Acellular Dermis ; Female ; Humans ; Mammaplasty ; methods ; Nipples ; surgery

OBJECTIVE: This study aimed to investigate the application of acellular dermal matrix and acellular bone matrix in the management of oro-antral fistula. METHODS: Nine patients with oro-antral fistula (with defect greater than 5 mm×5 mm) after maxillary cyst resection or maxillary molar extraction were selected. The defects were repaired by the simultaneous implantation of acellular dermal matrix and acellular bone matrix. RESULTS: The incisions of nine patients were all primary healing. After 6 months of follow-up, the oro-antral communication healed well, and no symptom such as nasal congestion or runny nose was observed. The clinical and CT examinations confirmed wound healing. CONCLUSIONS The usage of acellular dermal matrix and acellular bone matrix is a reliable repairing method for ora-antral fistula.
Acellular Dermis ; Bone Matrix ; Fistula ; surgery ; Humans ; Wound Healing

OBJECTIVETo explore the influence of the thickness of retained denatured dermis on the survival rate of grafted skin in swine with deep partial-thickness burn.

METHODSFour deep partial-thickness wounds were reproduced respectively on both sides of spine in 7 Chinese domestic pigs. The wounds of 6 pigs were divided into 0.25, 0.50, 0.75, and 1.00 mm groups with 12 wounds in each group according to the random number table. Tangential excision and auto-skin grafting were performed. Before the tangential excision, 1 tissue specimen was harvested from the center of each remaining wound for the estimation of the depth of burn, and histological observation was done. After the tangential excision, 1 tissue specimen was harvested from the area near the center of each wound for the measurement of the depth of retained denatured dermis with histological examination. The 8 wounds of one pig were set as the control group, and the operation was done, and then they were treated with exposure treatment after biopsy specimens were taken with above-mentioned method. The general condition of wounds in 5 groups was observed from immediately after injury to post injury month (PIM) 3. On post injury day (PID) 7, the survival rate of grafted skin was observed in 0.25, 0.50, 0.75, and 1.00 mm groups. Wound healing time was recorded. At PIM 3, the specimens were harvested from the wounds of 5 groups, and their ultra microstructures were observed by transmission electron microscope. Data were processed with rank-sum test, one-way analysis of variance, and LSD test.

RESULTSThe depth of the burn tissue was (1.120 ± 0.211) mm. The depths of retained denatured dermis in 0.25, 0.50, 0.75, and 1.00 mm groups were respectively (0.830 ± 0.031), (0.701 ± 0.010), (0.382 ± 0.031), and (0.141 ± 0.040) mm. At PID 8, all grafted skin in 0.25 and 0.50 mm groups became necrotic; most grafted skin in 0.75 mm group was necrotic; most grafted skin in 1.00 mm group survived with only a few became necrotic and separated from the wounds. The scabs were gradually separated from the wounds of control group. On PID 15, the grafted skin which did not survive in 0.25, 0.50, and 0.75 mm groups was gradually separated from the wounds with exudate forming scab on the surface in varying degrees, while the wounds in 1.00 mm group were all healed, and the incidence of scabs formation was highest in control group. At PIM 3, scar contraction was found in 0.25, 0.50, 0.75 mm groups and control group, while no obvious scar was observed in 1.00 mm group. There were statistically significant differences in the survival rate of grafted skin in 0.25, 0.50, 0.75, and 1.00 mm groups (χ(2) = 19.421, P < 0.001). The survival rate was the highest in 1.00 mm group [70% (60%, 80%)], while the survival rate was 20% (0, 30%) in 0.75 mm group, and it was in both 0.25 and 0.50 mm groups with non-survival of all the grafted skin. There were statistically significant differences in the wound healing time among 5 groups (F = 41.450, P < 0.001). The wound healing time in 0.25 and 0.50 mm groups were respectively (18.2 ± 1.5), and (18.7 ± 2.3) d, not statistically significant different from that of control group [(18.4 ± 1.7) d, P values both above 0.05]. The wound healing time in 0.75 mm group [(14.9 ± 2.6) d] was significantly different from those of 0.25, 0.50 mm groups and control group (P values all below 0.01). The wound healing time in 1.00 mm group [(9.5 ± 1.2) d] was significantly shorter compared with that of the other 4 groups (P values all below 0.01). Before tangential excision, the zone of infiltration of the inflammatory cells was observed in the deep dermis of wounds in 5 groups. After tangential excision and before auto-skin grafting, the depth from the fault surface to the zone of infiltration of the inflammatory cells varied in 0.25, 0.50, 0.75, and 1.00 mm groups while more inflammatory cells were observed in control group. At PIM 3, many fibroblasts were observed in the dermis of wounds in 1.00 mm group with abundant rough endoplasmic reticulum and basically intact organelles.

CONCLUSIONSPerforming autologous skin grafting on deep partial-thickness burn, in which the depth of retained denatured dermis was 0.10 mm, may help regenerate dermal function and alleviate scar formation.

Animals ; Burns ; surgery ; Dermis ; surgery ; transplantation ; Graft Survival ; Male ; Skin Transplantation ; methods ; Swine ; Wound Healing

Biological Dressings ; Dermis ; cytology ; transplantation ; Extracellular Matrix ; transplantation ; Gingival Recession ; surgery ; Humans ; Mouth Diseases ; surgery

The augmentation of soft tissue defects is one of the critical problems in the oral and maxillofacial surgery. Various types of graft materials, both autologous and non-autologous, have been used for the augmentation of soft tissue in the facial region. However, it is not easy to choose an ideal material for soft tissue augmentation because each has its advantages and disadvantages. An ideal graft material should meet the following criteria : it should not leave a scar at the area from which it was taken; should have less likelihood of causing infection; should feel natural after implanted; and should be not absorbed. Among the materials meeting these criteria, human dermis and artificial dermis are commonly used for clinical purposes. The present study was aimed to investigate and compare the resorption rate and the histological change following the use of the autologous dermis, the human homogenous dermis Alloderm(R), and the artificial dermis Terudermis(R) to reconstruct the soft tissue defect. Twenty mature rabbits of either sex, weighing about 2 kg, were used. Each rabbit was transplanted with the autologous dermis, Alloderm(R), and Terudermis(R) size 1 x 1-cm at the space between the external abdominal oblique muscle and the external abdominal oblique fascia. They were then divided into 4 groups (n=5 each) according to the time elapsed after the surgery: 1, 2, 4, and 8 weeks. The resorption rate was calculated by measuring the volume change before and after the transplantation, and H-E stain was preformed to observe the histological changes. The resorption rate after 8 weeks was 21.5% for the autologous dermis, 16.0% Alloderm(R), and 36.4% Terudermis(R), suggesting that Alloderm(R) is the most stable while Terudermis(R) is the most unstable. In microscopic examinations, the autologous dermis graft was surrounded by inflammatory cells and showed foreign body reactions. The epidermal inclusion cyst was observed in the autologous dermis graft. Terudermis(R) and Alloderm(R) demonstrated neovascularization and the progressive growth of new fibroblast. The results suggest that Terudermis(R) and Alloderm(R) can be availably for substituting the autologous dermis.
Cicatrix ; Dermis* ; Fascia ; Fibroblasts ; Foreign Bodies ; Humans ; Rabbits* ; Surgery, Oral ; Transplants*

Hydroxyapatite which has been used as bone substitute in orthopedic and maxillofacial surgery is used as ocular implant recently. It has been shown to be completly biocompatable, nontoxic and nonallegic so less extrusion and migration develop. We performed 37 cases of hydroxyapatite implantation: 20 cases(51.4%) after evisceration, 8 cases(21.6%) after enucleation and 9 cases(24.3%) secondarily for the better prosthetic motility. Wound dehiscence developed in 6 cases(16.2%): 2 cases(10.0%) after evisceration, 2 cases(25.0%) after enucleation and 2 cases(22.2%) after secondary hydroxyapatitie implanation. Wound dehiscence was managed with dermis graft in 1 case and healed spontaneously in 1 case. Another 4 cases are under observation to expect the wound dehiscence to heal spontaneously. But no extrusion, migration and infection of implant were noted. We thought that wound dehiscence after hydroxyapatite implantation was related to conjunctival damage and atrophy by coarse surface of hydroxyapatite implant. Wound dehiscence can develop after hydroxyapatite implantation but careful patient selection and reducing tissue damage during surgery may alleviate the problems of wound dehiscence.
Atrophy ; Bone Substitutes ; Dermis ; Durapatite* ; Orthopedics ; Patient Selection ; Surgery, Oral ; Transplants ; Wounds and Injuries

Mucoepidermoid carcinoma on the lip is a very rare disease, consisting of epidermoid and mucus-producing cells histologically. A 47 year old female had had an asymptomatic, palpable, bean-sized nodule on the center of her upper lip for 2 years. Histological findings showed multiple oval nests consisting of epidermoid & clear cells and cystic spaces filled with faintly eosinophilic amorphous material in a fibrotic background throughout the dermis, subcutis, and muscular layer After a diagnosis of mucoepidermoid carcinoma, Mohs micrographic surgery was performed for complete removal, and A - T flap with M plasty was designed for appropriate repair.
Carcinoma, Mucoepidermoid* ; Dermis ; Diagnosis ; Eosinophils ; Female ; Humans ; Lip* ; Middle Aged ; Mohs Surgery* ; Rare Diseases

Modified Mohs surgery is a procedure which eliminated chemical fixation step from Mohs chemosurgery. This technique is faster, less painful and more tissue conserving, allows for immediste repairs, yields higher quality histologic preparations and facilitates an interdisciplinary apporoach; it is the treatment of choice for recurrent or difficult skin cancers. A 58-year-old femele patient presented with a 2x 3cm sized dark brownish, ulcerated nodule on the left upper eyelid. Histopathologic findings revealed several small solid nest composed of basalioma cells in the dermis. We treated with modified Mohs surgery and obtained good result.
Carcinoma, Basal Cell* ; Dermis ; Eyelids ; Humans ; Middle Aged ; Mohs Surgery* ; Skin Neoplasms ; Ulcer

Soft tissue expansion technique has been a very useful method for the reconstruction of scalp defects and alopecia since the scalp is an unyielding tissue allowing minimal distension in traditional local flap surgery. As a result, there has been wide use of the tissue expansion method in the reconstruction of scalp defect and treatment of alopecia in the plastic surgery. There have been many concerns about histomorphologic changes of the overlying skin and the underlying structure resulting from tissue expansion. We also know that progressive tissue expansion induces increased mitotic activity of the epidermis and thining of the dermis in the overlying skin, as well as significant gross, histologic bony erosion in the underlying structure. However, little informations have been reported about the changes of the hair and pilocebaceus units in scalp expansion. We compared the horizontal sections of the expanded scalp and its longterm histologic changes with a normal unexpanded scalp specimen as a control. The terminal hair proportions to the vellus hair both increased. There was a 32% decrease in follicular units, a 24% decrease in terminal hair, and a 23% decrease in total hairs 8 week after scalp expansion compared to the normal unexpanded scalp. The perifollicular inflammatory changes and fibrosis observed in the full expanded scalp specimen disappeared within 12 weeks after removal of the expander and the flap transposition. In our observation, tissue expansion at the hair-bearing scalp did not precipitate any adverse changes on the hair follicles. On the contrary, we observed that secondary scalp expasion could be safetly performed 3 months after the first scalp expansion.
Alopecia ; Dermis ; Epidermis ; Fibrosis ; Hair Follicle* ; Hair* ; Humans* ; Scalp* ; Skin ; Surgery, Plastic ; Tissue Expansion*

The widely prevailing Millard's rotation-advancement flap method is characterizes with the upper lip scar on a philtral column and that it is less conspicuous than LeMesurier's or Tennison's metheds. Nowadays, straight line closure methods are employed together with the Millard's. However there are still some problems which are a straight line closure that goes against the principle of plastic surgery, a noticeable scar, tenting of the peak of Cupid's bow, a short lip tendency, and depression of the lip when the muscle contracts. In this respect, we designed two or three small trapezoid skin flaps on the cleft side and the same number of releasing incision lines on the non-cleft side and then let them interdigitate one another. We called it dovetail cheiloplasty. The muscle work was done by suturing one third of the cleft side muscle to the dissected dermis of the non-cleft side skin flap just under the philtral dimple. Our patients had a primary incomplete, a microform type cleft lip or a secondary cleft lip deformity. The result of employing this method showed an inconspicuous scar, a shorter lip, and a natural formation of the philtrum. We believe this method induces the improvement of straight line closure with respect to the quality of scars and the morphology of an upper lip.
Cicatrix ; Cleft Lip ; Congenital Abnormalities ; Depression ; Dermis ; Humans ; Linear Energy Transfer ; Lip ; Microfilming ; Skin ; Surgery, Plastic