• Archives of Plastic Surgery
• /
• 제33권1호
• /
• pp.107-112
• /
• 2006

If autogenous nail is lost in nail bed injuries, alternative effective nail bed protection material is questionable in postoperative follow up period. The conventional modality with autogenous nail coverage have several disadvantages such as drawback of maintenance, higher chance of loss and complex dressing step (eg. ointment apply for humidification and nail fixation using tape or bandage). So, we have studied the usefulness of adhesive silicone gel sheet for alternative nail bed protection material until the end of nail regeneration. From March 2003 to July 2004, we have experienced 215 traumatic nail bed injuries except fingertip loss. Among these patient, we classified two groups, 30 cases with autogenous nail protection(Group I) and 30 cases with adhesive silicone gel sheet protection(Group II). Mean full nail growth time was 3.6 months in group I and 3.8 months in group II. Mean final nail appearance score(0: poor, 4: excellent) was 3.0 in group I and 3.5 in group II. Adhesive silicone gel sheet protection(Group II) was slightly superior to the autogenous nail protection in final appearance, especially sterile matrix laceration. In conclusion, we believe that adhesive silicone gel sheet application is a simple, acceptable, alternative method for protecting nail bed with loss of autogenous nail. It has a number of advantages compared with autogenous nail such as better humidification, controllable hygiene, less pain, less hospitalization, less frequent visit, less chance of loss, avoiding complex dressing step and more even pressure with adhesiveness, flexibility and durability.

• Journal of Trauma and Injury
• /
• 제20권1호
• /
• pp.1-5
• /
• 2007

Purpose: Grafting with autograft skin remains the most effective method for treating skin defects. When insufficient donor sites are present or patients are afraid of the operation, a skin graft is impossible. Cultured allogenic keratinocytes speed wound healing by providing cover and by producing growth factors and extracellular matrix protein. We report an application of cultured allogenic keratinocytes ($Kaloderm^{(R)}$, Tegoscience, Seoul, Korea) in the treatment of an acute partial thickness skin defect. Methods: From March 2005 to January 2006, 20 patients with a partial thickness skin defect were treated with cultured allogenic keratinocytes. The wound was covered with a sheet of cultured allogenic keratinocytes and ointment with $Bactigras^{(R)}$ gauze. The wound was inspected every two or three days. We regarded completion of epithelialization as wound healing. Results: The mean period between time of injury and time of $Kaloderm^{(R)}$ application was 7.5 days. The time taken from application of $Kaloderm^{(R)}$ to complete closure of the wounds was 7.2 days. Conclusion: In view of the favorable outcome, cultured allogenic keratinocytes are safe and effective biologic dressing materials for use in the treatment of open wounds.

• Archives of Plastic Surgery
• /
• 제48권1호
• /
• pp.33-43
• /
• 2021

Background Acellular dermal matrices (ADMs) have become an essential material for implant-based breast reconstruction. No previous studies have evaluated the effects of sterility of ADM under conditions of radiation. This study compared sterile (irradiated) and aseptic (non-irradiated) ADMs to determine which would better endure radiotherapy. Methods Eighteen male Balb/C mice were assigned to the control group with no irradiation (group 1) or one of two other groups with a radiation intensity of 10 Gy (group 2) or 20 Gy (group 3). Both sterile and aseptic ADMs were inserted into the back of each mouse. The residual volume of the ADM (measured using three-dimensional photography), cell incorporation, α-smooth muscle actin expression, and connective tissue growth factor expression were evaluated. The thickness and CD3 expression of the skin were measured 4 and 8 weeks after radiation. Results In groups 2 and 3, irradiated ADMs had a significantly larger residual volume than the non-irradiated ADMs after 8 weeks (P<0.05). No significant differences were found in cell incorporation and the amount of fibrosis between irradiated and non-irradiated ADMs. The skin was significantly thicker in the non-irradiated ADMs than in the irradiated ADMs in group 3 (P<0.05). CD3 staining showed significantly fewer inflammatory cells in the skin of irradiated ADMs than in non-irradiated ADMs in all three groups after 4 and 8 weeks (P<0.05). Conclusions Under radiation exposure, irradiated ADMs were more durable, with less volume decrease and less deposition of collagen fibers and inflammatory reactions in the skin than in non-irradiated ADMs.

• Archives of Plastic Surgery
• /
• 제49권3호
• /
• pp.413-417
• /
• 2022

The authors present a unique case of osteonecrosis of a cortical half of a fibula free flap that has not been reported in the literature yet. This complication was associated with the impairment of the vascularization of periosteum in the cortical half of fibula that was fixated with a nonlocking reconstructive 2.0-mm plate and screws but other factors could have been involved. The patient was submitted to excision of a cemento-ossifying fibroma that resulted in a left hemimaxilectomy mesoinfrastructure defect classified as the Cordeiro type 2B. The 42-year-old female patient was submitted to reconstruction with an osteomusculocutaneous fibula free flap plus a segment of fibula graft. The two bone segments of the free flap used to reconstruct the anterior and left alveolar crest were fixated with a reconstructive 2.0-mm plate of matrixMANDIBLE system. The only reported complication was an oronasal fistula that healed with conservative treatment and the referred osteonecrosis of the external cortical half of the fibula free flap with plate exposure at 2.5 years postoperatively. Surgical excision of the osteonecrosed cortical half of the fibula with the plate and screws was performed, while the other cortical underwent bone union as corroborated by computed tomography scans.

• Archives of Plastic Surgery
• /
• 제49권6호
• /
• pp.710-715
• /
• 2022

Background The latissimus musculocutaneous flap (LD flap) is a useful option for breast reconstruction following mastectomy. It has the advantage of obtaining sufficient tissue padding and natural shape by using autologous tissue. However, with the emergence of the skin-sparing mastectomy technique and artificial dermis matrix, direct-to-implant (DTI) breast reconstruction has become the first choice of surgery. The purpose of this study was to compare the satisfaction levels of patients who underwent DTI and LD flap with implant using patient-reported Breast-Q results. Methods A retrospective study was performed reviewing the records of 49 women who underwent immediate breast reconstruction with DTI or LD flap with implant and responded to the BREAST-Q questionnaire after the operation. The patient-reported breast-Q results were analyzed and correlated to the demographic information and intraoperative information. Results A total of 26 patients who underwent reconstruction with LD flap with implant and 23 patients with DTI were identified and responded to the questionnaire after an average of 32.3 and 10.4 months postoperation, respectively. According to the patient response to the breast-q values, satisfaction with breast was 60.0 and 57.0 points, psychosocial well-being 61.0 and 60.0 points, and sexual well-being 41.0 and 43.0 points in the two groups. Overall, there was no significant difference in the breastQ score between the two groups. Conclusion Patients who underwent DTI breast reconstruction seemed equally satisfied with the appearance and outcome of their breast reconstruction compared with LD flap with implant. Therefore, it appears that DTI is adequately replacing LD with implant.

• Archives of Plastic Surgery
• /
• 제36권5호
• /
• pp.578-582
• /
• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Archives of Plastic Surgery
• /
• 제35권1호
• /
• pp.1-6
• /
• 2008

Purpose: In tissue engineering, it is important that the scaffolds have high affinity with cells for making efficient use of cells. The authors studied the binding affinity of human adipose stem cells(ASCs) to micronized acellular dermal matrix(alloderm) using biotin and avidin linkages.Methods: Human ASCs were harvested from adipose tissue obtained by abdominoplasty. ASCs($1{\times}10^4$, $5{\times}10^4$, $1{\times}10^5$, $5{\times}10^5$, $1{\times}10^6$, $5{\times}10^6$ cells) were attached to micronized alloderm(1mg) in three groups; 1) control group in which no ASCs and alloderm was treated; 2) serum group in which alloderm was exposed to fetal bovine serum; and 3) biotin group in which biotinylated cells were attached to biotinylated alloderm. The binding affinities were determined 1 day after making ASC-alloderm complexes. The proliferation rates were determined by XTT assays in 4, 7, 14, and 21 days and scanning electron microscopic examination was performed in 7 and 21 days after culture of ASC-alloderm complexes.Results: The binding affinities of the biotin group were significantly increased in all cell concentrations. Maximum binding affinity was observed at $5{\times}10^4/mg$ of micronized dermal matrix in biotin group. The viabilities were lowest in biotin group in contrast to binding affinity, but the difference was not significant. SEM showed well attachment of cells to micronized dermal matrix in all groups. Conclusion: The use of avidin/biotin facilitated human ASCs attaching to micronized acellular dermal matrix. This attachment would not disturb adipose stem cells viabilities. The present study suggests that avidin/ biotin can be used as making efficient use of cells in adipose tissue engineering.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제18권3호
• /
• pp.411-427
• /
• 1996

The purpose of this study was to observe the healing process and the distribution of fibronectin in injured condylar cartilage and bone by using LM and SEM. In order to perform this study, 40 male rat, weighing about 250g were selected. Under general anesthesia with Pentobarbital sodium, condylar cartilage and neck bone were resected. Then, the wound was irrigated with saline and closed with 5-0 chromic catgut and 4-0 silk by layer-to-layer suturing. The experimental rats were sacrificed by perfusion with 3% paraformaldehyde at 1st and 4th week after operation. The condylar process and surrounding tissues were cut, demineralized, dehydrated and embedded in paraffin. The histological observation of the specimens in LM level was performed after H-E stain and Azan stain. For localization of fibronectin, immunostaining was achieved by the avidin-biotin complex method. To study the change on condylar surface, the specimens were dehydrated, dried, gold coated and were observed with a scanning electron microscope(Hitachi S-2300). The results were as follows ; 1. The cartilage group and the bone group were repaired with epiphyseal cartilage layer on the cut surface as the normal control group. 2. The cut surface was repaired more quickly in the cartilage group than in the bone group. 3. Chondrocytes, diferentiated during healing, were stained strongly to anti-fibronectin, and fibronectin was supposed to participatein chondrocyte differentiation and cartilagenous matrix formation. 4. Fibronectin was distributed more in the new bone than in the old bone, and the osteoblasts surrounding it were also stained strongly. Fibronectin was supposed to participate in new bone matrix formation. 5. Fibronectin is supposed to be associated with the differentiation, migration and adhesion of chondrocyte and osteoblast and to participate in endochondral bone formation.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제18권3호
• /
• pp.488-499
• /
• 1996

Diabetes mellitus revealed a chronic disorder of lipid, carbohydrate and protein metabolism characterized by insulin deficiency, and a striking tendency toward development of atherosclerosis, microangiopathy, nephropathy, neuropathy and recently cardiomyopathy etc. The mechanism of heart failure in patients with diabetic cardiomyopathy is not clear but diabetic cardiomyopathy usually occurs in persons with long standing diabetes. After diabetes induced in made Sprague- Dawley strain rats by injection of streptozotocin(60mg/kg), cardiac tissue with hematoxylin-eosin and Masson's trichrome stain was examined at 3 days, 1, 2, 4, 6 weeks later under light microscope. The results were obtained as follows : 1. In H&E stain of control group, myocardiac cells were shorter than skeletal muscle cell, which was branched out and connected each other at terminal with striation, intercalated disk and nucleus at center of cell. 2. In MT stain of control group, a few of collagen fibrile were seen at periva scular interstium, but wasn't seen between skeletal muscle fiber, and cardiac muscle was seen in various size. 3. In MT stain of experimental group, increased collagen fiber deposition at perivascular interstiums were seen periodically. 4. In MT stain of experimental group, increased collagen fiber deposition at interstitial matrix between perimyocardiac cells were seen at 3 day, 4 weeks and 6 weeks after DM induction. 5. In H&E stain of experimental group, partial degeneration of myocardiac cells was seen after 4 weeks of DM induction. From above results, streptozotocin induced diabetes mellitus increased collagen around perivascular and between intercellular matrix in heart.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제29권6호
• /
• pp.494-498
• /
• 2007

Pleiotrophin or osteoblast-specific factor 1(HOSF-1) is a growth-associated protein present in bone matrix. This study was designed to study pleiotrophin expression in osteoblastic cells. Pleiotrophin was expressed by osteoblast-like cell line. Pleiotrophin expression increased following the proliferative phase and was minimal at the terminal phases of the induced differentiation of cultured MC3T3-E1 cells. Pleiotrophin expression represents another autocrine factor that may contribute to the physiologic control of induced bone formation. In this study, induced osteogenesis will be examined in the context of the osteoblast expression of and regulation by PTN. I hypothesized that PDGF-BB stimulation of PTN expression represents an important paracrine signal during the induced osteogenesis associated with periodontal and implant surgeries. The possible mediation by PTN of anabolic effects attributed to PDGF-BB stimulation was examined in cell culture models of osteoblast differentiation. These studies will contribute fundamental insights to osteoblast biology and insights regarding the potential use of factors such as PTN in the clinical environment.