• Archives of Plastic Surgery
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• v.50 no.6
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• pp.586-592
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• 2023

Background One-stage reconstruction with "thin perforator flaps" has been attempted to salvage limbs and restore function. The deep inferior epigastric perforator (DIEP) flap is a commonly utilized flap in breast reconstruction (BR). The purpose of this study is to present the versatility of DIEP flaps for the reconstruction of large defects of the extremities. Methods Patients with large tissue defects on extremities who were treated with thin DIEP flaps from January 2016 to January 2018 were included. They were minimally followed up for 36 months. We analyzed the etiology and location of the soft tissue defect, flap design, anastomosis type, outcome, and complications. We also considered the technical differences in the DIEP flap between breast and extremity reconstruction. Results Overall, six free DIEP flaps were included in the study. The flap size ranged from 15 × 12 to 30 × 16 cm². All flaps were transversely designed similar to a traditional BR design. Three flaps were elevated with two perforators. Primary closure of the donor site was possible in all cases. Five flaps survived with no complications. However, partial necrosis occurred in one flap. Conclusion A DIEP flap is not the first choice for soft tissue defects, but it should be considered for one-stage reconstruction of large defects when the circulation zone of the DIEP flap is considered. In addition, this flap has many advantages over other flaps such as provision of the largest skin paddle, low donor site morbidity with a concealed scar, versatile supercharging technique, and a long pedicle.

• Anatomy and Cell Biology
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• v.57 no.1
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• pp.13-17
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• 2024

Masseter are commonly botulinum neurotoxin targeted muscle for facial contouring in aesthetic field. However, paradoxical masseteric bulging is common adverse effect that has not been discussed with ultrasonographic observations. Retrospective study has been conducted from October, 2021 to January, 2023, out of 324 patients have done blinded botulinum neurotoxin injection in the masseter at the middle and lower portion of the masseter with each side of 25 units (letibotulinum neurotoxin type A), 3 patients demonstrated paradoxical masseteric bulging has been reported and the image observed by ultrasonography by physician. Based on the observations made, we can infer that the function of the moving muscle involves twisting of the muscle fibers during contraction, along with the twisting of the deep inferior tendon, which causes the muscle to be divided into anterior and posterior compartments rather than into superficial and deep compartments of masseter. In ultrasonographic observe the skin surface of a patient with paradoxical masseteric bulging, it is observable that either the anterior or posterior part contracts significantly. The functional units of anterior and posterior compartment are observable as muscular contraction of inward movement of the muscle from either the anterior or posterior functional unit.

• Journal of radiological science and technology
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• v.31 no.3
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• pp.223-228
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• 2008

The most critical point in the medical use of radiation is to minimize the patient's entrance dose while maintaining the diagnostic function. Low-energy photons (long wave X-ray) among diagnostic X-rays are unnecessary because they are mostly absorbed and contribute the increase of patient's entrance dose. The most effective method to eliminate the low-energy photons is to use the filtering plate. The experiments were performed by observing the image quality. The skin entrance dose was 0.3 mmCu (copper) filter. A total of 80 images were prepared as two sets of 40 cuts. In the first set (of 40 cuts), 20 cuts were prepared for the non-filter set and another 20 cuts for the Cu filter of signal + noise image set. In the second set of 40 cuts, 20 cuts were prepared for the non-filter set and another 20 cuts for the Cu filter of non-signal image (noisy image) with random location of diameter 4 mm and 3 mm thickness of acryl disc for ROC signal at the chest phantom. P(S/s) and P(S/n) were calculated and the ROC curve was described in terms of sensitivity and specificity. Accuracy were evaluated after reading by five radiologists. The number of optically observable lesions was counted through ANSI chest phantom and contrast-detail phantom by recommendation of AAPM when non-filter or Cu filter was used, and the skin entrance dose was also measured for both conditions. As the result of the study, when the Cu filter was applied, favorable outcomes were observed on, the ROC Curve was located on the upper left area, sensitivity, accuracy and the number of CD phantom lesions were reasonable. Furthermore, if skin entrance dose was reduced, the use of additional filtration may be required to be considered in many other cases.

• Journal of the Korean Applied Science and Technology
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• v.33 no.1
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• pp.143-154
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• 2016

This study is related to develop a snail extract through a snail secondary fermentation process, getting anti-aging activity with healthy and beauty skin care scientific applications. In order to obtain a primary fermentation was incubated with Hericium erinaceus mycelium. Through the secondary fermentation process using Leuconostoc mesenteroides, was deeply described a total process of obtaining second fermented extract using snail body. Mycelium is applied in this study was extracted using Hericium erinaceus mycelium and Leuconostoc mesenteroides. The final yield of the extract was 62 wt%. Experimental results of secondary fermentation snail extract were contained with 32 wt% water, 31.5 wt% total amino acid protein, 15.7 wt% polysaccharide, 12.3 wt% fatty acid and others 8.5 wt%. In addition, in order to study about skin beauty care and anti-aging activity, we evaluated antioxidant activity with DPPH, elastin enzyme (elastase) inhibitory activity, tyrosinase inhibition rate, collagen synthetic function, fibroblast synthetic activity. First; anti-oxidative activity of secondary fermentation snail extract (IC50%) was spent with 7.27 mg/mL, control samples were spent with green tea extract was 11.8 mg/mL, common snails extract was 15.7 mg/mL, DL-a-tocopherol was 9.25 mg/mL respectively. Second; elastin enzyme inhibitory activity of secondary fermentation snail extract (IC50%) was spent with 32.5 mg/mL, control samples were also spent with green tea extract was 45.9 mg/mL, general snail extract was 67.7 mg/mL. Third; tyrosinase inhibitory activity of secondary fermentation snail extract (IC50%) was spent with 140.3 mg/mL, control samples were also spent with green tea extract was 250.7 mg/mL, general snails extract was 389.5 mg/mL, niacineamide was 125.9 mg/mL. Forth; fibroblast synthetic activity of secondary fermentation snail extract was increased with 125.6%, control samples were also spent with green tea extract was 98.9%, general snails extract was 109.5%, niacineamide was 125.9 mg/mL, DL-a-tocopherol was 96.2%. Fifth; collagen synthetic activity of secondary fermentation snail extract was increased with 118%, control samples were also spent with green tea extract was 87.3%, general snails extract was 93.2%, adenosine was 127.9%. In conclusion, on the basis of this study, in the future it is expected to be applied to the skin beauty care application and development of Korean style cosmetic products.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.738-743
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• 2009

Background: There is no standardized tool and parameter that can accurately assess the sympathetic function before and after performing sympathectomy in patients with primary palmar hyperhidrosis. We examined the effective-ness of the sympathetic skin response (SSR) study for documenting the change of sympathetic denervation before and after performing selective thoracic sympathicotomy. Material and Method: We prospectively investigated the SSR from 12 healthy subjects who were diagnosed with primary hyperhidrosis. Each SSR was recorded on the right palm or sole with electrical stimuli applied to the skin at the left wrist and foot and vice versa for the controlateral side. This test was performed before, 2 weeks and 1 year after selective thoracic sympathicotomy. The data was corrected for the onset latency and the amplitude of the SSR (n=24). Result: The mean age of the 12 patients was $24.6{\pm}0.4$ years (range: 19~36) and the gender ratio was 1 : 0.7. The mean values of the preoperative, postoperative 2 weeks and postoperative 1 year onset latency and amplitude of the palmar side (n=24) were $1.46{\pm}0.24$ msec and $6,043{\pm}2,339{\mu}V$, $1.63{\pm}0.42$ msec and $823{\pm}638{\mu}V$, and $1.44{\pm}0.39$ msec and $2,412{\pm}1,546{\mu}V$, respectively. The mean values of the plantar side (n=38) were $1.83{\pm}0.42$ msec and $2,816{\pm}1,694{\mu}V$, $2.16{\pm}0.39$ msec and $1,445{\pm}1,281{\mu}V$ and $1.95{\pm}0.25$ msec and $1,622{\pm}865{\mu}V$, respectively. Among the documented parameters, only the palmar amplitude (p=0.002) showed statistical significance in recording the change of the sympathetic system within the same individual for the pre and postoperative period. Conclusion: The SSR amplitude ratio may be a useful parameter for documenting the efficacy of sympathetic denervation after selective sympathicotomy.

• Journal of Applied Biological Chemistry
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• v.64 no.2
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• pp.185-192
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• 2021

Psoriasis is a chronic intractable skin disease caused by various inflammatory cytokines such as IL-6, CXCL8, TNF-α, and IFN-γ, as well as IL-17A secreted from Th17 cells and is characterized by hyperkeratosis and chronic inflammation of the epidermis. Brazilin, an active ingredient of Caesalpinia sappan L., is known to exert antioxidant and anti-inflammatory activity, and function in skin barrier improvement. In particular, it was shown as a potential material for treating psoriasis in a tumor necrosis factor (TNF)-α-stimulated HaCaT keratinocyte model. However, the direct regulation of the C-C motif chemokine ligand (CCL) 20, a psoriasis-inducing factor, by brazilin has not been reported. Therefore, in this study, we investigated the suppression of CCL20 and the regulatory mechanism by brazilin using a psoriasis-like model. First, brazilin downregulated CCL20 and CXCL8 in IL-17A-stimulated HaCaT cells in a concentration-dependent manner by inhibiting signal transducer and transcription (STAT)3 phosphorylation. In addition, brazilin significantly inhibited the expression of psoriasis-related genes CXCL8, CCL20, IL-1, IL-6, and TNF-α in TNF-α/IL-17A/IFN-γ-stimulated HaCaT cells. Moreover, brazilin also had a positive effect on improving the skin barrier in TNF-α/IL-17A/IFN-γ-stimulated HaCaT cells. The above results indicated that brazilin ultimately downregulated CCL20 expression by inhibiting STAT3 phosphorylation, and also suppressed the expression of psoriasis-induced cytokines. If the efficacy of brazilin in improving psoriasis is verified through animal models and clinical trials in the future, it may represent a potentially therapeutic substance for psoriasis patients.

• Journal of Society of Preventive Korean Medicine
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• v.16 no.1
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• pp.43-56
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• 2012

Objective : In this study, we assessed the anti-bacterial effects and epidermal permeability barrier function of red onion juice comparing to yellow onion juice and $Houttuynia$ $cordata$ extract $in$ $vitro$. Methods : 3types of red and yellow onion juice were prepared as antibacterial agent candidates with Houttuynia cordata hot water extract using 4 different bacterial strains ($Escherichia$ $coil$, $Salmonella$ $enterica$ $subsp.$ $enterica$, $Staphylococcus$ $epidermidis$, $Staphylococcus$ $aureus$ $subsp$) by colony counting method. The expression of filaggrin, a marker of keratinocyte differentiation, and serine palmitoyl transferase (SPT), a marker of the formation of the stratum corneum lipid barrier, in human HaCat keratinocytes were analyzed using HaCaT cell line. The expression of COX-2 and AP-1 which is a factor of COX-2 transcription were also analyzed by western blotting method. Results : There was detectable anti-bacterial effects on $Staphylococcus$ $epidermidis$, $Staphylococcus$ $aureus$ $subsp$ among 1%, 5%, 10% extracts of yellow and red onion.(81%-100%) The bacteriocidal effects were not shown on $Escherichia$ $coil$, $Salmonella$ $enterica$ $subsp.$ $enterica$ among $Houttuynia$ $cordata$, yellow onion and red onion extracts. The in vitro results showed the concentration-dependent effects on the expression of both filaggrin and SPT in HaCat cells among 0.01%, 0.05%, 0.1%, 0.5% extracts in Houttuynia cordata and red onion, reflecting the notion that $Houttuynia$ $cordata$ and red onion can induce epidermal keratinocyte differentiation and improve the recovery of skin barrier functions. The concentration-dependent effects also have been shown on the expression of both COX-2 and AP-1 among 0.01%, 0.05%, 0.1%, 0.5% extracts in $Houttuynia$ $cordata$ and red onion, while slight effect in yellow onion. Conclusion : Red onion juice could be a potential candidate enhanser for the skin care and cosmetology.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.1
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• pp.83-91
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• 2008

The goal of reconstruction following ablative therapy for intraoral cancer is the restoration of form and function to permit a return to activities of daily life. Traditional reconstruction includes split thickness skin grafts, myocutaneous flaps and, more recently, various free flaps. Free flaps provide higher level of functional recovery relative to that seen with other techniques but require the complexity of the technique and microvascular anastomosis and thus, extended surgical time and occasionally a second team for harvesting. The platysma myocutaneous cervical flap is a possible alternative for intraoral reconstruction. It is thin and pliable like the tissue provided by the radial forearm free flap. It can be harvested with enough tissue to close most head and neck ablative defects. There is virtually no donor site morbidity involved. This study evaluated 7 patients affected by intraoral squamous cell carcinoma (SCC). All patients underwent the resection of intraoral SCC with neck dissection and subsequent intraoral reconstruction with the superiorly based platysma myocutaneous cervical flap. Flap-related complications occurred in 3 patients. Adjuvant radiation therapy was performed in 3 patients. Average follow-up was 24.1 months after surgery, with a range of 8 to 42 months. All patients presented self assessment of discomfort associated with intraoral recipient sites and cervical donor sites. However, the neck function measured by two-inclinometer technique was within the normal range during relatively long term follow-up period. Our study concluded that superiorly based platysma myocutaneous cervical flap is good alternative to free flaps, especially for relatively smaller defects and for the defects appropriate for the rotation arc of the flap.

• Journal of Life Science
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• v.24 no.5
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• pp.588-593
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• 2014

Tumor angiogenesis is important in tumorigenesis and therapeutic interventions in cancer. To know inhibitor and effector of tumor angiogenesis in cancer, the specific gene of tumor and angiogenesis may develop the mechanisms of cancer suppression and therapy. Recently, we described the role of RalA-binding protein 1 (RLIP76) in tumor angiogenesis. Tumor vascular volumes were diminished, and vessels were fewer in number, shorter, and narrower in RLIP76 knockout mice than in wild-type mice. Moreover, angiogenesis in basement membrane matrix plugs was blunted in the knockout mice in the absence of tumor cells, with endothelial cells isolated from the lungs of these animals exhibiting defects in migration, proliferation, and cord formation in vitro. RLIP76 is expressed in most human tissues and is overexpressed in many tumor types. In addition, the protein regulates tumorigenesis and angiogenesis in vivo and in vitro. As the export of chemotherapy agents is a prominent cellular function of RLIP76, it is a major factor in mechanisms of drug resistance. Moreover, RLIP76 acts as a selective effector of the small GTPase, R-Ras, and regulates R-Ras signaling, leading to cell spreading and migration. Furthermore, in skin carcinogenesis, RLIP76 knockout mice are resistant, with tumors that form showing diminished angiogenesis. Thus, RLIP76 is required for efficient endothelial cell function and angiogenesis in solid tumors.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.712-716
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• 2010

Purpose: Extensive lumbosacral defects after removal of spinal tumors have a high risk of wound healing problems. Therefore it is an effective reconstructive strategy to provide preemptive soft tissue coverage at the time of initial spinal surgery, especially when there is an instrument exposure. For soft tissue reconstruction of a lumbosacral defect, a variation of the gluteal flap is the first-line choice. However, the musculocutaneous flap or muscle flap that is conventionally used, has many disadvantages. It damages gluteus muscle and causes functional disturbance in ambulation, has a short pedicle which limits areas of coverage, and can damage perforators, limiting further surgery that is usually necessary in spinal tumor patients. In this article, we present the superior gluteal artery perforator turn-over flap that reconstructs complex lumbosacral defects successfully, especially one that has instrument exposure, without damaging the ambulatory function of the patient. Methods: A 67 year old man presented with sacral sarcoma. Sacralectomy with L5 corpectomy was performed and resulted in a $15{\times}8\;cm$ sized complex soft tissue defect in the lumbosacral area. There was no defect in the skin. Sacral stabilization with alloplastic fibular bone graft and reconstruction plate was done and the instruments were exposed through the wound. A $18{\times}8\;cm$ sized superior gluteal artery perforator flap was designed based on the superior gluteal artery perforator and deepithelized. It was turned over 180 degrees into the lumbosacral dead space. Soft tissue from both sides of the wound was approximated over the flap and this provided in double padding over the instrument. Results: No complications such as hematoma, flap necrosis, or infection occurred. Until three months after the resection, functional disturbances in walking were not observed. The postoperative magnetic resonance imaging scan shows the flap volume was well maintained over the instrument. Conclusion: This superior gluteal artery perforator turn-over flap, a modification of the conventional superior gluteal artery perforator flap, is a simple method that enabled the successful reconstruction of a lumbosacral defect with instrument exposure without affecting ambulatory function.