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As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%-90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8-12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.
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Ginsenoside, one of the active compounds in Panax ginseng, inhibits tumor growth factor-beta 1 (TGF-ß1) and reduces the level of collagen type 1. Ginsenoside Rb1 promotes burn wound healing. Our study evaluated the effects of ginsenoside Rb1 on hypertrophic scar remodeling. A total of 72 hypertrophic scars were generated on the ears of six New Zealand white rabbits. Treatment groups were administered with intradermal injections of ginsenoside Rb1 at various amounts (0.07mg, 0.28mg and 0.56mg), and evaluated on postoperative Day 35. Scar elevation index was used as a quantitative measure, and picrosirius staining of histological sections was used to assess collagen arrangement. We determined relative mRNA expression of collagen type 1 as well as scar related factors; matrix metalloproteinase 2 (MMP2), tissue-inhibitor of metalloproteinase 1 (TIMP1), alpha-smooth muscle actin (α-SMA), and TGF-ß1. Immunohistochemistry assays were performed additionally. Application of 0.56mg of ginsenoside Rb1 resulted in significant decrement of scar elevation index, in comparison with control and lower dosage groups, furthermore achieved broader and randomly arranged collagen fibers resembling findings in normal dermis. Ginsenoside Rb1 concentration inversely correlated with the mRNA expression and immunohistochemical reactivity of scar related factors; MMP2, TIMP1, α-SMA, and TGF-ß1. In addition, ginsenoside Rb1 suppressed collagen type 1 expression. Ginsenoside Rb1 is therapeutic in hypertrophic scar remodeling with the highest efficacy at 0.56mg of dosage. Ginsenoside Rb1 demonstrated inhibitory effects on hypertrophic scar in quantitative and histologic analysis. Further research is needed to determine optimal ginsenoside Rb1 application and exposure conditions.
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Cicatriz Hipertrófica/fisiopatología , Ginsenósidos/farmacología , Cicatrización de Heridas/efectos de los fármacos , Animales , Cicatriz Hipertrófica/metabolismo , Cicatriz Hipertrófica/patología , Colágeno Tipo I/metabolismo , Oído/lesiones , Oído/patología , Oído/fisiopatología , Fibrosis , ConejosRESUMEN
The purpose of this study was to devise an expanded ischemic flap model and to investigate the role of AMD-3100 (Plerixafor, chemokine receptor 4 inhibitor) in this model by confirming its effect on mobilization of stem cells from the bone marrow. Male Sprague-Dawley rats were used as an animal research model. The mobilization of stem cells from the bone marrow was confirmed in the AMD-3100-treated group. The fractions of endothelial progenitor cells (EPC) and the vascular endothelial growth factor receptor (VEGFR) 2+ cells in the peripheral blood were increased in groups treated with AMD-3100. The expression of vascular endothelial growth factor (VEGF) was increased in response to expansion or AMD injection. The expression of stromal cell derived factor (SDF)-1 and VEGFR2 were increased only in unexpanded flap treated with AMD-3100. Treatment with AMD-3100 increased both the number and area of blood vessels. However, there were no statistically significant differences in the survival area or physiologic microcirculation in rats from the other groups. This endogenous neovascularization induced by AMD-3100 may be a result of the increase in both the area and number of vessels, as well as paracrine augmentation of the expression of VEGF and EPCs. However, the presence of a tissue expander under the flap could block the neovascularization between the flap and the recipient regardless of AMD-3100 treatment and expansion.
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Células Progenitoras Endoteliales/citología , Células Madre Hematopoyéticas/citología , Compuestos Heterocíclicos/farmacología , Colgajos Quirúrgicos/irrigación sanguínea , Expansión de Tejido/métodos , Animales , Fármacos Anti-VIH/farmacología , Bencilaminas , Células de la Médula Ósea/citología , Quimiocina CXCL12/biosíntesis , Ciclamas , Subunidad alfa del Factor 1 Inducible por Hipoxia/metabolismo , Masculino , Neovascularización Fisiológica , Óxido Nítrico Sintasa de Tipo III/metabolismo , Ratas , Ratas Sprague-Dawley , Receptores CXCR4/antagonistas & inhibidores , Colgajos Quirúrgicos/cirugía , Factor A de Crecimiento Endotelial Vascular/biosíntesis , Receptor 2 de Factores de Crecimiento Endotelial Vascular/biosíntesis , Receptor 2 de Factores de Crecimiento Endotelial Vascular/metabolismoRESUMEN
BACKGROUND: The typical clinical symptoms of glomus tumors are pain, tenderness, and sensitivity to temperature change, and the presence of these clinical findings is helpful in diagnosis. However, the tumors often pose diagnostic difficulty because of variations in presentation and the nonspecific symptoms of glomus tumors. To the best of our knowledge, few studies have reported on the usefulness of magnetic resonance imaging (MRI) in diagnosing glomus tumors in patients with unspecific symptoms. METHODS: THE INCLUSION CRITERIA OF THIS STUDY WERE: having undergone surgery for subungual glomus tumor of the hand, histopathologic confirmation of glomus tumor, and having undergone preoperative MRI. Twenty-one patients were enrolled. The characteristics of the tumors and the presenting symptoms including pain, tenderness, and sensitivity to temperature change were retrospectively reviewed. RESULTS: Five out of 21 patients (23%) did not show the typical glomus tumor symptom triad because they did not complain of pain provoked by coldness. Nevertheless, preoperative MRI showed well-defined small soft-tissue lesions on T1- and T2-weighted images, which are typical findings of glomus tumors. The tumors were completely resected and confirmed as glomus tumor histopathologically. CONCLUSIONS: Early occult lesions of glomus tumor in the hand may not be revealed by physical examination because of their barely detectable symptoms. Moreover, subungual lesions may be particularly difficult to evaluate on physical examination. Our cases showed that MRI offers excellent diagnostic information in clinically undiagnosed or misdiagnosed patients. Preoperative MRI can accurately define the character and extent of glomus tumor, even though it is impalpable and invisible.
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BACKGROUND: Surgical skin flaps are useful, but flap necrosis is a common problem. Epigallocatechin gallate (EGCG), the major polyphenol of green tea, has been investigated as a neovascularization agent to counteract necrosis. OBJECTIVES: To evaluate the effect of EGCG on random pattern skin flap survival. MATERIALS AND METHODS: The rat dorsal skin flap model was employed. One hundred rats were divided into five groups of equal size. Experimental Group A received local injection of EGCG to the flap, experimental Group B received topical application of EGCG, control Group C received local injection of saline, control Group D received topical application of an acetone-olive oil mixture, and control Group E received no treatment. The surviving area of the flap, regional blood perfusion, capillary density, and vascular endothelial growth factor (VEGF) expression were evaluated. RESULTS: We observed a larger area of skin flap survival in Groups A and B than in the control groups. Doppler measurement showed greater perfusion in Groups A and B, and the capillary density and VEGF expression were significantly higher in the experimental animals. CONCLUSION: The EGCG treatment enhanced neovascularization and regional perfusion and, as a result, improved skin flap survival.
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Inductores de la Angiogénesis/uso terapéutico , Catequina/análogos & derivados , Procedimientos Quirúrgicos Dermatologicos , Supervivencia de Injerto/efectos de los fármacos , Colgajos Quirúrgicos/irrigación sanguínea , Animales , Capilares/patología , Catequina/uso terapéutico , Femenino , Inmunohistoquímica , Necrosis , Ratas , Ratas Sprague-Dawley , Flujo Sanguíneo Regional , Colgajos Quirúrgicos/patología , Factor A de Crecimiento Endotelial Vascular/metabolismoRESUMEN
BACKGROUND: A giant congenital melanocytic nevus (GCMN) is a malformation of the pigment cells. It is a distress to the patients for two reasons: one is disfigurement, and the other is the possibility of malignant changes. However, the underlying mechanisms of the development of GCMN and melanotumorigenesis in GCMN are unknown. Hence, the aim of this study was to identify the proteomic alterations and associated functional pathways in GCMN. RESULTS: Proteomic differences between GCMN (n = 3) and normal skin samples (n = 3) were analyzed by one-dimensional-liquid chromatography-tandem mass spectrometry Relative levels of the selected proteins were validated using western blot analysis. The biological processes associated with the abundance modified proteins were analyzed using bioinformatic tools. Among the 46 abundance modified proteins, expression of 4 proteins was significantly downregulated and expression of 42 proteins was significantly upregulated in GCMN compared to normal skin samples (p < 0.05). More importantly, 31% of the upregulated proteins were implicated in various cancers, with five proteins being specifically related with melanoma. The abundance modified proteins in GCMN were involved in the biological processes of neurotrophin signaling, melanosome, and downregulated of MTA-3 in ER-negative breast tumors. In particular, an increase in the expression of the 14-3-3 protein family members appeared to be associated with key cellular biological functions in GCMN. Western blot analysis confirmed the upregulation of 14-3-3epsilon, 14-3-3 tau, and prohibitin in GCMN. CONCLUSION: These findings suggest that GCMN exhibits potential proteomic alterations, which may play a role in melanotumorigenesis, and the significant alteration of 14-3-3 family proteins could be a key regulator of the biological pathway remodeling in GCMN.
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BACKGROUND: Adipose-derived stem cells (ASCs) have positive effects in the wound healing process. OBJECTIVE: To clarify whether ASCs positively mitigate scar formation in the wound remodeling process. MATERIALS AND METHODS: Full-thickness skin defects were created on the dorsal skin of Yorkshire pigs. After the defects were transformed into early scars, ASCs were injected, and the same amount of phosphate buffered saline (PBS) was injected in the control group. Clinical and histologic examinations were performed. RESULTS: In the experimental group, the areas of scars were smaller than those of control groups. The color of scars was more similar to that of the surrounding normal tissue, and scar pliability was better. The number of mast cells decreased, and more-mature collagen arrangement was noted. In the early period of scar remodeling, the expression of transforming growth factor beta (TGF-ß)3 and matrix metalloproteinase 1 (MMP1) was greater in the experimental group than in control group. In the late period, the level of alpha smooth muscle actin and tissue inhibitor of metalloproteinase 1 were dramatically less, although the level of MMP1 was lower in the experimental group than in control group. CONCLUSIONS: Local injection of ASCs decreases scar size and provides better color quality and scar pliability. It decreases the activity of mast cells and inhibits the action of TGF-ß against fibroblasts and positively stimulates scar remodeling through greater expression of MMP molecules.
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Tejido Adiposo/citología , Cicatriz/metabolismo , Cicatriz/patología , Trasplante de Células Madre , Células Madre/citología , Actinas/metabolismo , Animales , Recuento de Células , Cicatriz/prevención & control , Colágeno/ultraestructura , Color , Humanos , Masculino , Mastocitos , Metaloproteinasa 1 de la Matriz/metabolismo , Proyectos Piloto , Porcinos , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Factor de Crecimiento Transformador beta1/metabolismo , Factor de Crecimiento Transformador beta3/metabolismoRESUMEN
BACKGROUND: A port-wine stain begins with thin macular lesions and eventually becomes hypertrophic and forms nodules. Although laser therapy for port-wine stain is a safe treatment modality that has been well-established, the long-standing port-wine stain has a tendency to respond less well to laser treatment. The authors performed total surgical resections of long-standing port-wine stain in the facial region, and attempted to clarify the histomorphologic changes. METHODS: The records of 15 patients with long-standing port-wine stain were reviewed for nodules and associated characteristics. After removal of the vascular lesions, the affected area was reconstructed with a radial forearm free flap or a skin graft depending on cosmetic considerations. All specimens obtained from resection were stained with hematoxylin and eosin and Victoria blue for elastic fibers for histomorphologic analysis. After a mean follow-up period of 12 years, the outcomes of surgical management were assessed. RESULTS: The nodules developed in 13 patients, and the mean age for nodule onset was 30 years. Victoria blue staining of the nodular lesions showed an intermingling of thick-walled vessels with abundant elastic fibers and thin-walled vessels without elastic fibers, which are findings typical of arteriovenous malformations. After surgical management, most of the outcomes were satisfactory, without complications or recurrence at long-term follow-up. CONCLUSIONS: A long-standing nodular port-wine stain can convert to a high-flow malformation with an arterial component, and these lesions are different from early-stage port-wine stains. For the treatment of long-standing port-wine stain that is resistant to laser therapy, surgical methods will bring more satisfactory outcomes than traditional laser therapy.
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Colgajos Tisulares Libres , Mancha Vino de Oporto/patología , Mancha Vino de Oporto/cirugía , Adolescente , Adulto , Femenino , Humanos , Terapia por Láser , Masculino , Persona de Mediana Edad , Mancha Vino de Oporto/complicaciones , Estudios Retrospectivos , Trasplante de Piel , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AIMS: Adipose-derived stem cells (ASC) are known to be able to restore injured tissue via differentiation and paracrine effects. In this study, we investigated the effect of ASC on photo-aged human dermal fibroblasts (HDF) based on paracrine function. In particular, we wanted to determine a more effective method of ASC application and the fate of the photo-aged fibroblasts. METHODS: We compared two application methods of ASC: transwell and conditioned medium culture with photo-aged fibroblasts. Proliferation rate, collagen synthesis, matrix metalloproteinase (MMP) production and expression of p16 were measured by real-time polymerase chain reaction (PCR) after culture. Flow cytometry for apoptosis assay was also conducted to determine the fate of the photo-aged fibroblasts. RESULTS: ASC induced proliferation of photo-aged HDF and type I collagen production and decreased MMP-1 production and expression of p16. In an apoptosis assay, ASC converted necrotic or late apoptotic cells to early apoptotic cells. These results were similar in both experimental groups. CONCLUSIONS: The results indicate that the paracrine effects of ASC may have a role that is as important as cell-to-cell communication between ASC and fibroblasts. We believe that conditioned medium may be a useful material for anti-aging skin therapy instead of cell therapy. Also, ASC might have an anti-aging effect on photo-aged fibroblasts even at a genetic level.
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Tejido Adiposo/citología , Senescencia Celular/efectos de la radiación , Fibroblastos/citología , Fibroblastos/efectos de la radiación , Comunicación Paracrina/efectos de la radiación , Células Madre/citología , Rayos Ultravioleta , Adolescente , Anexina A5/metabolismo , Apoptosis/efectos de la radiación , Proliferación Celular/efectos de la radiación , Forma de la Célula/efectos de la radiación , Niño , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Inhibidor p16 de la Quinasa Dependiente de Ciclina/metabolismo , Femenino , Fibroblastos/metabolismo , Citometría de Flujo , Regulación de la Expresión Génica/efectos de la radiación , Humanos , Masculino , Metaloproteinasa 1 de la Matriz/genética , Metaloproteinasa 1 de la Matriz/metabolismo , Reproducibilidad de los Resultados , Células Madre/metabolismo , Adulto Joven , beta-Galactosidasa/metabolismoRESUMEN
PURPOSE: In the present study, we used the diabetic mouse as a model of delayed wound healing to investigate the effects of human cord blood mesenchymal stem cells (CB-MSC) on wound healing. METHODS: A delayed wound healing model was used by db/db mice. Study models were divided by an injection of human CB-MSC with phosphate buffered solution (PBS) by a different method. One was a locally topical injection, the other was a systemic injection via the end tail vein. Both models were treated with 2.0 × 10(6) CB-MSC after an 8-mm full thickness defect was made by a skin punch biopsy on the back. We evaluated the wound size, transforming growth factor (TGF)-ß, and vascular endothelial growth factor histologic evaluation, and vessel counts. Engraft of CB-MSC was detected by an antihuman antibody. RESULT: Wound healing was accelerated in the experimental group in the topical injection model with statistical significance on the 6th, 9th, and 12th day (P < 0.05). In the systemic injection model, wound healing was completed from the 9th day, but there was no statistical significance. TGF-ß increased in the first week and decreased in the third week in the experimental groups of both models. But there were opposite results in the control groups of both models. The statistical differences were found in first and third week in topical injection and in the third week in systemic injection (P < 0.05). Vascular endothelial growth factor increased in all groups and in all models as the wound healing. But statistical significance did not show between all experimental and control groups. Anti-human antibody immunochemical staining was positive in the wound. CONCLUSION: We concluded that CB-MSC had a positive effect on wound healing. Statistically significant results were noted in the topical injection model. We also reported good effects on the systemic injection model, although we did not find any statistical significance. CB-MSC may influence wound healing by TGF-ß.
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Sangre Fetal/citología , Trasplante de Células Madre Mesenquimatosas , Piel/lesiones , Cicatrización de Heridas , Animales , Diabetes Mellitus Experimental/fisiopatología , Humanos , Inyecciones Intralesiones , Inyecciones Intravenosas , Ratones , Ratones Endogámicos C57BL , Ratones Mutantes , Factor de Crecimiento Transformador beta/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Cicatrización de Heridas/fisiologíaRESUMEN
Antiadhesive barrier solution (AABS) has been proven to prevent intraabdominal adhesion by reducing inflammation and fibrosis formation. Because this mechanism can also be applied to capsule formation after the breast implant insertion, we hypothesize that AABS can reduce capsular contraction and evaluate the efficacy of AABS on perisilastic implant capsule formation after submuscular insertion. A silicone block was inserted beneath the panniculus carnosus muscle in 10 rats. The experiment group received 0.1 mL of AABS (Guardix, Hanmi Medical Co.) instilled into the pocket, whereas the control group received 0.1 mL saline solution. Periimplant capsules were excised after 4 weeks and were evaluated for inflammatory cell count, capsular thickness, collagen pattern, and amount of myofibroblast. The inflammatory cell count and the capsular thickness were lower in the experiment group than in the control group (P < 0.05). The collagen pattern was loose and parallel in the experiment group, and the amount of myofibroblast was much less compared with the control group. AABS reduced the amount of inflammatory cells, myofibroblast, and capsular thickness. It also made the collagen fibers in the capsule loose and parallel. Therefore, AABS seemed to be effective in reducing the periimplant capsule formation.
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Implantación de Mama/efectos adversos , Carboximetilcelulosa de Sodio/farmacología , Ácido Hialurónico/farmacología , Adherencias Tisulares/prevención & control , Animales , Recuento de Células , Contractura/prevención & control , Modelos Animales de Enfermedad , Combinación de Medicamentos , Inmunohistoquímica , Masculino , Ratas , Ratas Sprague-Dawley , Siliconas , Adherencias Tisulares/patologíaRESUMEN
A visible cutaneous scar develops from the excess formation of immature collagen in response to an inflammatory reaction. This study examined the role of epidermal growth factor (EGF) in the formation of cutaneous scars. Twenty Crl:CD-1 (ICR) mice were used and 2 full-thickness skin wounds were made on the dorsum of each mouse. One of the wounds was treated with recombinant human EGF by local application and the other was treated with saline for control until complete healing was achieved. The EGF-treated group's wounds healed faster than the control group's. The width of the scar was smaller by 30% and the area was smaller by 26% in the EGF-treated group. Inflammatory cell numbers were significantly lower in the EGF-treated group. The expression of transforming growth factor (TGF)-beta(1) in the EGF-treated group was increased. It was observed that the amount of collagen in the EGF-treated group was larger than the control group. In the EGF-treated group, the visible external scars were less noticeable than that in the control group. These results suggest that EGF can reduce cutaneous scars by suppressing inflammatory reactions, decreasing expression of TGF-beta(1), and mediating the formation of collagen.
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Cicatriz/prevención & control , Factor de Crecimiento Epidérmico/farmacología , Proteínas Recombinantes/farmacología , Cicatrización de Heridas/efectos de los fármacos , Animales , Cicatriz/patología , Colágeno/metabolismo , Humanos , Inflamación/metabolismo , Ratones , Piel/efectos de los fármacos , Piel/metabolismo , Piel/patologíaRESUMEN
BACKGROUND AND OBJECTIVES: Recently developed laser lipolysis systems have been disappointing because they require more time to remove the same amount of fat than other liposuction methods. A new Nd:YAG laser has been introduced that uses the 1,444 nm wavelength, better absorbed by fat. STUDY DESIGN/MATERIALS AND METHODS: This study consisted of two protocols. The first protocol was an in vivo minipig model. Four 10x10 cm(2) areas were treated on the back of the first minipig. Using the same total energy and power settings (5,000 J, 8 W), both the 1,064 nm and 1,444 nm lasers were used to irradiate the two cephalic areas. The two caudal areas were irradiated with both lasers, using the maximum power settings (12 W with the 1,064 nm laser, 8 W with the 1,444 nm laser). Another minipig was administered a preoperative injection of tumescent solution and treated with the same condition. Measurements of fat volume with computed tomography and histologic exams were conducted. The second experiment involved in vitro human fat. Equal amounts of human fat, harvested by liposuction, were put into test tubes and irradiated with 1,064 nm and 1,444 nm lasers. Oil production was measured from each test tube. RESULTS: A marked reduction in fat volume and more oil vacuoles and giant cells in histology were identified with the 1,444 nm wavelength compared to the 1,064 nm wavelength. Human fat in the in vitro experiments also revealed more oil production following the use of the 1,444 nm laser. CONCLUSION: The 1,444 nm Nd:YAG laser showed a greater lipolytic effect compared to the 1,064 nm Nd:YAG laser in in vivo minipig and in vitro human fat experiments. To achieve a full understanding of the effects of 1,444 nm Nd:YAG laser lipolysis on the human body, in vivo experimentation will be necessary.
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Tejido Adiposo/cirugía , Terapia por Láser , Láseres de Estado Sólido/uso terapéutico , Lipectomía/instrumentación , Animales , Técnicas Cosméticas , Humanos , Masculino , Modelos Animales , PorcinosRESUMEN
PURPOSE: There have been numerous attempts to use pharyngoesophageal reconstruction to restore swallowing function. Much controversy exist over reconstruction after total or partial pharyngectomy, and there is also debate over whether to continue with the reconstructive procedure with a narrow strip of remnant mucosa or complete it after total pharyngectomy. We analyzed the utility of omega-shaped radial forearm free flap (RFFF) using the narrow remnant posterior pharyngeal wall. METHODS: Patients in group 1 (n = 12) had a narrow remnant pharyngeal wall with a width of less than 3 cm. Those in group 2 (n = 35) had a remnant pharynx with a width larger than 3 cm. The incidence of fistula, stricture, and swallowing difficulty were evaluated. Swallowing difficulty was graded using a 7-point visual analog scale. All circumferential hypopharyngeal reconstruction with tubed RFFF, pectoralis major flap, and jejunal free flap were also compared with group 1. RESULTS: All flaps survived, and 1 fistula (8%) was detected in group 1. Compared with tubed RFFF (46%) and tubed pectoralis major flap (57%), this is a relatively low rate of fistula formation. In group 1, normal diet was possible in 92% of patients, but 1 patient can tolerate a liquid diet only. In group 2, normal diet was possible in 80% of patients. As for swallowing difficulty, the median visual analog scale score for both groups 1 and 2 was 6 points. When comparing different flaps, stricture and fistula rate was 0 and 8% in group 1, 15 and 46% in tubed RFFF, 43 and 57% in tubed pectoralis major flap, and 33 and 5% in jejunal flap, respectively. CONCLUSIONS: We performed all surgeries taking care not to transgress the wide excision principle with the remnant hypopharyngeal wall. For remnant lesions greater than 3 cm, patch-type RFFF was performed, whereas for those less than 3 cm, omega-shaped RFFF was done. We achieved fairly good results in both groups without total resection of the narrow remnant hypopharyngeal wall.
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Hipofaringe/cirugía , Faringectomía/clasificación , Faringe/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/clasificación , Anastomosis Quirúrgica/métodos , Constricción Patológica/etiología , Trastornos de Deglución/etiología , Dieta , Estudios de Seguimiento , Antebrazo/cirugía , Supervivencia de Injerto , Humanos , Neoplasias Hipofaríngeas/cirugía , Hipofaringe/patología , Yeyuno/trasplante , Laringectomía/clasificación , Fístula Oral/etiología , Músculos Pectorales/trasplante , Enfermedades Faríngeas/etiología , Faringe/patología , Complicaciones Posoperatorias , Radio (Anatomía) , Estudios Retrospectivos , Recolección de Tejidos y Órganos/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Gossypiboma is derived from the Latin word gossypium, meaning cotton, and it means a postoperatively retained foreign body used in operations. Several cases of gossypiboma have been reported especially after abdominal surgery, but there has not been any reported case in plastic surgery. Mandibular contouring surgery cannot ensure a view wide enough to avoid injury to surrounding structures such as a facial artery and a retromandibular vein. In addition, many surgeons pack the sponge into the operative field to prevent bleeding, and surgeons may neglect remnant surgical materials. Recognition of gossypiboma is essential but is often considerably delayed and cause medicolegal problems. Therefore, it is important to ensure that every effort is made to prevent such occurrences. We had a chance to evaluate and treat gossypiboma, and in this paper, we want to share our experiences. MATERIALS AND METHODS: In circa 1999 to 2007, there were 3 cases diagnosed as gossypiboma after a mandible angle surgery. All patients were female, and some had signs of fever, swelling, tenderness, and purulent discharge of an oral wound. We performed a computed tomographic scan and blood test, and foreign body removal was done under general anesthesia. Intraoperatively, the diagnosis of gossypiboma was confirmed. RESULTS: All symptoms were reduced or subsided after surgery. It was noted that no postoperative infection remained. CONCLUSIONS: Gossypiboma must be considered when fever, unilateral swelling, tenderness, or unhealed oral wound is sustained despite an antibiotics therapy and a drainage procedure after a mandible angle surgery. In that case, a computed tomographic scan can be recommended as an effective method for detection of gossypiboma.
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Cuerpos Extraños/etiología , Mandíbula/cirugía , Tapones Quirúrgicos de Gaza/efectos adversos , Adulto , Antiinfecciosos Locales/uso terapéutico , Legrado , Edema/etiología , Femenino , Fiebre/etiología , Humanos , Persona de Mediana Edad , Povidona Yodada/uso terapéutico , Procedimientos de Cirugía Plástica/efectos adversos , Supuración , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/etiología , Irrigación Terapéutica , Tomografía Computarizada por Rayos XRESUMEN
This study examines the role of botulinum toxin type A (BoTA) in preventing the collapse of the peripheral vessels in the cutaneous flap and in increasing the survival of the flap. Because BoTA cleaves the SNAP-25 protein, the release of vasoconstriction cotransmitters as well as acetylcholine would be blocked. Dorsal skin flaps in rats were elevated and returned to the original position. In the BoTA and the control group, either BoTA or saline was injected into the entire flap. The flap survival rate measurement and a histopathological examination were performed 1 week after flap elevation. The cutaneous blood flow was measured in three different areas of each flap, serially. In BoTA group, there was a significant increase in the survival rate (93.79 +/- 6.06%, p=0.042). In the control group, the blood flow was decreased significantly immediately after flap elevation. The blood flow was high in all areas in the BoTA group in a week, and also most of the vessels maintained their shape without collapsing. In conclusion, pretreatment with BoTA increases the dorsal skin flap survival in rats by increased perfusion, and further studies should be performed to determine the possible mechanism by which BoTA attenuates the sympathetic vasoconstriction effect in skin flaps.
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Toxinas Botulínicas Tipo A/administración & dosificación , Supervivencia de Injerto/efectos de los fármacos , Trasplante de Piel/patología , Colgajos Quirúrgicos/patología , Cicatrización de Heridas/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Inyecciones Intralesiones , Microcirculación/efectos de los fármacos , Neurotoxinas/administración & dosificación , Proyectos Piloto , Ratas , Ratas Sprague-Dawley , Colgajos Quirúrgicos/irrigación sanguínea , Resultado del Tratamiento , Vasoconstricción/efectos de los fármacos , Cicatrización de Heridas/fisiologíaAsunto(s)
Cicatriz/cirugía , Procedimientos Quirúrgicos Dermatologicos , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Cirugía Plástica/métodos , Adulto JovenRESUMEN
The ischial area is by far the most common site for pressure sores in wheelchair-bound paraplegic patients, because most of the pressure of the body is exerted on this area in the seated position. Even after a series of successful pressure sore treatments, the site is very prone to relapse from the simplest everyday tasks. Therefore, it is crucial to preserve the main pedicle during primary surgery. Several surgical procedures, such as myocutaneous flap and perforator flap, have been introduced for the treatment of pressure sores. During a 4-year time period at our institute, we found favourable clinical results using the inferior gluteal artery perforator (IGAP) procedure for ischial sore treatment. A total of 23 patients (20 males and three females) received IGAP flap surgery in our hospital from January 2003 to January 2007. Surgery was performed on the same site again in 10 (43%) patients who had originally relapsed after undergoing the conventional method of pressure sore surgery. The average age of patients was 47.4 years (range 26-71 years). Most of the patients were paraplegic (16 cases, 70%) and others were either quadriplegic (four cases, 17%) or ambulatory (three cases, 13%). Based on hospital records and clinical photographs, we attempted to assess the feasibility and practicability of the IGAP flap procedure through comparative analysis of several parameters including the size of the defective area, treatment modalities, relapses, complications, and postoperative treatments. The average follow-up duration for 23 subjects was 25.4 months (range 5-42 months). All flaps survived without major complications. Partial flap necrosis developed in one case but secondary healing was achieved and the final outcome was not impaired. Most of the cases healed well during the follow-up period. Postoperative complications such as wound dehiscence and fistula developed in some subjects, but all healed well with a secondary treatment. A total of five cases relapsed after surgery due to tissue deficit and these were treated with bursectomy and muscle transposition flap to fill the dead space. We propose that the IGAP flap should be considered a viable alternative to other methods of ischial pressure sore surgery owing to its many advantages, which include the ability to preserve peripheral muscle tissue, the variability of flap designs, relatively good durability, and the low donor site morbidity rate.
Asunto(s)
Parálisis/complicaciones , Úlcera por Presión/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Adulto , Anciano , Femenino , Humanos , Isquion , Masculino , Persona de Mediana Edad , Úlcera por Presión/etiología , Recurrencia , Estudios RetrospectivosRESUMEN
BACKGROUND: Enophthalmos is the most distressing and common complication of the blow-out fracture. In spite of well-established indications for early operative repair of orbital fracture, 7-10% of patients treated non-operatively develop enophthalmos. There have been reports on the correlation between changes of orbital bone and enophthalmos; however, there is no report on muscle changes in computed tomography (CT) in medial blow-out fracture. The present authors have documented the correlation between change of medial rectus muscle and enophthalmos using CT scan in medial blow-out fracture patients. METHODS: In this study (from January 2001 to December 2006) of 340 patients diagnosed with medial blow-out fracture, 24 patients were treated non-operatively. Nine patients (Group 1) have over 2-mm enophthalmos and 15 patients (Group 2) have enophthalmos less than 2mm. The height-to-width (H-W) ratios of medial rectus muscle were measured in coronal views, and the size of defects were measured in coronal and axial views in CT. Hertel's exophthalmometry was measured on both eyes for all patients. RESULTS: The H-W ratios measured in the affected orbits were statistically significant between the two groups (p<0.0001). However, the size of defect is not related with enophthalmos in two groups statistically (P=0.421). CONCLUSION: These results mean that the H-W ratio of medial rectus muscle in coronal views of CT is a useful parameter to predict enophthalmos, and whether H-W ratios of medial rectus muscle over 0.7 need surgical correction.