PURPOSE: The wound of a patient who has chronic venous insufficiency is easy to recur. Also they develop a complication even after the conservative therapy or skin graft. We have to diagnose the venous stasis ulcer correctly and remove the cause to improve the effectiveness of treatment. We operated endoscopic perforating vein ligation and splitt thickness skin graft on a patient with venous stasis ulceration on right leg. METHODS: A 26 year old male patient who had a scalding burn on his right leg in July 2005 checked into our hospital in March 2008. Even though he got three operations-the split thickness skin graft-at different clinics, the wound did not heal. The size of the wound was 12 by 8 cm2 and granulation with edema and fibrosis had been formed. We kept observation on many collateral vessels and perforating vein through venogram and doppler sonography and firmly get to know that the wound came with chronic venous insufficiency. After a debridement and an application of VAC(r) for two weeks, the condition of granulation got better. So we proceeded with the operation using subfascial endoscopic perforating surgery and split thickness skin graft. RESULTS: Through the venogram after the operation, we found out that the collateral vessels had been reduced compared to the previous condition and the widened perforating vein disappeared. During a follow up of 6 months, the patient did not develop recurrent stasis ulcer and postoperative complications. CONCLUSION: Subfascial endoscopic perforator ligation is a relatively simple technique with a low complication rate and recurrence rate. Split thickness skin graft with subfascial endoscopic perforator surgery can be a valuable method for treating severe venous stasis ulcers.
Burns ; Debridement ; Edema ; Fibrosis ; Follow-Up Studies ; Humans ; Leg ; Ligation ; Male ; Porphyrins ; Postoperative Complications ; Recurrence ; Skin ; Transplants ; Varicose Ulcer ; Veins ; Venous Insufficiency

BACKGROUND: This paper discusses the treatment protocol for patients with frostbite. METHODS: We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012. RESULTS: Our clinical series of patients (n=17) included 13 men and four women, whose mean age was 42.4+/-11.6 years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of 12.7+/-3.3 days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of 35+/-4.3 days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation. CONCLUSIONS: With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.
Clinical Protocols ; Cold Temperature ; Debridement ; Female ; Foot ; Frostbite ; Hand ; Humans ; Male ; Patient Education as Topic ; Retrospective Studies ; Skin Transplantation ; Surgical Procedures, Operative

BACKGROUND: Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. METHODS: From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. RESULTS: The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. CONCLUSIONS: In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.
Burns ; Child, Preschool ; Congenital Abnormalities ; Demography ; Female ; Fingers ; Hand ; Hand Deformities ; Humans ; Incidence ; Male ; Medical Records ; Retrospective Studies ; Skin ; Skin Transplantation ; Tissue Donors ; Transplants

PURPOSE: Most burn scar contractures are curable with skin grafts, but free flaps may be needed in some cases. Due to the adjacent tissue scarring, local flap is rarely used, and thus we may consider free flap which gives us more options than local flap. However, inappropriate performance of free flap may lead to unsatisfactory results despite technical complexity and enormous amount of effort. The author will discuss the points we should consider when using free flaps in treating burn scar contractures METHODS: We surveyed patients who underwent free flaps to correct burn scar contractures from 2000 to 2007. We divided patients into two groups. The first group was those in which free flaps were inevitable due to exposure of deep structures such as bones and tendons. The second group was those in which free flap was used to minimize scar contracture and to achieve aesthetic result. RESULTS: We performed 44 free flap on 42 patients. All of the flaps were taken well except one case of partial necrosis and wound dehiscence. Forearm free flap was the most common with 21 cases. Most of the cases(28 cases) in which free flaps were inevitable were on the wrist and lower limbs. These were cases of soft tissue defect due to wide and extensive burns. Free flaps were done in 16 cases to minimize scar contracture and to obtain aesthetic outcome, recipient sites were mostly face and upper extremities. CONCLUSION: When using free flaps for correction of burn scar contractures, proper release and full resurfacing of the contracture should be carried out in advance. If inadequate free flap is performed, secondary correction is more challenging than in skin grafts. In order to optimize the result of reconstruction, flap thickness, size and scar of the recipient site should be considered, then we can achieve natural shape, and minimize additional correction.
Burns ; Cicatrix ; Contracture ; Forearm ; Free Tissue Flaps ; Humans ; Lower Extremity ; Necrosis ; Skin ; Tendons ; Transplants ; Wrist

PURPOSE: Wide scars occurring on the lower face and neck cause both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. METHODS: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil(R) tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule formed by the tissue expander was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst(R) facial garment in order to stabilize the operation site at least twelve months. RESULTS: The most prevalent location of the scar was the cheek(15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was 55.7+/- 39.4cm2. CONCLUSION: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.
Chin ; Cicatrix ; Congenital Abnormalities ; Fascia ; Free Tissue Flaps ; Humans ; Mandible ; Muscles ; Neck ; Periosteum ; Skin ; Surgical Flaps ; Sutures ; Tissue Expansion ; Tissue Expansion Devices ; Transplants

PURPOSE: The latissimus dorsi flap and the serratus anterior flap have been used as combined flaps to reconstruct extensive defects. Because these two muscles are usually supplied by the subscapular- thoracodorsal vessels, the two flaps can be based on vascular pedicle that is long and anatomically reliable. In this case, we reported that serratus anterior possessed an anomalous arterial supply totally independent from the subscapular pedicle while raising combined latissimus dorsi and serratus anterior flap. METHODS: A 35-year-old male with extensive soft tissue defect in the left perineum and thigh visited. Muscle defects of the medial thigh were observed, and femoral nerve and vessels were exposed. Combined latissimus dorsi and serratus anterior free flap was raised to reconstruct defect. On raising flaps, artery supplying the serratus anterior muscle originated from the axillary artery directly, was lying on the undersurface of the serratus anterior muscle. RESULTS: Because two flap pedicles had no communication and latissimus dorsi muscle was large enough to cover soft tissue defect, we transferred only latissimus dorsi free flap with 1:3 meshed skin graft. Patient had limb salvage and satisfactory functional outcome. CONCLUSION: There are many variations of arterial pedicles of flaps. However, most of these variations remain within known anatomical consistence, thus is an indicator in planning the dissection of the vessels. According to documents, arterial pedicle to the serratus muscle not originated from the thoracodorsal artery is rarely reported, and in most of these cases, the arteries are originated from the subscapular artery. Thus pedicle directly originated from the axillary artery to serratus muscle is a very rare variation in its vascular anatomy.
Adult ; Arteries ; Axillary Artery ; Deception ; Femoral Nerve ; Free Tissue Flaps ; Humans ; Limb Salvage ; Male ; Muscles ; Perineum ; Skin ; Thigh ; Transplants

PURPOSE: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to succeed, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one-stage operation on bone exposed soft tissue defect with AlloDerm(R)(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. METHODS: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm(R)(25/1000 inches, meshed type) was applicated on wound, and thin split thickness(6-8/1000 inches) skin graft was done at the immediately same operative time. RESULTS: Average age of patients was 53.6 years(25 years-80 years, SD=16.8), and 13 patients were male (male:female=13:1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site(tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm(R) took without additional surgery in 12 of 14 patients. Partial graft loss was shown in four cases. Two cases were small in size under 1x1cm, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm(R) was enough. Average duration of admission period of patients without additional surgery was 15 days(13-19 days). CONCLUSION: AlloDerm(R) and thin split thickness skin graft give us an advantage of short surgery time and less limitations in donor site than flap surgery. Postoperative scar is smaller compared to in conventional skin graft because of firmer restoration of dermal structure with AlloDerm(R). We propose that AlloDerm(R) and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.
Acellular Dermis ; Bandages ; Bone and Bones ; Burns ; Burns, Electric ; Cadaver ; Cicatrix ; Free Tissue Flaps ; Granulation Tissue ; Hemorrhage ; Humans ; Imidazoles ; Lower Extremity ; Male ; Metatarsal Bones ; Muscles ; Nitro Compounds ; Postoperative Complications ; Skin ; Tissue Donors ; Toes ; Transplants

PURPOSE: As a central feature of the face, the nose has considerable significance in appearance and expression. Reconstruction of full thickness defects of the nasal ala has always been a challenge because of the 3-dimensional structure. For reconstruction of post burn defects of ala, skin graft, local or pedicled flap and composite graft are optionally available. We have reconstructed the ala defects using adiposocutaneous graft and observed the outcome. METHODS: From March 2003 to December 2010, 19 cases in 11 patients with scar contracture and defect on ala portion were performed operation using adiposocutaneous graft. As a donor site, we used the inguinal crease and posterior auricular area and the donor site was primarily closed. We made incision through the superior rim of ala and released fully. A graft is applied to recipient site with larger size than recipient volume. RESULTS: The mean age of the patient was 38.6 years (16~51), males are seven patients and females are four patients. The operation was performed bilaterally in 5 patients and unilaterally in 6 patients. Composite grafts were harvested from inguinal area in 13 cases and posterior auricular area in 6 cases. In one case, we did 4 times of operation to get enough volume. All the grafts were well taken. The mean size of the graft was 3.63 cm2. CONCLUSION: For reconstruction of post burn defects of ala, it's not easy to use local flap or pedicled flap because of hardness and fibrosis of surrounding tissue. So, we choose adiposocutaneous graft for ala deformity reconstruction, got satisfactory outcome in color matching and texture.
Burns ; Cicatrix ; Congenital Abnormalities ; Contracture ; Female ; Fibrosis ; Hardness ; Humans ; Male ; Nose ; Skin ; Surgical Flaps ; Tissue Donors ; Transplants

PURPOSE: The objective of this study is to analyze the epidemiological characteristics of pediatric burn patients and to determine the targets for a pediatric burn prevention program. METHODS: A retrospective review of all medical records of acute pediatric burn patients (age < 15 years old) admitted to our hospital between January 2005 and December 2009 was performed. RESULTS: 1472 males and 1323 females were investigated, with a male to female ratio of 1.11 : 1. The greatest number of burn patients were those with an age of 1~2 years (1,463, 52.3%). Scalding burn was the most common cause of injury, which accounted for 2183 (78.1%) patients, followed by contact burns (10.5%), flame burn (4.9%), steam burn (3.6%). Especially steam burn was the second cause of injury in the age under 1 year, while flame burn was the second cause of injury in the age over 7 years. During recent 5 years, incidence of flame burn, steam burn, electrical burn gradually decreased. Variation of seasonal incidence is minimal and most of the patients (2,716 cases, 97.2%) had burns less than 20% TBSA (Total body surface area). The median hospital stay was 18.79 days, and the rate of operation was 28.6% with a high rate in electrical burn (76.2%), flame burn (50.0%), steam burn (46.1%). 6 patients died in this series, which yielded a mortality rate of 0.2%. CONCLUSION: Prevention efforts should reflect recent study results. Focused prevention program and campaign to make people aware of risk factors and their avoidance is required to reduce the number of burn accidents in children.
Burns ; Child ; Female ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Retrospective Studies ; Risk Factors ; Seasons ; Steam

PURPOSE: The face is very important body area. So, for burns on the face, early wound healing is important of all. Since B.C.1500, Greeks started using phototherapy for wound healing. Although phototherapy has been studied a long time, the mechanism and result of researches have not been clearly defined. So, the authors will evaluate the effectiveness of the phototherapy, spectrum of 633 nm and 830 nm, and the effectiveness in second degree facial burn. METHODS: We studied 30 burn patients with second degree burn wounds with symptoms of edema, discharge, and redness whom admitted from August 2006 to May 2008. Wound healing of phototherapy was compared to that with hydro-gel dressing. We evaluated each groups by the time it took for wound to epithelize, swelling disappearance, the amount of exudates, hospital days. Satisfaction question surveyed by patients ranging from 0 to 5 scales with 0 being the lowest and 5 being the highest. RESULTS: The duration of epithelization was 10+/-2.3 days in cases with phototherapy. Setting the factor's point becoming 1, the duration of cases with hydro-gel dressings was redness 5+/-2.2 days, discharge 6+/-1.8 days, and the average admission days were 11+/-1.6 days. The group with phototherapy was evaluated superior to the control group in satisfaction index by 30%. CONCLUSION: Simple hydro-gel dressing on facial burn is a routine job. Considering the fact that face is the most prominent sight-catching point, we should try to heal the wound as soon as possible. Phototherapy is the choice that we can use to shorten the duration of redness, the time it takes to epithelize and increase satisfaction index. So if possible, when got a burn on face, authors recommend the phototherapy.
Bandages ; Burns ; Edema ; Exudates and Transudates ; Humans ; Phototherapy ; Weights and Measures ; Wound Healing