• 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.

• KSBB Journal
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• 제23권1호
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• pp.8-17
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• 2008

There are many different approaches to healing of acute and chronic ulcer and large skin defect, such as burn. Currently available wound covers fall into two categories. Permanent covering, such as autografts, and temporary ones, such as allograft including de-epidermized cadaver skin, bioartificial skin, xenografts, and synthetic dressings. Autologous skin grafting in the form of split- or full-thickness skin is still the good standard. Following on from developments in the 1980s involving the use of cultured keratinocyte grafts in wound healing, the last decade has been great progress in the fabrication of composite bioartificial skin grafts. However, two bottleneck on producing cultured bioartificial skin, whether of the simple epithelial cell sheet type, or the more complex composite type, continue to be the generation of sufficient keratinocytes cheaply and quickly and develop biocompatible dermal scaffolds. This article covers the development, clinical application, and current research directions associated with bioartificial skin.

• Journal of Medicine and Life Science
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• 제18권3호
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• pp.56-60
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• 2021

In recent decades, tissue engineering advances have led to more skin substitutes becoming available. Acellular dermal matrix, initially developed for use in the treatment of full-thickness burns, is made by removing the cellular components from the dermis collected from donated bodies or animals. This class of scaffold is used to replace skin and soft tissue deficiencies in a variety of fields, including breast reconstruction, abdominal wall reconstruction, and burn treatment. Herein, we provide a detailed review of the clinical applications of acellular dermal matrix.

• Medical Lasers
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• 제9권1호
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• pp.51-57
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• 2020

Background and Objectives For experiments on simulated burn, the preparation of an animal model is a very important step. The purpose of the current experiment is to design a simple and controllable method for the preparation of third-degree scald in a mouse model using the boiling water method. Materials and Methods A total of 18 Swiss mice were used. After the anesthetization, the mice were scalded by boiling water (100℃) using a mold with a 1 cm² circle area on the dorsum at contact times of 3s, 5s, and 8s. After confirming that 8 seconds of scald can cause a third-degree scald, the skin samples were collected at day 2, 4, 6, 8, 10, and 12, and analyzed by histopathological examinations. The wound retraction index (WRI) was also measured. Results Third-degree scald involving full-thickness skin was observed in the 8-second scald group, while a 3-second scald caused a superficial second-degree scald and a 5-second scald caused a deep second-degree scald. After third-degree scald, the burn wound continued to contract until day 14. Conclusion The scalding model of mice can be successfully established by the boiling water method. This method is easy to operate, it has a low cost, and it can control the scald depth by controlling the scald time. This is adequate to study skin thermal injury in the future. The scald model established by this method can last for 14 days.

• 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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• 제36권5호
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• pp.519-524
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• 2009

Purpose: This study was conducted to establish the most effective method of cell therapy by comparing and analyzing the level of wound healing after various cell delivery methods. Methods: Human mesenchymal stem cells were administered using 5 different methods on full thickness skin defects which were deliberately created on the back of 4 - week old mice using a 8 mm punch. Different modes of administration, cell suspension, local injection, collagen GAG matrix seeding, fibrin, and hydrogel mix methods were used. In each experiment group, $4{\times}105$ mesenchymal stem cells were administered according to 5 deferent methods, and were not for the corresponding control group. Results: The wound healing rate was fastest in the local injection group. The wound healing rate was relatively slow in the collagen matrix group, however, the number of blood vessels or VEGF increased most in this group. Conclusion: For rapid wound healing through wound contraction, it is advantageous to administer MSC by the local injection method. For the healing process of a wide area, such as a burn, the seeding of cells to collagen matrix is thought to be effective.

• 대한화상학회지
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• 제23권2호
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• pp.54-59
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• 2020

Purpose: A fourth degree burn is a full-thickness burn of the skin usually accompanied by damage to deep structures and commonly results in extensive damage to surrounding tissues which makes the treatment of the wound difficult. Coverage of these wound using free flap is known to effective but not commonly used. The purpose of our study is to review our experience and suggest early application of free flap surgery. Methods: A retrospective review was performed from 2010 to 2019, on a total of 34 fourth degree burn patients undergone free flap surgery as primary treatment in our hospital. We reviewed the location of the injury, etiology, TBSA (%), Presence of osteomyelitis, flap choice, complications, period of injury to surgery and healing. Results: Using free flap as a primary reconstrcuction, the outcome is satisfactory. The treatment period was shortened, and there was less loss of function due to complications. Also the incidence of osteomyelitis and amputation was significantly low. Conclusion: Applying free flap surgery as soon as possible in fourth degree burns is effective, such as reducing complications such as infection, reducing amputation, shortening treatment period, and preventing severe sequelae.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권3호
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• pp.189-199
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• 2006

Purpose of study: Partial thickness skin graft is the golden standard regimen for full-thickness skin defect caused by burn or trauma. However, in case of extensive burns of more than 50% of total body surface area, the donor site is not sufficient to cover all defects. As a second choice, allograft, xenograft and synthetic materials have been used to treat skin defect. Among them the amniotic membrane(AM) was used as a biological dressing for centuries because of its potential for wound healing. In this study, quantification of EGF in AM and effect of AM-collagen complex on full thickness skin defects was examined. Materials & Methods: The concentration of EGF in fresh, deep frozen and freeze-dried AM was evaluated by ELISA. EGF-R immunostaining was performed in freeze-dried AM. SD rats weighing 250${\sim}$300g was used for wound healing experiment. Three full thickness skin defects(28mm diameter) were made on dorsal surface of SD rat. The control group was covered by Vaselin gauze and AM-collagen complex and $Terudermis^{(R)}$. was grafted in two other defects. Healing area, Cinamon's score were evaluated before biopsy. Grafted sites were retrieved at 3 days, 1 week, 2 weeks and 4 weeks after operation. H & E and Factor VIII immunohistochemical stain was performed to evaluate the microscopic adhesion and structural integrity and microvessel formation. Results: 1. EGF concentration of fresh, deep frozen and freeze-dried AM showed similar level and EGF-R was stained in epithelial layer of freeze-dried AM. 2. At 4 weeks after grafting, the healing area of AM-collagen and Terudermis group was 99.29${\pm}$0.71% and 99.19${\pm}$0.77 of original size. However, that of control group was 24.88${\pm}$2.90. 3. The Cinamon's score of AM-Collagen and $Terudermis^{(R)}$. group at 4 weeks was 15.6${\pm}$1.26 and 14.6${\pm}$3.13 and that of control group was 3.7${\pm}$0.95. Significant difference was observed among control and experimental groups(p<0.05). 4. Histologic examination revealed that AM protected leukocyte infiltration and epithelial migration was nearly completed at 4 weeks. $Terudermis^{(R)}$. group showed mild neutrophil infiltration until 2 weeks and completion of epithelization at 4 weeks. Control group showed massive leukocyte infiltration until 4 weeks. 5. Microvessels were increased sharply at 1 week and control group at 1 and 4 week showed significant differences with $Terudermis^{(R)}$. group of same interval(p<0.05) but no differences were found with AM group(p<0.05). Conclusion: EGF and EGF-R were well preserved in freeze-dried AM. AM attached to collagen acted as excellent biologic dressing which had similar effect with $Terudermis^{(R)}$. AM showed anti-inflammatory action and healing was completed at 4 weeks after full-thickness skin defect.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.483-488
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• 2012

Background Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. Results The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. Conclusions In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

• Archives of Plastic Surgery
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• 제35권5호
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• pp.521-526
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• 2008

Purpose: Most burn scar contractures are curable with skin grafts, but free flaps may be needed in some cases. Due to the adjacent tissue scarring, local flap is rarely used, and thus we may consider free flap which gives us more options than local flap. However, inappropriate performance of free flap may lead to unsatisfactory results despite technical complexity and enormous amount of effort. The author will discuss the points we should consider when using free flaps in treating burn scar contractures Methods: We surveyed patients who underwent free flaps to correct burn scar contractures from 2000 to 2007. We divided patients into two groups. The first group was those in which free flaps were inevitable due to exposure of deep structures such as bones and tendons. The second group was those in which free flap was used to minimize scar contracture and to achieve aesthetic result. Results: We performed 44 free flap on 42 patients. All of the flaps were taken well except one case of partial necrosis and wound dehiscence. Forearm free flap was the most common with 21 cases. Most of the cases(28 cases) in which free flaps were inevitable were on the wrist and lower limbs. These were cases of soft tissue defect due to wide and extensive burns. Free flaps were done in 16 cases to minimize scar contracture and to obtain aesthetic outcome, recipient sites were mostly face and upper extremities. Conclusion: When using free flaps for correction of burn scar contractures, proper release and full resurfacing of the contracture should be carried out in advance. If inadequate free flap is performed, secondary correction is more challenging than in skin grafts. In order to optimize the result of reconstruction, flap thickness, size and scar of the recipient site should be considered, then we can achieve natural shape, and minimize additional correction.