PURPOSE: Phototherapy uses the changes caused by the athermal and atraumatic absorption of the photon's energy by the tissue for therapeutic effect. Phototherapy has been proven to be useful in various conditions, for example, in pain attenuation, wound healing and skin rejuvenation. The aim of this research was to evaluate the clinical efficacy of 830 nm LED phototherapy for burn patients. METHODS: We recruited 11 patients who visited this hospital between June and December 2012 with superficial 2nd degree burns to the face for comparative analysis. For phototherapy, we used infrared LED with wavelength of 830 nm. For comparative analysis, we covered one side of the face with sterile aluminum foil and fabric during the treatment. Photographs were taken at the time of each treatment and the time taken for epithelialization and the level of patient satisfaction were also investigated. RESULTS: All 11 patients were male and the mean age was 44.0+/-11.9 years (range of 28~63 years). The cause of the burns was flame burn for 7 patients, and electric sparks in 4 patients. The time taken to achieve epithelialization after the burns was 8.1+/-2.2 days (range 4~12 days) for the side that received phototherapy, while it was 9.1+/-2.9 days (range 4~14 days) for the side that was not treated with phototherapy. In terms of patient satisfaction, 3 patients were 'Very Satisfied', 6 patients were 'Satisfied', 2 patients replied 'Adequate' and none of the patients were 'Unsatisfied'. CONCLUSION: LED phototherapy of 830 nm wavelength can shorten the time taken for burn wound healing. It also was not associated with serious complications except for skin dryness, so it can be a useful treatment method for burns that produces satisfactory outcome for the patients.
Absorption ; Aluminum ; Burns ; Humans ; Infrared Rays ; Lasers, Semiconductor ; Male ; Patient Satisfaction ; Phototherapy ; Rejuvenation ; Skin ; Wound Healing

PURPOSE: Marjolin's ulcer is a rare malignancy that occur in chronic wounds or scars. Marjolin's ulcers tend to infiltrate adjacent tissue more extensively than squamous cell carcinoma that occurs in normal skin, and it is prone to recurrence and metastases, leading to a poor prognosis. Hence, its accurate diagnosis and treatment is very important. The aim of this study was to investigate the diagnostic value and clinical efficacy of preoperative 18F-FDG-PET/CT. METHODS: The study population consisted of 27 patients who were suspected to have Marjolin's ulcer who visited this hospital between January 2009 and June 2012, and who had also received preoperative PET/CT. To confirm the diagnostic efficacy of preoperative PET/CT, the PET/CT findings of the primary lesion and the lymph node, as well as the post-operative histology results were compared to investigate the sensitivity, specificity, false-positive and false-negative rates. RESULTS: The sensitivity and the specificity for the primary lesion of the Marjolin's ulcer in the preoperative PET/CT were 93.3% and 100% respectively. The false-positive rate and the false-negative rate here were 0% and 6.7% respectively. The sensitivity and the specificity for the lymph node metastases of the Marjolin's ulcer in the preoperative PET/CT were 100% and 66.7% respectively. The false-positive rate and the false-negative rate here were 33.3% and 0% respectively. The histological results of Marjolin's ulcer showed that 14 patients had squamous cell carcinoma and 1 had sarcoma. CONCLUSION: Preoperative PET/CT used for the assessment of Marjolin's ulcer and its primary lesion showed a high level of sensitivity and specificity. It was also useful because it allowed the assessment of the primary lesion, lymph node metastases, and distant metastases with a single test. However, the specificity for lymph node metastases was relatively lower, and more research would be needed to improve this.
Carcinoma, Squamous Cell ; Cicatrix ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography ; Prognosis ; Recurrence ; Sensitivity and Specificity ; Skin ; Ulcer

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: Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow. METHODS: A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The patients' data including age, sex, cause of injury, wound dimensions, timing of flap coverage, postoperative elbow motion, and complications were investigated. RESULTS: Between 2001 and 2012, 16 patients were treated at our hospital. The mean age was 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral arm flaps, and 4 radial forearm flaps. The average defect size was 183.5 cm2 (range, 28 to 670 cm2). Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days). The mean postoperative active elbow flexion was 98degrees (range, 85degrees to 115degrees). Partial flap failure occurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%), hematoma (23.5%), seroma (35.3%), and wound infection (5.9%). CONCLUSIONS: Flap selection for elbow reconstruction is determined by the defect size and the extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a single-staged, reliable, and relatively simple procedure that permits initiation of early rehabilitation, thereby improving a patient's functional outcome.
Arm ; Burns ; Elbow ; Forearm ; Hematoma ; Humans ; Necrosis ; Retrospective Studies ; Seroma ; Surgical Flaps ; Wound Infection

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: DC cardioversion is the treatment choice for atrial fibrillation and flutter. Because of the high voltage power across the thorax, most patients suffer some degree of superficial erythema or burn at the pad site. 2nd or 3rd degree burn and muscle necrosis is very rare after shock. We experienced one case of 3rd degree burn with ulceration after DC cardioversion. METHODS: A 44-year-old male was admitted to local hospital with the presenting palpitation and atrial fibrillation on ECG. During radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillatoin, DC cardioversion was performed. The patient did not complain of any pain or discomfort at the pad site during or immediately after the procedure. Approximately 14 days after the shock, he had blisters at the pad site. But he received simple dressing treatment at the local hospital for 6 months. When he visited our burn clinic, there was 3x5 cm sized 3rd degree burn with eschar and necrotic fat tissue at the pad site of right back. Surgical removal of a necrotic tissue was performed on the patient by STSG (Split thickness skin graft) with Matriderm(R). RESULTS: Muscle fascia was exposed after debridement of the necrotic skin and fat tissue. The skin graft was well taken within 2 weeks after operation. CONCLUSION: In case of using monophasic 360 J, approximately 3,000 V energy is discharged. The energy is sufficient to cause burn injury to skin. Damage may result both thermal burn and electrical burn. The burn degree in the electric circuit is proportional to amperage and time, is inversely proportional to pad site area. We therefore suggest that in order to reduce deep burn, DC cardioversion is started with lower energy shocks, proper pad placement and correct pad application is important. And we give a notice that deep pad burn possibly occur after the cardioversion procedure.
Adult ; Atrial Fibrillation ; Bandages ; Blister ; Burns ; Catheter Ablation ; Debridement ; Electric Countershock ; Electrocardiography ; Erythema ; Fascia ; Humans ; Male ; Muscles ; Necrosis ; Shock ; Skin ; Thorax ; Transplants ; Ulcer

PURPOSE: In cases of high voltage electrical burns, a wound occurs as current enters or leaves the body and is accompanied by deep tissue injury. If upper extremity amputation is inevitable, consideration should be given to the residual limb functions, secondary reconstruction, and wearing of an upper prosthesis. Our hospital has achieved satisfactory outcomes through the use of a pedicled latissimus dorsi (LD) flap in patients undergoing transhumeral amputation and shoulder disarticulation due to upper extremity damage from high voltage electrical burns. METHODS: The study was targeted to five patients who suffered high voltage electrical burns, underwent above-elbow amputation, and were reconstructed in the acute and secondary phases using a pedicled LD flap from January 2005 to December 2011. All patients underwent equilateral pedicled LD flap surgery, with primary closure at the donating site. RESULTS: The average age of patients was 49.6 years (38~64); they were all male. One patient underwent sublayer skin grafting after a pedicled muscular LD flap, and four patients had a pedicled myocutaneous LD flap: one patient among the four had a forearm flap after the pedicled myocutaneous LD flap. All flaps were well adhered, and post-surgical flap reduction and local flaps were performed for adequate sizing and aesthetic improvement. CONCLUSION: In cases of upper arm amputation due to wide upper extremity damage caused by electrical burns, the use of the pedicled LD flap and adequate amputation length made subsequent wearing of a prosthesis possible. The pedicled LD flap procedure allowed reconstruction of a relatively large area of soft tissue and the surgery to the donating site was unproblematic.
Amputation ; Amputation Stumps ; Arm ; Burns ; Disarticulation ; Extremities ; Forearm ; Humans ; Male ; Prostheses and Implants ; Shoulder ; Skin Transplantation ; Upper Extremity

PURPOSE: The use of the Ondol, which is a traditional Korean floor heating system, has made the electric heating pad popular in Korea. Although the surface temperature of electric pads is around 45 degrees, rarely they can cause severe contact burns. Because an electric pad is usually used while sleeping, the skin could be exposed to heat and pressure for a prolonged period. The purpose of this study was to investigate the epidemiology and clinical features of these types of burns and to advise caution in the use of electric heating pads. METHODS: We performed a retrospective analysis of 58 cases identified from March 2007 to March 2012 at the Hangang Sacred Heart Hospital plastic surgery department. Collected data included sex, age, seasonal variation, distribution and extent of the burn, underlying disease, related factors, and treatment. RESULTS: Patients (23 females and 10 males) were predominantly in their twenties, with an average age of 40.7 years (range, 14~83). The majority of the burns occurred during winter (51.5%). According to the patients' histories, sleeping in a drunken state was the most common associated factor, with taking hypnotics and lying under spinal anesthesia being the second and third factors, respectively. Eight patients had diabetes mellitus and four patients had hypoesthesia after spinal cord injury and cerebral stroke. The lower extremity was the most commonly involved site (42.4%), followed by the buttocks (33%). The extent burn areas accounted for less than 2% of the total body surface area. But deep second degree and third degree burns were sustained that required surgical intervention. CONCLUSION: Unconsciousness and hypoesthesia were the primary factors that provoked contact burns related to the use of electrical pads. Although the percentage of body surface area burns is often small, the burns caused by electric pads can cause deep thermal injuries, necessitating the use of skin grafts and local flaps. These injuries could be prevented by taking precautions when using electric pads and by educating the public.
Anesthesia, Spinal ; Body Surface Area ; Burns ; Buttocks ; Deception ; Diabetes Mellitus ; Female ; Floors and Floorcoverings ; Heart ; Heating ; Hot Temperature ; Humans ; Hypesthesia ; Hypnotics and Sedatives ; Korea ; Lower Extremity ; Retrospective Studies ; Seasons ; Skin ; Spinal Cord Injuries ; Stroke ; Surgery, Plastic ; Transplants ; Unconsciousness

PURPOSE: Electrical burn of scalp is uncommon. Much more, chronically exposed dura in unstable burn scar is quite exceptional. Hence, we report a case of chronically exposed dura following electrical burn. METHODS: A 63-year-old man presented with an about 40 years history of an ulcerative lesion arising from electrical burn scar with 'squeeze like sensation' around wound. Wound was about 6 x 8cm. Area in the center was 3 x 3 cm nonviable dura without sequestrum. Tangential excision with an intraoperative neurosurgical consultation and transposition flap under general anesthesia was done. Intraoperative biopsy was done. The wound was diagnosed as chronic osteomyelitis, not Marjolin ulcer. Flap was taken successfully. But after 5 days, infectious discharge had been appeared during 2 weeks, despite irrigation and drainage. As flap was re-evaluated, we could see remnant necrotic dura. After that, latissimus dorsi muscle free flap with meshed split thickness skin graft was transferred without excision of necrotic dura. RESULTS: Flap was taken successfully. Follow-up at 10 weeks has been uneventful, with good and stable coverage of the wound. CONCLUSION: It is true that complete excision of devitalized tissue with sagittal sinus obliteration is prerequisite to flap taken. But necrotic dura was tangentially excised instead of total dura excision, because, posterior two-thirds of the sagittal sinus was involved underneath. Muscle is rich in blood vessels and decrease the recipient-site bacterial count effectively. In this case, muscle flap with skin graft without total dura excision is an alternative treatment.
Anesthesia, General ; Bacterial Load ; Biopsy ; Blood Vessels ; Burns ; Burns, Electric ; Cicatrix ; Drainage ; Dura Mater ; Follow-Up Studies ; Free Tissue Flaps ; Humans ; Middle Aged ; Muscles ; Osteomyelitis ; Scalp ; Skin ; Transplants ; Ulcer

PURPOSE: A wart is caused by epidermal infection with the human papilloma virus. Although wart naturally disappears in some cases, it require treatment because of pain, aesthetic problem, and the possibility of malignant change. Conventional non-surgical treatment cannot be a fundamental solution for the pain and has such disadvantages as frequent recurrence and difficulties in achieving a satisfactory outcome. A surgical procedure was performed on patients with wart and the procedure had a good outcome. METHODS: We investigated the gender, age, lesion site, mean treatment duration, and presence or absence of recurrence in 21 patients with a wart within the period of January 2007 to July 2011. For local lesions, primary closure, including subcuticular suture after the excision, was performed. If the defect size was too big to do primary closure, we performed rotation flap. For wide multiple lesions, a split thickness skin graft was performed. RESULTS: Among the 21 patients, 12 patients were male and 9 patients were female, and their mean age was 42 years(SD=17.38, range: 11~75 years). The lesion site was the foot in 10 patients, the hand in 8 patients, the face in 2 patients, and the scalp in 1 patient. The mean treatment duration was 13.5 days(SD=4.36, range: 6~15 days) for the primary closure or rotation flap, and 18.5 days(SD=2.12, range: 17~20 days) for the skin graft. 20 patients were cured without recurrence. No recurrence was observed in the patients who underwent primary closure or rotation flap. One of the two patients who underwent a skin graft of their wart that had covered their entire palm had local recurrence in part of her finger tips. CONCLUSION: We performed surgical procedure on recalcitrant wart. As a results, we can treat it with short treatment duration, low recurrence rate and less scarring and get high patient satisfaction.
Cicatrix ; Female ; Fingers ; Foot ; Hand ; Humans ; Male ; Papilloma ; Patient Satisfaction ; Recurrence ; Scalp ; Skin ; Sutures ; Transplants ; Viruses ; Warts