• Clinics in Shoulder and Elbow
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• v.24 no.3
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• pp.183-188
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• 2021

We report a case of a 69-year-old right-dominant man who had an open Monteggia-like lesion of the right elbow (Gustilo-Andersen IIIA) with severe proximal ulna bone loss associated with an ipsilateral ulnar shaft fracture due to a motorcycle accident. The patient underwent two-stage surgery. Wound debridement and bridging external fixation were performed at first. Three months later, a frozen massive osteochondral ulnar allograft was implanted and fixed with a locking compression plate. A superficial wound infection appeared 5 weeks after the second surgery. Superficial wound debridement, negative pressure therapy, and antibiotics were administered for 3 months, achieving infection healing. At 3 years post-surgery, the elbow range of motion was satisfactory with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 16.7. Radiographs and computed tomography scans showed good allograft-bone integration without allograft reabsorption or hardware loosening. Although not complication-free, massive ulna osteochondral allograft implantation can be considered a valid option in cases of open Monteggia-like lesions associated with ulnar shaft fracture and severe bone loss in active patients, whenever osteosynthesis or joint replacement is not a proper solution. This type of bone stock restoration allows for future surgery, if needed.

• KSBB Journal
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• v.23 no.1
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• pp.8-17
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• 2008

There are many different approaches to healing of acute and chronic ulcer and large skin defect, such as burn. Currently available wound covers fall into two categories. Permanent covering, such as autografts, and temporary ones, such as allograft including de-epidermized cadaver skin, bioartificial skin, xenografts, and synthetic dressings. Autologous skin grafting in the form of split- or full-thickness skin is still the good standard. Following on from developments in the 1980s involving the use of cultured keratinocyte grafts in wound healing, the last decade has been great progress in the fabrication of composite bioartificial skin grafts. However, two bottleneck on producing cultured bioartificial skin, whether of the simple epithelial cell sheet type, or the more complex composite type, continue to be the generation of sufficient keratinocytes cheaply and quickly and develop biocompatible dermal scaffolds. This article covers the development, clinical application, and current research directions associated with bioartificial skin.

• Proceedings of the PSK Conference
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• 2003.10b
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• pp.226.2-226.2
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• 2003

.The healing of a bone defect is complex, and involves a wide range of cellular, molecular, physiological, and biological processes. The main effect of bone substitute is to promote wound healing by induce cell proliferation. Bone defect sites usually are localized below the original bone surface; therefore, space production and maintenance between the membrane and the original bone surface is essential. As a result, membranes must have proper mechanical strength to prevent the collapse of the soft tissue and maintain wound space that permits membranes of poly (L-lactide) (PLLA) were fabricated to provide and maintain sufficient space for bone growth. (omitted)

• Archives of Plastic Surgery
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• v.39 no.2
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• pp.130-136
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• 2012

Background : Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner. Methods : A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study. Results : We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from $4{\times}9cm$ ($36cm^2$) to $15{\times}30cm$ ($450cm^2$) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was $102^{\circ}$ (range, $45^{\circ}$ to $140^{\circ}$). Conclusions : In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.

• Journal of Chest Surgery
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• v.49 no.5
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• pp.366-373
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• 2016

Background: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. Methods: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (${\geq}$3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion. Results: Follow-up was 100% complete (mean $85{\pm}24months$). CWPM was inversely correlated with single lung VC (Spearman R=-0.72, p=0.0003), global VC (R=-0.51, p=0.02) and diaphragm excursion (R=-0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC. Conclusion: Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea.

• Proceedings of the Korean Institute of Electrical and Electronic Material Engineers Conference
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• 2000.07a
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• pp.152-155
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• 2000

PWM inverter-fed traction motor is able to occur problems by additive transient surge stress and harmonic loss in contrast with motor driven by 60Hz sine wave alternating source. Therefore in this paper, test method and standard of existed already were investigate, "thermal + electric" complex degradation test that considered additive degradation occurred by inverter drive carried out in order to obtain insulation reliability of traction motor driven by inverter. It seems that this test method confers large value of application at reliability estimation which the subject of complete motor not windings sample from now on.

• Proceedings of the Korean Society of Plant Pathology Conference
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• 1995.06b
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• pp.55-75
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• 1995

Induction of HMG-Co A reductase (HMGR) is essential for the biosynthesis of sesquiterpenoid phytoalexins and steroid derivatives in Solanaceous plants following wounding and pathogen infection. To better understand this complex step in stress-responsive isoprenoid synthesis, three classes of cDNAs for HMGR (hmg1, hmg2, and hmg3) were isolated from a potato tuber library. The potato cDNAs had extensive homology in open reading frames but had low homology in the 3'-untranslated regions. RNA gel blot analysis using gene-specific probes revealed that hmg1 is induced by wounding but wound induction is strongly suppressed by arachidonic acid or by inoculation with Phytophthora infestants. In contrast, hmg2 and hmg3 are slightly induced by wounding and strongly enhanced by arachidonic acid or inoculation. The induction and suppression of HMGR genes parallel the suppression of steroid and stimulation of sesquiterpenoid accumulations observed in earlier investigations. Treatment of the tuber disks with a low concentration of methyl-jasmonate doubled the wound induced accumulation of hmg1 transcripts and steroid-glycoalkaloid accumulation, but did not affect the abundance of transcripts for hmg2 or hmg3 nor induce phytoalexins. High concentration of methyl-jasmonate suppressed hmg1 mRNA and steroid-glycoalkaloid accumulation, induced hmg3 mRNA, and did not elicit phytoalexins. Lipoxygenase inhibitors suppressed the accumulation of of hmg1 transcripts and steroid-glycoalkaloids, which were restored by exogeneous methyl-jasmonate. Methyl-jasmonate applied together with arachidonic acid enhanced the elicitor induced accumulation of sesquiterpenes and sustained steroid-glycoalkaloid levels with transcript levels for the various HMGR mRNAs equal to or greater than wound-only treatment. These results domonstrate that the consequences of wound- and pathogen-responses of plants are different at the levels of gene expression and associated secondary metabolism.

• Journal of the Society of Cosmetic Scientists of Korea
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• v.26 no.1
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• pp.59-80
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• 2000

본 연구는 dermal equivalent를 이용하여 AHA류(lactic acid, glycolic acid, citric acid 및 malic acid) 및 보습 원료(sodium hyaluronate, glycerine, natural carbohydrate complex)에 대한 wound healing 효과 및 그 기작을 알아보기 위한 것이다. AHA류 및 보습 원료의 독성은 dermal equivalent를 이용하여 m assay를 실시한 후 적정 농도를 petri dish위에 조성한 dermal equivalent에 처리하였다. 그리고 wound healing 효과를 알아보기 위하여 collagen 수축률을 측정하였다. 또한 collagen 합성을 촉진하는 것으로 잘알려진 vitamin C도 함께 처리하였다. AHA류의 경우 평균 pH 2-3으로 매우 낮기 때문에 4N NaOH를 이용하여 pH를 6-7사이로 조절한 sample를 함께 실험하였다. 보습 원료의 경우 전반적으로 10% 이상의 높은 NR$_{50}$보여 주었다. 특히 sodium hyaluronate(1% stock solution)의 경우에는 16% NR$_{50}$를 보여 주었다. pH를 6-7로 조절한 AHA류의 경우에는 전반적으로 0.6% 내외의 NR$_{50}$를 보이는 가운데 lactic acid는 상대적으로 높은2% NR$_{50}$를 보여 주었다. Collagen 수축률 측정 실험 결과에서는 2% sodium hyaluronate(1% stock solution)가 대조군에 비하여 처리 후 2일째 25%내외의 향상된 수축률을 보여 주었다. pH를6-7로 조절한 AHA류 중 0.1%의 malic acid의 경우에서는 대조군에 비하여 처리 후 1일째 및 2일째 각각 28% 및 35%의 수축률을 보여 주었으며 pH를 6-7로 조절한 0.1% vitamin C에서도 유사한 결과를 보여 주었다. 반면에 pH를 6-7로 조절한 0.1% citric acid의 경우에는 10-20%의 낮은 수축률을 보여 주었다. MTT assay를 이용한 UV 조사 후 pH를 6-7로 조절한 AHA류의 repairing UV damage 효과에 대한 실험에서 0.1% 및 0.01%의 malic acid와 0.01% citric acid은 irradiation control에 비하여 약 10% 이상 세포수를 증가시켰다. 그러나 예외적으로 citric acid의 경우 0.1% 농도에서 오히려 20%내외로 세포수가 감소되는 경향을 보여주었다. 그리고 lactic acid 및 glycolic acid는 두드러지는 효과를 나타내지 않았다. Collagen 합성을 측정 실험에서는 pH를 6-7로 조절한 AHA류에서는 대조군에 비하여 상대적으로 12-19% 더 합성을 촉진하였다. 반면에 pH가 2-3인 AHA류의 경우에는 대조 군과 유사하거나 조금 낮은 합성율을 보여 주었다.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.599-606
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• 2021

Background Postoperative dehiscence and surgical site infection after spinal surgery can carry serious morbidity. Multidisciplinary involvement of plastic surgery is essential to minimizing morbidity and achieving definitive closure. However, a standardized approach is lacking. The aim of this study was to identify effective reconstructive interventions for the basis of an evidence-based management protocol. Methods A retrospective review was performed at a single tertiary institution for 45 patients who required 53 reconstruction procedures with plastic surgery for wounds secondary to spinal surgery from 2010 to 2019. Statistical analysis was performed for demographics, comorbidities, and treatment methods. Primary outcomes were postoperative complications, including dehiscence, seroma, and infection. The secondary outcome was time to healing. Results The overall complication rate was 32%, with dehiscence occurring in 17%, seroma in 15% and infection in 11% of cases. Median follow-up was 10 months (interquartile range, 4-23). Use of antibiotic beads did not affect rate of infection occurrence after wound closure (P=0.146). Use of incisional negative pressure wound therapy (iNPWT) was significant for reduced time to healing (P=0.001). Patients treated without iNPWT healed at median of 67.5 days while the patients who received iNPWT healed in 33 days. Demographics and comorbidities between these two groups were similar. Conclusions This data provides groundwork for an evidence-based approach to soft tissue reconstruction and management of dehiscence after spinal surgery. Timely involvement of plastic surgery in high-risk patients and utilization of evidence-based interventions such as iNPWT are essential for improving outcomes in this population.

• Archives of Plastic Surgery
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• v.46 no.4
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• pp.365-370
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• 2019

The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed-correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.