• Archives of Plastic Surgery
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• v.33 no.5
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• pp.666-668
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• 2006

Purpose: Livedo vasculitis is recurrent painful ulceration of the feet, ankles and legs characterized by purpuric papules and plaques that undergo superficial necrosis and healing with residual white atrophic scars (atrophie blanche). The typical histopathologic findings of livedo vasculitis are characterized by endothelial proliferation and hyaline degeneration along with thrombosis of dermal vessels. Standard therapeutic strategies for treatment of livedo vasculitis are usually on the basis of rheologic, anti-inflammatory or immnosuppressive treatments, a aspirin, dipyridamole, glucocorticosteroids, pentoxyfylline, or high-dose intravenous immunoglobulin are often ineffective or partially effective. Methods: We report a case of 24-year-old male patient with livedo vasculitis on the ankles and dorsal surfaces of both feet. Results: The lesion that had been unresponsive to medical treatment were successfully healed with complete debridement and skin grafting without recurrences. Conclusion: Surgical treatment can be one of the therapeutic choice in Livedo vasculitis.

• Biomolecules & Therapeutics
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• v.27 no.2
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• pp.185-192
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• 2019

Coculture with adipose-derived stem cells (ADSCs) can stimulate proliferation and migration of melanocytes. To enhance outcomes of skin disorders caused by melanocyte loss or death, mixed transplantation with ADSCs has been suggested. However, role of cocultured ADSCs in proliferation and migration of melanocytes remains unclear. This study determined the effect of ADSCs on production of growth factors and expression levels of intergrins in primary culture of adult human melanocytes with or without ADSCs and in nude mice grafted with such melanocytes. Higher amounts of growth factors for melanocytes, such as bFGF and SCF were produced and released from ADSCs by coculturing with melanocytes. Relative levels of integrins ${\beta}1$, ${\alpha}5$, and ${\alpha}6$ as well as adhesion to fibronectin and laminin were increased in melanocytes cocultured with ADSCs. Such increases were inhibited by neutralization of bFGF or SCF. Relative levels of bFGF, SCF and integrins were increased in nude mice skin after grafting with melanocyte+ADSC cocultures. Collectively, these results indicate that ADSCs can stimulate proliferation and migration of melanocytes by increasing expression of integrins in melanocytes through upregulation of production/release of melanocyte growth factors such as bFGF and SCF.

• Journal of Trauma and Injury
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• v.37 no.2
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• pp.151-157
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• 2024

Electrical burn injuries can cause more damage than clinical evaluations initially suggest. The energy waves penetrate from the surface to the deepest layers of tissue, causing extensive harm at every level. The neck is a critical area, both functionally and aesthetically. We present a case involving a young male patient with a severe fourth-degree electrical burn on the neck, who underwent a single-stage debridement and reconstructive surgery. The pectoralis major myocutaneous flap is a versatile option for various head and neck reconstructions. However, if the donor site cannot be closed primarily and requires split-thickness skin grafting, it can result in unsightly scars and deformities. For large flap paddles, it is ideal to reconstruct the secondary defect with locoregional flaps. In this case, we successfully reconstructed the donor site's secondary defect using a contralateral internal mammary artery perforator flap, without resorting to any skin grafts. The early postoperative results demonstrated satisfactory cosmesis, patient satisfaction, and functional outcomes.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.2
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• pp.130-136
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• 1995

Vestibuloplasty are following categories : Mucosal advancement(submucous), secondary epithlization(reepithelization) and grafting vestibuloplasty. Although certain procedures are indicated for alveolar bone loss and sulcus shortening, relapse can occur. Every efforts to minimize or compensate for it is controversy. O'Steen(1970) reported the mucous graft methods that none of vestibular shrinkage and graft contracture. 15patients in mucous graft vestibuloplasty with fibrin adhesive system(Beriplast) were taken in cases of alveolar bone resorption and mucosal shortening due to traumatized alveolar bone defects, senile atrophic alveolar bone, postoperative cyst or tumor resection, edentulous alveolar bone loss, and others. A technique in the use of small piece of palatal mucosa$(1{\times}20mm)$ from the lateral aspect of the palate with adhesive system provided to secure the skin grafts, avoid stent fixation, postoperative patient's comfort and less time-consuming than the standard technique, especially excellent bleeding control.

• Journal of Trauma and Injury
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• v.36 no.1
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• pp.60-64
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• 2023

Upper extremity vascular injuries occurring with acute compartment syndrome are very challenging to manage in an emergency context in resource-poor settings. The need to always recognize the likelihood of coexisting compartment syndrome guides surgeons to perform concomitant fasciotomy to ensure a better outcome. We managed three vascular injuries in the upper extremities in two patients with concomitant imminent compartment syndrome observed intraoperatively. The first injury was complete brachial artery disruption following blunt trauma, while the second and third injuries were radial and ulnar artery transection caused by sharp glass cuts. Both patients were treated with vascular repair and fasciotomy. Secondary wound coverage was applied with split-thickness skin grafting, and the outcomes were satisfactory. Concomitant fasciotomy potentially improves the outcomes of vascular repair in emergency vascular surgery and should be considered for all injuries with the potential for acute compartment syndrome.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.21-27
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• 2002

Pressure sores are an ulceration and necrosis of the skin and underlying tissue usually occur after prolonged or repeated pressure by interruption of blood flow from the small. vessels to the skin and deep tissue. The management of pressure sores is mostly difficult and requires prolonged hospitalization or repeated surgical interventions with a high recurrence rate. In this article we reviewed 14 cases of National Pressure Ulcer Advisory Pannel staging III, IV over the lateral malleolar area of the ankle in 2 years period from January 1999 to October 2001. The pressure over lateral malleolar area was mainly due to unique Korean sitting position with cross legs at flexed hips and knees or supine position of patient with external rotation of low extremity. Male to female ratio was 11: 3 and ages were between 36 and 83 (mean age: 67.1 years). Associated diseases were DM(7 cases), Hemiparesis caused by CVA(2 cases), Liver cirrhosis(2 cases), disarticulation of opposite hip due to squamous cell ca.(1 case), Intertrochanteric Fx.(1 case). Wound cultures reported Staphylococus, Pseudomonas and others. Abnormally elevated ESR and CRP were seen in 6 cases. Operative treatments were irrigation and debridement, direct closure with gravity drainage and skin grafting. The most important aspect of pressure sore treatment is pressure relief of the lateral malleolar area. Pressure-relieving Cast or Brace was helpful for local management and preventing recurrence.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.352-357
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• 2007

Purpose: The coverage of distal soft tissue defects and bony exposure of the lower extremity has long been recognized to be difficult clinical problem. Covering with a local skin flap is usually impractical because of the extensive and deep crush, hence free flap has been used commonly for the coverage of the wound. Although it can provide good results, it has many disadvantages. Designing an adipofascial flap raised on perforating vessels of the posterior tibia artery is a reliable and simple method to perform, and it can solve these problems. Methods: From May 2005 to May 2006, 8 patients underwent reconstruction of lower leg defects utilizing various type of the posterior tibial artery perforator adipofascial flaps. The flap provided a durable and thin coverage for the defect, as well as a well vascularized bed for skin grafting. Results: The flap size ranged $15-80cm^2$, and skin graft was done for the recipient site. The flap were successfully used for the lower extremity reconstruction in most cases. Minor complications occurred in 4 cases. There was no functional disability of the donor site with esthetically pleasing results. Furthermore, these flaps were both easy to raise and insured sufficient arterial blood supply. Conclusion: We believe there are many advantages to this posterior tibial artery perforator adipofascial flap and that it can be highly competitive to the free flaps in the lower extremity reconstruction.

• Archives of Plastic Surgery
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• v.50 no.1
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• pp.106-115
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• 2023

Background Primary contraction of full-thickness graft has been traditionally quoted to be 40%. There are lacunae in literature to elaborate on the factors influencing it ever since. Methods About 75 subjects who underwent full-thickness grafting procedures to resurface small defects were included in the study. The initial and final graft dimensions after primary contraction were traced on X-ray templates and the percentage of contraction was evaluated using the graphical method. This was further correlated with age, collagen, elastic matrix metalloproteinases-1 (MMP-1) and -2 content along with dermal thickness of the skin specimen sent from the graft. Results The primary contraction of the graft had a very significant correlation only with the initial size of graft harvested with a linear regression of 33.3% and a Spearman's correlation of 0.587 significant at a p-value of 0.001. Conclusion This study though preliminary tries to highlight an important factor that primary contraction of grafts is a physical phenomenon independent of its contents like collagen, elastin, or MMP-1 and -2 or age and dependent on its initial size of harvest instead.

• Korean Journal of Veterinary Research
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• v.40 no.3
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• pp.497-504
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• 2000

To document that effects of hyperbaric oxygen(HBO) and ${\alpha}-tocopherol$ on full-thickness skin grafts in rat, we performed full-thickness skin grafts bilaterally on each rats. The HBO-treated rats were received HBO twice daily for 90 minutes at 2 ATA. Surgical control rats were not treated with HBO. ${\alpha}-tocopherol$ treated rats were received the agent via oral gastric tube daily for 3 days preoperative and a fourth dose 1 to 2 hours postoperative. HBO plus ${\alpha}-tocopherol$ treated rats were received HBO and ${\alpha}-tocopherol$ as mentioned above. Biopsy specimens were taken from each rat at the time of grafting and on days 2, 4, 7, 10, 14, 21, and 28, then were processed for tissue-concentration of total glutathione(GSHt), oxidized/reduced glutathione level, and thiobarbituric acid-reactive substance(TBARS) levels. The percentage of viable graft on day 10 ranged from 67 to 93%, and was not significantly different among the each other groups. The percentage of viable graft were, however, higher in HBO plus ${\alpha}-tocopherol$ treated rats(78.6%) than in HBO alone treated rats(59.1%), ${\alpha}-tocopherol$ alone treated rats(66.7%) and surgical control rats(58.2%). TBARS concentration had a significant increase from preoperative concentration at day 2, and peak concentration at day 4(p<0.01). Concentration then decreased to preoperative concentration at day 28. GSHt concentration of free skin graft had a similar patteren of change in four groups and decreased significantly from preoperative concentration at day 2, returning to preoperative concentration by day 7(surgical control, HBO-treated, and ${\alpha}-tocopherol-treated$, alone) and 28(HBO plus ${\alpha}-tocopherol-treated$). Percentage of the concentration of reduced glutathione decreased in surgical control, HBO-treated and, ${\alpha}-tocopherol-treated$(p<0.05), and HBO plus ${\alpha}-tocopherol-treared$(p<0.01) on day 7 after surgery, whereas the concentration of oxidized increased significantly in HBO-treated(p<0.05), ${\alpha}-tocopherol-treated$(p<0.05), and HBO plus ${\alpha}-tocopherol-treated$(p<0.01).

• Archives of Plastic Surgery
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• v.43 no.6
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• pp.564-569
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• 2016

Background Alar retraction is a challenging condition in rhinoplasty marked by exaggerated nostril exposure and awkwardness. Although various methods for correcting alar retraction have been introduced, none is without drawbacks. Herein, we report a simple procedure that is both effective and safe for correcting alar retraction using only conchal cartilage grafting. Methods Between August 2007 and August 2009, 18 patients underwent conchal cartilage extension grafting to correct alar retraction. Conchal cartilage extension grafts were fixed to the caudal margins of the lateral crura and covered with vestibular skin advancement flaps. Preoperative and postoperative photographs were reviewed and analyzed. Patient satisfaction was surveyed and categorized into 4 groups (very satisfied, satisfied, moderate, or unsatisfied). Results According to the survey, 8 patients were very satisfied, 9 were satisfied, and 1 considered the outcome moderate, resulting in satisfaction for most patients. The average distance from the alar rim to the long axis of the nostril was reduced by 1.4 mm (3.6 to 2.2 mm). There were no complications, except in 2 cases with palpable cartilage step-off that resolved without any aesthetic problems. Conclusions Conchal cartilage alar extension graft is a simple, effective method of correcting alar retraction that can be combined with aesthetic rhinoplasty conveniently, utilizing conchal cartilage, which is the most similar cartilage to alar cartilage, and requiring a lesser volume of cartilage harvest compared to previously devised methods. However, the current procedure lacks efficacy for severe alar retraction and a longer follow-up period may be required to substantiate the enduring efficacy of the current procedure.