반복된 단순포진 각막염의 반흔에 발생한 포마 그로메라타 진균각막염 1예

전종화,류남희,장성동 대한안과학회 2014 대한안과학회지 Vol.55 No.8

Purpose: To report a case of Phoma glomerata keratitis occurring in recurrent herpes simplex keratitis cicatrix. Case summary: A 63-year-old male patient was admitted to our hospital with complaints of abrupt visual deterioration and ocular pain in his left eye. He was treated for recurrent herpes simplex keratitis in the same eye 12 years prior. Because central desmatocele was observed as a result of advanced corneal stromal melting, Gram staining, Potassium Hydroxide (KOH) mount, and culture were performed in corneal scrape specimens. On microbiological evaluation, a Phoma species was detected and Phoma glomerata was diagnosed using DNA sequencing method. Two consecutive amniotic membrane transplantations were performed with topical antifungal agents. The lesion was not improved when using topical amphotericin B and natamycin eyedrops, thus fluconazole eyedrops were used additionally. The corneal infection was resolved with central thick opacification. Conclusions: In the present case, herpetic keratitis was the main underlying causative factor because the patient had no past history of trauma. When diverse appearances of keratitis occur in herpes simplex keratitis patients, clinicians need to consider the concurrence of fungal infection, especially Phoma glomerata, a rare fungal organism. J Korean Ophthalmol Soc 2014;55(8):1229-1232

두피나 눈썹부의 반흔성형술 시 편리한 모발고정법

박재희,오갑성 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.5

Difficulties with intraoperative fixation of hair or eyebrow sometimes occur because of displacement or dislodgment of hair during surgery. So we have found that the simple application of a small transparent adhesive disposable dressing, such as Tegaderm or OpSite Flexigrid, can prevent this. One of the advantages of this technique, compared with stapler fixation of the hair, is that it does not cause local trauma. An OpSite Flexigridor Tegaderm is placed such that it covers both the scar and operation site hair. The hair or eyebrow were easily, quickly, and firmly positioned even on the nonshaved scalp. The technique seems to have no drawbacks, and when the Tegaderm or Opsite Flexigrid is removed, patient experiences little discomfort. We have never seen an allergic or direct traumatic cutaneous response following the use of these materials.

Correlation between dermal thickness and scar formation in female patients after thyroidectomy

김홍일,곽찬이,김효영,이형석,박은주,김정훈,박진형 대한두개안면성형외과학회 2018 Archives of Craniofacial Surgery Vol.19 No.2

Background: Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. Methods: For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. Results: There was a positive correlation between dermal thickness and scar score (p<0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (p<0.05). Conclusion: Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.Skinfold thickness / Hypertrophic cicatrix Background: Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. Methods: For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. Results: There was a positive correlation between dermal thickness and scar score (p<0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (p<0.05). Conclusion: Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.

안와골절 재건후 발생한 반흔성 하안검 외반증에 대한 증례보고

장계표(Gye Pyo Jang),박영주(Young Ju Park),조영승(Young Seung Cho),김미자(Mi Ja Km),김정래(Jung Rae Kim),박준우(Jun Woo Park),안병근(Byung Keun Ahn) 대한구강악안면외과학회 1998 대한구강악안면외과학회지 Vol.24 No.2

Ectropion is a drooping or eversion of the lower eyelid as a result of lower lid laxity, canthal tendon laxity, or cicatrix formation from scarring. Ectropion can also be congenital or develop with aging. This complication can arise from primary trauma to the lower lid apparatus or as a result of unfavorable healing and scar contracture. To prevent development of ectropion, a careful attention in case of operation for orbital frature repair or blepharoplasty is necessary. Especially, excessive dissection or retraction of skin and orbicularis muscle should be avoided, and formation of edema and hematoma should be prevented by complete hemostasis. It might be helpful to massage on the eyelid frequently. In spite of endeavors mentioned above, lareral canthoplasty or skin graft must be performed when postoperative ectropion is occurred. With literature review the authors present a case report that good clinical result is achieved by lateral tarsal strip procedure on cicatricial ectropion caused by a complication of reconstruction of blow-out fracture.

Platysma Flap with Z-Plasty for Correction of Post-Thyroidectomy Swallowing Deformity

Min Kyeong Jeon,강석주,선욱 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.4

Background Recently, the number of thyroid surgery cases has been increasing; consequently, the number of patients who visit plastic surgery departments with a chief complaint of swallowing deformity has also increased. We performed a scar correction technique on post-thyroidectomy swallowing deformity via platysma flap with Z-plasty and obtained satisfactory aesthetic and functional outcomes. Methods The authors performed operations upon 18 patients who presented a definitive retraction on the swallowing mechanism as an objective sign of swallowing deformity, or throat or neck discomfort on swallowing mechanism such as sensation of throat traction as a subjective sign after thyoridectomy from January 2009 till June 2012. The scar tissue that adhered to the subcutaneous tissue layer was completely excised. A platysma flap as mobile interference was applied to remove the continuity of the scar adhesion, and additionally,Z-plasty for prevention of midline platysma banding was performed. Results The follow-up results of the 18 patients indicated that the definitive retraction on the swallowing mechanism was completely removed. Throat or neck discomfort on the swallowing mechanism such as sensation of throat traction also was alleviated in all 18 patients. When preoperative and postoperative Vancouver scar scales were compared to each other, the scale had decreased significantly after surgery (P<0.05). Conclusions Our simple surgical method involved the formation of a platysma flap with Zplasty as mobile interference for the correction of post-thyroidectomy swallowing deformity. This method resulted in aesthetically and functionally satisfying outcomes.

An outbreak of devastating facial stigmata caused by a single unlicensed aesthetic practitioner

Dai Won Jun,김다희,박민석,김영진,Jung Ho Lee 대한미용성형외과학회 2022 Archives of Aesthetic Plastic Surgery Vol.28 No.4

Background The practice of medicine by uncertified personnel is a common concern in public healthcare. Although the introduction of the Korean National Health Insurance Service has significantly reduced the number of these cases, the problem persists in the field of aesthetics. Herein, we report an outbreak of devastating facial stigmata in patients treated with illegal cosmetic procedures. Methods During 1 week in November 2021, five patients presented to Bucheon St. Mary’s Hospital for the management of identical patterns of severe facial scarring. Each patient had been treated for “skin rejuvenation” by a single unlicensed practitioner. Months of needling therapy by the practitioner, aimed at resolving the problem, only aggravated the scarring. The victims visited our hospital after the practitioner ceased to answer their calls. The patients had similar presentations with multiple prominent scars on both cheeks. Ectropion of the right lower eyelid due to scar contracture was observed in one patient. Results Five monthly treatments with intralesional triamcinolone injection and laser therapy were performed. Despite thorough management, the patients were left with improved but distinctive stigmata on their faces. Conclusions Cases of illegal aesthetic procedures are difficult to prosecute because the patients have implicitly agreed to the procedure. Therefore, active legislative measures should be adopted to prevent further victimization. Public education on the dangers of illegal aesthetic practices is also necessary.

Comparison of long-term abdominal scarring after DIEP flap reconstruction: conventional dermal sutures versus INSORB dermal staples

민재청,전동녘,김형배,Eun Key Kim,Jin Sup Eom,Hyun Ho Han 대한미용성형외과학회 2024 Archives of Aesthetic Plastic Surgery Vol.30 No.3

Background The importance of adequate wound closure in plastic surgery cannot be overstated. With the goals of shortening the operative time and improving outcomes, various methods and devices have been introduced to enhance the speed and quality of wound closure. To simplify dermal closure with favorable outcomes, several studies have compared results between the INSORB dermal stapler and conventional dermal sutures. We hypothesized that the dermal stapler would yield satisfactory scar forma tion without increasing complication rates over the long term. Methods This retrospective study included patients who had undergone breast recon struction with a deep inferior epigastric perforator (DIEP) free flap between October 2019 and May 2020 at a single center. Postoperative photographs of the patients’ ab dominal scars were assessed at a minimum of 248 days by three blinded attending plastic surgeons using the Vancouver Scar Scale. Results A total of 108 patients who underwent DIEP-free flap reconstruction after mas tectomy were included in this study. Among them, 68 patients (group 1) underwent der mal closure with the INSORB dermal stapler, while 40 patients (group 2) underwent con ventional dermal sutures. No significant differences were observed between the two groups in terms of vascularity, pigmentation, pliability, scar height, or overall scar assess ment. Additionally, there was no significant difference in complication rates between the two groups. Conclusions The INSORB dermal stapler is a valuable tool that can reduce operative time while delivering satisfactory outcomes. When used appropriately with proper training, it can mitigate perioperative complications and alleviate the surgical burden for the sur geon.

Comparison of the effect of silicone gel sheets by thickness on excisional scars in pediatric and adolescent patients

김민지,이우범,박동하 대한미용성형외과학회 2022 Archives of Aesthetic Plastic Surgery Vol.28 No.1

Background Selecting effective products among the various types of silicone gel sheets can be challenging for surgeons. Therefore, we assessed the effect of silicone gel sheet thickness on surgical scars in pediatric and adolescent patients. Methods From December 2017 to May 2018, we identified patients aged 1–19 years who underwent excision. Among these patients, those who were prescribed 0.3-mm or 1.0-mm-thick silicone sheets were selected. Scars were subjectively evaluated using a questionnaire consisting of seven items. Objective evaluation was performed by two plastic surgeons using the Vancouver Scar Scale (VSS). Results The mean age of the 49 selected patients was 9.78 years. The patients were divided into two groups according to the thickness of the silicone gel sheet used (0.3 mm vs. 1.0 mm). Objective evaluation of the patients’ scars revealed more favorable results in the 0.3 mm group than in the 1.0 mm group (P=0.010). Multivariate analysis of VSS scores indicated that the resulting scars in cases involving the trunk were of poorer quality than those involving facial areas (P=0.015). Additionally, favorable (i.e., belowaverage) VSS scores were significantly less likely in patients with longer scars (odds ratio [OR], 0.896; 95% confidence interval [CI], 0.834–0.963; P=0.003) or thicker silicone sheets (OR, 0.085; 95% CI, 0.011–0.699; P=0.019). Conclusions The use of thinner silicone gel sheets in children and adolescents resulted in better scars according to subjective evaluations, underscoring the importance of compliance in pediatric patients. The type of operation and surgical lesion should also be considered when planning the management of surgical scars.

Anti-Vascular Endothelial Growth Factor (Bevacizumab) Therapy Reduces Hypertrophic Scar Formation in a Rabbit Ear Wounding Model

곽도훈,배태희,김우섭,김한구 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.6

Background Hypertrophic scarring is a pathological condition that occurs after trauma or surgery. Angiogenesis occurs more often with hypertrophic scarring than with normotrophic scarring. The regulation of angiogenesis is one of the key factors in hypertrophic scar management. Vascular endothelial growth factor (VEGF) is an essential factor in the angiogenetic response. This study investigated whether decreasing the level of VEGF is effective for treating hypertrophic scarring. Methods Ten 8-week-old female New Zealand white rabbits were included. Four defects were created on each ear by using a 6-mm punch. Bevacizumab (Avastin, Roche Pharma, Basel, Switzerland) was administered in one ear and normal saline was administered in the other ear. Treatment was administered starting on day 2, every 2 days, until day 14. The levels of VEGF were measured using enzyme-linked immunosorbent assay on day 10 and histologic results were analyzed on day 40. Results Bevacizumab induced-defects showed less hypertrophic scarring when compared with the control group as measured by the scar elevation index (SEI) and loose collagen arrangement. The SEI in the experimental group was 1.89±0.13, compared to 1.99±0.13 in the control group (n=30, P=0.005). Additionally, the VEGF level was lower (38.72±11.03 pg vs. 82.50±21.64 pg, n=10, P=0.001) and fewer vessels existed (8.58±0.76 vs. 7.2±1.20, n=10, P=0.007). Conclusions Preventing excessive angiogenesis is effective for preventing scar formation, especially with hypertrophic scarring. Although it is not an approach that is sufficient alone for the management of scarring, it may be one of several important strategies for scar treatment.

The Effect of Stromal Vascular Fraction on Scar Formation of Transverse Rectus Abdominis Muscle Flap Donor Sites: A Pilot Study

Koo Tee Tae,진웅식 대한창상학회 2022 Journal of Wound Management and Research Vol.18 No.1

Background: Stromal vascular fraction (SVF), which plays a substantial role in wound healing, has been discussed in many recent studies concerning its positive effect on scar formation. Our study explored the effects of SVF on scar formation from partially-removed transverse rectus abdominis muscle (TRAM) flaps after inset. Methods: From December 2017 to May 2020, we enrolled 11 patients undergoing breast reconstruction performed by a single surgeon using the free TRAM flap. As a split-body, placebo-controlled study, SVF was subcutaneously injected into one side of the abdomen, and normal saline was injected into the other side of each patient. Scarring was evaluated using the Vancouver Scar Scale (VSS) and Patient Scar Assessment Questionnaire (PSAQ) at 1, 6, and 12 months after surgery, and histology was evaluated with immunofluorescence analysis at 6 months after surgery. Results: No statistically significant differences were noted in the total scores or subcategory score of the VSS and PSAQ between the test and control groups. Some patients showed more positive staining for alpha smooth muscle actin, collagen type I, and type III in the test group than in the control group. However, quantification of positively stained areas showed no statistically significant difference. Conclusion: Intraoperative SVF injection had no demonstrable clinical effect on scar quality. Histology with immunofluorescence analysis also failed to demonstrate any significant effect of SVF on scars at the microscopic level. Despite previous studies indicating the positive effects of SVF on scar quality, this pilot study questions its true effectiveness.