Effect of Retinoic Acid Derivatives Using Polyethylene Glycol(PEG), Polyvinyl Pyrrolidone(PVP) on Dermal Wound Healing

Retinoids are compounds with pleiotropic functions, selectively targeting certain skin structures. They are vitamins which must be derived from diet because retinol(vitamin A) is not synthesized in the body, and also they are hormones with intracrine activity, because retinol is transformed into molecules that bind to nuclear receptors, exhibit their activity, and are subsequently inactivated. Enhanced healing of full-thickness skin wounds has been demonstrated in early wound healing studies. OBJECTIVE: Our purpose is to observe the chemical and histologic effects of topical retinoid derivatives(0.05%) applied directly to the dermal wound of guinea pig. METHODS: We prepared five kinds of retinoid derivative, applied each one on the wound on back of guinea pig. After 4 and 8 weeks, each wound was observed under microscope and analyzed for the amount of the collagen. RESULTS: Among the newly developed retinoid derivatives, PVP-RA(ester form) was the most effective in wound healing of the dermal damaged guinea pig. CONCLUSION: Retionid derivatives were effective in dermal wound healing if well prepared.

Combined Facial Rejuvenation Using Endoscopic Face Lift and Laser Resurfacing

Facial aging is a complex process of gravity-induced soft tissue ptosis and photoaging. In the standpoint of ideal rejuvenation, face lifting combined with laser resurfacing offers significant improvement in aesthetic outcome unachievable by either procedure alone and has many advantages. Neverthless, the simultaneous combination has never been popularized due to the non-specific thermal effects of the laser and risks of skin necrosis in Korea. This report documents the safety and effectivness of combined procedures when using systematic consideration and modified techniques in orientals. This study included 26 Fitzpatrick type III, IV orientals who didn't complaint lower face aging. A dramatic rejuvenation in soft tissue reposition and skin quality was produced in combined endoscopic forehead and midface lift with laser resurfacing cases. The standard forehead lift using endoscopic subperiosteal deep plane seldom interfere flap resurfacing. An endoscopic subperiosteal and subcutaneous midface lift repositions the midface tissue effectively without preauricular incision. Newer variable pulse Er:YAG lasers allow precise ablation and coagulation separately. The minimal excessive thermal injury from variable Er:YAG lasers, modified techniques for flap and skin care program would make it possible to safely perform laser resurfacing with surgical facial rejuvenations on non smokers. There were no incidents of persistent erythema or pigmentation abnormality, scar, full thickness flap necrosis. By following the considerations suggested in this report, the combination of controlled skin resurfacing with face lifting may be safe and effective in orientals.

A Case of Kimura Disease on Parotid Gland

Kimura disease(KD) is a chronic inflammatory disorder of unknown etiology and results from an abnormal proliferation of lymphoid follicles and vascular endothelium and rarely has been reported in Korea. Clinical findings of Kimura disease include solitary or multiple, firm, subcutaneous nodules, which usually are located on the head or neck but parotid region is the most common site. The clinical course of the disease is chronic, with lesions frequently persisting or recurring despite treatment. The prognosis for KD is good, with no potential for malignant transformation. Our case is a 45-years-old man who had huge mass on left cheek which had slowly grown since about 10 years before. We planned to perform superficial parotidectomy but the mass was poorly demarcated due to extensive fibrosis and adhesion and had easy bleeding tendency. After frozen biopsy, we performed tumor debulking operation followed by cyclosporin therapy by the dose of 2.5 mg/Kg/day. The lesion was almostly cleared successfully after 3 months later. We report important aspects of clinical findings, histologic features, and therapeutic options of the rare case of KD with review of the previous articles.

Comparison of Treatment Effect between Superficial Suction and Subdermal Excision in Osmidrosis

Osmidrosis develops in many young people due to the apocrine gland becoming active after the adolescent period and can cause difficulty in social activities and personal relationships. We compared 2 surgical treatment methods for osmidrosis, superficial suction and subdermal excision, to determine how many of apocrine glands could be removed and examine if a significant difference was present in treatment outcome. The subjects used for the present study included 62 patients of whom 46 patients underwent subdermal excision and 16, superficial suction. We counted the total number of apocrine glands in tissue samples obtained using those 2 methods, fixed in formalin and treated with usual histologic treatment. We calculated the number of apocrine glands per unit area by measuring the axillary area of the surgery site determined before surgery. The patients who underwent surgery using those 2 methods were divided into satisfactory group and unsatisfactory group by evaluating the results subjectively and objectively after surgery. The satisfactory rate was 95.7% in 46 patients who underwent subdermal excision and 81.25% in 16 patients who underwent superficial suction. An average of 127.82 apocrine glands/ cm2 were removed through subdermal excision and 72.71 apocrine glands/cm2, through superficial suction. We determined that more apocrine glands were removed with a statistical significance using subdermal excision. However, considering the result that 81.25% satisfactory rate was seen despite 57% of apocrine glands being removed with superficial suction compared with subdermal excision, superficial suction would be also effective in reducing the number of apocrine glands to below a threshold.

Dual Plane Midface Lift Through Subperiosteal and Subcutaneous Dissection

The standard SMAS face lift and deep plane face lift don't adequately correct an aging midface, especially nasojugal groove and nasolabial fold. An endoscopic subperiosteal and subcutaneous midface lift reposition the midface tissue more superiorly and successfully rejuvanate the nasojugal groove and nasolabial fold, creating a more youthful appearance. This study is about endoscopic subperiosteal and subcutaneous midface lift which had been performed to 13 patients in our hospital from April 1999 to April 2001. The deep layer of the midface soft tissue is suspended by subperiosteal dissection and the superficial layer, including skin and malar fat pad, suspended by subcutaneous dissection. Both subperiosteal and subcutaneous planes are easy and safe dissection planes which prevent injury of the facial nerve branches. The endoscopic midface lift with subperiosteal and the subcutaneous dissections is an effective method to correct infraorbital hollowness, nasojugal groove and nasolabial fold.

Nerve Regeneration After Autogenous Nerve Graft Using Perfabricated Adiponeural and Myoneural Flap: An Experimental Study

Most of the peripheral nerve injuries from crushing or compressive forces are accompanied by surrounding soft tissue injuries. As a result, poor vascularity due to fibrosis and sacr formation compromises regeneration of the grafted nerve. Vascularized nerve graft shows superior regeneration to that of a non-vascularized one. However, the human body provides few donor sites of vascularized nerve graft clinically. We presumed that the prefabricated myoneural or adiponeural flap, which include fabricated nerves wrapped with surrounding vascularized muscle or adipose tissue flap, influences superiorly on the regeneration of grafted nerve because that surrounding vasculatity indirectly enhances the vascularity of the grafted nerve itself. Thirty adult male Sprague-Dawley rats were divided into three groups: 1) conventional reversed autogenous graft of the femoral nerve alone(n=10); 2) nerve graft entubulated with abdominal adipose tissue flap with a pedicle of inferior epigastric artery(n=10); 3) nerve graft entubulated with adductor muscle flap with a pedicle of the first muscular branch of the femoral artery(n=10). At three months postoperatively, grafted nerves were examined by electrophysiologic study to check amplitudes and motor nerve conduction velocities, as well as histopathologic study for evaluation of regenerated nerve cells, fibrosis and neo-vascularization. Consquently, nerve regeneration was found in all three groups. Both the myoneural and adiponeural flap groups had better improved results of nerve regeneration compared to that of the conventional nerve graft group. The result of myoneural flap group was superior to that of the adiponeural flap group. The myoneural flap group showed minimal fibrosis and less prominent neovascularization around moderately regenerated nerves. The adiponeural flap group showed more severe perineural and endoneural fibrosis, as well as vascular proliferation around focal regenerated nerves. The results of myoneural flap group proved to be statistically significant. We concluded that it is possible to use nerve graft entubulated with a vascularized muscle flap (myoneural flap) as a substitute for vascularized nerve graft.

An experimental study on the effect of Ginkgo Biloba extract (EGb 761) on the healing process after weak crush injury

Late results of microvascular patency after crush or crush avulsion injury have been relatively poor. A key factor in the poor results may relate to the presence of damaged tissue, but the mechanism of this thrombus formation is still imcompletely understood. One current theory about the origin of thrombus after vessel trauma involves increased exposure of the subendothelial tissue to platelets that adhere and aggregate at the injury site, initiating thrombus formation. Most surgeons have usually used several anticoagulant drugs to prevent thrombosis for 2-3 weeks after trauma or microvascular repair. We thought that Ginkgo biloba extract (EGb 761), which has a number of pharmacologic actions, could promote microvasculature healing and prevent thrombosis. The femoral arteries of rats were dissected. Each group was as follows:-1. group A (n=10): intact group (not crushed vessel),2. group B (n=10); crushing injury (not EGb 761-treated group),3. group C (n=10); crushing injury (EGb 761-treated group). Group B and C underwent crush injury with the energy of 0.07J. We compared patency rate and histological examination. All arteries were patent at postoperative 14 days, and in histologic finding, group C (group with EGb 761 treatment among the crushed injury group) showed significant improvement of vascular endothelial and medial regeneration.

Reconstruction of Soft - Tissue Defects in the Lower Extremities Using Local or Free Muscle Flaps

According to increment of industrial accidents and traffic accidents, complex injuries of the lower extremity accompanied with broad soft-tissue defects. Lower extremity possess disadvantageous anatomical characteristics includes poor vascularity easily result in compromised circulation, rigid tissue distensibility, easy infectability followed by soft-tissue defects and relatively long healing periods. Furthermore, it easily happens that osteomyelitis or non-union was followed by bony exposure or fractures, and it must considered to weight-bearing or gate. So, It is impotant to select a appropriate method in reconstruction of the lower extremities and it is applicable to variety of surgical techniques according these considerations. The goal of flap coverage in the lower extremity should be not only satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. The Authors estimated that skin graft and local flap surgery for bony exposed area and soft-tissue defect in weight- bearing area may not be successful. In this article, we have tried to established a reconstruction method in the lower extremity based on experiences and clinical analyses of reconstruction of the soft-tissue defects using local or free muscle flap transfer in 54 cases(49 patients) from 1993.3 to 2000.2. Results revealed 93% flap survival, but there were flap failure noted in 4 cases: one appears in the local muscle flap transfer, other three appear in the free muscle flap transfer. Among the 49 patents, 28 patients(58%) accompanied with open comminuted fractures and 11 patients (22%) visited us with infection. We think that soft-tissue defects in lower extremities associated with open comminuted fractures and infections should be reconstructed by flaps that include healthy muscles effectively due to benefits of muscle itself.

Management of Maxillary or Mandibular Fractures with Model Surgery and Occlusal Splint

Maxillary and mandibular fractures account for a large proportion of facial bone fractures. The primary objective in reduction of marillary or mandibular fractures is to return the structures to normal position of function and cosmetic contour, i.e. restoration of normal occlusal relations through proper positioning of the teeth and bony structures. Interdental wiring, intermaxillary fixation, rigid internal fixation or external pin fixation are common methods in the management of jaw fractures, varying with the age of the patient, location or extent of fracture. Malocclusion is not an uncommon complication after management of jaw pacture. We managed 16 patients (13 males, 3 females) of mandibular or maxillary fractures with model surgery and occlusal splint from July 1998 to August 1999. The average age of patients was 27.4 years and the average follow-up period was 6 months. We achieved good occlusal relationship without malunion, nonunion, or loss of teeth. Acrylic occlusal splints are rigid, strong, easily adjusted and repaired, translucent, lightweight and tolerated well by the oral mucosa. It is useful in the maintenance of intermaxillary fixation and in maintaining continuity of the maxillary or mandibular dental arch, as well as providing precise dental alignment during healing. Splints are helpful in managing fractures of the symphysis, parasymphyseal region, body and alveolar ridges of the mandible, sagittal fractures of the hard palate, and severely comminuted mandible fractures.

Management of Fournier's Gangrene with PGE1 and Bilateral Superomedial Thigh Flap

Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital or perianal regions. Management of this disease has involved prompt surgical debridement with initiation of broad spectrum antibiotics and intensive supportive care. Multiple debridements orchiectomy, urinary deversion, and fecal diversion should be performed as clinically indicated. Hyperbaric oxygen therapy and topical application of unprocessed honey may prove to be useful adjuncts as new therapies. After excision of all necrotic tissue, the tissue losses have been managed by primary repair. split-thickness skin grafts, rotational or free myocutaneous flaps and omental flaps. Skin graft did not take on bare testis lacking the tunica vaginalis, and gracilis myocutanous flap was too bulky to cover the scrotal area. The progress of necrosis ceased by using intravenous PGE1 injection in the aspect of characteristic obliterative endarteritis causing cutaneous and subcutaneous vascular thrombosis and necrosis of tissue in Fournier's gangrene. We have reconstructed large scrotal defects with bilateral superomedial thigh flap in three Fournier's gangrene patients after stopping tissue necrosis with PEG1 treatment and several surgical debridements of the wounds. The use of this flap ensures a virtually normal sensation, which is important for the erotic propensity of the scrotum. Easy flap design and dissection, as well as primary closure of the donor site, are another benefits of this method.

The Effect of Ginkgo Biloba Extract(EGb 761)on the Patency Rate after Microvascular Anastomosis on Severely Damaged Microvasculature in the Rats

Replantation after crush amputation has a relatively low success rate. Thrombus formation due to vessel and tissue trauma is considered as the principal cause of failure. In the laboratory and clinically, we have been tried to improve the post-anastomosis patency rate in crushed microvasculature. To accomplish this, we have usually used several anticoagulant drugs. Extracts from the leaves of Ginkgo biloba (EGb) have been used therapeutically for centuries. EGb exerts a number of pharmacologic actions. Eighty rats were control group and another 80 rats were treated with EGb 761. The femoral arteries underwent crush injury with an energy of 0.4J, and the vessles in each group were divided and anastomosed by a standard microsurgical technique. Each group was comprised as follows: (1) control group(A1,A2): group A1(n=40); intraluminal saline irrigation, group A2(n=40); intraluminal saline irrigation+heparin 40 u/ml(IV). (2) EGb 761 treated group(B1, B2): groupB1(n=40); intraluminal saline irrigation, group B2(n=40); intraluminal saline irrigation + heparin 40 u/ml(IV). At postoperative 14 days, the patency rates were; group A1 20%, group A2 77.5%, group B1 47.5%, group B2 92.5%. These results were interpreted as follows: the patency rate was significantly increased in the EGb 761-only treated group(p>0.01), the heparin-only treated group(p>0.01), and the EGb 761 and heparin-combined at crushed microvessel surgery. However the patency rate of the EGb-only treated group was significantly lower than that of the heparin-only treated group(p>0.01). And in the EGb 761 and heparin-combined treated group compared to the heparin-only treated group, there was some patency rate increase in the combined treated group, but there was no significant difference between them(p=0.060).

Reconstruction of the soft tissue deffect of lower extremity in complicated case

This study includes 19 cases of complicated low extremity injury to whom underwent microvascular free-tissue transfer in cases of open comminuted fracture, osteomyelitis, and vascular compromise or extensive soft tissue defect from Nov. 1994 to July 1997. The average time after injury to coverage was 25 days. The nineteen patients underwent a total of nineteen free tissue transfers primarily, and eighteen (94.7 per cent) of the transfers survived. Major complications were encountered recurrent failure of the free tissue transfer in one patient and partial necrosis in the other flap, which were successfully treated by flow-through radial forearm free flap and distally based superficial sural artery flap respectively. Two patients were sustained below knee amputation, one above knee amputation, despite of survival of flaps. This reveals limb salvage in 84 percent. The microvascular reconstruction is a versatile and reliable methods in complicated cases after severe trauma. Free tissue transplantation should be considered as a primary treatment in such complicated cases.

Reconstruction of soft tissue defects using free serratus anterior muscle and adifofascial flap

The optimal reconstruction of soft tissue defects with exposure of blood vessel, nerve, tendon muscle, and bone requires muscle flap that provides a durable surface, appropriate bulk and stability. The serratus anterior muscle has been suggested as a versatile and reliable flap for reconstruction of head and neck and extremity injuries. In our department, reconstructive operations were performed for 18 patients who had soft tissue defect of upper or lower extremities or head from March 1995 to February 1996. We performed free flap of serratus anterior muscle in 13 patients, free flap of adipofascial tissue overlying serratus anterior muscle in 3 patients, free flap of both serratus anterior muscle and adipofascial tissue in 1 patient, free flap of serratus anterior muscle and rib in 1 patient. Their ages were 5 to 56 years, the ratio of male to female was 14 : 4. The defects involved the upper extremity in 6 patients, lower extremity in 10 patients, and scalp in 2 patients. Free flap using adipofascia overlying serratus anterior muscle was performed when gliding surface was required due to the exposure of some structure such as tendon. The average duration from operation to follow-up examination was 4 months(from 1 to 12 months). One total necrosis was observed in the patient who had crushing injury of forearm, and one partial necrosis was observed in other patient. In the rest 16 cases, results of operation were satisfactory. This kind of flap was very useful in reconstruction of soft tissue defect and gliding surface due to easy dissection, capability of getting long vascular pedicle, and no serious functional and cosmetic deficit on donor site.

Reconstruction of soft tissue defects using free serratus anterior muscle and adifofascial flap

The optimal reconstruction of soft tissue defects with exposure of blood vessel, nerve, tendon muscle, and bone requires muscle flap that provides a durable surface, appropriate bulk and stability. The serratus anterior muscle has been suggested as a versatile and reliable flap for reconstruction of head and neck and extremity injuries. In our department, reconstructive operations were performed for 18 patients who had soft tissue defect of upper or lower extremities or head from March 1995 to February 1996. We performed free flap of serratus anterior muscle in 13 patients, free flap of adipofascial tissue overlying serratus anterior muscle in 3 patients, free flap of both serratus anterior muscle and adipofascial tissue in 1 patient, free flap of serratus anterior muscle and rib in 1 patient. Their ages were 5 to 56 years, the ratio of male to female was 14 : 4. The defects involved the upper extremity in 6 patients, lower extremity in 10 patients, and scalp in 2 patients. Free flap using adipofascia overlying serratus anterior muscle was performed when gliding surface was required due to the exposure of some structure such as tendon. The average duration from operation to follow-up examination was 4 months(from 1 to 12 months). One total necrosis was observed in the patient who had crushing injury of forearm, and one partial necrosis was observed in other patient. In the rest 16 cases, results of operation were satisfactory. This kind of flap was very useful in reconstruction of soft tissue defect and gliding surface due to easy dissection, capability of getting long vascular pedicle, and no serious functional and cosmetic deficit on donor site.

The Reliability of Ultrasonographic Fending of Silicone Breast Implant Rupture

This retrospective study evaluated possible rupture of silicone gel breast implants in 92 patients. the series included patients undergone augmentation mammoplasty(n=59), and reconstructive mammoplasty(n=23) from Sep. 1993 to Aug. 1996. the age of implants ranged from 4 months to 8 years(mean:23.1months). of these, 19 cases displayed Ultrasonographic sings of rupture. of 13 implants removed, 7 were intact and 6 were ruptured. Implant contour deformities and radial folds are often seen in both ruptured and intact silicone implants and therefore cannot serve as reliable signs of rupture. A stepladder sign in intact implant is believed to be the result of reverberation artifacts within the interior of the implant. Due to these false-positive ultrasonographic findings, ultrasonographiy is not as absolutely reliable tool for the diagnosis of implant rupture. Alternative imaging methods(CT, MRI) are required to establish an accurate preoperative diagnosis.

PREFABRICATION OF VASCULARIZED NERVE GRAFT BY CREATION OF MYONEURAL FLAP

No abstract available.

A clinical analysis on hand injuries

No abstract available.

A follow-up syudy of 123 peripheral nerve injuries in the upper extremity

No abstract available.

Replantation of amputated digits distal to the dip joint

No abstract available.

Reconstruction of the soft tissue defects in the lower extremities

No abstract available.