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Background: The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons. Methods: This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors. Results: Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p= 0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R= 0.479, p< 0.001) and depth (p< 0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis. Conclusion: There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.
Background: Due to the different handling properties of unsintered hydroxyapatite particles/poly-L-lactic acid (uHA/PLLA) and polycaprolactone (PCL), we compared the surgical outcomes and the postoperative implantation accuracy between uHA/PLLA and PCL meshes in orbital fracture repair. Methods: Patients undergoing orbital wall reconstruction with PCL and uHA/PLLA mesh, between 2017 and 2019, were investigated retrospectively. The anatomical accuracy of the implant in bony defect replacement and the functional outcomes such as diplopia, ocular motility, and enophthalmos were evaluated. Results: No restriction of eye movement was reported in any patient (n = 30 for each group), 6 months postoperatively. In the PCL group, no patient showed diplopia or enophthalmos, while the uHA/PLLA group showed two patients with diplopia and one with enophthalmos. Excellent anatomical accuracy of implants was observed in 27 and 22 patients of the PCL and uHA/PLLA groups, respectively. However, this study showed that there were neither any significant differences in the surgical outcomes like diplopia and enophthalmos nor any complications with the two well-known implants. Conclusion: PCL implants and uHA/PLLA implants are safe and have similar levels of complications and surgical outcomes in orbital wall reconstruction.
This study examined the changes in the protein and mineral composition of Gryllus bimaculatus fermented with Bacillussubstilis and the mycelia of Basidiomycetes. Normal Gryllus bimaculatus (S) and experimental group data obtained after aninoculation of Bacillus substilis (SC) (KACC 19623), Pleurotus eryngii (SP) and Cordyceps millitaris (SC) were compared. The crude protein content of the Gryllus bimaculatus (control) was 75.48%, but it decreased to 64.55, 54.32, and 63.53%after fermentation with SB, SP and SC, respectively (p<0.05). An analysis of the organic elements showed that the contentsof the carbon and nitrogen sources were also reduced after fermentation, and the most significant decrease was observedafter fermentation with SP. In SDS-PAGE, a 120 kDa and a 48 kDa protein of Gryllus bimaculatus were found. On the otherhand, protein bands faded after fermentation with SP and SC, respectively. Moreover, no visible band was observed afterfermentation with SB. According to amino acid analysis, the total free amino acid content increased 3.84 and 1.74 timesafter fermentation with SB and SP, respectively, compared to the corresponding baseline data. In contrast, it decreased by0.52 times after fermentation with SC. Among the essential amino acids found in crickets fermented with SB, the valine andisoleucine content was 3.57 and 2.64 times higher, respectively, than the recommended daily amount of essential aminoacids.
Background and Objectives Nasal obstruction is common in patients with sleep disordered breathing (SDB). Polysomnography (PSG) is a standard diagnositc tool for sleep disorders, but it can not evaluate the quality of life (QOL). We tried to assess the efficacy of the septoturbinoplasty on patients with SDB and nasal obstruction by using self reported measures that have been known as a tool for evaluating the general and disease specific QOL. Subjects and Method Thirty-five patients who had snoring and sleep apnea confirmed by PSG and symptomatic nasal obstruction caused by deviated nasal septum were enrolled. All patients underwent septoturbinoplasty to improve nasal obstruction. QOL was assessed before and 2 months after surgery. Medical Outcome Study Short Form 36 (SF-36) and Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Stanford Sleepiness Scale (SSS), Insomnia Severity Index (ISI), Beck Depression Inventory (K-BDI), Nasal Obstruction Symptom Evaluation (NOSE) scale were included in the measures. A statistical analysis was performed using a paired t-test. Results Snoring sound level, PSQI, ESS, ISI, and NOSE were improved significantly (p< 0.05). SSS, BDI and total SF-36 were improved but not significantly (p>0.05). Conclusion QOL in patients with SDB and nasal obstruction was improved by nasal surgery. Different kinds of self-reported measures could be more informative as they can provide pre and post treatment results with respect to psychosomatic effects in patients with SDB.
Cysts of thoracic duct are uncommon. The most commonly involved site is the thoracic segment of the thoracic duct followedby the abdominal and cervical segments of the thoracic duct. To date, about 15 cases of cervical thoracic duct cysts have beendescribed in the literature. Information regarding the natural history of these cysts and their pathogenesis is limited. The primarysymptom and sign are generally a palpable soft left supraclavicular swelling. We report a case of cervical thoracic duct cyst witha review of literature. (Korean J Otolaryngol 2006;49:1123-5)