• 대한두개안면성형외과학회지
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• 제21권1호
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• pp.49-52
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• 2020

The specialized structure of the upper eyelid ensures complete closure of the eye and eyeball sealing. An upper eyelid injury can cause various symptoms associated with eyeball trauma, not just scar formation or eyelid deformity. In this report, we describe a case of lagophthalmos observed after wound repair in a patient with a crushing injury caused by a grinder. Several surgical techniques are used to treat lagophthalmos or scar contracture. In most cases, a releasing procedure is performed after 6 months of initial repair. However, if the patient has severe symptoms that are not relieved by conservative care, early revision is inevitable. We describe a case of early lagophthalmos successfully resolved with pentagonal wedge resection, fat redistribution, and full-thickness skin grafting. After the revisional surgery, we observed that the patient regained the ability to completely close the injured eyelid, with restoration of function and favorable cosmetic outcomes. Pentagonal wedge resection to release a retracted structure, fat redistribution to prevent readhesion, and full-thickness skin grafting for enough amount of skin to regain upper eyelid function is useful for scar release and lagophthalmos following crushing injuries of the upper eyelid.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.425-432
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• 2013

Background Recently, the number of thyroid surgery cases has been increasing; consequently, the number of patients who visit plastic surgery departments with a chief complaint of swallowing deformity has also increased. We performed a scar correction technique on post-thyroidectomy swallowing deformity via platysma flap with Z-plasty and obtained satisfactory aesthetic and functional outcomes. Methods The authors performed operations upon 18 patients who presented a definitive retraction on the swallowing mechanism as an objective sign of swallowing deformity, or throat or neck discomfort on swallowing mechanism such as sensation of throat traction as a subjective sign after thyoridectomy from January 2009 till June 2012. The scar tissue that adhered to the subcutaneous tissue layer was completely excised. A platysma flap as mobile interference was applied to remove the continuity of the scar adhesion, and additionally, Z-plasty for prevention of midline platysma banding was performed. Results The follow-up results of the 18 patients indicated that the definitive retraction on the swallowing mechanism was completely removed. Throat or neck discomfort on the swallowing mechanism such as sensation of throat traction also was alleviated in all 18 patients. When preoperative and postoperative Vancouver scar scales were compared to each other, the scale had decreased significantly after surgery (P<0.05). Conclusions Our simple surgical method involved the formation of a platysma flap with Z-plasty as mobile interference for the correction of post-thyroidectomy swallowing deformity. This method resulted in aesthetically and functionally satisfying outcomes.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.551-555
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• 2012

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity, and the standard treatment is extensive surgical excision. Cesarean scar endometriosis is a type of cutaneous endometriosis arising on or near a Cesarean section scar. A 44-year-old woman presented with a $9{\times}6$ cm sized dark-brown, stony-hard, irregular, lower abdominal mass of four years duration. The patient had a history of two Cesarean deliveries, 14 and 16 years ago. Suspecting endometriosis, we excised the tumor conservatively rather than extensively to prevent incisional hernia considering the benign nature of the tumor and the low possibility of recurrence because the patient's age was near menopause, along with simultaneous bilateral salpingo-oophorectomy that was performed in this case. On reconstruction, mini-abdominoplasty was adopted to avoid possible wound complications and cosmetic deformities. The patient was satisfied with the cosmetic results, and neither recurrence nor functional problems occurred during the 1-year follow-up period. Plastic surgeons should keep in mind the possibility of cutaneous endometriosis in an abdominal mass of a female of reproductive age with a previous history of pelvic or intra-abdominal surgery. An optimal result from oncological, functional, and cosmetic standpoints can be achieved with conservative excision followed by mini-abdominoplasty of extensive Cesarean scar endometriosis.

• Tribology and Lubricants
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• 제31권3호
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• pp.125-140
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• 2015

In this paper, we present the results of the wear analysis of journal bearings on a stripped-down single-cylinder engine during start-up and coast-down by motoring. We calculate journal bearing wear by using a modified specific wear rate considering the fractional film defect coefficient and load-sharing ratio for the asperity portion of a mixed elastohydrodynamic lubrication (EHL) regime coupled with previously presented graphical data of experimental lifetime linear wear in radial journal bearings. Based on the calculated wear depth, we obtain a new oil film thickness for every crank angle. By examination of the oil film thickness, we determine whether the oil film thickness at the wear scar region is in a mixed lubrication regime by comparing dimensionless oil film thickness, h/σ, to 3.0 at every crank angle. We present the lift-off speed and the crank angles involved with the wear calculation for bearings #1 and #2. The dimensionless oil film thickness, h/σ, illustrates whether the lubrication region between the two surfaces is still within the bounds of the mixed lubrication regime after scarring of the surface by wear. In addition, we present in tables the asperity contact pressure, the real minimum film thickness at the wear scar region, the modified specific wear rate, and the wear angle, α, for bearings #1 & #2. To show the real shape of the oil film at wear scar region, we depict the actual oil film thickness in graphs. We also tabulated the ranges of bearing angles related with wear scar. We present the wear volume for bearings #1 and #2 after one turn-on and turn-off of the engine ignition switch for five kinds of equivalent surface roughness. We show that the accumulated wear volume after a single turn-on and turn-off of an ignition switch normally increases with increasing surface roughness, with a few exceptions.

• Archives of Plastic Surgery
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• 제42권1호
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• pp.20-27
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• 2015

Background Hypertrophic scars and keloids are associated with abnormal levels of growth factors. Silicone gel sheets are effective in treating and preventing hypertrophic scars and keloids. There has been no report on the change in growth factors in the scar tissue following the use of silicone gel sheeting for scar prevention. A prospective controlled trial was performed to evaluate whether growth factors are altered by the application of a silicone gel sheet on a fresh surgical scar. Methods Four of seven enrolled patients completed the study. Transforming growth factor (TGF)-${\beta}1$, platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) were investigated immunohistochemically in biopsies taken from five scars at 4 months following surgery. Results In both the epidermis and the dermis, the expression of TGF-${\beta}1$ (P=0.042 and P=0.042) and PDGF (P=0.043 and P=0.042) was significantly lower in the case of silicone gel sheet-treated scars than in the case of untreated scars. The expression of bFGF in the dermis was significantly higher in the case of silicone gel sheet-treated scars than in the case of untreated scars (P=0.042), but in the epidermis, the expression of bFGF showed no significant difference between the groups (P=0.655). Conclusions The levels of TGF-${\beta}1$, PDGF, and bFGF are altered by the silicone gel sheet treatment, which might be one of the mechanisms of action in scar prevention.

• Archives of Plastic Surgery
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• 제38권2호
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• pp.194-198
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• 2011

Purpose: Heterotopic calcification is the abnormal deposition of calcium salts in tissues other than bone and enamel, and it occurs in the form of dystrophic calcification or metastatic calcification. This deposition can occur under many conditions, but in some rare cases, it may develop in burns and nonhealed scars. It is difficult to treat the combination of heterotopic calcification and ulceration in scar tissues by using conservative therapy and to determine the margin of excision in such cases. Our study proposes the use of intraoperative C-arm-guided mapping of lesions with heterotopic calcification, and adequate excision of ulcers in chronic scars where heterotopic calcification is also observed. Methods: This study included 2 patients and was conducted from January 2010 to July 2010. The first patient was a 63-year-old woman who presented with atypical calcium deposits and chronic ulceration in the lower one-third region of the right leg. The second patient was a 38-year-old man who presented with a nonhealing ulcer that had developed on the right leg 3 months earlier he had a history of 40% scalding burns on the entire body. Surgery is the most reliable method for treating heterotopic calcification therefore, both patients were treated using intraoperative C-arm-guided marginal mapping of heterotopic calcification, followed by release of contracture, and eventually split-thickness skin grafting. Results: Plain radiographs of the leg showed spotty radiopaque areas in the hard part of the scar well superficial to the underlying bones. Histopathological analysis revealed multiple foci of calcified deposits, increased fibrosis, and inflammation in the scar tissue. Surgery-related complications were not observed. Conclusion: C-arm guided excision of calcified scars and the release of contracture can cure nonhealing ulcers and may therefore prevent recalcification.

• Archives of Plastic Surgery
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• 제38권2호
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• pp.148-154
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• 2011

Purpose: As the Korean life style is becoming westernized at a rapid pace, the rate of breast cancer is growing at the same time. So, the case of breast reconstruction after mastectomy increases, too. Points of breast reconstruction are symmetry, scar, size, and shape. Especially symmetry and scar are more important than others for Korean. This study is aimed to identify the method of breast reconstruction that accomplished the best results in terms of symmetry and scar. Methods: A total 15 patients were operated on from March of 2005 to July of 2009. The 5 patients were reconstructed by mammoreduction method after periareolar incision, the 7 patients were reconstructed by pectoralismajor transfer with implant after periareolar incision, and 3 patient were reconstructed by both breast augmentation. Results: Follow up period was 20.2 months on average and no complications such as breast deformity were observed. In symmetry of breast, the satisfaction score of periareolar approach is 4.4 and the satisfaction score of other approaches are 4.2 (p>0.05). But in scar of breast, the satisfaction score of periareolar approach is 4.6 and the satisfaction score of other approaches is 3.4 (p<0.05). Conclusion: In conclusion, Author's method of breast reconstruction after removal of breast cancer through periareolar incision is effective method in patients who care about aesthetic result after mastectomy.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.323-328
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• 2012

Background Among the various methods for correcting nasal deformity, the composite graft is suitable for the inner and outer reconstruction of the nose in a single stage. In this article, we present our technique for reconstructing the ala and columella using the auricular chondrocutaneous composite graft. Methods From 2004 to 2011, 15 cases of alar and 2 cases of columellar reconstruction employing the chondrocutaneous composite graft were studied, all followed up for 3 to 24 months (average, 13.5 months). All of the patients were reviewed retrospectively for the demographics, graft size, selection of the donor site and outcomes including morbidity and complications. Results The reasons for the deformity were burn scar (n=7), traumatic scar (n=4), smallpox scar (n=4), basal cell carcinoma defect (n=1), and scar contracture (n=1) from implant induced infection. In 5 cases of nostril stricture and 6 cases of alar defect and notching, composite grafts from the helix were used ($8.9{\times}12.5$ mm). In 4 cases of retracted ala, grafts from the posterior surface of the concha were matched ($5{\times}15$ mm). For the reconstruction of the columella, we harvested the graft from the posterior scapha ($9{\times}13.5$ mm). Except one case with partial necrosis and delayed healing due to smoking, the grafts were successful in all of the cases and there was no deformity of the donor site. Conclusions An alar and columellar defect can be reconstructed successfully with a relatively large composite graft without donor site morbidity. The selection of the donor site should be individualized according to the 3-dimensional configuration of the defect.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.806-810
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• 2009

Purpose: Gynecomastia is an abnormal increase in the volume of the male breast. Subcutaneous mastectomy was the first surgical treatment for gynecomastia. But because of the complications such as nerve injury and scar formation, subcutaneous mastectomy has been substituted with liposuction. Recently various techniques including ultrasound - assisted liposuction has been used for treatment of gynecomastia. The purpose of this study is to evaluate the results of XPS$^{(R)}$ microresector(Shaver) for treatment of gynecomastia. Methods: 17 patients, 33 breasts of gynecomastia, Simon grade I or II have been treated with XPS$^{(R)}$ microresector(Shaver). The mean age was 24.5. The subcutaneous tissue and glandular tissue were removed with XPS$^{(R)}$ microresector(Shaver). The operation time, the weight of removed tissue and patients' satisfaction score were accessed. Results: The mean operation time was 78.2 minutes. The mean weight of removed tissue was 113.8 g. There was no significant complications such as necrosis, hematoma, infection or scar contracture. Patients' satisfactory score of scar, shape and confidence were 8.4, 8.2 and 8.4 respectively. As the average score was 8.3, almost patients were satisfied with their breasts. Conclusion: The authors have treated 17 patients suffering from gynecomastia with XPS$^{(R)}$ microresector(Shaver). We obtained short operation time, early recovery, minimal operative scar and less complications with XPS$^{(R)}$ microresector(Shaver) for the treatment of gynecomastia, and patients were satisfied with the results of our method. We concluded XPS$^{(R)}$ microresector(Shaver) is an alternative option for the treatment of gynecomastia.

• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 1995년도 춘계학술대회
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• pp.79-79
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• 1995

Although synthetic antisense oligodeoxynucleotides (ODNs) have been used to dissect gene function in vitro, technical difficulties of targeted delivery prevented the use of this approach for investigating the effect of gene products in vivo. Here we report the use of local delivery of antisense transforming growth factor-${\beta}$l (TGF-${\beta}$1) oligonucleotides to decrease the fibrosis in the skin wound. Adult wounds heal with scar-tissue formation, whereas fetal wounds heal without scarring and with a lesser inflammatory and cytokine response. We reasoned that strategy emptying antisense TGF-${\beta}$1 ODNs complementary to TGF-${\beta}$1 mRNA might decrease the scarring in dermal wound of mouse. To evaluate this concept, we tested the effects of antisense ODNs targeted to TGF-${\beta}$1 mRNA by topical application of the chemical on the skin wound. Phosphorothioate antisense ODNs was employed to retard their degradation. When antisense TGF-${\beta}$1 ODNs were applied into the wound site, there was a maked reduction of scar compared with control wound site, These effects of antisense TGF-${\beta}$1 ODNs on the scar formation were associated with decreased expression of TGF-${\beta}$1 gene. However sense TGF-${\beta}$l ODNs had no effect on expression of TGF-${\beta}$1 gene. Also, control wounds healed with excessive fibrosis, whereas the antisense treated wounds healed with less fibrosis. In conclusion, our results indicate that antisense TGF-${\beta}$1 ODNs could be used for amelioating scar formation during wound healing.