There are many complications related to paralyzed patients. Heterotopic ossification in pressure sore patients is reported to be rarely developed, but once it occurs, it frequently causes joint stiffness which may aggrevate the pressure sore wound. This paper was based on a clinical study of heterotrophic ossification in 6 quadriplegic and paraplegic patients from 1988 to 1997 at St. Paul's Hospital. All were males aged between 22 and 58 years (mean age, 45.5 years). The sites of pressure sore were in the ischial and trochanteric areas. Heterotopic ossification had developed around the hip joint and the ischial area. The mean onset time was 3.6 years (minimum 10 months maximum 8 years) after trauma. Plain X-ray, bone scan CT and pathological examination were helpful in confirming the diagnosis of heterotopic ossification. The mechanism of heterotopic ossification is not exactly known, but chronic trauma or inflammation could be one etiology. There are still many difficulties in management of heterotopic ossification, but prevention is the most important treatment.
Diagnosis ; Femur ; Hip Joint ; Humans ; Inflammation ; Joints ; Male ; Ossification, Heterotopic* ; Pressure Ulcer* ; Wounds and Injuries

In this study of a developed soft tissue filler, adipose tissue equivalents were constructed using adipose stem cells (ASCs) and micronized acellular dermal matrix (Alloderm). After labeling cultured human ASCs with fluorescent green protein and attaching them to micronized Alloderm (5X10(5) cells/1 mg), ASC-Alloderm complexes were cultured in adipogenic differentiation media for 14 days and then injected into the dorsal cranial region of nude male mice. The viabilities of ASCs in micronized Alloderm were determined at 1, 4, 7, and 14 days, and complexes, which had been cultured for 14 days and implanted in vivo for 2 months, were histologically evaluated by light, confocal, and scanning electron microscopy. The viabilities represented that ASCs in micronized Alloderm were alive during the culture period. ASC-Alloderm complexes cultured for 14 days contained round cells with large lipid vesicles by light microscopy and many spherical cells by SEM. ASCs in implanted ASCAlloderm complexes harvested from mice at 2 months postinjection were histologically found to have differentiated into adipocytes which had green fluorescence dye. Micronized Alloderm may be found useful as scaffold for human ASCs when constructing fat tissue for three-dimensional soft tissue filling. The present study suggests that ASC-Alloderm complexes can be used as injectable three-dimensional soft tissue fillers.
Adipocytes/*cytology ; Adipogenesis ; Adipose Tissue/cytology ; Animals ; Cell Differentiation ; Cells, Cultured ; Collagen/*chemistry ; Fluorescent Dyes/chemistry ; Injections, Subcutaneous ; Male ; Mice ; Mice, Nude ; Microscopy, Electron, Scanning ; Stem Cell Transplantation/*methods ; Stem Cells/cytology/pathology ; Time Factors ; Tissue Engineering/*methods ; Transplantation, Heterologous

No abstract available.
Breast Neoplasms* ; Breast* ; Humans ; Necrosis*

PURPOSE: Among reasons for reoperations in augmentation mammoplasty, palpable implant, due to thin skin is relatively common, but not easy to correct, especially if thin skin area is wide. The capsule around the implant is a physiologic response to foreign body, naturally formed, and suitable for use as a flap because of its high vascularity. Authors report that capsular flap is very effective and successful method for correction of implant palpability in secondary breast augmentation. METHODS: From September 2007 to September 2008, the capular flaps were performed on 5 patients having palpable and wrinkling breast implants due to very thin skin among the cases on whom secondary augmentation mammaplasty had been performed. After the capsular flap was elevated according to thin skin area, the capsular flap was turned down or over to cover the thin skin area and made the thin skin area thick. RESULTS: Post-implant palpable breast wrinkling had been successfully corrected by capsular flaps and breast implants were not palpable any more during the follow-up period (average 9.2 months). All patients who suffered from deformed breast were satisfied. CONCLUSION: Authors suggest that the capsular flap be a ideal, effective and useful method in management of implant palpability.
Breast ; Breast Implants ; Female ; Follow-Up Studies ; Foreign Bodies ; Humans ; Mammaplasty ; Skin

Pressure sores are common complications in patients with spinal injuries or cerebrovascular accidents. The management of pressure sores requires prolonged hospitalization and repeated surgical interventions with a high recurrence rate. Particularly osteomyelitis following initial pressure sores persistently complicates wound healing and recovery. Furthermore, it may also ultimately result in serious sepsis; thus an early diagnosis of osteomyelitis in pressure sore patients is crucial along with appropriate surgical and antibiotic therapy. Although many diagnostic methods were reported, there is no single 'gold' standard for early diagnosis of pressure sore-associated osteomyelitis. Authors reviewed pre-operative CBC, plain X-ray, Tc-99m bone scan, and post-operative biopsy results in 37 patients who had received surgical treatment for pressure sores in a 5-year period from September 1991 to August 1996. Based on these reviews, authors compared and analyzed the sensitivity and specificity in diagnosing osteomyelitis.The results were as follows: 1. Of 37 patients studied, 25 cases were confirmed histologically as osteomyelitis. Ischial region revealed the highest incidence of pressure sore-related osteomyelitis(78%, 14 out of 18 cases) while the regional incidence was as following in descending order : ischial, sacral, and greater trochanteric area. 2. Tc-99m bone scan had superior sensitivity(100%) and specificity(83%) to other pre-operative studies in diagnosing osteomyelitis.In conclusion, authors suggest that Tc-99m bone scan is the best diagnostic method because of its high sensitivity and specificity if osteomyelitis is clinically suspected in pressure sore patients. And in case the test result is positive, agressive surgical bone resection and appropriate antibiotic therapy based on bacterial culture from deep bone specimen should be combined to prevent complications or recurrences.
Biopsy ; Early Diagnosis ; Femur ; Hospitalization ; Humans ; Incidence ; Osteomyelitis ; Pressure Ulcer* ; Recurrence ; Sensitivity and Specificity ; Sepsis ; Spinal Injuries ; Stroke ; Wound Healing

No abstract available.
Myxoma*

PURPOSE: In tissue engineering, it is important that the scaffolds have high affinity with cells for making efficient use of cells. The authors studied the binding affinity of human adipose stem cells(ASCs) to micronized acellular dermal matrix(alloderm) using biotin and avidin linkages. METHODS: Human ASCs were harvested from adipose tissue obtained by abdominoplasty. ASCs(1x10(4), 5x10(4), 1x10(5), 5x10(5), 1x10(6), 5x10(6) cells) were attached to micronized alloderm(1mg) in three groups; 1) control group in which no ASCs and alloderm was treated; 2) serum group in which alloderm was exposed to fetal bovine serum; and 3) biotin group in which biotinylated cells were attached to biotinylated alloderm. The binding affinities were determined 1 day after making ASC-alloderm complexes. The proliferation rates were determined by XTT assays in 4, 7, 14, and 21 days and scanning electron microscopic examination was performed in 7 and 21 days after culture of ASC-alloderm complexes. RESULTS: The binding affinities of the biotin group were significantly increased in all cell concentrations. Maximum binding affinity was observed at 5x10(4)/mg of micronized dermal matrix in biotin group. The viabilities were lowest in biotin group in contrast to binding affinity, but the difference was not significant. SEM showed well attachment of cells to micronized dermal matrix in all groups. CONCLUSION: The use of avidin/biotin facilitated human ASCs attaching to micronized acellular dermal matrix. This attachment would not disturb adipose stem cells viabilities. The present study suggests that avidin/ biotin can be used as making efficient use of cells in adipose tissue engineering.
Abdominoplasty ; Acellular Dermis ; Adipose Tissue ; Avidin ; Biotin ; Collagen ; Electrons ; Humans ; Mesenchymal Stromal Cells ; Stem Cells ; Tissue Engineering

Melkersson-Rosenthal syndrome is a rare condition and clinical diagnosis was established on the basis of the triad: facial or lip edema, peripheral facial palsy and scrotal or plicated tongue. Labial swelling(Cheilitis granulomatosa) is the most common feature of this syndrome complex. The lips may enlarge up to three times their normal size, resulting in aesthetic deformity and functional disability. The condition appears to be a granulomatous disorder causing edema and inflammation of the soft tissues of the face, lips, oral cavity and particularly, the facial nerve. Traditional medical interventions are only marginally successful in treating this syndrome. We report the case of a young man with cheilitis granulomatosa as a manifestation of Melkersson-Rosenthal syndrome successfully treated by transverse and vertical star-shaped resection with a transmodiolar labial suspension suture at mouth angle. Our result shows symmetry of the lip, a normalized anterior projection, dimensional harmony between upper and lower lip and no disfiguring cicatrices.
Congenital Abnormalities ; Diagnosis ; Edema ; Facial Nerve ; Facial Paralysis ; Inflammation ; Lip ; Melkersson-Rosenthal Syndrome* ; Mouth ; Sutures ; Tongue

Chitin and chitosan, polysaccharides made up of polymeric N-acetly glucosamine and D-glucosamine, are widely found in nature, forming the skeletons of crustaceans and insects, as well as the components of bacteria cell walls. Chitin and chitosan have been known to have many useful biological properties such as biocompatibility, biodegradability, antimicrobial activity, and wound healing. There properties have been known to be different depending on the degree of deacetylation of chitin, but it has not yet been fully evaluated. The purpose of this study was to evaluate the wound healing effect by the degree of deacetylation. Full-thickness skin incision was made on the backs of Sprague-Dawley rats. Three concentrations of powder, comprising 90% chitin, 50% chitin and 10% chitin, were separately embedded in the wounds of 3 rat groups. The wound-breaking strength and the collagen-hydroxyproline content of the skin at the wound sites were measured and histological examination was performed at postoperative 3, 7, and 10 days. The 50% chitin group had the highest tensile strenght of all groups. But the 50% chitin and 90% chitin groups had the lowest collagen hydroxyproline levels among all groups. The wounds treated with 50% chitin powder were completely reepithelialized and granulation tissue in the wound was observed 7 days after initial wounding. The arrangement of collagen fibers in the skin was ordered and similar to normal skin The 50% chitin powder is considered to be the most efficient wound healing accelerator among different concentrations of chitin powder.
Animals ; Bacteria ; Cell Wall ; Chitin* ; Chitosan* ; Collagen ; Glucosamine ; Granulation Tissue ; Hydroxyproline ; Insects ; Polymers ; Polysaccharides ; Rats* ; Rats, Sprague-Dawley ; Skeleton ; Skin ; Wound Healing* ; Wounds and Injuries*

In this study, the authors investigated the effects of adipose-derived stromal cells (ADSCs) and of their extract on wound healing. After creating wound healing splint model on the backs of mice, ADSCs and their extract were applied. Wound healing rates were calculated at 3, 5, 7, 10, and 14 days after the wounding, and tissues were harvested at 7 and 14 days for histological analysis. Wound healing rates were significantly higher at 7, 10, and 14 days in the cell group than in the control, but in the cell extract group wound healing rates were significantly decreased (P<0.05). Histological scores and capillary densities in the cell group were significantly higher at 2 weeks (P<0.05). In the cell group, thick inflammatory cell infiltration and many capillaries were observed at 1 week, and thick epithelium and numerous large capillaries were observed at 2 weeks. The present study suggests that ADSCs accelerate wound healing as known, and the effects of ADSCs on wound healing may be due to replacing insufficient cells by differentiation of ADSCs in the wound and secreting growth factors by differentiated cells, and not due to the effect of factors within ADSCs.
Adipocytes/*transplantation ; Animals ; Cells, Cultured ; *Disease Models, Animal ; Humans ; Male ; Mice ; Mice, Inbred BALB C ; Stem Cell Transplantation/*methods ; Treatment Outcome ; Wound Healing/*physiology ; Wounds, Penetrating/*pathology/*surgery