The Management of Chronic Wound with Modified Portable Negative Pressure Therapy

PURPOSE: V.A.C. is a new concept which is closed dressing with negative pressure to promote wound healing. It has been widely used as the treatment of chronic and acute wounds such as pressure sores, burns, stasis ulcers, and other complicated wounds. However It has disadvantages such as high cost and the need of specific equipment. In this article, we described new method to overcome these disadvantages. METHODS: We made newly innovated equipment with 50cc syringe and spring to create negative pressure. From May 2006 to May 2007, we applied it to two patients with chronic wound. RESULTS: The treatment period was 5 weeks for one case and 3 weeks for the other case. Both patients were healed completely without admission and wound healing was accelerated. During follow-ups, there were no complications. The mean cost for single dressing was 9,590 won. CONCLUSION: Modified portable negative therapy using newly innovated equipment could accelerate wound healing better than conventional dressing. It lowers the number of dressings, saves cost of treatment, and enables treatment as outpatient basis.

The Usability of Perforator-based Fasciocutaneous Flap for Trochanteric Pressure Sore

PURPOSE: Myocutaneous flap was widely used for trochanteric pressure sore but it had many drawbacks such as donor site morbidity, dog-ear deformity and functional muscle sacrifice. We have performed fasciocutaneous flap based on perforating vessels and succeeded in overcoming its drawbacks. METHODS: We experienced 11 cases of perforator-based fasciocutaneous flap for the coverage of trochanteric pressure sore in 9 patients, 2 cases of which were bilateral. The ambulatory status of patient group is as follows: 6 of them used a wheelchair, 2 of them are free walking, 1 of them use a wheelchair or crutches. Flap was supplied by cutaneous perforating vessel of descending branch of the lateral circumflex femoral artery and the third perforating artery of the deep femoral artery. The size of wounds were from 4x6.5cm to 10x13cm. RESULTS: We did not find any flap loss or congestion except 2 partial wound dehiscences and 1 wound infection. Donor site morbidity was not found. We observed no recurrence of the pressure sore during the 2.5 year follow-up period. CONCLUSION: We considered that perforator-based fasciocutaneous flap could overcome the traditional drawbacks of the conventional myocutaneous flap and its modified flap for trochanteric pressure sore. And this flap has many advantages for covering trochanteric pressure sore without any donor site deformity and morbidity, which would greatly improve the aesthetic result.

Primary Cutaneous Anaplastic Large Cell Lymphoma: A Case Report

PURPOSE: Anaplastic large cell lymphoma, has the following three characteristics of a malignant lymphoma; 1) An irregular large nucleus, called pathologic atypical cells, 2) Eosinophilic cytoplasm, 3) Immunologically positive for Ki-1. Anaplastic large cell lymphoma occurs mostly in the lymph nodes, but about 40% has been observed to occur in other tissues. Skin is the one of the main sources of origin and it is called 'primary cutaneous anaplastic large cell lymphoma'. METHODS: A 69-year-old male patient with an erythematous nodule, sized 1.5 X 1.7 cm on his right hand dorsum was excised under local anesthesia and on biopsy was diagnosed as 'Dermatofibrosarcoma Protuberans'. Three months after the local excision and biopsy, same natured mass reoccurred in the same region, and then spontaneous regressed after three weeks. However, metastatic large mass of 4.0 X 5.0 cm, of same nature was observed on the elbow. The large mass was operated with wide excision and biopsy. RESULTS: On final diagnosis, with an immunofluorescent stain with CD30(Ki-1), 'Primary cutaneous large cell lymphoma' was made. After follow up for three years, we did not observed recurrence and metastasis. CONCLUSION: We have reported that we have diagnosed primary cutaneous large cell lymphoma and treated without recurrence and metastasis.

Inverted Nipple Correction through Modified Broadbent-Woolf Method

Inverted nipple can be a cause of great distress, leading to potential breast feeding problems, and repeated irritation and inflammation. Many surgical and non-surgical procedures have been described for reshaping the nipple and areola so that it once again projects out from the breast. The aim of the study presented here is to show a reliable and effective method for treating inverted nipple particularly the more serious cases of Grade II and III as classified in the Han and Hong classification of nipple inversion. We added to vertical Z-plasty based on the Broadbent- Woolf method to the correction of inverted nipple This is a simple procedure with very few recurrence of inversion after treatment particularly for women no longer breast feeding. We saw good results with patients during the 6 to 18 months follow up period. 5 patients(9 inverted nipples) were treated. All patients had congenital nipple inversion. Each patient had no plans to breast feed in the future. There was no recurrence and sensory change, no postoperative hematoma or any seroma complications. All patients had good aesthetic results and their overall satisfaction was high. We considered that this method was effective and simple for correction of the inverted nipple.

Eyebrow Reconstruction with Single Hair Transplantation

People who have thin eyebrows seek to enhance the density of their eyebrows. Eyebrow reconstruction could be accomplished by tattooing, pedicled flap, composite graft and hair transplantation. However, tattooing is neither permanent nor natural. The pedicled flap or the composite graft leaves an unsightly scar and unnatural results. High level skill and long operation time is the only disadvantage of eyebrow hair transplantation reconstruction but this problem can be overcome by having a well trained operation team. The authors present 130 cases of single eyebrow hair transplantation in one stage with pure cosmetic aims. The majority of patients had congenital thin eyebrows and no definite cause of thinning was found. The results were adequate and almost all of the patients were satisfied with their newly grown dense eyebrow hair.

Preadipocyte Culture in Chitosan-Alginate Gel

Alginate gel is widely used as a scaffold in tissue engineering. Alginate solution has anionic properties, and calcium or magnesium cation has been used to crosslink alginate into a gel form. Chitosan not only has cationic properties but also is known to promote wound healing. Although there are some studies of chitosan- alginate gel use in drug delivery, reports of its application as a scaffold in tissue engineering are rare. The purpose of this study is to make chitosan-alginate gel and to investigate its biocompatibility as a scaffold for preadipocyte culture. 1, 2, 4, 6% chitosan solutions were mixed with 2% alginate solution to make various concentrations of chitosan-alginate gels. All of the gel which were made have been measured by Viscometer. Preadipocytes obtained from human breast fat tissue were seeded into each chitosan-alginate gel, and cell viability was measured by XTT colorimetric assay on the 2th, 4th, and 7th day of preadipocyte culture. The results of analysis were as follows. Each viscosity of 4% and 6% chitosan-alginate gels is similar to that of the calcium-alginate gel and 4% and 6% chitosan-alginate gels shows significantly higher cell viability than the calcium-alginate gel(p<0.05). In conclusion, chitosan-alginate gel is thought to be an appropriate scaffold for preadipocyte culture in tissue engineering.

Double Eyelid Operation Using Partial Incision and Continuous Buried Suture

e double eyelid operation is one of the most common aesthetic operation in Korea. The non-incision method have advantage such as decreased swelling, faster recovery and so forth. However difficulties arise in case of excessively fatty upper eyelids. The authors have devised a method for use with the fatty upper eyelid. Through the partial incision, orbital fat was removed and the double fold was made with the continuous buried suture technique. This technique was performed in 215 cases in 462 total double eyelid operation in Metro Plastic Surgery Clinic from August 2000 to May 2002. We experienced satisfactory results in all cases except 1 case of asymmetry and 1 case of fold loss. The authors conclude that this method achieves a shorter operation time, less morbidity and better cosmetic results in fatty upper eyelids than the other incision methods.