• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.57-61
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• 2008

Tuberculous arthritis on the sternoclavicular joint is an uncommon disease and a delayed diagnosis can be due to the obscure clinical symptoms. We should suspect tuberculous arthritis in patients with slowly progressive pain, swelling, mild fever and a previous history of tuberculosis. Early diagnosis is important through conducting a thorough physical examination and performing laboratory tests and radiologic study. Tuberculous arthritis on the sternoclavicular joint should be treated with a combination of systemic antituberculous agents and thorough surgical debridement in marked damaged joints. When performing this operation, it is important not only to minimized the injury of the costoclavicular ligament, but also to avoid injury to the surrounding the vital structures such as the mediastinum and pleura after aggressive resection or radical debridement. We describe here 2 cases of the tuberculous arthritis on the sternoclavicular joint: one case had a good result after surgical debridement with using an anti-tuberculous agent, and the other had fatal complications such as mediastinal abscess and pleural effusion after the operation.

• Archives of Plastic Surgery
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• v.44 no.6
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• pp.482-489
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• 2017

Background Polydeoxyribonucleotide (PDRN) is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. Methods This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10) and a PDRN group (n=10). Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL) or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week) and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week). Transcutaneous oxygen tension ($TcPO_2$) was evaluated using the Periflux System 5000 with $TcPO_2/CO_2$ unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain) of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field) was calculated. Results Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P<0.01), day 14 (P<0.001), and day 28 (P<0.001). The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094). Complete healing was achieved in every patient. Conclusions In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.245-249
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• 2010

Purpose: High-pressure injection injury is caused by accidental injection of the high-pressure injection devices in industry. The initial benign appearance of the wound fools patients into delays in an adequate treatment. And it can result in disastrous outcomes such as necrosis and amputation. To avoid the poor prognosis, the injuries require a prompt surgical intervention. The purpose of this article is to recognize the poor outcome of the highpressure injection injury and to introduce an adequate treatment in need. Methods: We have 4 cases of the high-pressure injection injuries in the hand from April, 2005 to March, 2009. Average age is 39 years (30 - 49 years old), 2 cases are the palm of dominant hand, 1 case is the thumb of dominant hand, and 1 case is the palm of non-dominant hand, respectively. We followed up these patients for 20 months on average. In 3 cases, the immediate, aggressive surgical intervention was carried out, but the other one was delayed in early adequate treatment. The wounds were covered by local advancement flap, anterolateral thigh free flap, conservative treatment with antibiotics and dressing. Results: No pathogens after culture were found nor any findings of fracture in imaging study. Conservative treatment, local advancement flap and anterolateral thigh free flap for the open wound resulted in a desirable aesthetic outcome. In a long-term follow up, functional capability of the patient was also satisfactory. Conclusion: Upon initial evaluation, most high-pressure injection injuries present as innocuous wounds with very few symptoms and result in delaying the proper management. And the majority of high-pressure injection injuries will produce significant morbidity to the hand, amputation. And the initial aggressive surgical debridement was needed to prevent the poor outcome. The key to success in treating high-pressure injection injuries of the hand is the prompt aggressive surgical intervention.

• Journal of Veterinary Clinics
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• v.41 no.4
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• pp.234-240
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• 2024

A 9-year-old, 5.6 kg female Shih Tzu dog presented with exudate at the right eye enucleation site three months post-enucleation at the local animal hospital. Surgical removal of the periorbital tissue was immediately performed. Still, the clinical signs were not improved. Thus, the dog was referred to Chonnam National University Veterinary Medical Teaching Hospital for treatment. On physical examination, pinkish-colored viscous exudate was observed, and the Periodic acid-Schiff (PAS) staining of the exudate confirmed a leakage of saliva. Computed tomography (CT) scan images showed an indistinct margin of the right zygomatic salivary gland, leading to a suspected right zygomatic salivary gland rupture. Consequently, sialoadenectomy was planned. The surgical approach to the zygomatic salivary gland was performed along the ventral margin of the zygomatic arch without ostectomy. After dissecting the masseter muscle, the ruptured zygomatic salivary gland and the affected salivary duct were successfully removed. There were no complications, and no pain response occurred at the surgical site for three months after surgery. This report demonstrates potential complications resulting from aggressive periorbital tissue debridement following enucleation. Before surgery, it is necessary to determine the cause using PAS staining and a CT scan.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.666-668
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• 2006

Purpose: Livedo vasculitis is recurrent painful ulceration of the feet, ankles and legs characterized by purpuric papules and plaques that undergo superficial necrosis and healing with residual white atrophic scars (atrophie blanche). The typical histopathologic findings of livedo vasculitis are characterized by endothelial proliferation and hyaline degeneration along with thrombosis of dermal vessels. Standard therapeutic strategies for treatment of livedo vasculitis are usually on the basis of rheologic, anti-inflammatory or immnosuppressive treatments, a aspirin, dipyridamole, glucocorticosteroids, pentoxyfylline, or high-dose intravenous immunoglobulin are often ineffective or partially effective. Methods: We report a case of 24-year-old male patient with livedo vasculitis on the ankles and dorsal surfaces of both feet. Results: The lesion that had been unresponsive to medical treatment were successfully healed with complete debridement and skin grafting without recurrences. Conclusion: Surgical treatment can be one of the therapeutic choice in Livedo vasculitis.

• Archives of Craniofacial Surgery
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• v.17 no.3
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• pp.103-110
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• 2016

Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.2
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• pp.224-227
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• 2000

Gunshot wounds to the face are often dramatic at the time of presentation. Although care must be individualized, protocol approach helps the clinician rapidly evaluate patient and plan treatment. Early X-ray films help to determine the precise trajectory. Rapid neurologic assessment and early CT scanning based on physical examination ot trajectory will allow for identification of even occult injuries early. Lead poisoning arising from bullet lead in the synovial cavity of the hip, synovial cavity of the chest and pleural space have been reported. A combination of surgical debridement and chelation therapy with oral succimer produce a satisfactory outcome. We have managed a patient with Lt facial gunshot wound and Lt mandible angle fracture by open reduction of angle fracture and surgical removal of remnant bullet and medially advanced cheek skin flap. We have obtained good result and report this case with review of literatures.

• Archives of Plastic Surgery
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• v.32 no.6
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• pp.782-786
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• 2005

Pressure sores are a common complication of hospitalized patients. However, It is often impossible to correct surgically because the general conditions of these patients are poor. It is known that the hydrogel has a powerful autolytic effect by providing moist environments and facilitates wound healing and hydrocolloid dressing is also known to promotes granulation tissue formation and epithelialization. The patients were treated with hydrogel(Purion $gel^{(R)}$, Coloplast A/S, Denmark) and hydrocolloid dressing (Comfeel Plus Transparent $Dressing^{(R)}$, Coloplast A/S, Denmark) after surgical debridement of pressure sores progressed to stage III(n=2) and IV(n=7). This combination treatment could facilitate to debride the nectrotic tissue and promote granulation tissue formation epithelialization simultaneously. We could achieve complete healing of pressure sores using the combination treatment without requiring surgical correction. In conclusion, hydrogel in combination with hydrocolloid dressing is effective in acheiving complete healing of progressed pressure sores.

• Journal of Veterinary Clinics
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• v.33 no.2
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• pp.124-128
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• 2016

A 7-year-old intact female Maltese dog presented with a history of bite wounds. Physical examination revealed labored breathing, four puncture wounds with subcutaneous emphysema of the thorax, and paradoxical respiratory movement of the right thoracic wall. On radiography, a segmental fracture of the right 7th rib and a single fracture of the 8th rib were evident on the dorsal thorax. An inward displacement of the fractured segment and contusion of the right caudal lung lobe were identified with computed tomography. A diagnosis of pseudo-flail chest was made. Exploratory thoracotomy revealed a full-thickness muscular defect, a marked discoloration of the right caudal lung lobe, a segmental fracture of the right 7th rib, and a single fracture of the right 8th rib. Necrotic tissues were removed using surgical debridement. The fractured 7th and 8th ribs were corrected using a single interfragmentary wiring technique. The thoracic wall was reconstructed using the latissimus dorsi muscle flap. Additional thoracic stabilization using a thermoplastic splint was applied to correct paradoxical respiratory movement. The external splint was removed 4 weeks postoperatively. There was no evidence of respiratory abnormalities 18 months postoperatively.

• Journal of Veterinary Clinics
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• v.25 no.6
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• pp.545-548
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• 2008

A 3-year-old castrated male Siberian husky was presented for evaluation after being hit by a car. On physical examination, the dog showed open-mouth, displacement of mandible and hypersalivation with blood ting. The base of tongue was transected almost 80% on the bias from right dorsal side to the left ventral side. Radiography demonstrated separation of mandible symphysis, and fracture of right condyle and vertical ramus. After debridement of the necrotic tissue, tongue apposition with simple interrupted suture was performed. Mandibular symphysis, condyle and mandibular vertical ramus fractures were fixed using pin, cerclage wire, T-plate, and K-wires. The mouth was irrigated daily using chlorhexidine after surgery. The sutures that were loose here or untied at tongue were re-sutured under sedation. The transected tongue was healed and recovered its normal movement after 6 weeks.