• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권3호
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• pp.111-115
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• 2014

Purpose: This study evaluated powdered burn wound dressing materials from wild silkworm fibroin in an animal model. Methods: Fifteen rats were used in this experiment. Full-thickness $2{\times}2cm$ burn wounds were created on the back of rats under anesthesia. In the two experimental groups, the wounds were treated with two different dressing materials made from silkworm fibroin. In the Control Group, natural healing without any dressing material was set as control. The wound surface area was measured at five days, seven days and 14 days. Wound healing was evaluated by histologic analysis. Results: By gross observation, there were no infections or severe inflammations through 14 days post-injury. The differences among groups were statistically significant at seven days and 14 days, postoperatively (P<0.037 and 0.001, respectively). By post hoc test, the defect size was significantly smaller in experimental Group 1 compared with the Control Group and experimental Group 2 at seven days postoperatively (P=0.022 and 0.029, respectively). The difference between Group 1 and Group 2 was statistically significant at 14 days postoperatively (P<0.001). Group 1 and control also differed significantly (P=0.002). Group 1 showed a smaller residual scar than the Control Group and Group 2 at 14 days post-injury. Histologic analysis showed more re-epithelization in Groups 1 and 2 than in the Control Groups. Conclusion: Burn wound healing was accelerated with silk fibroin spun by wild silkworm Antheraea pernyi. There was no atypical inflammation with silk dressing materials. In conclusion, silk dressing materials can be used for treatment of burn wound.

• 대한화상학회지
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• 제22권2호
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• pp.58-65
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• 2019

Wound caused by high-tension electrical burns is difficult to manage because the wound is deep and complex. The wound is progressively necrotic due to microvascular injury resulting in deep tissue exposure. So, coverage of the wound at the entry point and the exit point is cumbersome, often requiring flap coverage. We experienced a case of one patient for peroneal artery perforator free flap coverage on the palm of the right hand of the entry point of electrical burn. The left foot wound of electrical exit point was covered by full thickness skin graft. Also a small wound was on the left side of the lower back was the exit point of electrical burn. The lower back wound was healed and recurred repeatedly after burn. On postburn day 6 month, through the radiologic exam, metal shadow was identified in the left gluteus muscle forming chronic sinus. We explored the wound of sinus and a foreign body was identified in the sac as multi braid wires thin as hair. According to the patient's past history, we suspected that the back wound was caused by electrical burn injury through the wires.

• Archives of Plastic Surgery
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• 제43권6호
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• pp.612-613
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• 2016

• Archives of Plastic Surgery
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• 제41권4호
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• pp.317-324
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• 2014

Background Burn infliction techniques are poorly described in rat models. An accurate study can only be achieved with wounds that are uniform in size and depth. We describe a simple reproducible method for creating consistent burn wounds in rats. Methods Ten male Sprague-Dawley rats were anesthetized and dorsum shaved. A 100 g cylindrical stainless-steel rod (1 cm diameter) was heated to $100^{\circ}C$ in boiling water. Temperature was monitored using a thermocouple. We performed two consecutive toe-pinch tests on different limbs to assess the depth of sedation. Burn infliction was limited to the loin. The skin was pulled upwards, away from the underlying viscera, creating a flat surface. The rod rested on its own weight for 5, 10, and 20 seconds at three different sites on each rat. Wounds were evaluated for size, morphology and depth. Results Average wound size was $0.9957cm^2$ (standard deviation [SD] 0.1845) (n=30). Wounds created with duration of 5 seconds were pale, with an indistinct margin of erythema. Wounds of 10 and 20 seconds were well-defined, uniformly brown with a rim of erythema. Average depths of tissue damage were 1.30 mm (SD 0.424), 2.35 mm (SD 0.071), and 2.60 mm (SD 0.283) for duration of 5, 10, 20 seconds respectively. Burn duration of 5 seconds resulted in full-thickness damage. Burn duration of 10 seconds and 20 seconds resulted in full-thickness damage, involving subjacent skeletal muscle. Conclusions This is a simple reproducible method for creating burn wounds consistent in size and depth in a rat burn model.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.829-835
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• 2011

Purpose: The two major concerns in skin grafting are poor color match in the recipient site and the donor site morbidity. And, glabrous skin on the palmar aspect of the hands and plantar aspect of the feet attributes define the skin on the palm and fingers sole as functionally and aesthetically different from skin on other parts of the body. When there is a glabrous skin defect, it should be replaced with similar skin to restore function and aesthetics. The palmar crease areas were used to minimize these problems. The purpose of this study is to present the precise surgical technique of the full thickness skin graft using distal palmar and midpalmar creases for aesthetic better outcome for hand injuries. Methods: From May 2006 to April 2010, 10 patients with 11 defects underwent glabrous full thickness skin grafting of finger defects. Causes included seven machinery injuries, two secondary burn reconstructions, and one knife injury. Donor sites included ten glabrous full thickness skin graft from the distal palmar crease and one from the midpalmar crease. Results: Follow-up ranged from 3 months to 24 months. All glabrous skin grafts demonstrated complete taking the recipient sites and no incidence of the complete or partial loss. The donor site healed without complications, and there were no incidences of significant hypopigmantation, hyperpigmentation, or hypertrophic scarring. Conclusion: The important aspects of this method involve immediate return of glabrous skin to the defect site and restoration of the recipient site's crease by simple primary closure from adjacent skin. The glabrous skin of the palm provides the best tissue match for the reconstruction of the hands, but only a limited amount of tissue is available for this purpose. Full thickness skin grafting using palmar crease of the defects is the ideal way of reconstructing glabrous skin to restore both function and aesthetics and minimize donor site morbidity.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.338-343
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• 2021

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.589-594
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• 2010

Purpose: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. Methods: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. Results: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. Conclusion: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.

• Archives of Plastic Surgery
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• 제35권1호
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• pp.67-72
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• 2008

Purpose: The hand is frequently affected area in high voltage electrical burn injury as an input or output sites. Electrical burn affecting the hand may produce full thickness necrosis of the skin and damage deep structures beneath the eschar, affecting the tendon, nerve, vessel, even bone which result in serious dysfunction of the hand. As promising methods for the reconstruction of the hand defects in electrical burn patients, we have used the peroneal perforator free flaps. Methods: From March 2005 to June 2006, we applied peroneal perforator free flap to five patients with high tension electrical burn in the hand. Vascular pedicle ranged from 4cm to 5cm and flap size was from $4{\times}2.5cm$ to $7{\times}4cm$. Donor site was closed primarily.Results: All flaps survived completely. There was no need to sacrifice any main artery in the lower leg, and there was minimal morbidity at donor site. During the follow-ups, we got satisfactory results both in hand function and in aesthetic aspects.Conclusion: The peroneal perforator flap is a very thin, pliable flap with minimal donor site morbidity and is suitable for the reconstruction of small and medium sized wound defect, especially hand with electrical burn injury.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.405-412
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• 2022

Although modern medicine has made great strides in the management of burn injuries, associated complications such as pain, infection, dyspigmentation, and scarring have yet to be fully dealt with. Although skin grafting and meshing are routinely performed on burn patients, this method poses a risk for adverse effects. Activated autologous platelet-rich plasma (aaPRP), which is increasingly used in the field of plastic surgery, contains growth factors beneficial for wound regeneration. Seven cases of burns with varying severity and conditions that were treated with intralesional subcutaneous injection and intravenous aaPRP are presented and discussed herein. This case series indicates that subcutaneous and intravenous aaPRP is a safe procedure with the potential to be an alternative when skin grafting cannot be done or as an adjunct treatment to skin grafting.

• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.179-185
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• 2002

The wrist and forearm are a frequently damaged area in high tension electrical injury as an input or output of the current. Electrical burns affecting the wrist and forearm may produce full thickness necrosis of the skin and damage deep vital structures beneath the eschar, affecting the local tendons, nerves, even bones and joints which result in serious dysfunction of the hand. From January 1997 to December 2001, we had treated 20 patients with high tension electrical burn in the wrist and forearm using anterolateral thigh free flap. Average follow up period were 24 months and we get satisfactory results both in functional and aesthetic aspects. This flap is considered useful in one-stage reconstruction of wide and large soft tissue defect combined with arterial injuries.