• Korean Journal of Oriental Medicine
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• v.18 no.3
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• pp.119-126
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• 2012

1. Objectives Sasang constitutional medicine is unique in Korean traditional medicine. It diagnoses and treats patients based on his/her Sasang constitution (SC). Skin properties have been used as an effective diagnostic component in the classification of SC types in clinics. In this paper, we investigated the SC-based health relevance of skin elasticity and wrinkle properties. 2. Methods The skin elasticity and wrinkle of forearm and dorsal hand were measured in 299 elderly female subjects. To determine the subject's Sasang constitution, we adopted the classification results from a newly developed SC diagnostic tool. The health states of the subjects were scored by two Korean traditional medical doctors, by whom each subject was categorized either into the healthy state or the unhealthy state. 3. Results As a result, the elasticity hysteresis of forearm (E_HYS), the visco-elasticity (VE_MEAN), and the wrinkle frequency energy of backhand (W_HAND) showed significant differences between Taeum-in group and Soeum-in group. In case of the Soeum-in on unhealthy state, VE_MEAN was decreased significantly (p<.05). W_HAND and W_ARM_H of the healthy Taeum-in were less than those of the unhealthy Taem-in. 4. Conclusions In this study we showed that, for an elderly female population, skin elasticity and viscosity were significantly different not only between each SC type but also between healthy group and unhealthy group in each constitution. In particular, Soeum-in subjects were inferred to be superior in retaining skin softness when they were healthy, and Taeum-in subjects were easy to lose their firmness of skin surface when they became unhealthy.

• Archives of Plastic Surgery
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• v.34 no.1
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• pp.64-69
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• 2007

Purpose: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. Methods: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. Results: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. Conclusion: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.

• The Journal of Korean Medicine
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• v.18 no.1
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• pp.25-39
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• 1997

Shoulder hand syndrome is characterized by pain, vasomotor instability, and tenderness, mainly in the distal upper extremity. The pathophysiologic mechanism of this syndrome is not yet proved. The purpose of this study is to evaluate the usefulness of thermographic imaging on shoulder hand syndrome after stroke for early diagnosis and its clinical pattern analysis including acupuncture and electroacupuncture therapy. This study was performed from June to September in 1996 on 46 stroke patients who were admitted at Oriental hospital of Kyung Hee Medical Center. The study group were 23 patients with shoulder hand syndrome. The control group were 23 patients without shoulder hand syndrome. Skin temperatures on the both upper extremities were measured by Digital Infrared Thermographic Imaging(D.I.T.I.) before the study and 3 weeks later again. The results were as follows; 1. The shoulder hand syndrome group were significantly more restricted in shoulder passive range of motion than the control group. 2. The shoulder hand syndrome group showed significant temperature difference of both dorsal hands. 3. The electroacupunture therapy group were significantly more improved on the temperature difference of both dorsal hands than acupuncture therapy group in 3 weeks later. 4. Both posterior arms showed the biggest temperature difference from 11 to 30 days in shoulder hand syndrome group. 5. The lesser passive ROM(range of motion) of shoulder group showed significantly increased temperature difference of both hands. The above results show that measurement of shoulder passive range of motion and D.I.T.I. is a useful method for early diagnosis on shoulder hand syndrome and its clinical pattern analysis including evaluation of acupuncture and electroacupuncture therapy. Continuous study will be needed for more clinical application and evaluation on shoulder hand syndrome.

• Journal of Environmental Health Sciences
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• v.27 no.2
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• pp.22-29
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• 2001

To evaluate the cutaneous injury in liver damaged rats by toluene application to the skin, toluene(35mg/㎤) was sequentially applied for 5 days to the dorsal skin of liver damaged rats with $CCl_4$ (6 times ever other day:0.1$m\ell$/100 g body weight-50% $CCl_4$in olive oil). The cutaneous ultrastructural changes were unexoectably not observed in liver from $CCl_4$-treated rats although necrotic liver damage appeared under light microscope. In these animals by the application of toluene to rat skin the cutaneous xanthine oxidase activity was significantly increased(p<0.05), but cytochrome P450 content was not different from that of the control or only $CCl_4$-treated rats. On the other hand, the cutaneous superoxide dismutase and catalase activities in liver damaged animals were significantly respectively(p<0.05, p<0.001), decreased by toluene application to the skin compared with control and especially the former enzyme activity was significantty decreased(p<0.01), compared with that of liver damaged rate rat but glutathione peroxidase, glutathione-S-transferase activities were not significantly different from those of the control or liver damaged rats. Futhermore, the reduced gluathione content of skin was also significantly decreased by toluene application to the liver damaged animals. In conclusion, the great deposits of cerrous peroxide and ultramorphological changes in skin tissue of liver damaged animals by toluene application may be responsible for the oxygen free radical.

• Journal of Acupuncture Research
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• v.29 no.4
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• pp.105-111
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• 2012

Objectives : An objective measurement for the effects of acupuncture therapy had been regarded as one of the important agendas in the research of acupuncture. This case report aimed to measure the changes of blood flow on the skin flap after one session of electroacupuncture treatment. Methods : A 27-year-old male patient was treated with ipsilateral or contralateral electroacupuncture on the $LI_{11}$, $LU_{10}$, $LI_{10}$, $TE_5$, $SI_3$ and Ex- $UE_9$(Palsa) in the arm with the skin flap on dorsal region of the hand. Changes of blood perfusion on the skin flap and opposite dorsum of hand were measured with laser Doppler blood perfusion imager(LDPI). Results : Immediate post-treatment relative changes of the blood perfusion on the skin flap and opposite hand after one session of ipsilateral electroacupuncture was 21% and 18% higher than values from pre-treatment assessment, respectively. On the contrary, when needled contralaterally, relative changes of the blood perfusion on the affected and unaffected hand was 7% lower and 22% higher than values from pre-treatment assessment, respectively. Mean differences of the blood perfusion between on the skin flap and on control hand remained similar after the ipsilateral acupuncture treatment but substantially increased(44.58 of perfusion units). Conclusions : Electroacupuncture may alter the local blood flow on the skin flap. More study is needed to investigate the effects of acupuncture on the blood flow and microcirculation on the skin tissue by well-designed clinical and experimental studies.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.663-667
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• 2022

Finger dorsum defects are a challenging situation. Many reconstruction methods are used in these defects. Extended reverse dorsal metacarpal artery (RDMA) flap is used in dorsal finger reconstruction. Venous congestion in this flap is most important cause of flap failure. In this case, we presented a case in which we used heparin cream due to development of venous congestion in our patient who underwent an extended RDMA flap. A 24-year-old female patient presented to the emergency department with a defect of dorsal of left-hand fourth finger. Defect was covered with an extended RDMA flap. On postoperative first day, venous congestion was observed, and heparin cream was applied three times a day on flap. The signs of venous congestion were regressed. Tissue healed as a result of superficial epidermolysis and skin grafting. No functional limitation was observed in sixth-month postoperative control. Venous congestion is the most important cause of flap failure of extended RDMA flaps. Generally, subcutaneous heparin administration and leech therapy are used. In our case, heparin was applied as a cream instead of subcutaneously, and flap healing was observed as a result of superficial epidermolysis. Heparin cream application can also be used as a treatment option in flaps with venous congestion.

• Archives of Plastic Surgery
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• v.46 no.4
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• pp.359-364
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• 2019

Background Few scales are currently available to evaluate changes in hand volume. We aimed to develop a hand grading scale for quantitative assessments of dorsal hand volume with additional consideration of changes in skin texture; to validate and prove the precision and reproducibility of the new scale; and to demonstrate the presence of clinically significant differences between grades on the scale. Methods Five experienced plastic surgeons developed the Hand Volume Rating Scale (HVRS) and rated 91 images. Another five plastic surgeons validated the scale using 50 randomly selected images. Intra- and inter-rater agreement was calculated using the weighted kappa statistic and intraclass correlation coefficients (ICCs). Paired images were also evaluated to verify whether the scale reflected clinical differences. Results The intra-rater agreement was 0.95 (95% confidence interval, 0.922-0.974). The interrater ICCs were excellent (first rating, 0.94; second rating, 0.94). Image pairs that differed by 1, 2, and 3 grades were considered to contain clinically relevant differences in 80%, 100%, and 100% of cases, respectively, while 84% of image pairs of the same grade were found not to show clinically relevant differences. This confirmed that the scale of the HVRS corresponded to clinically relevant distinctions. Conclusions The scale was proven to be precise, reproducible, and reflective of clinical differences.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.43-50
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• 2004

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.93-98
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• 2001

Purpose : This describes our experience with a tenocutaneous free flap from the dorsum of the foot or radial forearm to reconstruct the dorsal skin and extensor tendons of the hand. Material and Methods : Between february 1987 and July 1998, we treated 9 patients with composite tissue loss on the dorsal hand caused by crushing injury. Nine men had an average age of 26.4 years(range, $19{\sim}47$). We treated 5 patients with the free dorsalis pedis flap including the extensor tendons and the superficial peroneal nerve and 4 patients with reverse forearm flap including the brachioradialis tendon and/or superficial radial nerve. Flap size was average 4.4(3,2cm. Evaluation of the results was based on the survived flap rate, the recovery rates for range of motion of the metacarpophalageal joints in the operated fingers. two-point discrimination. Results : All flaps were well vascularized and survived completely. Recovery rates for range of motion of the metacarpophalageal joints in operated fingers range from $78%{\sim}99%$(average, 90%). Two-point discrimination of the transferred flaps in 5 patients average $20{\pm}3.5mm$. Conclusion : The advantages of this procedure are mass action reconstruction with tendon, one-stage operation, faster healing with less adhesion formation, and early mobilization.

• Biomedical Science Letters
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• v.7 no.2
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• pp.71-77
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• 2001

To evaluate the effect of occlusive skin on the activity of cutaneous oxygen free radical metabolizing enzymes in rats, the dorsal skin was covered with closed glass chamber shaped petri dish, 46 mm in diameter and 10 mm in height and sealed by an adhesive. Five day-occluded group showed more increased activity of xanthine oxidase (XO) than that of control, and the activity of five day-occluded group was higher than that of ten day-occluded group. The activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were significantly higher in ten day-occluded group than in control or five day-occluded group. All the more, five day-occluded group showed the decreasing tendency of SOD and GPx activities compared to those of control. On the other hand, the cerrous perhydroxide deposits were observed in the intercellular space of the stratum basale in five day-occluded group under the electronic microscope using a cytochemistry method. Futhermore, the degree of cerrous perhydroxide reaction was lower in ten day-occluded group than in five day-occluded group. In conclusion, the increased XO activity and the decreased SOD and GPx activities are likely to responsible far the accumulation of $H_2O_2$ in five day-occluded group.