• Journal of Korean Physical Therapy Science
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• v.8 no.1
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• pp.923-934
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• 2001

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 bum, biochemical assay and morphological changes in skin tissue, serum and liver tissue were examined. The effects of bum injury on the levels of glutathione, lipid peroxide and on the activities of oxygen free radical generating and scavenging enzymes have been determined in association with observing of histologic and ultrastructural changes, measuring the protein concentration in plasma, and counting the number of intravascular polymorphonuclear leukocytes. The activity of xanthine oxidase, an enzyme of oxygen free radical generating system. was elevated (p<0.01) in serum, but not in skin and in liver tissue. Futhermore, thermal injury decreased not only the protein concentration in plasma but also the number of leukocytes, that indicates induction of edema formation with protein exudation and inflammation by neutrophil infiltration into the internal organs. These data suggest that acute dermal scald burn injury leads to liver damage, that is related to elevation of xanthine oxidase activity in serum. Xanthine oxidase may be a key role in the pathogenesis of liver damage induced by skin burn.

• Archives of Plastic Surgery
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• v.49 no.1
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• pp.86-90
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• 2022

Performing a skin graft is not feasible for tendon-exposed defect reconstruction because tendons are fibrous connective tissues with relatively poor blood supply. This study proposes a method to effectively perform skin graft surgery in tendon-exposed wounds. A 48-year-old male patient with diabetes mellitus had a very large left dorsal foot defect (8×8 cm). The wound bed had healthy granular tissue, with tendon exposure. The tendons were turned over so that the posterior side would behave as the anterior side. The edge of the paratenon was then fixed together to the surrounding granulation tissue or dense remnant fascia using absorbable sutures, and the close granulation tissue was approximated and buried. A split-thickness skin graft was performed after 1 week. The graft site was stably taken on postoperative day 3. A small disruption was then observed at the graft site within 1 week postoperatively, but conservative treatment was continued for 1 month, after which the defect site was completely restored. This technique can increase the success rate of skin grafts for defects with tendon exposure.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.293-298
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• 2005

Osseointegrated prosthetic auricular reconstruction can be classified as either direct or indirect. In the $Br{\aa}nemark $ system of direct osseointegration, implants are placed into the mastoid process of the temporal bone. In the Epitec system of indirect osseointegration, implants are inserted into a three-dimensional carrier plate that is fixed to the mastoid by means of screws. We experienced forty-four cases using the indirect system and seventeen cases using the direct system. We compared with two systems by complications, such as skin reaction, implant loosening, implant loss. There were no specific differences in the skin reaction around the implants and abutments in relation to age or system used. The degree of skin reaction was different according to the conditions around the implant: in cases of virgin microtia, a skin flap was used to cover the implant, in contrast to grafted skin coverage for failed autogenous reconstruction. In both systems, the skin reaction was more severe and frequent in skin flap than in grafted skin. Loosening of the implant was more frequent in the direct system; however, accidental detachment of the implant from the abutment was more frequent in the indirect system. To reduce complications of skin reaction in osseointegrated prosthetic auricular reconstruction, it is important for soft tissue around implant to immobilize. Therefore, grafted skin is better than skin flap as soft tissue around implant. And immobilization of soft tissue around implant by wound dressing is major facter.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.408-411
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• 2019

Hairless scalp areas can occur due to trauma, tumors, or congenital disease. This aesthetically unpleasing condition can lead to psychosocial distress, and thin skin flaps may be prone to scarring. Treating the hairless scalp by simple excision is challenging because of skin tension. Tissue expanders are a good option for hairless scalp resurfacing. However, a single expansion may be inadequate to cover the entire defect. This report describes good results obtained using a serial resurfacing method involving re-expansion of the flap with a tissue expander to treat two patients with large lesions: one due to aplasia cutis congenital and another who underwent dermatofibrosarcoma protuberance resection. The results suggest that scalp resurfacing by serial tissue expansion using a tissue expander can be used for extensive lesions.

• Journal of Korean Medicine Rehabilitation
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• v.24 no.3
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• pp.111-119
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• 2014

Objectives This study aims to analyze a thermal distribution in biological living tissue during warm needling therapy by using a finite element method. The analysis provides an understanding of warm needling's efficacy and safety. Methods A model which consisted of four-layered tissue and stainless steel needle was adopted to analyze the thermal distribution in living tissue with a bioheat transfer analysis. The governing equation for the analysis was a Pennes' bioheat equation. A heat source characteristic of warm needling therapy was obtained by previous experimental measurements. The first analysis of the time-dependent temperature distribution was conducted through points on a boundary between the needle and the tissue. The second analysis was conducted to visualize the horizontal temperature distribution. Results When heat source's peak temperatures was above $500^{\circ}C$ and temperature rising rates were relatively slow, the peak temperature at skin surface exceeded a threshold of pain and tissue damage ($45^{\circ}C$), whereas when the peak temperature was around $400^{\circ}C$, the peak temperature at the skin surface was within a safe limit. In addition, the conduction of combustion energy from the moxa was limited to the skin layer around the needle. Conclusions The results suggest that the skin layer around the needle can be heated effectively by warm needling therapy, but it appears to have little effect at the deeper tissue. These findings enhance our understanding of the efficacy and the safety of the warm needling therapy.

• Journal of Yeungnam Medical Science
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• v.5 no.2
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• pp.25-30
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• 1988

Soft-tissue expansion is a new surgical technique of providing donor tissue in modern reconstructive surgery. This technique provides a quantity of tissue of similar color, texture, and hair-bearing qualities for reconstruction of adjacent defects. It is known that the expanded skin shows several constant histologic changes including the increase in collagen fibers and vascularity within dermis, and thinning of subcutaneous tissue and dermis. In this study, the author observed serial histologic changes of rabbit skin induced by progressive tissue expansion upto excessive expansion of 6 times. The results are as follows : 1. Changes in the thickness of the epidermis was minimal until 3 times of expansion, but slight thinning was observed at excessive expansion state. 2. The thickness of the dermis was progressively decreased, and collagen fibers in the dermis was rapidly increased in early phase of expansion. 3. The vascularity in the dermis was also progressively increased. 4. The skin appendages showed no structural changes even in excessive expansion. 5. The panniculus carnosus showed no atrophic changes and the thickness was maintained in excessive expansion.

• Archives of Plastic Surgery
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• v.32 no.5
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• pp.635-640
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• 2005

Sentinel lymphnode biopsy is widely performed in the management of malignant melanoma and breast cancer. The sentinel lymphnode is the prime site of draining from the malignant lesion and of metastasis. The aim of this study was to evaluate a usefulness of lymphoscintigraphy in conjunction with a removal of sentinel lymphnodes of skin and soft tissue malignancy. We studied 11 patients selected between January, 2003 and November, 2004. Clinically sentinel lymphnodes free of metastasis were examined with lymphoscintigraphy, gamma detection probe and vital dye staining, and we reviewed histopathologic findings and inert status of the nodes and the results fo treatment. Nine cases were malignant melanoma, one was squamous cell carcinoma on the left hand and another one leiomyosarcoma. Sentinel lymphnodes were identified in all cases. Three cases of malignant melanoma had positive sentinel lymphnodes on histological examination. All patients with positive sentinel lymphnodes were treated with therapeutic regional lymphadectomy, chemotherapy and adjuvant regimen. Four patients underwent PET scanning and followed sentinel lymphnode biopsy. Two had no metastasis signs on PET scanning. Therapeutic lymphnode dissection was carried out upon the patients whose sentinel lymphnode was positive on PET scanning. We contend that lymphoscintigraphy and sentinel lymphnode biopsy are reliable to confirm regional lymphnode metastasis of the skin and soft tissue malignancy, and blind extensive lymphnode dissection can be spared.

• Archives of Plastic Surgery
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• v.41 no.2
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• pp.126-132
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• 2014

Background Extensive degloving injuries of the extremities usually result in necrosis of the flap, necessitating comprehensive skin grafting. Provided there is a sufficient tool to evaluate flap viability, full-thickness skin can be used from a nonviable avulsed flap. We used a Wood's lamp to determine the viability of avulsed flaps in the operation field after intravenous injection of fluorescein dye. Methods We experienced 13 cases during 16 months. Fifteen minutes after the intravenous injection of fluorescein dye, the avulsed skin flaps were examined and non-fluorescent areas were marked under Wood's lamp illumination. The marked area was defatted for full-thickness skin grafting. The fluorescent areas were sutured directly without tension. The non-fluorescent areas were covered by defatted skin. Several days later, there was soft tissue necrosis within the flap area. We measured necrotic area and revised the flap. Results Among all the cases, necrotic area was 21.3% of the total avulsed area. However, if we exclude three cases, one of a carelessly managed patient and two cases of the flaps were inappropriately applied, good results were obtained, with a necrotic area of only 8.4%. Eight patients needed split-thickness skin grafts, and heel pad reconstruction was performed with free flap. Conclusions A full-thickness skin graft from an avulsed flap is a good method for addressing aesthetic concerns without producing donor site morbidity. Fluorescein dye is a useful, simple, and cost-effective tool for evaluating flap viability. Avulsed flap injuries can be managed well with Wood's lamp illumination and a full-thickness skin graft.

• Clinical Pain
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• v.15 no.2
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• pp.92-96
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• 2016

Objective: High frequency wave has been used in cancer treatment and cosmetic area but not in musculoskeletal pain yet. The purpose of this study is to evaluate temperature distribution according to depth and confirm safety of high frequency wave through animal study. Method: High frequency wave was applied to the posterior limb of 9 Sprague-Dawley rats for 20 minutes (experimental group) and no wave was used in the same number of rats for control group. Tissue temperature was measured from skin surface to 1 cm depth (surface, 1 mm, 5 mm, and 1 cm) for 5 seconds. Results: In the experimental group, temperature was elevated 3.2℃ at skin surface, 2.87℃ at 1 mm, 2.25℃ in 5 mm, and 1.74℃ in 1 cm depth. These were significantly different from those in the control group (p<0.001). There was no bulla or redness in the skin after high frequency wave stimulation and neither change of myocytes nor collagen degeneration was found in the tissue histology. There was no apoptosis in the skin surface and muscle layer in TUNEL assay. Conclusion: High frequency wave elevated tissue temperature from the skin to muscle layer without both histologic change and apoptosis.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.659-666
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• 2010

Purpose: Blepharoplasty plays a vital role in facial rejuvenation. Aging eyelids are the result of relaxation of lid structures as the skin, the orbicularis muscle, and mainly the septum, with subsequent protrusion or pseudoherniation of intraorbital fat contents. Traditional blepharoplasty has often involved the excision of excessive lax skin and muscle and removal of fat, leaving the eyelid unnatural and even causing the brow ptosis. The authors propose the septal approach through which the amount of skin excision can be decreased and solid fixation can be achieved in the upper blepharoplasty. Methods: From November 2007 to February 2010, total of 15 patients underwent upper blepharoplasty with septal approach. In 9 patients, orbital septum anchored into the orbital periosteum only. But in 6 patients, the attenuated septum was strengthened through shortening and fixing into orbital periosteum with non-absorbable suture. Results: Pleasing results were obtained from most of the patients. But one patient who had septum anchoring procedure complained of slight undercorrection, therefore secondary operation with septum shortening procedure was followed. Conclusion: We found that the method using orbital septum fixation into orbital periosteum has several advantages: less amount of skin excision, less recurrence rate, and more natural appearance. And the results were reliable and satisfactory.