• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.52-57
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• 2016

Objective : Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. Methods : We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. Results : Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). Conclusion : When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

• 대한의생명과학회지
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• 제13권1호
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• pp.25-32
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• 2007

The purpose of this study was to investigate the effect of the high voltage pulsed Current (HVPC) stimulation on the healing rate and the proliferative activity of keratinocytes and IGF-I mRNA expression of an incisional wound in rat skin. Twenty male Sprague-Dawley rats ($265{\sim}290g$) were randomly divided into HVPC (n=10) and control group (n=10). Rats received 10 mm length of full-thickness incision wound on the back under the anesthesia. The HVPC group received electrical stimulation with a Current intensity of 50 V at 100 pps for a duration of 30 minutes, while the control group was given the same treatment without electricity for a week. Polarity was negative in first three days and positive thereafter. The wound length was measured and evaluated as percentage. The mean number of nucleolar organizer regions (NORs) per nucleus and level of IGF-I mRNA expression were calculated. The mean percent of wound closure were $51.17{\pm}17.76%$ and $80.71{\pm}11.91%$, respectively, in the sham treated control and HVPC stimulated groups (t=-4.308, P<0.001). The mean NOR number per nucleus of the keratinocytes in the control and HVPC group were $1.85{\pm}0.20$ and $2.70{\pm}0.23$, respectively (t=8.638, P<0.001). The IGF-I mRNA level were $0.76{\pm}0.44$ and $1.32{\pm}0.41$, respectively, in the control and HVPC stimulated wounds (t=2.906, P<0.01). There was a positive correlation between the mean NOR number per nucleus and IGF-l mRNA level with a Pearson product moment correlation coefficient of 0.72 (P<0.05). These findings suggest that the HVPC may activate the rRNA of the basal keratinocytes and upregulate the IGF-I mRNA levels by alteration of the electrical environment, and it may increase proliferative activity of the keratinocytes in the skin wound of the rat.

• The Journal of Korean Physical Therapy
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• 제12권3호
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• pp.319-329
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• 2000

The purpose of this study w8s to evaluate the effects of pulsed electromagnetic energy(Diapulse) and microcurrent on the wound healing in rabbits. 15 domestic rabbits were randomly assigned to the PRME(n=5). MC(n=5) and CON(n=91 group. Each rabbits were anesthetized with lidocaine HCL $2\%$. Skin wounds were created laterally on the back of IS domestic rabbits(33cm). From 24 hours after being injured, the rabbits of the PEME group were irradiated with an intensity of 3 at a 300 pulses per second, which were applied for 15 minutes every day during the 12 days. The MC group were stimulated with an intensity of $50{\mu}A$ at frequency of40 pulses per second, which were applied for 15 minutes every day during the 12 days. The CON group were not stimulated. The rabbits were sacrificed and the incised wound pans were processed appropriately for the light microscopic examination on the 3rd day, 6th day and 12th day before the beginning of wound treatment. The areas of wound were measured with metric graph paper. The results were as tallows. 1 The PRME and MC group compared with control group showed that wound closure rate increased on 6th, 12th day. 2. It was found that the CON group did not show a complete maturation and had a chronic inflammatory response. Judging from the irregularity of intercellular space and the loose alignment of connective tissue. these findings showed that wound healing was delayed. 3. It showed that inflammatory cells. fibroblasts and epithelial cells activity rapidly processed in the PEME group compared with the CON group. It was found that the PEMI; group showed a advanced remodeling of epithelial layer and a positive repair of connective tissue. 4. It showed that fibroblasts, epithelial cells and inflammatory cells activity rapidly processed in the MC group compared with the CON group. It was found that the MC group showed a improved remodeling of epithelial layer and a dense connective tissue.

• 한국임상수의학회지
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• 제18권4호
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• pp.418-423
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• 2001

각막상피의 창상치유에 중요한 역할을 하는 것으로 알려진 Nerve Growth Factor(NGF)의 내인성 변화와 국소적 투여효과를 알아보았다. 6마리의 Beagle 을 사용하여 비교군인 오른쪽 눈에만 6mm의 기계적인 각막 창상을 만들었고 왼쪽 눈은 대조군으로 사용하였다. 눈물은 수술후 1주일동안 매일, 각막 상피는 수술중 그리고 수술후 7일에 각각 채취하여 NGF 농도를 enzyme-linked immunosorbent assay (ELISA)를 사용하여 측정하였다. 2차 실험으로, 16마리의 Bealgle을 사용하여 오른쪽 눈에 위와 동일한 창상을 만든 후, 창상 부위가 회복될 때까지 recombinant human (rh) NGF (n=4), murine NGF (n=6) 그리고 anti-NGF blocking antibody (n=6)를 6시간마다 점안하였으며, 왼쪽 눈은 bovine serum albumin (BSA)를 점안하여 대조군으로 사용하였다. 창상 면적은 NIH image software를 이용하여 분석하였다. 대조군에 비하여, 비교군의 눈물내 NGF는 치유초기에 현저하게 증가하였으며, 각막 상피의 NGF도 유의적인 증가를 보였다. 그러나 rh NGF, murine NGF, anti-NGF blocking antibody처치군과 BSA처치군 간에는 각막창상 치유에 유의적인 차이가 인정되지 않았다. 각막창상후, rh NGF 혹은 murine NGF의 추가적인 국소점안은 정상개의 각막상피 치유에 효과가 없었으나, 창상후 초기 치유기동안 눈물과 손상받은 각막상피에서 내인성 NGF의 급격한 보상성 증가로 미루어 NGF는 각막 상피의 창상치유에 중요한 역할을 하는 것으로 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제39권
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• pp.5.1-5.9
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• 2017

Many congenital and acquired defects occur in the maxillofacial area. The buccal fat pad flap (BFP) is a simple and reliable flap for the treatment of many of these defects because of its rich blood supply and location, which is close to the location of various intraoral defects. In this article, we have reviewed BFP and the associated anatomical background, surgical techniques, and clinical applications. The surgical procedure is simple and has shown a high success rate in various clinical applications (approximately 90%), including the closure of oroantral fistula, correction of congenital defect, treatment of jaw bone necrosis, and reconstruction of tumor defects. The control of etiologic factors, size of defect, anatomical location of defect, and general condition of patient could influence the prognosis after grafting. In conclusion, BFP is a reliable flap that can be applied to various clinical situations.

• 한국산림과학회지
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• 제98권5호
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• pp.618-629
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• 2009

The objective of this study was to examine the impact of pruning (P treatment) and transplanting (T treatment) of Acer palmatum on cambial growth and compartmentalization of pruning wounds for one year after treatments. Changes of cambial electrical resistance (CER), sizes of pruning wounds, cambial growth of trunks and stems near the wounds, and total phenols at branch unions during the period were examined using a total of 49 trees. After harvesting, areas of discolored wood behind the wounds, relative proportions of extractives, holocellulose and lignin at branch unions were also determined. CER and the cambial growth of trunk at 30 cm above the ground (TGR) were inversely correlated, and differences of CER and TGR among three treatments were significant. TGRs of control, P treatment and P+T treatment after the treatments were 112.2%, 72.4% and 52.5% of the annual growth for the year before the treatments, respectively. The cambial growth rate of stem (SGR) at 1.5 cm above the branch bark ridge and the closure rate of pruning wound (WCR) for one year after treatments were positively correlated, and WCR of P treatment of 39.8% was significantly higher than that of P+T treatment of 31.8%. Wounds of P+T treatment formed greater discolored area per unit area of pruning wound (D/W Ratio) than those of P treatment significantly. Lower WCR and higher D/W Ratio of P+T treatment suggested less ability of compartmentalizing the wounds than P treatment. Total phenols at branch core of pruning wound for both treatments heightened a month after treatment, and then lowered. The contents at below core of the wound were higher than those at control ones continuously, while they became similar each other at above core. Relatively high phenol contents of the extractives at P+T treatment implied that trees with P+T treatment allocated more energy to compartmentalize their wounds. Holocellulose and lignin contents at the branch core of treated branch unions of both treatments were lower and higher, respectively, than at the same part of the union with living branch, as results of the tree reaction to protection from wounding and microbial invasion.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.309-314
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• 2011

Purpose: Necrotizing fasciitis is a life-threatening, destructive soft tissue infection with a very high rate of mortality that needs early diagnosis and aggressive treatment. Systemic Lupus Erythematosus (SLE) is a systemic, autoimmune disease and it's major cause of mortality is an infection. But necrotizing fasciitis in SLE is very rare and there have been only 22 cases reported in the literatures. We reported a patient of necrotizing fasciitis with SLE and reviewed 22 others from literature research. Methods: A 40-year-old female patient with a history of SLE for 6 years came to the emergency room. The patient complained of severe pain and swelling on her right leg. She was diagnosed as necrotizing fasciitis and underwent emergency fasciotomy. As wound cultures showed variable organisms, she was treated with broad-spectrum antibiotics and underwent several surgical debridements. Then, the wound was treated with the V.A.C (Vacuum Assisted Closure) device and split thickness skin grafting was performed two times. Results: Skin graft was well taken within 2 weeks after operations and the patient was discharged to outpatient follow up. There was no complication related with surgery and she could walk without cane after 3 months. Conclusion: We treated a necrotizing fasciitis in a patient with SLE and reviewed 22 others from literature research. The case presented here suggests that necrotizing fasciitis is a rare disease in SLE patients, but should be considered in the differential diagnosis of soft tissue infection in SLE patients. A high index of suspicion is needed for early diagnosis and proper management in these patients.

• 대한응급의학회지
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• 제29권6호
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• pp.649-655
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• 2018

Objective: This paper reports the possibility of using of a locking horizontal mattress suture technique in repairing lacerations that are difficult to suture with staples. Methods: Data were collected retrospectively over a 6-month period regarding the routine repair of scalp lacerations: those in areas injured by a high energy blunt mechanism, continued to bleed after pressure, nonlinear or damaged skin repaired with a locking horizontal mattress technique, and simple interrupted technique. The effects of the two techniques used to repair scalp lacerations on wound healing, complication rate, and patient satisfaction were examined. The categorical variables are expressed as the number and percent. A Mann-Whitney-Wilcoxon test was used for statistical analysis. A P-value less than 0.05 was considered significant. Results: Thirty-seven consecutive patients with scalp lacerations presented for care. Wound closure was accomplished with the locking horizontal mattress sutures in 40.5% (n=15) (median length, 5.0 cm; interquartile range [IQR], 4.0-7.0 cm). Simple interrupted sutures (median length, 4 cm; IQR, 3.0-5.0 cm) were used in 59.5% (n=22) (P=0.015). The frequency of additional bandage compression (P=0.008), frequency of exudative hemorrhage (P=0.018), and suture mark frequency at suture removal (P=0.047) were significantly lower in the locking horizontal mattress group. Conclusion: The locking horizontal mattress suture, which has the advantage of a horizontal mattress suture, may be one of the ways that can be used alternatively to treat scalp lacerations that difficult to suture with staples.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.435-440
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• 2005

The reconstruction of deep soft tissue defects of lower extremities combined with bone exposure has been difficult problems. When it is impossible to raise local skin flap, we have been usually used the gastrocnemius musculocutaneous flap, cross leg flap or free flaps. However, In musculocutaneous flap, aesthetical appearance of the calf is not appropriate because of too bulky flap. Although the success rate of the free flap has improved, still failure of flap occurs in cases of the chronic ischemic state. As the concepts of perforator flap has recently developed and widely used due to its thin flap thickness. Between January 2002 to December 2004, we treated 7 patients with soft tissue defect in leg with chronic ischemic limbs with perforator island flap. Preoperative angiography were done in all case and we used 2 medial sural perforator flaps, 1 anterior tibial artery perforator flap, 1 posterior tibial artery perforator flap, 3 anterolateral thigh perforator flap. Partial necrosis of flap was seen in one patient but no further surgical procedure was required for wound healed spontaneously. Perforator island flaps are thin, reduce donor site morbidity, conceal donor site with primary closure and it is useful for resurfacing soft tissue defect of lower extremities.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.51-55
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• 2009

Purpose: Excessive apocrine gland secretion and bacterial decomposition cause axillary osmidrosis, which results in physical discomforts and social problems of patients. Many surgical procedures have been introduced such as skin excision and simple closure, local flap, skin graft, subcutaneous shaving and liposuction method, but the result was not satisfactory to patients and several complications, such as symptom recurrence, hematoma, seroma, delayed wound healing, skin flap necrosis and scarring remain as problems. Methods: For the purpose of reducing these problems, we employed combination treatment of liposuction and rasping method. From January 2006 to February 2008, Total 54 patients were treated with this procedure for bilateral axillary osmidrosis. Results: Follow - up evaluation period was from 2 months to 12 months, and the results were satisfactory. In our method, the length of skin incision is less than 1 cm, so the resultant scar is negligible. Apocrine glands in subcutaneous tissue were mostly removed by liposuction apparatus and remained other glands in subdermal area were mostly removed by rasping. The recurrence rate and postoperative complication were minimal. Conclusion: Our method is very simple, short operation time and excellent results without specific complication.