• Archives of Plastic Surgery
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• 제34권5호
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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.

• 생물환경조절학회지
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• 제22권2호
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• pp.146-153
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• 2013

토마토 접목순화장치 개발을 위한 기초실험의 일환으로 대목의 종류 및 활착실내의 온습도가 접목활착율에 미치는 영향을 조사하였다. 접목활착실의 온도는 $23^{\circ}C>17^{\circ}C>20^{\circ}C>26^{\circ}C$ 순으로 초기 활착율과 최종활착율이 높은 것으로 조사 되었으며, 상대습도는 높을수록 활착율은 양호한 결과를 나타냈다. 단 상대습도가 90% 이상 처리구에서는 곰팡이병에 의한 이병주 발생도 같이 증가하는 경향을 나타냈다. 대목의 종류에 따른 초기활착율은 'Kanbarune'의 $26({\pm}1)^{\circ}C$와 'Solution'의 $20({\pm}1)^{\circ}C$를 제외하고는 대목의 종류와 관계없이 모든 온도 처리구에서 83% 이상 양호한 활착율을 보였으나, 최종 활착율에서는 처리 온도간에 뚜렷한 유의적 차이를 나타내, $23({\pm}1)^{\circ}C$에서만 대목의 종류와 관계없이 85%에서 90%전후의 활착율을 보였고, $20({\pm}1)$와 $26({\pm}1)^{\circ}C$에서는 65~75% 정도로 활착율이 저하되었다. 특히, $27({\pm}1)^{\circ}C$에서는 이병주의 증가로 건묘생산율은 모든 대목처리구에서 65% 이하였다. 일반적으로 알려져 있는 고온기 접목활착 최적온도인 $23({\pm}1)^{\circ}C$에서는 대목의 종류에 따른 건묘생산율은 84~88% 전후로 대목 품종간 유의적 차이는 없었다. 접목활착실내 상대습도 조건에 따른 최종 접목활착율은 초기 2~3일간은 상대습도를 90%로 유지하고 나머지 7~8일간은 75% 정도로 유지하는 처리구에서 100% 접목활착 성공율을 나타냈고, 전기간 90%로 유지한 처리구와 1일 90%, 9일간은 75%로 유지한 처리구에서는 90%전후의 성공률을 나타냈다. 전반적으로 높은 상대습도 유지기간이 길수록 초기 활착율은 증가하는 경향을 보였으나, 고습도에서 장기간 묘를 양생할 경우, 곰팡이병 발생 등으로 최종 건묘생산율은 감소하므로, 초기 2~3일간만 90% 전후로 유지하고 나머지 구간은 75% 전후로 유지하는 것이 고온기 토마토 접목 활착율 향상을 위한 바람직한 조건이라 판단되었다. 각 처리간 묘소질에는 큰 차이를 나타내지 않았으나, 전반적으로 활착율이 양호했던 처리구에서 묘소질이 타 처리구에 비해 상대적으로 좋았으며, 이러한 경향은 특히 근권부의 형태적 특성을 조사한 결과에서 명료하게 나타났다. 이상의 결과 고온기 토마토 활착실내의 환경관리는 23도 전후의 온도에서 $80({\pm}5)%$의 상대습도로 관리하는 것이 건묘생산에 적합할 것으로 판단되었다.

• Archives of Plastic Surgery
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• 제35권6호
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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.

• 대한치과의사협회지
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• 제11권3호
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• pp.195-198
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• 1973

The authors have treated a squamous-cell carcinoma occurred in molar region of the right mandible in 52-year old woman by means of bony resection and banked tibial bone graft, and made the normal appearance of her face. The result as follow: 1) The healing of a graft is similar to the healing of an uninfected fracture except that it will take considerably longer. It is of the utmost importance that it should be well immobilized, otherwsie there is danger of absorption of bone and fibrous union. 2) Until the graft acquires a blood supply it is easily infected, for it has no defence against organisms, so it is most important to prevent wound infection set in.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.341-345
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• 2015

Background A tie-over dressing is the accepted method to secure skin grafts in order to prevent haematoma or seroma formation. We describe the novel application of a barbed suture tie-over for skin graft dressing. The barbs act as anchors in the skin so constant tensioning of the suture is not required. Methods From January 2014 to August 2014 we used the technique in 30 patients with skin defects requiring split-thickness or full-thickness grafts. Patient demographics, clinicopathological details and graft outcome were collected prospectively. Results The majority of cases were carried out for split-thickness skin grafts (n=19) used on the lower limb (n=20). The results of this novel technique were excellent with complete (100%) graft take in all patients. Conclusions Our results demonstrate the clinical application of a barbed device for securing skin grafts with excellent results. We find the technique quick to perform and the barbed device easy to handle, which can be applied without the need for an assistant.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.607-612
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• 2005

A traditional tie-over dressing may be applied to support the take of a skin graft. Although there are many advantage of this method, it has significant disadvantages, including time-consuming application. Furthermore, when the dressing is changed, the gauze becomes hard and can be stuck to the graft, causing damage and pain upon removal. The purpose of our study is to evaluate the effect of semi-occlusive dressing using polyurethane foam and film dressing($Allevyn^{(R)}$, $Opsite^{(R)}$) after full thickness skin graft. The authors treated 45 cases including burn scar contracture(n=38), syndactyly (n=1), absence of nipple-areolar complex(n=4), traumatic skin defect(n=1) and contact burn(n=1) with authors' method and 39 patients including burn scar contracture (n=39) with the tie-over dressing between 2000 and 2004. The patients in polyurethane foam and film dressing group ranged from 1 to 62 years of age (mean age, 15.1 years) and the patients in tie-over dressing group ranged from 2 to 60 years of age(mean age, 21.3 years). The postoperative results were analyzed according to the following measures: (1) the duration of graft-taking, (2) the admission period, (3) complications. Compared with the traditional tie-over dressing, polyurethane foam and film dressing was shown to be more successful in a reduced duration of graft-taking, in which was similar to the former in the rate of graft-taking, a reduced admission period and patient's discomfort. We concluded that semi-occlusive dressing using $Allevyn^{(R)}$ and $Opsite^{(R)}$ was an effective method after full thickness skin graft, which was easy to shape to difficult body locations, such as web spaces, fingers and maintains a moist environment for wound healing and does not stick to the wound.

• Archives of Plastic Surgery
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• 제43권5호
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• pp.418-423
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• 2016

Background Skin grafting is a relatively simple and thus widely used procedure. However, the elastic and structural quality of grafted skin is poor. Recently, various dermal substitutes have been developed to overcome this disadvantage of split-thickness skin grafts. The present study aims to determine the feasibility of RapiGraft as a new dermal substitute. Methods This prospective study included 20 patients with partial- or full-thickness skin defects; the patients were enrolled between January 2013 and March 2014. After skin defect debridement, the wound was divided into two parts by an imaginary line. Split-thickness skin grafting alone was performed on one side (group A), and RapiGraft and split-thickness skin grafting were used on the other side (group B). All patients were evaluated using photographs and self-questionnaires. The Manchester scar scale (MSS), a chromameter, and a durometer were used for the scar evaluation. The average follow-up period was 6 months. Results The skin graft take rates were 93% in group A and 89% in group B, a non-significant difference (P=0.082). Statistically, group B had significantly lower MSS, vascularity, and pigmentation results than group A (P<0.05 for all). However, the groups did not differ significantly in pliability (P=0.155). Conclusions The present study indicates that a simultaneous application of RapiGraft and a split-thickness skin graft is safe and yields improved results. Therefore, we conclude that the use of RapiGraft along with skin grafting will be beneficial for patients requiring reconstructive surgery.

• 생물환경조절학회지
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• 제18권4호
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• pp.385-392
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• 2009

접목 후 활착환경의 관리는 접목의 성공여부를 결정하는 중요한 요인이다. 일반적으로 활착초기 접목부위의 캘러스 분화를 촉진하고 식물체의 지나친 위조를 막기 위해 $25{\sim}30^{\circ}C$ 정도 온도와 90% 이상의 높음상대습도 조건하에서 관리하다가 활착이 진행됨에 따라 점차 온도 및 상대습도를 낮추고, 광 조사량을 늘려주는 환경관리방법이 제시되고 있다(Kim 등, 2001). 본 연구에서는 고추 접목묘의 활착 및 생육향상을 위한 활착단계별 환경조건을 제시하고자, 활착기간 중 온도, 상대습도 및 광 조건이 접목활착률 및 생육에 미치는 영향을 조사하였다. 암조건 하에서 총 6일간의 접목활착기간을 3단계로 나누어, 활착 1단계는 온도 $30^{\circ}C$, 상대습도 95% 조건하에서, 활착 2, 3단계에서는 온도($20^{\circ}C$, $25^{\circ}C$, 및 $30^{\circ}C$) 및 상대습도(75%, 85%, 및 95%) 조건을 달리 처리하였을 때, 접목활착률 및 생육을 조사하였다. 고추 접목묘의 활착을 위해서는 활착 초기 $30^{\circ}C$, 95% 상대습도 조건에서 2일정도 관리한 후, 이후 4일간은 온도와 상대습도 조건을 각각 $20{\sim}25^{\circ}C$, 75~85% 정도로 낮추어 주는 것이 바람직할 것으로 판단된다. 또한 접목활착기간 동안 온도 $30^{\circ}C$, 상대습도 85% 및 암 조건을 대조구로 하여, 활착기간 중 온도($25^{\circ}C$ 및 $30^{\circ}C$), 상대습도(65%, 75%, 및 85%) 및 광 조건(광 조사 유무, 광 조건 $45{\pm}2{\mu}mol{\cdot}m^{-2}{\cdot}s^{-1}$)을 달리하여 처리하였 때, 접목 활착률은 처리간 차이가 없었으며 활착기간 중 저온 저습의 광조사 기간이 길수록 생육이 증가하는 경향을 보여, $25^{\circ}C$ 온도조건하에서 저광 조사 및 65% 까지의 저습 조건이 고추 접목묘의 활착 및 생육촉진에 효과적인 것으로 판단된다.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.102-109
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• 2024

Background Skin defects in the hands are common injuries, and autologous skin grafting is the ideal treatment. However, complications can occur at the donor and recipient sites. This study compares the "Swing-door" technique with conventional skin grafting. Methods From August 2019 to February 2023, 19 patients with skin defects of hand underwent the "Swing-door" split-thickness skin graft (STSG) technique. The thin epithelial layer was elevated with proximal part attached. Skin graft was harvested beneath. Donor site was then closed with epithelial flap like a "Swing-door". The outcomes were evaluated in terms of healing time, scar formation, and pain at the donor and recipient sites. The data were compared with the conventional STSG. Results The "Swing-door" group had lower graft take percentages, but complications did not significantly differ between the two groups. The "Swing-door" technique resulted in better cosmetic outcomes, as evidenced by lower Vancouver Scar Scale scores, faster donor site epithelialization, and reduced pain and discomfort during the early postoperative period, as measured by Visual Analog Scale. Conclusion The "Swing-door" STSG is a useful alternative for treating hand skin defects.

• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.43-50
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• 2004

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.