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: A Tessier classification number 7 cleft is an uncommon malformation that results from a failure of mesenchymal fusion within the maxillary and mandibular prominences of the 1st pharyngeal arch. Many operative techniques of the number 7 cleft repair have been proposed to restore function and improve aesthetics. Fifteen patients underwent repair of a number 7 cleft over 13 years by a modification of the surgical Technique, and an appraisal of the operative outcome is reported herein. METHODS: A retrospective review was conducted involving 15 patients with number 7 clefts who underwent surgery from 1996 to 2009. The changes in surgical technique included skin closure, attachment of the orbicularis oris muscle, and position of the repaired commissure; the changes were analysed with a review of the medical records and the outcomes of surgery were analysed via photographs. Specifically, the technique of skin closure was changed from the a Z-plasty to a linear closure, the orbicularis oris muscle overlapped attachment was replaced by a side-to-side approximation with horizontal mattress sutures, and the position of the repaired commissure was changed from 1mm laterally to 1mm medially in reference to the non-cleft side. RESULTS: A Z-plasty caused additional cutaneous scarring, an overlapped attachment of the orbicularis oris muscle caused a thick oral commissure, and the repaired commissure migrated to the lateral side, so a 1mm, laterally-positioned commissure caused asymmetry. The altered procedure included a linear skin closure, a side-to-side orbicularis oris muscle approximation, and a 1mm, medially-positioned commissure, which together resulted in a good outcome. CONCLUSION: The altered procedure for repair of a number 7 cleft as described herein, yields a short scar, no functional problems with the orbicularis oris muscle, a thin oral commissure, and symmetry of the repaired commissure.
Branchial Region ; Cicatrix ; Esthetics ; Humans ; Macrostomia ; Medical Records ; Muscles ; Retrospective Studies ; Skin ; Sutures

PURPOSE: Deficiencies of the abdominal wall can be the a result of infection, surgery, trauma, or primary herniation. For abdominal wall reconstruction, synthetic materials have been shown to provide a better long-term success rate than primary fascial repair. But, synthetic materials cannot elicit angiogenesis or produce growth factor and are therefore plagued by an inability to clear infection. As a result of the inherent drawbacks of synthetic, significant effort has been spent on the identification of new bioprosthetic materials. The aim of our study is to evaluate the effectiveness of a synthetic material(PROCEED(R)) and an ADM(SureDerm(TM)) to repair abdominal wall defects in a rabbit models. METHODS: We measured the tensile strength of the SureDerm(TM) and PROCEED(R) by a Tension meter(Instron 4482). 16 Rabbit models were assigned to this study for abdominal wall reconstruction. Abdominal defect of 8 rabbits were reconstructed by PROCEED(R) and the rest were reconstructed by SureDerm(TM). We assessed gross and histologic examinations for the reconstructed abdominal wall. RESULTS: The tensile strenth of SureDerm(TM) and Gore Tex(R) is 14.64+/-0.51 Mpa, 8.54+/-0.45 Mpa. PROCEED(R) was estimated above the limits of measurement. Inflammatory reaction of PROCEED(R) persisted for 32weeks, but SureDerm(TM) decreased after 16weeks. Vascular ingrowth into the SureDerm(TM) was seen after 32 weeks. The basement membrane of SureDerm(TM) changed into a form of pseudoperitoneum. In PROCEED(R), it seemed like pseudoepithelial lining was made from the fibrosis around the mesh. CONCLUSION: In our study, the SureDerm(TM) not only have less inflammatory reaction and presented more angiogenesis than the PROCEED(R), but also have pseudoperitoneum formation. It is expected that SureDerm(TM) is useful for abdominal wall reconstruction. However, a long-term study of its usage consequences are thought to be needed.
Abdominal Wall ; Acellular Dermis ; Basement Membrane ; Fibrosis ; Rabbits ; Tensile Strength

PURPOSE: Stem cells continue to receive research attention in the clinical fields, and adipose-derived stem cells(ADSCs) have been shown to be a good source raw material. Many plastic surgeons are researching the ADSC adipogenesis with a view of conducting clinical trials, and many attempts have been made to identify the factors that promote the adipogenesis of ADSCs, but comparatively few correlation studies have been undertaken to explore the relation between reactive oxygen species(ROS) and the ADSC adipogenesis. We undertook this study is to investigate the effects of ROS on ADSC adipogenesis. METHODS: ADSCs were isolated and cultured from abdominal adipose tissue, and cultured in different media; 1) DMEM(control), 2) adipogenesis induction culture medium, 3) adipogenesis induction culture medium with ROS(20 microM/50 microM H2O2), 4) adipogenesis induction culture medium containing ROS(20 microM/50 microM H2O2) and antioxidant(10 microM/20 microM Deferoxamine). We compared adipogenesis in these different media by taking absorbance measurements after Oil-Red O staining every 5 days. RESULTS: After culturing for 20 days, significant differences were observed between these various culture groups. Absorbance results showed significantly more adipogenesis had occurred in media containing adipogenesis induction culture medium and H2O2(in a H2O2 dose-dependently manner) than in media containing adipogenesis induction culture medium and no H2O2(p<0.001). Furthermore, in media containing adipogenesis induction culture medium, H2O2, and antioxidant, absorbance results were significantly lower than in adipogenesis induction culture medium and H2O2(p<0.001). CONCLUSION: These findings suggest that ROS promote the adipogenesis of ADSCs. We suggests that ROS could be used in the adipose tissue engineering to improve fat cell differentiation and implantable fat tissue organization.
Abdominal Fat ; Adipocytes ; Adipogenesis ; Adipose Tissue ; Oxygen ; Reactive Oxygen Species ; Statistics as Topic ; Stem Cells

PURPOSE: Necrotizing fasciitis is a life-threatening, destructive soft tissue infection with a very high rate of mortality that needs early diagnosis and aggressive treatment. Systemic Lupus Erythematosus(SLE) is a systemic, autoimmune disease and it's major cause of mortality is an infection. But necrotizing fasciitis in SLE is very rare and there have been only 22 cases reported in the literatures. We reported a patient of necrotizing fasciitis with SLE and reviewed 22 others from literature research. METHODS: A 40-year-old female patient with a history of SLE for 6 years came to the emergency room. The patient complained of severe pain and swelling on her right leg. She was diagnosed as necrotizing fasciitis and underwent emergency fasciotomy. As wound cultures showed variable organisms, she was treated with broad-spectrum antibiotics and underwent several surgical debridements. Then, the wound was treated with the V.A.C(Vacuum Assisted Closure) device and split thickness skin grafting was performed two times. RESULTS: Skin graft was well taken within 2 weeks after operations and the patient was discharged to outpatient follow up. There was no complication related with surgery and she could walk without cane after 3 months. CONCLUSION: We treated a necrotizing fasciitis in a patient with SLE and reviewed 22 others from literature research. The case presented here suggests that necrotizing fasciitis is a rare disease in SLE patients, but should be considered in the differential diagnosis of soft tissue infection in SLE patients. A high index of suspicion is needed for early diagnosis and proper management in these patients.
Adult ; Anti-Bacterial Agents ; Autoimmune Diseases ; Canes ; Debridement ; Diagnosis, Differential ; Early Diagnosis ; Emergencies ; Fasciitis, Necrotizing ; Female ; Follow-Up Studies ; Humans ; Leg ; Lupus Erythematosus, Systemic ; Outpatients ; Porphyrins ; Rare Diseases ; Skin ; Skin Transplantation ; Soft Tissue Infections ; Transplants

PURPOSE: The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. In order to satisfy that goal, variable reduction mammaplasty methods are performed, however, two methods such as vertical reduction method and inverted T-scar method are currently most used. We compared indications and advantages of the two methods and set up useful guidlines. METHODS: For 15 years from 1995 to 2010, we experienced 84 patients(162 breasts). We performed vertical reduction method as Lejour's superior pedicle technique(45 patients) and inverted T-scar method as Goldwyn's inferior dermal flap technique(39 patients). We evaluated the result of the operation comparing patient's age, amount of resected tissue, complications and post-operative scars of the two methods. RESULTS: The mean age was 36 years and the vertical reduction group was 3 years younger than inverted T-scar group. The mean breast tissue resection amount per one breast, inverted T-scar group(712 gm) was lagger than vertical reduction group(395 gm). CONCLUSION: There is no ideal method for reduction mammaplasty until now. However, we suggest that guide line, the vertical reduction method is effective for minimal and moderate macromastia in young and middle aged women and inverted T-scar method is appropriate for severe macromastia with ptosis in elderly women. Recently, all procedures tried shorter and smaller scar on the vertical line as small I, J or L shape scar, and inframammary fold as short inverted T-scar.
Aged ; Breast ; Cicatrix ; Female ; Humans ; Hypertrophy ; Mammaplasty ; Middle Aged

PURPOSE: It is generally believed that alopecia is caused by various factors such as scars, stress, genetical factors, androgens, etc. Androgenic alopecia is one of the most common cause of alopecia and found mainly in males. Propecia(Merck & Co., USA) and Minoxidil(McNEIL-PPC, Inc, USA) were the drugs approved from FDA for treatment of androgenic alopecia. Surgical treatments such as flap, tissue expansion, scalp reduction and hair transplantation can be considered if necessary. Hair micrograft techniques were developed for natural hair shapes and minimal adverse effect. There were attempts to measure the length of the forehead of the Korean young adults. However attempts to classify the shape and location of forehead hairline were rare. This study attempted to find out standard hairlines of young adults in their 20s & 30s and the result would be the guideline of the hairline in hair replacement surgery of male patients in their 40s & 50s. METHODS: 200 male adults in 20s and 30s were photographed and measured the length of 11 vertical index lines to determine hairline. The indexes are the distances from hairline to intercanthal midpoint(A), to medial canthus (B), to upper eyelid fissure(C), to lower eyelid fissure(D), to lateral canthus(E) and distance from lateral highest point to medial lowest point, if the hairline is M-shape(F). Additionally, we classified the hairlines into 4 groups, M, horizontal, inverted U and irregular shapes. RESULTS: The most common hairline of male adults in their 20s is inverted U-shape(53.3%), followed by horizontal-shape, M-shape, irregular-shape. In their 30s, inverted U-shape(59%) is followed by irregular-shape, M-shape, horizontal-shape. The M-shape is more frequently found in males in 30s than those in 20s. The mean values of the indexes in their 20s are as follows: A(76.14mm), B(Rt: 75.78mm, Lt:76.41mm), C(Rt: 69.43mm, Lt: 69.92mm), D(Rt: 76.92mm, Lt:77.46mm), E(Rt: 64.16mm, Lt: 64.73 mm), F(4.09mm). Those in their 30s are as follows: A(76.13mm), B(Rt: 76.114mm, Lt: 76.02mm), C(Rt: 69.87 mm, Lt: 70.37mm), D(Rt: 77.37 mm, Lt: 77.58mm), E(Rt: 69.63mm, Lt: 69.85mm), F(6.14 mm). CONCLUSION: The knowledge about human body measurement is indispensable to plastic surgeons. In this study, inverted U shape is the most common type of hairline in 30s, and similar distribution is found in 20s. The percentage of M shape in their 30s is elevated more than 10% compared to that in their 20s. The study of hairline shapes and 11 indexes of hairlines can be useful for planning of the hair transplantation and postoperative evaluation. This study being based on photogrammetry, there may be differences between actual distance of curved face and projected distance on flat photographs.
Adult ; Alopecia ; Androgens ; Cicatrix ; Eyelids ; Forehead ; Hair ; Human Body ; Humans ; Male ; Photogrammetry ; Scalp ; Tissue Expansion ; Transplants ; Young Adult