Endoscopy-assisted ultrasonic surgical aspiration of axillary osmidrosis: a retrospective review of 896 consecutive patients from 1998 to 2004

Axillary osmidrosis is a distressing and troublesome problem that causes a serious handicap in personal and social life. Many different methods have been introduced to treat axillary osmidrosis, however, they are often accompanied by marked complications. We analysed our experiences using endoscopy-assisted ultrasonic surgical aspiration in treating the axillary osmidrosis. From June 1998 to February 2004, a total of 896 patients (562 females, 334 males) were treated for axillary osmidrosis using endoscopy-assisted ultrasonic surgical aspiration. Our method was satisfactory in 815 patients (91%) and recurrence of odour occurred only in 29 (3.2%) patients. It also showed complications in 28 (3.1%) patients. Our method leaves a small inconspicuous scar and no contracture of the axillary skin after a short and comfortable recovery period and maintains normal axillary hair growth patterns. Axillary osmidrosis can be best treated by endoscopy-assisted ultrasonic surgical aspiration and this operation has many advantages with a high success rate, a low complication rate, and a rapid recovery period.

The fetal wound healing: a review

Fetal wound healing has drawn the attention of many researchers from diverse background and specialties. Fetal wound healing is unique and differs from postnatal healing in that fetal skin wounds heal rapidly without scar formation. If the mechanism underlying such phenomenon can be elucidated, it will be serve as a significant milestone in the study of wound healing. Furthermore, the implications for therapeutic applications in wound management and in diseases where scarring is the basic pathogenetic mechanism would be immense. Rather than to list the results and conflicting data of numerous studies, this article hopes to provide a general overview of the recent developments.

Quantitative and qualitative muscular changes after selective neurotomy

Disfigurement of body contour, caused by excessive muscular hypertrophy, can seldom be effectively and safely corrected by lipectomy, liposuction or combined partial myomectomy. This study was conducted to obtain basic knowledge for the development of a safe and effective method of treating patients with excessive and unwelcome muscle hypertrophy. Accordingly, we developed a new experimental rat model, consisting of the peroneal nerve and its target muscles - the anterolateral crural muscle group. After severance of 1/4, 1/2, and 1/1 of the peroneal nerve, functional parameters based on gross movement and electrophysiologic data were monitored. Changes in the external circumference and weight of the anterolateral crural muscle were documented and compared with control sides. Histologic and histomorphometric parameters of the muscle were also documented. Average takeoff latency in 1/4 and 1/2 neurotomy groups was increased to 130% and 154% of the control at 3 months, and 156% and 149% of control at 6months, respectively. Similarly, average peak-to-peak compound action potentials were 72% and 59% of the control at 3months and 57% and 50% of control at 6months. No definite gait disturbances were evident in the partial neurotomy groups. Maximal circumferences of the anterolateral crural muscle group were significantly reduced to 86%, 71% and 66% of the control in the 1/4, 1/2 and 1/1 neurotomy groups at 3 months (p < 0.001), and to 74%, 68% and 64% of the control at 6 months, respectively (p < 0.001). The corresponding weights were 76%, 62%, and 50% of the control sides at 3 months, and 70%, 56%, and 48% at 6 months in 1/4, 1/2 and 1/1 neurotomy groups. Histograms drawn showing the number of muscle fibers per mm2 in cross-sections, showed a total number of 239 +/- 52 in the control group; the size of muscle fibers was mainly medium to large. The more extensive the neurotomy, the greater the was the number of small angulated muscle fibers, up to a total of 1,564 +/- 211. Although more research work and clinical trials are required, we believe that selective neurotomy has the potential of being an effective tool for reducing muscle bulk, and avoiding apparent muscular dysfunction and complications.

Morphometric study of regeneration through vascularized nerve graft in a rabbit sciatic nerve model

Adequate vascularization is essential for a successful nerve graft. Theoretically, immediate vascularization will minimize fibroblast infiltration and support axonal regeneration. In this study, histomorphologic and morphometric studies were carried out to determine whether vascularized grafts are beneficial, in terms of axonal regeneration. In a rabbit model, 4-cm segments of sciatic nerve were obtained and placed as a nonvascularized graft on one side, and as a pedicled vascularized graft fed by the inferior gluteal vessel on the contralateral side. Histomorphologically, the distribution of myelinated nerve fibers and Schwann cells was evaluated after toluidine blue staining, at 2-, 3-, and 4-month intervals. The following results were obtained. 1) Myelinated nerve fibers were more abundant in the proximal, middle, and distal segments of the vascularized nerve group at 2 and 3 months. 2) The average nerve-fiber diameter was greater in the vascularized nerve graft group at 2, 3, and 4 months (2 to 10 microm). 3) Schwann cells were more abundant in the proximal, middle, and distal segments of the vascularized nerve graft group at all time points. Based on the above findings, the immediate restoration of circulation in the vascularized nerve graft can be accountable for the increased number of surviving Schwann cells, the rapid clearing of axons, and myelin-sheath changes that occur during Wallerian degeneration, thus enabling "morphologically" optimal regeneration.

Rice cooker steam hand burn in the pediatric patient

Burn injuries often lead to significant cosmetic and functional deformity. In the Orient, household electric rice cookers have caused a significant number of steam burns to infant hands. The clinical course and treatment outcome of these burns have been studied retrospectively in a review of the medical records of 79 pediatric patients treated for acute hand steam burns and of 38 other patients who underwent correction for postburn contracture. Electric rice cookers caused all of the acute pediatric steam burns treated at our institute. Of the 81 hands treated between 1995 and 1998, 38.3 percent healed with conservative treatment and 61.7 percent required skin grafting. The volar aspects of the index and middle fingers were those most frequently involved. Eighteen of 36 hands (50 percent) grafted with split-thickness skin developed late contractures requiring additional procedures. Among the 38 patients who underwent correction for postburn deformity, initial treatment was split-thickness grafting for 60.5 percent, full-thickness skin grafting for 7.9 percent, and spontaneous healing for 31.6 percent. Awareness among medical personnel and continued public education should be promoted to help prevent this unique type of pediatric steam burn from occurring.

Rectangular flap for horizontal upper vermilion tightness in secondary cleft lip deformity

Radical paring of the cleft edge during a primary cleft operation or repeated secondary surgeries can result in tightness of the upper lip. The degree of the resulting side-to-side tension can vary, from mild cases for which improvement is sought through realignment of the misplaced oral sphincter muscle in secondary revision, to severe cases for which the possibility of a lip switch flap must be considered. When the lip tightness accompanies more than three-quarters loss of the Cupid's bow, an Abbé flap is an alternative. However, the lip switch flap is far from ideal, in both artistic and functional perspectives, and should be avoided if at all possible in mild to moderate degrees of lip tightness. This study presents a method of correcting horizontal cleft upper lip tightness, especially of the vermilion. The method involves local transfer of an inferiorly based rectangular flap from the relatively redundant upper two-thirds to the lower one-third of the upper lip and vermilion. Primary indications for the technique include vermilion tightness with half to three-quarters loss of Cupid's bow. The method has the advantage of supplementing the horizontal lip dimension on the cleft side and restoring a natural Cupid's bow, thereby repositioning the shifted philtral column and adding fullness to the lower one-third of the upper lip. Incorporation of the upper lip scar in the rectangular flap removes ugly scars and spares the lower lip from surgical violation. The orbicularis sphincter function, as seen in facial animation, was well regained. Twenty unilateral and three bilateral cases with a maximal follow-up period of 4.5 years are presented.

Needle fixation technique in cartilage grafting

Exact placement of onlay cartilage grafts in auricular reconstruction and rhinoplasty demands technical experience. Recycled straight and curved needles have been used in a percutaneous manner for cartilage fixation. The method is easy, noninvasive, and is a time-saving procedure that can be used in various situations requiring a cartilage graft through a small incision.

Congenital upper auricular detachment

A rare case of unilateral congenital ear deformity has been presented. The deformity is characterized by detachment and posterior rotation of the right upper auricle in an otherwise grossly normal auricle. We believe that this deformity may be related to defective mesenchymal fusion or accretion between the auricular hillocks of the hyoid and mandibular arches. Satisfactory correction was achieved by auricular repositioning with two triangular flaps.

The role of Müller's muscle reconsidered

It is a traditional teaching that the levator aponeurosis is the main transmitter of the levator palpebrae muscle. However, there are several points that raise doubts in this fundamental concept of the levator aponeurosis as being the primary interconnecting mechanism in upper lid elevation. Despite the structural integrity of the levator complex, drooping of the upper eyelids is seen to develop in situations such as Horner's syndrome and in times of excessive fatigue and sleepiness. Amid the controversy in the literature regarding the specific role of the levator aponeurosis in the lid-elevating mechanism, we have observed that the levator aponeurosis fails to make constant attachment to the tarsal plate. This has led us to speculate on the possible role of the posterior lamella - Müller's muscle - as the primary transmitter of the levator muscle action to the tarsal plate.