• Journal of Korean Medicine Rehabilitation
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• v.24 no.3
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• pp.87-98
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• 2014

Objectives The present study aimed to investigate the effects of acupuncture and herbal external preparation on wound healing procedure in a deep partial thickness burn model in rats. Methods A total of 40 male Sprague-Dawley rats were allocated into four groups with an equal number in each group: acupuncture treatment group, herbal external perparation group, Silver sulfadiazine dressing group and control group. We describe the effect of acupuncture and herbal external preparation on morphologic and histologic changes, epithelial growth factor (EGF), hematological value of the deep partial thickness burn wound in rats. Results At 21th day after wounding the wound size in acupuncture treat group and herbal external preparation group were decreased more significantly compared to control group. In addition, epidermal regeneration on acupuncture treatment was than other treatment and control group in histological finding. Hematological findings revealed that acupuncture treatment group and herbal external prepartion group was more effective than control group in reducing inflammation response induced by burn. In acupuncture treated group, neutrophil and leukocyte level were significantly decreased compared to other treatment group. Also, this study showed that EGF was obviously expressed in nascent tissue when wounds were treated with the acupuncture and herbal external preparation after injury. In particular, acupuncture treatment group had a significant increase of EGF expression in burn wound healing area when compared with the other treatment groups. Conclusions These findings suggest that acupuncture and herbal external prepration may improve burn wound healing through decreasing inflammatory reaction, increasing tissue regeneration and expression of EGF. Moreover, acupuncture treatment could be more effective in comparison with Silver sulfadiazine dressing.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.578-582
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• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.521-526
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• 2008

Purpose: Most burn scar contractures are curable with skin grafts, but free flaps may be needed in some cases. Due to the adjacent tissue scarring, local flap is rarely used, and thus we may consider free flap which gives us more options than local flap. However, inappropriate performance of free flap may lead to unsatisfactory results despite technical complexity and enormous amount of effort. The author will discuss the points we should consider when using free flaps in treating burn scar contractures Methods: We surveyed patients who underwent free flaps to correct burn scar contractures from 2000 to 2007. We divided patients into two groups. The first group was those in which free flaps were inevitable due to exposure of deep structures such as bones and tendons. The second group was those in which free flap was used to minimize scar contracture and to achieve aesthetic result. Results: We performed 44 free flap on 42 patients. All of the flaps were taken well except one case of partial necrosis and wound dehiscence. Forearm free flap was the most common with 21 cases. Most of the cases(28 cases) in which free flaps were inevitable were on the wrist and lower limbs. These were cases of soft tissue defect due to wide and extensive burns. Free flaps were done in 16 cases to minimize scar contracture and to obtain aesthetic outcome, recipient sites were mostly face and upper extremities. Conclusion: When using free flaps for correction of burn scar contractures, proper release and full resurfacing of the contracture should be carried out in advance. If inadequate free flap is performed, secondary correction is more challenging than in skin grafts. In order to optimize the result of reconstruction, flap thickness, size and scar of the recipient site should be considered, then we can achieve natural shape, and minimize additional correction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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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.