• Archives of Plastic Surgery
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• 제40권5호
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• pp.610-615
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• 2013

Background Cephalometric analysis is essential for planning treatment in maxillofacial and aesthetic facial surgery. Although photometric analysis of the Korean nose has been attempted in the past, anthropometry of the deeper nasal structures in the same population based on computerized tomography (CT) has not been published. We therefore measured three anthropometric parameters of the nose on CT scans in our clinical series of patients. Methods We conducted the current retrospective study of a total of 100 patients (n=100) who underwent a CT-guided radiological measurement at our institution during a period ranging from January of 2008 to August of 2010. In these patients, we took three anthropometric measurements: the nasofrontal angle, the pyramidal angle, and the linear distance between the nasion and the tip of the nasal bone. Results The mean nasofrontal angle was $131.14^{\circ}$ in the male patients and $140.70^{\circ}$ in the female patients. The mean linear distance between the nasion and the tip of the nasal bone was 21.28 mm and 18.02 mm, respectively. The mean nasal pyramidal angle was $112.89^{\circ}$ and $103.25^{\circ}$ at the level of the nasal root, $117.49^{\circ}$ and $115.60^{\circ}$ at the middle level of the nasal bone, and $127.99^{\circ}$ and $125.04^{\circ}$ at the level of the tip of the nasal bone, respectively. Conclusions In conclusion, our data will be helpful in the preparation of silicone implants for augmentation and/or corrective rhinoplasty in ethnic Korean people.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.510-516
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• 2013

Background This paper discusses the treatment protocol for patients with frostbite. Methods We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012. Results Our clinical series of patients (n=17) included 13 men and four women, whose mean age was $42.4{\pm}11.6$ years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of $12.7{\pm}3.3$ days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of $35{\pm}4.3$ days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation. Conclusions With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.496-504
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• 2013

Background Amniotic-fluid-derived stem cells and amniocytes have recently been determined to have wound healing effects, but their mechanism is not yet clearly understood. In this study, the effects of amniotic fluid stem cells and amniocytes on wound healing were investigated through animal experiments. Methods On the back of Sprague-Dawley rats, four circular full-thickness skin wounds 2 cm in diameter were created. The wounds were classified into the following four types: a control group using Tegaderm disc wound dressings and experimental groups using collagen discs, amniotic fluid stem cell discs, and amniocyte discs. The wounds were assessed through macroscopic histological examination and immunohistochemistry over a period of time. Results The amniotic fluid stem cell and amniocyte groups showed higher wound healing rates compared with the control group; histologically, the inflammatory cell invasion disappeared more quickly in these groups, and there was more significant angiogenesis. In particular, these groups had significant promotion of epithelial cell reproduction, collagen fiber formation, and angiogenesis during the initial 10 days of the wound healing process. The potency of transforming growth factor-${\beta}$ and fibronectin in the experimental group was much greater than that in the control group in the early stage of the wound healing process. In later stages, however, no significant difference was observed. Conclusions The amniotic fluid stem cells and amniocytes were confirmed to have accelerated the inflammatory stage to contribute to an enhanced cure rate and shortened wound healing period. Therefore, they hold promise as wound treatment agents.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.516-522
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• 2017

Background Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure. Methods We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection. Results The total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction. Conclusions Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient's clinical symptoms do not improve, surgeons should consider implant removal.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.482-489
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• 2017

Background Polydeoxyribonucleotide (PDRN) is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. Methods This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10) and a PDRN group (n=10). Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL) or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week) and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week). Transcutaneous oxygen tension ($TcPO_2$) was evaluated using the Periflux System 5000 with $TcPO_2/CO_2$ unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain) of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field) was calculated. Results Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P<0.01), day 14 (P<0.001), and day 28 (P<0.001). The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094). Complete healing was achieved in every patient. Conclusions In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.539-544
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• 2017

Background We conducted this study to identify factors that may prolong the length of the hospital stay (LHS) in patients with diabetic foot (DF) in a single-institution setting. Methods In this single-center retrospective study, we evaluated a total of 164 patients with DF, and conducted an intergroup comparison of their baseline demographic and clinical characteristics, including sex, age, duration of diabetes, smoking status, body mass index, underlying comorbidities (e.g., hypertension or diabetic nephropathy), wound characteristics, type of surgery, the total medical cost, white blood cell (WBC) count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate, and albumin, protein, glycated hemoglobin, and 7-day mean blood glucose (BG) levels. Results Pearson correlation analysis showed that an LHS of >5 weeks had a significant positive correlation with the severity of the wound (r=0.647), WBC count (r=0.571), CRP levels (r=0.390), DN (r=0.020), and 7-day mean BG levels (r=0.120) (P<0.05). In multiple regression analysis, an LHS of >5 weeks had a significant positive correlation with the severity of the wound (odds ratio [OR]=3.297; 95% confidence interval [CI], 1.324-10.483; P=0.020), WBC count (OR=1.423; 95% CI, 0.046.0-356; P=0.000), CRP levels (OR=1.079; 95% CI, 1.015-1.147; P=0.014), albumin levels (OR=0.263; 95% CI, 0.113.3-673; P=0.007), and 7-day mean BG levels (OR=1.018; 95% CI, 1.001-1.035; P=0.020). Conclusions Surgeons should consider the factors associated with a prolonged LHS in the early management of patients with DF. Moreover, this should also be accompanied by a multidisciplinary approach to reducing the LHS.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.135-139
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• 2020

Background This study aimed to determine the magnitude of volume reduction of the latissimus dorsi (LD) muscle after treatment using only postoperative radiotherapy (PORTx) in patients who underwent immediate breast reconstruction using an extended LD musculocutaneous (eLDMC) flap after partial mastectomy. Methods We retrospectively reviewed 28 patients who underwent partial mastectomy and an eLDMC flap, received only PORTx, and underwent chest computed tomography (CT) 7 to 10 days after surgery and 18±4 months after the end of radiotherapy, from March 2011 to June 2016. The motor nerve to the LD was resected in all patients. One plastic surgeon performed the procedures, and the follow-up period was at least 36 months (mean, 46.6 months). The author obtained LD measurements from axial CT views, and the measurements were verified by an experienced radiologist. The threshold for statistical significance was set at P<0.05. Results A statistically significant decrease in the LD volume was found after the end of PORTx (range, 61.19%-80.82%; mean, 69.04%) in comparison to the measurements obtained 7 to 10 days postoperatively (P<0.05). All cases were observed clinically for over 3 years. Conclusions The size of an eLDMC flap should be determined considering an average LD reduction of 69% after PORTx. Particular care should be taken in determining the size of an eLDMC flap if the LD is thick or if it occupies a large portion of the flap.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.126-134
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• 2020

Background Pectus excavatum is less common in females than in males, and it often aggravates a coexistent breast asymmetry. We conducted a study comparing female patients' versus medical professionals' evaluation of pectus excavatum repair to assess differences in aesthetic outcome ratings. Moreover, we evaluated the influence of surgical correction on patients' self-perception. Methods Of 30 female patients who were initially screened, 18 patients (mean age, 20 years) who underwent bar removal after surgical correction of pectus excavatum deformity participated in the survey (60%). They completed a questionnaire rating their appearance before and after surgery and responded to a psychological questionnaire about the changes that they had experienced. The mean interval between pectus bar removal and evaluation was 28 months. Standardized preoperative and postoperative patient photographs were evaluated using the same questionnaire by a panel of medical professionals and students (n=24) and the results were compared. Results Patients rated their preoperative deformity as more severe than the other evaluators, revealing the significant impact of the deformity on patients' self-perception. Postoperatively, patient and professional evaluations were much better than before and were very similar. The psychological evaluation showed a clear improvement in well-being. The ratings of the medical professionals were not influenced by their degree of medical education. Conclusions Surgical correction of pectus excavatum in female patients positively influences body perception and psychological well-being. It should therefore not be considered as a merely aesthetic correction, but as an important procedure to restore a patient's self-perception.

• 접착 및 계면
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• 제14권1호
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• pp.1-12
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• 2013

Core 입자로 methyl methacrylate (MMA), ethyl methacrylate (EMA)를 사용하고 shell 입자로 MMA, EMA, 2-hydroxyl ethyl methacrylate (2-HEMA), glycidyl methacrylate (GMA) 및 methacrylic acid (MAA)를 각각 사용하여 개시제 ammonium persulfate (APS), 유화제로 sodium dodecyl benzene sulfonate (SDBS)의 농도(0.01~0.03 wt%), 단량체의 종류와 조성을 변화시켜 수용성 유화중합으로 다중 core-shell복합입자를 제조하여 전환율, 입자경 및 입도분포, 평균분자량, 분자구조, 유리전이온도, 플라즈마 처리후의 접촉각, 등온열분해속도 및 인장강도를 각각 측정하여 다음과 같은 결론을 얻었다. SDBS 농도 0.02 wt%에서 MMA core-(EMA/GMA) shell 복합입자의 전환율이 98.5%로 우수하였고, 입자직경은 SDBS 농도 0.03 wt%에서 EMA core-(MMA/GMA) shell의 복합입자가 $0.48{\mu}m$로 높게 나왔다. 유리전이온도 측정으로부터 공중합체는 1~2개의 전이곡선 그리고 다중 core-shell 복합입자는 3개의 전이곡선을 얻었다. 전체적으로 접착박리강도의 크기는 shell 단량체가 MMA core인 경우 EMA/MAA > EMA/2-HEMA > EMA/GMA의 순으로 되었다.

• Elastomers and Composites
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• 제38권4호
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• pp.303-315
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• 2003

계면활성제가 흡착된 $CaCO_3$를 제조하여 흡착된 유화제의 농도, 개시제의 종류와 농도, 교반속도 및 반응온도에 따라 무기/유기계 core-shell 입자를 제조하였다. 제조된 복합입자의 전환율을 측정하여 중합의 최적조건과 분자량측정, 가수분해도, 필름형성온도, 유리전이온도, 입자경 측정 그리고 입자의 형태를 고찰하여 다음과 같은 결론을 얻었다. 무기/유기 core-shell 입자의 합성의 경우에는 유화제인 SDBS를 0.5 wt% 첨가한 $CaCO_3$를 core로 하여 MMA와 $3.16{\times}10^{-3}mol/L$ 농도의 APS를 단계적으로 주입하여 중합함으로서 $CaCO_3$ 입자 표면에서 MMA의 중합을 잘 유도할 수 있었으며 중합 도중 새로운 폴리머 입자의 생성이 적었다. 무기/유기계의 core-shell 입자의 경우는 염산에 의한 $CaCO_3$ 분해를 이용하여 캡슐화를 조사하고 시차주사열량계(DSC)에 의한 유리전이온도와 열분해 감소중량을 측정한 결과 외부의 유기 폴리머만 분해되는 특성, 에폭시 수지에서의 분산이 캡슐화 되지 않은 $CaCO_3$보다 우수한 특성, 입자경 분포도 측정 결과 입자경 분포도가 고르지 않고 그리고 전자 현미경에 의한 입자모양이 구형화된 특성등으로 core-shell 입자의 구조와 특성을 확인하였다.