• Archives of Plastic Surgery
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• v.38 no.5
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• pp.649-654
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• 2011

Purpose: Split-or full-thickness skin grafts are used to reconstruct palmar skin and soft tissue defects after trauma or to release burn scar contracture on the hand. Glabrous skin defects should be substituted with similar skin to preserve function and aesthetics. The authors report their experiences with a technique that uses a full-thickness graft taken from glabrous skin on the ulnar edge of the palm for the reconstruction of soft tissue defects of the hand. Methods: During a three-year period from 2007 to 2010, 22 patients with burn scar contracture and 12 patients with post-traumatic skin defects on their hands were treated with full-thickness skin graft operations. The palmar skin and soft tissue defects after release of burn scar contracture or debridement of post-traumatic wounds were reconstructed with full-thickness skin grafts harvested from the ulnar border of their palms. All donor-site wounds were primarily closed. Results: The followup periods ranged from 3 to 25 months. Contractures of the hand were corrected without recurrence, and the grafts showed relatively good contour and color match to the adjacent fields. There were no reported complications such as significant color change or hypertrophic scarring. The grafted skin showed an average 5.9 mm static two-point discrimination obtained in fingertip reconstruction cases, indicating satisfactory reinnervation. Conclusion: Glabrous full-thickness grafts harvested from the palmar ulnar border is a very useful way of reconstructing soft tissue defects on hands, including fingertips, for function restoration, favorable aesthetic results, and low donor-site morbidity.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.415-420
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• 2011

Purpose: The reconstruction of a soft tissue defect of the heel pad can be challenging. One vital issue is the restoration of the ability of the heel to bear the load of the body weight. Many surgeons prefer to use local flaps or free tissue transfer rather than a skin graft. In this study, we evaluated the criteria for choosing a proper flap for heel pad reconstruction. Methods: In this study, 23 cases of heel pad reconstruction were performed by using the flap technique. The etiologies of the heel defects included pressure sores, trauma, or wide excision of a malignant tumor. During the operation, the location, size and depth of the heel pad defect determined which flap was chosen. When the defect size was relatively small and the defect depth was limited to the subcutaneous layer, a local flap was used. A free flap was selected when the defect was so large and deep that almost entire heel pad had to be replaced. Results: There was only one complication of poor graft acceptance, involving partial flap necrosis. This patient experienced complete recovery after debridement of the necrotic tissue and a split thickness skin graft. None of the other transferred tissues had complications. During the follow-up period, the patients were reported satisfactory with both aesthetic and functional results. Conclusion: The heel pad reconstructive method is determined by the size and soft-tissue requirements of the defect. The proper choice of the donor flap allows to achieve satisfactory surgical outcomes in aesthetic and functional viewpoints with fewer complications.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.691-694
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• 2011

Purpose: With an increase in the population of immunocompromised patients, the incidence of maxillary sinus aspergillus infection has also escalated. Maxillary sinus aspergillosis is generally extended to the sinus antrum, base or thin orbital wall and ethmoid air cell region. We experienced a case of maxillary sinus aspergillosis which was extended directly to the soft tissue of the cheek. Methods: A 46-year-old man with acute myelogenous leukemia was consulted for the defect of the anterior wall of the maxillary sinus, and cheek. Radiologic and histologic findings were consistent with invasive maxillary sinus aspergillosis. The otolaryngology department performed debridement via endoscopic sinus surgery first. Coverage of the resulting defect in the anterior wall of the maxillary sinus and its inner layer was undergone by the plastic and reconstructive surgery department, using a pedicled superficial temporal fascia flap and a split thickness skin graft. The remaining skin defect of the cheek was covered with a local skin flap. Results: The patient went through an uneventful recovery. There was no recurrence during 6 months of follow-up. Conclusion: Maxillary sinus aspergillosis usually involves the orbit or the gingiva but in some cases it may directly invade soft tissues of the cheek. Such an atypical infection extending into the cheek may lead to a large soft tissue defect requiring coverage. Thus, any undiagnosed soft tissue defect involving the cheek or maxillofacial area, especially in immunocompromised patients, should be evaluated for aspergillosis. We present this rare case, with a review of the related literature.

• Journal of Veterinary Clinics
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• v.24 no.2
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• pp.280-283
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• 2007

A 6-year-old male dog was referred to Animal Medical Center, Chonbuk National University with large distal extremity abrasion wound to the hind limb by automobile accident. The wound was reconstructed with an autogenous, full-thickness skin mesh graft. The graft was harvested from the ventrolateral abdominal wall and transplanted to the wound. The skin mesh graft survived successfully without any noticeable complications. Successful grafting requires asepsis, an adequately prepared recipient bed through the surgical debridement and lavage, proper harvesting and preparation of the graft. Full-thickness skin mesh graft has lesser skin contraction which prevents formation of scar. Meshing the graft provides more graft flexibility over uneven, convex and concave surfaces and allows adequate drainage. The full-thickness skin mesh graft can be successfully used for the treatment of large distal skin wounds in dogs.

• Journal of Veterinary Clinics
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• v.33 no.5
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• pp.300-303
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• 2016

An age-unknown, 4.8 kg, male, wild, domestic short-hair cat was presented for left hindlimb lameness. A physical examination revealed a draining tract which was suspected of bite on left calcaneal bone. The left tarsal joint was markedly swollen and exudates were observed around the draining tract. Sequestrum at left calcaneus bone, and osteolysis were identified by radiography. The sequestrum and its surrounding exudative tissue were debrided during surgery and the tissue was submitted for bacterial culture and sensitivity test. The debridement caused a bone defect ($1.5cm{\times}0.5cm{\times}0.5cm$) on the medial left calcaneal bone. Plate and screw fixation was performed to the calcaneus bone as buttress plate. Recombinant human bone morphogenetic protein-2 (rhBMP-2) loaded hydroxyapatite was implanted in the bone defect. Furthermore, Amikacin-impregnated collagen sponges were also placed around bone plate to deliver local antibiotics. A systemic antibiotic treatment regimen based on bacterial culture and sensitivity test results was administered for 4 weeks. The wound properly healed without any signs of infection, and the bone healing was confirmed by radiography. The patient showed normal weight bearing ambulation at 18 weeks after surgery. The use of rhBMP-2 and local antibiotic delivery system is a good surgical option for the one-stage treatment of chronic osteomyelitis.

• Proceedings of the KACD Conference
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• 2003.11a
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• pp.608-608
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• 2003

The main objectives of root canal therapy are cleaning and shaping and then obturating the root canal system in 3 dimensions to prevent reinfection. Many instrumentation techniques and devices, supported by an irrigation system capable of removing pulp tissue remnants and dentin debris, have been proposed to shape root canals. But current regimens in chemomechanical debridement using instrumentation and irrigation with NaOCl are not predictably effective in root canal disinfection. These findings are not surprising because the root canal system is complex and contains numerous ramifications and anatomical irregularities. The microorganisms in root canals not only invade the anatomic irregularities of the root canal system but also are present in the dentinal tubules. Therefore further disinfection with an effective antimicrobial agent may be necessary and it well1mown that use of intracanal medication will lower bacterial count in infected root canals. Calcium hydroxide has a long history of use in endodontics, and more attention has been given to the use of calcium hydroxide as intracanal dressing for the treatment of infected pulp. However, when treatment is completed in one visit, no intracanal medications other than intracanal irrigants are used. Recently, a mixture of a tetracycline isomer, an acid, and a detergent(MTAD), has been introduced as a final rinse for disinfuction of the root canal system. It has been shown that MTAD is able to remove the smear layer with minimal erosive changes on the surface of dentin, and is effective against Enterococcus faecalis, a microorganism resistant to the action of other antimicrobial medications. In another study, the ability of MTAD was investigated to disinfect contaminated root canals with whole saliva and compared its efficacy to that of NaOCl Based on the results, it seems that MTAD is significantly more effective than 5.25% NaOCl in eradicating bacteria from infected root canals. In the cytotoxicity evaluation, MTAD is less cytotoxic than engenol, 3% $H20_2,\;Ca(OH)_2$ paste, 5.25% NaGCl, Peridex, and EDTA and more cytotoxic than 2.63%,1.31% and 0.66% NaOCl. Is it promising or transient?

• Restorative Dentistry and Endodontics
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• v.38 no.3
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• pp.154-159
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• 2013

Objectives: The aim of this study was to compare the cleaning efficacy of different final irrigation regimens in canal and isthmus of mandibular molars, and to evaluate the influence of related variables on cleaning efficacy of the irrigation systems. Materials and Methods: Mesial root canals from 60 mandibular molars were prepared and divided into 4 experimental groups according to the final irrigation technique: Group C, syringe irrigation; Group U, ultrasonics activation; Group SC, VPro StreamClean irrigation; Group EV, EndoVac irrigation. Cross-sections at 1, 3 and 5 mm levels from the apex were examined to calculate remaining debris area in the canal and isthmus spaces. Statistical analysis was completed by using Kruskal-Wallis test and Mann-Whitney U test for comparison among groups, and multivariate linear analysis to identify the significant variables (regular replenishment of irrigant, vapor lock management, and ultrasonic activation of irrigant) affecting the cleaning efficacy of the experimental groups. Results: Group SC and EV showed significantly higher canal cleanliness values than group C and U at 1 mm level (p < 0.05), and higher isthmus cleanliness values than group U at 3 mm and all levels of group C (p < 0.05). Multivariate linear regression analysis demonstrated that all variables had independent positive correlation at 1 mm level of canal and at all levels of isthmus with statistical significances. Conclusions: Both VPro StreamClean and EndoVac system showed favorable result as final irrigation regimens for cleaning debris in the complicated root canal system having curved canal and/or isthmus. The debridement of the isthmi significantly depends on the variables rather than the canals.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.53-57
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• 2011

Purpose: Pyoderma gangrenosum is a rare inflammatory, reactive dermatosis marked by painful cutaneous ulcer. The causes of pyoderma gangrenosum remain unclear. Gastrointestinal, hematological, rheumatological, and immmune disorders may be associated with pyoderma gangrenosum. The appearance of this disease may range from mild skin ulcers to life-threatening conditions. Generalized multiple ulcerative pyoderma gangrenosum is very rare. Here we report our experience with a case of multiple ulcerative pyoderma gangrenosum accompanied by ulcerative colitis. Methods: A 67-year-old man had cutaneous ulcers at multiple sites including the scalp, face, chest, abdomen, hands, and buttocks. He also developed gastrointestinal symptoms such as intermittent dyspepsia and bloody excrement. Debridement and irritation aggravated the disease progress. We gave a diagnosis of pyoderma gangrenosum with ulcerative colitis based on the clinical appearance and biopsy. The patient was treated with systemic intravenous steroid therapies and careful wound cares. Ulcers of the scalp and buttocks were treated with split thickness skin grafts. Results: Most of the multiple cutaneous ulcers were treated by systemic intravenous steroid therapies and wound cares. The rest of the ulcers were treated with skin grafts. Systemic intravenous steroid therapy was used to treat the ulcerative colitis. Conclusion: Generalized multiple ulcerative pyoderma gangrenosum is very rare. Without making an accurate diagnosis, hasty surgical treatments could aggravate the progression of the disease. Additionally, care should be taken to systemically treat underlying disease as well as administrating local treatments for the skin lesions. Intravenous systemic steroid therapy and skin grafts are useful treatments for generalized pyoderma gangrenosum.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.113-116
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• 2014

A 52-year-old man was referred to our hospital due to fever and myalgia that occurred 2 weeks earlier. He showed a complete atrioventricular block on his electrocardiogram, and his vital signs were unstable. On his transthoracic echocardiograph, the 1.5 cm vegetation in the aortic valve with severe aortic regurgitation suggested infective endocarditis. His transesophageal enchocardiograph showed abscess in his mitral-aortic intervalvular fibrosa and vegetation was suspected on his anterior mitral valve leaflet. The patient underwent an emergent operation for valve replacement with temporary epicardial pacing. Intraoperatively, the septal leaflet of his tricuspid valve was injured during the debridement of the abscess pocket that was extended to the membranous septum. The aortic, mitral, and tricuspid mechanical valves were replaced with annular reconstruction without complications. After 14 days of intravenous antibiotics, we successfully changed the epicardial pacemaker into a transvenous DDD-type permanent pacemaker by placing a left ventricular lead via the coronary sinus and an atrial lead in the right atrium appendage. The patient was discharged in a tolerable state and was examined uneventfully in our hospital's outpatient clinic for 8 months.

• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.296-300
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• 2018

Penile shaft reconstruction requires adequate soft tissue characteristics as well as constant vascular pedicles when considering a perforator flap. The free flap technique using various donor sites and regional conventional and perforator flaps have been utilized for penile shaft reconstruction. Still, the free flap techniques include challenging surgical procedures in addition to postoperative management. The regional flap can be applied to limited defects due to the size and shape. We performed the bilateral superficial external pudendal artery (SEPA) perforator flaps in order to reconstruct a circumferential penile shaft defect. The circumferential wound has noted necrotic tissue involving superficial (Dartos) fascia. We underwent debridement, preserving deep (Buck's) fascia and corpus spongiosum. Thereafter, the soft tissue defect was covered with bilateral SEPA perforator flaps. The patient has been observed for 27 months, showing penile resilience without deformity or wound-related problems.