An effective aesthetic toe-shortening procedure

Background@#Many people with a longer second toe or lesser toes experience symptoms such as corns, hammertoe, and numerous others, especially when wearing open-toe shoes. Proximal interphalangeal joint arthrodesis using intraosseous loop wiring performed through a hidden side incision is a useful method to shorten the lesser toes aesthetically. @*Methods@#Aesthetic toe-shortening procedures were performed in 30 patients. All patients were evaluated by a physical examination and X-rays, and they underwent proximal interphalangeal joint arthrodesis using intraosseous loop wiring through a medial incision. Demographic characteristics, including foot morphology, were analyzed. The number of resected toes and resection amounts of each toe were measured. Patients’ satisfaction was determined through a questionnaire administered at each follow-up. @*Results@#In total, 91 toe-shortening procedures were performed in 30 patients who were followed up for an average of 24 months (range, 6–48 months). Sixteen patients had Greek-type feet (53.3%) and 14 had square-type feet (46.7%). Twelve patients had hammer toe deformity (40.0%) and 13 had corns (43.3%). The average length of the resected second and third toes was 9.66±2.79 mm (range, 5–15 mm) and 7.78±2.51 mm (range, 5–12 mm), respectively. The vast majority of patients were satisfied with the final results. No significant complications such as nonunion occurred. Only one case of mild angulation of the second toe was noted. @*Conclusions@#Aesthetic toe-shortening using the procedure described here can prevent the development of lessor toe deformities and provide permanent, aesthetically pleasing results with a short recovery time.

Expression of Bis in the mouse gastrointestinal system / 대한해부학회지

The Bcl-2 interacting death suppressor (Bis) protein is known to be involved in a variety of pathophysiological conditions. We recently generated bis-deficient mice, which exhibited early lethality with typical nutritional deprivation status. To further investigate the molecular basis for the malnutrition phenotype of bis deficient mice, we explored Bis expression in the digestive system of normal mice. Western blot analysis and quantitative real time reverse transcription polymerase chain reaction analysis indicated that Bis expression is highest in the esophagus, followed by the stomach, colon, jejunum and ileum. Immunohistochemical data indicated that Bis expression is restricted to the stratified squamous epitheliums in the esophagus and forestomach, and was not notable in the columnar epitheliums in the stomach, small intestine and colon. In addition, strong Bis immunoreactivity was detected in the striated muscles surrounding the esophagus and smooth muscles at a lesser intensity throughout the gastrointestinal (GI) tract. Ganglionated plexuses, located in submucous layers, as well as intermuscular layers, were specifically immunoreactive for Bis. Immunofluorescence studies revealed that Bis is co-localized in glial fibrillary acidic protein-expressing enteric glial cells. Immunostaining with neuron specific esterase antibodies indicate that Bis is also present in the cell bodies of ganglions in the enteric nervous system (ENS). Our findings indicate that Bis plays a role in regulating GI functions, such as motility and absorption, through modulating signal transmission between the ENS and smooth muscles or the intestinal epitheliums.

Evaluation of the Various Artificial Skin Substitutes Implanted onto Nude Mice

PURPOSE: The purpose of this study is to evaluate the remodeling process of the various skin substitutes in 4th and 6th weeks following the transplantation when transplanted onto nude mice. METHODS: Three types of artificial skin substitutes, such as PLGA scaffold with keratinocyte sheets(group 1), acellular human dermis(Surederm(TM)) and keratinocyte sheet(group 2), bioengineered skin(Neoderm(TM))(group 3), were applied to the wound on nude mice. All mice were killed in 2, 4 weeks and/or 6 weeks after grafting and tissue samples were harvested from the back of mice. The changes in wound size, degree of angiogenesis, formation of basement membrane and epidermis, density of collagen fibers and neural restoration were examined. RESULTS: There was no significant changes in wound size among the three groups. However, the size of wound decreased in the non-substituted group due to contracture. Degree of angiogenesis and systhesis of collagen or neurofilaments were mostly increased in bioengineered skin(Neoderm(TM))(group 3), followed by acellular human dermis(Surederm(TM)) and keratinocyte sheet(group 2), PLGA scaffold with keratinocyte sheets (group 1). However, group 3 and group 2 showed similar thickness of basement membrane and epidermis. CONCLUSION: We found that degree of angiogenesis, formation of basement membrane and skin appendages, density of collagen fibers and neurofilaments can be the categories to evaluate the success of artificial skin substitution in early stages.

Visual Disturbance following Autologous Fat Injection into Periorbital Area

PURPOSE: Autologous fat injection into the facial area is a frequently used technique in aesthetic plastic surgery for augmentation of the soft tissue. Fat injection is a very safe procedure because of the advantage of being autologous tissue. Minimal foreign body reaction or infections are noted after fat injection. However, there may be some complications including those as severe as blindness. There have been some case reports on visual disturbances after autologous fat injection reported in the literature. METHODS: A 21-year-old female patient underwent autologous fat injection into left eyebrow area to correct depression of soft tissue. Immediately after injection of autologous fat, she complained sudden visual loss on the left eye. She had come to our emergency room and ophthalmologic evaluation showed that the patient could only recognize hand motion. There was no abnormality of the optic nerve on magnetic resonance imaging. Suspecting an ischemic optic neuritis from fat embolism of the central retinal artery, the patient was treated conservatively with occular massage, antiglaucomatic agent, anti-inflammatory drugs and antibiotics. Visual field examination showed visual defect of half the lower hemisphere. RESULTS: While maintaining antiglaucomatic agents and non steroidal anti inflammatory drugs, fundoscopic examination showed no abnormalities on the second day of admission. Visual field examination showed an improvement on the fourth day along with decreased eyeball pain. Significant improvement of vision was noted and the patient was discharged on the fifth day of admission. The patient was followed-up 2 days afterwards with improved vision and visual field defect. CONCLUSION: We describe an unusual case of sudden unilateral visual disturbance following autologous fat injection into periorbital area.

Bacterial Identification in the Medicinal Leech

The use of medicinal leech(Hirudo medicinalis) has been increased during the past years and is a very common procedure for treatment of venous congestion in flaps and replanted part in plastic surgery. One of the main complication in using leeches is infection. We used the medicinal leeches in venous congestion after total ear reconstruction(8 cases) and replanted finger(1 case). A bacteriologic study of the leeches is undertaken before applying it to the patient and an antibiotic susceptibility test was also performed. In 6 patients. 6 pathogenic organisms were identified, and in 2 cases 2 different organisms were identified simultaneously.