• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.68-73
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• 2011

Traditional management of comminuted tibia fractures with massive bone and soft tissue defect includes soft tissue coverage and bone grafting. However, this method requires a large flap and a substantial amount of bone graft. Acute shortening can reduce the amount of required soft tissue and bone graft. We report a case of open tibia and fibula fracture with severe bone and soft tissue defect that was successfully treated by acute shortening of the tibia with immediate fibular strut bone graft and then by gradual lengthening of the tibia at its proximal metaphysis.

• 대한치주과학회:학술대회논문집
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• 1997.11a
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• pp.97-97
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• 1997

• Journal of Dental Rehabilitation and Applied Science
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• v.32 no.4
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• pp.330-337
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• 2016

Gingival recession could occur after orthodontic or endodontic treatment. This could influence not only functional and aesthetic problem, but also patient's treatment satisfaction. There are a lot of techniques for preventing gingival recession, but laterally positioned flap with subepithelial connective tissue graft could get definite advantages such as increase of keratinized gingival width and harmonious color match between graft tissue and surrounding tissue. Clinician should select a right patient case and diagnosis with clinical and radiography exam. In a surgical procedure, getting enough amounts of subepithelial connective tissue and flap coverage should be taken into consideration. The clinical outcomes in this case report shows laterally positioned flap with subepithelial connective tissue graft could be a treatment with predictive outcome.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.2
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• pp.114-120
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• 2007

The augmentation of soft tissue defects is one of the critical problems in the oral and maxillofacial surgery. Various types of graft materials, both autologous and non-autologous, have been used for the augmentation of soft tissue in the facial region. However, it is not easy to choose an ideal material for soft tissue augmentation because each has its advantages and disadvantages. An ideal graft material should meet the following criteria : it should not leave a scar at the area from which it was taken; should have less likelihood of causing infection; should feel natural after implanted; and should be not absorbed. Among the materials meeting these criteria, human dermis and artificial dermis are commonly used for clinical purposes. The present study was aimed to investigate and compare the resorption rate and the histological change following the use of the autologous dermis, the human homogenous dermis $Alloderm^{(R)}$, and the artificial dermis $Terudermis^{(R)}$ to reconstruct the soft tissue defect. Twenty mature rabbits of either sex, weighing about 2 ㎏, were used. Each rabbit was transplanted with the autologous dermis, $Alloderm^{(R)}$, and $Terudermis^{(R)}$ size $1{\times}1-cm$ at the space between the external abdominal oblique muscle and the external abdominal oblique fascia. They were then divided into 4 groups (n=5 each) according to the time elapsed after the surgery: 1, 2, 4, and 8 weeks. The resorption rate was calculated by measuring the volume change before and after the transplantation, and H-E stain was preformed to observe the histological changes. The resorption rate after 8 weeks was 21.5% for the autologous dermis, 16.0% $Alloderm^{(R)}$, and 36.4% $Terudermis^{(R)}$, suggesting that $Alloderm^{(R)}$ is the most stable while $Terudermis^{(R)}$ is the most unstable. In microscopic examinations, the autologous dermis graft was surrounded by inflammatory cells and showed foreign body reactions. The epidermal inclusion cyst was observed in the autologous dermis graft. $Terudermis^{(R)}$ and $Alloderm^{(R)}$ demonstrated neovascularization and the progressive growth of new fibroblast. The results suggest that $Terudermis^{(R)}$ and $Alloderm^{(R)}$ can be availably for substituting the autologous dermis.

• Archives of Plastic Surgery
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• v.34 no.5
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• pp.587-592
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• 2007

Purpose: In case of postburn flexion contracture of the fingers, skin graft, geometrical relaxation techniques, local flap, and free flap have been used. Among these procedures, full-thickness skin grafts from the inguinal area are widely used to reconstruct a postburn flexion contracture in the fingers. But there are many esthetic and functional problems in this procedure. Especially, hyperpigmentation of the skin-grafted fingers poses a troublesome problem, particularly in the patients who have dark colored skin. To solve the problem, we have used pulp graft which was harvested from the lateral aspect of great toe. In the present study, we report pulp graft, with which we have obtained a good result in the treatment of postburn flexion contracture of the fingers. Methods: Between September of 2004 and August of 2006, great toe pulp graft was performed to 20 sites of 15 patients. After release of the postburn flexion contracture using Z-plasty, the composite tissue (pulp) harvested from the lateral aspect of great toe was grafted on the raw surface. Moisture dressing with ointment and foam dressing material was performed. Stratum corneum of the graft got stripped off in two to four weeks after pulp graft. The color of the pulp graft was slightly reddish, then it became similar to the adjacent tissue. Results: There was complete take in all the patients who were treated with pulp graft. Great toe pulp graft provided similar color and texture to the adjacent skin, high rate of graft take, and left only a minimal scar at donor site. Conclusion: Thick keratin layer and inelastic nature of the pulp make this type of the graft much easier and simpler, and ensure a better take. Pulp graft is useful method for the reconstruction of the postburn flexion contracture in fingers.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.716-722
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• 2008

Purpose: Split or full thickness skin graft is generally used to reconstruct the palmar skin and soft tissue defect after release of burn scar flexion contracture of hand. As a way to overcome and improve aesthetic and functional problems, the authors used the preserved superficial fat skin(PSFS) composite graft for correction of burn scar contracture of hand. Methods: From December of 2001 to July of 2007, thirty patients with burn scar contracture of hand were corrected. The palmar skin and soft tissue defect after release of burn scar contracture was reconstructed with the PSFS composite graft harvested from medial foot or below lateral and medial malleolus, with a preserved superficial fat layer. To promote take of the PSFS composite graft, a foam and polyurethane film dressing was used to maintain the moisture environment and Kirschner wire was inserted for immobilization. Before and after the surgery, a range of motion was measured by graduator. Using a chromameter, skin color difference between the PSFS composite graft and surrounding normal skin was measured and compared with full thickness skin graft from groin. Results: In all cases, the PSFS composite graft was well taken without necrosis, although the graft was as big as $330mm^2$(mean $150mm^2$). Contracture of hand was completely corrected without recurrence. The PSFS composite graft showed more correlations and harmonies with surrounding normal skin and less pigmentation than full thickness skin graft. Donor site scar was also obscure. Conclusion: The PSFS composite graft should be considered as a useful option for correction of burn scar flexion contracture of hand.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.4
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• pp.289-300
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• 2007

Purpose: This study was aimed to histologically evaluate $Silicone^{(R)}$, $Gore-tex^{(R)}$, $AlloDerm^{(R)}$, and $Medpor^{(R)}$ implants for augmentation rhinoplasty after graft in the subperiosteum of mural calvarium respectively. Materials and method: Twenty four male ICR mice were used. $Silicone^{(R)}$, $Gore-tex^{(R)}$, $AlloDerm^{(R)}$, and $Medpor^{(R)}$ were grafted respectively in the subperiosteum of frontal bone. Animals were sacrificed at 1 week, 4 week and 8 week after graft. Histological observation was performed after H&E staining. Results: All groups were healed without any extrusion of implant materials and inflammatory cell infiltration. In Silicone group, $Silicone^{(R)}$ was well enclosed by thin fibrous tissue at 1 week, which became thicker and stable at 4 weeks and 8 weeks. And there was no destruction or resorption of $Silicone^{(R)}$ In Gore-tex group, there was no destruction or resorption of $Gore-tex^{(R)}$. Thin fibrous tissue and cell infiltration from peripheral tissue were observed at 1 week, 4 weeks and 8 weeks. In AlloDerm group, $AlloDerm^{(R)}$ was enclosed by fibrous tissue. Cell infiltration was observed at 1 week, 4 weeks and 8 weeks. In Medpor group, there was no inflammation, destruction or resorption of $Medpor^{(R)}$ and it was contacted directly to the bone without interposition of fibrous tissue. Porous area was filled by bone or soft tissue. Conclusion: These results suggest that $Gore-tex^{(R)}$, $AlloDerm^{(R)}$, and $Medpor^{(R)}$ graft are more stable than $Silicone^{(R)}$ graft and that $Silicone^{(R)}$, $Gore-tex^{(R)}$, $AlloDerm^{(R)}$ are appropriate for graft on nasal tip and $Medpor^{(R)}$ is appropriate for graft on nasal dorsum.

• Archives of Reconstructive Microsurgery
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• v.24 no.2
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• pp.56-61
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• 2015

Purpose: We report on the clinical result after coverage of a soft tissue defect on the medial foot and ankle with an adipofascial flap based on the perforator from the posterior tibia artery. Materials and Methods: Nine patients with soft tissue defects on the medial foot and ankle area from March 2009 to May 2014 underwent the procedure. Average age was 54 years old (range, 8~82 years). There were five male patients and four female patients. The causes of the defect were trauma (4), tumor (3), and infection (2). The pivot point of transposition of this flap is the lower perforator originating from the posterior tibia artery. The fatty tissue side of this flap could be used to resurface the defect. The donor site was closed primarily with the preserved skin, and a small caliber drain tube was used. The split-thickness skin graft was grafted to the flap and the wound. If the wound was still infected, this skin graft could be performed at a later date. Results: All flaps survived and normal soft tissue coverage was obtained for the medial foot and ankle of all patients after the skin graft. Normal footwear was possible for all cases because of thin coverage. There was an extension contracture on the medial ray of the foot, which was resolved by contracture release and skin graft. Conclusion: For the medial foot and ankle soft tissue defect, the medial crural adipofascial flap based on a perforator branch of the posterior tibia artery could be a good option to cover it.

• Journal of Periodontal and Implant Science
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• v.28 no.2
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• pp.263-273
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• 1998

For histologic observation of the regenerated bone following guided tissue regeneration (GTR) using ePTFE membranes with calcium carbonate implant and autogenous bone graft, biopsies were collected from 2 patients during 5-year-postoperative surgical reentry. In both combined cases with guided tissue regeneration in conjunction with calcium carbonate implant and autogenous bone graft, significant bone fill and gain in probing attachment level was observed. In histologic examination, specimen in GTR case with calcium carbonate grafting was composed of a dense bone containing vascular channel with lamellar structure and viable bone cells in lacunae, however considerable calcium carbonate particles remained unresorbed and isolated from regenerated bone by the dense cellular and fibrous connective tissue. No formative cells could be seen in contact with remained calcium carbonate particles. In GTR case with autogenous bone grafting, specimen show was composed of a dense lamellar bone containing vascular channel, which showed normal alveolar bone architectures. The present observation indicate that guided tissue regeneration in conjunction with grafting, especially autogenous bone graft, has highly osteogenic potential, however resorbable calcium carbonate granules were not completely resorbed at 5 year postimplantation.

• Journal of Periodontal and Implant Science
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• v.38 no.2
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• pp.231-236
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• 2008

Purpose: The treatment of gingival recessions is needed to reduce root sensitivity and improve esthetical satisfaction. Several surgical techniques have been proposed to achieve these goals. The use of connective tissue grafts has made esthetic root coverage a predictable procedure. Numerous clinical studies have represented that using connective tissue grafts to cover exposed root surface showed high success rates. This is a case report which demonstrates the technique to obtain root coverage of a buccal recession defect. Materials and Methods: A 35-year-old patient with a high level of oral hygiene was selected for the study. This patient had one Class I Miller recession defect in the mandible. A coronally advanced flap in combination with the connective tissue graft was chosen for the treatment. After surgery, the patient was told to visit the hospital once a week for his oral management and professional prophylaxis. The depth of initial recession was 4.0 mm. Result: After three months, it reduced to 0.0 mm, and the average recession reduction was 4.0 mm. The average root coverage was 100%. Conclusion: The connective tissue graft is both effective and predictable way to produce root coverage in increasing the width of CAL and KT of various adjacent gingival recessions.