• Journal of Periodontal and Implant Science
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• 제26권1호
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• pp.276-292
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• 1996

The purpose of this study was to evaluate whether removal of gingival epithelium with pulsed Nd :YAG laser could inhibit the downgrowth of junctional epithelium after alloplastic material grafting in periodontal bone defect. The periodontal bone defects were created surgically on the palatal aspect of the upper right and left molar teeth in 30 rats and filled with resorbable calcium carbonate($Biocoral\;450^{(R)}$: Inoteb, France). The control sites(right molar area) was sutured. The test side (left molar area) received controlled deepithelization of the oral and sulcular epithelium with pulsed Nd:YAG laser($Sunrise\;Maste^{(R)}$: Sunrise Technologies, U.S.A.) under the mode of 1.75W, 15Hz, 116mJ/pulse and was sutured. The control and test sites were evaluated clinically and histologically, at 1, 3, 7, 14, and 28 days postoperation. Clinically, the gingiva showed normal color and shape at the 5th day in the control site and at the 10th day in the test sites. Histologically, the junctional epithelium was formed at the 7th day in the control sites and at the 14th day in the test sites, and the long JE attachment were observed at the 28th day in both sites. The attachment of connective tissue to root surface was observed initially at the 7th day in the control sites and at the 14th day in the test sites, and completed at the 28th day in both sites. In summary, these results showed that the removal of oral epithelium using pulsed Nd:YAG Laser could not prevent epithelial downgrowth after alloplastic material implantation in rat periodontal bone defect.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.31-36
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• 2010

Purpose: The primary goal of palatoplasty is to enable normal speech with harmonious growth of face. Some children who had palatoplasty display typical findings of transverse maxillary deficiency requiring orthodontic widening of the maxilla. Levi (2009) described a cleft palate repair coupled with pedicled buccal fat pad flaps to cover bone exposed areas of the hard palate. Hence we report clinical experiences of cleft palate repair using pedicled buccal fat pad flap. Methods: Four Veau class II and a Veau class I cleft palate patients underwent palatoplasty with buccal fat pad flap by single surgeon from April 2009 to August 2009. Two patients received 2-flap palatoplasty and three patients 1-flap palatoplasty, respectively. After the cleft palate repair, sharp mosquito scissors was placed in the superior buccal sulcus just lateral to the maxillary tuberosity and inserted directly through the mucosa resulting in buccal fat pad extrusion. The elevated flap was moved to cover mucoperiosteal defect in hard palatal area. Results: Five patients underwent primary palatoplasty using buccal fat pad flap. Flap harvest and inset took on average 9 minutes per flap. Mucosal epithelization took 18 days on average. No patients had complications related to the buccal fat pad flap. Conclusion: Buccal fat pad pedicled flap has significant potential to function as an added vascularized tissue layer in cleft palate repair and we can expect better growth of maxilla with this method although longer duration of follow-up was unavailable.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권2호
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• pp.116-120
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• 2012

The buccal fat pad is specialized fat tissue located anterior to the masseter muscle and deep to the buccinator muscle. Possessing a central body and four processes it provides separation allowing gliding motion between muscles, protects the neurovascular bundles from injuries, and maintains facial convexity. Because of its many advantageous functions, the use of the buccal fat pad during oral and maxillofacial procedures is promoted for the reconstruction of defects secondary to tumor resection, and those defects resulting from oroantral fistula caused by dento-alveolar surgery or trauma. We used the pedicled buccal fat pad in the reconstruction of intraoral defects such as oroantral fistula, maxillary posterior bone loss, or defects resulting from tumor resection. Epithelization of the fat tissue began 1 week after the surgery and demonstrated stable healing without complications over a long-term period. Thus, we highly recommend the use of this procedure.

• Journal of Periodontal and Implant Science
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• 제40권4호
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• pp.201-205
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• 2010

Purpose: The purpose of this study was to evaluate the clinical effectiveness of and patient's satisfaction with treatment of gingival melanin hyperpigmentation with a Nd:YAG laser and a high speed rotary instrument. Methods: Three patients with melanin hyperpigmentation in the anterior parts of the gingiva were chosen for this case study. Clinical photographs were taken at the preoperative state and three patients were treated under local anesthesia. In the maxilla, the gingival deepithelization was conducted with a high speed diamond bur, whereas, in the mandible with a Nd:YAG laser. Clinical photographs were taken immediately after the procedures and at the 1st, 2nd, and 4th week to evaluate clinical color changes. A week after the procedure, the patients filled out a questionnaire about any pain or discomfort. At the 4th week after the procedure, the patients filled out questionnaires about esthetic aspects of the results of treatment. Results: In all cases, both anterior gingival areas were depigmented with satisfaction and the patients did not complain of severe pain or discomfort. At the 1st week of healing, the gingiva showed moderate to fast epithelization. Two weeks after the procedure, clinically, the gingiva showed almost complete healing. Four weeks after the procedure, there was significant improvement in gingival melanin hyperpigmentation. Conclusions: The Nd:YAG laser and the high speed rotary instruments seem to be effective for the esthetic treatment of gingival melanin hyperpigmentation.

• Radiation Oncology Journal
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• 제9권1호
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• pp.17-25
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• 1991

수술전 방사선 조사는 불가능한 수술을 가능케 하며, 암의 크기를 축소시켜 수술범위를 감소시킬 수 있어 조직 및 장기의 보존과 기능을 유지할 수 있게 한다. 그러나 수술의 성과는 완전한 창상의 치유없이는 이루어질수가 없으며 수술전에 시행하는 방사선조사는 창상의 회복을 불완전하게 만들거나 지연시키는 것으로 알려져 있어 문제점으로 대두되고 있다. 본 연구는 252마리의 마우스 좌우측 하지 상단 내측 피부에 일회 2000cGy의 방사선조사를 실시 한후 즉시, 1, 2, 4, 8, 12, 16, 20주후에 외과적 피부절개 및 봉합과 유사한 창상을 만들었고, 그후 일정한 간격으로 창상의 장력강도 측정과 병리학적 관찰을 하고 방사선조사와 수술이 시행될때까지의 시간적 간격과 창상 치유정도의 상관관계를 분석하여 다음과 같은 결론을 얻었다. 1. 방사선 조사직후와 1주, 2주내에 창상이 발생된 경우에는 장력강도의 최고치의 발현 및 상승속도가 지연되어 통계학적으로 의의가 있었다. 2. 방사선 조사후 $4\sim8$주내에 창상이 발생되었을 경우 장력강도의 변화는 대조군과 비교해서 별다른 차이가 없었다. 3. 방사선 조사후 12,16,20주내에 창상이 발생되면 장력강도의 최고치의 발현과 상승 속도가 약간 지연되었다. 4. 대조군에 비해 방사선조사군의 창상의 장력 강도 평균치는 모든 관찰기간동안 감소되었다. 5. 병리조직학적 소견상 상피세포는 방사선조사군에서도 정상적인 속도로 재생되었으며 섬유아세포 및 교원질의 출현시기는 대조군에 비해서 약간 지연되었으나 장력강도의 상승과 교원질량간에 상관관계가 존재함을 추정할 수 있었다. 6. 방사선 조사후 창상 발생의 관찰기간이 경과함에 따라 장력강도의 평균치가 오히려 감소됨은 영양과 전신상태에 관련있는 것으로 생각되었다. 그러므로 수술전 고선량의 방사선 조사를 시행하면, 창상치유는 지연시키며 특히 방사선조사 직후, 1주 및 2주후에 수술을 시 행할 경우 창상치유를 심하게 지연시킬 수 있고, 또 12, 16,20주후에도 역시 창상치유의 지연을 예상할 수 있겠다. 그러나 $4\sim8$주후에 수술을 시행하면 별부작용없이 창상 치유가 가능하므로 가장 적절한 수술시기 라고 생각한다.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.600-606
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• 2010

Purpose: Although traditional and current treatment strategies may demonstrate success, persistence or recurrence of difficult-to-heal wounds remain significant problems. A novel product, Hyalomatrix$^{(R)}$ (Fidia Advanced Biopolymer, Abano Terme, Italy) is a bilayer of an benzyl esterified hyaluronan scaffold beneath a silicone membrane. The scaffold delivers hyaluronan to the wound, and the silicone membrane acts as a temporary epidermal barrier. We present the results obtained with Hyalomatrix$^{(R)}$ in the treatment of difficult-to-heal wounds. Methods: From November, 2008 to March, 2010, Hyalomatrix$^{(R)}$ has been used on total 10 patients with wounds that were expected difficult to heal with traditional and other current strategies. After average 37.4 days from development of wounds, Hyalomatrix$^{(R)}$ was applied after wound debridement. On the average, Hyalomatrix$^{(R)}$ application period was 17.6 days. After average 16.5 days from removal of Hyalomatrix$^{(R)}$, skin grafts was performed. Results: In all cases, regeneration of fibrous granulation tissues and edge re-epithelization were present after the application of the Hyalomatrix$^{(R)}$. And all of the previous inflammatory signs were reduced. After skin grafts, no adverse reactions were recorded in 9 cases. But in one case, postoperative wound infection occured due to a lack of efficient fibrous tissues. In this model, the Hyalomatrix$^{(R)}$ acts as a hyaluronan delivery system and a barrier from the external environments. In tissue repair processes, the hyaluronan performs to facilitate the entry of a large number of cells into the wounds, to orientate the deposition of extracellular matrix fibrous components and to change the microenvironment of difficult-to-heal wounds. Conclusion: Our study suggests that Hyalomatrix$^{(R)}$ could be a good and feasible approach for difficult-to-heal wounds. The Hyalomatrix$^{(R)}$ improves microenvironments of difficult-to-heal wounds, reduces infection rates and physical stimulus despite of aggravating factors.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.491-495
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• 2005

In partial thickness burn injuries, silver sulfadiazine cream 1%(SSD, $Silvadene^{(R)}$) is the most commonly used topical agent worldwide. But silver sulfadiazine cream 1% has no exudate absorption property. Usually after escar is removed from wound surface, $Silvadene^{(R)}$ is changed to saline wet gauze dressing to promote epithelization. $Aquacel^{(R)}$(ConvaTec, UK) is a 100% sodium carboxymethylcellulose Hydrofiber material. It absorbs exudates directly into the hydrofibers by vertical wicking which allows rapid uptake of liquid into the fibers. The absorbed exudate fluid can be distributed to the entire dressing rather than just over the wound surface, which results in larger fluid absorption capacity. From April, 2003 to July, 2004 a study was done with 40 patients who had variable partial thickness burns. $Aquacel^{(R)}$ dressing was compared in 21 cases to silver sulfadiazine cream 1% and saline wet gauze dressings in 19 cases. In the $Aquacel^{(R)}$ cases, the average healing time on the face was $5.36{\pm}1.69$ a day; on the hands was $8.46{\pm}2.15$ a day; and, on the neck was $6.0{\pm}2.0$ a day. With the $Silvadene^{(R)}$ and Saline wet gauze dressing, the average healing time on the face was $6.44{\pm}1.74$ a day; on the hands was $13.79{\pm}5.35$ a day; and, on the neck was $11.17{\pm}3.31$ a day. As a result, the $Aquacel^{(R)}$ group showed a shorter healing time compared to the $Silvadene^{(R)}$ and saline wet gauze dressing group and patients were satisfied because of less pain and improved comfort. In conclusion, $Aquacel^{(R)}$ is a better choice for partial thickness burn injuries because of shorter healing time, less pain and more confortable dressing.

• 대한약리학회지
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• 제31권3호
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• pp.377-384
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• 1995

연교액기스가 창상치료제로서의 사용가능성을 검증하기 위하여 연교의 창상치유 효과와 독성에 대하여 조사하였으며 아울러 연교액기스가 항생작용이 있는지도 조사하였다. 연교의 창상치유 효과를 Tetrachlorodecaoxygen anion complex(TCDO) 및 단백질을 제거한 혈액투석액(Haemyl)과 생리식염수의 창상치료 효과와 비교하였다. 4일, 11일, 14일째의 창상면적은 연교액기스, TCDO, Haemyl의 치료에 의하여 대조구인 생리식염수의 치료구에 비해 유의하게 적었다. 그러나 8일째의 창상면적은 다만 연교액기스의 치료구만 유의하게 적었다. 조직학적 검사에서도 연교액기스, TCDO, Haemyl의 치료구가 생리식염수의 치료구에 비해 표피화가 촉진되었다. 간 효소활성도(GOT, GPT), 혈구의 수에 있어서 연교액기스의 투여가 대조구에 비하여 어떤 유의적 차이가 보이지 않았으며 그외에도 연교액기스는 병원균의 증식을 억제하지 않았다. 이런 결과들은 연교액기스가 장차 창상 치료제로서의 개발 가능성이 시사하였으며 그의 약리작용은 항생작용과 무관한 것으로 추정된다.

• Archives of Plastic Surgery
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• 제47권3호
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• pp.217-222
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• 2020

Background Surgical reconstruction of chronic wounds is often infeasible due to infection, comorbidities, or poor viability of local tissues. The aim of this study was to describe the authors' technique for improving the regenerative and antimicrobial potential of a combination of modified nanofat and platelet-rich plasma (PRP) in nonhealing infected wounds. Methods Fourteen patients met the inclusion criteria. Fat tissue was harvested from the lower abdomen following infiltration of a solution of 1,000 mL of NaCl solution, 225 mg of ropivacaine, and 1 mg of epinephrine. Aspiration was performed using a 3-mm cannula with 1-mm holes. The obtained solution was decanted and mechanically emulsified, but was not filtered. Non-activated leukocyte-rich PRP (naLR-PRP) was added to the solution before injection. Patients underwent three sessions of injection of 8-mL naLR-PRP performed at 2-week intervals. Results Thirteen of 14 patients completed the follow-up. Complete healing was achieved in seven patients (53.8%). Four patients (30.8%) showed improvement, with a mean ulcer width reduction of 57.5%±13.8%. Clinical improvements in perilesional skin quality were reported in all patients, with reduced erythema, increased thickness, and increased pliability. An overall wound depth reduction of 76.6%±40.8% was found. Pain was fully alleviated in all patients who underwent re-epithelization. A mean pain reduction of 42%±33.3% (as indicated by visual analog scale score) was found in non-re-epithelized patients at a 3-month follow-up. Conclusions The discussed technique facilitated improvement of both the regenerative and the antimicrobial potential of fat grafting. It proved effective in surgically-untreatable infected chronic wounds unresponsive to conventional therapies.

• Journal of Chest Surgery
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• 제30권8호
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• pp.739-746
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• 1997

기관결손을 대체할 이장적인 보철물을 개발하려는 다양한 실험연구가 있었다. 인공기관보철물의 조건으로 는 공기에 비투과성, 적이지 않는 형태의 안전성, 생체내에서 섬 유아세포의 증식과 상피세포 재생에 필요한 생체적합성이 요구된다. 생체적합성이 우수한 포리우레탄 소재의 다공성포리우레탄 튜브에 gelatin으로 도포하고 isoplastic고리를 보강하여 외경 20 m길이 30 m의 인공기관보철물을 제작하였다. 인공기관의 생체적합성과 상피세포재생을 촉진하기위해 콜라겐 물질인 gelatin을 감마선으로 고정하여 도포하였다. 인공기관보철물을 잡종성견 10마리를 대상으로 경흉부기관에 이식하였다. 실험군에서는 다공성 폴리머에 gelatin으로 피복한 인공기관을 이식하였고 대조군에서는 gelatin으로 피복하지않은 인공기관과 ,다공성 폴리머에 gelatin을 피복한 기관에 자가심장 편을 접합시킨 것을 이식하여 실험하였다. 다공성 폴리머에 gelatin피복한 기관과 자가심낭편을 접합한 기관 을 이식한 후 6주째에 인공기관 내면에 상피화가 관찰되었다. gelatin 피복한 기관을 대상으로 외번문합과 내 문합을 비교한 결과 외번문합에서 문합부의 육아종 협착이 더 심하게 생겼다. 심낭편을 접착한 기관에서는 문합부와 접착부에 감염과 염증이 있었다. 본 실험결과 다공성포리우레탄 튜브에 gelatin을 도포한 인공기관 보철물은 상피재생과 생체적합성이 우수하며 재질개선과 문합부의 협착을 막는 연구보완이 되면 임상적용 을 기대 할수 있다.