Weight to volume conversion: an easy and practical breast volume estimation.

Background: Accurate breast volume estimation is essential for symmetrical breast reconstruction. Easy conversion of the weight of the resected breast tissue to volume could result in precise volume measurements. This study aimed to introduce the use of a mathematical constant (k) to estimate the breast volume from the weight. Methods: Eighty-nine female patients with breast cancer who underwent surgery at King Chulalongkorn Memorial Hospital between September 2010 and February 2011 were enrolled in this prospective study. The mammographic density of each patient was classified according to the breast imaging reporting and data system (BI-RADS) into groups a, b, c, and d. The breast density number and mathematical constant (k) were calculated, and the data matched. This technique was validated by comparing the measured and calculated volumes. Results: Sixty-six, 22, and 1 patients underwent total mastectomies (TMs), skin-sparing mastectomies (SSMs), and nipple-sparing mastectomies (NSMs), respectively. The breast densities were 1.0629, 1.1545, and 1.2233 g/mL, and the constant number (k) was 0.9409, 0.8662, and 0.8175 for BI-RADS a, combined BI-RADS b and c, and BI-RADS d, respectively. The validation process showed no significant differences between the measured and calculated volumes [95% confidence interval (95% CI)]. The correlation coefficient (r) was 0.984. Conclusions: Accurate breast volume estimation is a key factor in achieving symmetry in breast reconstruction. Combining existing data, including the weight of the resected breast tissue and mammographic density findings, an easy and accurate method to calculate the resected breast volume was introduced.

Nutritional Support with Omega-3 Fatty Acids in Burn Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: In burn patients, the profound effect of nutritional support on improved wound healing and a reduced rate of hospitalization and mortality has been documented. Fish oil as a primary source of omega-3 fatty acids in nutritional support may attenuate the inflammatory response and enhance immune function; however, unclear effects on the improvement of clinical outcomes in burn patients remain. METHODS: The systematic literature review was conducted by searching the electronic databases: Cochrane Library, PubMed, ScienceDirect, and Scopus to assess the randomized controlled trials of nutritional support with omega-3 fatty acids compared to control diets in patients that presented with burns from any causes. RESULTS: Seven trials were included in this meta-analysis. We found no significant differences in length of stay (LOS) (p = 0.59), mortality (p = 0.86), ventilation days (p = 0.16), gastrointestinal complications-e.g., constipation and diarrhea (p = 0.73)-or infectious complications-e.g., pneumonia and sepsis (p = 0.22)-between the omega-3-fatty-acid-receiving group and the control/other diets group. CONCLUSIONS: We did not find a benefit of omega-3 support in reducing the various complications, mortality and LOS in burn patients. Further studies are necessary to find the effect of nutritional support with omega-3 fatty acids over low-fat diets in this population.

3D PED BURN app: A precise and easy-to-use pediatric 3D burn surface area calculation tool.

Background and aims: Calculating the precise total burn surface area is crucial when treating burn patients, particularly children. The Lund and Browder chart and Rule of Nines, 2-dimensional diagrams that are widely used, are subject to high interrater variance, and they can severely overestimate the burn area. Previously, the adult 3-dimensional burn area calculation mobile application was developed. Aiming to improve accuracy, a 3-dimensional pediatric burn surface area calculation mobile application ("3D PED BURN") was developed to overcome the limitations of the conventional methods. Method: Fifteen 3-dimensional pediatric burn surface area models based on detailed anthropometric measurements collected from 85 patients were developed and categorized into four age groups: <1 year; 1-4 years; 5-9 years, and 10-15 years. According to their weight and height, the models in each group were fractionated into large, medium, and small body sizes. Result: A precise and easy-to-use application was developed based on these data. This application is a promising and more accurate calculation tool for burn surface area in pediatric patients. Its low inter-rater variance makes it reliable for use by various healthcare personnel. Conclusion: The 3D PED BURN app is a pediatric 3D burn surface area calculation tool that is both accurate and simple to use.

B1 repetitive sequence methylation enhances wound healing of second-degree burns in rats.

The accumulation of DNA damage in burn wounds delays wound healing. DNA methylation by short interspersed nuclear element (SINE) small interfering (si)RNA prevents DNA damage and promotes cell proliferation. Therefore, SINE siRNA may be able to promote burn wound healing. Here, a SINE B1 siRNA was used to treat burn wounds in rats. Second-degree burn wounds were introduced on the backs of rats. The rats were then divided into three groups: a B1 siRNA-treated, saline-treated control, and saline + calcium phosphate-nanoparticle-treated control group (n=15/group). The wounds were imaged on days 0, 7, 14, 21 and 28 post-injury. The tissue sections were processed for methylation, histological and immunohistochemical examination, and scored based on the overall expression of histone H2AX phosphorylated on serine 139 (γH2AX) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Burn wound closure improved in the B1 siRNA-treated group compared with that in the control group, especially from days 14-28 post-injury (P<0.001). The overall pathological score and degree of B1 methylation in the B1 siRNA-treated group improved significantly at days 14-28 post-injury, with the maximum improvement observed on day 14 (P<0.01) compared with the NSS and Ca-P nanoparticle groups. Immunohistochemical staining revealed lower expression of γH2AX and 8-OHdG in the B1 siRNA-treated group than in the control groups at days 14-28 post-injury; the maximum improvement was observed on days 14 and 21. These data imply that administering SINE siRNA is a promising therapeutic option for managing second-degree burns.

An anthropometric study of the external ear in the Thai population.

Auricular dimensions are important data for the treatment of auricular deformities, either congenital or acquired. Many previous studies have shown that the auricular dimension varies among ethnic groups; however, there are currently no available data for the Thai population. The objective of this investigation was to provide normative values regarding the adult ear dimensions in Thailand. A total of 200 Thai volunteers between the ages of 18 and 70 years (80 men, 120 women) were enrolled in this study. We measured six dimensions, including the auricular, lobular, and conchal length and width and the auricular projection at the superaurale and tragal levels. Moreover, we calculated the auricular, lobular, and conchal indices. The selected dimensions of the external ears were shown as means ± standard deviations. These parameters were then compared between the right and left sides, men and women and participants aged ≥50 and <50 years. We found that men have a significantly larger and more projected ear than women do. The length of the entire auricles and the length of the earlobe were also significantly longer in the population ≥50 years than those <50 years. This study provides normative data of the external ear dimension and projection in the adult Thai population. These data can be used to reconstruct the ear and face more appropriately for Thai individuals.

The Effect of Cold Water on Pain Evaluation During Negative Pressure Wound Therapy Dressing Changes: A Prospective, Randomized Controlled Study.

Negative pressure wound therapy (NPWT) is a technique using vacuum dressing to promote wound healing in complicated wound. However, for many patients, the application and removal of the NPWT is source of procedural pain. The authors hypothesized that administering cold sterile water into the NPWT sponge would decrease pain during dressing changes. A prospective randomized controlled study was conducted on 27 patients who were undergoing 81 NPWT wound dressing changes (n = 81) at a single institution between October 2016 and September 2017. Each patient had 3 NPWT dressing changes. Cold sterile water (5.74 °C), room temperature sterile water (26.89 °C), and nothing were randomized and administered in the NPWT tubing into the sponge 10 minutes before changing the dressing in each and every procedure. Pain scores were assessed using a 0 to 10 numeric pain scale. Patients administered with cold water reported less pain than those administered with room temperature sterile water during the dressing change (4 vs 5.67; P < .003), and much less pain than those with nothing instilled before dressing change (4 vs 6.59; P < .001). There is no statistically significant difference in pain score between using the room temperature sterile water group and the control group that instilled nothing (5.67 vs 6.59; P = .065). This study has shown that cold water administered through the suction tubing before the dressing change had a better reduction in pain score than using room temperature sterile water and the control group.

Alu repetitive sequence CpG methylation changes in burn scars.

Alu elements are retrotransposons related to epigenetic modifications. To date, the role of epigenetics in hypertrophic scars from burn remains unknown. Here, our aim was to examine the pathophysiology of hypertrophic scars from an epigenetic perspective. For that, we performed a cross-sectional analytical study using tissue and blood samples from burned and healthy patients (n = 23 each) to detect Alu methylation levels and patterns. The results of the combined bisulfite restriction analysis technique were categorized into four groups based on the methylation status at the CpG dinucleotides from the 5' to the 3' ends of the Alu sequence: hypermethylated (mCmC), hypomethylated (uCuC), and partially methylated (uCmC and mCuC). Alu methylation levels were significantly lower in hypertrophic scar tissues than in normal skin (29.37 ± 2.49% vs. 35.56 ± 3.18%, p = 0.0002). In contrast, the levels were significantly higher in white blood cells from blood samples of burned patients than in those of control blood samples (26.92 ± 4.04% vs. 24.58 ± 3.34%, p = 0.0278). Alu total methylation (mC) and the uCmC pattern were significantly lower, whereas uCuC was significantly higher, in hypertrophic scar tissues than in normal skin (p < 0.0001). Receiver operating characteristic analysis indicated that the uCmC and uCuC patterns are useful as hypertrophic scar DNA methylation markers after burn, with 91.30% sensitivity and 96.23% specificity and 100% sensitivity and 94.23% specificity, respectively. Our findings suggest that epigenetic modifications play a major role in hypertrophic scar pathogenesis, and may be the starting point for developing a novel technique for burn scar treatment.

The Anatomical Study of the Nasal Septal Cartilage with its Clinical Implications.

BACKGROUND: Several rhinoplasty and nasal reconstruction procedures require cartilage. Various studies have reported on the nasal septal cartilage as a donor site for Caucasian and Asian populations. However, studies regarding the Thai nasal septal cartilage dimensions are rare. This study aimed to examine the length, height, area, and thickness of the nasal septal cartilage, along with implications of the size and quantity of the available cartilage, for grafting in Thai cadavers. METHODS: We analyzed the nasal septal cartilage in 42 Thai cadavers. The length, height, area, and thickness were digitally measured using ImageJ 1.52 software, along with the size and area of the available cartilage for grafting after preserving a 10-mm L-strut. Data were compared between sexes. RESULTS: The mean height, length, and area of the nasal septal cartilage were 30.96 ± 5.90 mm, 26.13 ± 6.90 mm, and 636.10 ± 196.13 mm2, respectively. The length did not differ significantly between sexes. However, the height and area in male cadavers were greater than those in female cadavers. The mean thickness ranged from 0.77 to 1.02 mm depending on the area, with the thickest and thinnest areas being the superoposterior and inferoposterior parts, respectively. The mean height, length, and area of the harvestable cartilage were 20.96 mm, 16.13 mm, and 384.84 mm2, respectively, after excluding the L-strut. CONCLUSION: Our results provide major anatomical data of the Thai nasal septal cartilage. Its implication for use of the septal cartilage for grafting is 21 mm in height and 16 mm in length, which is sufficiently safe to maintain nasal support. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Inflammatory reaction, clinical efficacy, and safety of bacterial cellulose wound dressing containing silk sericin and polyhexamethylene biguanide for wound treatment.

Bacterial cellulose wound dressings containing silk sericin and PHMB (BCSP) were developed in our previous studies. It had good physical properties, efficacy, and safety. For further use as a medical material, this dressing was investigated for its efficacy and safety in split-thickness skin graft (STSG) donor-site wound treatment compared to Bactigras® (control). Moreover, the inflammatory responses to both dressings were also deeply investigated. For in vivo study, expressions of anti-inflammatory cytokines were intensely considered in the tissue interfacing area. The result showed that IL-4 and TGF-ß from BCSP-treated tissue had advantages over Bactigras®-treated tissue at 14 and 21 days post-implantation. For clinical study, a single-blinded, randomized controlled study was generated. The half of STSG donor site wound was randomly assigned to cover with BCSP or Bactigras®. Twenty-one patients with 32 STSG donor site wounds were enrolled. The results showed that wound-healing time was not significantly different in both dressings. However, wound quality of BCSP was better than Bactigras® at healing time and after 1 month (p < 0.05). The pain scores of BCSP-treated wound were statistically significant lower than Bactigras®-treated wound (p < 0.05). No sign of infection or adverse event was observed after treatment with both dressings. In conclusion, the inflammation responses of the dressing were clearly clarified. The advantages of BCSP were wound-quality improvement, pain reduction, and infection protection without adverse events. It was fit to be used as the alternative treatment of STSG donor site wound.

Spermatogenesis Abnormalities following Hormonal Therapy in Transwomen.

OBJECTIVE: To measure spermatogenesis abnormalities in transwomen at the time of sex reassignment surgery (SRS) and to analyze the association between hormonal therapy duration and infertility severity. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: One-hundred seventy-three transwomen who underwent SRS from January 2000 to December 2015. INTERVENTIONS: All orchidectomy specimens were retrospectively reviewed and classified. History of hormonal therapy duration was retrieved from medical records. MAIN OUTCOME MEASURES: Histological examinations of orchidectomy specimens were performed to assess spermatogenesis. RESULTS: One-hundred seventy-three orchidectomy specimens were evaluated. Histological examinations showed maturation arrest in 36.4%, hypospermatogenesis in 26%, Sertoli cell-only syndrome in 20.2%, normal spermatogenesis in 11%, and seminiferous tubule hyalinization in 6.4% of the specimens. Spermatogenesis abnormality severity was not associated with the total therapy duration (P = 0.81) or patient age at the time of surgery (P = 0.88). Testicular volumes and sizes were associated with spermatogenesis abnormality severity (P = 0.001 and P = 0.026, right testicle and left testicle, resp.). CONCLUSIONS: Feminizing hormonal treatment leads to reductions in testicular germ cell levels. All transwomen should be warned about this consequence, and gamete preservation should be offered before starting hormonal treatment.

The masseteric nerve: An anatomical study in Thai population with an emphasis on its use in facial reanimation.

BACKGROUND: The use of the masseteric nerve has been escalated as a donor nerve for facial reanimation in facial palsy patient (Wang et al., 2014; Manktelow et al., 2006; Klebuc, 2011; Bianchi et al., 2012; Zuker et al., 2000; Bae et al., 2006; Terzis, Konofaos, 2013; Terzis, Olivares, 2009; Bianchi et al., 2014). Previous studies had been done in Euro-Caucasian cadavers (Kaya et al., 2014). However, difference in anatomical details does exist between Asian and Euro-Caucasian population (Tzou et al., 2005; Farkas et al., 2005). In this study, we have conducted a detailed anatomical study of masseteric nerve in adult Thai cadavers which might elaborate better details of masseteric nerve anatomy in Asian population. METHODS: Twenty eight hemifaces from 14 adult Thai non-formaldehyde preserved soft cadavers were used in this study. The anatomical pathway of the masseteric nerve was defined relating to four surgical landmarks which are auricular tragus, zygomatic arch, posterior border of the temporomandibular joint, and alar base. RESULTS: The suitable starting area for the masseteric nerve dissection is 3.7 ± 0.4 cm anterior to the auricular tragus at the level of 0.8 ± 0.2 cm inferior to the zygomatic arch. The nerve was found 1.1 ± 0.2 cm deep to the superficial surface of the masseteric fascia and 1.7 ± 0.2 cm anterior to the posterior border of the temporomandibular joint. The point where the nerve giving off its first branch as it courses distally is 7.3 ± 0.7 cm from the ipsilateral alar base. The mean diameter of this nerve is 1.59 ± 0.42 mm. CONCLUSION: The anatomy of the masseteric nerve during its course in the muscle is consistent. In our study, the details of its anatomy is slightly different from the previous works which were performed in the Euro-Caucasian cadavers.

The Role of Negative-Pressure Wound Therapy in Latissimus Dorsi Flap Donor Site Seroma Prevention: A Cohort Study.

BACKGROUND: Donor site seroma is the most common complication after latissimus dorsi (LD) flap harvest. This study aimed to evaluate the efficacy of negative-pressure wound therapy (NPWT) in preventing donor site seroma formation after the harvest of an LD flap for breast reconstruction. METHODS: In this prospective matched-pair study, 40 patients in whom an LD flap was harvested for breast reconstruction were enrolled. NPWT was used in 20 patients, and in a control group composed of another 20 patients, the conventional donor site dressing technique was used. Information was collected regarding postoperative complications, the incidence of seroma, total drainage volume, the number of percutaneous seroma aspirations, and the volume aspirated. RESULTS: In the NPWT group, the incidence of seroma formation after drain removal was significantly lower than in the control group (15% vs. 70%; odds ratio=0.07; relative risk, 0.24). Both the mean percutaneous aspirated volume (P=0.004) and the number of percutaneous aspirations (P=0.001) were also significantly lower in the NPWT group. There were no significant differences in the total drainage volume or the duration of wound drainage between the NPWT dressing group and the control group (P>0.05). CONCLUSIONS: This study showed that NPWT is a promising tool for reducing the incidence of seroma formation after removing the drain at the donor site after LD flap harvesting. It is a simple and safe technique.

Pilot Clinical Evaluation of PoreSkin: A Human Acellular Dermal Matrix in Burn Scars.

Background: An extensive full-thickness wound need a graft, sometime very large. However, donor sites are often limited. Dermal substitutes are among the tissue-engineered products applied to clinical use. PoreSkin, a human acellular dermal matrix (hADM) manufactured by the Faculty of Medicine, Chulalongkorn University, is the first human dermal substitute developed in Thailand. Objective: Assess the safety and ability in achieving durable and definitively cosmetic coverage using PoreSkin. Material and Method: Eleven hypertrophic burn scars were enrolled in the present study. After scar excision, PoreSkin was placed followed by delayed split-thickness skin graft, three weeks later. The primary outcomes were the engraftment rate of the Poreskin and the skin graft. The secondary outcomes included complications and the final cosmetic appearance. Results: The engraftment rate of PoreSkin was 97.7% at day 21. The engraftment rate of autologous sheet skin graft placed over PoreSkin was 91.8%. Regarding the quality of the scar, using the Vancouver scar scale, it shows a statistically significant improvement (p<0.05). No major complications or rejection were observed. Conclusion: The performance of PoreSkin as a human acellular dermal matrix (hADM) is comparable to other commercial dermal substitutes in term of engraftment rate, complications, and rejection.

Randomized Clinical Trial of the Innovative Bilayered Wound Dressing Made of Silk and Gelatin: Safety and Efficacy Tests Using a Split-Thickness Skin Graft Model.

We developed the novel silk fibroin-based bilayered wound dressing for the treatment of partial thickness wounds. And it showed relevant characteristics and accelerated the healing of full-thickness wounds in a rat model. This study is the clinical evaluation of the bilayered wound dressing to confirm its safety and efficacy for the treatment of split-thickness skin donor sites. The safety test was performed using a patch model and no evidence of marked and severe cutaneous reactions was found. The efficacy test of the bilayered wound dressing was conducted on 23 patients with 30 split-thickness skin graft donor sites to evaluate healing time, pain score, skin barrier function, and systemic reaction in comparison to Bactigras. We found that the healing time of donor site wounds treated with the bilayered wound dressing (11 ± 6 days) was significantly faster than those treated with Bactigras (14 ± 6 days) (p = 10(-6)). The wound sites treated with the bilayered wound dressing showed significantly less pain and more rapid skin functional barrier recovery than those treated with Bactigras (p = 10(-5)). Therefore, these results confirmed the clinical safety and efficacy of the bilayered wound dressing for the treatment of split-thickness skin graft donor sites.

The development of sex reassignment surgery in Thailand: a social perspective.

This paper reviews the development of gender reassignment in Thailand during the period of 1975-2012, in terms of social attitude, epidemiology, surgical patients' profile, law and regulation, religion, and patients' path from psychiatric assessment to surgery. Thailand healthcare for transsexual patients is described. Figures related to the number of sex reassignment surgeries performed in Thailand over the past 30 years are reported. Transsexual individuals are only apparently integrated within the Thail society: the law system of Thailand in fact, does not guarantee to transsexuals the same rights as in other Western countries; the governmental healthcare does not offer free treatments for transsexual patients. In favor of the transsexual healthcare, instead, the Medical Council of Thailand recently published a policy entitled "Criteria for the treatment of sex change, Census 2009." The goal of this policy was to improve the care of transsexual patients in Thailand, by implementing the Standards of Care of the World Professional Association of Transgender Health. Currently, in Thailand, there are 6 major private groups performing sex reassignment surgery, and mostly performing surgery to patients coming from abroad. Particularly, the largest of these (Preecha's group) has performed nearly 3000 vaginoplasties for male-to-female transsexuals in the last 30 years.

Clinical potential of a silk sericin-releasing bioactive wound dressing for the treatment of split-thickness skin graft donor sites.

PURPOSE: An ethyl alcohol-precipitated silk sericin/PVA scaffold that controlled the release of silk sericin was previously developed and applied for the treatment of full-thickness wounds in rats and demonstrated efficient healing. In this study, we aimed to further evaluate the clinical potential of this scaffold, hereafter called "silk sericin-releasing wound dressing", for the treatment of split-thickness skin graft donor sites by comparison with the clinically available wound dressing known as "Bactigras®". METHODS: In vitro characterization and in vivo evaluation for safety of the wound dressings were performed. A clinical trial of the wound dressings was conducted according to standard protocols. RESULTS: The sericin released from the wound dressing was not toxic to HaCat human keratinocytes. A peel test indicated that the silk sericin-releasing wound dressing was less adhesive than Bactigras®, potentially reducing trauma and the risk of repeated injury upon removal. There was no evidence of skin irritation upon treatment with either wound dressing. When tested in patients with split-thickness skin graft donor sites, the wounds treated with the silk sericin-releasing wound dressing exhibited complete healing at 12 ± 5.0 days, whereas those treated with Bactigras® were completely healed at 14 ± 5.2 days (p = 1.99 × 10(-4)). In addition, treatment with the silk sericin-releasing wound dressing significantly reduced pain compared with Bactigras® particularly during the first 4 postoperative days (p = 2.70 × 10(-5) on day 1). CONCLUSION: We introduce this novel silk sericin-releasing wound dressing as an alternative treatment for split-thickness skin graft donor sites.

Primary angiosarcoma of the breast: a case report and review of the literature.

Primary angiosarcoma of the breast is rare. Therefore, no randomized trial can be used as guideline for diagnosis and treatment. To achieve optimal outcome, previous reports of case series are the sources for management with expected long-term survival. The objective of the present case report is to demonstrate complete pathologic response to neoadjuvant taxanes without recurrence after two years of follow-up.

Skin sparing mastectomy with immediate reconstruction in early breast carcinoma: a preliminary study.

BACKGROUND AND OBJECTIVE: Surgical treatment for breast cancer has some special aspects different from other cancers, since surgeons have to concern of both oncologic safety and esthetic outcome. Modified radical mastectomy (MRM) can give the oncologic safety but not esthetic outcome. Breast conserving therapy improves cosmetic but results in more local recurrence than modified radical mastectomy. Skin sparing mastectomy (SSM) with immediate reconstruction for early breast cancer has been reported by several investigators to have comparable outcome with MRM and better esthetic result. The purpose of the present study was to examine patients who underwent SSM with immediate reconstruction at King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Patients who underwent SSM with immediate reconstruction by the authors at King Chulalongkorn Memorial Hospital, Bangkok Thailand between May 2007 and January 2011 were studied. The immediate reconstruction was performed with transverse rectus abdominis musculocutaneous flaps or latissimus dorsi flaps. Postoperative early and late complications as well as local recurrence were studied to examine the oncologic safety and esthetic outcome. RESULTS: Fourteen patients were enrolled into the present study. The age ranged from 33 to 59 years (mean 47 years). The follow up time ranged from six to 50 months (mean 26.5 months). Postoperative complications included wound infection in one patient (7%), seroma at donor site of latissimus dorsi flaps in two patients (40%) and fat necrosis in five patients (55%). There was no skin flap necrosis, no hematoma, no arm numbness, no wound dehiscense, no abdominal wall hernia, and no lymphedema of the arm. No local recurrence was detected CONCLUSION: This preliminary report shows that skin-sparing mastectomy with immediate reconstruction is a good alternative in management of early breast cancer. There was no serious postoperative complication. The esthetic result was acceptable. No local recurrence was observed. Long-term follow up with more patients are required to confirm its applicability in early breast cancer patients.

Comparative study between chitin/polyacrylic acid (PAA) dressing, lipido-colloid absorbent dressing and alginate wound dressing: a pilot study in the treatment of partial-thickness wound.

BACKGROUND: Polyacrylic acid grafted chitin (Chitin-PAA) contains a hydrogel characteristic that makes it more suitable for wound dressing application. In animal models, Chitin-PAA dressing exhibited properties as a promising dressing. Epithelization promotion, rapid reduction of wound size, reduction of inflammatory cell response, and less toxicity had been noted. OBJECTIVE: Carryout a pilot clinical comparative study of Chitin-PAA dressing, lipido-colloid absorbent dressing, and alginate wound dressing in the treatment of partial-thickness wound. MATERIAL AND METHOD: Between June 2006 and March 2007, 36 partial-thickness wounds were randomized into three groups and three different types of dressing were used. Each wound was treated until it was completely healed, and a visual analogue scale was used for the pain evaluation. RESULT: The present study shows the visual analogue pain score in the Chitin-PAA group seems to be a bit higher than the Urgocell group but not statistically different. The completely healed day is not significantly different. Three patients in the lipido-colloid absorbent dressing groups had wound infection but eventually healed after treatment. CONCLUSION: There was no statistical difference in terms of visual analogue pain score and healing time between the lipido-colloid absorbent dressing, alginate dressing, and chitin-PAA dressing.

Bilateral scrotal flap: pedicle and dimension of flap in cadaveric dissections.

Penile paraffinoma is not uncommon among Thai males. The definite treatment involves the complete removal of skin and subcutaneous tissue infiltrated by the foreign material and resurfacing in the penile shaft with skin graft or scrotal flap in severe cases. In the present study the authors undertook an anatomical investigation of external pudendal vessels and scrotal skin in 5 soft cadavers. The authors found that the anterior scrotal artery branching from the external pudendal artery at the point 2-2.7 cms. from midline at pubic symphysis level and running in the internal spermatic plane. Anterior scrotal artery supplied scrotal skin 62.5-100% (mean 75.9%) in anteroposterior dimension and 66-100% (mean 88%) in superoinferior dimension. The authors recommended that this flap must elevate deep to the internal spermatic plane, just close to tunica vaginalis and the dimension of flap should not be more than 62.5% in anteroposterior and 66% in superoinferior dimension.