Purpose: Necrotizing fasciitis is a life-threatening, destructive soft tissue infection with a very high rate of mortality that needs early diagnosis and aggressive treatment. Systemic Lupus Erythematosus (SLE) is a systemic, autoimmune disease and it's major cause of mortality is an infection. But necrotizing fasciitis in SLE is very rare and there have been only 22 cases reported in the literatures. We reported a patient of necrotizing fasciitis with SLE and reviewed 22 others from literature research. Methods: A 40-year-old female patient with a history of SLE for 6 years came to the emergency room. The patient complained of severe pain and swelling on her right leg. She was diagnosed as necrotizing fasciitis and underwent emergency fasciotomy. As wound cultures showed variable organisms, she was treated with broad-spectrum antibiotics and underwent several surgical debridements. Then, the wound was treated with the V.A.C (Vacuum Assisted Closure) device and split thickness skin grafting was performed two times. Results: Skin graft was well taken within 2 weeks after operations and the patient was discharged to outpatient follow up. There was no complication related with surgery and she could walk without cane after 3 months. Conclusion: We treated a necrotizing fasciitis in a patient with SLE and reviewed 22 others from literature research. The case presented here suggests that necrotizing fasciitis is a rare disease in SLE patients, but should be considered in the differential diagnosis of soft tissue infection in SLE patients. A high index of suspicion is needed for early diagnosis and proper management in these patients.
Expansion in the scope and technique of head and neck tumor resection during the past two decades has paralleled precise tumor localization with advanced radiographic imaging and the availability of microvascular free tissue transfer. Especially, the defect reconstruction utilizing free flap results in improvement of patient survival due to decrease of local recurrence by wide resection of cancer. The rectus abdominis free flap has been used widely in reconstruction of the breast and extremities. However, the report of cases on its applications in the head and neck, based on the deep inferior epigastric artery and vein, is rare. This flap is one of the most versatile soft-tissue flaps. The deep inferior epigastric artery and vein are long and large-diameter vessels that are ideal for microvascular anastomosis. The skin area that can be transferred is probably the largest of all flaps presently in use. The versatility of the donor site is due to the ability to transfer large areas of skin with various thickness and amounts of underlying muscle. This article is to report reconstruction of midface defects utilizing the rectus abdominis free flap in 2 patients with maxillary squamous cell carcinoma and discuss briefly considerations in flap design and orbital exenteration, and healing of irradiated recipient site by hyperbaric oxygen therapy with literature review.
Park, Sun-Hyung;Park, Sung-Hun;Cho, Young-Moon;Kim, Jung-Hoon
The korean journal of orthodontics
/
v.32
no.5
s.94
/
pp.355-360
/
2002
After orthodontic treatment, there are several changes in soft tissue profile. Changes appear at lower anterior facial profile area, especially upper and lower lip. But there are many individual variations in the pattern of changes. So, this study was conducted to find out that the basic upper lip thickness could be one of the factors that could influence the treatment results. The samples were composed of 43 adult patients who had their 4 first premolars extracted. Groups were classified by their basic lip thickness. In group 1(thin upper lip group), there was negative relationship between mentolabial angle and lower lip change. In group 2(average lip thickness group), upper lip change was related to upper incisor change, lower incisor change, lower lip change and nasolabial angle change. And lower lip change was related to upper lip change, upper incisor change, lower incisor change. In group 3(thick upper lip group), there was no relation between both lip change and other variables.
Patients who want to reduce their lip protrusion usually estimate the severity of the lip protrusion on the frontal aspect. Most orthodontists have a perplexed experience of a reduced thin line of vermilion border on the frontal aspect as incisors we retracted, even though the lip protrusion is thought to be reduced favorably on the sagittal aspect. Some patients also look older after orthodontic treatment because of severe lip thinning. This unaesthetic reduction of vermilion border urges us to study the vertical lip change during orthodontic procedure. The purpose of this study was to evaluate the vertical lip and perioral soft tissue changes in respect to incisor retraction in an effort to analyze which factors might be responsible for their vertical changes, using the multiple regression analysis. The results were as follows. 1. Upper and lower lip philtrum length(SnLs, LiB') were increased after retraction of anterior teeth, where as upper and lower vermilion height(LsSuls, StmiLi), and vermilion length(LsLi) were decreased. 2. Upper and lower lip length(SnStms, StmiB'), and soft tissue lower anterior facial height(SnMe') did not show any significant difference after treatment. 3. The increase of the upper lip philtrum length was mainly influenced by the extrusion of upper anterior teeth(${\Delta}U1V$), and the increase of the lower lip philtrum length was mainly influenced by the initial overjet before treatment. 4. The decrease of the upper and lower lip vermilion height was mainly influenced by the decrease of upper lip thickness.
Purpose: The biocompatibility and bio-adhesive property of a dental implant abutment are important for proper soft tissue healing and maintenance of osseointegration of implant. However, studies of soft tissue healing and mucosal attachment of various materials of implant abutment other than titanium are still needed. In this study, cell attachment, proliferation, cytotoxicity of human gingival fibroblast for ceramic, gold alloy, Ni-Cr alloy and, commercially available pure titanium as a control were evaluated, using MTS and scanning electron microscopy. Materials and Methods: Specimen was designed to disc, 4mm diameter and 1mm thickness, made of ceramic, gold alloy, Ni-Cr alloy and commercially available pure titanium. Primary culture of human gingival fibroblasts were grown in Dulbecco's modified Eagle's medium with 10% fetal bovine serum and 1% antibiotics. Cells were inoculated in the multiwell plates placed the specimen disc. Cell Titer 96 AQucous One Solution Cell Proliferation Assay were done after 1hour 3hours, 24hours, 3days, 5days of incubation. The discs were processed for scanning electron micrography to evaluate cell attachment and morphologic change. Results: The results were obtained as fellows. 1. The ceramic showed high cell attachment and proliferation and low cytotoxicity, which is as much bioadhesive and biocompatible as titanium. 2. The gold alloy represented limited proliferation of human gingival fibroblast and the highest cytotoxicity among tested materials (p<0.05). 3. The Ni-Cr alloy limited the proliferaion of the human gingival fibroblast compared to titanium(p<0.05) but cytotoxicity on the bottom of well was not so considerable, compared to titanium. 4. On the scanning electron micrographs , the ceramic showed good attachment and proliferation of human gingival fibroblast, which was similar to titanium. But gold alloy and Ni-Cr alloy showed the shrinkage of gingival fibroblast both after 24 hours and 3 days. On 5th day, small amount of the human gingival fibroblast proliferation was observed on the Ni-Cr alloy, while the shrinkage of gingival fibroblast was still observed on the gold alloy. Conclusions: These results suggest that the ceramic abutment is as biocompatible as titanium to make proper mucosal seal. The gold alloy has a high cytotoxicity to limit proliferation of gingival fibroblast, which suggest limited use on the anterior tooth where soft tissue healing is recommeded.
Su Young Yun;Hye Jung Choo;Hae Woong Jeong;Sun Joo Lee
Journal of the Korean Society of Radiology
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v.83
no.5
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pp.1071-1080
/
2022
Purpose To compare the MR findings of septic and acute gouty arthritis of the knee joint. Materials and Methods This retrospective study included patients who underwent knee MRI for septic or gouty arthritis at our hospital between October 2012 and October 2018. The MR findings were analyzed for the presence of bone marrow edema, soft tissue edema, abscess, pattern of synovial thickening (frondlike, lamellated, diffuse linear), maximum thickness of the synovium, and joint effusion volume. The gouty (n = 5) and septic arthritis (n = 10) groups were compared using the Wilcoxon rank-sum test and Fisher's exact test. Results No statistically significant differences were observed for each item. One patient in the gouty arthritis group and seven in the septic arthritis group had bone marrow edema. Soft tissue abscess formation was only observed in the septic group. The incidence of each synovial thickening pattern was as follows: 100% (diffuse linear) in the gouty arthritis group and 20% (frondlike), 50% (lamellated), and 30% (diffuse linear) in the septic arthritis group. Conclusion Differentiation of gouty arthritis and septic arthritis based on imaging findings is difficult. However, lamellated synovial thickening patterns, bone marrow edema, and soft tissue abscess formation are more commonly observed in patients with septic arthritis than in those with gouty arthritis.
Kim, Yun-Jeong;Park, Ji-Man;Kim, Sungtae;Koo, Ki-Tae;Seol, Yang-Jo;Lee, Yong-Moo;Rhyu, In-Chul;Ku, Young
Journal of Periodontal and Implant Science
/
v.46
no.6
/
pp.372-381
/
2016
Purpose: The aim of this study was to determine the relationship between buccal bone thickness and gingival thickness by means of a noninvasive and relatively accurate digital registration method. Methods: In 20 periodontally healthy subjects, cone-beam computed tomographic images and intraoral scanned files were obtained. Measurements of buccal bone thickness and gingival thickness at the central incisors, lateral incisors, and canines were performed at points 0-5 mm from the alveolar crest on the superimposed images. The Friedman test was used to compare buccal bone and gingival thickness for each depth between the 3 tooth types. Spearman's correlation coefficient was calculated to assess the correlation between buccal bone thickness and gingival thickness. Results: Of the central incisors, 77% of all sites had a buccal thickness of 0.5-1.0 mm, and 23% had a thickness of 1.0-1.5 mm. Of the lateral incisors, 71% of sites demonstrated a buccal bone thickness <1.0 mm, as did 63% of the canine sites. For gingival thickness, the proportion of sites <1.0 mm was 88%, 82%, and 91% for the central incisors, lateral incisors, and canines, respectively. Significant differences were observed in gingival thickness at the alveolar crest level (G0) between the central incisors and canines (P=0.032) and between the central incisors and lateral incisors (P=0.013). At 1 mm inferior to the alveolar crest, a difference was found between the central incisors and canines (P=0.025). The lateral incisors and canines showed a significant difference for buccal bone thickness 5 mm under the alveolar crest (P=0.025). Conclusions: The gingiva and buccal bone of the anterior maxillary teeth were found to be relatively thin (<1 mm) overall. A tendency was found for gingival thickness to increase and bone thickness to decrease toward the root apex. Differences were found between teeth at some positions, although the correlation between buccal bone thickness and soft tissue thickness was generally not significant.
A 9-year-old intact female Poodle (weighing 3.6 kg) was presented for the treatment of a partial and full thickness burn that covering 45% of body including bilateral thigh and sacrolumbar region. Autologous platelet-rich plasma (PRP) stimulates angiogenesis, promoting vascular in-growth and fibroblast proliferation. On the unrecovered right thigh of the dog, autologous PRP was injected into the lesion after application of micro-needles. For macroscopic evaluation digital, photographs were taken from wounds at days 0, 3, 5, 13, 21, and 28. On the $3^{rd}$ day after PRP application, epithelialization was accelerated. Application of autologous PRP accelerated wound-healing rate and healing time in full thickness burns as well as secondary complications originating from unrecovered wounds. The delayed lesion was completely healed on the $28^{th}$ day by autologous PRP treatment. In human, PRP was increasingly used in the treatment of a variety of soft tissue in the management of chronic non-healing wounds. This study has shown that PRP treatment can be a valuable and effective aid on intractable wound healing in the dog with burns.
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.
Kang, Jae Kyoung;Lee, Jae Seong;Suh, Michelle;Lim, Gil Chae;Shin, Myoung Soo;Yun, Byung Min
Archives of Craniofacial Surgery
/
v.20
no.5
/
pp.319-323
/
2019
Cochlear implant extrusion, which is a common complication of cochlear implants, is generally repaired by a well visualized soft-tissue flap. A 61-year-old female patient with a medical history of schizophrenia who had a skin ulcer that caused cochlear implant extrusion, but that would be a stronger statement was referred to our department for removal of the implant and reconstruction of the resultant scalp defect. Accordingly, the broad defect was covered via rotation of a temporoparietal fascia flap (TPFF) using the superficial temporal artery, with the pedicle in the preauricular region as the pivot point. Coverage of TPFF was achieved with a split-thickness skin graft using the scalp as the donor site, which led to a quick recovery after the operation and satisfactory results in terms of aesthetics. This case suggests that a TPFF might be used as a flexible flap with low donor site morbidity for reconstructing cases of cochlear implant extrusion accompanied by a large full-layer scalp defect.
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