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Purpose: Finger immobilization by Kirschner-wire (K-wire) insertion may be used for postoperative stability after release of scar contracture. K=wire insertion through the phalangeal bone requires drilling and can result in joint and/or tendon injury or pain during wire removal. To prevent these problems, we inserted the K-wire through the soft tissue. Methods: Seventy-five fingers of 45 patients who underwent reconstruction of scar contracture of the fingers were immobilized by K-wire. After contracture release, just before skin grafting and/or local flap surgery, in full extension of the finger, a K-wire was inserted manually from the fingertip to the proximal phalanx of metacarpal bone through the soft tissue or the K-wire was felt on the recipient bed, the K-wire was inserted on the dorsal side of the finger. K-wires were manually removed two weeks after surgery. Results: In most cases, the time to insert the K-wire was 2-3 minutes per finger, and immobilization and stability was maintained for two weeks. In two fingers, the K-wire came out prematurely during wound care; this did not affect the overall outcome. There were no complications due to K-wire insertion of pain during removal. Conclusion: Finger immobilization by K-wire insertion through soft tissue is simple to perform, leads to stable immobilization, has no adding prodedure. This method is useful for temporary finger immobilization in full extension.
Purpose: Subciliary approaches to orbitozygomatic fractures have high incidence of complications such as scleral show and ectropion. Abnormal rearrangement of eyelid flaps may be a very important factor to induce abnormal cicatrical and consequent contracture. To prevent this problem, we used temporary lower eyelid suspension. Methods: A total of two hundred five patients were investigated for lower eyelid complication of orbitozygomatic fractures that underwent reconstruction with subciliary approach. The lower eyelid margin was pulled up toward the forehead using lower eyelid suspension suture to stretch the lower lid flaps. The lid suspension was maintained for one day after surgery. Results: The complications of the lower eyelid were in 15 cases(7.3%); seven cases(3.4%) of visible depressed scar, three cases(1.4%) of scleral show, two cases(1%) of ectropion, two cases(1%) of conjunctival swelling and one case(0.5%) of hematoma. Conclusions: The lower eyelid suspension seems to allow adhering lid flap in proper anatomical position and in the status of the maximal stretch and consequently preventing the severe complications such as scleral show and ectropion caused by scar contraction after subciliary approach.
Syndactyly is one of the most common malformations occurring in the hand. the child born with a syndactylized hand may be handicapped for life if successful surgery is not carried out. Syndactyly is frequently associated with other anomalies, of which congenital constriction ring, heart anomalies, orodigital anomalies, and hemangioma. The aim of surgery is to construct a web or commissure and cover any defects on the sides of the fingers. Unsatisfactory results may be due to subsequent web contractures of the divided fingers. Fifty-three cases of syndactyly in twenty-nine patients were corrected by the authors' method. Authors used a large dorsal rectangular flap with a somewhat wider proximal base than distal end, and small volar triangular flap with lateral relaxing incisions for interdigitation of flaps and reconstruction of web space, and performed zig-zag incision for division of syndactylyzed fingers.
In small or superficial burns, wound coverage can be attempted using skin grafts, local or distant flaps. When more severe burns that involve bone, tendons or other soft tissues are present, the use of free tissue transfers allowed healing and ultimately satisfactory function. We performed 42 free tissue transfers for 40 patients with severe burns for 15 years. Their ages ranged from 17 to 72, with average age of 33.31 patients were male and 9 female. In the causes of burn, there were 20 cases of acute burns; 1 flame burn, 6 contact burns, 12 electrical burns, and 1 chemical burn. 20 cases were scar deformities after burn injuries; 2 flame burna, 12 scalding burns, 1 contact burns, 5 electrical burns. In the affected sites, 7 cases were head and neck areas, 22 upper extremities, and 11 lower extremities. In the free tissue transfers, 27 cases were cutaneous flap, 4 myocutaneous flap, 6 tenocutaneous flap, 1 tenomyocutaneous flap, 2 osteocutaneous flap, and 2 omental flap. As for accompanied surgical procedures, 5 cases were for tendon graft, and 6 for nerve graft. Complications were 4 marginal necroses of flap by wound infection and 1 total loss due to vascular thrombosis. But they were all completely restored with wound dressing, skin graft or local flap. Free tissue transfers were useful for the coverage of composite tissue defect in severe burns.
Intralesional belomycin injection has been an effective treatment of recalcitrant warts since 1970. A 1 U/ml solution of bleomycin sulfate in normal saline or lidocaine solution was injected intralesionally in 72 warts of 33 patients on the hands, forearm, feet, and face. Dosage of bleomycin was dependent on the size of warts, usually 0.1 to 0.15 cc of solution. All patients was permitted to wash the treated area without care. 59 (81.9%) of 72 warts were cured after one injection, 12 (16.7%) warts after two or three bleomycin injections. One large wart was not cured. Most patients experienced minimal painful discomfort for two to three days after one to two days of injection, but did not take the analgesics. There was no evidence of systemic and local toxicities. The most responsive warts shoed hemorrhagic black eschars that separated after 2 to 3 weeks and healed with very little or no scar tissue. Intralesional bleomycin injection is a reliable and useful alternative for the treatment of warts.
Glomus tumor is rare benign tumor of the normal glomus, which is a neuroarterial canalsystem called the Sucquet-Hoyer canal. The function of the glomus appears to be to regulate local blood pressure and local heat by blood flow. The etiology of its development is unknown, but some patients have history of trauma. Glomus tumor has been described in the trunk as well as in upper and lower extremits hand (the most common location). The triad of pain, tenderness and sensitivity to cold is characteristics of glomus tumor of the hand. Treatment consists of surgical excision of the lesion under the tourniquet control and magnification for complete removal of the lesion. Glomangiosarcoma or malignant form of glomus tumor is exceptionally rare. Only a few cases have been reported. We experienced five cases of glomus tumor and a cases of glomangiosarcoma treated by complete removal of tumors through partial elevatioin of nail. Typical pain of the lesion was disappeared after operation, also nail deformity did not occurred.
It has been generally believed that male pattern baldness occurs in woman who has elevated level of androgen. Since the introduction of tissue expansion technique by Dr. Neumann in 1957, it has showed the excellent result in the treatment of scalp defect. In this paper, 3 female patients with male pattern baldness were operated b using tissue expanders & deepithelization technique of anterior border of the flap. They all have normal level of testosterone & no virilizing symptom. All cases were successfully reconstructed with natural figure of anterior hair line. The major advantage of tissue expansion is that it generates new hair-bearing scalp. The increases in vascularity which occurs during expansion allows large, safe flap. Donor sites are also relatively easily closed. The disadvantages of the expansion include the need for two or more surgical procedures and multiple office visits. There is also cosmetic defect as the expanders become larger. In conclusion, male pattern baldness that is characterized by M-shaped frontotemporal recession can occur in woman who has normal level of androgen. Tissue expansion & deepithelization technique of anterior border of the flap was the most valuable technique in the correction of male pattern baldness.
In the grafted skin, the water contained in the superficial portion of the stratum corneum plays an important role in determining the texture match and flexibility of grafts skin with microstructure of skin surface. We evaluate the water content, hygroscopicity and water holding capacity of grafted skin in 78 patients grafted on the face and the palm by skin surface Hydrometer(SKICON-100, IBS Inc. Japan) and the correlation between their parameters of normal donor skin and normal recipient skin, and study the nature of the texture match of grafted skin and it's attributing factors. The results are as follows : 1. The parameters of grafted skin are lesser than those of normal recipient skin. 2. The parameters of grafted skin are higher than those of normal donor skin. 3. The parameters of full thickness grafted skin are higher than those of split thickness grafted skin. 4. Closer the donor site is placed to the recipients site, higher the parameters of grafted skin are. 5. Younger the patients are, higher the parameters of grafted skin are. In the grafted skin, the water contained in the superficial portion of the stratum corneum plays an important role in determining the texture match and flexibility of grafts skin with microstructure of skin surface.