• Environmental Engineering Research
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• v.9 no.1
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• pp.31-37
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• 2004

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.224-230
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• 2021

Background Little is known about the sensate recovery of skin grafts over free non-neurotized muscle flaps. The aim of this study was to evaluate the sensitivity of free gracilis muscle flaps and meshed skin grafts without nerve coaptation. Methods Thirteen consecutive patients with a median age of 55 years (range, 21-70 years) who underwent lower extremity reconstruction between September 2014 and October 2016 were included. Complications, flap contour, skin perception, and sensate recovery were assessed. Results All flaps survived completely. In one patient, wound dehiscence and infection occurred 1 month after surgery. After a median follow-up of 14 months (range, 10-51 months), a satisfactory contour and skin perception were achieved. The Semmes-Weinstein (SW) monofilament test (154.8±22 g) and static two-point discrimination (2-PD) (12.6±0.7 mm) showed intermediate recovery compared to the surrounding site (41% and 76%, respectively). There was an intermediate correlation between flap size and sensate recovery (2-PD: r=0.27, P=0.36; SW test: r=0.45, P=0.12). Vibration sensation recovered to 60%, whereas thermal sensation remained poor (19% at 5℃ and 25% at 25℃). Conclusions Finer sensation could be partially restored. However, thermal sensation remained poor.

• Structural Engineering and Mechanics
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• v.68 no.3
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• pp.299-312
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• 2018

In this paper, an extended finite element method is proposed to analyze both geometric and material non-linear behavior of general Functionally Graded Material (FGM) plate-shell type structures. A user defined subroutine (UMAT) is developed and implemented in Abaqus/Standard to study the elastoplastic behavior of the ceramic particle-reinforced metal-matrix FGM plates-shells. The standard quadrilateral 4-nodes shell element with three rotational and three translational degrees of freedom per node, S4, is extended in the present study, to deal with elasto-plastic analysis of geometrically non-linear FGM plate-shell structures. The elastoplastic material properties are assumed to vary smoothly through the thickness of the plate-shell type structures. The nonlinear approach is based on Mori-Tanaka model to underline micromechanics and locally determine the effective FGM properties and self-consistent method of Suquet for the homogenization of the stress-field. The elasto-plastic behavior of the ceramic/metal FGM is assumed to follow Ludwik hardening law. An incremental formulation of the elasto-plastic constitutive relation is developed to predict the tangent operator. In order to to highlight the effectiveness and the accuracy of the present finite element procedure, numerical examples of geometrically non-linear elastoplastic functionally graded plates and shells are presented. The effects of the geometrical parameters and the volume fraction index on nonlinear responses are performed.

• Archives of Plastic Surgery
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• v.34 no.5
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• pp.622-627
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• 2007

Purpose: Although the autogenous tissue transfer has been the mainstay of the breast reconstruction, concern for the donor site morbidity can lead to the superseded method using tissue expander with implant or permanent expander-implant. However, the additional procedure of tissue expansion possibly cause discomfort and raise the cost. We tried to verify the efficacy of using the saline-filled breast implant by itself for the safe and convenient immediate breast reconstruction modality if the patients have small, round and non-ptotic breasts and the sufficient breast skin can be saved with mastectomy. Methods: From July 2002 to July 2005, 29 breasts of 26 patients were restored only with the saline-filled breast implant immediately after the skin sparing or nipple-areolar skin sparing mastectomy in Asan Medical Center. A pocket with pectoralis major and serratus anterior muscle was created and the implant was covered with this muscle pocket. Simultaneous contralateral augmentation was performed in patients whose mastectomy specimen weighed less than 100g. Results: Using only the saline-filled breast implant resulted in the successful reconstruction with few complications including partial necrosis of nipple areolar skin (five cases, 17.2%), capsular contracture (three cases, 10.3%), hematoma (one case, 3.4%), depigmentation of areolar skin (one case, 3.4%), hypertrophic scar (one case, 3.4%), which were all healed by conservative management. There were no significant complications such as implant exposure and subsequent removal. Conclusion: Immediate breast reconstruction only with the saline-filled breast implant can be a satisfactory alternative option for the patients whose breast is small, round and non-ptotic, especially when the nipple-areolar skin of the breast is preserved in the mastectomy.

• Archives of Plastic Surgery
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• v.42 no.4
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• pp.391-406
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• 2015

Macrodystrophia lipomatosa (MDL) is a rare congenital non-hereditary disorder that has significant impact on patient morbidity. This study provides a comprehensive review of the natural history, diagnosis, management, and outcomes of the disorder. A literature search in PubMed was conducted to identify cases of MDL from January 1950 to 14 February 2014. After ruling out articles without information related to the management of the disorder, a summary of 32 studies was performed. An additional three cases from the authors are also presented. Based on 57 journal articles and three additional cases from the authors, around 108 cases of MDL were reviewed. Most patients were males who were admitted to a treatment clinic in the first four years of life. The lower extremities were more frequently affected, with unilateral presentation being most common. They commonly underwent a single-staged surgical procedure with follow-up periods ranging from more than one year up to 21 years. Out of 43 cases that underwent surgical procedures, 13 reported no complications, and there were seven cases of esthetic satisfaction and 15 cases of significant functional improvement. Depending on the severity of a patient's condition, the use of non-invasive diagnostic tools should be carefully considered. Surgery might be a better choice of management than observation, taking into account possible future complications in the absence of surgery and the beneficial outcomes of surgical procedures.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.248-254
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• 2008

Purpose: Human acellular dermal matrix(ADM) is widely used in the treatment of congenital anomalies and soft tissue deficiencies. But it is rapidly degraded in the body and does not provide satisfactory results. There is a need to improve collagen fiber stability through various methods and ultimately regulate the speed of degradation. Methods: The ADMs were added with various cross-linking agents called glutaraldehyde, dimethyl 3,3'-dithiobispropionimidate to produce cross-linked acellular dermal matrices. 1,4-butanediol diglycidyl ether solution was applied with a pH of 4.5 and 9.0, respectively. The stability of cross-linked dermal matrix was observed by measuring the shrinkage temperature and the degradation rates. The cross- and non-cross linked dermis were placed in the rat abdomen and obtained after 8, 12 and 16 weeks. Results: The shrinkage temperature significantly increased and the degradation rate significantly decreased, compared to the control(p<0.05). All of cross-linked dermises were observed grossly in 16 weeks, but most of non-cross linked dermis were absorbed in 8 weeks. Histologically, the control group ADM was found to have been infiltrated with fibroblasts and most of dermal stroma were transformed into the host collagen fibers. However, infiltration of fibroblasts in the experiment was insignificant and the original collagen structure was intact. Conclusion: Collagen cross-linking increases the structural stability and decreases degradation of acellular dermis. Therefore, decrease in body absorption and increase in duration can be expected.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.755-758
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• 2008

Purpose: In order to determine the amount of wound healing, objective sequential assessments of changes in wound size and depth are essential. Although a variety of measurements for wound healing have been proposed, a gold standard for quantifying day-to-day changes in healing has not been established. We present here a simple and non-invasive wound measurement method that quantitatively and accurately documents changes of the size of a raw surface and the volume of a soft tissue defect using a stereoimage optical topometer(SOT) system. Methods: Using a 5mm diameter biopsy punch, four circular wounds were created on abdominal area of a diabetic mouse. Photographs were taken using SOT system at baseline, 5th day and 10th postoperative day. The wound margin was traced on a digitalized photo and evaluated the area and the volume of the wound by SOT system. Results: The SOT system calculated a mean wound surface of $15.93{\pm}0.29mm^2$ and volume of $827.50{\pm}88.86$ intensity/pixel${\times}$area(I/PA) immediately after wounding. On the 5th day after the operation wound surface declined by $10.73mm^2$ and on the 10th day declined by $5.95mm^2$. The wound volume also declined from 827.50 I/PA to 161.75 I/PA and 30.50 I/PA on 0, 5th and 10th day, respectively. Conclusion: The SOT system described in this study represents a reliable, simple, practical, and non-invasive technique to accurately monitor and evaluate wound healing.

• Archives of Plastic Surgery
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• v.44 no.4
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• pp.313-318
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• 2017

Background Jeju Island is geographically and socioeconomically distinct from the mainland of South Korea. Thus, the presentation and management of non-melanocytic skin cancers (NMSC) of the head and neck may differ from those in other regions of the country. We compared the clinical characteristics and treatment modalities of NMSC on Jeju Island with the findings of similar regional studies. Methods Patient data, including age, sex, diagnosis, tumor site, treatment, and recurrence, were obtained from the medical and pathology records of patients diagnosed with NMSC between January 2010 and June 2015. Results In total, 190 patients (57 men) with a mean age of 75 years (range, 42-97) were assessed. Overall, 203 NMSCs were diagnosed, including 123 basal cell carcinomas and 80 squamous cell carcinomas. The tumor sites included the nose, cheeks, periorbital area, and lips (n=55, 54, 25, and 20, respectively). We identified 92 T1-stage and 60 T2-stage tumors, and 120 cases were treated with wide surgical resection and 17 cases were treated with radiation therapy at the medical center. Of the 120 cases treated surgically, 69 required reconstructive surgery using a local skin flap, 22 required full-thickness skin grafting, and 12 underwent primary closure. Basal and squamous cell carcinomas recurred in 2 and 1 cases, respectively. Conclusions Compared to the reports from other regions, the average patient age was 10 years higher, with a marked female preponderance. While the proportion of squamous cell carcinoma was higher than in other regions, the tumor distribution and surgical management profiles were similar.

• Archives of Plastic Surgery
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• v.42 no.2
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• pp.232-239
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• 2015

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.478-482
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• 2020

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has received increasing interest among plastic surgeons as a long-term complication of breast augmentation. Although the prognosis is usually good, mortality is a possible outcome. Most of the cases reported in the past two decades have been from the United States, Europe, and Australia, whereas cases of BIA-ALCL in Asia remain rare. Herein, we describe the first known case of BIA-ALCL in Thailand, in which a 32-year-old woman developed BIA-ALCL 3 years after breast augmentation using textured implants. The patient underwent bilateral removal of the implants and ipsilateral total capsulectomy. This case report-the first of its kind from Thailand-should increase awareness of BIA-ALCL among plastic surgeons in Asia. The true incidence of BIA-ALCL in Asia may be underreported.