Periumbilical Dermal Graft as a Good Option for Volume Enhancement in Secondary Cleft Lip Deformity: A Case Report

Volume deficiency and poorly defined cupid's bow of the upper lip are frequently encountered problems in secondary cleft lip deformities. In this report, we present the method of a periumbilical dermal graft for correcting secondary cleft lip deformity. A 17-year-old male patient presented with a poorly defined notching cupid's bow and volume deficiency of the upper lip. He had undergone cleft lip surgery when he was 2 years old. We planned to perform a periumbilical dermal graft. There were sufficient amount of periumbilical subdermis and fat tissue thickness to obtain abundant volume. The periumbilical contour was similar to the natural contour of the lip. Less scarring was expected. There was no need to change the posture during operation, making it easy to harvest. Postoperative evaluations showed vermilion symmetry. Ideal cupid's bow shape and position were achieved without color mismatch. As a result, we obtained an ideal volume of the upper lip. Therefore a periumbilical dermal graft is a good option for correcting volume deficiency of the lip with good aesthetic outcomes.

Coverage of a 4(th) Degree Contact Burn of Scalp and Calvarium Using a Fasciocutaneous Transposition Flap: A Case Report

Scalp and calvarium defects are caused by trauma, burn, tumor resection, or congenital diseases. We experienced a few cases of severe electrical burn of scalp and calvarium, but fourth-degree contact burn of scalp and calvarium is a rare case. A 67 years old man was presented with a 25% total body surface area contact burn. A 20 cm×15 cm thick eschar on the patient's scalp was observed. Among various techniques for scalp reconstruction, we planned fasciocutaneous transposition flap with split thickness skin graft for coverage of large defect. Considering aesthetically satisfactory outcome, we designed a fasciocutaneous transposition flap including the hair-bearing areas. We additionally used skin graft for uncovered surrounding areas. There were no flap necrosis, graft loss, or any other surgical complications after the surgical flap and skin graft. At 6-month follow-up, the operation site was stable. The patient satisfied with functional and aesthetical outcomes, so we report this case.

Coverage of Skin Defect in Deep Second Degree Burn by Using Skin Graft After Advancement Flap

PURPOSE: Skin graft is useful treatment in burn wound. The major disadvantage of traditional skin graft is related to recipient site scarring and donor site morbidity. Then we present our successful experience of using skin graft after advancement flap. METHODS: The study is based on 22 patients who has deep 2nd burn wound with eschar and 3rd degree burn wound. We performed split-thickness skin graft in 17 patients, and fullthickness skin graft in 5 patients. After undermining of wound margin about 1.3 cm~4 cm, we performed suture of wound marginal skin and subcutaneous tissue with absorbable suture materials. Then we harvested skin according to reduced wound size, and we applied donor skin in recipient area. RESULTS: The skin graft area of the 17 patients who had split skin-thickness graft showed a decline of 25% compared with that of the initial burn wound. 5 patents who had full-thickness skin graft also showed a decrease of 10% in the skin graft area compared with that of the initial burn wound. All Grafts were well taken in 22 patients without skin loss. By observing the progress 12 to 15 months after the operation, minor hypertrophic scar on the boundary of grafted skin area was observed in the 2 patents and hypertrophic scar or contracture was not seen in all 22 patients. CONCLUSION: Skin graft after advancement flap can be used as a treatment in deep 2nd degree and 3rd degree burn wound. Compared with traditional skin graft, the result seems to be good cosmetically and functionally.

Clinical Consideration of Contact Burn Caused by Hair Straightener

PURPOSE: Hair straightener is a common tool among various household electric appliances used for hair styling. Hair straightener has plate consists of metal or ceramic, which lead to possible burn if contacted. Main users of hair straightener are young women whereas main victims of hair straightener caused-burn are infants. Among patients visiting our burn medical center, the case of attending hospital due to contact burn by hair straightener tends to increase. METHODS: Retrospective research was conducted 72 patients with contact burn by hair straightener among patients admitted to our burn medical center from Jan 2012 to Dec 2014. Subjects were classified by age, gender, affected site and degree and treatment method. RESULTS: 72 subjects consisted of 39 infants, 9 children, adolescence and 24 adults. Affected sites were presented as hands in 31, face in 21, foot in 13, arms in 5 and legs in 2 subjects. Degree of burn was presented as deep second degrees in 67 and third degrees in 5 subjects; 70 subjects were cured through conservative treatment whereas 2 subjects had local flap. CONCLUSION: Contact burn by hair straightener can be ranged from partial to full thickness skin defect. It is important to note this kind of burn develops more frequently in infants and is preventative. Education for young women who use hair straightener is crucial. Training regarding function and design improvement of hair straightener is also essential. Uncovering the heated plate after use through a separate lock device might be great help for prevention of contact burn if developed.

Usefulness of Silicone Net Dressing in Fixation of Skin Grafts

PURPOSE: Skin graft may fail for a number of reasons. Hematoma or seroma formation prevents graft adherence. Traditionally tie-over dressing has been used in skin graft fixation, but skin graft in convex and narrow place like fingers or toes, tie-over dressing is hard to be applied. And Vaseline gauze over graft often adheres to graft by exudate into gauze fibers and hardening, and may cause damage to graft in dressing change. We report successful results of using silicone net dressing in fixation of split thickness skin graft over these place. METHODS: After skin graft, the silicone net, Mepitel(R) (Molnlycke Health Care, Box 13080, SE-402 52 Goteborg, Sweden) was applied over the graft followed saline wet gauze dressing in 25 patients. 13 cases were on finger, 8 cases were on foot or toes, 4 cases were on anterior chest. RESULTS: In 22 cases, there were no hematoma or seroma formation, Mepitel(R) maintained 5 days after skin graft. And then, Mepitel(R) was removed from the graft. In 3 cases, there were hematoma formation, Mepitel(R) was removed at 3 days after skin graft. In all cases, grafts were taken well without maceration or skin eruption. CONCLUSION: The silicone net, Mepitel(R), is dressing material made of silicone gel bound to a pliable polyamide net, and it can provide uniform pressure to the graft, even in convex and narrow place. And net like structure allows the exudates of the wound to pass freely into the secondary absorbent dressing and easier to remove from the grafts than Vaseline gauze. We think that the use of a Mepitel(R) is a efficient tool for securing skin grafts.

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.

Effective Dressing Considering Adhesion and Absorptance in Treatment of Second Degree Facial Burn

PURPOSE: In second degree burn injuries of face, it is important to solve much discharge of early burn wound and shorten healing time. We introduce methodical and effective dressing in treatment of second degree facial burn at focus to solve much discharge of early burn wound and to shorten healing time. METHODS: From March, 2011 to December 2013, a study was done with 398 patients who had second degree burn wound on face. Initially we performed dressing with hydrofiber agent (Aquacel(R)). After cleansing with saline, Vasaline guaze was layed on face, and hydrofiber agent were layed over it, and Vasaline guaze was layed over there again, then saline wet guaze dressing performed. When we changed dressing daily, we evaluated burn wound degree. In superficial second degree burn wound like pinkish colored wound, we repeated hydrofiber agent and saline wet guaze dressing. In deep second degree burn wound like pale or mottled colored wound, we changed dressing with cultured allogenic keratinocyte (Kaloderm(R)). RESULTS: Number of patients with only superficial second degree burn wound was 272, with superficial second degree and deep second degree burn wound together was 113, with only deep second degree burn wound was 13. In only superficial second degree burn wound, the average healing time was 5.1 days with hydrofiber agent and saline wet dressing. In superficial second degree and deep second degree burn wound together, the average healing time was 7.2 days with hydrofiber agent and saline wet guaze dressing and cultured allogenic keratinocyte. In deep second degree burn wound, average healing time was 11 days with hydrofiber agent and saline wet guaze dressing and cultured allogenic keratinocyte. CONCLUSION: In this strategy, hydrofiber agent is good to be attached on irregular surface of facial burn wound, and we use hydrofiber agent to make wet environment to promotion wound healing, not as absorbable material. We use Saline wet guaze as absorbable material. And after evaluation of degree of burn, we use cultured allogenic keratinocyte to promote wound healing in case of deep second degree burn. We think this strategy using hydrofiber agent and saline wet gauze and cultured allogenic keratinocyte on facial burn wound is very effective dressing method.

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.

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.

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.

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.

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.

The Clinical manifestations and Signs of Long Term Use with Temporary Double-fold Making Materials on Upper Eyelid

BThere are many materials which can make beautiful, clear eyelid crease with temporary effect. Double fold tape and glue are the most popular materials to make artificial double eye lids. However, the long-term use of these materials seems to make cause many local problems. This study was conducted to identify the long-term side effects of double-fold tape and glue. A total of 191 patients who have experienced double fold tape or glue were enrolled. The information of age, double-fold making product, and side effects were collected, based on medical records and, Patient & Observer scale(1: 'Normal', 5: 'Abnormal/Severe). The mean period of use was 23.7 months. The time required to make double-fold was 5~30 minutes. The most common symptom was itching sense, followed by decrease skin elasticity, skin dryness, and change of skin color. The most common signs was skin laxity, followed by eruption, keratinization, pigmentation, and local inflammation. One patient underwent medical treatment for conjunctivitis after double-fold glue usage. Double fold tape or glue can lead a problem with skin due to lack of oxygen exposure and rubbing eye lids with a stick. Appropriate use of double-fold products and careful monitoring of side effects are needed.

Vermilion Augmentation of Secondary Cleft Lip and Nose Deformity by AlloDerm(R)

Secondary deformities can exist after repair of cleft lip by sophisticated method of primary cheiloplasty and can affect some or all of the previously cleft regions. There may be lip scar, nasal deformity, vermilion deficiency, and maxillary hypoplasia. The correction of secondary cleft deformities is difficult and requires efforts of a multidisciplinary team. There are many operative techniques for correction of the vermilion deficiency, for example double V-Y advancement mucosal flap or double pendulum flap etc. But, these methods are very complex and can remained the scar on vermilion. Twenty six patients of secondary cleft lip and nose deformity with vermilion deficiency were operated in our department from January 1999 to June 2002. The secondary cleft lip and nose deformity was corrected by various operative methods, and the vermilion deficiency corrected by using acellular human dermis(AlloDerm(R), Life Cell Corp., Woodlands, Texas). The three cases suspected for AlloDerm(R) to be absorbed showed that the augmentation of vermilion was poor but another cases showed satisfactory result with good augmentation of vermilion and minimal scar. In conclusion, vermilion augmentation using AlloDerm(R) has the several advantages such as simplicity, shorter operation time, and effectiveness compared with other surgical methods.