• 대한의생명과학회지
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• 제6권2호
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• pp.119-129
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• 2000

피부는 인체의 표면을 보호하는 중요한 기관으로 피부가 손상되었을 경우 상처 재생은 염증기, 상피화기, 수복기의 정상적인 재생 단계를 거치며 치유된다 최근 저강도 레이저의 생물학적 효과로서 상처 재생과의 밀접한 관련성이 알려지고 있다. 본 연구는 저강도 레이저가 상처 재생에 미치는 유의한 효과를 세포 형태학적으로 확인하기 위해 실험적으로 유도한 가토 피부 상처 (2$\times$2 cm)에 12일 동안 5 Hz, 830 nm, 1.6 J/$cm^2$의 자극강도 (10 min/day)로 상처면에 레이저를 적용한 결과, 다음과 같은 곁과를 얻었다. 레이저 조사군의 경우 결합조직의 수복과 상피의 재형성이 대조군과 비교했을 매우 빠르게 진행되는 것으로 관찰되었으며, 특히 섬유아세포의 활성과 육아조직 합성율이 유의하게 증가되는 것으로 확인되었다. 이상의 연구 곁과를 종합해 달 때 유효한 치료강도의 저강도 레이저 자극은 피부의 개방성 창상 및 욕창 등의 상처 치유를 촉진할 수 있는 것으로 사료된다.

• 대한두개안면성형외과학회지
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• 제16권3호
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• pp.143-146
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• 2015

In this report, we present a scalp defect reconstruction with lateral arm free flap. We highlight the difficulty in obtaining a recipient vein and the venous drainage managed through an open end of the donor vein. A 52-year-old woman presented with a pressure sore on the left scalp. A lateral arm free flap was transferred to cover this $8{\times}6cm$ defect. The arterial anastomosis was successful, but no recipient vein could be identified within the wound bed. Instead, we used a donor venous end for the direct open venous drainage. In order to keep this exposed venous end patent, we applied heparin-soaked gauze dressing to the wound. Also, the vein end was mechanically dilated and irrigated with heparin solution at two hour intervals. Along with fluid management and blood transfusion, this management was continued for the five days after the operation. The flap survived well without any complication. Through this case, we were able to demonstrate that venous congestion can be avoided by drainage of the venous blood through an open vessel without the use of leeches.

• Archives of Plastic Surgery
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• 제45권4호
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• pp.375-378
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• 2018

In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasound-guided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.

• Journal of Chest Surgery
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• 제15권4호
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• pp.422-427
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• 1982

A clinical analysis of 82 cases who were sustained the penetrating gun-shot wound in the chest by 8 bullets was done during 4~ year-period from January 1978 to August 1982 in the department of thoracic surgery, CA FGH. Among 82 cases, 61 cases [74.4%] of them were brought to the Hospital by ambulance, 21 cases [25.6%] were by Helicopter and 76 cases [92.7%] of them were admitted within 4 hours after wounding. Thirty eight [46.3%] patients were treated by closed thoracotomy only, 19 cases [23.2%]by open thoracotomy, 18 cases [22.0%] by primary closure with debridement, and 7 cases [8.5%] by vascular surgery. Causes of open thoracotomy were due to massive intrapleural bleeding in 16 cases, rupture of diaphragm in 2 Gases, and heart injury in one case. Among 25 cases of surgical complications, wound infection was most common in 16 cases [53.5%] and recurrent pneumothorax in 3 cases [10%], empyema in 3 cases [10%], and BPF in one case [3.3%]. Hospital mortality was seen in 6 cases due to hypovolemic shock and respiratory insufficiency in 4 cases, spinal shock in 2 cases due to spinal injury.

• Journal of Trauma and Injury
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• 제37권2호
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• pp.147-150
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• 2024

This case report describes the management of a 51-year-old female patient who arrived at the emergency room with a stab wound to the upper right chest. Immediate medical interventions were undertaken, including blood transfusions and endotracheal intubation. To prevent tension and control bleeding, gauze packing was applied directly through the large open wound. Further surgical exploration identified a laceration in the lung, necessitating a right upper lobe resection. Postoperatively, the patient's vital signs stabilized, and she was subsequently discharged without complications. This case highlights the decision-making process in selecting between an emergency department thoracotomy and an operating room thoracotomy for patients with penetrating chest trauma. It also illustrates the role of gauze packing in managing tension and hemorrhage. In summary, gauze packing can be an effective interim measure for stabilizing patients with traumatic injuries, unstable vital signs, and large open chest wounds, particularly when a chest tube is already in place, to prevent tension and facilitate bleeding control prior to surgical intervention.

• 대한족부족관절학회지
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• 제23권3호
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• pp.110-115
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• 2019

Purpose: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. Materials and Methods: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. Results: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. Conclusion: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.

• Advances in pediatric surgery
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• 제2권1호
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• pp.8-16
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• 1996

Laparoscopic appendectomy is relatively well-established as an alternative to conventional open appendectomy by many laparoscopic surgeons. However, experience in the pediatric population remains limited. Over a period of 2 years, a total of 155 pediatric patients with acute appendicitis or complicated appendicitis were studied to compare laparoscopic and open appendectomies in childhood. Laparoscopic appendectomy was attempted in 49 patients and completed in 48 patients(98.0%). Open appendectomy was performed in 107 patients. The severity of disease, age, and male to female ratio were similar in both groups. The operation time was shorter in the laparoscopic group than open group but the difference was not significant statistically($43.7{\pm}11.3$ minutes versus $49.0{\pm}21.4$ minutes, p=0.066). In the laparoscopic group, the mean duration of surgery for the former half patients was significantly longer than for the latter half($49.6{\pm}9.2$ minutes versus $38.1{\pm}10.3$ minutes, p=0.001). The mean number of doses of analgesia required postoperatively was significantly less in patients undergoing laparoscopic appendectomy($2.4{\pm}1.8$ versus $3.3{\pm}2.5$, p=0.021). There were only 2(4.2%) wound infections after laparoscopic appendectomy compared with 10(9.3%) complications including 7 wound infections, 1 intestinal obstruction, and 2 pulmonary complications after open appendectomy, but the difference was not significant(p=0.614). Patients undergoing laparoscopic appendectomy had a shorter period of hospitalization($3.2{\pm}2.2$ days versus $6.4{\pm}1.6$ days. p=0.001). The present study suggests that laparoscopic appendectomy shortens operating time and hospital stay with diminished postoperative pain. Laparoscopic appendectomy in children offers advantages over open appendectomy as noted in adults. The authors consider laparoscopic appendectomy to be the reasonable alternative to open appendectomy in children.

• 동의생리병리학회지
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• 제19권1호
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• pp.92-97
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• 2005

Inhibition of inflammatory response, acceleration of basal cell growth, and balanced synthesis of extracellular matrix (ECM) are important in healing of cutaneous open wounds. In order to evaluate the healing effects of water extracts of Radix Astragali (the root of Astragalus membranaceus (Fisch.)) on open wound at early stage, the experimental open wounds were generated on the dorsal sides of SD rats under anesthesia. The boiled-water extracts of Radix Astragali $(100{\mu}l)$, soaked into an occlusive film dressing were applied once a day for eleven consecutive days. The healing process was assessed by measuring macroscopic appearance and wound areas of the open wounds. The molecular aspects of healing process by Radix Astragali extracts were also investigated by Hematoxylin-Eosin (H-E) double staining and immunohistological staining of collagen type I in the healed skin area, implying cell density and linear alignment of the granulation tissue, and ECM synthesis and its remodeling, respectively. The Astragali radix extracts were found to significantly accelerate the cutaneous wound healing by suppressing the inflammation and stimulating the basal cell growth in wounded area, as compared to epidermal growth factor (EGF).

• Journal of Chest Surgery
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• 제33권1호
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• pp.20-25
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• 2000

Background: Median sternotomy remains the standard approach used by surgeons for most intracardiac operations but the residual scar is cosmetically unsatisfactory. To avoid an unsightly midline scar we have tried to use alternative skin incision (bilateral subm-ammary skin incision) to median sternal skin incision, In this study we have tried to compare different postoperative results of wound between two different skin incisional methods. Material and Method: Between June 1997 and June 1998, a bilateral subma-mmary skin incision combined with vertical sternotomy was performed in 21 pediatric female patients (submammary group)to repair acyanotic congenital heart disease. after the period we carried out a retrograde study about postoperative wound states comparing this incision with median sternal skin incision controls in whom there were 23 pediatric pat-ients (control group). Result: Patients' age ranged from 14 to 96 months(mean 38.2 months) Mean duration of subcutaneous drains using Hemovac which was used only in the patients of submammary group was 4.2 days and total amount of the drained effusion was 51.1 ml. Postoperative wound complications included wound eruption in one patient wound disruption in one patient and skin necrosis in 3 patients in submammary group and included wound disruption in 4 patients in controls. mean duration required for wound healing was 15,5 days in submammary group versus 10.4 days in controls. The mean scar length was 12.5 cm in submammary group versus 11.3 cm in controls. The average follow-up was 8.2 months in submammary group versus 9.0 months in controls. In submammary group 3 patients parents(14.3%) were pleased with their cosmetic results of wound scar but 8(38.1%) were dissatisfied. Among the 23 patients in control group 8(34.8%) were pleased but 8(34.8%) complained ofunhappiness with the scar.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.393-399
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• 2008

Purpose: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. Methods: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. Results: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. Conclusion: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.