PURPOSE: Microcirculation of diabetic patients is commonly comporomised, regardless of the condition of the macrocirculation. Therefore, direct tissue oxygenation measurement is recommended in determining tissue viability and predicting wound healing potential. This study was designed to determine cut-off value of the tissue oxygenation in predicting wound healing in diabetic foot patients. METHODS: This study included 41 feet of 41 diabetic foot patients who were treated in the Diabetic Wound Center of author's institution between January and June, 2009. Main inclusion criteria were type 1 or 2 diabetes and a foot ulcer (duration > 3 weeks) and ulcer area(from 1cm2 to 4cm2). Measurements of the area of diabetic foot ulcer were carried out before treatment. Transcutaneous oxygen pressure(TcpO2) was measured at adjacent site of ulcer. The healing wound was defined as complete wound closure within 12 weeks. RESULTS: Average diabetic foot ulcer areas with healing and nonhealing wounds were 2.67+/-0.76 and 2.59+/-0.75 cm2, respectively. There was no significant difference in the wound area between the groups. Average foot TcpO2 in healing and nonhealing wounds were 68.56+/-23.07 and 30.98+/-16.66mmHg, respectively(p<0.01). The rate of healing wound increased as TcpO2 increased. In particular, TcpO2 lower than 40mmHg and higher than 40mmHg showed the most significant difference(wound healing rates of 25% and 71%, respectively). CONCLUSION: Based on the results of the study, the minimal TcpO2 value thought to be required for adequate wound healing in diabetic wounds(cut-off value) is 40 mmHg.
Diabetic Foot ; Foot ; Foot Ulcer ; Humans ; Microcirculation ; Oxygen ; Tissue Survival ; Ulcer ; Wound Healing

PURPOSE: The shape and location, the amount of the wound and the characteristics of the remaining tissues are known to influence wound contraction. The previous studies using small animals have not been an appropriate model because the wound healing mechanisms and skin structures are different from those of the human. The purpose of this study is to evaluate wound contraction according to the shape and location of the wound using a Micropig(R). METHODS: Four Micropigs(R)(Medikinetics, Pyeongtaek, Korea) that were 10 months of age weighed 25kg were used. Full thickness skin defects were made by clearing all the tissues above the fascial layer in the shape of square, a regular triangle and a circle of 9cm2 each on the back around the spine. Eight wounds were created on the back of each pig, 50mm apart from each other. The randomly chosen wound shapes included 11 squares, 11 regular triangles, and 10 circles. Wound dressing was done every other day with polyurethane foam. The wound size was measured using a Visitrak Digital(R)(Smith & Nephew, Hull, UK) on every other day after surgery from day 2 to day 28. A biopsy was performed on day 3, and 1, 2, 3 and 4 weeks to investigate the degree of acute and chronic inflammation, the number of microvesssel and myofibroblast density using H & E stain and immunohistochemistry. The wound contraction rate was calculated to figure out the differences among each of the shapes and the locations. RESULTS: The ultimate shape of the circle wound was oval, and that of the regular triangle and square were stellate. The maximum contraction rate was obtained on 8 to 10 days for all the shapes, which corresponds with the immunohistochemical finding that myofibroblast increases in the earlier 2 weeks whereas it decreases in the later 2 weeks. Epithelialization was seen in the wound margin on day 7 and afterwards. The final wound contraction rates were highest for the regular triangle shapes; however, there were no statistically significant differences. The wound contraction rates by locations showed statistically significant differences. The wound in the cephalic area presented more contractions than that of the wounds in the caudal area. CONCLUSION: The location of a wound is more important factor than the wound shape in wound contraction.
Animals ; Bandages ; Biopsy ; Contracts ; Humans ; Immunohistochemistry ; Inflammation ; Myofibroblasts ; Polyurethanes ; Skin ; Spine ; Wound Healing

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 15x5mm 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+/-4.80% and 81.79+/-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.
Absorption ; Animals ; Collagen ; Dermis ; Fibroblast Growth Factor 2 ; Graft Survival ; Humans ; Inflammation ; Plastics ; Rats ; Transplants

PURPOSE: The use of tissue expander/implant in breast reconstruction using tissue expander-implant is one of the most common surgical procedures. The use of AlloDerm as a sling to reestablish the lower pole of the pectoralis major muscle results a decrease in morbidity compared with more invasive procedures. However the use of AlloDerm is more expensive than other options. We decided to compare AlloDerm with Permacol, which has been safely used in human body reconstruction and is less costly than AlloDerm. METHODS: After mastectomy, the inferolateral origin of the pectoralis major muscle was elevated. Either AlloDerm or Permacol was sutured to the chest wall at the level of the previously marked inframammary fold. The lower border of the pectoralis major muscle and the upper portion of the crescent-shaped piece of either AlloDerm or Permacol was sutured together using a tension free technique, and a tissue expander was subsequently inserted into the subpectoral-subAlloDerm (or Permacol) dual pocket. RESULTS: AlloDerm was used in twenty-one patients(28 breasts) and Permacol was used in six patients(11 breasts) for tissue expander-implant breast reconstruction. During the mean follow-up period of 17 months(8~25 months). Two infections(7%) occurred in AlloDerm cases and four infections(36%) occurred in Permacol cases. CONCLUSION: This study is the first comparison of tissue expander/implant breast reconstruction using AlloDerm and Permacol. The use of Permacol resulted in more postoperative infection compared with the use of AlloDerm. This report is still limited with the small number of cases studied.
Breast ; Cadaver ; Collagen ; Female ; Follow-Up Studies ; Human Body ; Mammaplasty ; Mastectomy ; Muscles ; Thoracic Wall ; Tissue Expansion ; Tissue Expansion Devices

PURPOSE: Ameloblastomas are rare benign tumors of odontogenic origin, and compose about 1% of all oral and maxillomandibular cysts and tumors. Because this neoplasm has a high rate of local recurrence, segmental mandibulectomy with a 1~2cm safety margin and immediate microsurgical reconstruction is an accepted treatment modality. The authors experienced four mandibular reconstruction cases that underwent secondary dental implantation. Here, the authors describe these cases and their long-term results. METHODS: Four patients with ameloblastoma of the mandible underwent segmental mandibulectomy and reconstruction with a free fibula osseous flap from January 1999 to May 2005, followed by secondary dental implantation. Recurrence, bony union, implant osseointegration, and functional and aesthetic results were evaluated by radiologic imaging, by physical examination, and by using photographs. RESULTS: All free flaps survived with no evidence of flap loss. To date, no recurrence has been noted clinically or radiologically. Imaging after mandibular reconstruction with a free fibular flap revealed satisfactory bony unions and mandibular contours. The patients achieved good aesthetic and functional results after the secondary implantation. CONCLUSION: Mandibular reconstruction using a fibular osseous flap and secondary dental implantation can produce good functional and aesthetic results after segmental mandibulectomy for ameloblastoma.
Ameloblastoma ; Dental Implantation ; Dental Implants ; Fibula ; Free Tissue Flaps ; Humans ; Mandible ; Mandibular Osteotomy ; Mandibular Reconstruction ; Osseointegration ; Physical Examination ; Reconstructive Surgical Procedures ; Recurrence ; Surgical Flaps

PURPOSE: Surgery for thyroid gland requires skin incisions that can result in postsurgical neck scar. To overcome this, many surgeons performed a endoscopic thyroidectomy. But, this approach had a some problems. One of postoperative problems, iatrogenic cervical dystonia(CD) may occur. At common, CD is defined as a syndrome characterized by prolonged muscle contraction causing twisting, repetitive movements or abnormal posture. Botulinum toxin A(BTA, Botox(R), Allergan, Irvine, CA, USA) is well known treatment agent in the treatment of CD. So, the authors applied BTA injection in rare case with iatrogenic CD resulting in endoscopic thyroidectomy. METHODS: A 43-year-old female had endoscopic subtotal thyroidectomy operation 3 years ago. She had symptoms such as progressive cervical pain, abnormal neck posture, depression, and sleep difficulty. About 1 year later, the patient who had previous myomectomy of the clavicular head of sternocleidomastoid muscle, however, symptoms were not improved. And then the patient received BTA therapy in our department. The 2 units per 0.1mL solution was administered in a 1mL tuberculin syringe. RESULTS: The dose of BTA used in the patient was 36 units for vertical platysmal bands, superficially, and 10 units for ipsilateral sternocleidomastoid muscle, intramuscularly. After 2 weeks, additional the dose of BTA used in the patient was 5 points for remained scar bands, superficially. Complications related to injection such as significant swallowing difficulties, neck muscle weakness, or sensory change were not observed. In 9 months follow-up, the patient maintained a good result from the method of BTA injection alone. CONCLUSION: The basic concept is selective denervation for the hyperactive individual muscles and scar bands. We conclude that BTA is an effective and safe treatment for CD despite the iatrogenic and complex presentation of this complication.
Adult ; Botulinum Toxins ; Cicatrix ; Deglutition ; Denervation ; Depression ; Female ; Follow-Up Studies ; Head ; Humans ; Muscle Contraction ; Muscles ; Neck ; Neck Muscles ; Neck Pain ; Posture ; Skin ; Thyroid Gland ; Thyroidectomy ; Torticollis ; Tuberculin

PURPOSE: Kabuki syndrome is a multiple malformation syndrome that was first reported in Japan. It is characterized by distinctive Kabuki-like facial features, skeletal anomalies, dermatoglyphic abnormalities, short stature, and mental retardation. We report two cases of Kabuki syndrome with the surgical intervention and speech evaluation. METHODS: Both patients had velopharyngeal insufficiency and had a superior based pharyngeal flap operation. The preoperative and postoperative speech evaluations were performed by a speech language pathologist. RESULTS: In case 1, hypernasality was reduced in spontaneous speech, and the nasalance scores in syllable repetitions were reduced to be within normal ranges. In case 2, hypernasality in spontaneous speech was reduced from severe level to moderate level and the nasalance scores in syllable repetitions were also reduced to be within normal ranges. CONCLUSION: The goal of this article is to raise awareness among plastic surgeons who may encounter such patients with unique facial features. This study shows that pharyngeal flap operation can successfully correct the velopharyngeal insufficiency in Kabuki syndrome and post operative speech therapy plays a role in reinforcing surgical result.
Abnormalities, Multiple ; Dermatoglyphics ; Face ; Hematologic Diseases ; Humans ; Intellectual Disability ; Japan ; Reference Values ; Speech Therapy ; Velopharyngeal Insufficiency ; Vestibular Diseases

PURPOSE: Hyoid bone is a U-shaped bone in the anterior of the neck. Hyoid bone fractures are exceedingly rare and represent only 0.002% of all fractures because of its protective position relative to the mandible and its suspension by elastic musculature. We report a patient who presented hyoid bone fracture associated with hypoglossal nerve palsy. We also discuss the possible complication and treatment. METHODS: A 69-year-old man was transferred from another institution because of persistent purulent discharge from the left chin. He had a history of trauma in which a knuckle crane grabbed his face and neck in the construction site. A CT scan at the time of the accident demonstrated a comminuted fracture of the right side of the mandible and hyoid bone fracture at the junction between body and right greater cornua. The displaced fracture of hyoid bone and fullness in the pre-epiglottic space were noted, probably indicating some edema. The patient was transferred into ICU after treatment of emergency tracheostomy because the patient showed respiratory distress rapidly. When the patient was hospitalized in our emergency room, he complained of dysphagia and pain when swallowing. On examination of oral cavity, the presence of muscle wasting with fasciculation of the tongue was noted and the tongue deviates to the left side on protruding from the mouth. Pharyngolarygoscopy was performed to make sure that there was no evidence of progressive swelling and pharyngeal laceration. RESULTS: The patient underwent surgical removal of dead and infected tissue from the wound and reconstruction of mandibular bony defect by iliac bone grafting. Hyoid bone fracture was managed conservatively with oral analgesics, soft diet and restricted movement. Hypoglossal nerve palsy was resolved within 7 weeks after trauma without complications. CONCLUSION: Closed hyoid bone fracture is usually uncomplicated and thus it can be treated conservatively. Surgical intervention for hyoid bone fracture is recommended for patient with airway compromise, pharyngeal perforation and painful symptoms which show no response to conservative care. Furthermore, since respiratory distress syndrome may develop quickly, close observation is required. Besides, hypoglossal nerve palsy is a rarely recognized complication of hyoid bone fracture.
Aged ; Analgesics ; Bone Transplantation ; Chin ; Deglutition ; Deglutition Disorders ; Diet ; Edema ; Emergencies ; Fasciculation ; Fractures, Comminuted ; Humans ; Hyoid Bone ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Mandible ; Mouth ; Muscles ; Neck ; Tongue ; Tracheostomy

PURPOSE: Heterotopic calcification is the abnormal deposition of calcium salts in tissues other than bone and enamel, and it occurs in the form of dystrophic calcification or metastatic calcification. This deposition can occur under many conditions, but in some rare cases, it may develop in burns and nonhealed scars. It is difficult to treat the combination of heterotopic calcification and ulceration in scar tissues by using conservative therapy and to determine the margin of excision in such cases. Our study proposes the use of intraoperative C-arm-guided mapping of lesions with heterotopic calcification, and adequate excision of ulcers in chronic scars where heterotopic calcification is also observed. METHODS: This study included 2 patients and was conducted from January 2010 to July 2010. The first patient was a 63-year-old woman who presented with atypical calcium deposits and chronic ulceration in the lower one-third region of the right leg. The second patient was a 38-year-old man who presented with a nonhealing ulcer that had developed on the right leg 3 months earlier he had a history of 40% scalding burns on the entire body. Surgery is the most reliable method for treating heterotopic calcification therefore, both patients were treated using intraoperative C-arm-guided marginal mapping of heterotopic calcification, followed by release of contracture, and eventually split-thickness skin grafting. RESULTS: Plain radiographs of the leg showed spotty radiopaque areas in the hard part of the scar well superficial to the underlying bones. Histopathological analysis revealed multiple foci of calcified deposits, increased fibrosis, and inflammation in the scar tissue. Surgery-related complications were not observed. CONCLUSION: C-arm guided excision of calcified scars and the release of contracture can cure nonhealing ulcers and may therefore prevent recalcification.
Adult ; Burns ; Calcium ; Cicatrix ; Contracture ; Dental Enamel ; Female ; Fibrosis ; Humans ; Inflammation ; Leg ; Middle Aged ; Ossification, Heterotopic ; Salts ; Skin ; Ulcer

PURPOSE: Mucinous eccrine carcinoma of the skin is rare skin adnexal malignant tumor, which most commonly occurs in the head and neck regions. This tumor, although rarely metastatic, has a high incidence of local recurrence. We report a case of mucinous eccrine carcinoma developed on the Lt. cheek which was treated by Mohs surgery. METHODS: The patient was a 53-year-old man who showed a palpable skin-colored 1.5 x 1.5cm sized mass on Lt. cheek. We treated it by wide excision, but it recurred several times on the same region. So we finally did the Mohs surgery and full thickness skin graft. RESULTS: The histologic characteristics are large mucinous pools with fibrous septae and clusters of tumor cells. Special stains showed that the mucin was positive reactivity on Periodic acid Schiff. Also the immunocytochemical studies showed a positive reactivity to carcinoembryonic antigen, S-100 protein, cytokeratin-7. Therefore pathologist reported it as a mucinous eccrine carcinoma. CONCLUSION: Authors experienced a rare case of primary mucinous eccrine carcinoma on Lt. cheek which had recurred several times. Because of the high local recurrence rate, we did the Mohs surgery and got an good result. Therefore the early Mohs surgery would be a good choice to primary mucinous eccrine carcinoma.
Carcinoembryonic Antigen ; Cheek ; Coloring Agents ; Head ; Humans ; Incidence ; Keratin-7 ; Middle Aged ; Mohs Surgery ; Mucins ; Neck ; Periodic Acid ; Recurrence ; S100 Proteins ; Skin