• Archives of Plastic Surgery
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• v.40 no.1
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• pp.11-18
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• 2013

Background To minimize the inflammatory reaction and improve healing, a new modified dermal substitute composed of an atelocollagen, chondroitin-6-sulfate, and amniotic membrane (AM) was applied to full-thickness skin defects in a pig. Atelocollagen was extracted from bovine skin, and two modified dermal substitutes were generated according to the cross-linking type. Methods The AM-collagen dermal substitutes were characterized and compared with currently used dermal substitutes in a pig skin defect model. There were five experimental groups: dehydrothermal (DHT) cross-linking atelocollagen with the AM on the top (AM-DHT), DHT and chemical cross-linking atelocollagen with the AM on the top (AM-DHT/chemical), Terudermis, Integra, and AlloDerm. After $3{\times}3cm$ full-thickness skin defects on the back of a pig were created, each dermal substitutes dermal substitutes was randomly grafted on the defects. Two weeks after grafting, autologous partial-thickness skin was over-grafted on the neodermis. The take rate of the dermal substitutes, skin, and histological sections were all assessed at 1, 2, and 4 weeks postoperatively. Results More rapid healing and a higher take rate were evident in the AM-DHT and Terudermis groups. Histological examination revealed fewer inflammatory cells and more fibroblast hyperplasia in these two groups. Four weeks after surgery, the amount of newly formed collagen was significantly more appropriate in the AM-DHT group. Conclusions These observations provide supporting evidence that a newly developed amniotic-collagen dermal substitute may inhibit inflammatory reactions and promote wound healing.

• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.120-126
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• 2018

Background: Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. Methods: For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. Results: There was a positive correlation between dermal thickness and scar score (p<0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (p<0.05). Conclusion: Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.

• Journal of the Society of Cosmetic Scientists of Korea
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• v.32 no.2 s.57
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• pp.123-127
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• 2006

In this study, we evaluated the crow's fret of 95 Korean female by using mechanical assessments; Skin-Visiometer SV 600 and Dermascan C. Transparency profilometry (Skin Visiometer) were using a very thin skin print which allowed parallel light to pass through and was analysed immediately after production. High-frequency (20 MHz) ultrasonography (Dermascan C) enabled non-invasive evaluation in skin thickness and echodensity. We found a correlation between skin roughness and dermal density. Particularly, we showed a significant correlation between skin roughness (R2) and dermal thickness. Also, we demostrated a significant negative correlation between dermal density and dermal thickness (p < 0.05). Therefore, the ultrasonography system might be considered a very useful method in wrinkle evaluation with the transparency profilometry. Further study will be required.

• KSBB Journal
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• v.29 no.1
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• pp.42-49
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• 2014

The aim of this study was to develop a composite human skin equivalent for wound healing. Collagen type1 and acellular dermal matrix powder were utilized as the scaffold with dermal fibroblasts and keratinocytes for the development of a composite human skin equivalent. Fibroblast maintained the volume of composite skin equivalent and also induced keratinocytes to attach and proliferate on the surface of composite skin equivalent. The composite human skin equivalent had a structure and curvature similar to those of real skin. Balb-C nu/nu mice were used for the evaluation of full-thickness wound healing effect of the composite human skin equivalent. Graft of composite skin equivalent on full-thickness wound promoted re-epithelialization and granulation tissue formation at 9 days. Given the average wound-healing time (14 days), the wound in the developed composite skin equivalent healed quickly. The overall results indicated that this three-dimensional composite human skin equivalent can be used to effectively enhance wound healing.

• Korean Journal of Head & Neck Oncology
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• v.31 no.1
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• pp.5-8
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• 2015

Backgrounds: The purpose of this study was to compare full thickness skin graft with inguinal skin to split thickness skin graft for coverage of the radial forearm free flap donor site. Patients and Methods: 25 patients who was reconstructed with radial forearm free flap for head and neck cancer were reviewed retrospectively. Results: The graft loss rates of full thickness skin graft were less than split thickness skin graft or split thickness skin graft with dermal substitutes. The recovery times of donor site and skin graft donor site of full thickness skin graft were also shorter than split thickness skin graft or split thickness skin graft with dermal substitutes. Skin texture and aesthetic results of donor site were improved and complications as itching and pain sensation were decreased. Conclusion: Full thickness skin grafts with inguinal skin should be considered for patients requiring a radial forearm free flap.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.10-16
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• 2019

Background: Physicians tend to overcorrect when applying the acellular dermal matrix for reconstructive option because of volume decrement problem after absorption comparing with initial volume. However, there are no studies on the exact volume decrement and absorption rate with commercial products in South Korea. To figure out absorption rate of acellular dermal matrix product in South Korea (Megaderm), authors designed this experiment. Methods: Nine mice were used and randomly divided into three groups by the time with sacrificing. The implant (Megaderm) was tailored to fit a cuboid form ($1.0cm{\times}1.0cm$ in length and width and 2.0 mm in thickness). A skin incision was made at anterior chest with blade #15 scalpel with exposing the pectoralis major muscle. As hydrated Megaderm was located upon the pectoralis major muscle, the skin was sutured with Ethilon #5-0. After the surgical procedure, each animal group was sacrificed at 4, 8, and 12 weeks, respectively, for biopsies and histological analysis of the implants. All samples were stained with routine hematoxylin and eosin staining and Masson's trichrome staining and the thickness were measured. A measurements were analyzed using Friedman test. Statistically, the correlation between thicknesses of Megaderm before and after implantation was analyzed. Results: After sacrificing the animal groups at postoperative 4, 8, 12 weeks, the mean tissue thickness values were $2.10{\pm}1.03mm$, $2.17{\pm}0.21mm$, and $2.40{\pm}0.20mm$ (p= 0.368), respectively. The remaining ratios after absorption comparing with after initial hydrated Megaderm were 82.7%, 85.4%, and 94.5%, respectively. In histopathological findings, neovascularization and density of collagenous fiber was increased with time. Conclusion: Author's hypothesis was absorption rate of implant would be increased over time. But in this experiment, there is no statistical significance between mean absorption thickness of implant and the time (p= 0.368). Also it can be affected by graft site, blood supply, and animals that were used in the experiment.

• Archives of Plastic Surgery
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• v.46 no.6
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• pp.558-565
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• 2019

Background The scalp, an excellent donor site for thin skin grafts, presents a limited surface but is rich in stem cells. The purpose of this study was to test a double harvesting procedure from the scalp and to evaluate the capacity of the dermal layer. Methods Two layers corresponding to a split-thickness skin graft (SSG) and a split-thickness dermal graft (SDG) were harvested from the scalp using a Zimmer dermatome during the same procedure. Healing of the scalp donor site, reason for recipient site grafting, and the percentage of graft loss were evaluated. Results Fourteen patients, comprising six men and eight women with a mean age of 34.2 years, were treated according to our protocol. The most common reason for a recipient site graft was a postburn scar deformity (10/14 patients). The mean area of scalp SSGs was 151.8 cm². The mean area of scalp SDGs was 88.2 cm². The mean healing time of scalp donors was 9.9 days. The only donor complication was a tufted scar deformity. Conclusions Skin defects in the scalp of donors healed faster and led to less scarring than defects at other donor sites. Scalp SDGs needed 10 days for adequate epithelization. The scalp was the best donor site for SSGs and SDGs for burn reconstructive patients.

• Archives of Craniofacial Surgery
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• v.15 no.1
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• pp.14-21
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• 2014

Background: There are several options for replacement of the dermal layer in fullthickness skin defects. In this study, we present the surgical outcomes of reconstruction using acellular dermal substitutes by means of objective and subjective scar assessment tools. Methods: We retrospectively reviewed the medical records of 78 patients who had undergone autologous split-thickness skin graft with or without concomitant acellular dermal matrix (CGDerm or AlloDerm) graft. We examined graft survival rate and evaluated postoperative functional skin values. Individual comparisons were performed between the area of skin graft and the surrounding normal skin. Nine months after surgery, we compared the skin qualities of CGDerm graft group (n=25), AlloDerm graft group (n=8) with skin graft only group (n=23) each other using the objective and subjective measurements. Results: The average of graft survival rate was 93% for CGDerm group, 92% for AlloDerm group and 86% for skin graft only group. Comparing CGDerm grafted skin to the surrounding normal skin, mean elasticity, hydration, and skin barrier values were 87%, 86%, and 82%, respectively. AlloDerm grafted skin values were 84%, 85%, and 84%, respectively. There were no statistical differences between the CGDerm and AlloDerm groups with regard to graft survival rate and skin functional analysis values. However, both groups showed more improvement of skin quality than skin graft only group. Conclusion: The new dermal substitute (CGDerm) demonstrated comparable results with regard to elasticity, humidification, and skin barrier effect when compared with conventional dermal substitute (AlloDerm).

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.567-575
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• 2011

Purpose: Acellular human dermis is very useful implant for use in plastic and reconstructive surgery. However, the volume of acellular human dermis graft is known to decrease for a long time. Basic fibroblast growth factor (bFGF) is a polypeptide that enhances the collagen synthesis and angiogenesis. In the current study we examined whether bFGF could improve the survival of acellular human dermis ($SureDerm^{(R)}$) by increasing angiogenesis of the graft. Methods: Forty rats were divided into two groups (control and bFGF). A 2-mm thick piece of $SureDerm^{(R)}$ was cut into smaller pieces that were $15{\times}5$ mm in size. Two subcutaneous pockets were made on the back of each rat. Grafts sprayed with bFGF were implanted in the bFGF group and injected with bFGF after transplantation every 3 days for 2 weeks. In the control group, the grafts were treated with phosphate-buffered saline (PBS) instead of bFGF. Four days, and 1, 4, and 12 weeks after the implantation, the grafts were harvested and gross and histologic examinations were performed. Inflammation grade, graft thickness, neocollagen density, and neocapillary count were measured. Results: The bFGF group displayed more rapid accumulation of inflammatory cells with a higher density of neocapillaries, and increased active collagen synthesis. After 12 weeks, the thickness of the grafts in the control and bFGF groups was $75.15{\pm}4.80%$ and $81.79{\pm}5.72%$, respectively, in comparison to the thickness before transplantation. There was a statistically significant difference between both groups ($p$ <0.05). Conclusion: bFGF was effective in reducing the absorption of acellular human dermal grafts by increasing angiogenesis and accelerating engraftment. In conclusion, bFGF may be a good tool for use in acellular human dermal graft transplantation for reconstructive surgery involving soft-tissue defects.

• Medical Lasers
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• v.10 no.4
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• pp.246-249
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• 2021

The carbon dioxide (CO₂) laser is one of the treatment options used for xanthelasma palpebrarum. However, even if the full dermal layer is removed, the lesion can recur due to the residual lipid deposits. A 44-year-old male patient with xanthelasma on both upper eyelids was treated with a pulsed dye CO₂ laser. On the right upper eyelid, we carried out a CO₂ laser treatment until the yellowish plaque was almost invisible and the full thickness of the dermal layer was removed. On the left upper eyelid, the dermal layer was partially removed and an additional squeezing out of yellowish particles was done. The lesion treated by the squeezing out of lipid droplets showed better long-term results than the lesion treated up to the deeper dermal layer.