaled 90% in satisfaction and moderate in 10% (2 cases), complaining of mild nasal tip deviation. Physicians detected 2 cases of apparent deformity with patient recognition; one patient with mild step deformity at the osteotomy site and the other patient with minimal implant mobility. Conclusion: By accompanying profound understanding of the fracture anatomy, more active and assertive approach in nasal fracture reduction can be coincide with simultaneous lateral osteotomy to reduce the rate of secondary deformity and to obtain more cosmetically satisfying result.

The Algorithm-Oriented Management of Nasal Bone Fracture according to Stranc's Classification System

  • Park, Ki-Sung;Kim, Seung-Soo;Lee, Wu-Seop;Yang, Wan-Suk
    • Archives of Craniofacial Surgery
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    • v.18 no.2
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    • pp.97-104
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    • 2017
  • Background: Nasal bone fracture is one of the most common facial bone fracture types, and the surgical results exert a strong influence on the facial contour and patient satisfaction. Preventing secondary deformity and restoring the original bone state are the major goals of surgeons managing nasal bone fracture patients. In this study, a treatment algorithm was established by applying the modified open reduction technique and postoperative care for several years. Methods: This article is a retrospective chart review of 417 patients who had been received surgical treatment from 2014 to 2015. Using prepared questionnaires and visual analogue scale, several components (postoperative nasal contour; degree of pain; minor complications like dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, and headache; and degree of patient satisfaction) were evaluated. Results: The average scores for the postoperative nasal contour given by three experts, and the degree of patient satisfaction, were within the "satisfied" (4) to "very satisfied" (5) range (4.5, 4.6, 4.5, and 4.2, respectively). The postoperative degree of pain was sufficiently low that the patients needed only the minimum dose of painkiller. The scores for the minor complications (dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, headache) were relatively low (36.4, 40.8, 65.2, 32.3, and 34 out of the maximum score of 100, respectively). Conclusion: Satisfactory results were obtained through the algorithm-oriented management of nasal bone fracture. The degree of postoperative pain and minor complications were considerably low, and the degree of satisfaction with the nasal contour was high.

Constructing New Paradigms in the Design Education System -New suggestions in the design environment and design education for the information network era- (정보네트워크 시대의 새로운 디자인 지식체계 구축을 위한 교육 프로그램 연구 -정보 네트워크 시대의 디자인 환경과 디자인 교육의 새 방향-)

  • 이현주;신계옥;이은주;김태경;류성현
    • Archives of design research
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    • v.14 no.2
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    • pp.267-278
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    • 2001
  • Beyond the simple stage of technical development, the growth of information networks have changed areas such as the economy, communities, and education. Existing knowledge and new knowledge about these things have developed and either coexist or conflict with each other. It is difficult to predict the result of this interaction since old and new information is changing so quickly. The transition from a simple communication to an interactive communication is related to a changed communication environment which involves a more complex level of understanding. Establishing the new design concept which is aimed at the future and developing new educational programs which respond to these new information networks are important in order to educate designers who can adjust to the new information network era and construct design education. This paper reports research about the process of developing new education systems that explore the new design paradigms, the changing information network, and the proper approaches to developing design education programs which fulfill these requirements.

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Study in Analyzing Method of Web Interface Design (웹 인터페이스디자인 분석방법 연구)

  • 이현주;이정현;방경락;류성현;신계옥;이은주
    • Archives of design research
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    • v.14 no.2
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    • pp.209-216
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    • 2001
  • With rapid growth of internet uses and the new media, web has become a new medium of communicating and sharing of information. Therefore, the methodology of web interface design must be set to improve the efficiency of communicating and sharing information The study has researched on analyzing method of web interface design for effective uses of web. The study is a precedent research of methodology of web interface design based on the following structures-grouping web contents, information architecture, web page design, structural elements of interface design. Accordingly, the study provides the analyzing method of web interface design with the basis of its structural elements. The analyzing method of web interface design is divided into three steps-grouping of web sites, analyzing structural elements, and evaluation. As a result, grouping and embodying of interface design brings usability guideline for design development as well as collecting of data for examining further results through design processes.

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Graphic Characteristics in Laser Images (레이저영상의 그래픽 적 특성에 관한 연구)

  • 황인화
    • Archives of design research
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    • v.14
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    • pp.77-84
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    • 1996
  • The aspirations toward newness and uniqueness, which are represented as the main character of modern society and the motivation of the Art, have made the media for the Art, Design and Image varied and developed. As one of those streams, laser technology has stood out for the visual media of mystery and fantasy in the field of Public Entertainment, Image Exhibition and Art, and also it could be accelerated by the advancement of Electronics and Physics. This study focuses on the image creation by the laser technology, as the great product of the state-of-the-art science, whose physical feature produces visual effect of fantasy. As the first approach, the knowledge on the physical feature and technology of laser and system composition should be preceded in the step of planning and creation of laser image. Through the further understanding on graphic feature of laser image which increases the artistic quality of the image, this study hopefully activates the laser image works by the specialists and the artists in the field, and finally the creation of master-pieces.

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Utility of Lateral Circumflex Femoral Artery Perforator's 3D Image with MD-CT (MD-CT로 얻은 가쪽넙다리휘돌이 관통동맥 3D 영상의 유용성)

  • Park, Soo Ho;Shim, Jeong Su;Lee, Sang Kon;Park, Dae Hwan
    • Archives of Plastic Surgery
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    • v.35 no.4
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    • pp.379-384
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    • 2008
  • Purpose: Currently, using perforator artery flaps especially anterolateral thigh flaps are widely used for reconstruction of extremities, head and neck. Obtaining a precise anatomical picture prior to operation will translate to a more accurate, efficient and safe procedure. Authors used 3D-image work up via 64-slice MDCT to make a more precise preoperative plan. Methods: A total of 10 patients underwent soft tissue reconstruction with anterolateral thigh flap from December 2006 to December 2007. The 64-Channel MDCT (LightSpeed VCT, GE, USA) was used and 3D images were reconstructed. Findings from MDCT were applied to the preoperative planning and confirmed with intraoperative findings. Results: The average number of perforator arteries from lateral circumflex femoral artery was 2. The average lengths of vascular pedicle from the origin of lateral circumflex femoral artery to the first and second perforator artery were 11.0 cm and 20.0 cm, respectively. The average diameter of the pedicle artery was 2.2 mm. The locations of the perforator arteries were mapped and localized on the body surface based on the MDCT result. These were confirmed through direct visualization intraoperatively. Conclusion: MDCT has an advantage of obtaining accurate images of the general anatomy and even fine structures like perforator arteries. By using this state-of-the-art diagnostic imaging technique, it is now possible to make an operative plan safely and easily.

Otoplasty with High Density Polyethylene Implant(MEDPOR®) (잠복이에서 고밀도 폴리에틸렌 삽입물(MEDPOR®)을 이용한 귀성형술)

  • Lee, Keun-Cheol;Kwon, Yong-Seok;Heo, Jung;Moon, Ju-Bong;Kim, Seok-Kwun
    • Archives of Plastic Surgery
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    • v.36 no.2
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    • pp.167-173
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    • 2009
  • Purpose: The key points of treatment of cryptotia are the elevation of invaginated ear helix and the correction of deformed cartilage. Prevention of stabilized cartilage contouring from returning to the previous state is also important. The authors carried otoplasty by modified Onizuka's method or Ohmori's method that conchal cartilage graft or high density polyethylene implant(MEDPOR$^{(R)}$) graft served as fixation after spreading posterior aspect of adhered antihelix and a splint for prevention of recurrence of cartilage deformities. The aim of this study is to reveal the availability of the high density polyethylene implant(MEDPOR$^{(R)}$) graft for the correction of cryptotia. Methods: We have repaired 17 cryptotic deformities using cartilage graft from cavum of concha(12 cases) or high density polyethylene implant(5 cases) for correction of deformed cartilage. We investigate the operative time, complications, and satisfaction of postoperative ear shape on both autogenous cartilage graft group and high density polyethylene implant graft group. Results: There was 1 case of reinvagination on autogenous cartilage graft group. Implant exposure was occurred on high density polyethylene implant graft group, as 1 case. These were statistically no differences between autogenous cartilage graft group and high density polyethylene implant graft group to the satisfaction of ear shape. Conclusion: High density polyethylene implant(MEDPOR$^{(R)}$) present an alternative to autogenous material as they allow of fibrovascular ingrowth, leading to stability of the implant and decreased infection rates. The correction of deformed cartilage by using the high density polyethylene implant(MEDPOR$^{(R)}$) is a good option for the treatment of cryptotia.

Risk Factors of and Treatments for Pharyngocutaneous Fistula Occurring after Oropharynx and Hypopharynx Reconstruction

  • Do, Su Bin;Chung, Chul Hoon;Chang, Yong Joon;Kim, Byeong Jun;Rho, Young Soo
    • Archives of Plastic Surgery
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    • v.44 no.6
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    • pp.530-538
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    • 2017
  • Background A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula. Methods Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation. Results A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation. Conclusions Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.

Study on the Convenient Interface to the University Web-based Library System (Web을 기반으로 한 대학교 도서관 시스템에 있어서 용이한 인터페이스에 관한 연구)

  • 이현정;정재욱
    • Archives of design research
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    • v.15 no.1
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    • pp.93-100
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    • 2002
  • The University's web library is a form of library that enables to deal with information about searching loaning, returning of books or data housed in it through web. With the advent of the network and multimedia following the entrance to an information-oriented society, we are experiencing a big change in how to communicate and acquire information. Massive multimedia information transmitted by image and moving picture through the network, made it possible to overstep the limit of the physical gap between information suppliers and users. Despite this important role, it is accompanied by problems such as copyright, scarcity of recognition, paralysis of infra, technical matters and reliability which demand development. In this thesis, according to the State University Evaluation Standards, search node and user interface by system used in 20 different universities possessing web-based library sites were compared are analysed. On the basis of this, an experimental user interface for web-based University libraries was produced, and various questionnaires and data leer this produced interface were collected, classified and analyzed. With the application of the results for the work above to the general search system interface of the web-based library, we proposed a new user interface that contains the following functions, such as location and loan condition of books, search frequency and steps for purchasing books inside the web library.

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