A Clinical Study on Recent Causing Agents of Chemical Burns

Purpose@#Due to rapid changes in the industrial structure in last decade, the wider various types of chemical agents were introduced. Burn surgeons should be well-informed with rapid changes of chemical burns. We present the recent incidence trends of causing agents of chemical burns. @*Methods@#From 2010 to 2019, 92 chemical burn victims were included in this study. A retrospective study was made about the type, distribution and incidence of the causing agents of chemical burns. Initial treatments of most chemical burn wounds are copious saline irrigation by tap water, except hydrofluoric acid burn cases managed by 10% calcium gluconate injection. In alkali chemical burns on extremity, if thin eschars appear in postburn 2∼3 days, acute early surgical escharectomy and split thickness skin graft were done. @*Results@#More than 9 types of major chemicals causing chemical burns were surveyed, and the most common causing agent of chemical burns was Hydrofluoric acid (23.9%) followed by Acetic acid (19.6%) and Sodium hydroxide (8.7%). @*Conclusion@#From 2010 to 2019, changes in the causing agent of chemical burns are that the types of major causing agents of chemical burns have increased and the distribution and incidence of causing agents have changed compared to previous reports. According to this study, more than 9 types of major chemicals causing chemical burns were surveyed, and the most common causing agent of chemical burns was Hydrofluoric acid (23.9%) followed by Acetic acid, Sodium hydroxide.

Rhombus Subcutaneous Pedicle Skin Flap for Reconstruction of Linear Depressed Postburn Scar Band

This paper presents our clinical experiences for reconstruction of the linear depressed postburn scar band by rhombus subcutaneous pedicle skin flap (RSPF). We report new RSPF, it’s versatility, and effectiveness for correction of the mild to moderate linear depressed postburn scar band. To correct the postburn scar band, we have newly designed the Rhombus Subcutaneous Pedicle Skin Flap (RSPF), which is made as rhombus-shaped skin flap on the inside of scar band. After excision of burn scar band, the each vertex of RSPF flap is advanced into the skin defects at apex of extended skin incision, which is starting from the upper and lower portion of the removed burn scar band at a near right angle. This flap can add more extra skin to adjacent superior and inferior area of excised scar band. We have experienced 2 cases of RSPF for reconstruction of linear depressed postburn scar band deformities in lower extremity. After 3 weeks to 3 months postoperative follow ups, relatively satisfactory results were obtained in all cases. We had successfully reconstructed the linear depressed postburn scar postburn band of lower extremity using the rhombus subcutaneous pedicle skin flap. For the correction of mild to moderate sized linear depressed postburn scar band deformities in extremity, the RSPF is simple, and very effective without donor morbidity.

Solitary sclerotic fibroma on the thigh

Sclerotic fibroma is a rare fibrous tumor of the skin associated with Cowden’s disease. In 1989, Rapini described sclerotic fibroma without Cowden’s disease as solitary sclerotic fibroma of the skin. It is a solid, well-circumscribed, slow-growing nodular tumor and it looks similar to a keloid scar. Consequently, it is extremely difficult to make a differential diagnosis of solitary sclerotic fibroma with keloid scar based on clinical findings only. The authors report a case of solitary sclerotic fibroma arising at the left lateral thigh of a 25-year-old man.

Keyhole vertical mini-abdominoplasty for correction of lower abdominal striae

Striae gravidarum are a common problem in postpartum women, who may experience serious emotional distress due to multiple streaks of scars on the abdomen. There is still no consensus on the treatment method for this problem. For a postpartum woman in her late 30s, who requested striae removal from the lower mid-abdomen, we developed and performed the keyhole-shaped vertical mini-abdominoplasty. This 37-year-old woman, who had given birth to two children, presented with multiple striae on the lower mid-abdomen and periumbilical area, as well as mild bulging in this area. The keyhole-shaped vertical mini-abdominoplasty, including multiple striae on the lower mid-abdomen and periumbilical skin, was designed. An area of striated lower abdominal and periumbilical skin, measuring approximately 10×15 cm2 and weighing about 450 g, was excised. Midline reinforcement of the loosened anterior rectus sheath with 3-0 Prolene sutures was done. Both lateral abdominal skin flaps were medially advanced to close the skin defects. Postoperatively, the patient had a favorable lower abdominal appearance with markedly fewer striae on the lower mid-abdomen and periumbilical area. The keyhole vertical mini-abdominoplasty can effectively correct moderate striae on the lower mid-abdomen and periumbilical area in postpartum women in their late 30s to middle age.

Versatile Scalp Donor Split Thickness Skin Graft in Burn Patients

PURPOSE: It is well known the advantages of scalp donor split thickness skin graft(STSG) in deep burn wound because of its scarless donor healing, and good color match in face. Inspite of the advantages of scalp as a skin donor site during split thickness skin graft some authors report the frequent postoperative folliculitis, and partial alopecia on scalp donor site. We had experienced 21 burn patients, who had full thickness skin defects caused by burn injuries, were successfully managed with scalp donor split thickness skin graft with our optimal donor management protocols. METHODS: We had 21 deep burn patients, who were managed with thin STSG from scalp donor for coverage of full thickness skin defects. The operative techniques of the harvesting scalp STSG, and scalp donor dressing care are such as followings. After the infiltration of the donor scalp area with 1:1,000,000 epinephrine diluted with saline, then usually 0.012~0.015 inch thickness skin were harvested with air driven Zimmer® dermatome. On postoperative 6days, the one layer of adhered Vaseline gauze at donor scalp site was manually removed, and the entire scalp was cleansed with water. After then the daily hair washing was continued to remove the desiccated scaly crust with thick exudate at the growing hair and follicle. RESULTS: The scalp split thickness skin graft at the recipient sites in 21 burn patients were survived completely. Ranges of patient's age were 8 months to 56. The size ranges of scalp STSG were 2×2 cm~12×15 cm. The grafted scalp donor STSG were survived in all cases. The mean epithelialization period of scalp donor was 7.2 days. The one case of transient folliculitis (5%) from the postoperative 8days was occurred, and it was disappeared slowly with vigorous daily hair washing, antiseptics and systemic antibiotics. In all cases, there was no micro-alopecia or alopecia, and scars in scalp donor after follow ups. The donor site pain was markedly disappeared within 1~2 postoperative day. The hemorrhage from the scalp donor site during operation was not noticeable. The newly growing hair at the scalp donor was noted from the 3 postoperative days by palpation or unaided eye through the Vaseline gauze dressing. The average lengths of newly growing hair shaft are 2~3 mm in postoperative 8 days, 5~6 mm in postoperative 14 days. CONCLUSION: We had successful reconstruction of postburn skin defects using scalp donor split thickness skin graft without donor scars, persistent folliculitis or alopecia on scalp donor. From the postoperative 6~7 days after harvesting the scalp donor STSG, early vigorous daily washing with water and open dressing of scalp donor site should be recommended in order to prevent folliculitis. After long-term follow ups, the scalp split skin grafted recipient sites showed reliable, and relatively good color match with surrounding skin in face and dorsum of hand.

Temporal augmentation with calvarial onlay graft during pterional craniotomy for prevention of temporal hollowing

BACKGROUND: Atrophy of muscle and fat often contributes to temporal hollowing after pterional craniotomy. However, the main cause is from the bony defect. Several methods to prevent temporal hollowing have been introduced, all with specific limitations. Autologous bone grafts are most ideal for cranial defect reconstruction. The authors investigated the effectiveness of bony defect coverage and temporal augmentation using pterional craniotomy bone flap. METHODS: This study was conducted in 100 patients who underwent brain tumor excision through pterional approach from 2015 to 2016. Group 1 underwent pterional craniotomy with temporal augmentation and group 2 without temporal augmentation. In group 1, after splitting the calvarial bone at the diploic space, the inner table was used for covering the bone defect and as an onlay graft for temporal augmentation. The outcome is evaluated by computed tomography at 1-year follow-up. RESULTS: The mean operative time for temporal augmentation was 45 minutes. The mean follow-up was 12 months. The ratio of temporal thickness of operated side to non-operated side was 0.99 in group 1 and 0.44 in group 2, which was statistically different. The mean visual analogue scale score was 1.77 in group 1 and 6.85 in group 2. CONCLUSION: This study demonstrated a surgical technique using autologous bone graft for successfully preventing the temporal hollowing and improved patient satisfaction.

Myxoid Solitary Fibrous Tumor on the Scalp

Myxoid solitary fibrous tumor (SFT) is very rare soft tissue neoplasm. It is microscopically composed of spindle cells which is individually separated by delicate band of collagen fibers. And this tumor cells are immunohisto-chemistrically highlighted by CD34. Myxoid SFT has indolent clinical course and a good prognosis, so it is important to make a diagnosis because of its morphological similarities to myxoid spindle cell neoplasms that have different prognoses and treatment. We report the case of a 20-year-old female with a myxoid SFT found in the left temporo-parietal scalp. This case report appears to be the first reported scalp occurrence of this rare tumor.

Optimizing Outcomes in the Reconstruction of Postburn Scar Hand Deformities

PURPOSE: Reconstruction of severe postburn hand deformities with flexion or extension contractures with finger webbing deformities, large hypertrophic scars of dorsal hand are frequently encountered problems in burn hand surgery. To obtain the good results after correction of various type of postburn scar hand deformities, we have used the sophisticated reconstructive procedures such as scar contracture release, skin graft, and use of acellular dermal matrix (ADM). We report reliability and usefulness of these novel updated procedures according the type of postburn hand deformities, and reviewed the literatures. METHODS: We had 82 postburn hand deformities. Among them we selected 7 patients of severe postburn hand deformities, which had different affected sites involving over 1/3 of hand. To reconstruct the finger flexion contractures, the scar contracture release and full thickness skin graft was most frequently performed. For correction of finger webbing deformities, the 5 flap Z-plasty for 1(st) web, dorsal and volar interposition flap for 2, 3 and 4 web, FTSG were used. The diffuse hypertrophic scar of dorsum of hand was reconstructed with total excision of scars, skin coverage with one piece of medium thickness STSG, and postoperative clenched hand position. The postburn palmar contractures was reconstructed with extensive contracture release followed by resurfacing with ADM (AlloDerm™) and thin STSG. The severe postburn abduction contractures of wrist was treated by total excision of scars, ADM (CGDerm™), and thin STSG. RESULTS: After 1 month to 1.6 years follow up, relatively satisfactory results were obtained in all patients. As complications, 1 case of recurrent palmar contractures, which was reconstructed with ADM (AlloDerm™) with thin STSG, were noticed. CONCLUSION: The postburn finger flexion contractures could be managed by the scar contractures release and FTSG. This method is very safe and reliable. For reconstruction of postburn finger webbing deformities, it is mandatory to use 5-flap Z-plasty for 1(st) webbing deformities, and dorsal and volar interposition flap for 2, 3 and 4(th) webbing deformities concomitantly with resurfacing with FTSG. The diffuse hypertrophic scars of dorsum of hand was managed by total excision of scars, resurfacing with one large piece of over medium thickness STSG, and postoperative clenched hand position. After release of scar contractures of hand, acellular dermal matrix (ADM) with thin STSG can be used in case of deficient FTSG donor site.