• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.123-129
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• 2019

Objective : Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision. Methods : The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the 'double incision' whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision. Results : Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection. Conclusion : The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.

• Journal of Chest Surgery
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• v.33 no.1
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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.

• Journal of Chest Surgery
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• v.22 no.1
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• pp.155-157
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• 1989

Median sternotomy is the incision of choice to allow access to the anterior mediastinum, heart, or both lungs. The vertical skin incision generally gives a poor cosmetic result. In certain patients particularly those who are asymptomatic and undergoing short, low risk procedures, cosmetic considerations are of relatively greater importance. A bilateral horizontal submammary skin incision with dissection of a flap including the subcutaneous tissue and breast allows exposure of the sternum so that a median sternotomy can be performed. We have performed this incision in 12 patients undergoing open heart surgery. Although obtaining the usual midsternal exposure takes some extra time, results have shown the va1ue of this approach and its benefit to the patients.

• Archives of Plastic Surgery
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• v.50 no.2
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• pp.142-147
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• 2023

Some of Asian eyelids have double fold and some do not. Many people tend to prefer double eyelid in aesthetic and functional reasons. Since the mechanism of double eyelid is bonding the eyelid skin to the eye-opening tissue, the principle of double eyelid surgery is also connecting the eyelid skin to levator component. Double eyelids are differentiated by their shape according to the height and curvature. The double eyelid surgery procedure is divided into incision method and nonincision method. And the incision method is subdivided into double fold line design, skin and oculi muscle incision or excision, pretarsal or preaponeurotic soft tissue excision, fixation of posterior lamella to anterior lamella, and skin suture. The nonincision method is to connect the posterior lamella and the anterior lamella as a thread only without an incision. A successful double eyelid surgery creates a fold well-balanced in height, curvature, and depth of the fold based on patient's preference. In this article, the author's own methods of performing surgery are described, with a step-by-step guide and surgical tips.

• Archives of Plastic Surgery
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• v.45 no.4
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• pp.325-332
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• 2018

Background Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. Methods A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctival incision and an elevator through the intraoral incision. Results The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. Conclusions The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2008.05a
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• pp.97-97
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• 2008

• Journal of Veterinary Clinics
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• v.30 no.4
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• pp.241-246
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• 2013

The objective of this study was to investigate the effects of implanted chitosan applied to surgically created wound in Japanese Macaque monkeys. 4 healthy Japanese Macaque monkeys were used. A 4 cm straight skin incision was made and undermined skin ($4{\times}4cm$) over on the 2 monkeys both sides of the dorsal midline, and a 4 cm circular skin incision was made on 2 monkeys both sides of the dorsal midline. One wound (left side) was implanted 1 mg (straight incision) and daily 0.2 mg (circular incision) of cotton type chitosan and the other wounds were treated with normal saline (3 ml) in monkeys. Each straight wound was closed with two interrupted sutures of 2-0 sutures. The monkey's circular skin incision is opened. At 14 days after initial wounding, each wound was taken for histological observations in monkeys. The inflammatory cells in the chitosan group are observed less than the control group, the collagen and the fibrin in the chitosan are observed more than the control group in monkeys. So the wound healing is moderately enhanced for chitosan treatment. The fibroblasts and the capillaries increased for chitosan treatment. The treatment of chitosan in wound is to promote healing.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.33-42
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• 2000

The purpose of this study was to compare the wound healing process after skin incision using scalpel, $CO_2$ laser and pulsed Nd:YAG laser in rats. After skin on the back was incised 3 cm long, rats were sacrificed at 1, 3, 7, 14, 21 and 28 days. Macroscopic, histologic and immunohistochemical examinations using the collagen type IV and the CD34 antibodies which are necessary to the forming process of new capillary were performed. Results obtained were as follows ; Macroscopically the initial wound healing of the laser group was about $1{\sim}2$ weeks slower than that of the scalpel group. There weren't however any remarkable differences in all groups in 4 weeks after incision. By histologic finding, acute inflammatory cells were more prominent during the initial wound healing in the scalpel group than in the other groups. Epithelialization started in the order of scalpel, $CO_2$ and Nd:YAG laser group after skin incision. By the Masson's trichrome stain, collagen synthesis in the Nd:YAG laser group was more slowly initiated than in the other groups. But it was completed at the $3{\sim}4$ weeks in all groups. Immunohistochemically, collagen type IV and CD34 expression were markedly increased at 2 weeks in the scalpel and $CO_2$ laser group. Meanwhile, in the Nd:YAG laser group, these reactions were observed later tan the other groups. Collagen type IV and CD34 expression were decreased in all groups after 4 weeks. These results suggest that $CO_2$ and Nd:YAG laser showed similar healing process compared with scalpel and a potential substitute for scalpel in skin incision.

• Journal of Veterinary Clinics
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• v.25 no.5
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• pp.379-384
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• 2008

The objective of this study was to determine output power for skin incision in 0.3 mm spot diameter $CO_2$ laser by measuring (1) the wound depth, (2) initial dermal tissue damage, (3) degree of wound healing at different power (4W, 5W and 6W) in beagle dogs. Three healthy 2-year-old beagle dogs were used. Four 2 cm straight skin incisions were made with 0.3 mm spot diameter $CO_2$ laser on the each dog's both side of dorsal midline in three beagle dogs. The skin incisions were performed for $10{\sim}15$ seconds for same dosage. And then each wound was closed with surgical stapler. At 0, 3, 7 and 14 days after initial wounding, each wound was taken for histological observation. On macroscopic and microscopic observation, initial incisional wound did not show difference in three group. And also re-epithelialization, dermal tissue damage and inflammatory response did not show significant difference among groups. This study reveals that 4W, 5W and 6W may be suitable output power in 0.3 mm spot diameter $CO_2$ laser for the skin incision in beagle dogs.

• Archives of Plastic Surgery
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• v.32 no.2
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• pp.245-249
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• 2005

Various surgical procedures have been described for treating osmidrosis axillare. Elimination of the apocrine glands is prime goal. Optimal operative procedure is characterized as follows: minimal axillary scar(which has cosmetic merits), less complications such as hematoma and seroma, short and less painful recuperating period, minimal damage to the skin and low recurrence rate. Three types of incision technique in subdermal shaving method have beeb commoly used. First, single incision method has an advantage of minimal scarring but more recurrence due to incomplete removal of apocrine glands may occur. Second, double incision technique(Bipedicled flap) has advantages of complete excision, low recurrence rate and relatively minimal scarring, but it could cause frequent necrosis of skin and folding of skin flap. Skoog's method is the third method, which makes four flaps by offset cruciate incisions. It is a better technique in aspect of complete excision of apocrine glands and low recurrence rate but has disadvantages such as development of hypertrophic scar or scar contracture in the line that lies perpendicular to natural axillary skin crease. We used a modified procedure which has shorter length in vertical and transverse incision compared with the classic Skoog's method. We dissected further subcutaneous tissue through the diamond-shaped incision and utilize wide operation field that provide adequate excision of subdermal tissue and proper hemostasis. Between 1999 and 2004, we operated 160 osmidrosis axillare in 80 patients in this technique. Most patients obtained satisfactory result with very low complications. Hematoma or seroma 3.1% Infection 0.6% Partial wound disruption 10% Recurrence 1.2%. Modified Skoog's method for treating osmidrosis axillae could be a optimal technique providing wide operation field for adequate excision of apocrine glands and proper hemostasis and leaving relatively inconspicuous scar and low incidence of scar contracture.