• Archives of Plastic Surgery
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• 제34권3호
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• pp.409-412
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• 2007

Purpose: Percutaneous Kirschner wire fixation is common method for hand fracture. It is simple but has risk of ascending infection through the pin and bony injury by multiple drilling. Ascending infection through pin tract is mostly superficial and can be treated with antibiotics and aseptic dressing. This is a case review of subacute osteomyelitis on phalangeal bones after Kirschner wire fixation with literature review. Methods: A 40-years-old man with distal phalangeal fracture on right second finger is presented. He went to a local clinic and had percutaneous Kirschner wire fixation under local anesthesia. He was transferred to our hospital for ulcerative wound on DIP joint at 4 weeks after operation. Radiography showed osteolytic change around medulla of middle and distal phalanges, leading to diagnosis of a subacute osteomyelitis. We treated it with amputation at the level of shaft of middle phalanx. Results: The postoperative course was uneventful. We thought several possible reasons for osteomyelitis in our case. First, it could resulted from ascending infection through the wire. Second, it could be resulted from a bony burn by repeated drilling. And bony necrosis could be a consequence of arterial insufficiency caused by 2 pin insertion. Conclusion: We suggest that a precise pinning based on accurate anatomical understanding is required for a percutaneous Kirschner wire fixation. The frequency of drilling should be minimized. Careful observation and patient education for pin site care are essential.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.564-569
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• 2013

Background Scalp defects may be caused by various etiological factors, and they represent a significant surgical and aesthetic concern. Various surgical techniques can be applied for reconstructive work such as primary closure, skin grafting, pedicled or free flaps. In this article, the authors share their clinical experience with scalp operations using the technique of local flaps and discuss the application of this method from the perspective of not only the size of the defect, but also in relation to the anatomical area, quality of surrounding tissue, and patient's condition. Methods During the period from December 2007 to December 2012, 13 patients with various scalp defects, aged 11 to 86 years, underwent reconstruction with local pedicle flaps. The indications were based on the patients' condition (age, sex, quality of surrounding tissue, and comorbidities) and wound parameters. Depending on the size of the defects, they were classified into three groups as follows: large, 20 to 50 $cm^2$; very large, 50 to 100 $cm^2$; extremely large, 100 $cm^2$. The location was defined as peripheral (frontal, temporal, occipital), central, or combined (more than one area). We performed reconstruction with 11 single transposition flaps and 1 bipedicle with a skin graft on the donor area, and 2 advancement flaps in 1 patient. Results In all of the patients, complete tissue coverage was achieved. The recovery was relatively quick, without hematoma, seroma, or infections. The flaps survived entirely. Conclusions Local flaps are widely used in scalp reconstruction since they provide healthy, stable, hair-bearing tissue and require a short healing time for the patients.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.227-239
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• 2022

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.108-114
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• 2022

Reconstruction of defects around the knee region requires thin and pliable skin. The superior lateral genicular artery (SLGA) flap provides an excellent alternative to muscle-based flaps. The anatomy and the surgical techniques of the SLGA flap were reviewed and the results of cases using the SLGA flap for coverage of knee and proximal leg defects were analyzed. SLGA flaps were performed in two cases and followed up for at least 6 months. Twelve articles on the use of the SLGA flap were also identified. A review of 39 cases showed that the mean diameter of the perforator supplying the skin of the flap was 1.04 mm, while the mean diameter of the SLGA at its origin was 1.78 mm. The mean length of the pedicle measured from the origin of the popliteal artery was 7.44 cm. The average dimensions of the flap were 14.8×6.6 cm with primary closure of the donor site in 61.5% of cases. Of these cases, 38.5% were due to trauma, 23.1% were post-burn complications, 12.8% were defects after resection of tumors, and 10.3% were for ulcers post-bursectomy. The most common complication was flap tip necrosis. All studies reported favorable outcomes with complete wound healing.

• Archives of Plastic Surgery
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• 제49권5호
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• pp.617-632
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• 2022

Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1-13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1-43%), 7% (95% CI < 1-34%) for dermal graft interposition, < 1% (95% CI < 1-37%) for radial forearm free flap, < 1% (95% CI < 1-52%) for ligation of the fistula, 17% (95% CI < 1-64%) for interposition of a deltopectoral flap, 9% (95% CI < 1-28%) for primary closure, and 2% (95% CI < 1-20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.315-324
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• 2023

Hemoglobinopathies such as sickle cell disease (SCD) are traditionally considered a relative contraindication to free tissue transfer, due to concerns that erythrocyte sickling will increase the risk of microvascular thrombosis and flap failure. This article describes a case report with the successful use of free tissue transfer in a patient with SCD and provides a systematic literature review on free tissue transfer in SCD. A retrospective chart review was performed of a patient with SCD who underwent free tissue transfer at the authors' institution. A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the keywords "free tissue transfer," "free flap," or "microsurgery" and "sickle cell" on PubMed, Ovid/Medline, and Scopus. A 29-year-old male with delayed presentation of an electrical burn to the face and scalp underwent wound closure with a free anterolateral thigh flap. Key management principles included red blood cell transfusion to keep hemoglobin S under 30% and hemoglobin greater than 10 g/dL, maintenance of hydration, normothermia, adequate analgesia, and postoperative anticoagulation. Systematic literature review identified 7 articles describing 13 cases of free tissue transfer in 10 patients with SCD, with combined complete free flap success in 10 of the 13 flaps. Free tissue transfer can be successfully performed in patients with SCD. However, evidence on the optimal management of this unique patient population in the perioperative period after free tissue transfer is limited to case reports in the literature.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권3호
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• pp.189-199
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• 2006

Purpose of study: Partial thickness skin graft is the golden standard regimen for full-thickness skin defect caused by burn or trauma. However, in case of extensive burns of more than 50% of total body surface area, the donor site is not sufficient to cover all defects. As a second choice, allograft, xenograft and synthetic materials have been used to treat skin defect. Among them the amniotic membrane(AM) was used as a biological dressing for centuries because of its potential for wound healing. In this study, quantification of EGF in AM and effect of AM-collagen complex on full thickness skin defects was examined. Materials & Methods: The concentration of EGF in fresh, deep frozen and freeze-dried AM was evaluated by ELISA. EGF-R immunostaining was performed in freeze-dried AM. SD rats weighing 250${\sim}$300g was used for wound healing experiment. Three full thickness skin defects(28mm diameter) were made on dorsal surface of SD rat. The control group was covered by Vaselin gauze and AM-collagen complex and $Terudermis^{(R)}$. was grafted in two other defects. Healing area, Cinamon's score were evaluated before biopsy. Grafted sites were retrieved at 3 days, 1 week, 2 weeks and 4 weeks after operation. H & E and Factor VIII immunohistochemical stain was performed to evaluate the microscopic adhesion and structural integrity and microvessel formation. Results: 1. EGF concentration of fresh, deep frozen and freeze-dried AM showed similar level and EGF-R was stained in epithelial layer of freeze-dried AM. 2. At 4 weeks after grafting, the healing area of AM-collagen and Terudermis group was 99.29${\pm}$0.71% and 99.19${\pm}$0.77 of original size. However, that of control group was 24.88${\pm}$2.90. 3. The Cinamon's score of AM-Collagen and $Terudermis^{(R)}$. group at 4 weeks was 15.6${\pm}$1.26 and 14.6${\pm}$3.13 and that of control group was 3.7${\pm}$0.95. Significant difference was observed among control and experimental groups(p<0.05). 4. Histologic examination revealed that AM protected leukocyte infiltration and epithelial migration was nearly completed at 4 weeks. $Terudermis^{(R)}$. group showed mild neutrophil infiltration until 2 weeks and completion of epithelization at 4 weeks. Control group showed massive leukocyte infiltration until 4 weeks. 5. Microvessels were increased sharply at 1 week and control group at 1 and 4 week showed significant differences with $Terudermis^{(R)}$. group of same interval(p<0.05) but no differences were found with AM group(p<0.05). Conclusion: EGF and EGF-R were well preserved in freeze-dried AM. AM attached to collagen acted as excellent biologic dressing which had similar effect with $Terudermis^{(R)}$. AM showed anti-inflammatory action and healing was completed at 4 weeks after full-thickness skin defect.

• 한국식품영양과학회지
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• 제24권6호
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• pp.1026-1038
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• 1995

Aloe식물에서 만든 전통적 aloe는 현대 임상 의약분 야에서 이전의 인기를 거의 잃고 있지만 aloe gel은 그 간 그의 효능 즉 여려가지 치료작용과 대사에 대한 유익한 tonic 효과를 밝히려는 수많은 연구자들에 의해서 꾸준히 gel의 치료 효능이 주장되어 온 반면에 상당수의 연구자들에 의한 상반된 연구 결과로 인해 aloe gel 효능에 대한 논쟁은 계속되고 있다. 그럼에도 불구하고 aloe gel을 원료로한 외용 또는 내용의 치료제와 화장품 그리고 특히 건강 식품들(general tonics)이 대중적 인기를 끌고 있다. 따라서 현재는 aloe gel 산업이 비교적 경제성을 크게 유지하는데 여기에는 일부 promotional works나 대중 매체의 영향도 일조 했으리라 본다(21). Gel의 유익한 생리작용을 내는 원인 물질에 관한 그간 많은 연구 보고에서 gel의 미량 성분들 중 salicylic acid의 진통 소염착용, Mg ion의 마취작용, Mg-lactate의 항 histamine작용, Aloctin A의 세포 성장 촉진에 의한 상처 치료작용, carboxypeptidase와 bradykinase에 의한 통증 감소와 소염작용이 여러 연구자들에 의해 제안되었으나 이들 생리작용이 현대 임상 약리학에서 거의 입증이 안되었고 지지를 지 못했다. Gel내 미량 anthraquinone 배당체(aloin)가 false substrate inhibitor작용에 기인한 항 prostanoid (항PG와 항TX) 효과에 의한 소염, 화상, 동상 상처 치료 작용을 낸다는 가설이 한 때 상당 기간 많은 연구자들에 의해 주장되었으나 이 제안도 증명되지 못했고 이제는 다른 연구자들의 다른 주장들에 의해 가려지고 있다. 또 gel의 항미생물, 항당뇨, 간해독 작용 등이 gel내 미량 anthraquinone 화합물의 작용에 기인할 것으로 제안되었다. 1980년 중반 부터 최근(1993년)에 이르기 까지 많은 연구자들에 의해 새로이 주장 되고 있는 gel의 생리작용은 주성분 다당류인 acetylglu-comannan과 acetylmannan 및 glycoprotein에 의한 면역 증진 내지 면역 조절작용에 의한 감염 상처 치료, 소염, 항미생물, 항암 작용이 계속 제안되고 있다. 저자는 acetylpolysacchride의 acetyl기가 in vivo에서 cyclooxy-genase를 억제하여 항 prostanoide 효과를 낼 것으로 가정해 본다. 이제는 acetylpolysacchride에 대한 여러 주장들이 임상적으로 증명되어 gel의 효력에 대한 논쟁에서 결론이 날 것으로 기대해 본다. Aloe gel의 다당류 acemannan의 실험 동물(개)에 대한 독성 실험 결과 복강내 주입에 의한 최저 부작용 유발량은 5.0mg/kg이었으나 aloe gel은 일반적으로 무독한 것으로 알려져 있다. 그러나 aloe gel의 임상 적용에서 가끔 과민 반응에 의한 부작용 사례 보고를 다수 볼 수 있고 실험적 연구에서도 입증되어 있으므로 aloe gel을 건강 식품으로 섭취하는 경우는 국소 적용시 유의해야 할 점이라 생각된다. 결국 aloe gel의 오랜 연구역사를 볼 때 어떤 생리작용의 기전에 의존한던 간에 aloe gel이 유익한 여러 효과를 낸다는 사실을 간단히 부정하기는 어려울 것 같다.울 것 같다.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.483-488
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• 2012

Background Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. Results The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. Conclusions In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

• 미생물학회지
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• 제44권2호
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• pp.85-92
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• 2008

Pseudomonas aeruginosa는 기회 감염성 병원균으로, Cystic fibrosis, 미생물 감염성 각막염,화상 부위 2차 감염 등의 다양한 질병을 초래한다. 정족수 인식(쿼럼 센싱)이라고도 알려져 있는 세포간 신호전달 기전이 이러한 감염에서 중요한 역할을 하기 때문에 P. aeruginosa의 정족수 인식 시스템들이 집중적으로 연구되어 왔다. P. aeruginosa의 정족수 인식 시스템들을 소개하는 많은 문헌들이 주로 두 개의 주요 acyl-homoserine lactone (AHL) 계열 정족수 신호물질들인 N-3-oxododecanoyl homoserine lactone (3OC12)과 N-butanoyl homoserine lactone (C4)에 초점을 맞추어 설명하고 있지만, 실제로는 몇 가지 새로운 신호물질들이 발견되어져 왔고, 그들이 P. aeruginosa의 병독성과 신호전달에 중요한 역할을 할 수 있음이 제안되어져 왔다. 그 중 하나가 PQS(Pseudomonas quinolone signal; 2-heptyl-3-hydroxy-4-quinolone)인데, 이 물질은 현재 P. aeruginosa의 잘 규명된 주요 신호물질로 인식되고 있다. 이에 더하여, 최근의 연구들은 또 다른 가능성 있는 P. aeruginosa신호물질들을 제안해 왔는데, diketopiperazines (DKPs)과 pyocyanin이 그들이다. DKPs는 환형 dipeptide로써 이를 구성하는 아미노산의 종류에 따라 다양한 구조를 가진다. P. aeruginosa의 배양액에서 검출된 몇몇 DKPs들이 기존에는 AHL에만 특이적으로 반응한다고 알려졌던 Vibrio 랸�N갸 LuxR biosensor를 활성화 시킬 수 있다는 것이 발견되어 새로운 신호물질로 제안되었다. Pyocyanin (1-hydroxy-5-methyl-phenazine)은 P. aeruginosa가 생산하는 여러 phenazine 화합물들 중의 하나로써, 특징적인 청록색을 띄는 산화-환원 활성물질이다. 이 물질도 정체 성장기 동안 일부 정족수 인식의 조절을 받는 유전자들의 발현을 증가시키는 최종 신호 인자로 최근 제안되었으며, 그 신호는 또 다른 전사 조절 인자인 SoxR에 의해 매개된다고 제안되었다. 본 논문에서는 P. aeruginosa에서 새롭게 발견, 제안되고 있는 이들 신호 전달 물질들에 대해 자세히 다루어 보기로 한다.