• Korean Journal of Veterinary Research
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• v.39 no.3
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• pp.645-652
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• 1999

The purpose of the present study was to investigate the effect of bovine amniotic membrane grafts on healing of full-thickness skin wound in dogs. Two $3cm{\times}3cm$ area-matched full-thickness skin wounds were induced bilaterally on the dorsolateral aspect of the trunk of 15 dogs. Chlorhexidine-treated amnion, dried amnion, silver sulfadiazine and 0.9% sterile saline solution were applied on the wound area and examined grossly and histopathologically. Begining 14 days after wounding, amnion applied group had appreciably less amount of inflammatory exudate and hemorrhage than sulfadiazine and saline treated groups. From 14 days after wounding, the degree of wound contraction in amnion groups, especially in the dried amnion group was greater than that of the sulfadiazine and saline treated groups. The percentages of wounds completely healed on 28 days after wounding in saline treated group, chlorhexidine-treated amnion group, dried amnion group and sulfadiazine treated group were 33%, 50%, 83% and 50%, respectively. Microscopically neovascularization and fibrosis were first noticed on 5 days after wounding in the dried amnion group and sulfadiazine treated group, on 7 days in the chlorhexidine-treated amnion group and on 14 days in the saline treated group. Epithelialization in the dried amnion and sulfadiazine treated groups was first noticed on 9 days after wounding, which was faster than that in the other groups. The present study suggests that bovine amniotic membrane, especially dried bovine amnion is effective on healing of full-thickness skin wound in dogs through both wound contraction and epithelialization.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.552-554
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• 2011

Purpose: Though its general usage, traditional tie-over dressing using suture has a few drawbacks such as difficulty in re-fixation after its opening especially when hematoma or seroma has occurred. It is rather difficult to maintain a stable dressing on curvy parts of body like flank, buttocks and that leads to unsatisfactory results of the surgery. Authors recommend a quick and repeatedly doable method, tie-over dressing that incorporates the usage of hooks and rubber bands. Methods: Debridement was done at a recipient site to be able to do skin graft. A right size of skin graft was prepared and placed upon the defect site with suture. Enough number of hooks were attached using Blue nylon at the normal skin of the edge of grafted area. We Applied dressing with ointment and fluffy gauze then fixed the dressing by attaching a rubber band at the hook to give a certain amount of tension. One or two days after the surgery, we opened the tie-over dressing and repeated the tie-over dressing by reusing the hooks and rubber band. Results: The skin grafts were all successfully taken and by repeating tie-over dressing using hooks and rubber, we could take the advantage of shortened the dressing time and eliminate the inconvenience of the patient and the surgeon by using bandages and fixing tapes. Conclusion: The advantage of tie over dressing using hooks and rubber bsnds are its easy re-doability early detection of probable complications, preventability of reoccurence of hematoma and seroma. Therefore, authors report this as considering the tie-over dressing using hooks and rubber bands is recommendable.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.80-91
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• 1996

A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.3
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• pp.262-267
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• 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.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.421-426
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• 2010

Purpose: Patients with serious burns are prone to chondritis due to lack of soft tissue in the auricle, which can cause severe defects in the auricular morphology. In addition, skin damage occurs frequently in the vicinity of post-burn wounds, presenting difficulties in reconstruction surgery. An auricular reconstruction has functional and cosmetic significance. The aim of this study is to develop appropriate reconstruction methods for auricular defects. Methods: Thirty seven patients, who were treated for auricular defects from 2005 to 2009, were enrolled in this study. A local flap, multiple regional flaps and cartilage framework with or without a temporal fascial flap were applied in reconstruction surgery according to the location of the auricular defect. Results: The age of the subjects ranged from 11 to 56. Some subjects had defects that cover more than half of the helical rim with most exhibiting post-burn scars in the vicinity, for whom a multiple regional flap was used. A single use of a tubed flap was sufficient for subjects with defects that covered less than half of the helical rim. A regional flap was also used for reconstruction in subjects with defects covering both the helical rim and antehelix. Conclusion: Achieving satisfactory results from the skin flaps and skin grafts for post-burn auricular defects in both functional and cosmetic aspects is a difficult task. Therefore, selecting an appropriate surgical method through proper diagnosis of the auricular defect and the state of the available skin in the vicinity is essential.

• Archives of Craniofacial Surgery
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• v.22 no.2
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• pp.85-92
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• 2021

Background: Patients with secondary deformities associated with unilateral cleft lip and nose might also suffer from nostril stenosis due to a lack of tissue volume in the nostril on the cleft side. Here, we used full-thickness skin grafts (FTSGs) to reduce nostril stenosis and various methods for skin volume augmentation. We compared the changes in the symmetry of both nostrils before and after surgery. Methods: From February 2016 to January 2020, 34 patients underwent secondary cheiloplasty and open rhinoplasty for secondary deformities of the unilateral cleft lip and nose with nostril stenosis. FTSG was used on the nostril floor, nasal columella, and alar inner lining. The measured nasal profile included the nostril surface, nostril circumference, width of the nostril floor, and distance from the alar-facial groove to the nasal tip. The "overlap area," which was defined as the largest overlapping area when the image of the cleft nostril was flipped to the left and right and overlaid on the image of the normal side nostril, was also calculated. The degree of symmetry was evaluated by dividing the value of the cleft side by that of the normal side of each measured profile and expressed as "ratios." Results: The results of all profile ratios, except for the nostril floor width, became significantly close to 1, which represents full symmetry. The overlap area ratio improved from 62.7% to 77.3%, meaning that the length and width of the nostril as well as the overall shape became similar (p< 0.05). Conclusion: When performing cleft rhinoplasty with nostril stenosis, FTSG is useful to achieve symmetry in the nostril size and shape. Skin grafting is simpler to perform than the other types of local flap, and the results are generally satisfactory.

• Archives of Plastic Surgery
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• v.44 no.3
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• pp.234-237
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• 2017

Paraffinoma is a destructive complication of paraffin oil injection, usually associated with massive tissue destruction, thus requiring radical surgery and subsequent complex reconstruction. Although breast and penile paraffinomas have been widely described and their management is quite standardized, paraffinomas of the knee are still rare and only few case reports or small case series are available in the current literature. We describe the case of a 77-year-old man with a large paraffinoma of the right knee that occurred after self-injection of paraffin oil, 58 years before. He underwent wide surgical resection of the soft tissues overlying the knee and subsequent two-stage reconstruction by using acellular dermal matrix and, after 20 days, split-thickness skin grafts. Follow-up after 16 months showed no signs of skin ulcerations or inflammation, with an overall improvement in function. Even though conventional flap reconstructions may be still useful, the authors believe that acellular dermal matrices represent a safe, reliable, and less invasive alternative for challenging soft tissue reconstructions even in elderly patients with multiple medical problems.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.43-47
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• 2013

Purpose: Un-healing and centrally located defect on back area, it is sometimes a challenge for the reconstructive surgeon. Although skin grafts are considered as the first choice for reconstruction of large skin defect on the back region, it is not always helpful but vascularized flaps provide a superior functional and aesthetic outcome. The present study was designed to investigate the clinical anatomy of the lumbar artery perforator flap to reconstruct back ulcer. Materials and Methods: Clinical anatomy study was undertaken using computed tomographic angiographic analysis. We identified the courses of lumbar arteries and its perforators, measured pedicle length by layers. The location of the perforator vessel was charted against anatomical landmarks. Results: The pedicle lengths of the third and fourth lumbar artery perforator reached a mean of 27.8 mm and 37.1 mm respectively from superficial fascia to deep fascia. The fourth perforator was more laterally located than the third perforator and less than 1 cm above the iliac crest. A case in which the fourth lumbar artery perforator was used as flap pedicle is described. Conclusion: For the reconstruction of central defect on the back area, the lumbar artery perforator flap coverage may be a good alternative option. Computed tomographic angiography can easily identify the course and location of lumbar artery perforators and can be helpful to elevate the flap successfully.

• Archives of Plastic Surgery
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• v.45 no.4
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• pp.375-378
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• 2018

In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasound-guided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.112-116
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• 2017

The ideal scalp reconstruction involves closure of the defect with similar hair-bearing local tissue in a single step. Various reconstructions can be used including primary closure, secondary healing, skin grafts, local flaps, and microvascular tissue transfer. A 53-year-old female patient suffered glioblastoma, which had recurred for the second time. The neuro-surgeons performed radial debridement and an additional resection of the tumor, followed by reconstruction using a serratus anterior muscle flap with a split-thickness skin graft. Unfortunately, the flap became completely useless and a bilateral rotation flap was used to cover the defect. Two month later, seroma with infection was found due to recurrence of the tumor. Additional surgery was performed using multiple perforator based island flap. The patient was discharged two weeks after surgery without any complications, but two months later, the patient died. Radical surgical resection of tumor is the most important curative option, followed by functional and aesthetic reconstruction. We describe a patient with a highly malignant tumor that required multiple resections and subsequent reconstruction. Repeated recurrences of the tumor led to the failure of reconstruction and our strategy inevitably changed, from reconstruction to palliative treatment involving fast and stable wound closure for the patient's comfort.