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: 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

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: 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

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: Anatomically, the foot is provided with insufficient blood supply and is relatively vulnerable to venous congestion compared to other parts of the body. Soft tissue defects are more difficult to manage and palliative treatments can cause hyperkeratosis or ulcer formation, which subsequently requires repeated surgeries. For weight bearing area such as the heel, not only is it important to provide wound coverage but also to restore the protective senses. In these cases, application of flaps for hind foot reconstruction is widely recognized as an effective treatment. In this study, we report the cases of soft tissue reconstruction for which various types of flaps were used to produce good results in both functional and cosmetic aspects. METHODS: Data from 37 cases of hind foot operation utilizing flaps performed between from June 2000 to June 2008 were analyzed. RESULTS: Burn related factors were the most common cause of defects, accounting for 19 cases. In addition, chronic ulceration was responsible for 8 cases and so forth. Types of flaps used for the operations, listed in descending order are radial forearm free flap(18), medial plantar island flap(6), rotation flap(5), sural island flap(3), anterolateral thigh free flap(2), lattisimus dorsi muscular flap(2), and contra lateral medial plantar free flap(1). 37 cases were successful, but 8 cases required skin graft due to partial necrosis in small areas. CONCLUSION: Hind foot reconstruction surgeries that utilize flaps are advantageous in protecting the internal structure, restoring functions, and achieving proper contour aesthetically. Generally, medial plantar skin is preferred because of the anatomical characteristics of the foot (e.g. fibrous septa, soft tissue for cushion). However alternative methods must be applied for defects larger than medial plantar skin and cases in which injuries exist in the flap donor/recipient site(scars in the vicinity of the wound, combined vascular injury). We used various types of flaps including radial forearm neurosensory free flap in order to reconstruct hind foot defects, and report good results in both functional and cosmetic aspects.
Accounting ; Burns ; Cosmetics ; Foot ; Forearm ; Free Tissue Flaps ; Heel ; Hyperemia ; Necrosis ; Organic Chemicals ; Palliative Care ; Skin ; Thigh ; Transplants ; Ulcer ; Weight-Bearing

PURPOSE: Patients with serious burns are prone to chondritis due to lack of soft tissue in the auricle, which can cause severe defects in the auricular morphology. In addition, skin damage occurs frequently in the vicinity of post-burn wounds, presenting difficulties in reconstruction surgery. An auricular reconstruction has functional and cosmetic significance. The aim of this study is to develop appropriate reconstruction methods for auricular defects. METHODS: Thirty seven patients, who were treated for auricular defects from 2005 to 2009, were enrolled in this study. A local flap, multiple regional flaps and cartilage framework with or without a temporal fascial flap were applied in reconstruction surgery according to the location of the auricular defect. RESULTS: The age of the subjects ranged from 11 to 56. Some subjects had defects that cover more than half of the helical rim with most exhibiting post-burn scars in the vicinity, for whom a multiple regional flap was used. A single use of a tubed flap was sufficient for subjects with defects that covered less than half of the helical rim. A regional flap was also used for reconstruction in subjects with defects covering both the helical rim and antehelix. CONCLUSION: Achieving satisfactory results from the skin flaps and skin grafts for post-burn auricular defects in both functional and cosmetic aspects is a difficult task. Therefore, selecting an appropriate surgical method through proper diagnosis of the auricular defect and the state of the available skin in the vicinity is essential.
Burns ; Cartilage ; Cicatrix ; Cosmetics ; Humans ; Skin ; Transplants

BACKGROUND: An area of the skull exposed by burn injury has been covered by various methods including local flap, skin graft, or free flap surgery. Each method has disadvantages, such as postoperative alopecia or donor site morbidities. Due to the risk of osteomyelitis in the injured skull during the expansion period, tissue expansion was excluded from primary reconstruction. However, successful primary reconstruction was possible in burned skull by tissue expansion. METHODS: From January 2000 to 2011, tissue expansion surgery was performed on 10 patients who had sustained electrical burn injuries. In the 3 initial cases, removal of the injured part of the skull and a bone graft was performed. In the latter 7 cases, the injured skull tissue was preserved and covered with a scalp flap directly to obtain natural bone healing and bone remodeling. RESULTS: The mean age of patients was 49.9+/-12.2 years, with 8 male and 2 female. The size of the burn wound was an average of 119.6+/-36.7 cm2. The mean expansion duration was 65.5+/-5.6 days, and the inflation volume was an average of 615+/-197.6 mL. Mean defect size was 122.2+/-34.9 cm2. The complications including infection, hematoma, and the exposure of the expander were observed in 4 cases. Nonetheless, only 1 case required revision. CONCLUSIONS: Successful coverage was performed by tissue expansion surgery in burned skull primarily and no secondary reconstruction was needed. Although the risks of osteomyelitis during the expansion period were present, constant coverage of the injured skull and active wound treatment helped successful primary reconstruction of burned skull by tissue expansion.
Alopecia ; Burns ; Female ; Free Tissue Flaps ; Hematoma ; Humans ; Inflation, Economic ; Male ; Osteomyelitis ; Scalp ; Skin ; Skull ; Tissue Donors ; Tissue Expansion ; Transplants

PURPOSE: Spontaneous tendon rupture of finger is defined the rupture of tendon without any intrinsic or extrinsic pathological processes in finger. Spontaneous flexor tendon ruptures are rare. Burn affects not only skin but also muscle and tendon according to the depth. Particularly, burn in hand badly affects movement of finger. Thus, We report the case of spontaneous flexor tendon rupture of finger that happened after burn. METHODS: We studied a 42 year old male presented with third degree electrical burn at the palm of the right hand. And then, Terudermis(R) was applied on 23rd day after burn and split thickness skin graft was applied on 37th day after burn. After operation, there were no special symptoms for some period. But, on 74th day after burn, while providing physical therapy to finger, he could not flex his thumb of the hand with popping sound and edema. So we performed US and MRI scan, finally diagnosed complete tear on FPL tendon of the right hand which was in flexor tendon injury zone IV. We harvested donor from Palmaris longus and tendon graft was applied. RESULTS: After operation, graft was well taken without other problem. And after applying splint, 4th day after tendon graft, active finger extension was done with passive flexion achieved using a rubber band attached to the finger tip. 4 weeks after the operation, splint was removed and the patient gently started active exercise. CONCLUSION: Spontaneous rupture of flexor tendon is rare and moreover, there was no case report of rupture after burns so far. We are now reporting that we early diagnosed the spontaneous flexor tendon rupture of the burned hand and functionally corrected by tendon graft.
Burns ; Edema ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Male ; Muscles ; Pathologic Processes ; Rubber ; Rupture ; Rupture, Spontaneous ; Skin ; Splints ; Tendon Injuries ; Tendons ; Thumb ; Tissue Donors ; Transplants