• Archives of Plastic Surgery
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• 제37권6호
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• pp.763-768
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• 2010

Purpose: Reconstruction of soft tissue defect using tissue expander can provide better flap which is more similar to surrounding tissue in color, skin texture and hair compared to other methods. Many pediatric patients need reconstruction of soft tissue defect because of giant congenital nevi, congenital or acquired malformations and burn scars. Reconstruction using tissue expander is adequate to minimize dysmorphism in these patients. We intended to assess outcomes of using tissue expander in pediatric patients by retrospective study. Methods: Total cases were 168 of pediatric patients who received soft tissue reconstruction using tissue expander by the same surgeon from February, 1982 to May, 2009. All patients who received soft tissue reconstruction were under 10 years old. Mean age was 4.3 years old, the youngest 13 months, the oldest 8 years. Eightynine cases were male and 79 cases were female. Most common cause was giant hairy nevi (67 cases, 39.9%), secondary cause was burn scar/scar contracture (61 cases, 36.3%). Trunk (38 cases, 22.6%) was most common anatomical location. Results: Soft tissue defects were successfully covered using tissue expander in 149 cases (88.7%) without major complications. There was infection on 8 cases (4.7%) and we treated by adequate antibiotics in these cases. There were tissue expander folding or valve displacement on 5 cases (3%). Conclusion: Usage of tissue expander is useful on pediatric patients because tissue expansion is rapid on children and there are less secondary contractures on operation site than full thickness skin graft. Because of psychological stress due to tissue expander, operation should be performed before school age.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.118-123
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• 2001

Introduction : We report advantages of distally based superficial sural artery flap in the soft tissue defect in lower leg, ankle and foot. They are easier and less complicated technique than others. Material & Method : Total 26 patients were operated and their soft tissue defect site were 10 cases of anterior tibial surface, 6 cases of Achilles tendon area, 3 cases of lateral and medial surface of tibia, 3 cases of foot dorsum surface, 3 cases of sole, 1 case of medial aspect of ankle. Average pedicle distance was 12.8 cm(range $8{\sim}21cm$) and follow up period was mean 18 months. Result : We obtained 24 cases of excellent and good results. The two cases were reported low complication rate, which were one case of skin necrosis covered full thickness skin graft, and the other case of infection. Conclusion : The advantage of distally based superficial sural artery flap in soft tissue defect are long distant pedicle, short operation time, easy elevation of pedicle, constant and reliable blood supply and good cosmetic result with thin-thickness flap.

• Archives of Reconstructive Microsurgery
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• 제9권1호
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• pp.80-87
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• 2000

Acute high speed accidents that results in full thickness skin defect and exposure of tendon, nerve, vessel and periosteum over denuded bone demands soft tissue coverage. Exposed bone often ensues chronic infection and requires free flap transplantation which surely covers defects in one stage operation and enhances transport of oxygen-rich blood and converts a non-osteogenic or partially osteogenic site into a highly osteogenic site, but exposed bone which had performed free flap transplantation sometimes necroses and needs secondary bone procedure. Scar contracture limits joint motion should be excised and covered with normal soft tissue to restore normal range of motion. Authors have performed the large latissimus dorsi myocutaneous free flap in 8 cases of extensive soft tissue defect and exposed bone lesion in the leg and 1 case of the flap was failed. The secondary ilizarov bone procedure was performed in 3 of 8 cases. 2 cases of large burn scar contracture and 1 case of posttraumatic scar contracture in lower extremity were restored with the large latissimus dorsi myocutaneous free flap. Authors concluded that large latissimus dorsi myocutaneous free flap is the most acceptable microvascular procedure in large soft tissue defect combined with exposed periosteum and bone requiring secondary bone procedure and in large burn scar contracture limiting knee joint motion.

• Archives of Plastic Surgery
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• 제36권5호
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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.

• Journal of Periodontal and Implant Science
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• 제48권3호
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• pp.152-163
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• 2018

Purpose: To determine whether the swelling and mechanical properties of osmotic self-inflating expanders allow or not the induction of intraoral soft tissue expansion in dogs. Methods: Three different volumes (0.15, 0.25, and 0.42 mL; referred to respectively as the S, M, and L groups) of soft tissue expanders (STEs) consisting of a hydrogel core coated with a silicone-perforated membrane were investigated in vitro to assess their swelling behavior (volume swelling ratio) and mechanical properties (tensile strength, tensile strain). For in vivo investigations, the STEs were subperiosteally inserted for 4 weeks in dogs (n=5). Soft tissue expansion was clinically monitored. Histological analyses included the examination of alveolar bone underneath the expanders and thickness measurements of the surrounding fibrous capsule. Results: The volume swelling ratio of all STEs did not exceed 5.2. In tensile mode, the highest mean strain was registered for the L group ($98.03{\pm}0.3g/cm$), whereas the lowest mean value was obtained in the S group ($81.3{\pm}0.1g/cm$), which was a statistically significant difference (P<0.05). In addition, the S and L groups were significantly different in terms of tensile strength ($1.5{\pm}0.1g/cm$ for the S group and $2.2{\pm}0.1g/cm$ for the L group, P<0.05). Clinical monitoring showed successful dilatation of the soft tissues without signs of inflammation up to 28 days. The STEs remained volumetrically stable, with a mean diameter in vivo of 6.98 mm, close to the in vitro post-expansion findings (6.69 mm). Significant histological effects included highly vascularized collagen-rich fibrous encapsulation of the STEs, with a mean thickness of $0.67{\pm}0.12mm$. The bone reaction consisted of resorption underneath the STEs, while apposition was observed at their edges. Conclusions: The swelling and mechanical properties of the STEs enabled clinically successful soft tissue expansion. A tissue reaction consisting of fibrous capsule formation and bone loss were the main histological events.

• 대한정형도수물리치료학회지
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• 제27권1호
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• pp.21-30
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• 2021

Background: This study aimed to investigate the effects of muscle energy technique (MET) and instrument assisted soft tissue mobilization (IASTM) on knee extension ROM, knee extensor/flexor strength and muscle thickness immediately and after 24 hours. Methods: A total of 30 subjects participated in this study. The participants were assigned to either MET (n=15) or IASTM (n=15). 90-90 straight leg raise, knee extensor/flexor muscle strength, muscle thickness test were measured before, immediately after and 24 hours after the intervention. Results: Both groups significantly improved knee extension ROM on immediate (MET 10.7°, IASTM 10.21° increased) and after 24 hours assessment (MET 5.61°, IASTM 5.47° increased)(p<.05). In the MET group, knee extension and flexion muscle strength increased immediately after intervention (p<.05). In the IASTM group, knee extension muscle strength increased and knee flexor muscle strength decreased immediately after intervention (p<.05). Furthermore, both groups showed a pattern of returning to the initial strength after 24 hours. In both groups, no significant difference in muscle thickness immediately and after 24 hours was observed (p>.05). Conclusion: According to the results of the present study, MET and IASTM technique showed lasting effectiveness in flexibility of shortened hamstring immediately after and in 24 hours after the intervention. In both groups, MET increased muscle strength and increased ROM, while IASTM decreased muscle strength and increased ROM, with no change in muscle thickness.

• 대한치과교정학회지
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• 제30권1호
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• pp.101-114
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• 2000

한국인 성인에서 연령 증가에 따른 연조직 측모 변화 양상을 규명하기 위하여 남자 17명과 여자 8명을 대상으로 24세와 32세에 촬영된 측모 두부X-선 규격사진을 비교, 분석한 결과 다음과 같은 결론을 얻었다. 1. 관찰 기간 동안, 남녀 모두 경조직에서는 통계적으로 유의한 변화가 없었다 (p>0.05). 2. 연조직의 전후적 계측치에서 남자는 턱부위 (Pog', Gn')의 유의한 증가를, 여자는 하순 (LI)의 유의한 감소를 관찰할 수 있었다 (p<0.05). 3. 연조직의 수직적 계측치에서 남녀 모두 상순의 길이 (Sn-Sto) 가 증가하는 경향을 보였으나 통계적 유의성은 남자에서만 나타났고 하안면 고경 (Sn-Gn') 은 남녀 모두에서 유의하게 증가하였다 (p<0.05). 4. 연조직 두께는 남녀 모두 전체적으로 증가하는 경향을 보였으며 특히 턱부위 (Pog', Gn') 에서 유의한 증가가 있었다 (P<0.05).

• Archives of Plastic Surgery
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• 제32권4호
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• pp.435-440
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• 2005

The reconstruction of deep soft tissue defects of lower extremities combined with bone exposure has been difficult problems. When it is impossible to raise local skin flap, we have been usually used the gastrocnemius musculocutaneous flap, cross leg flap or free flaps. However, In musculocutaneous flap, aesthetical appearance of the calf is not appropriate because of too bulky flap. Although the success rate of the free flap has improved, still failure of flap occurs in cases of the chronic ischemic state. As the concepts of perforator flap has recently developed and widely used due to its thin flap thickness. Between January 2002 to December 2004, we treated 7 patients with soft tissue defect in leg with chronic ischemic limbs with perforator island flap. Preoperative angiography were done in all case and we used 2 medial sural perforator flaps, 1 anterior tibial artery perforator flap, 1 posterior tibial artery perforator flap, 3 anterolateral thigh perforator flap. Partial necrosis of flap was seen in one patient but no further surgical procedure was required for wound healed spontaneously. Perforator island flaps are thin, reduce donor site morbidity, conceal donor site with primary closure and it is useful for resurfacing soft tissue defect of lower extremities.

• 치과방사선
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• 제8권1호
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• pp.49-61
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• 1978

A study was made to investigate a relationship existing in the dentoskeletal framework and the soft tissue profile around the face, and compare the sexual differences between boys and girls having the normal occlusion in the mixed dentition. The lateral cephalograms were composed of 67 boys aged 10.3 years and 68 girls aged 10.4 years, respectively. By means of the lateral cephalograms, both the hard-and soft tissue structures were simultaneously analyzed, measured and evaluated by introducing the several reference items: S-N plane, palatal plane, mandibular plane, N-A line and A-P line for the dentoskeletal structures and N’-P’line for the soft tissue, and the 21 measuring points for the both structures. The significant findings were as follows: 1. In general the boys showed the larger nasal component dimension than did the girls, but the length and height of nose(N’-Prn and NA-Prn) showed the significant sexual difference among those when evaluated statistically. 2. The lip-thickness was found to be minimal in the region of nasion, greater in the region of pogonion, and much greater in the region of point A in the both sexes, but the only thickness over point A(A-A’) showed the significant sexual difference statistically. 3. The upper and lower lip position were found to be located anteriorly to the esthetic line in the both sexes, but upper lip position showed the significant sexual difference when evaluated statistically. 4. The regions of nose and upper lip had a tendency not to be following the underlying skeletal profile.

• Journal of Korean Dental Science
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• 제13권1호
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• pp.11-20
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• 2020

Purpose: This study sought to identify differences in hard and soft tissue chin profile changes in skeletal Class III patients after bimaxillary surgery, with or without advancement genioplasty. Materials and Methods: The retrospective study was conducted based on cephalometric analysis of skeletal and soft tissue variables. Lateral cephalograms taken at 3 different time points were utilized: pre-operation (T0), immediately post-operation (T1), and at least 6 months (11.0±2.6 months) post-operation (T2). The 2 groups were matched for sample size (n=20 each). Data were analyzed using independent t-tests with Bonferroni correction. Result: Group N (bimaxillary surgery alone) and Group G (bimaxillary surgery with an advancement genioplasty by horizontal sliding osteotomy) did not differ significantly in terms of demographic characteristics. The soft tissue chin thickness of Group G increased more after surgery, followed by a greater decrease during the postoperative period, and was eventually not significantly different from Group N at T2. On the other hand, the mentolabial sulcus depth of Group G (5.5±1.3 mm) was significantly greater than that of Group N (4.4±0.9 mm) (P=0.006) at T2. Conclusion: Although Group G showed a statistically significantly greater decrease in soft tissue chin thickness during the postoperative period, there were no significant intergroup differences in the chin profile for at least 6 months after the surgery, except for the mentolabial sulcus depth, which was greater in Group G than in Group N.