Purpose: The digital artery perforator flap was recently introduced and has been proven to be useful for reconstruction of various finger defects. Short operative time, less invasive surgery, and reliable flap circulation are the major advantages of this flap. The authors presented the clinical cases of the digital artery perforator flap and compared them with the distant flaps within a hand (thenar and hypothenar flaps) to reveal their differences. Methods: From May of 2006 to February of 2009, the authors performed reconstructions of finger defects with the digital artery perforator flaps in 10 patients as with the distant flaps within hand in 9 patients (7 thenar and 2 hypothenar flaps). In these two groups of the patients, flap size, use of skin graft, length of stay in hospital, healing time, complications were reviewed retrospectively and compared with statistical analysis (Student's t-test). Results: All flaps survived completely. The mean size of the perforator flap was $0.9{\times}1.9\;cm$ and the mean distant flap within a hand was $1.9{\times}2.0\;cm$. The use of skin graft was reduced in the perforator group because the donor site of the flap was closed primarily. The hospitalization period and healing time also reduced significantly in the perforator group. Minor complications (partial flap loss) were noted in small percentages in both groups but resolved with conservative management. Mean follow-up period was about 6 weeks. Conclusion: The digital artery perforator flap was smaller than the distant flap but its reconstruction of finger defects was reliable and comparable to the conventional distant flaps within a hand. This flap would be not only an alternative method but very useful in the management of various finger defects, because of ease of operative technique, less invasive surgery, decreased need of skin graft, and shorter period of hospitalization and healing time.
Wound healing is the result of interaction of normal cellular and biochemical responses that restore the interrupted anatomical structure in limited period. When any response of them is impaired, it results in chronic wound. The factors that influence the wound healing process is not only limited to the fundamental disease of the individual but also the local factors, especially various growth factors secreted from the various cells involved in tissue regeneration have important role. Recent reports that the chronic wounds are depleted of these growth factors have led active studies on the alteration of local wound environment with manipulation of the growth factors and the its application in management of chronic wounds. We investigated the effect on the chronic wounds in 10 patients with various pathologic conditions to suggest the appropriate application and guideline of the indication. The chronic wounds resulting from various causes in 10 patients were treated with rhPDGF gel and good wound care. All the chronic wounds were located on the lower extremity and the average diameter was 2.5 cm. 7 patients were completely cured within 8 weeks, however the patient who received previous radiation therapy the healing was delayed to 14 weeks. Two patients with vascular ulcer were not cured with rhPDGF alone. Local application of rhPDGF has yielded complete cure of the chronic wound in 70% of the patients within 2 months. The author suggests that it would be an effective alternative treatment modality of chronic wound when it is applied with good wound care and appropriate indication.
In order to formulate an aqueous topical preparation of epidermal growth factor(EGF) for the treatment of open wound and bum, the stability of EGF in aqueous vehicles containing various stabilizers was evaluated and the pharmacological activity of gel preparations formulated with poloxamer 407 was determined with wound model. Various additives, which are known as potent stabilizers for proteins and polypeptides so far, were used to increase the stability of EGF in aqueous vehicles. The contents of EGF in the vehicles containing stabilizers were determined with an HPLC method after the storage at $37^{\circ}C$. EGF was more stable in ultrapure water than RO water or saline. All the additives studied resulted in deleterious effects on EGF stability. Therefore, it was speculated that any additives or impurities in the vehicle made EGF unstable. However, nitrogen purge of solution increased the stability of EGF in aqueous vehicles. The aqueous topical preparations of EGF were formulated with poloxamer 407 as a gel base in saline. Gelatin or amastatin was employed as a protease inhibitor. The pharmacological effect of EGF gel was studied with open wound model in mice. EGF preparations, made of oleaginous base or poloxamer gel base, showed significant healing effect compared to the control group(p<0.05). The addition of protease inhibitor in poloxamer 407 gel resulted in significant healing effect compared to the gel without it(p<0.05). Body weights of mice treated with EGF preparation were increased at the first day after the formation of open wound, while those of the control group were decreased. The EGF gel made of poloxamer 407 containing a pretense inhibitor would be a promising aqueous topical preparation for EGF.
This study was carried out to investigate the effects of pycnogenol (PYC) on the cutaneous wound healing of the mice. The wounds were extracted on days 1, 3, 5, and 7 post-injury for histomorphometrical analysis including wound area, infiltrating inflammatory cells, wound contracture including collagen deposition. As the result, the wound area of PYC-treated group was larger than the control group on days 1 to 7. Inflammatory cells in the PYC-treated wounds were decreased at day 1 compared to the control wound tissue. From day 3 to 7, there was no significant difference between the control and the PYC-treated skin wounds. Though the degree of contraction in the PYC-treated group was lower than that of the control group from days 1 to 5, but appeared significantly higher on day 7. Compared to the control group, collagen accumulation in the PYC-treated group was higher than that of the control group from days 5 to 7. From this result, it may support the possibility that PYC would be useful agent for early inflammatory response and matrix remodeling phase of the skin wounds.
Choi, Sungwook;Seo, Kyu Bum;Shim, Seungjae;Shin, Ju Yeon;Kang, Hyunseong
Clinics in Shoulder and Elbow
/
v.22
no.4
/
pp.190-194
/
2019
Background: The duration of immobilization after arthroscopic rotator cuff repair and the optimal time to commence rehabilitation are still the subject of ongoing debates. This study was undertaken to evaluate the functional outcome and rotator cuff healing status after arthroscopic rotator cuff repair by comparing early and delayed rehabilitation. Methods: Totally, 76 patients with small, medium, and large sized rotator cuff tears underwent arthroscopic repair using the suturebridge technique. In early rehabilitation group, 38 patients commenced passive range of motion at postoperative day 2 whereas 38 patients assigned to the delayed rehabilitation group commenced passive range of motion at postoperative week 3. At the end of the study period, clinical and functional evaluations (Constant score, the University of California, Los Angeles [UCLA] shoulder score) were carried out, subsequent to measuring the range of motion, visual analogue scale for pain, and isokinetic dynamometer test. Rotator cuff healing was confirmed by magnetic resonance imaging at least 6 months after surgery. Results: No significant difference was obtained in range of motion and visual analogue scale between both groups. Functional outcomes showed similar improvements in the Constant score (early: 67.0-88.0; delayed: 66.9-91.0; p<0.001) and the UCLA shoulder score (early: 20.3-32.3; delayed: 20.4-32.4; p<0.001). Furthermore, rotator cuff healing showed no significant differences between the groups (range, 6-15 months; average, 10.4 months). Conclusions: Delayed passive rehabilitation does not bring about superior outcomes. Therefore, early rehabilitation would be useful to help patients resume their daily lives.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
/
v.35
no.2
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pp.112-119
/
2009
Extracellular matrix(ECM) is known to function as a reservoir of endogenous growth factors, can be an effective delivery system of growth factor that easily lost bioactivity in solution. Fibrillar collagens like type I collagen, are the major constituent of the ECM and structural protein of bone. Also, it can be a scaffold for osteoblast migration. The purpose of this study was to compare the effects of absorbable Atelo-collagen Sponge($Teruplug^{(R)}$) insertion in tooth extraction sites on periodontal healing of the mandibular second molar after the extraction of the impacted third molar. The study population comprised 31 cases who had been scheduled for surgical removal of impacted mandibular third molars. All patients were in good general health and were not using any medication that would influence wound healing after surgery. In 15 cases control group, none was inserted into the tooth extraction site. In 16 cases experimental groups, $Teruplug^{(R)}$ was inserted into the tooth extraction site. We evaluated tooth mobility, pocket depth, gingival margin level preoperatively and 1 week, 2 weeks, 4 weeks, and 3 months postoperatively. The change was compared with two groups using Mann-Whitney test. The results were as follows. 1. There was no significant change of tooth mobility on both groups. 2. There was tendency of decreasing of previous pocket depth causing tooth extraction on both groups. 3. On gingival margin level, there was various change according to initial swelling and loss of attachment on both groups. 4. There was tendency of decreasing of gingival margin level on both groups because of removal of inflammation and decreasing of previous pocket depth. 5. There was large change of pocket depth on buccal middle, distal, lingual distal area because of tooth extraction and bone reduction. Compared with the control group and experimental group, we observed significant difference during some periods. The results of this study suggest that absorbable atelo-collagen sponge($Teruplug^{(R)}$) is relatively favorable bone void filler with prevention of tissue collapse, food packing and enhance periodontal healing.
The healing effect of the aroma treated fabrics with lavender and lemon aromas was investigated by assessing the autonomic nervous responses of human body. For this cause Lemon and lavender microcapsules were coated on a cotton fabric using a water-based acrylic binder, respectively. And the study created a total of four aroma treated fabrics at a concentration of 2% and 5% respectively. Electrocardiogram(ECG), skin conductance, and Blood flow, of ten participants were measured for 30 sec at a stable condition, at a stress status (working memory task), and at a stimulation status (after rubbing aroma treated fabrics). Subjective sensibilities of the aromas were also evaluated. With regard to the responses of the autonomic nervous system, in order to understand how the values gained after the normalization process would cause different physiological signals between the stable state and the aroma-stimulated state as well as between the stress state and the aroma-stimulated state, the study conducted a non-parametric test, friedman test as well and analyzed tendencies. LF/HF turned out to be significantly different to the stress state, and according to the results of the post-hoc comparison, lemon 5% presented statistically significant differences among the lavender 2%, lavender5%, lemon2%. Lemon 5% stimuli increased stress but stimuli consisting of the lavender 2%, the lavender 5% and the lemon 2% decreased stress because of a psychological rest. And the stimuli of the lavender 2%, the lavender 5%, the lemon 2% presented a healing effect in this research.
Journal of International Society for Simulation Surgery
/
v.3
no.1
/
pp.36-38
/
2016
Fibrous dysplasia is a relatively rare disease but the management would be quite challenging. Because this is not a malignant tumor, the preservation of the facial contour and the various functions seems to be important in treatment planning. Until now the facial bone reconstruction with autogenous bone would be the standard. Although the autogenous bone would be the ideal one for facial bone reconstruction, donor site morbidity would be the inevitable problem in many cases. Meanwhile, various types of allogenic and alloplastic materials have been also used. However, facial bone reconstruction with many alloplastic material have produced no less complications including infection, exposure, and delayed wound healing. Because the 3D printing technique evolved so fast that 3D printed titanium implant were possible recently. The aim of this trial is to try to restore the original maxillary anatomy as possible using the 3D printing model, based on the mirrored three dimensional CT images based on the computer simulation. Preoperative computed tomography (CT) data were processed for the patient and a rapid prototyping (RP) model was produced. At the same time, the uninjured side was mirrored and superimposed onto the traumatized side, to create a mirror-image of the RP model. And we molded Titanium mesh to reconstruct three-dimensional maxillary structure during the operation. This prefabricated Titanium-mesh implant was then inserted onto the defected maxilla and fixed. Three dimensional printing technique of titanium material based on the computer simulation turned out to be successful in this patient. Individualized approach for each patient could be an ideal way to restore the facial bone.
Full-thickness scalp burns secondary to hair coloring are rare; however, such defects can be large and complex reconstruction of hair-bearing tissue may be necessary. Many skin-stretching devices that use gradual traction have been applied to take advantage of the viscoelastic properties of the skin. A 21-year-old female patient was seen with a burn defect on her occipital scalp leading to exposed subcutaneous tissue after chemical application of hair coloring in a salon. The dimensions of the wound were $10cm{\times}5cm$, and a skin graft or flap would have been necessary to close the defect. Two long transfixing K-wires (1.4 mm) and paired 3-wire threads (23 gauge), which are readily available in most hospitals, were applied over a period of 12 days for trichophytic closure of the defect. The remaining scalp scars after primary trichophytic closure with this skin-stretching method were refined with hair follicle transplantation. This skin-stretching method is simple to apply and valuable for helping to close problematic areas of skin shortage that would otherwise require more complicated procedures. This case shows a relatively unknown complication of hair coloring and its treatment.
The authors treated a 58-year old female patient who had come to the Department of Oral Medicine, KNUH due to the chief complaints of gingival enlargement and bleeding on the upper and lower jaw. The lesions were diagnosed as cyclosporin-A induced gingival enlargement by patient's history and clinical examination. The patient was treated with gingivectomy using pulsed Nd:YAG laser. After gingivectomy the wound was compressed with 0.1% chlorhexidine-soaked gauze to prevent relapse of the lesion. Good healing process was observed and there were no recurrences until 3-month follow-up visit. From the results of this clinical trial it was suggested that a pulsed Nd:YAG laser gingivectomy would be helpful for the treatment of cyclosporin-A induced gingival enlargement in renal transplant patients.
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