ABSTRACT
Surgical management of acral lentiginous melanoma on the toe poses a difficult challenge because of the lack of surrounding tissue. A full-thickness skin graft after excision may provide a good cosmetic outcome, but graft failure can occur due to limited blood flow of the toe and the thin skin covering over the deep fascia in the pressure bearing area may cause gait disturbance. A negative-pressure device can be beneficial for fixing the graft and stimulating the growth of granulation tissue. A 55-year-old woman diagnosed with malignant melanoma on the right third toe underwent wide excision, after which secondary intention healing was initiated using negative-pressure therapy. When the wound had regenerated enough granulation tissue after 2 weeks, a full-thickness skin graft was performed, which was secured with negative-pressure therapy. The graft was successfully taken after a week thereafter. Accordingly, the use of negative-pressure therapy in the surgical management of acral lentiginous melanoma may be a good option because it facilitates full-thickness skin graft survival in an avascular surface area and aids in the thickening of the pressure bearing area, where acral lentiginous melanoma is likely to occur.
Subject(s)
Female , Humans , Cosmetics , Fascia , Gait , Graft Survival , Granulation Tissue , Intention , Melanoma , Skin , Toes , Transplants , UrsidaeABSTRACT
BACKGROUND: Cephalometric analysis is essential for planning treatment in maxillofacial and aesthetic facial surgery. Although photometric analysis of the Korean nose has been attempted in the past, anthropometry of the deeper nasal structures in the same population based on computerized tomography (CT) has not been published. We therefore measured three anthropometric parameters of the nose on CT scans in our clinical series of patients. METHODS: We conducted the current retrospective study of a total of 100 patients (n=100) who underwent a CT-guided radiological measurement at our institution during a period ranging from January of 2008 to August of 2010. In these patients, we took three anthropometric measurements: the nasofrontal angle, the pyramidal angle, and the linear distance between the nasion and the tip of the nasal bone. RESULTS: The mean nasofrontal angle was 131.14degrees in the male patients and 140.70degrees in the female patients. The mean linear distance between the nasion and the tip of the nasal bone was 21.28 mm and 18.02 mm, respectively. The mean nasal pyramidal angle was 112.89degrees and 103.25degrees at the level of the nasal root, 117.49degrees and 115.60degrees at the middle level of the nasal bone, and 127.99degrees and 125.04degrees at the level of the tip of the nasal bone, respectively. CONCLUSIONS: In conclusion, our data will be helpful in the preparation of silicone implants for augmentation and/or corrective rhinoplasty in ethnic Korean people.
Subject(s)
Female , Humans , Male , Anthropometry , Korea , Nasal Bone , Nose , Retrospective Studies , Rhinoplasty , SiliconesABSTRACT
With the gradual increase of cases using fillers, cases of patients treated by non-medical professionals or inexperienced physicians resulting in complications are also increasing. We herein report 2 patients who experienced acute complications after receiving filler injections and were successfully treated with adipose-derived stem cell (ADSCs) therapy. Case 1 was a 23-year-old female patient who received a filler (Restylane) injection in her forehead, glabella, and nose by a non-medical professional. The day after her injection, inflammation was observed with a 3x3 cm skin necrosis. Case 2 was a 30-year-old woman who received a filler injection of hyaluronic acid gel (Juvederm) on her nasal dorsum and tip at a private clinic. She developed erythema and swelling in the filler-injected area A solution containing ADSCs harvested from each patient's abdominal subcutaneous tissue was injected into the lesion at the subcutaneous and dermis levels. The wounds healed without additional treatment. With continuous follow-up, both patients experienced only fine linear scars 6 months postoperatively. By using adipose-derived stem cells, we successfully treated the acute complications of skin necrosis after the filler injection, resulting in much less scarring, and more satisfactory results were achieved not only in wound healing, but also in esthetics.
Subject(s)
Adult , Female , Humans , Young Adult , Cicatrix , Dermis , Erythema , Esthetics , Follow-Up Studies , Forehead , Hyaluronic Acid , Inflammation , Mesenchymal Stem Cell Transplantation , Necrosis , Nose , Skin , Stem Cells , Subcutaneous Tissue , Wound HealingABSTRACT
BACKGROUND: Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow. METHODS: A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The patients' data including age, sex, cause of injury, wound dimensions, timing of flap coverage, postoperative elbow motion, and complications were investigated. RESULTS: Between 2001 and 2012, 16 patients were treated at our hospital. The mean age was 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral arm flaps, and 4 radial forearm flaps. The average defect size was 183.5 cm2 (range, 28 to 670 cm2). Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days). The mean postoperative active elbow flexion was 98degrees (range, 85degrees to 115degrees). Partial flap failure occurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%), hematoma (23.5%), seroma (35.3%), and wound infection (5.9%). CONCLUSIONS: Flap selection for elbow reconstruction is determined by the defect size and the extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a single-staged, reliable, and relatively simple procedure that permits initiation of early rehabilitation, thereby improving a patient's functional outcome.
Subject(s)
Humans , Arm , Burns , Elbow , Forearm , Hematoma , Necrosis , Retrospective Studies , Seroma , Surgical Flaps , Wound InfectionABSTRACT
Scleroderma is a rare disease characterized by hard and thick skin, due to fibrosis of tissue with excessive deposition of collagen and extracellular matrix. It is well known that sclerodermatous skin does not heal well after trauma and also difficult to select proper reconstruction method. This article presents a treatment of skin and soft tissue defect with tendon exposure in a scleroderma patient using artificial dermis and STSG. A 67-year old woman, diagnosed as localized scleroderma in 2001, had contact thermal burn on her right hand 2 months ago. She was referred due to 9x5 cm sized skin and soft tissue defect with inflammation and necrosis on the dorsum of her right hand. Necrotic and inflammated tissues were excised under local anesthesia and, on postoperative day 13, debridement & artificial dermis (Terudermis(R)) was applied under general anesthesia. Her cutaneous lesion was spread so widely that we couldn't find appropriate donor site. After 16 days, wound was covered with STSG donated from sclerodermatous skin on right thigh. Artificial dermis was taken without inflammation or other specific complications, and she had uneventful post-operative course after STSG.
Subject(s)
Female , Humans , Anesthesia, General , Anesthesia, Local , Burns , Collagen , Debridement , Dermis , Extracellular Matrix , Fibrosis , Hand , Inflammation , Necrosis , Rare Diseases , Scleroderma, Localized , Skin , Tendons , Thigh , Tissue DonorsABSTRACT
Wounds on fetal skin can be repaired without leaving scars until the second trimester, but after this period, skin wounds leave scars as in adults. It's known that certain growth factors such as TGF-beta, and bFGF are present at a very low levels during wound repair in fetal skin. These low levels of growth factors minimize inflammatory response and fibroblast proliferation at the wound site, which in turn inhibit collagen synthesis, and thus, allows scarless wound healing. Recently bone morphogenetic proteins (BMPs), one of the TGF-beta superfamily members, have been studied in the wound healing process. According to several studies, BMPs are related to the differentiation and growth of epithelial and mesenchymal cells, but the precise functions of BMPs and of BMP receptors on skin wound healing have not been elucidated. In this study, we investigated the expression pattern of BMP receptors in fetal skin during the second trimester and in adult skin by immunohistochemical staining and RT-PCR. BMP receptors were detected on the suprabasal epithelial cells and in the hair follicles in adult skin, but were not defected in the fetal skin except for the hair follicles. This was confirmed by confirming mRNA levels of BMP receptors by RT-PCR in both adult and fetal skins. In conclusion, BMPs and BMP receptors seem to be related to fetal and adult wound healing, and low levels of BMPs and BMP receptors during the second trimester seem to contribute to scarless wound healing in the fetus, as is TGF-beta during the second trimester.
Subject(s)
Humans , Fetus/metabolism , Immunohistochemistry , Receptors, Cell Surface/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Skin/embryologyABSTRACT
The search for a new flap with minimal donor morbidity has been pursued by many plastic surgeons. Numerous donor sites available for microsurgical composite tissue transplantation have been described owing to the tremendous advances made in the field of microsurgery. To be suifable for use as a free flap, a sizable vessel must be included within the tissue, leading to significant donor morbidity. There have been studies for prefabrication of an axial pattern flap in an effort to create a new flap, but most of these methods relied solely on revascularization of a preexisting composite tissue. Our experiment, using an isolated femoral artery and vein as the main pedicle, led to formation of a capsule flap through a normal foreign body reaction between 2 silastic sheet implants. On this induced capsule flap, a skin graft was performed and a total of 40 axial pattern capsulo-cutaneous flaps from 20 Sprague-Dawley rats were successfully obtained after nearly 12 weeks through 4 stages of experiment, including a delay procedure at the second stage. Pathology revealed neovascularization, and abundantly impregnated vascular structures near the pedicle were observed along with random pattern collagen fibers. The skin graft took 100% on this newlyformed axial pattern capsular flap and thus implied that the capsule structure was able to survive on it`s own and was able to support skin grafts. This new flap using only the isolated artery and vein structure can be induced according to various needs with minimal donor morbidity.
Subject(s)
Humans , Arteries , Collagen , Femoral Artery , Foreign-Body Reaction , Free Tissue Flaps , Microsurgery , Pathology , Rats, Sprague-Dawley , Skin , Tissue Donors , Tissue Transplantation , Transplants , VeinsABSTRACT
The reconstruction of soft tissue defects with open fracture around the knee joint is limited by its unique location. Free tissue transfer is hindered by the selection of the recipient vessel and problems of microsurgery. The arc of rotation, defect size, and location must be taken into consideration in the use of regional muscle transfer such as gastrocnemius. According to Mathes et al, the flap survival can be enhanced by selective division of the dominant segmental pedicles, only a part of which can normally be transposed safely on its minor segmental pedicle. Neovascularization, vascular proliferation, and dilatation have also been produced by the delay procedure using silicone sheets. The authors have used the delay procedures with wrapping of the gracilis or sartorius muscle which enabled distally-based transposition of these muscles. The method showed satisfactory outcome in resurfacing the wound around the knee joint. The indictions for this procedure were defects of moderate size and those difficult to reach with conventional muscle flaps. The flap could reach the upper one-third of the lower leg. Other merits are relative simplicity and reliability without significant extension of hospital stay. The drawbacks are the two operative procedures necessary and the risk of infection due to silicone sheets.
Subject(s)
Dilatation , Fractures, Open , Knee Joint , Knee , Leg , Length of Stay , Microsurgery , Muscles , Silicones , Surgical Procedures, Operative , Wounds and InjuriesABSTRACT
A number of methods have been introduced for support the orbital floor following a maxillectomy without orbital exenteration or severe facial trauma. These methods including skin graft and muscular sling provided the unsatisfactory results, like as diplopia, orbital ptosis, enophthalmos and severe facial deformity. Therefore the bone and soft tissue reconstructions using microvascular free flaps were performed recently by many surgeons, but long time operation, donor site morbidity, postoperative large scar, and ptosis of the flap were pointed out as disadvantages of free flap reconstruction. Vascularized calvarial bone flap, a modified method of free calvarial bone graft, was adequate for reconstruction of the orbital floor and the infraorbital rim as a horizontal buttress, especially in case of poor vascular bed and postradiated state. The authors introduced the vascularized calvarial bone flap for the orbital floor and the infraorbital rim reconstruction in 3 cases of maxillectomy, and could be obtained satisfactory results aesthetically and functionally.
Subject(s)
Humans , Cicatrix , Congenital Abnormalities , Diplopia , Enophthalmos , Free Tissue Flaps , Orbit , Skin , Tissue Donors , TransplantsABSTRACT
Microsurgical techniques have developed numerous territories suitable for free tissue transfer. However, there are so many flaps in plastic and reconstructive surgical field, so no one dare to say which flap is the best. The radiovolar area of the forearm constitutes a versatile source for composite tissue free flap reconstruction for many areas of the body. The skin is thin and relatively hairless, and the vascular pedicle is long and large caliber The flap can be harvested conjunction with tendons and bone. The skin can be reliably reinnervated. We have used 32 radial forearm free flaps to reconstruct defect in various areas of the body resulting from tumor ablation, postburn scar contracture and penile amputation injury. We had two flap failures, one developed necrosis from venous thrombus formation, the other from the infection due to sepsis. Thirty of the 32 flaps survived completely. Overall survival rate was 94%. The donor sites have been relatively inconspicuous.
Subject(s)
Humans , Amputation, Surgical , Cicatrix , Contracture , Forearm , Free Tissue Flaps , Necrosis , Plastics , Sepsis , Skin , Survival Rate , Tendons , Thrombosis , Tissue DonorsABSTRACT
Vitiligo is a common aquired progressive leukoderma. Various procedures have been employed for those patients not responsive to medical therapy. Split-thickness skin grafting(STSG) has been used for the treatment of vitiligo for over three decades, but it did not gain popularity as it had some postoperative complications. We employed improved methods to three selected stable, nonprogressive vitiligo patients, And we evaluated its effectiveness, complications. All patients showed good attachment and repigmentation. Observed complications were uneven surface and hyperpigmentation of recipient site and milium on donor site. This method can be an the alternative treatment for patients with stable type of vitiligo.
Subject(s)
Humans , Dermabrasion , Hyperpigmentation , Postoperative Complications , Skin , Tissue Donors , Transplants , VitiligoABSTRACT
No abstract available.