• Clinics in Shoulder and Elbow
• /
• 제24권4호
• /
• pp.245-252
• /
• 2021

Background: In patients with total elbow arthroplasty (TEA), the soft-tissue around the elbow can be vulnerable to soft-tissue complications. This study aims to assess the outcomes after soft-tissue reconstruction following TEA. Methods: We retrospectively included nine adult patients who underwent soft-tissue reconstruction following TEA. Demographic data and disease characteristics were collected through medical chart reviews. Additionally, we contacted all four patients that were alive at the time of the study by phone to assess any current elbow complications. Local tissue rearrangement was used for soft-tissue reconstruction in six patients, and a pedicle flap was used in three patients. The median follow-up period was 1.3 years (range, 6 months-14.7 years). Results: Seven patients (78%) underwent reoperation. Four patients (44%) had a reoperation for soft-tissue complications, including dehiscence or nonhealing of infected wounds. Five patients (56%) had a reoperation for implant-related complications, including three infections and two peri-prosthetic fractures. At the final follow-ups, six patients (67%) achieved successful wound healing and two patients had continued wound healing issues, while two patients had an antibiotic spacer in situ and one patient underwent an above-the-elbow amputation. Conclusions: This study reports a complication rate of 78% for soft-tissue reconstructions after TEA. Successful soft-tissue healing was achieved in 67% of patients, but at the cost of multiple surgeries. Early definitive soft-tissue reconstruction could prove to be preferable to minor interventions such as irrigation, debridement, and local tissue advancement, or smaller soft-tissue reconstructions using local tissue rearrangement or a pedicled flap at a later stage.

• Archives of Plastic Surgery
• /
• 제48권1호
• /
• pp.10-14
• /
• 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
• /
• 제50권6호
• /
• pp.593-600
• /
• 2023

Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee jointmobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.

• Pediatric Infection and Vaccine
• /
• 제30권3호
• /
• pp.152-158
• /
• 2023

황색 포도알균은 흔한 피부 및 연조직 감염의 원인이며, panton-valentine leukocidin (PVL) toxin 생산 황색 포도알균은 전 세계적으로 발견되고 있으며 심각한 감염을 일으키는 것으로 알려져 있다. 그러나, PVL 양성 황색 포도알균으로 인한 신생아 감염은 매우 드물다. 저자들은 생후 7일 신생아에서 발견된 PVL 양성 황색 포도알균 감염으로 인한 심한 피부, 연조직 감염 사례를 보고하고자 한다. 환자는 당일 발생한 발열, 2일 전 시작된 둔부 열감, 부종, 압통으로 응급실로 내원하였다. 내원 당일, 발열, 빈맥, 전신 컨디션 저하, 둔부의 열감과 압통 진행이 확인되었다. 초음파 및 자기공명영상검사에서 피부 및 연조직, 일부 근육을 침범한 괴사성 근막염이 확인되었다. 둔부 병변에서 배농한 검체에서 PVL 양성 메티실린내성 황색포도알균 (MRSA)이 배양되었고, 균혈증은 없었다. 환자는 한달 간의 정맥 항생제 투여와 외과적 배액 수술 후 회복되었다. 퇴원 한달 후, 환자는 외이도염으로 재입원, 피부에서 동일한 MRSA가 확인되었다. 병변은 정맥 항생제 투여 및 소독만으로 호전되었다. 환자는 0.5% 클로르헥시딘 목욕을 통해 탈집락화(decolonization)를 시행하였고, 회복 후 재감염은 없었다. 본 사례는 PVL 생산 황색 포도알균 감염에 대해 적극적인 배액 수술 및 항생제 치료가 필수적이며, 재발 및 지역사회 확산을 방지하기 위해 추가적인 탈집락화가 필요함을 시사한다.

• Archives of Reconstructive Microsurgery
• /
• 제12권1호
• /
• pp.13-18
• /
• 2003

Fournier's gangrene is a synergistic necrotizing fasciitis of the perineal, perirectal and urogenital area and can be fatal unless treated in early stage. Perianal and urogenital infections are common causes of the disease but it can occur after artificial procedure on perineal area using by surgical instruments. It is mixed aerobic and anaerobic infection and E. coli is the most common causative bacteria. Untill now many investigators have focused on early diagnosis, preserving hemodynamic stability, broad-spectrum systemic antibiotics and treatment of underlying disease in management of Fournier's gangrene. The authors have experienced five patients of chronic liver disease whose necrotizing perineal infections developed spontaneously and treated them aggressively as described above and reconstructed perineal soft tissue defects using by various surgical methods, then we got good results both functionary and cosmetically. From now on, we would better reconstruct soft tissue defect of perineum with skin graft or pedicled flap in early stage when treat Fournier's gangrene, thereafter we can get an ultimate increase in patient's life quality.

• Journal of Microbiology and Biotechnology
• /
• 제33권12호
• /
• pp.1692-1697
• /
• 2023

Staphylococcus aureus integrated with mecA gene, which codes for penicillin-binding protein 2a, is resistant to all penicillins and other beta-lactam antibiotics, resulting in poor treatment expectations in skin and soft tissue infections. The development of a simple, sensitive and portable biosensor for mecA gene analysis in S. aureus is urgently needed. Herein, we propose a dual-toehold-probe (sensing probe)-mediated exonuclease-III (Exo-III)-assisted signal recycling for portable detection of the mecA gene in S. aureus. When the target mecA gene is present, it hybridizes with the sensing probe, initiating Exo III-assisted dual signal recycles, which in turn release numerous "3" sequences. The released "3" sequences initiate catalytic hairpin amplification, resulting in the fixation of a sucrase-labeled H2 probe on the surface of magnetic beads (MBs). After magnet-based enrichment of an MB-H1-H2-sucrase complex and removal of a liquid supernatant containing free sucrase, the complex is then used to catalyze sucrose to glucose, which can be quantitatively detected by a personal glucose meter. With a limit of detection of 4.36 fM for mecA gene, the developed strategy exhibits high sensitivity. In addition, good selectivity and anti-interference capability were also attained with this method, making it promising for antibiotic tolerance analysis at the point-of-care.

• Pediatric Infection and Vaccine
• /
• 제16권1호
• /
• pp.1-5
• /
• 2009

Methicillin-resistant Staphylococcus aureus (MRSA), a leading cause of nosocomial infections, has been increasingly recognized in communities of the United States. This article will review the clinical spectrum and treatment of MRSA infections in children in the context of recent epidemiological changes of MRSA infections. In general, community-associated (CA) MRSA most frequently causes skin and soft tissue infections and has an increased association with invasive infections, particularly pneumonia and musculoskeletal infections. Hospital-associated (HA) MRSA strains tend to be associated with bloodstream infections, pneumonia, and surgical site infections. Different from the United States, CA-MRSA infections are not common in Korea (only 5.9%); however, there are some CA-MRSA clones that are different from HA-MRSA clones in Korea and from CA-MRSA clones in other countries. The treatment of MRSA infections should be guided by antimicrobial susceptibility testing, the site of infection, and the infection severity. Vancomycin is the treatment of choice for invasive MRSA infections. Other agents such as trimethoprim-sulfamethoxazole, clindamycin, linezolid, quinupristin-dalfopristin, and daptomycin have been used for some conditions.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제19권3호
• /
• pp.243-249
• /
• 1997

The purpose of this study is to describe the clinical availability of a variety of intraoral local flaps in reconstruction of oral soft tissue defects, Forty patients with oral soft tissue defects were treated by tongue, buccinator, palatal, labial, facial artery musculomucosal, buccal fat pad, and masseter muscle crossover flap. Total 43 intraoral flaps were used to reconstruct a variety of intraoral soft tissue defects, such as oronasal fistula, oroantral fistula, traumatic deformities and other. The age of patients ranged from 7 to 72 years, with mean age of 39.6 years. Follow up period ranged from 2 to 66 months, mean follow up period of 21.6 months. There were 9 complications, of which four were partial necrosis, three infections, one total necrosis, and 1 speech problem. Except for total necrosis, most of the recipient sited healed uneventually without severe morbidity. We consider that a variety of intraoral local flaps can be available for reconstruction of small of moderate large intraoral soft tissue defects.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제29권3호
• /
• pp.262-267
• /
• 2007

Implantation of allografts has increased widely with not only the availability of many allogenic bone but also allogenic soft tissues. The aim of tissue banking is to provide surgeons with safe tissues compatible with their intended clinical application. The incidence of tissue transplant-transmitted infection is unknown and can only be inferred from prospective studies. The possibility of donor-to-recipient disease transmission through soft tissue transplantation can be considered by reviewing the risk associated with other transplanted hard tissues. Viral, bacterial, and fungal infections have been transmitted via transplantation of soft tissue allografts such as skin, cornea, dura, pericardium. fascia lata, and heart valves. Corneas have transmitted rabies, Creutzfeldt-Jakob disease (CJD), hepatitis B (HBV), cytomegalovirus (CMV), herpes simplex virus (HSV), bacteria, and fungi. Heart valves have been implicated in transmitting tuberculosis, hepatitis B. HIV-1 and CMV. CJD has been transmitted by dura and pericardium transplants. Skin has transmitted CMV, bacteria, and fungi. Cadaveric skin, pericardium, dura, and fascia lata have been used in dental patients with intra-oral soft tissue injuries and GBR. This study is review of the considering transmission of infectious disease in allogenic soft tissues and guidelines of reducing the risk. Prior to use, many tissues are exposed to antibiotics, disinfectants, and sterilants, which further reduce or remove the risk of transmitted disease. Because some soft tissue grafts cannot be subjected to sterilization steps, the risk of infectious disease transmission remains and thorough donor screening and testing is especially important.

• Pediatric Infection and Vaccine
• /
• 제23권1호
• /
• pp.62-66
• /
• 2016

최근 전세계적으로 지역사회 기원 메티실린내성 황색포도알균(CA-MRSA)에 의한 피부연부조직 감염증이 증가하고 있다. 16개월의 한국 여아가 생후 6개월부터 시작된 반복되는 피부연부조직 감염증을 주소로 내원하였다. 환아의 가족들도 환아와 비슷한 시기에 피부연부조직 감염증의 병력이 있었다. 환아의 혈중 면역글로불린 및 NBT 검사는 정상이었고, 피부 병변 외에는 가족 모두 건강하였다. 환아의 감염증 부위의 고름 배양 및 비강 내 보균 검사시 모두 PVL genes을 생성하는 CA-MRSA ST714 SCCmec type IV가 확인되었고, 이는 ST30의 single locus variant로서 국내에서는 보고된 적이 없는 MRSA의 유전형이다. 환아와 함께, 환아의 균주와 동일 항생제 감수성 양상을 보이는 MRSA 보균자인 환아부에게 재발 방지를 위해서 비강내 mupirocin 5일 요법을 시행하였고 이후 10개월간 추가적인 재발은 없었다.