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.

A Case of Melkersson-Rosenthal Syndrome

Melkersson-Rosenthal syndrome is a rare condition and clinical diagnosis was established on the basis of the triad: facial or lip edema, peripheral facial palsy and scrotal or plicated tongue. Labial swelling(Cheilitis granulomatosa) is the most common feature of this syndrome complex. The lips may enlarge up to three times their normal size, resulting in aesthetic deformity and functional disability. The condition appears to be a granulomatous disorder causing edema and inflammation of the soft tissues of the face, lips, oral cavity and particularly, the facial nerve. Traditional medical interventions are only marginally successful in treating this syndrome. We report the case of a young man with cheilitis granulomatosa as a manifestation of Melkersson-Rosenthal syndrome successfully treated by transverse and vertical star-shaped resection with a transmodiolar labial suspension suture at mouth angle. Our result shows symmetry of the lip, a normalized anterior projection, dimensional harmony between upper and lower lip and no disfiguring cicatrices.

The Psychological Aspects of Spinal Cord Injury Patients with Pressure Sore

The occurrence of pressure sore is an important problem for persons with spinal cord injury. Spinal cord injury patients suffer from pressure sore and psychological problems, but surgeons have mainly focused on wound not psychological problems. Pressure sore is almost accompanied by spinal cord injury. Surgeons should be interested in both surgery and psychological problems because of rapid recovery and good results. The purpose of this survey is to compare the patients with normal control in psychological aspects and to help the patients with proper treatment and rehabilitation. The authors used SCL-90-R(Symptom Checklist-90- Revision) for 56 spinal cord injury patients with pressure sore and 56 normal control. The results is that significant differences were found on the somatization, depression, anxiety, phobic anxiety subscales. This is considered that psychological chronic pain disorder, depressive disorder and anxiety disorder, so it will be effective that psychological supportive treatment, antidepressants and antianxiety drug for spinal cord injury patients with pressure sore.

Treatment of the Medial Orbital Wall Fracture using Transcaruncular Approach

Medial orbital wall fracture can easily be overlooked because typical clinical symptoms appear in only a few instances. However, if it is left untreated in case of no diplopia, cosmetically undesirable enophthalmos may develop. Various cutaneous approaches, previously used, may leave noticeable scar or provide a limited overview of the orbit medial wall fracture site. We used the transcaruncular approach in 36 cases of 35 patients for reconstruction of the medial orbital wall fracture. The incision was made at the junction of the medial 3/4 and lateral 1/4 of the caruncle, and extended along the conjunctival fornix superiorly and inferiorly to or beyond both puncta for 10 - 15 mm long respectively. After soft tissue was dissected, periosteum was incised at the posterior to the posterior lacrimal crest. Implants up to a height of 2.5 cm could be inserted.The diplopia was resolved in all cases after the surgery, and enophthalmos measured 0 to 2 mm in all patients. Postoperative computed tomographic scans showed favorable reduction of the herniated soft tissues and anatomic reduction of the medial wall without complication related to the surgical approach in all cases. Transcaruncular approach is a better alternative to transcutaneous incisions because it provides wide exposure of the medial orbital wall, no visible cutaneous scar, short operation time, and no damage of important internal structures.

The Role of Alginate Sponge on Growth and Differentiation of Preadipocytes

Recently, many researches have been carried out on the production of artificial tissue using tissue engineering. However, studies on fat tissue are still insufficient. The purpose of this study was to examine that alginate sponge can be used as a three-dimensional scaffold for the culture of preadipocytes compared with fibroblasts, and that preadipocytes can differentiate into mature adipocytes in this sponge. The 3T3-L1 preadipocytes and the 3T3 fibroblasts were separately cultured in three-dimensional alginate sponge for 14 days. The morphology of cell and sponge, cell proliferation rate, and glycerol phosphate dehydrogenase activity were evaluated at the indicated periods. The results were as follows; 1. The alginate sponge showed a highly porous, well-interconnected pore structure and the sizes of pores were from 100 to 400micrometer. 2. The fibroblasts in sponge exhibited spindle shape with long irregular fibers on the 7th day and there was no oil-red O stained cell until 14 days. However, the preadipocytes in alginate sponge were round and some of cells transformed into mature fat cells which were stained with oil-red O after 14 days. 3. The proliferation rates of preadipocyte group were increased gradually during the culture period, but lower than those of fibroblast group(P< 0.05). 4. The glycerol phosphate dehydrogenase activities of preadipocyte group were significantly higher than those of fibroblast group during the culture period(P< 0.05), and the activities of 14 day-cultured preadipocytes were about 30 times higher than those of 7 day-cultured preadipocytes. The results suggest that alginate sponge, which has fixed shape and porosity, is adequate three-dimensional scaffolds for culture of fibroblast and preadipocyte. In addition, preadipocytes could be well proliferated and differentiated into adipocyte in the alginate sponge.

The Effect of Tumor Necrosis Factor-alpa on Type I Procollagen and Collagenase Gene Expression in Hypertrophic Scar and Keloid Fibroblast

Recent studies have demonstrated that tumor necrosis factor-alpa(TNF-alpa) decreased production of type I and III procollagens and increased production of collagenase in cultured human dermal fibroblasts. The purpose of this study was to examine the effect of TNF-alpa on the level of expression of type I procollagen, collagenase mRNA in hypertrophic scar and keloid fibroblasts in culture. The cultured fibroblasts from normal skin, hypertrophic scar and keloid were exposed to 0, 1, 10, and 100 ng/ml of TNF-alpa for 24 hours. Then, type I procollagen mRNA and collagenase mRNA were measured by quantitative RT-PCR and quantified by computerized densitometry(TINA). In normal skin fibroblasts, TNF-alpa significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa and maximal enhancement for collagenase mRNA was noted at 100ng/ml of TNF-alpa. In hypertrophic scar fibroblasts, TNF-alpa significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa which was the same as normal skin fibroblasts but there were no significant differences among TNF-alpa treated groups for collagenase mRNA. In keloid fibroblasts, TNF-alpa also significantly decreased the level of type I procollagen mRNA and increased collagenase mRNA. The maximal inhibition for type I procollagen mRNA was noted at 100 ng/ml of TNF-alpa which was the same as normal skin and hypertrophic scar fibroblasts but there were no significant differences among TNF-alpa treated groups for collagenase mRNA. These results strongly suggested that TNF-alpa might have a role in preventing progression of fibroproliferative disease, such as hypertrophic scar or keloid, and that the most effective concentration of TNF-alpa was found in 100 ng/ml.

Growth and Differentiation of Preadipocytes in Alginate and Collagen Gels

Diverse developments in the field of tissue engineering have stimulated much research on tissue production. However, studies on fat tissue still remain insufficient. The purpose of this study is to examine if alginate gel and collagen gel can be used as a three-dimensional scaffold for the culture of preadipocytes, and if these gels can induce preadipocytes to differentiate into mature adipocytes. The preadipocytes harvested from rat epididymal fat pads were three-dimensionally cultured in 1%, 2% alginate gel and collagen gel for 14 days. The morphology, number, and activity of preadipocytes were examined during the experimental period. The results were as follows; 1. The preadipocytes of monolayer culture were spindle shape with rich cytoplasm. The preadipocytes of collagen gel were multipolar or star-like in shape and there was no oil-red 0 stained cell until 14 days. However, the preadipocytes in alginate gel were round and some of cells transformed into mature fat cells which were stained by oil-red 0 after 14 days. 2. The number of preadipocytes in collagen gel continuously increased for 14 days, and significantly increased compared to that of preadipocytes in monolayer culture after 7 days. However, the number of preadipocytes in alginate gel significantly decreased compared to that of preadipocytes in monolayer culture and collagen gel for 14 days, and there was no difference between 1% and 2% alginate gel groups in the number of preadipocytes. 3. The activity of preadipocytes in collagen gel was decreased until 7 days, but not significantly different after 10 days, when compared with that of preadipocytes in monolayer culture. And the activity of preadipocytes in alginate gel was decreased than that of preadipocytes in monolayer culture until 10 days, was higher than that of preadipocytes in collagen gel until 7 days, but was not significantly different compared with that of preadipocytes in monolayer culture and collagen gel on the 14th day. There was no difference between 1% and 2% alginate gel groups in activity of preadipocytes for 14 days. The results suggest that collagen gel are adequate three-dimensional scaffolds in which the proliferation of preadipocytes can be induced, and that alginate gel can be used as a three-dimensional scaffold that has the ability to induce differentiation of preadipocyte although the proliferation of preadipocytes is inhibited.

The Effects of Deferoxamine on the Oxygen Free Radical and Neutrophil in Ischemia-Reperfusion Injury

Adequate circulation is indispensable for flap survival. Ischemia-reperfusion injury is one of the causes of flap necrosis. Current evidence suggests that tissue damage associated with ischemia-reperfusion injury and inflammatory responses may be mediated by oxygen free radicals and neutrophils. Oxygen free radicals can directly alter structural component of tissue, attack membrane phospholipids and produce the chemotactic factor for neutrophil which is main cell in inflammatory reactions and an important source of oxygen free radicals. Deferoxamine is well known as a powerful chelator of iron and free radical scavenger. It is also known to decrease the skin flap necrosis. The purpose of this study is to evaluate the effects of deferoxamine on the oxygen free radicals and neutrophils after ischemia-reperfusion injury of skin flaps. A 6 x 3 cm sized island skin flap was made on the left abdomen of rat and the epigastric pedicle was occluded for 6 hours. Thirty minutes before reperfusion, the flaps were perfused with normal saline or deferoxamine. The flap survival rates were assessed by computerized planimetry on the fifth day after reperfusion. Tissues for assay of MDA and MPO were obtained at 6, 12, 24, 48 hours after reperfusion. The results were as follows: 1. Deferoxamine administration groups improved flap survival rates significantly compared to control groups (78.3+/-13.2%, 54.6+/-6.35%) (p = 0.0011). 2. The level of MDA was significantly lowered in deferoxamine administration groups compared to control groups(p<0.05). The levels of MDA were increased over time in each group but, the ircrement was steeper in control groups than that in deferoxamine administration groups. In control groups, the increment between 6 and 12 hours was argest. 3. MPO content was increased over time in each group but significantly low in deferoxamine administration groups compared to control groups(p<0.05). The increment of control groups was steeper than that of deferoxamine administration groups. We conclude that deferoxamine improve the flap survival rates after reperfusion injury by inhibition of production of oxygen free radicals and neutrophil influx via a free radical scavenger 8 anti-inflammatory action.

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.

The Effect of Rigid Internal Fixation on Growth of the Mandibulofacial Bone in Growing Rabbits

Craniofacial reconstructive procedures are frequently peformed with rigid fixation of the bone. During the period of active bone growth such manipulation may influence bone development. The purpose of this study was to determine the effects of metal plating of the mandible on the growth and morphology of the mandibulofacial skeleton. New Zealand white rabbits, 6 to7 weeks of age, were divided into 5 groups. They were designated as group I(nonoperated control, n=10), group II (rigid fixation of mandibular body after vertical osteotomy, n=10), group III(rigid fixation without osteotomy, n=10), group IV (interosseous wire fixation after osteotomy, n=10), and group V(rigid fixation and removal of plates and screws 4 weeks after osteotomy, n=7). Rabbits were sacrificed 12 weeks after operation and dry skull preparations were grossly measured and analyzed by direct measurement and by dorsoventral skull x-rays. Measurements taken were length, thickness, angle, and area of the mandibulofacial skeleton. Three-dimensional CT was used for volumetric measurement of the mandible. The data wee compared between the operated and nonoperated sides and significant differences between groups were evaluated using the paired t-test, the ANOVA test, and Dunn's test. The following results were obtained: 1. The length of the whole mandible and the anterior mandibular segment was decreased in groups II and III, compared with group I(p>0.05). These results show growth restriction of the plated mandible regardless of osteotomy. 2. The maxillary alveolus of the operated side was more anteriorly placed in groups II and III, compared with group I (p>0.05). 3. The thickness of the operated mandibular body showed a significant increase in groups II and III, compared with group I(p>0.05). 4. The length of the zygomatic arch of the operated side in all the experimental groups showed a significant decrease, compared with group I(p>0.05). The angular divergence of the mandibular ramus from the sagittal midline of the skull was increased in the operated side of groups II and III, compared with the nonoperated side (p>0.05). 5. Volume measurements of the mandible in groups II and III showed a significant reduction of the volume on the operated sides in the anterior mandibular segment, compared with group I(p>0.05). The volume of the operated mandibular body showed a significant increase in groups II and III, compared with group I(p>0.05). All gruops showed no significant difference in total hemiman dibular volume of the operated side compared with the nonoperated side. These results show that rigid fixation of mandibular fractures during the growth period causes a more severe growth restriction than either osteotomy or interosseous wiring.

Heterotopic Ossification in Pressure Sore: A Case Report

There are many complications related to paralyzed patients. Heterotopic ossification in pressure sore patients is reported to be rarely developed, but once it occurs, it frequently causes joint stiffness which may aggrevate the pressure sore wound. This paper was based on a clinical study of heterotrophic ossification in 6 quadriplegic and paraplegic patients from 1988 to 1997 at St. Paul's Hospital. All were males aged between 22 and 58 years (mean age, 45.5 years). The sites of pressure sore were in the ischial and trochanteric areas. Heterotopic ossification had developed around the hip joint and the ischial area. The mean onset time was 3.6 years (minimum 10 months maximum 8 years) after trauma. Plain X-ray, bone scan CT and pathological examination were helpful in confirming the diagnosis of heterotopic ossification. The mechanism of heterotopic ossification is not exactly known, but chronic trauma or inflammation could be one etiology. There are still many difficulties in management of heterotopic ossification, but prevention is the most important treatment.

Effects of topical applications of epidermal growth factor on wound healing of uve-irradiated rat

Chrionic exposure of the skin UVB radiation causes erythema and dermal connective tissue damage including wrinkling, neoplastic skin lesions, and delayed wound healing. The topical application of epidermal growth factor(EGF) has been reported to be effective in the treatment of partial and full thickness skin wounds, second degree burns, incision wound, and chronic ulcers. However, its effect thickness UVB damaged skin has not yet been defined. Fifty Sprague-Dawley rats were divided into four groups: UV irradiated-EGF treated group; UV irradiated-EGF untreated group; UV nonirradiated-EGF treated group; UV nonirradiated-EGF untreated Group peroperatively, the UV exposure groups were irradiated with UVB (40 mJ/cm2, 2 MEDs) on the dorsal skin every other day for 12 weeks. Following cessation of UNB exposure, a standard 6 cm midline dorsal linear incision was made in each animal. The animals in EGF treated group were topically applicated with EGF ointment (10 microgramg/g) twice a day. Wounds were excised and wound burst strength was applicated using tensiometer on the 7th and 10th postwounding days. The wound burst strength of the UV irradiated-EGF treated group (662+/-49.7 g/cm) was significantly increased compared to that of the UV irradiated-EGF untreated group (352 +/-40.3 g/cm) (p < 0.01) and even stronger than that of the UV nonirradiated-EGF untreated group (570+/-44.7 g/cm) (p < 0.05). On the 10th day, there was no significant difference in the wound burst strength between the UV irradiated-EGF treated group (1248 +/-101.3 g/ cm) and UV nonirradiated-EGF treated group (1270+/-98.5 g/cm) (p = 0.595). Histological examination revealed epidermal hyperplasia, degeneration of collagen fibers, and inflammatory cell infiltration in the UV irradiated groups. Thick epidermis, prominent skin appendages, increased capillaries and fibroblasts, and linear organization of collagen fibers were observed in EGF treated groups. These results indicate that repeated exposure to UVB irradiation alters normal skin structure and adversely affects subsequent wound healing and the topical application of epidermal growth factor facilitates wound healing of UVB damaged skin.

Bone infection associated with pressure sores: a clinical study

Pressure sores are common complications in patients with spinal injuries or cerebrovascular accidents. The management of pressure sores requires prolonged hospitalization and repeated surgical interventions with a high recurrence rate. Particularly osteomyelitis following initial pressure sores persistently complicates wound healing and recovery. Furthermore, it may also ultimately result in serious sepsis; thus an early diagnosis of osteomyelitis in pressure sore patients is crucial along with appropriate surgical and antibiotic therapy. Although many diagnostic methods were reported, there is no single 'gold' standard for early diagnosis of pressure sore-associated osteomyelitis. Authors reviewed pre-operative CBC, plain X-ray, Tc-99m bone scan, and post-operative biopsy results in 37 patients who had received surgical treatment for pressure sores in a 5-year period from September 1991 to August 1996. Based on these reviews, authors compared and analyzed the sensitivity and specificity in diagnosing osteomyelitis.The results were as follows: 1. Of 37 patients studied, 25 cases were confirmed histologically as osteomyelitis. Ischial region revealed the highest incidence of pressure sore-related osteomyelitis(78%, 14 out of 18 cases) while the regional incidence was as following in descending order : ischial, sacral, and greater trochanteric area. 2. Tc-99m bone scan had superior sensitivity(100%) and specificity(83%) to other pre-operative studies in diagnosing osteomyelitis.In conclusion, authors suggest that Tc-99m bone scan is the best diagnostic method because of its high sensitivity and specificity if osteomyelitis is clinically suspected in pressure sore patients. And in case the test result is positive, agressive surgical bone resection and appropriate antibiotic therapy based on bacterial culture from deep bone specimen should be combined to prevent complications or recurrences.

Augmentation rhinoplasty in Patients with Traumatic nasal Deformities

Nasal dorsal suppor may be weakened or lost during the corrective rhinoplasty procedures such as resection of dorsal deviation, osteotomies and reposition of deviated nasal bones, and incision, fracture, resection or scoring of the dorsal septal strut especially in the small flat noses. Partial or total augmentation of the nasal dorsum has an important role in the correction of asymmetry and restoration of aesthetic balance in the considerable amount of traumatic nasal deformities. We reviewed medical records, pre- and postoperative photographs of 53 patients with traumatic nasal deformities, which had been corrected by augmentation rhinoplasties. The majority of the patients were male (70%), ages of twenties and thirties (79%), injection by automobile accident, fist blows, and sports activities (76%), and were operated more than 3 years after injury (74%). Types of deformities were deviation only (47%), depression only (23%), deviation and depression (19%), deviation and hump (8%), and depression and widening (6%). At least two corrective procedures were needed in the deviated deformities and one procedure in the depressed deformities. Materials for augmentation were silicone implants in 55% and autogenous tissues in 45%. In terms of postoperative complications, displacement and/or absorption were observed in 6 of 24 (25%) autogenous augmentations and displacement and/or swelling in 8 of 29 (27.6%) silicone augmentations.

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

No abstract available.

Optic nerve injury following craniofacial trauma

No abstract available.

Management of hand degloving injuries with sandwich flaps

No abstract available.

Squamous cell carcinoma arising in eccrine poroma

No abstract available.

The treatment of recurred keloids with surgical excision and postoperative X-ray radiation

No abstract available.

Treatment of the complications after augmentation rhinoplasty: dermofat graft

No abstract available.