• Pediatric Infection and Vaccine
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• v.15 no.2
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• pp.146-151
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• 2008

Purpose : Multidrug-resistant Acinetobacter baumannii (A. baumannii) is recognized to be the most difficult pathogen to control and treat in pediatric burn centers. We analyzed the antibiotic susceptibility pattern of A. baumannii in our pediatric burn intensive care unit during the past 7 years. Methods : We retrospectively evaluated 56 patients (105 samples) under the age 15 years and who were infected with A. baumannii between January 1999 and December 2005. Results : Fot the 56 patients, the ratio of males to females was 1.15:1 and the median age was 48.3 months. The sites of 105 isolates were wounds (65%), sputum (20%), blood (6 %), cutdown tips (5%), endo-tip tubes (2%) and urine (2%). A. baumannii presented yearround. The annual antimicrobial resistance rate increased and the multidrug resistant rate for two or more antibiotics was 93.33%. For 3 patients in whom resistance emerged, the interval period between the susceptible and resistant strains after antibiotic use was a mean of 10 days. The A. baumannii isolated from blood were all multi-drug resistant pathogens. Conclusion : Multidrug resistance of A. baumannii is increasing. Strict infection control guidelines and active surveillance are needed for the prevention and treatment of A. baumannii in hospitals.

• Korean Journal of Biological Psychiatry
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• v.17 no.2
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• pp.79-85
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• 2010

Objectives : Trauma patients have attentional bias which enforces traumatic memories and causes cognitive errors. Understanding of such selective attention may explain many aspects of the posttraumatic stress disorder(PTSD) symptoms. Methods : We used the rapid serial visual presentation(RSVP) method to verify attentional blink in burn patients with PTSD. International affective picture system(IAPS) was used as stimuli and distracters. In the 'neutral test', patients have been presented series of pictures with human face picture as target stimuli. Each picture had 100ms interval. However the distance between target facial pictures was randomized and recognition of second facial picture accuracy was measured. In the 'stress test', the first target was stress picture which arouses patient emotions instead of the facial picture. Neutral and Stress tests were done with seven PTSD patients and 20 controls. In '85ms test' the interval was reduced to 85ms. The accuracy of recognition of second target facial picture was rated in all three tests. Eighty-five ms study was done with eighteen PTSD patients. Results : Attentional blinks were observed in 100-400ms of RSVP. PTSD patients showed increased recognition rate in the 'stress test' compared with the 'neutral test'. When presentation interval was decreased to 85 ms, PTSD patient showed decrease of attentional blink effect when target facial picture interval was 170ms. Conclusion : We found attentional blink effect could be affected by stress stimulus in burn patients. And attentional blink may be affected by stimulus interval and the character of stimulus. There may be some other specific mechanism related with selective attention in attentional blink especially with facial picture processing.

• Archives of Plastic Surgery
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• v.46 no.6
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• pp.558-565
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• 2019

Background The scalp, an excellent donor site for thin skin grafts, presents a limited surface but is rich in stem cells. The purpose of this study was to test a double harvesting procedure from the scalp and to evaluate the capacity of the dermal layer. Methods Two layers corresponding to a split-thickness skin graft (SSG) and a split-thickness dermal graft (SDG) were harvested from the scalp using a Zimmer dermatome during the same procedure. Healing of the scalp donor site, reason for recipient site grafting, and the percentage of graft loss were evaluated. Results Fourteen patients, comprising six men and eight women with a mean age of 34.2 years, were treated according to our protocol. The most common reason for a recipient site graft was a postburn scar deformity (10/14 patients). The mean area of scalp SSGs was 151.8 cm². The mean area of scalp SDGs was 88.2 cm². The mean healing time of scalp donors was 9.9 days. The only donor complication was a tufted scar deformity. Conclusions Skin defects in the scalp of donors healed faster and led to less scarring than defects at other donor sites. Scalp SDGs needed 10 days for adequate epithelization. The scalp was the best donor site for SSGs and SDGs for burn reconstructive patients.

• Korea Journal of Hospital Management
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• v.17 no.4
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• pp.167-187
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• 2012

Organizational growth is achieved through the process of finding opportunities in the environment and establishing a business model with internal and external resources. Bestian Hospital, which primarily focuses on saving the lives of patients with severe burns, has enlarged its business domain through deep understanding of burn patients' problems, including pain and complications during treatments, long-term treatments, skin reconstruction, and so on. Now Bestian is accelerating research for development of antipyretics and cosmetics for burn patients. The success of Bestian has been due to utilization of human and material resources that are essential to performance in the medical field. Also, Bestian properly used a management service organization(MSO) model and constructed an information technology(IT) system for supporting its businesses. However, previous successes do not guarantee continued success. Bestian is entering a new domain with different challenges than it has experienced so far, and how it deals with these challenges will decide its future.

• Archives of Plastic Surgery
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• v.47 no.6
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• pp.528-534
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• 2020

Split-thickness skin grafting (STSG) is the gold standard for coverage of acute burns and reconstructive wounds. However, the choice of the donor site for STSG varies among surgeons, and the scalp represents a relatively under-utilized donor site. Understanding the validity of potential risks will assist in optimizing wound management. A comprehensive literature search was conducted of the PubMed database to identify studies evaluating scalp skin grafting in human subjects published between January 1, 1964 and December 31, 2019. Data were collected on early and late complications at the scalp donor site. In total, 27 articles comparing scalp donor site complications were included. The selected studies included analyses of acute burn patients only (21 of 27 articles), mean total body surface area (20 of 27), age distribution (22 of 27), sex (12 of 27), ethnicity (5 of 27), tumescent technique (21 of 27), depth setting of the dermatome (24 of 27), number of harvests (20 of 27), mean days of epithelization (18 of 27), and early and late complications (27 of 27). The total rate of early complications was 3.82% (117 of 3,062 patients). The total rate of late complications was 5.19% (159 of 3,062 patients). The literature on scalp skin grafting has not yet identified an ideal surgical technique for preventing donor site complications. Although scalp skin grafting provided superior outcomes with fewer donor site complications, there continues to be a lack of standardization. The use of scalp donor sites for STSG can prevent early and late complications if proper surgical planning, procedures, and postoperative care are performed.

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.70-76
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• 1993

The authors analyzed the clinical results of the reconstructive surgery for injured hands and feet due to frostbites and electrical burn with microsurgery in 7 patients, 12 cases at the department of orthopaedic surgery, school of medicine, Kyung Hee university from Jan. 1989 to Jul. 1992, and the results were as foollowings. 1. The age at the time of injury was av 24.6 yrs ranging from 4 to 35 yrs, and all cases were male. 2. The follow up period was av. 24.4 Mo ranging from 12 Mo. to 56 Mo. 3. The causes of injury were frostbite in 9 cases, electrical burn in 2 cases. 4. Initial operative treatment was performed av. 69.3 days ranging from 2 to 210 days. 5. For the reconstructive procedure, scapular free flap was applied in 6 cases, radial forearm flap in 4, dorsalis pedis 1ffap in 1, neurovascular island flap in 1. 6. Among total 12 cases, there were 5 cases(41.7%) of wound infection and 3 cases (25.0%) of partial necrosis of donor flap. 7. In 11 cases(90.1%), the end result was satisfactory. In the analysis of above results the reconstruction with microsurgery is effective procedure for reconstruction of Injured hand and foot due to frostbite and electrical burn.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.743-747
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• 2008

Purpose: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to $3.5{\times}5cm$ chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.765-774
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• 2011

Purpose: Many facial burn patients suffer from hyperpigmentation and its treatment has been challenging. Vitamin C (ascorbic acid) has important physiologic effects on skin, including inhibition of melanogenesis, promotion of collagen biosynthesis, prevention of free radical formation, and acceleration on wound healing. The purpose of this study is to evaluate the effectiveness of Vitamin C iontophoresis for the treatment of postburn hyperpigmentation. Methods: The authors performed a retrospective analysis of 93 patients who were admitted for the treatment of facial burn from February 2008 through February 2010. Among them, 51 patients were treated with Vitamin C iontophoresis to control postburn hyperpigmentation and 42 patients were not. Experimental group was chosen 20 of 51 patients who had been treated with Vitamin C iontophoresis and had normal facial skin on the comparable contralateral aesthetic unit. Control group was chosen 20 of 42 patients who were not treated with Vitamin C iontophoresis and had also contralateral normal aesthetic unit. The resulting color of 20 patients who were treated with Vitamin C iontophoresis was compared with the color of the contralateral normal facial skin using a digital scale color analysis. Results were analyzed with Wilcoxon signed rank test. Results: The analysis revealed significant improvement of hyperpigmentation in the experimental group compared to control group. The difference of intial value and the value in 6 months showed significant change. Mean (${\Delta}^{initial}$-${\Delta}^{6month}$) of experimental group was 11.61 and control group was 7.23. Thus, the difference between the experimental group and the control group was 4.38. Therefore, Vitamin C iontophoresis revealed significant improvement of hyperpigmentation in the experimental group compared with control group. Conclusion: Vitamin C iontophoresis is an effective treatment modality for postburn hyperpigmentation.

• Archives of Plastic Surgery
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• v.48 no.5
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• pp.528-533
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• 2021

Bladder acontractility affects several thousand patients in the United States, but the available therapies are limited. Latissimus dorsi detrusor myoplasty (LDDM) is a therapeutic option that allows patients with bladder acontractility to void voluntarily. Our goal was to conduct a systematic review of the literature to determine whether LDDM is a better option than clean intermittent catheterization (CIC) (standard treatment) in patients with bladder acontractility. On January 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov databases, without time frame limitations, to identify articles on the use of LDDM for bladder acontractility. Of 75 potential articles, 4 fulfilled the eligibility criteria. The use of LDDM to treat patients with bladder acontractility was reported in four case series by the same group in Europe. Fifty-eight patients were included, and no comparison groups were included. The most common cause of bladder acontractility was spinal cord injury (n=36). The mean (±standard deviation) operative time was 536 (±22) minutes, postoperative length of hospital stay ranged from 10 to 13 days, and follow-up ranged from 9 to 68 months. Most patients had complete response, were able to void voluntarily, and had post-void residual volume less than 100 mL. Although promising outcomes have been obtained, evidence is still weak regarding whether LDDM is better than CIC to avoid impairment of the urinary tract among patients with bladder acontractility. Further prospective studies with control groups are necessary.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.385-392
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• 2009

Purpose: In the partial thickness burn management, despite of several advantages, the use of human amniotic membrane has been limited. The authors applied dried bovine amniotic membrane(DBAM) to overcome disadvantages of amniotic membrane for partial thickness burn and compared the effectiveness with cultured allogenic keratinocytes(CAK) that have been recently used for the management of burn. Methods: 16 patients with partial thickness burn, the mean age of 38 ranging 12 to 59 years, between August 2007 and May 2008 were assigned to this study. Either DBAM or CAK was applied, and the secondary dressing was removed on the following day. To compare treatment effect, time for epithelization, Vancouver scar scale and chromameteric results were evaluated. Results: The time for epithelization of DBAM was 10.1 days, that of CAK was 9.1 days, and they were shorter than the previous 2 - 3 weeks. At the follow up Vancouver scar scale was 2.8 for DBAM and 3.0 points for CAK and showed good results. The result of chromameter showed that the $L^*$, $a^*$, and $b^*$ values of the area applied DBAM were 60.1, 13.6, and 13.3, respectively, and the values of the area applied CAK were 60.1, 12.4, and 12.4, respectively. It was found that the skin color of the healed area after burn was darker, the redness was higher, and the yellowness was lower. After dressing, significant side effects were not observed, and in the cases of applying CAK, it was inconvenient as the moving area had to be fixed. Conclusion: With CAK, DBAM has several advantages such as the shortening of the epithelization period, reduction of scar and pigmentation, and convenient application, etc. Thus it is an effective method for the partial thickness burn management.