Successful eradication of helical rim keloids with surgical excision followed by pressure therapy using a combination of magnets and silicone gel sheeting.

Extremely limited data are available for the treatment of helical rim keloids. The purpose of the present study was to demonstrate the successful treatment of helical rim keloids using surgical exicison followed by a newly designed pressure therapy device. We treated 40 pure helical rim keloids in 36 patients with surgical excisions followed by pressure therapy using a combination of magnets and silicone gel sheeting for 12 hours over a period of 2 years, from May 2012 to February 2014, at tertiary medical centre. The follow-up period was 18 months. Primary outcome was recurrence of keloids. Secondary outcome was patient satisfaction as assessed by the Patient Observer Scar Assessment Scale (POSAS). The overall recurrence-free rate was 95·0% after a follow-up period of 18 months. Scores obtained from the POSAS showed that most items were reported to be improved. This adjuvant therapy protocol resulted in excellent outcomes in cases of helical rim keloids compared to previously published protocols.

Quantitative Mandibular Angle Ostectomy Facilitated by Oscillating-Blade Saw With Scalable Guide.

BACKGROUND: Although various techniques of mandibular angle ostectomy have been devised to correct overly prominent bony contours, none have incorporated methods to delineate the surgical line with precision. Herein, the authors describe one means of marking an ostectomy line more easily, using a specially designed oscillating-blade saw. METHODS: Between July 2013 and June 2014, a total of 75 patients underwent quantitative mandibular angle ostectomy using a custom oscillating-blade saw equipped with a scalable guide. Corticectomy, also done routinely to improve frontal appearance, called for a reciprocating saw only. Aesthetic outcomes gauged subjectively by the questionnaire about satisfaction and symmetry after postoperative 6 months. RESULTS: Satisfaction score was 4.9 and symmetric score was 4.7. No major complications, such as persistent nerve injury or fracture, were encountered. CONCLUSIONS: Use of an oscillating-blade saw equipped with a scalable guide facilitated quantitative mandibular angle ostectomy, enabling precise, and reproducible surgery with satisfactory outcomes with less complications.

Botulinum toxin A affects early capsule formation around silicone implants in a rat model.

Capsular contracture is one of the most common complications resulting from implants placed during mammoplasty and rhinoplasty, and there is no definitive solution or a method for preventing it. Recent reports suggest that botulinum toxin A (BoTA) is effective at reducing keloid scars clinically. Peri-implant capsules are histologically similar to keloid scars and hypertrophic scars. Therefore, we hypothesized that BoTA may reduce peri-implant capsule formation.To test our hypothesis, we divided 24 male Sprague-Dawley rats into an experiment group and a control group. We created two 15 × 15-mm subpanniculus pockets in each rat. Botulinum toxin A (0.5 mL; 5 U) was injected into the carnosa layer of the experimental group's pockets and 0.5 mL normal saline was similarly injected in the control group. Hemispherical silicone implants, 15 mm in diameter, were inserted into the pockets. After 6 weeks, the peri-implant capsule was excised and examined by histologic evaluation, immunohistochemical stain, scanning electron microscope, and real-time polymerase chain reaction.Capsular thickness, number of inflammatory cells, number of vessels, and transforming growth factor ß1 expression were reduced in the experimental group compared to the control group (P < 0.01). The experimental group's collagen pattern was loose and well organized. The total myofibroblast content was lower in the experimental group than in the control group; however, this difference was not statistically significant (P = 0.32). Additionally, the experimental group had a smaller fibrosis index than the control group (P < 0.05).Our results suggest that BoTA may provide an alternative treatment for reducing capsule formation and preventing contracture, and further studies may reveal the mechanism of action.

Ischemic oculomotor nerve palsy and skin necrosis caused by vascular embolization after hyaluronic acid filler injection: a case report.

Hyaluronic acid filler injection is widely used for soft tissue augmentation. However, there can be disastrous complications by direct vascular embolization. We present a case of ischemic oculomotor nerve palsy and skin necrosis after hyaluronic acid filler injection on glabellar.blepharoptosis, exotropia and diplopia developed suddenly after the injection, and skin necrosis gradually occurred. Symptoms and signs of oculomotor nerve palsy continuously improved with steroid therapy. Skin defects healed with minimal scars through intensive wound care.Percutaneous filler injection of periorbital areas should be performed carefully by experienced surgeons, and the possibility of embolization should be considered promptly if symptoms develop.

Improved scar appearance with combined use of silicone gel and vitamin C for Asian patients: a comparative case series.

BACKGROUND: In Asians, facial scars, even fine surgical scars, often can be conspicuous and uncomfortable. The authors used a topical silicone gel containing vitamin C on facial scars for the purpose of making the scar less distinct. METHODS: The study enrolled 80 patients. For the experimental group, the topical silicone gel mixture containing vitamin C was applied from the time of stitch removal to 6 months after the operation. The control group did not undergo any adjunctive treatment. Each participant was evaluated using the modified Vancouver Scar Scale (VSS) as well as erythema and melanin indices by spectrophotometer. RESULTS: With the modified VSS, the experimental group showed a significant decrease in scar elevation (p = 0.026) and erythema (p = 0.025). The hypo- or hyperpigmentation of the scars was more normalized in the experimental group. In the measured results via spectrophotometer, the experimental group showed a significant decrease in the melanin index (p = 0.045). The erythema index showed a statistically significant difference between the time of stitch removal and 6 months after the operation in the experiment group only. CONCLUSIONS: Topical use of silicone gel containing vitamin C has the effect of improving the appearance of fine surgical scars in Asian facial skin. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Osteoconductivity of porous polyethylene in human skull.

PURPOSE: Recently, biomaterials have been generally used in reconstruction of a bony defect or augmentation of the facial skeleton. Medpor implants in vivo in animal models showed both soft tissue and bony ingrowth into its pores and have been widely accepted to have an osteoconduction activity. However, in an in vivo study in humans, there was no definite evidence of bony ingrowth into the pores of Medpor. This study examined the osteoconductivity of Medpor in human vivo. METHODS: We gained a total of 24 Medpor blocks when removing a distraction device in 11 patients with craniosynostosis. The Medpor blocks were used for secure placement of the distraction device. The blocks were taken out after distraction and consolidation periods. The surface of Medpor in contact with the bone was histologically examined to confirm the osteogenic activity. RESULTS: There was no evidence of osteoconduction in all 24 specimens. The mean total duration of implantation was 2.5 months. CONCLUSIONS: In human vivo, implantation of a porous polyethylene implant is thought to have no osteogenetic effect through osteoconductive activity even in young children.

Descending necrotizing mediastinitis and facial palsy as serial complications in orthognathic surgery.

Orthognathic surgery is one of the most commonly performed cosmetic surgical procedures. Hemorrhage, infection, and facial palsy have been reported as complications of the surgery, but the occurrence is low. Our patient presented with facial palsy, postoperative bleeding, wound dehiscence, and descending necrotizing mediastinitis in a sequence. This is the first report of descending necrotizing mediastinitis after orthognathic surgery. Although these are very rare complications, awareness of the clinical presentation and the management of these conditions are important.

Versatility of three-dimensional total alar cartilage dissection in aesthetic rhinoplasty.

In many cases, Asians' noses are shorter; their nasal tips have a bulbous shape and typically lack the projection. To correct these problems, we completely dissected the alar cartilage in a three-dimensional manner by which the alar cartilage could be repositioned. Thus, no external force was exerted to the alar cartilage. For approximately 4 years, a total of 502 patients were treated with this surgical method. Using the open rhinoplasty, the alar cartilage was dissected in such a manner that it should be completely isolated from the skin, nasal mucosa, and upper lateral cartilage in 3 layers. Thereafter, using various nasal tip plasty techniques, the alar cartilage was reshaped and then repositioned. Patients were followed up for a mean period of 18 months. Then, the degree of subjective satisfaction of patients was analyzed with the use of 4-point visual analog scale scores. On the assessment of the degree of subjective satisfaction of patients, of a total of 502 patients, 87% responded as "very satisfactory" or "satisfactory." Through an analysis of the photographs taken before and after surgery, in patients with a short nose, the current surgical procedure was effective in extending the length of nose without the septal extension graft. The nasolabial angle was ideally expressed. Through meticulous cartilage manipulation, the tip projection improved and a bulbous shape of the nasal tip was resolved. In an aesthetic rhinoplasty for Asians, if plastic surgery of the nasal tip should be performed using a three-dimensional dissection of the alar cartilage, it would be helpful for surgeons to effectively and freely manipulate the alar cartilage according to their plans.

First percutaneous reduction and next external suspension with Steinmann pin and Kirschner wire of isolated zygomatic fractures.

We have introduced a less invasive, simple, and effective method for zygomatic fractures using percutaneous reduction with a Steinmann pin (S-pin) and temporary external suspension with a Kirschner wire (K-wire).For 2 years, 51 patients underwent first percutaneous reductions and then fixations, which is a method that we developed. After the S-pin no. 1 was percutaneously inserted at the most prominent point of the zygoma, closed reduction was first attempted using lever movement and temporary external suspension with a K-wire. If required, 1-site rigid fixation was performed on the zygomaticomaxillary buttresses via gingivobuccal incisions. Only 13 patients received K-wire suspensions and 38 patients received K-wire suspensions and lateral buttress fixations. We evaluated the postoperative result in 4 aspects (flattening, symmetry, scar, and paresthesia) using the 4-point visual analog score after at least 6 months.The mean maintenance period of the S-pin and K-wire was 12.3 days, and the mean operation time was 33 minutes. No serious complications, such as infections or external wire instability, were observed. Excellent or good results were achieved in more than 95% of patients in all 4 aspects mentioned.We believe that our method, which is the first percutaneous reduction using S-pin and temporary external suspensions with a K-wire with or without a lateral buttress rigid fixation, is a simple and effective method for noncomminuted zygomatic fractures.

Correlation of neotongue volume changes with functional outcomes after long-term follow-up of total glossectomy.

As the survival rate of tongue cancer has increased, longer-term results of tongue reconstruction are also being considered. The aim of this study was to report the long-term outcomes of total glossectomy.Of 14 patients who underwent total glossectomy, 11 were reconstructed with the rectus abdominis musculocutaneous free flap and 3 with the anterolateral thigh free flap. We reviewed survival rate, swallowing capacity, speech intelligibility, and volume reduction in flaps. Swallowing capacity and speech intelligibility were evaluated by visual analog scale scores (7 points) at 1 to 7 years after surgery, and changes in neotongue volume were examined by dividing volume into 4 stages.The 5-year disease-specific survival rate was 71%. Almost all patients were able to eat a soft diet and resume verbal communication. However, a sufficient volume of the reconstructed tongue was decreased over the course of time. Volume change was more definitive in the cases using the anterolateral thigh free flap than the rectus abdominis musculocutaneous free flap. Neotongue volume was also correlated with swallowing capacity and speech intelligibility.In total tongue reconstruction, wide and thick flaps such as the rectus abdominis musculocutaneous flap had better outcomes. Overcorrection with a sufficient flap volume is recommended for adequate oral intake owing to volume loss caused by radiation therapy, and functional muscle transfer should also be considered to prevent muscle atrophy. Lastly, static suspension procedures are emphasized to prevent airway aspiration for larynx preservation.

Evaluation of the extraction method for the cytotoxicity testing of latex gloves.

In this study, the cytotoxicity of medical latex gloves to cultured L-929 cells was determined using various extraction conditions. According to the extraction time and temperature, three types of extraction conditions were used: 1) 24 h at 37 degrees C; 2) 72 h at 37 degrees C; 3) 72 h at 50 degrees C. Also, four different extraction vehicles were used, namely, distilled water (DW), 9 g/l sodium chloride (saline) in DW, and culture media with or without serum. Under the above-mentioned conditions, the samples were extracted and then 2-fold serially diluted in the concentration range 3.13 - 50%. When extracted with either DW or saline for 24 h or 72 h at 37 degrees C, only 50% diluted samples showed distinct cytotoxicity to L-929 cells. Moreover, no cytotoxic potentials were observed when gloves were extracted with DW or saline at 50 degrees C for 72 h. Cytotoxicity was markedly greater when gloves were extracted with culture medium, irrespective of the presence of serum in the medium. These results suggest that optimal extraction conditions should be established for the cytotoxicity evaluations of biomaterials and medical devices.

Clinical experience with complications of hand rejuvenation.

PURPOSE: Prominent signs of ageing of the hands have recently been treated with permanent or longer-lasting injectable dermal fillers. However, few previous studies have described the long-term complications of such hand rejuvenation. The purpose of our report was to share our experience of 15 cases with long-term complications following hand rejuvenation using various medical fillers. PATIENTS AND METHODS: We performed a retrospective review of the management of 15 patients who presented with complications from the injection of synthetic fillers for hand rejuvenation at a tertiary medical centre over a period of 10 years from March 2002 to January 2011. RESULTS: Injected materials included polymethylmethacrylate (PMMA) microsphere filler, calcium hydroxyapatite filler, hyaluronic acid filler, poly-l-lactic acid (PLLA) filler and other medical fillers. Of the total study sample of 15 patients, nine underwent surgical excision, six patients with a history of PMMA or PLLA filler injection received intralesional steroid therapy and three patients with a history of hyaluronic acid filler injection received injection therapy using hyaluronidase. CONCLUSIONS: Hand rejuvenation complications can be successfully treated according to our proposed algorithm.