Reconstruction of MCP Joint or Web Space Region with Adipofascial Turnover Flap in Electric Burn Injuries

PURPOSE: In many cases, electric burn can affect regional MCP joint or web space of hand, and reconstruction of these area is significant, because it can lead severe functional and aesthetical impairment of hand. Considering many respects like hand anatomy, flap characters, functional and aesthetical results, we applied reverse adipofascial flap and report the effectiveness of this method. METHODS: From June 2010 to January 2014, 21 cases of electric burn at MCP joint or web space area were reconstructed with reverse adipofascial flaps. Within a week after theses injuries, we performed a debridement of the necrotic tissue. After elevation adipofascial flap under the skin, the flap was transferred to defect site and then we performed STSG over the flap. The donor site was closed primarily. RESULTS: Complete flap survival was achieved in 75.5% of total cases. And the partial necrosis was occurred in 7 cases. There were no other complications and satisfaction of patient survey was performed by 'Likert scale, 1~5 points', the average point was 4 that meant significantly good result. CONCLUSION: Like fasciocutaneous flap or free flap, the adipofascial flap can cover soft tissue defect with exposed or injured tendon or bone because it has good vascularity. Also, compared with other flaps, it has suitable for MCP joint or web space area in respect of flap size or bulkiness and it has more aesthetical advantages. In conclusion, adipofacial flap can be considered as appropriate method to reconstruction of electrical injury at regional MCP joint area and web space.

Axillary Fistula and Scar Contracture due to Uncontrolled Chronic Infection after Trans-Axillary Augmentation Mammaplasty

No abstract available.

The Usefulness of Enzyme Alginogel (Flaminal(R)) for 2nd Degree Burn Patient Treatment

PURPOSE: In conservative treatment of burn wounds, early epithelialization is essential to obtain good aesthetic and functional results. When choosing of dressing method to treat burn wound we should consider an optimal environment for healing. In this study, we used enzyme alginogel that is a new class of non cytotoxic wound care products. METHODS: Patient information from May 2012 to October 2012 was analysed for degree of epithelialization, bacterial loads and pain. We retrospectively reviewed the efficacy of enzyme alginogel (Flaminal(R)) in the experimenal group of 31 patients treated with this product and compared this with a control group of 30 patients treated with classical treatment. RESULTS: The study showed a significantly shorter healing time and decresed pain in the Flaminal(R) group. A limited number of patients were found to be positive for wound swabs and no severe inflammation and allergic reaction. CONCLUSION: Applying enzyme alginogel (Flaminal(R)) to burn wound showed satisfactory results in epithelialization, degree of pain. It can be one of treatment options for partial thickness burn wound.

Change of Symptom of Giant Cell Tumor at Tendon Sheath due to Flame Burn: A Case Report

PURPOSE: Giant cell tumor of tendon sheath is benign soft tissue tumor and recurrence rate is 7~40%. It is second most common tumor of the hand after ganglion cyst. It is generally non-tender mass and size of it is varied. We experienced the case that asymptomatic giant cell tumor of tendon sheath changed to symptomatic mass with pain after flame burn injury and then we report about this case. METHODS: 49 years old man was hospitalized because of flame burn with TBSA 30% involving scalp, face, both arm, right hand. About 30 days after burn injury, he complained about palpable tender mass at volar side of right hand. In past medical history, he had recognized the slow-growing palpable mass without pain from about 10 years ago. We planed excision and biopsy about the mass. Intraoperatively we found mass that was attached to flexor tendon sheath and the size of mass was about 5x7x4 cm3. RESULTS: The mass was defined as giant cell tumor of tendon sheath in result of biopsy. After surgery, there was no any specific symptom like pain, and in follow-up after about 5 months, there was no recurrence and motor function and sensory was normal. CONCLUSION: Generally giant cell tumor of tendon sheath is common benign tumor of hand and clinically the treatment is surgical excision because of discomfort from enlarged palpable mass rather than pain. In this case, we think inflammatory reaction of tumor itself or inflammation of soft tissue around tumor due to flame burn is cause of emerged pain of giant cell tumor.

Chemical Burn due to Mustard: A Case Report

PURPOSE: Mustard (Brassica spp.) has been used as a home remedy to cure various diseases like garlic, but its side effects like contact dermatitis due to local application at skin cannot be ignored. As a chemical burn due to local application of mustard has never been reported in Korea up to now, we will present a case in which who got a deep second degree burn due to local application of mustard. METHODS: A 56 year-old female patient who had pain at right wrist, knee, ankle, applied mustard paste for 5 hours. After one day, she visited hospital with bullous lesion with pain at wrist, knee, ankle and we confirmed that she got second degree chemical burn wound. During 3 days after admission, we performed foam dressing. And 4 days after admission, the burn wound was considered as deep second degree burn wound, we performed dressing with cultured allogenic keratinocyte (KaloDerm(R), Tegoscience, Seoul, Korea). RESULTS: After dressing with cultured allogenic keratinocyte, while exudate was being secreted by the lesion, saline wet dressing was applied. Exudate secretion decreased 7 days after application of cultured allogenic keratinocyte, and it stopped after 9 days. And it took about 10 days to remove dressing materials from the wound. When the dressing material had been removed, epithelialization was completed. CONCLUSION: Local application of pungent material like mustard or garlic as a traditional treatment is widely known, and side effect such as chemical burn due to garlic or contact dermatitis due to mustard also has been reported. We had another 2 cases of chemical burn due to garlic in addition to this case, and all 3 patients had local application for longer time than recommended time in traditional treatment. So, even if local application of them is effective in various disease, we should be aware that abuse of this traditional treatment should be avoided.