• 대한치과의사협회지
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• 제15권2호
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• pp.115-120
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• 1977

Extensive avulsion of the scalp, or stripping of a large area of soft tissue from the skull, is a serious accidnet. The avulsed scalp is often injured otherwise, such as by crushing, tearing, or from multiple laceration. The surrounding skin may be devitalized. Replacement of the scalp is usually followed by necrosis and sloughing within a short time. In such instances, the outer table of the cranium may become sucessively exposed. dry, dead, and affected by osteomyelitis. Hence the securing of early healing to prevent these is of the utmost importance. The successful case of reimplantation of the completely avulsed scalp, which is exposured to air for about 14 hours, is reported, in which there was partial growth of hair afterwards. The avulsed scalp caused by her long hair being caught in a grain belt was contaminated with hairs & dust. Authors treated this 19-year old female patient by split thickness skin graft, intermediate skin graft, full thickness skin graft from her own avulsed scalp.

• 대한수의학회지
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• 제39권3호
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• pp.645-652
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• 1999

The purpose of the present study was to investigate the effect of bovine amniotic membrane grafts on healing of full-thickness skin wound in dogs. Two $3cm{\times}3cm$ area-matched full-thickness skin wounds were induced bilaterally on the dorsolateral aspect of the trunk of 15 dogs. Chlorhexidine-treated amnion, dried amnion, silver sulfadiazine and 0.9% sterile saline solution were applied on the wound area and examined grossly and histopathologically. Begining 14 days after wounding, amnion applied group had appreciably less amount of inflammatory exudate and hemorrhage than sulfadiazine and saline treated groups. From 14 days after wounding, the degree of wound contraction in amnion groups, especially in the dried amnion group was greater than that of the sulfadiazine and saline treated groups. The percentages of wounds completely healed on 28 days after wounding in saline treated group, chlorhexidine-treated amnion group, dried amnion group and sulfadiazine treated group were 33%, 50%, 83% and 50%, respectively. Microscopically neovascularization and fibrosis were first noticed on 5 days after wounding in the dried amnion group and sulfadiazine treated group, on 7 days in the chlorhexidine-treated amnion group and on 14 days in the saline treated group. Epithelialization in the dried amnion and sulfadiazine treated groups was first noticed on 9 days after wounding, which was faster than that in the other groups. The present study suggests that bovine amniotic membrane, especially dried bovine amnion is effective on healing of full-thickness skin wound in dogs through both wound contraction and epithelialization.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.64-69
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• 2007

Purpose: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. Methods: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. Results: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. Conclusion: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.587-592
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• 2007

Purpose: In case of postburn flexion contracture of the fingers, skin graft, geometrical relaxation techniques, local flap, and free flap have been used. Among these procedures, full-thickness skin grafts from the inguinal area are widely used to reconstruct a postburn flexion contracture in the fingers. But there are many esthetic and functional problems in this procedure. Especially, hyperpigmentation of the skin-grafted fingers poses a troublesome problem, particularly in the patients who have dark colored skin. To solve the problem, we have used pulp graft which was harvested from the lateral aspect of great toe. In the present study, we report pulp graft, with which we have obtained a good result in the treatment of postburn flexion contracture of the fingers. Methods: Between September of 2004 and August of 2006, great toe pulp graft was performed to 20 sites of 15 patients. After release of the postburn flexion contracture using Z-plasty, the composite tissue (pulp) harvested from the lateral aspect of great toe was grafted on the raw surface. Moisture dressing with ointment and foam dressing material was performed. Stratum corneum of the graft got stripped off in two to four weeks after pulp graft. The color of the pulp graft was slightly reddish, then it became similar to the adjacent tissue. Results: There was complete take in all the patients who were treated with pulp graft. Great toe pulp graft provided similar color and texture to the adjacent skin, high rate of graft take, and left only a minimal scar at donor site. Conclusion: Thick keratin layer and inelastic nature of the pulp make this type of the graft much easier and simpler, and ensure a better take. Pulp graft is useful method for the reconstruction of the postburn flexion contracture in fingers.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권1호
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• pp.21-26
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• 2013

Objectives: Full thickness skin grafts (FTSG) offer several advantages; they are esthetically superb, have less postoperative shrinkage, and offer minimal postoperative pain and scar formation at the donor site. As a donor site of FTSG, the groin offers a relatively large area of skin with high elasticity. The aim of this study was to evaluate FTSG from the groin for reconstruction in oral and maxillofacial surgery. Materials and Methods: In a retrospective study, 50 patients (27 males, 23 females) who received FTSG from the groin were evaluated for their operation records, clinical photography, and medical records. Results: The width of skin from the groin was distributed from 2-8 cm (mean: 5.1 cm) at the donor site, while the long axis length was distributed from 3-13 cm (mean: 7.4 cm). A high number of patients, 47 patients (94%) out of 50, showed good healing at the donor site. Wound impairment was seen in 3 patients (6%), minor wound dehiscence in 2 patients, and severe wound dehiscence in 1 patient. In the recipient site, delayed healing was observed in 2 patients (4%). Conclusion: FTSG from the groin to repair soft tissue defects in reconstruction surgery is a good method due to the relatively big size of the graft, decreasing morbidity at the donor site, and higher graft survival rates.

• 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 Reconstructive Microsurgery
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• 제25권1호
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• pp.15-18
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• 2016

Any types of burn injury that involve more than deep dermis often require reconstructive treatment. In gluteal region, V-Y fasciocutaneous advancement flap is frequently used to cover the defect. However, in case of large burn wounds, this kind of flap cannot provide adequate coverage because of the lack of normal surrounding tissues. We suggest V-Y adipofascial flap using the surrounding superficially damaged tissue. We present the case of a patient who was referred for full-thickness burn on gluteal region. We performed serial debridement and applied vacuum-assisted closure device to defective area as wound preparation for coverage. When healthy granulation tissue grew adequately, we covered the defect with surrounding V-Y adipofascial flap and the raw surface of the flap was then covered with split-thickness skin graft. We think the use of subcutaneous fat as an adipofascial flap to cover the deeper defect adjacent to the flap is an excellent alternative especially in huge defect with uneven depth varying from subcutaneous fat to bone exposure in terms of minimal donor site morbidity and reliability of the flap. Even if the flap was not intact, it was reuse of the adjacent tissue of the injured area, so it is relatively safe and applicable.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권4호
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• pp.370-380
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• 1991

This article is intended to study histopathological and immunohistochemical response after autogenous full-thickenss skin graft in rat. 12 male Sprague-Dawley rats were used as the experimental animals. A $1Cm{\times}1Cm$ skin(0.7mm diameter) was taken on the right inguinal area of the rat. Another full-thickeness skin graft($1Cm{\times}1Cm$) was taken from the left inguinal area of the rat. And it was transplanted to the right inguinal area of the rat. The left side wound was closed directly. Light microscopic observation was made at the postoperative $1^{\circ}3^{\circ}8^{\circ}16$ day, after the hematoxylin - Eosin staining of the 4u-thick paraffin embedded specimens and the immunoshitochemical staining of the 10u-thick frozen specimens with mouse anti-rat monoclone antibodies and ABC staining kit. The results were as follows. 1. Electromicroscopic studies revealed interstitial tissue bleeding of transplanted autogenous skin. The response was severe in the 1 day group after operation, moederate in 3 day group, mild in 8 day group, and almost resovled in the 16 days group. 2. Electromicrospic studied also revealed a mild monocyte response in the 3 day and 8 day group. A histiocytic infiltrate was observed. There was a mild response in the 3 day group and moderate response in the 8 day group. 3. Immunohistochmically studies revealed a few pan T cells in the 1 day group, mild appearance of pen T cells and cytotoxic T cells in the 3 day group, a moderate infiltrate of pan T cells and helper T cells in the 8 day group, and total resolution of pan T cells in the 16 day group. 4. According to these finding, a strong inflammatory response was observed around transplanted autogenous skin in the 3 & 8 day groups. In the 16 day group this response had resolved histopathologically and immunohistologically.

• 대한두개안면성형외과학회지
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• 제22권4호
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• pp.204-208
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• 2021

Sebaceous carcinoma is a malignant neoplasm that usually arises in the sebaceous glands of the eyelids. Its pathogenesis is unknown; however, irradiation history, immunosuppression, and use of diuretics are known risk factors. The mainstay of treatment for sebaceous carcinoma of the eyelid is wide surgical resection with a safety margin of 5 to 6 mm, which often results in full-thickness defects. The reconstruction of a full-thickness defect of the eyelid should be approached using a three-lamella method: a mucosal component replacing the conjunctiva, a cartilage component for the tarsal plate, and a flap or skin graft for the skin of the eyelid. In this case, a full-thickness defect of the upper eyelid was reconstructed after tumor removal using a combination of a nasal septum chondromucosal composite graft and a forehead transposition flap, also known as a "Fricke flap." The flap was designed to include a line of the eyebrow on the lower margin of the flap to replace the eyelash removed during tumor excision. The wound healed completely, without any early or late complications, and the outcome was satisfactory.

• Archives of Plastic Surgery
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• 제46권2호
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• pp.167-170
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• 2019

Full-thickness scalp burns secondary to hair coloring are rare; however, such defects can be large and complex reconstruction of hair-bearing tissue may be necessary. Many skin-stretching devices that use gradual traction have been applied to take advantage of the viscoelastic properties of the skin. A 21-year-old female patient was seen with a burn defect on her occipital scalp leading to exposed subcutaneous tissue after chemical application of hair coloring in a salon. The dimensions of the wound were $10cm{\times}5cm$, and a skin graft or flap would have been necessary to close the defect. Two long transfixing K-wires (1.4 mm) and paired 3-wire threads (23 gauge), which are readily available in most hospitals, were applied over a period of 12 days for trichophytic closure of the defect. The remaining scalp scars after primary trichophytic closure with this skin-stretching method were refined with hair follicle transplantation. This skin-stretching method is simple to apply and valuable for helping to close problematic areas of skin shortage that would otherwise require more complicated procedures. This case shows a relatively unknown complication of hair coloring and its treatment.