The Effects of New Recombinant Protein of Fibronectin and beta ig-h3, T-CAM(Tetra Cell Adhesion Molecule) on Wound Healing

T-CAM(Tetra cell adhesion molecule) is new recombinant mixture of fibronectin and beta ig-h3. Fibronectin and beta ig-h3 are extracellular matrix protein involved in each phase of wound healing and sum of these materials may play synergistic effect on the wound healing. In order to evaluate wound healing effect of T-CAM on open wound in rabbit, we made four round full thickness skin defects, 3 cm in diameter, bilaterally on the dorsolateral aspect of New Zealand white rabbit's trunk. We divided the wound into four groups, according to the content of topocally applied onitments: Group A treated with ointment base only; Group B with ointment containing fibronectin microgram/ml; Group C with ointment containing beta ig-h3 300 microgram/ml; Group D with ointment containing T-CAM 300 microgram/ml. These ointments were applied daily on the wound. We compared each group with gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area with surface tracing the remained wound area on the 0, 6,th 12th, 18th day after wound formation and wound biopsy were performed on the 3rd, 6th, 10th, 14th, and 21st day after wound formation.The T-CAM group shows statistically significant (p < 0.05 ANOVA test and Scheffe's test) in wound contraction and totalwound healed area than other groups on the 6th day after wound formation, and equally significant on the 12th and 18th day after wound formation except in group C. In histological examination, T-CAM group shows less inflammatory cell infiltration, faster angiogenesis and marked fibroblast proliferation than other groups in early inflammatory period, and more matured, thickened reepithelization and regularly aligned collagen formation on the 14th and 21st day. This study suggest recombinant T-CAM shows synergistic effect on wound healing, and is expected as new potent material for treatment of wound healing.

Effect of Growth Hormone on Early Bony Regeneration in Distraction Osteogenesis

The purpose of this project was to study the effect of growth hormone on early bony consolidation in distraction osteogenesis of a dog mandible. Sixteen dogs were used for this study. An external distraction device was applied to the mandibular body and the mandibular distraction was started five days after the operation at a rate of 1 mm per day up to a 10-mm distraction. Dogs in the growth hormone group received a daily subcutaneous injection of 1 IU of recombinant human growth hormone per kilogram of body weight per week. Normal saline was injected in the control group. Bone mineral density was higher in the growth hormone group than the control group in the whole period. Bone mechanical strength was 300% higher in the growth hormone group than that in the control group. However, results were more suggestive than conclusive. Upon histological examination, the formation of a substantial amount of active woven bone was observed throughout the distracted zone in 6 weeks in the growth hormone group. In the control group, new bone was generated from the edge to the center of the distracted zone. But, the most central area of the distracted zone was filled with fibrous tissue in 6 weeks. In conclusion, growth hormone appears to be effective in early bony consolidation in distraction osteogenesis.

Effect of Injectable Calcium Sulfate on Early Bony Consolidation in Distraction Osteogenesis of Facial Bone

The purpose of this project was to study the effect of calcium sulfate on early bony consolidation in distraction osteogenesis. In the control group, a total of 17 patients were treated between December 1997 and December 1999. The age of patients ranged from 2 to 45 years. The follow up period was 6 to 24 months(mean 15.3 months). In experimental group, a total of eight patients with craniofacial microsomia were treated between April 2000 and February 2001. The age of patients ranged from two to 40 years old. All patients were male. The follow up period was 3 to 15 months. The operative procedure in adult was based on the Ortiz Monasterio's simultaneous mandibular and maxillary distraction technique. The authors modified the original Ortiz Monasterio's method by using Le Fort I osteotomy with complete separation of both pterygomaxillary junction and mandibular osteotomy to avoid the resistance during distraction. In child, the osteotomy of the mandible was performed to distract. In the control group, in adults, after 5 days of latent period, distraction was performed at a rate of 1 mm per day. After 6 to 8 weeks of consolidation period, intermaxillary fixation and distraction device were removed. In children, the distraction was started at a rate of 1 mm per day without latent period. The consolidation period was 4 to 6 weeks. In the experimental group, after 5 days of latent period, distraction was performed at a rate of 1 mm per day in 2 adults. However, in children distraction was performed at a rate of 1 mm per day in 2 patients and 2 mm per day in 4 patients without latent period. On the completion of distraction, the calcium sulfate mixed with carboxymethyl cellulose was injected into the distracted zone. Radiographs showed bony consolidation in 4 weeks in 1 child, 5 weeks in 1 child with distraction rate of 1 mm per day, in 5 - 7 weeks in 4 children with distraction rate of 2 mm per day and in 5 weeks in 2 adults with distraction rate of 1 mm per day after injection of the calcium sulfate. The consolidation period in adult was statistically significant compared with that of the control group using Mann-Whitney U test.In conclusion, these findings suggested that injectable calcium sulfate is effective for early bony consolidation in distraction osteogenesis in adult.

Periareolar Reduction Mammoplasty

The goals of the reduction mammoplasty are to reduce the volume of the breast, to create aesthetic shape that is stable over time, to maintain blood supply and innervation to the nipple-areolar complex, and to make fine limited scars. There are 3 rationales in our reduction mammoplasty. To reduce the scar, we perform the periareolar incision. To make effective reduction of the breast volume, and to preserve blood supply and innervation to the nipple-areolar complex, we use a central or an inferior pedicle technique. To prevent areolar widening, we use a purse-string suture. We performed the periareolar reduction mammoplasty to 36 breasts in 18 patients from Jul. 1998 to Jun. 2000. The mean follow up period was 8 months. The mean age was 41 and mean resection amount was 420 gm per breast. Most patients satisfied with their fine periareolar scars, adequate size of breasts and the innervation of the nipple-areolar complex. We applied this procedure to all kinds of macrostomia. The greatest advantage of the periareolar reduction mammoplasty is the inconspicuous limited scar. Other advantages over conventional technique include preservation of sensitivity to the nipple-areolar complex and shorter operative time. As disadvantages, 10 breasts(28%) showed areolar widening. In 8 of 10 breasts with areolar widening, purse-string suture was not applied in the skin flap margin of the outer circle and reoperation was executed to reduce the areolar size by excision of the widened areola. The application of the purse-string suture was carried out in 6 breasts. Two breasts with purse-string suture showed areolar widening possibly due to loosening of the purse-string suture knot. There were persistent periareolar wrinkles in 4 breasts and poor sensitivity to the nipple-areolar complex in 6 breasts in which more than 500 gm of breast tissue per breast was resected. Periareolar reduction mammoplasty is optimal for patients who require reduction of lesser than 500 grams per breast. In the severe macromastia with or without ptosis, inverted T-incision is preferable to the periareolar incision, and periareolar incision can be modified by adding wedge resection of the outer excess skin flap inferiorly which results in a periareolar and vertical scar below the nipple-areolar complex.