Myxoid Solitary Fibrous Tumor on the Scalp

Myxoid solitary fibrous tumor (SFT) is very rare soft tissue neoplasm. It is microscopically composed of spindle cells which is individually separated by delicate band of collagen fibers. And this tumor cells are immunohisto-chemistrically highlighted by CD34. Myxoid SFT has indolent clinical course and a good prognosis, so it is important to make a diagnosis because of its morphological similarities to myxoid spindle cell neoplasms that have different prognoses and treatment. We report the case of a 20-year-old female with a myxoid SFT found in the left temporo-parietal scalp. This case report appears to be the first reported scalp occurrence of this rare tumor.

Optimizing Outcomes in the Reconstruction of Postburn Scar Hand Deformities

PURPOSE: Reconstruction of severe postburn hand deformities with flexion or extension contractures with finger webbing deformities, large hypertrophic scars of dorsal hand are frequently encountered problems in burn hand surgery. To obtain the good results after correction of various type of postburn scar hand deformities, we have used the sophisticated reconstructive procedures such as scar contracture release, skin graft, and use of acellular dermal matrix (ADM). We report reliability and usefulness of these novel updated procedures according the type of postburn hand deformities, and reviewed the literatures. METHODS: We had 82 postburn hand deformities. Among them we selected 7 patients of severe postburn hand deformities, which had different affected sites involving over 1/3 of hand. To reconstruct the finger flexion contractures, the scar contracture release and full thickness skin graft was most frequently performed. For correction of finger webbing deformities, the 5 flap Z-plasty for 1(st) web, dorsal and volar interposition flap for 2, 3 and 4 web, FTSG were used. The diffuse hypertrophic scar of dorsum of hand was reconstructed with total excision of scars, skin coverage with one piece of medium thickness STSG, and postoperative clenched hand position. The postburn palmar contractures was reconstructed with extensive contracture release followed by resurfacing with ADM (AlloDerm™) and thin STSG. The severe postburn abduction contractures of wrist was treated by total excision of scars, ADM (CGDerm™), and thin STSG. RESULTS: After 1 month to 1.6 years follow up, relatively satisfactory results were obtained in all patients. As complications, 1 case of recurrent palmar contractures, which was reconstructed with ADM (AlloDerm™) with thin STSG, were noticed. CONCLUSION: The postburn finger flexion contractures could be managed by the scar contractures release and FTSG. This method is very safe and reliable. For reconstruction of postburn finger webbing deformities, it is mandatory to use 5-flap Z-plasty for 1(st) webbing deformities, and dorsal and volar interposition flap for 2, 3 and 4(th) webbing deformities concomitantly with resurfacing with FTSG. The diffuse hypertrophic scars of dorsum of hand was managed by total excision of scars, resurfacing with one large piece of over medium thickness STSG, and postoperative clenched hand position. After release of scar contractures of hand, acellular dermal matrix (ADM) with thin STSG can be used in case of deficient FTSG donor site.

Ulnar Neuropathy at Elbow after Flap to Graft Conversion Method for Osmidrosis Axillae

Ulnar neuropathy at elbow is the second most common entrapment neuropathy following carpal tunnel syndrome. However, ulnar neuropathy secondary to abnormal strain of the ulnar nerve over the sulcus due to an postoperative osmidrosis axillae position is one of rare causes of ulnar neuropathy at the elbow. Following the operation of osmidrosis axillae, a patient's arm movements were restricted with elbow flexion in order to prevent hematoma from developing at the operation site. In this case presented here, the patient developed ulnar neuropathy 7 day post osmidrosis axillae operation. He had weakness in flexion of the fourth and fifth metacarpophalangeal joints on the right hand, and also weakness in finger straddling, in particular, abduction of the 5th finger on the left hand. Additionally, there was tingling sensation of the fourth and fifth finger and the hypothenar eminence on the left hand. Motor and sensory nerve conduction studies of the left ulnar nerve showed delayed conduction velocities over the left ulnar sulcus. Ulnar neuropathy at the elbow was diagnosed based upon the clinical presentation electrophysiological findings. The patient had been advised to avoid the posture with prolonged flexion of the elbow. The symptoms had been completely resolved spontaneously in 5 months without any surgical intervention. This case has shown that postoperative osmidrosis axillae positon could cause ulnar neuropathy associated with excessive strain of the ulnar nerve during prolonged flexion of the elbow.

Conservative Treatment with Silicone Gel Sheet of Aplasia Cutis Congenita: Case Reports

Aplasia cutis congenita represents a congenital absence of all skin layers, and it may occasionally extend through the bone and dura of the skull. Since the first report by Cordon in 1767, over 500 cases have been reported. Eighty percents of all cases are found in the scalp, and 20 percents of these cases involve extremities and trunk and are often bilaterally symmetrical. Histologic examination demonstrates a layer of thin dermal collagen without overlying epithelium or adnexal structures. It has several clinical groups classified by the location and pattern of the skin defect, associated anomalies and the mode of inheritance. Its management is controversial and may be conservative treatment or the surgical option to provide definite skin cover. In 1990, Wexler suggested that conservative treatment using Silvadene was the preferred option. We would like to present 2 cases in which silicone gel sheet as a conservative treatment modality led to favorable outcomes. It was invented for the treatment of hypertrophic scar but has been used and studied for the open wounds in recent years. The use of silicone gel sheet on congenital skin defect has many advantages: the danger of infection is minimized due to frequent washing; prolonged hospitalization is prevented; pain or bleeding is minimized for dressing changes because it doesn't adhere to the wound; and it can be used after the epithelization for the prevention of hypertrophic scar.

The Effects of Water Soluble Chitin on the Open Wound Healing in Rabbits

The purpose of this study was to evaluate effects of chitin on open wound healing in rabbits. Using 15 rabbits, a round, full thickness defect of skin with 2 cm in diameter was made on the ventral surface of the each ear. The experimental animals were divided into 3 groups: control group untreated group), base ointment group (group treated with base ointment), and chitin ointment group(group treated with water soluble chitin ointment). A total of 30 wounds were made and each subgroup was allocated 10. On the 7th day after initial wounding, each wound site including surrounding tissue was taken for macroscopic and histological observations. The amount of epithelialization and granulation tissue were measured by Image Analysis System. In macroscopic examination, larger amount of exudate and granulation tissue were observed in water soluble chitin ointment group compared to control and base ointment groups. In histological examination, water soluble chitin ointment group showed thick epithelium and larger amount of granulation tissue and fibroblast deposition. The areas of epithelialization and granulation tissue were significantly increased in water soluble chitin ointment group compared to control and base ointment groups. In conclusion, water soluble chitin accelerated open wound healing by accelerating reepithelization and granulation tissue formation.

The Effect of Water Soluble Chitin on Wound Healing in Rats

The effect of water soluble chitin on wound healing in rats Chitin and chitosan, polysaccharides made up of polymeric N-acetyl glucosamine and D-glucosamine, are widely found in nature, forming skeletons of crustaceans and insects as well as components of bacteria cell walls. Chitin and chitosan have been known to have many useful biological properties such as biocompatibility, biodegradability, antimicrobial activity, and wound healing property. The key-point of practical use of chitin was making water soluble form. The purpose of this study was to compare the wound healing effect of water soluble with insoluble chitin. Full-thickness skin incision was made on the backs of the Sprague-Dawley rats. Three groups composed respectively with saline, water insoluble chitin and water soluble chitin were embedded in the wounds. The wound breaking strength and the collagen-hydroxyproline content of the wounded skins were measured and histological examination was performed at the time of 3, 7, 10 days respectively after the procedure. The tensile strength was maximum in case of water soluble chitin. The amount of collagen hydroxyproline was minimum in water soluble chitin. The wound treated with the water soluble and insoluble chitin was completely reepithelialized and granulation tissue in the wound was observed at 7 days after initial wounding. The arrangement of collagen fibers in the skin was orderly and similar to normal skin.

The Effect of Deacetylation of Chitin and Chitosan on Wound Healing in Rats

Chitin and chitosan, polysaccharides made up of polymeric N-acetly glucosamine and D-glucosamine, are widely found in nature, forming the skeletons of crustaceans and insects, as well as the components of bacteria cell walls. Chitin and chitosan have been known to have many useful biological properties such as biocompatibility, biodegradability, antimicrobial activity, and wound healing. There properties have been known to be different depending on the degree of deacetylation of chitin, but it has not yet been fully evaluated. The purpose of this study was to evaluate the wound healing effect by the degree of deacetylation. Full-thickness skin incision was made on the backs of Sprague-Dawley rats. Three concentrations of powder, comprising 90% chitin, 50% chitin and 10% chitin, were separately embedded in the wounds of 3 rat groups. The wound-breaking strength and the collagen-hydroxyproline content of the skin at the wound sites were measured and histological examination was performed at postoperative 3, 7, and 10 days. The 50% chitin group had the highest tensile strenght of all groups. But the 50% chitin and 90% chitin groups had the lowest collagen hydroxyproline levels among all groups. The wounds treated with 50% chitin powder were completely reepithelialized and granulation tissue in the wound was observed 7 days after initial wounding. The arrangement of collagen fibers in the skin was ordered and similar to normal skin The 50% chitin powder is considered to be the most efficient wound healing accelerator among different concentrations of chitin powder.

A Comparative study of the Implants used in the Management of Blowout Fracture

We developed an animal model to recreate the condition of an open fracture in communication with the maxillary sinus. We then studied wound healing of the sinus wall structures following fracture in the presence of autogenous bone and alloplastic implant. This model is designed to simulate the repair of an orbital floor fracture in humans. The New Zealand White rabbit was used as the animal model. Standardized 8mm defects were made bilaterally in the maxillary sinuses to include bone and mucosa in 36 rabbits. Two different implants and autogenous calvarial bone graft were placed in the soft-tissue pockets to obturate the defects, exposing one surface of the implant to the open sinus. Medpor porous polyethylene, silicone and calvarial bone implant were compared. Animals were killed at 1, 2 and 8 weeks after implantation. Gross examination of the specimens for the amount of mucosal closure and implant tissue fixation was performed. Histological sections were evaluated for bone and soft-tissue morphology juxtaposed to the implant. Complete closure of the mucosal defect was demonstrated with each type of implant. Medpor implants showed both vascular and soft-tissue ingrowth into pores by week 1. Bone ingrowth was seen by week 2. Closure of the Medpor obturated defects occurred more rapidly than in the silicone group. The Medpor implants and calvarial bone demonstrated bone and soft-tissue fixation, callus formation and maturation, while mature overlying mucosa was reconstituted over the defects. Silicone implants demonstrated a fibrous tissue reaction within 1 week of implantation and they never became fixed to bone or soft tissue. Maxillary sinus wall regeneration occurred in all defects. This study supports clinical observations of maxillary sinus wall regeneration in humans.

A Case of Necrotizing Fasciitis / 대한피부과학회지

Necrotizing fasciitis, first described by Wilson in 1952, is one of the most dramatic infectious diseases which develops at the level of superficial fascia and involves the overlying dermis. Clinical diagnosis is often initially confused with cellulitis, and delay in the diagnosis and treatment is associated with high mortality in the range from 30% to 70%. Early diagnosis and prompt excision of all devitalized tissue are critical because any remaining necrotic tissue will continue the rapidly progressive infectious process. We, herein, report a 64-year-old man who was presented with a typical clinical course of necrotizing fasciitis.

The Response of diabetic Rabbit Femoral Artey on the Electrical Stimulation and vasodilators

This experiment was aimed to investigate the contractile responses of the fermoral artery to the electrical stimulation and the inhibitory effects of verapamil and papaverine on the electrical stimulation of the fermoral artery in the control (n=46) and the diabetic rabbits(n=40). Diabetic rabbits were made by and administration of alloxan (100 mg/kg) intravenously and sacrified 8 weeks later. Femoral arterial rings 3 mm in length were taken and mounted on the force-displacement transducer for the measurements of isometric tension. All experiments were done in the aerated (95% O2 with 5% CO2)biological chamber filled with Kreb's solution and the initial tension of 1.5g was applied to the rings. After 1 hour of equilibrium of the rings, the contractile responses of the electrical stimulation on the femoral arterial rings were taken without vasoactive drugs and then, under verapamil and papaverine solution. And we compared the morphologic findings of the vessels in the two groups in relation to the functional changes by transmission electron miroscopy. The results are as follows: 1. The contractile responses in the presence of verapamil or papaverine solutions to the electrical stimulation were lowed significantly in the fermoral arterial rings of the diabetic rabbits compared with that of the control rabbits (verapamil; 10M~10M: p<0.01, papaverine; 10M & 10M: p<0.01). 2. Transmission electron microphotographs showed many morphological differences of the femoral arteries between the control and the diabetic rabbits. These were irregularities of the internal elastic lamina and the hypertrophy of the cytoplasms of the smooth muscle cells. And also, there were many vacuoles in the cytoplasm of the endothelial cells, lateral to the internal elastic laminaes, and between the smooth muscle cells in the diabetic rabbit femoral artery. By this study, we found that the contractile responses of the femoral arterial rings to the electrical stimulation were decreased in the diabetic rabbits, and the vasodiatory effects of verapamil and papaverine on the electrically stimulated femoral arterial rings were also lowered in the diabetic rabbits compared with the control rabbits. These changes of the vasular responses of the diabetic vessel may be associated with morphological changes manifested by transmission electron microscopy or any other functional derangement of the vessels.

RECONSTRUCTION OF FINGER DEFECTS WITH PEDICLED VENOUS ISLAND FLAP

Reconstruction of a injured digit needs good aesthetic result as well as functional recovery. Since Honda deported the first clinical application in 1984, the venous flap has been used increasingly for skin and soft tissue defects of the fingers and hands. From november 1992 to december 1995, 12 single-pedicled venous island flaps from hand dorsum were used for coverage of soft tissue defects of fingers over exposed bone, tendon, or joint. The pedicle of the flap included one superfitial dorsal vein of hand and its perivenous areolar tissue. Eight of twelve flaps survived completely and four necrosed partially possibly due to excessively long pedicle and poor perivenous areolar tissue. All donor sites were closed directly. Most patients were satisfied with postoperative result cosmetically and functionally. This method has several advantages : easy versatility and operability with superficial location of numerous dorsal vein, making good contour owing to proper thickness of flap, minimal donor site morbidity, and short operation time. We consider that the pedicled venous island flap is another reliable and useful method for reconstruction or finger defects as long as the pedicle length is not long and the perivenous areolar tissue is enough.

Osteogenic potentails of vascularized periosteal flap of rabbit membranous bone

No abstract available.

The effect of degenerated muscle graft on nerve regeneration of the rat sciatic nerve defect

No abstract available.

Tendon healing

No abstract available.

The clinical study of primary salivary gland tumors

No abstract available.

Malignant melanoma of the conjunctiva: report of two cases

No abstract available.

Nasal reconstruction with various flaps: case report

No abstract available.