• Archives of Plastic Surgery
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• 제38권4호
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• pp.527-530
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• 2011

Purpose: Liver transplantation is a groundbreaking section in the field of surgery. Nowadays over 90% of success rate is accomplished and life expectancy of the patients has been elongated. Patients are now seeking for surgical procedures including cosmetic plastic surgery. But these patients take immunosuppressive medication and steroids, which can increase the risk of wound infection, and delay wound healing. By reviewing the case of a 21-year-old liver transplant recipient who underwent mastopexy due to breast ptosis, we discussed about the matters we should consider when performing surgery in liver transplantation recipients. Methods: The patient was a 21-year-old female who received liver transplantation from her father. She was exposed to massive amount of steroids and immunosuppressants, which led to breast ptosis. The vertical and short horizontal incision mastopexy using a medial-based pedicle was done, 29 months after the liver transplantation. Results: On postoperative day 1, she was discharged. On day 10, sutures were removed and taping was applied. There was no sign of wound infection, wound dehiscence, hematoma or bleeding. The patient was followed up at 3, 6 and 9 months after the operation. Mild recurrence of the glandular ptosis was observed but revision was not required. Conclusion: We were able to successfully operate without any complications in the liver transplant recipient. With special attention and consideration, cosmetic plastic surgery can be safely performed in organ transplantation recipients.

• Archives of Plastic Surgery
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• 제46권4호
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• pp.291-302
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• 2019

Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.

• Archives of Aesthetic Plastic Surgery
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• 제23권3호
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• pp.143-145
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• 2017

Medical leech therapy is a treatment for the venous congestion of tissue flaps, grafts, and replants. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) following leech application at a congested flap after mastectomy. A 45-year-old woman had an invasive ductal carcinoma. Modified radical mastectomy was performed. The chest wall defect was reconstructed with a local rotation flap. On postoperative day (POD) 1, congestion and color change were observed, and 10 medical leeches were applied to the congested area. On POD 4, another 10 medical leeches were applied. On POD 12, wound necrosis progressed and a pus-like discharge appeared. A wound swab culture revealed MRSA. Debridement was carried out on POD 15. From POD 16, vancomycin and piperacillin/tazobactam were injected for 18 days. The wound culture on POD 18 also revealed MRSA. A split-thickness skin graft was performed on POD 28. MRSA has not been clearly identified in the literature as a leech enteric bacterium. Although MRSA may have come from another source, the present case raises the possibility of MRSA infections following leech application at congested flaps. When medical leeches are applied at the congestion site of a flap, an aseptic cradle will be helpful. Vancomycin irrigation may be needed if infection occurs.

• Journal of Trauma and Injury
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• 제33권4호
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• pp.260-263
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• 2020

Necrotizing fasciitis is an infection of the subcutaneous tissue that results in destruction of the fascia and is disproportionately common in patients with chronic liver disease or diabetes. Necrotizing fasciitis of the head and neck is rare, but has a high fatality rate. A 50-year-old man with a past medical history of diabetes reported a chief complaint of a wound in the posterior neck due to trauma. The wound had grown and was accompanied by pus and redness, and the patient had a fever. When the patient was referred to department of plastic & reconstructive surgery, the sternocleidomastoid muscle, semispinalis capitis muscle, splenius capitis muscle, and trapezius muscles were exposed, and the size of the defect was about 25×20 cm. Dead tissue resection was performed before negative-pressure wound therapy, followed by a split-thickness skin graft (STSG). After a 2-week course of aseptic dressing post-STSG, the patient recovered completely. No postoperative complications were observed for 1 year. Necrotizing fasciitis is a life-threatening, rapidly spreading infection, requiring early diagnosis and active surgical treatment. In addition, broad-spectrum antibiotics are required due to the variety of types of causative bacteria. Broad necrotizing fasciitis of the posterior neck is rare, but can quickly progress into a life-threatening stage.

• 구강회복응용과학지
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• 제36권1호
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• pp.21-28
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• 2020

목적: 치주포대는 감염 위험을 줄이고 치유를 증대 시킨다는 연구들이 있다. 본 연구는 치주 수술 후 부착형 창상 피복재의 사용이 치유 및 수술 만족도에 미치는 영향을 평가하고자 하였다. 연구 재료 및 방법: 치주 수술이 필요한 환자 28명을 대상으로 상악 또는 하악의 양측 사분면에 치주 수술을 시행하였다. Visual Analogue Scale (VAS)를 이용해 술 후 동통, 출혈, 식이 불편감, 지각 과민을 평가하고 추가적으로 작열감과 수술 만족도에 관해 평가하였다. 결과: 수술 후 동통, 출혈, 식이 불편감에 관한 VAS 평균 값은 창상 피복재 유무에 따라 각각; 동통: 2.82, 3.96 (P = 0.002), 출혈: 1.61, 2.54 (P = 0.008), 식이 불편감: 2.82, 4.18 (P < 0.001)로 창상 피복재를 적용한 그룹에서 불편감이 적었으며, 통계적으로 유의하였다. 작열감, 지각 과민과 창상 피복재 적용 유무 사이에 유의한 차이는 없었다. 수술 만족도는 75%에서 창상 피복재를 사용한 경우 높았다. 결론: 본 연구의 결과에 따르면, 창상 피복재의 사용유무와 작열감, 지각 과민과의 통계적 유의성은 없었으나 창상 피복재를 사용한 경우 술 후 동통, 출혈, 식이 불편감이 적었다.

• 한국산학기술학회논문지
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• 제10권11호
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• pp.3434-3443
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• 2009

본 연구는 3차병원에서 퇴원하는 환자의 상처관리에 대한 지식과 염려사항을 파악하기 위해 112명의 피부상처를 지니고 퇴원을 앞둔 112명 환자에게 구조화된 설문지로 면담을 통해 조사하였다. 상처의 유형은 외과적 절개(52.7%), 삽관상처(26.8%), 욕창(9.8%), 당뇨발과 동맥궤양(5.4%) 등이었다. 상처관리에 관한 지식은 52.0%의 정답률을 보였고, 상처관리에 대한 염려(범위1-7)는 2.79였고, 상처관리에 대한 지식과 염려는 상관관계가 유의하지 않았다. 퇴원후 상처관리에 관한 염려에 영향을 미치는 요인으로 유의한 변수는 상처관리에 대한 두려움, 상처통증, 입원기간, 및 주관적 건강인식으로 나타났다. 상처를 지니고 퇴원하는 환자들의 상처관리에 대한 지식은 부정확한 것이 많으며 다양한 염려사항들을 가지고 있으므로 퇴원계획시 이에 대한 구체적인 교육이 필요할 것이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권2호
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• pp.112-123
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• 2013

This study aims to investigate the clinical outcome following treatment of peri-implantitis lesions. Five subjects with 7 implants were treated with surgical approach. Four subjects with 6 implants were initially treated with non-surgical approach or hygiene control. However, inflammation was not resolved and more bone loss was found. Therefore, surgical treatment was performed. After surgical exposure of the defect, granulation tissue was removed and implant surface was treated using tetracycline and chlorhexidine. Then, the flaps were sutured. The wound healing was performed in a non-submerged mode. The present finding demonstrates stable results without progression of bone loss. In one subject, deep V shaped bone defect was filled with bone substitute (ICB, CanCellous Bone, Rockey Mountain Tissue Bank, USA), and resorbable membrane (Lyoplant$^{(R)}$, B.Braun Aesculap AG, Germany) was placed over the grafted defect and healing abutment was connected. However, the inflammation was not resolved and more bone loss was found. At one month after regenerative surgery, the implant was removed.

• 기본간호학회지
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• 제21권2호
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• pp.151-161
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• 2014

Purpose: The purpose of this study was to identify the risk factors that influence surgical site infections after surgery. Methods: This study was a retrospective research utilizing Electronic Medical Records. Data collection targeted 4,510 adult patients who had 8 different kinds of surgery (gastric surgery, colon surgery, laparoscopic cholecystectomy, hip & knee replacement, hysterectomy, cesarean section, cardiac surgery) in 4 medical care departments, at one general hospital between January 2006 and December 2011. Multivariate logistic regression analyses were used to identify the risk factors affecting surgical site infections after surgery. Results: Risk factors for increased surgical site infection following surgery were confirmed to be age (OR=1.59, p<.001), BMI (Body Mass Index)(OR=1.25, p=.034), year of operation (OR=2.45, p<.001), length of operation (OR=3.06, p<.001), ASA (American Society of Anesthesiology) score (OR=1.36, p=.025), classification of antibiotic used (OR=2.77, p<.001), duration of the prophylactic antibiotics use (OR=1.85, p<.001), and interaction between classification of antibiotic used and duration of the prophylactic antibiotics use (OR=1.90, p=.016). Conclusions: Results suggest that risk factors affecting surgical site infections should be monitored before surgery. The results of this study should contribute to establishing effective infection management measures and implementing surveillance systems for patients who have actual risk factors.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.73-77
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• 2002

Medical application of leeches, by means of leech's blood suction, has advantages in not only directly removing blood congestion, but also preventing hindrance to venous drainage by inhibiting local thrombus formation and inducing continuous bleeding. Nevertheless, Aeromonas hydrophila infection secondary to such suction is most common and may develop into serious conditions from local inflammatory reaction to total necrosis of replanted parts and enterocolitis as well as sepsis. Once infected, it requires infection treatment, removal of necrotic tissues and reconstruction. Hence, duration and cost of treatment increase while functional recovery falls markedly. Accordingly, we present measures to reduce Aeromonas infections as follows: First, do not manipulate as much as possible while the leeches are sucking or moving. Second, the site which suction plates of the leeches are attached, should be selected away from the surgical wound site or open wound as much as possible. Third, contaminated or blood-wet gauze should be replaced often so that the skin of surgical areas would not swell. Furthermore, bleeding or oozing should be well-drained. Fourth, the areas other than the sites of leech attachment should be covered with sterilized gauzes in order to limit leech movement.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권2호
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• pp.21-33
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• 1990

This study was performed to evaluate the effects of preoperative and postoperative radiation on the healing of surgical wound and the relationship between surgery-radiation interaval histopathologically. Experimental animals were 64 rats of Sprague-Dawely strain weighing about 180grams. In postoperative radiation group, a single dose of 1000 rads irradiation was delivered on 1,2,3, weeks after incision and 24 animals were sacrificed on the 1st, 3rd, 7th, and 14th day after radiation. In preoperative radiation group incision was performed on 1,2,3,4 weeks after a single dose of 1000 rads and 32 animals were sacrificed on the 1st, 3rd, 7th, and 14th after incision. Tissue specimens were prepared as usual methods and stained with hematoxyline-eosin for ordinary light microscopy. Histopathologic study revealed the following favorable results : 1. In 2 and 3 weeks radiation group after incision, the healing process was unaffected by radiation. 2. In 1 week radiation group after incision, the healing process was slightly retarded, as compared with 2,3 weeks radiation group after incision. 3. In 1,2 and 3 weeks incision group after radiation, the healing process appeared about 7 days later than that of control group. 4. In 4 weeks incision after radiation, the healing process was unaffected by radiation.