More Effective Facial Scar Revision in Asian

Facial scar is very stressful for patients and physicians, especially in the case of non-parallel to relaxed skin tension line (RSTL). In general, for long facial scar not parallel to RSTL, Z-plasty or W-plasty has been performed to change the direction of scar or divide it into multiple segmented scar. These methods would be suboptimal, however, in the instance of Asian skin prone to scar formation. So, we experienced good results for scar revision through scar excision and solid subcutaneous- dermal repair to minimize scar widening despite of leaving linear type of scar. From July 2004 to March 2007, our methods were undergone for facial scar longer than 3cm in 84 patients. All scars were excised along the scar margin and subcutaneous tissue and dermis were repaired using single layer of subcutaneous-dermal stitch with 4-0 or 5-0 PDS to elevate wound margin 3-4mm higher than adjacent skin surface. Skin was repaired with 6-0 Prolene. The rate of satisfaction was over 89%(75 of 84 patients), the mean scar widening was 0.61+/-0.20 mm, and secondary operations were made in 3 patients. The Asian skin has some characteristics such as thick skin, increased melanin, energetic proliferation of fibroblast, and vigorous collagen formation, etc. Because of characteristics of Asian skin mentioned above, the linear pattern repair, technically easier than Z-plasty or W-plasty, would be superior to them in terms of the results. The essentially important point for scar revision in linear pattern is very strong subcutaneous-dermal repair to make elevation of wound margin enough for tolerating the skin tension and preventing scar widening.

Multifactorial Factors of Diabetic Foot on Diabetes Mellitus Comparative Clinical Study

Among several kinds of diabetic complications reported, diabetic foot ulcers and lower extremity amputations are serious and expensive one. About 10 to 15% of people with diabetes mellitus experience that complication during their life time and half of all nontraumatic lower extremity amputation occur in people with diabetes. The prevention and care of diabetic complication of the foot continue to represent a major challenge to physicians. Neuropathy, infection, deformity and ischemia are major threats to the diabetic foot and overall functional well-being is the main concern of the diabetic foot patients. This retrospective study based on chart reviews 108 cases of diabetic patients: 54 cases of diabetic patients without foot problems and the other 54 cases with foot problems. The mean age of DM foot patients was 57.4 years and they suffered from diabetes for 12.9 years. The diabetic foot problems developed to gangrene, ulcer, and mummification in 33.2 days and their healing time required more than 40 days(mean 42.9 days). The patient of diabetic foot problems had higher level of blood sugar(p=0.023) and longer duration of diabetes mellitus(p=0.040). The most common site was digit, especially 1st and 2nd toe. Multiple lesions were involved in more than 10% of the patients. The majority of operation were debridement and closure, amputation, skin graft. The complications were wound disruption or delayed wound healing and partial skin graft loss. The incidence of diabetic foot was 2.6 times higher in peripheral neuropathic patient and the healing time was related to velocity of development of noticeable diabetic foot(Pearsson correlation coefficient). The peripheral neuropathy was significantly related to diabetic foot(p=0.000), and that was noticed in patients with longer duration of diabetic mellitus (p=0.023) and older age(p=0.032). The majority of DM foot patients was in the 5th to 7th decades(83.3%) and most of DM foot developed more than 5 years after DM diagnosis(91.7%). The mean healing time was 42.9 days and most common healing time was 5 weeks(38.8%). Managements of the diabetic foot require a multisystem approach that addresses the component problems of the neurovascular, skeletal, immune and integumentary system. A coordinated team effort by the plastic surgeon, vascular surgeon, endocrinologist, infectious disease specialist, neurologist, podiatrist as well as the physical therapist and social service representatives are often need to provide the diabetic patient with complete foot care.