• Medical Lasers
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• 제9권2호
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• pp.142-149
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• 2020

Background and Objectives A picosecond-domain laser treatment using a microlens array (MLA) or a diffractive optical element elicits therapeutic micro-injury zones in the skin. This study examined the patterns of tissue reactions after delivering multiple pulses of 1,064-nm, MLA-type, picosecond neodymium:yttrium-aluminum-garnet laser treatment. Materials and Methods Multiple pulses of picosecond laser treatment were delivered to ex vivo human or brown micropig skin and analyzed histopathologically. A high-speed cinematographic study was performed to visualize the multiple pulses of picosecond laser energy-induced skin reactions in in vivo human skin. Results In the ex vivo human skin, a picosecond laser treatment at a fluence of 0.3 J/cm² over 100 non-stacking passes generated multiple lesions of thermally-initiated laser-induced optical breakdown (TI-LIOB) in the epidermis and dermis. In the ex vivo micropig skin, stacking pulses of 20, 40, 60, 80, and 100 at a fluence of 0.3 J/cm² generated distinct round to oval zones of tissue coagulation in the mid to lower dermis. High-speed cinematography captured various patterns of twinkling, micro-spot reactions on the skin surface over 100 stacked pulses of a picosecond laser treatment. Conclusion Multiple pulses of 1,064-nm, MLA-type, picosecond laser treatment elicit marked TI-LIOB reactions in the epidermis and areas of round to oval thermal coagulation in the mid to deep dermis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.29.1-29.7
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• 2015

Facial asymmetry is found in patients with or without cosmetic facial alterations. Some patients have facial asymmetry that manifests underlying skeletal problems, while others have only limited soft-tissue facial asymmetry. Orthognathic surgery brings about a dermatic change, as soft tissue covers underlying bones. Limited soft-tissue asymmetry, meanwhile, is difficult to correct. The treatment modalities for the creation or restoration of an esthetically pleasing appearance were autogenous fat grafts, cartilage graft, and silicon injections. A young female patient had right-side facial asymmetry. The clinical assessment involved visual inspection of the face and palpation to differentiate soft tissue and bone. Although the extra-oral examination found facial asymmetry with skin atrophy, the radiographic findings revealed no mandibular atrophy or deviation. She was diagnosed as localized scleroderma with muscle spasm. In conclusion, facial asymmetry patients with skeletal asymmetry can be esthetically satisfied by orthognathic surgery; however, facial atrophy patients with skin or subdermal tissue contraction need treatment by cosmetic dermatological surgery and orthodontic correction.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.10-14
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• 2021

Soft tissue filler injections are widely used due to their immediate effects, predictable results, and high stability. However, as the use of soft tissue filler injections has increased, various complications have been reported. We report a life-threatening complication in a patient who developed sepsis and necrotizing fasciitis. A 45-year-old woman presented with right leg pain and discharge from the labia majora. The patient had received a soft tissue filler injection of unknown composition 1 year earlier and had recently undergone incision and drainage for an inflammatory cystic nodule. Antibiotic treatment was administered for cellulitis, but the infection progressed to necrotizing fasciitis and sepsis. Fasciotomy and intensive care unit treatment improved the systemic infection, but the soft tissue filler injection site did not respond to treatment for 1 month. Thus, the injection site was covered with a pedicled vertical rectus abdominis musculocutaneous flap after wide excision. The area of skin necrosis on the leg was covered with split-thickness skin grafts. Infections occurring after soft tissue filler injections are related to biofilms, and treatment is sometimes difficult. Therefore, although soft tissue filler injections have a favorable safety profile, it is important to be aware of the risk of life-threatening complications.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.716-722
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• 2008

Purpose: Split or full thickness skin graft is generally used to reconstruct the palmar skin and soft tissue defect after release of burn scar flexion contracture of hand. As a way to overcome and improve aesthetic and functional problems, the authors used the preserved superficial fat skin(PSFS) composite graft for correction of burn scar contracture of hand. Methods: From December of 2001 to July of 2007, thirty patients with burn scar contracture of hand were corrected. The palmar skin and soft tissue defect after release of burn scar contracture was reconstructed with the PSFS composite graft harvested from medial foot or below lateral and medial malleolus, with a preserved superficial fat layer. To promote take of the PSFS composite graft, a foam and polyurethane film dressing was used to maintain the moisture environment and Kirschner wire was inserted for immobilization. Before and after the surgery, a range of motion was measured by graduator. Using a chromameter, skin color difference between the PSFS composite graft and surrounding normal skin was measured and compared with full thickness skin graft from groin. Results: In all cases, the PSFS composite graft was well taken without necrosis, although the graft was as big as $330mm^2$(mean $150mm^2$). Contracture of hand was completely corrected without recurrence. The PSFS composite graft showed more correlations and harmonies with surrounding normal skin and less pigmentation than full thickness skin graft. Donor site scar was also obscure. Conclusion: The PSFS composite graft should be considered as a useful option for correction of burn scar flexion contracture of hand.

• 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.

• 대한물리의학회지
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• 제9권2호
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• pp.133-140
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• 2014

PURPOSE: The purpose of this study was to compare the effect of current density on penetration depth, tissue concentration and transdermal transport of methylene blue(MB) by iontophoretic transdermal delivery. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into 1 mA($0.11mA/cm^2$), 2 mA($0.22mA/cm^2$), 4 mA($0.44mA/cm^2$), and 8 mA($0.89mA/cm^2$) groups. These rats were exposed to anodic iontophoresis of 1% MB using a direct current for 15 minutes. The penetration depth were measured using light microscopy from cryosections of skin tissue. The tissue concentration and transdermal transport were measured using biochemical analysis from target skin tissues. The data were analyzed with one-way analysis of variance. RESULTS: The significant differences in the penetration depth, tissue concentration and transdermal transport were detected among the groups(p<.001). Post hoc comparisons of the penetration depth, tissue concentration and transdermal transport of he 2 mA, 4 mA, and 8 mA iontophoresis groups were greater than in the 1 mA iontophoresis group(p<.05). There was no significant difference, however, among 2 mA, 4 mA, and 8 mA iontophoresis group. CONCLUSION: There was no difference in the efficiency of iontophoresis from 2 mA($0.22mA/cm^2$) to 8 mA($0.89mA/cm^2$). Higher current density can cause skin injury and discomfort sensation. In general, $0.5mA/cm^2$ is proposed to be the maximum iontophoretic current which should be used on human. The appropriate current amplitude should be selected by considering the safety current density and the depth of the target tissue.

• 한국광학회지
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• 제28권5호
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• pp.236-240
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• 2017

본 논문에서는 적외선 카메라를 이용하여 집속형 초음파 치료장비인 HIFU (High intensity focused ultrasound)가 발생시키는 물리적인 변화를 연구하였다. HIFU는 비 침습적으로 음향 에너지를 피하조직에 전달할 수 있기 때문에 피부과에서 안면 윤곽형성 및 피부탄력 개선을 위해 사용되고 있다. 피부 리프팅을 목적으로 사용하는 7 MHz HIFU의 사용 효과에 대한 정량적인 정보를 제공하기 위해 온도 분포 및 비가역적 조직 변화에 대한 연구를 실시하였다. HIFU에서 발생한 초음파 에너지로 인해 피하조직 수 밀리미터 크기의 부위에서 발생하는 온도의 변화를 적외선 이미징을 통해 측정하였다. 각 초음파 에너지 조건에서 생긴 열 응고점의 길이를 측정하였고 통계 처리를 통해 정량화 하였다. 온도의 증가가 발생한 부위에 대해서는 조직 검사에서 조직의 비가역적인 변화를 확인하였다. 실험을 통해 확인한 결과 집속된 초음파 에너지 (0.4, 1.2, 2 J)에 비례해서 조직에서 발생하는 온도가 증가하였다. 초음파가 치료하는 초점 부위에 대해 $69{\sim}90^{\circ}C$ 이상의 최고 온도가 발생하였고, 고온이 발생한 지점에서 조직적인 변화가 일어남을 확인할 수 있었다. 조직 검사를 통해 조직 내부 콜라겐의 응고를 통한 조직 변화를 확인하였다. 본 논문의 ex-vivo 실험 결과를 근거로 HIFU를 이용한 조직 응고의 강도를 조절하기 위해 적외선 이미징을 이용하여 얻은 정량적 데이터를 이용할 수 있음을 확인하였다.

• The Journal of Korean Physical Therapy
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• 제14권1호
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• pp.63-73
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• 2002

In order to investigate a pathogenesis of liver damage induced by skin burn, thermal injury was induced by scald burn on entirely dorsal surface in rats (total body surface area 30%) except for inhalated injury. At 5 and 24 h after scald burn, biochemical assay in skin tissue, serum and liver tissue were examined. The effects of burn injury on the levels of glutathione, lipid peroxide and on the activities of oxygen of histologic and ultrasound changes, measuring. the protein concentration in plasma, and counting the number of intravascular polymorphonuclear leukocytes. Post burn 24 h, the content of glutathione was decreased (47.50%), whereas that of lipid peroxide was increased (37.01%), and the activity of superoxide dismutase was diminished (p<0.001). Thus decreasing the capacity of oxygen free radical scavenging enzymes led to oxidative injury in skin tissue. In liver tissue, at 24 h after scald burn, both the content of glutathione and the activity of catalase were markedly decreased (p<0.01, p<0.05), thus the imbalance between free radical generating and scavenging capacities has been induced.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.82-86
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• 2008

Purpose: Soft tissue defect can occur on the posterior aspect of the elbow after trauma or fracture fixation. To cover the defect and maintain elbow functions, various flap surgeries including latissimus dorsi muscle flap, lateral arm flap and radial forearm flap can be performed. We present the clinical results of transposition lateral arm flap for coverage of the elbow defect and discuss the cause of posterior soft tissue necrosis after fracture fixation. Materials and Methods: Two patients who had posterior soft tissue defect of the elbow after open reduction of the fractures around the elbow were treated with transposition lateral arm flap. The mean size of skin defect was 20 $cm^2$. The flap was elevated with posterior radial collateral artery pedicle and transposed to the defect area. Donor defect was covered with split thickness skin graft. The elbow was immobilized for 1 week in extended position and active range of motion was permitted. Results: All two cases of transposition lateral arm flap survived without marginal necrosis. The average range of motion of the elbow was 10~115 degrees. Mayo elbow performance score was 72 and Korean DASH score was 23. Conclusion: When elbow fractures are fixed with three simultaneous plates and screws, skin necrosis can occur on the posterior aspect of the elbow around olecranon area. If the size of skin defect is relatively small, transposition lateral arm flap is very useful option for orthopaedic surgeons without microsurgical technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권3호
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• pp.227-232
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• 2007

The radial forearm fasciocutaneous flap(RFFF) is a well-known flap for the reconstruction of oral and maxillofacial defects. It was first described by Yang et al. in 1981 and Soutar et al. developed it for the reconstruction of intraoral defect. RFFF provides a reliable, thin, and pliable soft tissue/skin paddle that is amenable to sensate reconstruction. It also has a long vascular pedicle that can be anastomosed to any vessel in either the ipsilateral or contralateral neck. However, split thickness skin graft(STSG) is most commonly used to cover the donor site, and a variety of donor site complications have been reported, including delayed healing, swelling of the hand, persistent wrist stiffness, reduced hand strength, and partial loss of the graft with exposure of the forearm flexor tendon. Various methods for donor site repair in addition to STSG have been developed and practiced to minimize both functional and esthetic morbidity, such as direct closure, V-Y closure, full thickness skin graft, tissue expansion, acellular dermal graft. We got a good result of using artificial dermis($Terudermis^{(R)}$) and secondary STSG for the repair of RFFF donor site defect esthetically and report with a review of literature.