The Effect of Placenta Extract on Proliferation and Differentiation of Human Chondrocytes

PURPOSE: The isolated human chondrocytes for cartilage reconstruction and transplantation presents a major problem as these cells would change biologically in vitro. For more effective applications of these cells in the clinical field, it is necessary to get a large amount of cells in a short period without affecting their function and phenotype. METHODS: This study reports the effects of placenta extract on chondrocytes in vitro. We initiated this study on the basis of the hypothesis that placenta extract can influence both the proliferation of chondrocytes and their biologic functions(for example, to express cell specific gene or to produce their own extracellular matrix). Chondrocytes in monolayer culture with or without placenta extract were collected and analyzed by MTT assay, ECM assay, and RT-PCR. RESULTS: Placenta extract stimulated the proliferation of chondrocytes in monolayer culture. The phenotype of chondrocytes was well maintained during the expansion in monolayers. Chondrocytes expanded in the presence of placenta extract produced ECM, glycosaminoglycan, abundantly. Compared to chondrocyte expanded in culture medium only, chondrocytes expanded with placenta extract demonstrated higher COL2A1 expression that was biochemically comparable to primary chondrocytes. This study provides an evidence that placenta extract is helpful to expand chondrocytes during tissue cultivation, to maintain their differentiated phenotype and to promote their function. CONCLUSION: These results suggest that placenta extract during cultivation play an important role in controlling cell behaviors. Furthermore, these results provide a biologic basis for cartilage tissue engineering.

Metastasizing Dermatofibroma to Lungs : A Case Report

PURPOSE: Dermatofibroma is a lesion several millimeters to several centimeters in size, arising from dermis or subcutaneous tissue, mostly at extremities of a middle aged female. It is a benign fibrous tumor that to our knowledge metastasis have not been reported and may recur only locally. Here we report a rare case of 36-year-old female with dermatofibroma arising from back and metastasized to both lungs. METHODS: We performed an en-block elliptical mass excision for skin lesion and metastatectomy for multiple nodules of both lungs. RESULTS: Histologically, the tumors of both lungs and skin lesion showed dilated cystic airspaces which were lined by respiratory epithelium with underlying layers of tumor cells. The tumor cells were composed of plump to spindled fibrohistiocytic cells arranged in storiform growth pattern. There were no cellular pleomorphism, atypical mitosis, and necrosis. These are the specific features of a dermatofibroma and we could examined the histologic findings of skin and lungs identical. Thus, this indicates that dermatofibroma of back was metastasized to both lungs. CONCLUSION: We report this case to notice that dermatofibroma is a benign tumor but it rarely metastasizes.

Medial Pedicle Vertical Reduction Mammoplasty

Most recent breast reduction techniques tend to get natural cone shaped breast with minimal scar. On this purpose, we have performed 7 cases of vertical reduction mammoplasty with medial pedicle from August 2003 to August 2005. The mean age of patient was 29, and the average resection amount was 760 gram per breast. The most of the patient were satisfied with their postoperative size, shape and scar. As compared with classical superior pedicle vertical reduction mammoplasty, by using medial pedicle, this technique could use short and wide-ranging pedicle, avoid skin undermining, evade exposure of pectoralis major fascia and remove the fixation as well. And this technique did not operate liposuction. As descrived above, the advantages of vertical mammoplasty using a medial pedicle are as follows: 1. Limited postoperative scar of incision. 2. More effective preservation of sensation to the nipple-areolar complex and physiological function as breast feeding. 3. More aesthetic shape of breast. 4. The procedure is easy to perform. 5. Shortening the period of postoperative care.

Usefulness of Omental Flap for Various Soft Tissue Reconstruction

Extensive and complicated defects on the body call for an omnipotent tool for a perfect reconstruction. Flaps derived from the omentum has many advantages over the conventional flaps. From 1999 to 2004, Omental flaps were applied for various soft tissue reconstructions. Among total 20 total 7 cases were for immediate reconstruction, 2 cases for chronic infection, 3 cases for simultaneous reconstruction of two defects, 4 cases for functional joint reconstruction and 4 cases were for flow- through revascularization. Among these cases, 3 cases were operated with minimal incision harvest technique. There were no complete flap failures, partial necrosis of the distal parts were noted on three cases. The omental flap is indicated on a large contaminated defect reconstruction due to its large size, well-vascularized, and malleable properties. The omental flap provides several additional advantages over other flaps, which are; the availability of the one staged simultaneous reconstruction of two defects with one flap, providing gliding function for the joint motion, and a flow-through characteristics with long vascular pedicle. But there are some serious shortcomings, including a long abdominal scar and intraabdominal problems. However, these are rare and can be minimized with our minimal incision technique. Due to its unique characteristics. the omentum is one of the ideal tissues for the reconstruction of the complicated soft tissue defects due to its unique characteristics.

Steatocystoma Multiplex in a Family

Steatocystoma multiplex is a rare, inherited disorder that is characterized by multiple, asymptomatic, variably sized dermal cysts. The condition is transmitted in an autosomal dominant fashion; although sporadic cases have been documented. Keratin 17 has been proposed to be an important factor in inherited steatocystoma. In this study, a 29-year old man has a 4-year history of asymptomatic, movable, skin-colored nodules on his face, neck, scalp, anterior chest and back. His father and elder-brother have similar lesions. Histologically, the cysts show a thin stratified squamous epithelium with sebaceous glands arising from its wall and an absence of the granular cell layer. Generally, there are two treatments-medical treatment and surgical treatment. In case of non- inflamed lesions, surgical excision or drainage is regarded as the best treatment. We tried excisional biopsy and until now there has been no recurrence in the operation area over the past 12 months following the operation.

Comparison of Wound Healing Effect of Different Forms of Chitosan

This study is to compare the effect of wound healing using three different types of chitin, which include the shapes of sponge, velvet, thick non-woven fabrics, and thin non-woven fabrics. The sponge type had more capacity to absorb the first discharge of a wound than the velvet type and the two non-woven fabrics types. Instead of absorbing the discharge effectively, the velvet type showed a difficulty to take off the dressing stuff from a wound since it was solidly stuck to the wound. The sponge type showed less infiltration of inflammatory cells, producing angiogenesis and fibroblast faster than any other types. Next, the thick non-woven fabrics type was a little more effective than the thin non-woven fabrics type: However, there was no difference between two types. The velvet type sustained the infiltration of inflammatory cells for the longest duration, producing slower angiogenesis and fibroblast. In wound contraction and wound healing, the sponge type was most effective with statistical significance than any other types(p0.05). In conclusion, the sponge type showed the best effectiveness to absorb the early discharge, facilitating the progress of inflammatory phase to increase the healing rate. It induced an early healing of wound caused by wound contraction rather than by wound epithelization.

Wound Healing Effect of the Chitosan Sponges Containing the T-CAM or Regenin

Tetra cell adhesion molecule(T-CAM) is a new recombinant mixture of fibronectin and ig-h3. Fibronectin and ig-h3 are extracellular matriprotein involved in each phase of wound healing, and the combination of these materials may generate a synergistic effect in wound healing. Regenin is easily attainable from protein recombination. It can be developed as wound healing material, and also it has a good effect in cell adhesion and proliferation. We combined the chitosan with regenin or T-CAM at different concentration, which are gene recombination material. They were applied to the artificial wound of white rabbit to compare the healing effect in each group. Round full thickness skin defects, 3 cm in diameter, were made bilaterally on the dorsolateral aspect of New Zealand white rabbit. Experimental group was divided into 6 groups, according to concentration of T-CAM and regenin with chitosan-based dressing materials as followings; Group C: control group - oint material dressing, Group Ch: chitosan base only, Group T1: chitosan base in combination with 25 microgram/ml of T-CAM, Group T2: chitosan base in combination with 625 microgram/ml of T-CAM, Group R1: chitosan base in combination with 25 microgram/ml of Regenin, Group R2: chitosan base in combination with 625 microgram/ml of Regenin. Gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area were compared with surface tracing of the remained wound area at the time of 7, 14, 21 days after wound formation. Wound biopsy were performed at the time of 7, 14, 21 days after wound formation. T1, T2 group and R1, R2 groups have less infiltration of inflammtory cell, fast appearance of new vessels, fibroblast, increased volume of collagen fiber comparing to C and Ch group. there's more statistical significance between T1 and T2 group. The same results were shown in Regenin group. In conclusion, our results suggest that T-CAM and Regenin have good effect in wound healing and higher concentration of T-CAM and Regenin is more effective in wound healing than lower concentration. In addition, comparision of same concentration of T-CAM and Regenin group presented almost same results.

A Case of Huge Keloid in the Both Earlobes

Keloid is a benign proliferative disease of dermal collagen which extends beyond the original wound. Management of keloids is still controversial. Many different treatment modalities may be used for this purpose, however, no one method has been found completely successful. Therefore, we combined three techinques, which is surgical excision, lesional steroid injection and compression, to improve therapeutic outcomes for earlobe keloids. In the first session, surgical excision of the keloid was performed. It was followed with triamcinolone acetonide injetion to the surgical field on the postoperative one week, and then followed at two weekly interval for two months. Slight pressure was applied by earring for six months. The authors found that a combination of three techniques for treatment of ear lobe keloid is recommended even for the recurrent lesion.

Correction of Whistle Deformity Using Modified V-Y Advancement Flap

Whistle deformity is deficiency of vermilion of the upper lip. It is a common sequelae of primary lip repair. Many methods have been devised to correct this deformity, most using neighbouring normal tissue of the upper lip. Methods such as Z-plasty, Double rotation, V-Y advancement flap, etc., have been commonly used for the correction of unilateral whistle deformity. We found that the V-Y advancement flap with transposition of deepithelialized tissue was more effective for the correction of whistle deformity than the original V-Y advancement flap. We named this new method 'Modified V-Y advancement flap'. The technique has been performed in 5 patients, 9 to 23 years of age, each with a whistle deformity. One years and six months was the longest follow-up period. Satisfactory results have been obtained and here the authors reported along with a review of the current literature.

A Case of Nevus Lipomatosus Cutaneous Superficialis on Abdomen

Nevus lipomatous cutaneous superficialis is an uncommon condition consisting of ectopic adipose tissue in the dermis and usually located in the pelvic region. There are 2 clinical variants. The first type is the multiple lesions of zonal distribution, present from birth or childhood, usually on the buttocks or the lower back. Sometimes coalescence of papules tend to form cerebriform plaques. The second type is a dome or sessile, papule, nodule with less restricted tendency in its distribution. We describe a 35-year- old female patient who had a soft, asymptomatic, skin colored cerebriform mass which gradually increased in size. Diagnosis was confirmed by clinical and histopathological findings. Treatment was made by excision and primary closure.

Combination Treatment of Osmidrosis by Liposuction and Endoscopic Shaver

Many surgical procedures have been introduced for treatment of axillary osmidrosis, but some complications, such as symptom recurrence, hematoma, seroma, delayed wound healing, skin flap necrosis and scarring, are not solved yet. Recently introduced liposuction method has several advantages over previous surgical methods, such as increased skin flap vascularity, minimal scarring and bleeding, etc, but the sympton recurrence rate has been reported 10-30%. Liposuction method could remove apocrine glands in subcutaneous tissue effectively, but the glands firmly seated in subdermis remain as the cause of sympton recurrence. For this reason, we employed combination treatment of liposuction and endoscopic subdermal shaving method. From March 1997 to February 2001, a total 71 patients (24 men and 47 women) had been treated with this procedure for bilateral axillary osmidrosis. In our procedure, apocrine glands in subcutaneous tissue were removed by liposuction method and the glands in subdermis were removed by using 4.5 mm incisor blade of endoscopic shaver. Follow-up evaluation period was from 3months to 24 months, and the results were satisfactory. No one suffered from sympton recurrence. Postoperative scar was negligible (below 0.5 cm) and other complications were minimal.

Rotation Fasciocutaneous Flap with Z - Plasty: Clinical Applications for Reconstruction of the Lower Leg

The reconstruction of foot remains difficult due to its unique structure, insufficient local soft tissue and poor vascularity in spite of many surgical modalities. The medial plantar island flap enables to obtain sensate and structurally similar tissue with single operative procedure. We reconstructed 5 cases of soft tissue defects on foot by using medial plantar island flap(3 cases proximally- based, 2 cases distally-based) in diabetics. Successful soft tissue coverage was achieved on medial malleolus, dorsal midfoot, tendo calcaneus, and forefoot. The size of the flap ranged from 3.5 x 3.0 cm to 6.0 x 4.0 cm. The follow-up period ranged from 8 to 26 months. All flaps survived without serious complications. All patients gained confidence in daily activities and were able to ambulate in normal footwear. This paper demonstrates that medial plantar island flap with proximally and distally-based pedicle should be considered as a useful technique for reconstruction of soft tissue defect from ankle to forefoot.

Proximally and Distally-Based Medial Plantar Island Flap

The reconstruction of foot remains difficult problem with many surgical modalities because foot has unique structure, insufficient local soft tissue and poor vascularity. The medial plantar island flap is capable of providing sensate and structurally similar tissue with single operative procedure. We reconstructed 5 cases of soft tissue defects on the foot by using medial plantar island flap(3 cases proximally- based, 2 cases distally-based) in diabetics. Successful soft tissue coverage was achieved on medial malleolus, dorsal midfoot, tendo calcaneus, and forefoot. The size of flap ranged from 3.5 x 3.0 cm to 6.0 x 4.0 cm. Follow-up ranged from 8 months to 26 months. All flaps survived without serious complication. All patients had protective sensation in daily activities and were able to ambulate in normal footwear. This paper demonstrates that medial plantar island flap with proximally and distally-based pedicle should be considered as a useful technique for reconstruction of soft tissue defect from ankle to forefoot.

The effects of surgical and chemical delay procedures on the survival of arterialized venous flaps in rabbits

An arterialized venous flap has the advantages of being thin and pliable, utilizing a large-caliber vein with a pedicle of almost any length, as well as obviating the need to sacrifice a donor artery. However, the main disadvantage of this flap is the partial necrosis of the large flap. The aim of this study was to investigate the efficacy of a surgical delay procedure and a combined surgical and chemical delay procedure on the survival of arterialized venous flaps. Ninety New Zealand white rabbits were divided into three groups: control group, a surgical delay group and a combined surgical and chemical delay group. These groups were further divided into subgroups depending on the delay period and the chemical agents. One arterialized venous flap was made from only one ear of each rabbit due to operative mortality, and 10 rabbits were distributed to each subgroup. The arterialized venous flap had an arterial inflow by anastomosis of the central auricular artery to the anterior branch of the central auricular vein and a venous outflow through the anterior marginal vein. The results were as follows ; 1. Control group : The arterialized venous flaps without any delay procedure showed complete necrosis of all flaps. 2. Surgical delay group : The mean percentages of survival areas of arterialized venous flaps were 36.6% in the 4-day delay group, 59.7% in the 7-day delay group. 3. Combined surgical and chemical delay group: a. A 3-day chemical delay in a continuation of a 4-day simultaneous surgical and chemical delay group: The mean percentages of survival areas of the arterialized venous flaps were 81.1% in the doxazosin mesylate group, 72.8% in the nitroglycerine patch group and 92.9% in a combination group of doxazosin mesylate and nitroglycerine patch. b. A 3-day chemical delay in a continuation of a 7-day simultaneous surgical and chemical delay group : The mean percentages of survival areas of the arterialized venous flaps were 94% in the doxazosin mesylate group, 90.2% in the nitroglycerine patch group and 99% in a combination group of doxazosin mesylate and nitroglycerine patch. In conclusion, the surgical delay procedure increases the percentage of survival areas of the arterialized venous flap in proportion to the delay period. The combination group of surgical and chemical delay procedure had a significant increase of the percentage of survival areas than that of the surgical delay group(p < 0.001). The best survival of the flap was obtained from the subgroup which had a 3-day chemical delay in a continuation of a 7-day simultaneous surgical and chemical delay with combined chemical agents.

The effects of surgical and chemical delay procedures on the survival of arterialized venous flaps in rabbits

An arterialized venous flap has the advantages of being thin and pliable, utilizing a large-caliber vein with a pedicle of almost any length, as well as obviating the need to sacrifice a donor artery. However, the main disadvantage of this flap is the partial necrosis of the large flap. The aim of this study was to investigate the efficacy of a surgical delay procedure and a combined surgical and chemical delay procedure on the survival of arterialized venous flaps. Ninety New Zealand white rabbits were divided into three groups: control group, a surgical delay group and a combined surgical and chemical delay group. These groups were further divided into subgroups depending on the delay period and the chemical agents. One arterialized venous flap was made from only one ear of each rabbit due to operative mortality, and 10 rabbits were distributed to each subgroup. The arterialized venous flap had an arterial inflow by anastomosis of the central auricular artery to the anterior branch of the central auricular vein and a venous outflow through the anterior marginal vein. The results were as follows ; 1. Control group : The arterialized venous flaps without any delay procedure showed complete necrosis of all flaps. 2. Surgical delay group : The mean percentages of survival areas of arterialized venous flaps were 36.6% in the 4-day delay group, 59.7% in the 7-day delay group. 3. Combined surgical and chemical delay group: a. A 3-day chemical delay in a continuation of a 4-day simultaneous surgical and chemical delay group: The mean percentages of survival areas of the arterialized venous flaps were 81.1% in the doxazosin mesylate group, 72.8% in the nitroglycerine patch group and 92.9% in a combination group of doxazosin mesylate and nitroglycerine patch. b. A 3-day chemical delay in a continuation of a 7-day simultaneous surgical and chemical delay group : The mean percentages of survival areas of the arterialized venous flaps were 94% in the doxazosin mesylate group, 90.2% in the nitroglycerine patch group and 99% in a combination group of doxazosin mesylate and nitroglycerine patch. In conclusion, the surgical delay procedure increases the percentage of survival areas of the arterialized venous flap in proportion to the delay period. The combination group of surgical and chemical delay procedure had a significant increase of the percentage of survival areas than that of the surgical delay group(p < 0.001). The best survival of the flap was obtained from the subgroup which had a 3-day chemical delay in a continuation of a 7-day simultaneous surgical and chemical delay with combined chemical agents.

Excision of skin tumors through T-shaped incision

Conventional removal of benign skin tumors with transverse or elliptical excision often results in depression, considerable dog ear formation and lengthening of the final scar. The resulting scar is always longer than the maximal diameter of the elevated skin tumor. Curvilinear transverse incision was designs on the center of the skin tumor, then on the center of transverse incision, the vertical limb incision was added to complete T-shaped incision. After local anesthetic solution was infiltrated through the designed lines, the mass was completely removed. To obliterate dead space, the mid point of the incision was approximated with a suture; there remained dog ears on both sides. To remove the dog ears, triangular flaps were advanced anteromedially, excised, and sutured. Resection of the skin tumors through T-shaped incision provides easy dissection, simultaneous dog ear and dead space repair and elimination of depression of the skin lesion site. To predict the length of the vertical limb incision, it was measured intraoperatively, the length of the vertical limb incision was ranged from 30% to 41% of the transverse incision. So, initially the length of the vertical limb incision was safely designed to remove dog ears and depression from one third of the transverse incision.

RECONSTRUCTION OF DISTAL LEG AND FOOT USING DISTALLY BASED ADIPOFASCIAL TURN-OVER FLAP

Reconstruction of soft tissue dejects on the lower leg and foot remains a difficult challenge for surgeons. If the deject was large and complicated by bone defects, an excellent result could be obtained with free tissue transfer. In case of no bony problem, no major infection and relatively small defect, a local flap is more Convenient and economic than free tissue transfer because of its simple, one-stage and reliable operation. The vascularization of the subcutaneous tissue reveals the predominance of the vascular network in this layer with regard to the dermal or fascial plane. The dermal vascular network at the donor site is sufficient to let the skin survive without its underlying subcutaneous vascular support. Distally based adipofascial flaps, nourished by the lower perforator originating from the major vessel as link pattern were. used successfully for reconstruction of the bone and/or tendon exposure of the lower leg and foot in 10 patients. Between February 1992 and December 1995, ten cases underwent this procedure to reconstruct soft tissue defect on the lower leg and foot. The average age of the patients was 50.6 years (range 5 - 73years). Follow-up was from 10 months to 38 months (mean 21 months). The average time of the operation was about 2 hours 18 minutes. The length to width ratio of adipofascial flap was 2.4 - 5.0 : 1 (mean 3.4 : 1). The advantages of this method are easy dissection, short operation, preservation of the major vascular pericles of the lower limb, skin preservation at the donor site, thus preserve the shape of the limb and minimize donor site scar, and versatility (it is supple and can adapt to every surface, and it can be grafted on the deep or the superficial side). In conclusion, this technique is an useful and alternative method for reconstruction of soft tissue defects on the lower leg and foot in selected cases.