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.

Staged Operation Using Fasciocutaneous Transposition Flap on Reconstruction of Exposed Patella Region in 4th Degree Burn: Case Report

PURPOSE: Soft tissue injuries of the patellar region are difficult problems because of insufficient arterial blood supply and lack of muscle. There have been many methods for reconstructing the soft tissue injuries of the patellar area such as primary closure, skin graft, muscle flap and free tissue transfer. However, each method has some limitations in their application. We used fasciocutaneous transposition flap according to limitations of patient's condition. METHODS: A 67-year-old-man was hospitalized by contact burn with TBSA 15% involving scalp, back, buttock, both legs. We found 20x30 cm2 sized eschar on right knee. We debrided necrotizing patella bone and found insufficient blood supply. In addition, general weakness, low weight (170 cm/42 kg), old age, DM made us to plan 2 staged operation. At first, coverage using medial fascio-cutaneous transposition flap. After 7 days, there were 1/4 necrosis by congestion. we used Vancomycin for systemic antibiotic treatments and betadine irrigation. 2 weeks after, We debrided necrotizing patella bone and coverage using lateral fascio-cutaneous transposition flap. RESULTS: There were no post-operative complications such as infection, hematoma, seroma or flap necrosis. And there was no contracture or contour deformity. CONCLUSION: Due to limitations of patient's condition, we used fasciocutaneous transposition flap instead of musculocutaneous flap or free flap. We gained satisfactory result by using fasciocutaneous flap in patella exposed wound reconstruction.

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.

Acute Cerebral Infarction Caused by Cerebral Vasospasm Due to High-Voltage Electrical Injury

No abstract available.

Treatment with Pursestring Suture Technique in Third Degree Burn on Breast: A Case Report

PURPOSE: Authors present the case of one patients who underwent local flap with pursestring suture technique to reconstruct third degree burn on breast. METHODS: A 66-year-old man visited emergency room with multiple whitish vesicles with serous discharge on face, neck, anterior chest and right arm. We performed dressing with foam and cultured allogenic keratinocyte. 14 days after burn injury, right breast wound was remained with eschar and granulation tissue. The size was 5x10 cm. We performed local flap with pursestring suture technique. The nipple was preserved. RESULTS: Postburn breast reconstruction using local flap with pursestring suture technique had results of small linear scar and minimum nipple-areolar complex deformity. There was no significant difference on both sides of the breast mound. CONCLUSION: Local flap with pursestring suture technique had results of small linear scar and minimum nipple-areolar complex deformity and it could be an effective method for reconstruction of postburn breast.

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.

The Clinical Efficacy of Early Dermabrasion and Frozen Cultured Allogenic Keratinocyte in Management of the Deep Second Degree Burn with Thin Eschar

PURPOSE: As in the case of the deep second-degree burn, proper eschar elimination and early epithelization is essential for spontaneous healing without surgical intervention. Accordingly, we have treated with using early dermabrasion and appling frozen cultured allogenic keratinocyte patients in deep second degree burns an eschar formed. METHODS: From January 2011 to January 2012 at Kepco medical center, we selected 46 patients who were suffered from deep second degree burn formed an eschar were enrolled. Patients were divided into two parts, study and control group. Study group were performed dermabrasion within first 3 days to 10 days of the injury and then applied frozen cultured allogenic keratinocyte. control group were managed moist dressing using hydrocolloid gel, form and alginate materials. We tried to prove its clinical efficacy by researching the period of wound healing, percentage of skin graft, and hospital days under chart review and photograph. RESULTS: In study group, the mean period of wound healing was 15.13+/-4.18 (mean+/-S.D.) days, and that of the hospitalization was 16.65+/-5.31 (mean+/-S.D.) days. For the 3 patients without the epithelization, skin graft was conducted. As for the control group, the mean period of wound healing was 24.22+/-2.79 (mean+/-S.D.) days, and that of the hospitalization was 28.30+/-3.33 (mean+/-S.D). 21 patients were conducted skin grafts. CONCLUSION: Based on these results, we concluded that the treatment in deep second degree burn patients eschar formed using early dermabrasion and frozen cultured allogenic keratinocyte is effective in reducing the duration of period of wound healing, hospital day and rate of skin graft.

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.

Treatment of Congenital Divided Nevus of the Eyelid with Excision and Blepharoplasty

No abstract available.

A Case of Delayed Hematoma Caused by Trauma Three Years after Breast Augmentation

Delayed breast hematoma is a very rare late complication inbreast implantation. A 32-year-old female patient presented with sudden and painful swelling of left breast. On physical examination, a swollen and tense breast was noted. No history of aspirin or any anticoagulant administration was documented. The patient went snowboarding 6 days ago and slipped down on the slope resulting in coccyx fracture. Preoperative CT scan with contrast revealed large fluid collection on left pericapsular area. Under local anesthesia, approximately 500cc of fresh blood clot was removed followed by compressive dressing on her left breast. At 6 hours after the operation, swelling of the left breast was noted again, and embolization of a branch of left lateral thoracic artery was performed with removal of 400cc hematoma under general anesthesia. The Saline-filled smooth prosthesis was inspected for consistency and exploration for any bleeding points was performed by endoscope. Capular rupture was noted from 12 o'clock to 3 o'clock, however, no bleeding points werefound. At 3 months period after the last surgery, the patient remained uneventful without any further problems. We hereby report a case of delayed breast hematoma 3 years after primary augmentation mammoplasty that occurred six days after the trauma.

A Study on Preferred Morphologic Feature and Proportion of Facial Aesthetic Subunit by Korean General Public

PURPOSE: As the influence of mass media increases, the general standard of attractiveness or beauty of a face also changes. The primary purpose of the study is to find out the factors of the attractive and beautiful face recognized by public. METHODS: We picked out standard model photography and operated with Adobe(R) Photoshop(R) and Monariza(R) virtual plastic surgery program. The contour of face, eye, nose, forehead, zygoma, chin and proportion of upper, middle, lower face were changed. The interview survey was conducted through structured standard photo for 310 respondents. That was utilized in the final analysis. Multiple regression analysis was executed by SPSS 12.0. It was used to deal with statistical data and all the other necessary analysis. RESULTS: According to general characteristics of the respondents, many differences were found in preferred face and facial aesthetic subunits. The younger generation preferred the lozenge and inverted triangle shape contour. The respondents over 40 of age preferred the egg shape contour. In chin and zygoma contour, the respondents at the age of 20 preferred distinctly small chin and relatively small lower face. On the other hand, the respondents over 40 of age preferred the wide zygoma relatively. In the proportion of upper, middle, lower face, 51.0% of respondents answered 1:1:1. If they want to have an aesthetic operation, they preferred protruding forehead. Also they preferred the small chin and V-shaped chin in frontal view. CONCLUSION: Many respondents preferred to have a plastic surgery for the better facial subunit. The statistical evidence from this study suggests that the harmony and balance of facial aesthetic subunits make attractive and beautiful face.