Medial Arterial Calcification and the Risk of Amputation of Diabetic Foot Ulcer in Patients With Diabetic Kidney Disease.

We assessed the risk factors for major amputation of diabetic foot ulcers (DFUs) in patients with diabetic kidney disease (DKD) stages 3b-5. For DFU assessment, in addition to DFU location and presence of infection, ischemia, and neuropathy, vascular calcification was assessed using the medial arterial calcification (MAC) score. Of 210 patients, 26 (12.4%) underwent major amputations. Only the location and extension of DFU, represented by Texas grade differed between the minor and major amputation groups. However, after adjusting for covariates, ulcer location of mid- or hindfoot (vs. forefoot, odds ratio [OR] = 3.27), Texas grades 2 or 3 (vs. grade 0, OR = 5.78), and severe MAC (vs. no MAC, OR = 4.46) was an independent risk factor for major amputation (all P < 0.05). The current use of antiplatelets was a possible protective factor for major amputations (OR = 0.37, P = 0.055). In conclusion, DFU with severe MAC is associated with major amputation in patients with DKD.

Increasing the Energy Gap between Band-Edge and Trap States Slows Down Picosecond Carrier Trapping in Highly Luminescent InP/ZnSe/ZnS Quantum Dots.

Non-toxic InP-based nanocrystals have been developed for promising candidates for commercial optoelectronic applications and they still require further improvement on photophysical properties, compared to Cd-based quantum dots (QDs), for better device efficiency and long-term stability. It is, therefore, essential to understand the precise mechanism of carrier trapping even in the state-of-the-art InP-based QD with near-unity luminescence. Here, it is shown that using time-resolved spectroscopic measurements of systematically size-controlled InP/ZnSe/ZnS core/shell/shell QDs with the quantum yield close to one, carrier trapping decreases with increasing the energy difference between band-edge and trap states, indicating that the process follows the energy gap law, well known in molecular photochemistry for nonradiative internal conversion between two electronic states. Similar to the molecular view of the energy gap law, it is found that the energy gap between the band-edge and trap states is closely associated with ZnSe phonons that assist carrier trapping into defects in highly luminescent InP/ZnSe/ZnS QDs. These findings represent a striking departure from the generally accepted view of carrier trapping mechanism in QDs in the Marcus normal region, providing a step forward understanding how excitons in nanocrystals interact with traps, and offering valuable guidance for making highly efficient and stable InP-based QDs.

Big Data Analysis of the Risk of Intracranial Hemorrhage in Korean Populations Taking Low-Dose Aspirin.

OBJECTIVES: Aspirin has traditionally been used as an analgesic and anti-inflammatory drug; however, low-dose aspirin is known to increase the risk of gastrointestinal and intracranial hemorrhage. In this study, the risk of intracranial hemorrhage in patients taking low-dose aspirin was assessed. MATERIALS AND METHODS: We used the Standard Sample Cohort DB dataset from the National Health Insurance Sharing Service of Korea. This dataset includes details of medical care and prescriptions for patients who used hospital services during a 14-year period throughout Korea. Of approximately 1 million total patients, data from 746,703 adults over the age of 30 years were included for analysis. An Χ2 test was performed to assess the effect of low-dose aspirin on intracranial hemorrhage. In addition, the relationship between use of low-dose aspirin and intracranial hemorrhage was analyzed using multiple logistic regression with consideration of all confounding variables. RESULTS: The results revealed no significant positive correlations between the use of low-dose aspirin and intracranial hemorrhage requiring hospitalization. CONCLUSIONS: Big data analysis of 746,703 patients in Korea over a period of 14 years showed that serious intracranial hemorrhage requiring hospitalization was unrelated to low-dose aspirin use. Moreover, low-dose aspirin use reduced the risk of intracranial hemorrhage in Korean populations.

Analysis of the Molecular Signature of Breast Implant-Associated Anaplastic Large Cell Lymphoma in an Asian Patient.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)-a new category of anaplastic large cell lymphoma associated with textured breast implants-has a distinct variation in incidence and is especially rare in Asia. We report the first case of BIA-ALCL in Korea and present its histological and genetic characteristics. A 44-year-old female patient presented with a typical clinical course and symptoms, including breast augmentation with textured breast implants, late-onset peri-implant effusion, and CD30+ALK- histology, followed by bilateral implant removal and total capsulectomy. For histological analysis, we performed immunohistochemistry of the bilateral breast capsules. For transcriptome analysis, we identified highly upregulated gene sets employing RNA-sequencing and characterized the lymphoma immune cell components. In the lymphoma-associated capsule, CD30+ cells infiltrated not only the lymphoma lesion but also the peritumoral lesion. The morphologies of the myofibroblasts and vessels in the peritumoral lesion were similar to those in the tumoral lesion. We observed strong activation of the JAK/STAT3 pathway and expression of programmed death ligand-1 in the lymphoma. Unlike the molecular profiles of BIA-ALCL samples from Caucasian patients-all of which contained activated CD4+ T cells-the Asian patient's profile was characterized by more abundant CD8+ T cells. This study contributes to a better understanding of the pathogenesis and molecular mechanisms of BIA-ALCL in Asian patients that will ultimately facilitate the development of clinical therapies.

Big Data Statistical Analysis of Facial Fractures in Korea.

BACKGROUND: The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA. METHODS: We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software. RESULTS: The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011. CONCLUSION: We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.

Assessing How Well Electronic Nursing Records Reflect Changes in the Nursing Profession's Scope of Practice in Korea.

Electronic health records, a source of key administrative data for patient care, have been used in Korea for the past 13 years. In recent years, there have been significant changes in the Korean hospital nursing care delivery system. "Comprehensive nursing service," in which nurses provide direct care to patients, including activities of daily living without a family member, is one of the changes in the nursing profession's scope of practice. Accordingly, this study attempts to determine how well the electronic nursing record reveals nursing services that are being used differently. This study analyzed 19 372 nursing records of a total of 200 patients using the random sampling method in two comprehensive nursing service wards and two noncomprehensive nursing service wards. The number of nursing activity records for all items in the comprehensive nursing service ward was higher; only three items showed significant differences. Five nursing diagnoses including "anxiety" and "pain" were more significantly used in the records of the comprehensive nursing service ward. This study found that there were significant differences in nursing records based on the nursing services provided and that the current electronic nursing recording system adequately reflects changes in nursing practice.

Relationship Between Nasal Fracture and Blowout Fracture: Can Nasal Fracture Be a Predictor of Blowout Fracture?

PURPOSE: Nasal and blowout fractures are the most common injuries from craniomaxillofacial trauma. Nasal fractures are easily diagnosed by clinical signs, such as pain and crepitus. However, blowout fractures are frequently asymptomatic and are easy to miss without computed tomographic (CT) scanning. This study analyzed the relation between the 2 fracture types to determine whether nasal fracture could be used as a predictor of blowout fracture. MATERIALS AND METHODS: CT scans of 1,368 patients who underwent reduction surgery for nasal fracture were retrospectively reviewed. The pattern of nasal fractures (n = 1,368) was classified as frontal or lateral according to the direction of impact. Blowout fractures (n = 297) were classified into 3 types according to the position of the fracture: medial, inferior, or inferomedial wall. After calculating the number of patients in each group, the relation between nasal and blowout fracture types was statistically analyzed. RESULTS: Of 305 patients with frontal-type nasal fractures, the incidence of medial, inferior, and inferomedial wall fracture was 26, 7, and 9, respectively. Of 1,063 patients with lateral-type nasal fractures, the incidence of medial, inferior, and inferomedial wall fracture was 118, 75, and 62, respectively. Medial wall fracture was most common in the 2 nasal fracture groups and showed a higher frequency in the lateral-type group. CONCLUSIONS: This study showed a strong relation between nasal fractures and medial wall blowout fractures. If nasal fracture is suspected, especially the lateral type, then thorough examination for medial wall blowout fracture, with a high index of suspicion, should be performed.

Ischemic Time in Free-Flap Surgery With Arteriovenous Bundle Interposition Graft: Comparison of Two Anastomosis Sequences.

BACKGROUND: During free-tissue transfer for scalp reconstruction, pedicle lengthening may be required when finding a recipient vessel is difficult because of defects from previous surgery. Arteriovenous (AV) bundle interposition grafting is a good option. This study compared 2 sequences of AV bundle interposition grafting when flap pedicle lengthening is needed. METHODS: Two anastomosis methods were used. In the recipient lengthening type (R type), the flap was harvested and the AV bundle was harvested from a donor vessel for lengthening. In the flap lengthening type (F type), the flap was harvested first. Next, in contrast to that in the R type method, the authors performed anastomosis with a flap pedicle and bundle before the AV bundle was harvested. RESULTS: The mean flap pedicle length was 8.75 cm (range, 5-11 cm). The AV bundle had a mean length of 9.25 cm (range, 6-13 cm), meaning that 13 cm of additional pedicle length can be added. The mean length of the extended vascular pedicle was 18 cm (range, 14-23 cm). CONCLUSION: This study compared the results of F type and R type AV bundle interposition grafting. The F type allowed easy monitoring of the anastomosis of the flap pedicle and ensured flap stability by reducing continuous ischemic time. Finally, this study confirmed the efficacy and safety of the AV bundle interposition graft in scalp reconstruction.

Clinical Outcomes Between Atrophic and Nonatrophic Mandibular Fracture in Elderly Patients.

The number of elderly patients with mandibular fracture is rapidly increasing. To improve outcome, it is important to understand the age-related characteristics of mandibular fracture. Thus, the aim of this study is to analyze the impact of atrophic change on mandibular fracture in elderly patients. The retrospective study was conducted in patients aged ≥65 years old, who underwent surgery for the treatment of mandibular fracture in our hospital from March 2006 until March 2015. Patient characteristics, such as age and gender, causes of injury, anatomic location of fracture, height of mandibular body, extent of atrophy, location of surgical sites, postoperative outcomes, and the follow-up period, were examined. Descriptive statistics were compared between atrophic and nonatrophic mandibles. The patients included 17 males and 12 females and the mean age was 71.9 years old. The average follow-up period was 6.06 months. Regarding occlusion and complications, there were no statistical differences between the atrophic and nonatrophic mandibular fractures. As major complications, nonunion occurred in 2 patients and malunion in 1 patient. There was no mortality associated with anesthesia or surgery. Atrophic and nonatrophic mandibular fractures in elderly patients can be treated successfully with surgery. There was no significant difference with respect to major complications between patients with atrophic and nonatrophic mandibular fractures.

Differentiation of human pluripotent stem cells into Medial Ganglionic Eminence vs. Caudal Ganglionic Eminence cells.

Human pluripotent stem cells (PSCs) represent an opportunity to study human development in vitro, to model diseases in a dish, to screen drugs as well as to provide an unlimited and ethically unimpeded source of therapeutic cells. Cortical GABAergic interneurons, which are generated from Medial Ganglionic Eminence (MGE) cells and Caudal Ganglionic Eminence (CGE) cells during embryonic development, regulate cortical neural networks by providing inhibitory inputs. Their malfunction, resulting in failure to intricately regulate neural circuit balance, has been implicated in brain diseases, such as schizophrenia, autism and epilepsy. In this study, using combinatorial and temporal modulation of developmentally relevant dorsoventral and rostrocaudal signaling pathways, we efficiently generated MGE cells vs. CGE cells from human PSCs, which predominantly generate Parvalbumin-expressing or Somatostatin-expressing interneurons vs. Calretinin-expressing interneurons, respectively. Efficient generation of specific differentiated progenies of hPSCs as shown in this study will be a pivotal step to realize the full potential of hPSCs for regenerative medicine, developmental studies, disease modeling, bioassay, and drug screening.

Fat Graft Survival After Recipient Site Pretreatment With Fractional Carbon Dioxide Laser.

BACKGROUND: Fat grafting is a commonly performed procedure not only for augmenting the soft tissue but also for regeneration in esthetic and reconstructive plastic surgery.However, unpredictable fat survival rate because of high resorption rate is remained as the main problem. The purpose of this study was to investigate the effect of pretreatment of the recipient site to the fat survival using fractional carbon dioxide (CO2) laser. METHODS: The rats were divided to 2 groups. Inguinal fat pads of rats were transplanted to the dorsum without pretreatment in the control group. The study group was preconditioned by fractional CO2 laser to the recipient site 1 week before fat graft.The pulse energy was set to 100 mJ. Transplanted fat tissues were harvested at postoperative days 1, 3, 7, 14, and 28 and were analyzed morphologically, histologically, and immunohistochemically. RESULTS: Weight and volume in the control group was more decreased than in the study group at postoperative day 28. Histological evaluation showed less inflammation, less fibrosis, less vacuolization, and better integrity of adipocytes. Immunohistologically, microvessel density in the study group was higher than in the control group (P < 0.05) at postoperative day 1. Survival rate in the study group was higher than in the control group at postoperative days 1, 3, 7, and 14 (P < 0.05). CONCLUSIONS: Pretreatment of recipient site using fractional CO2 laser helped vascularization in the early stage in fat graft and solved the ischemic condition, so it improved fat survival rate.

A Systematized Strategy in Corrective Rhinoplasty for the Asian Deviated Nose.

BACKGROUND: A deviated nose is a common deformity encountered in rhinoplasty. Over the past several decades, a variety of rhinoplasty techniques have been described focusing on the classification of bony and cartilaginous deviation. Nevertheless, corrective rhinoplasty is still a challenging procedure even for experienced surgeons because of the high recurrence rate of deviation. In attempt to reduce the recurrence rate, the author systematized the complex procedures by using a single technique regardless of the classification of a deviation. MATERIALS AND METHODS: Forty patients who underwent corrective rhinoplasty between June 2009 and December 2014 were reviewed retrospectively. All the patients were operated using 4 main surgical procedures: anterior approach septal correction, unilateral osteotomy, and medialization of the deviated complex to the contralateral intact side, and dorsal augmentation with a dermofat graft. Assessment of improvement was based on photo standardization. The degree of nasal deviation, nasofrontal angle, tip projection-to-nasal length ratio, vertical line of the upper lip-to-tip projection ratio, and columellar-labial angle were measured. RESULTS: Preoperative and postoperative anthropometric measurements revealed that the mean degree of deviation changed from 10.19° to 3.43° (P < 0.01), and the degree of nasofrontal angle changed from 131.55° to 133.14° (P < 0.01). All patients responded to both the preoperative and postoperative questionnaires. The questionnaires revealed a significant functional and cosmetic improvement from 36.84° to 76.95° and 39.45° to 79.41°, respectively (P < 0.0001). CONCLUSIONS: This systematized strategy to correct the Asian deviated nose provided reproducible and consistent results It also resulted in low recurrence rates and high postoperative satisfaction among patients.

Erratum: Correction of Figure: Simvastatin Reduces Capsular Fibrosis around Silicone Implants.

This corrects the article on p. 1273 in vol. 31, PMID: 27478339.

Simvastatin Reduces Capsular Fibrosis around Silicone Implants.

Capsular fibrosis and contracture occurs in most breast reconstruction patients who undergo radiotherapy, and there is no definitive solution for its prevention. Simvastatin was effective at reducing fibrosis in various models. Peri-implant capsular formation is the result of tissue fibrosis development in irradiated breasts. The purpose of this study was to examine the effect of simvastatin on peri-implant fibrosis in rats. Eighteen male Sprague-Dawley rats were allocated to an experimental group (9 rats, 18 implants) or a control group (9 rats, 18 implants). Two hemispherical silicone implants, 10 mm in diameter, were inserted in subpanniculus pockets in each rat. The next day, 10-Gy of radiation from a clinical accelerator was targeted at the implants. Simvastatin (15 mg/kg/day) was administered by oral gavage in the experimental group, while animals in the control group received water. At 12 weeks post-implantation, peri-implant capsules were harvested and examined histologically and by real-time polymerase chain reaction. The average capsular thickness was 371.2 µm in the simvastatin group and 491.2 µm in the control group. The fibrosis ratio was significantly different, with 32.33% in the simvastatin group and 58.44% in the control group (P < 0.001). Connective tissue growth factor (CTGF) and transforming growth factor (TGF)-ß1 gene expression decreased significantly in the simvastatin group compared to the control group (P < 0.001). This study shows that simvastatin reduces radiation-induced capsular fibrosis around silicone implants in rats. This finding offers an alternative therapeutic strategy for reducing capsular fibrosis and contracture after implant-based breast reconstruction.

Correction of Medial Blowout Fractures According to the Fracture Types.

BACKGROUND: Regarding the issue of blowout fracture, a variety of approaches and surgical techniques have been reported to improve postoperative results. However, there are no extant guidelines for the selection of these various methods. The current authors classified the medial blowout fracture into 3 different types and adapted to suitable surgical techniques. METHODS: Between October 2010 and March 2013, 89 patients who had medial blowout fracture were included in this study. We classified the study patients into 3 different categories: greenstick, simple, and complex. The greenstick type used the transnasal endoscopic approach and was reduced with packing after applying a silastic sheet. The simple type used an onlay covering technique. The complex type was treated using the transcaruncular approach and inlay implanting technique. After surgery, the continuity of orbital wall was checked by computed tomography. Patients were then examined for the following conditions: diplopia, eyeball movement, and enophthalmos. RESULTS: The greenstick category consisted of 12 cases, most cases were satisfied. One case relapsed after removal of the packing. In the simple category, a total of 9 cases were treated by onlay covering technique. In all 68 cases of the complex type, we could obtain suitable anatomical reconstruction with inlay implanting technique. Only 2 cases complained of transient diplopia and moderate enophthalmos. CONCLUSIONS: Appropriate clinical classification, depending on the type of fracture and selection of optimal treatment methods, could obtain the satisfactory result and improve the treatment outcomes in the correction of medial orbital wall fracture.

Efficient specification of interneurons from human pluripotent stem cells by dorsoventral and rostrocaudal modulation.

GABAergic interneurons regulate cortical neural networks by providing inhibitory inputs, and their malfunction, resulting in failure to intricately regulate neural circuit balance, is implicated in brain diseases such as Schizophrenia, Autism, and Epilepsy. During early development, GABAergic interneuron progenitors arise from the ventral telencephalic area such as medial ganglionic eminence (MGE) and caudal ganglionic eminence (CGE) by the actions of secreted signaling molecules from nearby organizers, and migrate to their target sites where they form local synaptic connections. In this study, using combinatorial and temporal modulation of developmentally relevant dorsoventral and rostrocaudal signaling pathways (SHH, Wnt, and FGF8), we efficiently generated MGE cells from multiple human pluripotent stem cells. Most importantly, modulation of FGF8/FGF19 signaling efficiently directed MGE versus CGE differentiation. Human MGE cells spontaneously differentiated into Lhx6-expressing GABAergic interneurons and showed migratory properties. These human MGE-derived neurons generated GABA, fired action potentials, and displayed robust GABAergic postsynaptic activity. Transplantation into rodent brains results in well-contained neural grafts enriched with GABAergic interneurons that migrate in the host and mature to express somatostatin or parvalbumin. Thus, we propose that signaling modulation recapitulating normal developmental patterns efficiently generate human GABAergic interneurons. This strategy represents a novel tool in regenerative medicine, developmental studies, disease modeling, bioassay, and drug screening.

Improvement of Fat Transplantation: Fat Graft With Adipose-Derived Stem Cells and Oxygen-Generating Microspheres.

BACKGROUND: Autologous fat transplantation has become increasingly popular in plastic surgery. However, high resorption rate limits the utility of this technique. To address this problem, this study examined fat transplantation with oxygen-generating microspheres and adipose-derived stem cells (ASCs) in a rat model. METHODS: The rats were assigned to four groups. Group 1 had fat transplantation only; group 2, fat transplantation with oxygen-generating microspheres; group 3, fat transplantation with ASCs; group 4, fat transplantation with oxygen-generating microspheres and ASCs. RESULTS: At postoperative 2 weeks, compared to the control group, weight and volume increased significantly in groups 3 and 4. The survival distance of fat cells from the margin of transplanted tissue was 247 µm in group 1, 379 µm group 2, 521 µm in group 3, and 669 µm in group 4. All of the experimental groups were significantly increased. Growth factors (fibroblast growth factor- 2 [FGF-2], insulin-like growth factor-1, epidermal growth factor, and vascular endothelial growth factor) analysis was performed through real-time polymerase chain reaction. Compared to the control group, the mean of the periods was statistically significant at FGF-2 in group 3 and FGF-2, insulin-like growth factor-1, and epidermal growth factor in group 4. CONCLUSIONS: In this study, fat transplantation was improved with oxygen-generating microspheres and ASCs. The oxygen-generating microspheres supply oxygen to adipocytes and ASCs where diffusion does not occur, increasing cell survival rate. Surviving ASCs become involved in the metabolic processes for adipocytes and induce angiogenesis. Therefore, fat transplantation result was improved. Excessive oxygen supply, however, reduces angiogenesis and may cause oxygen toxicity. So, further evaluation of oxygen-generating microspheres is necessary for application to tissues to determine appropriate oxygen concentration and a valid oxygen release period.

Evaluation of nurse staffing levels and outcomes under the government--recommended staffing levels in Korea.

AIM: This study aimed to evaluate registered nurse staffing levels and outcomes enforced by the current Korean nursing regulations. BACKGROUND: Registered nurse staffing levels are closely related to patient and nurse outcomes. Thus, the government's policy regarding nursing staffing has a practical impact, and better policies could lead to more appropriate nurse staffing. The actual evaluation of the government-recommended staffing levels in Korea is paramount for the establishment of a realistic and effective system that promotes quality care and patient safety. METHOD: The participating hospital operated under the government-recommended staffing levels (Grade 2 of the Graded Fee of Nursing Management Inpatient System). For unit-level evaluations, one surgical unit was chosen and its staffing level was changed by assigning one additional registered nurse for 6 months. Length of hospitalisation, incidents of death, overtime hours and nursing job performance were measured prior to and after the addition of the extra staff. RESULT: After 6 months, the length of patient hospitalisation and registered nurse overtime hours reduced and nurse job performance scores in the unit analysed improved. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: The results demonstrated that increasing the number of registered nurses beyond the current government-recommended staffing level improves patient and nurse outcomes. This indicates the importance and value of empirically assessing the need for changes in the recommended nurse staffing levels to develop appropriate, realistic and effective policies.

The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis.

[Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients.

Medial canthopexy using Y-V epicanthoplasty incision in the correction of telecanthus.

BACKGROUND: Telecanthus occurs because of the disruption of the medial canthal tendon (MCT). The deformity of medial canthus can result from nasoorbitoethmoid fractures, tumor resection, craniofacial exposure, congenital malposition, or aging. Repair of the MCT using transnasal wiring is regarded as a method of choice to treat telecanthus. We have introduced an oblique transnasal wiring using Y-V epicanthoplasty incision rather than the well-known classical bicoronal approach. METHODS: Eight patients with telecanthus were treated with this method. Through the medial canthal horizontal and periciliary incision, we could have an access to the medial orbital wall and the MCT. An oblique transnasal wiring was performed with the following steps: (1) after slit skin incision on the nasal recession of the contralateral frontoglabella area, 2 drill holes were made from this point to the superior and posterior region of the lacrimal fossa of the affected orbit; (2) a 2-0 wire was passed through the MCT and the holes; (3) the wire was pulled and tightened until the MCT was ensured and was twisted in the contralateral side. After the repositioning of the MCT, the skin was simply sutured. The excess skin was trimmed, and then the skin was sutured with nylon 7-0. The remaining "dog ear" in the lateral portion can be removed by additional periciliary skin incision and excision. RESULTS: All the patients achieved an improvement and a prompt recovery. The interepicanthal distance was decreased by 6.3 mm on average compared with that in the preoperative condition. All patients had no complication associated with surgeries. Of posttraumatic telecanthus, 5 patients were much satisfied with the outcomes, and 1 patient had recurrence on postoperative month 3. In cases of congenital anomaly or neoplasm, the telecanthus was also improved. CONCLUSIONS: An oblique transnasal wiring using Y-V epicanthoplasty incision could be a simple, safe method to correct the telecanthus with the following advantages: first, we could fix the MCT to the appropriate position with oblique transnasal wiring; second, a horizontal incision and a periciliary incision could be acquired with enough operative fields; third, Y-V epicanthoplasty incision is an effective method for minimizing unsightly scar formation.