Acellular Dermal Matrix to Treat Full Thickness Skin Defects: Follow-Up Subjective and Objective Skin Quality Assessments

박재윤,이태근,김지예,이명철,장윤규,이원재 대한두개안면성형외과학회 2014 Archives of Craniofacial Surgery Vol.15 No.1

Background: There are several options for replacement of the dermal layer in fullthicknessskin defects. In this study, we present the surgical outcomes of reconstructionusing acellular dermal substitutes by means of objective and subjective scarassessment tools. Methods: We retrospectively reviewed the medical records of 78 patients who hadundergone autologous split-thickness skin graft with or without concomitant acellulardermal matrix (CGDerm or AlloDerm) graft. We examined graft survival rate andevaluated postoperative functional skin values. Individual comparisons were performedbetween the area of skin graft and the surrounding normal skin. Nine months aftersurgery, we compared the skin qualities of CGDerm graft group (n=25), AlloDermgraft group (n=8) with skin graft only group (n=23) each other using the objective andsubjective measurements. Results: The average of graft survival rate was 93% for CGDerm group, 92% forAlloDerm group and 86% for skin graft only group. Comparing CGDerm grafted skin tothe surrounding normal skin, mean elasticity, hydration, and skin barrier values were 87%,86%, and 82%, respectively. AlloDerm grafted skin values were 84%, 85%, and 84%,respectively. There were no statistical differences between the CGDerm and AlloDermgroups with regard to graft survival rate and skin functional analysis values. However,both groups showed more improvement of skin quality than skin graft only group. Conclusion: The new dermal substitute (CGDerm) demonstrated comparable resultswith regard to elasticity, humidification, and skin barrier effect when compared withconventional dermal substitute (AlloDerm).

이마피판술과 후이개부 전층피부이식술을 이용한 안면부 연부조직 결손 재건 후 피부 색상의 비교

조성후,유성인,노복균,김의식,황재하,김광석,이삼용 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.1

Purpose: For facial reconstruction, skin color match is crucial to achieve great aesthetic result. Forehead flap and full thickness skin graft have been used for many years to reconstruct facial defect. Their results are aesthetically valuable with remarkable resemblance and harmony of the skin color between donor and recipient sites. The purpose of this study is to evaluate and compare the aesthetic outcome of the two methods as the analysis of skin color match.Methods: From January 1995 to December 2005, ten forehead flaps and ten full thickness skin grafts were performed. The reconstructed areas of forehead flaps were five noses and five eyelids. Recipient sites of full thickness skin grafts were seven eyelids, two noses and one forehead. In order to obtain the objective validity, the skin color of flap(or graft) and the recipient sites were measured by chromameter. The skin colors were quantified according to a three-dimensional coordinate system used in chromameter, L*(brightness), a*(redness), and b*(yellowness).Results: There was no significant color difference between forehead flap site and adjacent skin in all color values. On the other hand, the L* and b* values of graft sites were significantly lower than those of the adjacent skins. The a* values of graft sites were higher than those of the adjacent skins.Conclusion: This study reveals that skin color match of forehead flap is greater than that of full thickness skin graft. As forehead flap has adequate volume and great color match, it can be useful to reconstruct deep facial defect such as nasal defect. On the other hand, full thickness skin graft can be used for superficial defect like partial eyelid defect.

일차원 수축 배양 진피를 이용한 전층 피부의 제작과 이식에 관한 연구

이두형,홍성표 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.5

The most advanced viable synthetic skin which could be used on full thickness skin defect is the three dimensional contracted artificial skin desigined by Bell. To increase the biologic activities of the fibroblast in the artificial skin, authors designed the one dimensional contracted artificial skin which consists of dermal equivalent made by contraction of collagen gel in thickness only and epidermal equivalent made with cultured epidermal cells. Authors investigated the biologic activities and morphogenesis of the one dimensional contracted artificial skin and compared with those of three dimensional contracted artificial skin made according to the original Bell's method. And after the two different artificial skins were applied onto the rats the structural changes were investigated grossly and histologically. The results are as followings; 1. The extents of contraction of the one dimensional contracted artificial skin and three dimensional contracted artificial skin were 88-95% and 92-95% respectively. 2. In one dimensional contracted artificial skin the collagen fibers were aligned regularly along the plane of skin surface and the fibroblasts were bipolar, while in three dimensional contracted artifiial skin the collagen fibers were aligned randomly and the fibroblasts retained dendritic shape. 3. The number of viable firoblast was markedly decreased at 3 days of culture and after 3weeks of culture the viable fibroblasts in one dimensional contracted artificial skin increased over the number of preculture stage, while that in three dimensional contracted artifiial skin regressed to half of preculture stage. 4. After grafting the one dimensional contracted artificial skins were taken well at 77%, while the three dimensional-contracted artificial skins were not taken at all. 5. After grafting the blood vessels began to invade the lower dermis by 5 days and reached to upper dermis by 1 week. 6. After grafting the normal shaped intercellular matrices were reorganized by 1 week. 7. After grafting the epidermis was fully differentiated by 1 week. 8. There was no sign of rejection phenomenon such as inflammatory cell infiltration. In conclusion the intercellular matrices of the one dimensional contracted artificial skin is reorganized from culture stage and after grafting the one dimensional contracted artificial skin becomes to normal like strucutre faster than three dimensional contracted artificial skin.

인공진피(Terudermis)를 사용한 심부피부 및 연부조직결손에 대한 치료

신준호,야나가(다나베) 히로코,다이 요시아키,기요카와 켄스케,이노우에 요지로,이정형,백봉수 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

Various reconstructive procedures have been applied for the skin and soft tissue defect. However, the sacrifice of the donor site in flap surgery and skin grafting and involving problems of deformity or adhesion with underlying tissue in skin have facilitated the development of skin substitute. The history of artificial skin starred in 1980's with the invention of the "Stage I" membrane by Yannas, and Burke. Since then, it has been improved and applied to the clinical cases of extensive burn injury and full thickness skin defect the resection of the nevus. Recently, an artificial dermis(Terudermis), which is composed of fibrillar athelocollagens and heat-denaturated athelocollagens was developed by Terumo Co. Terudermis has the advantage of allowing early incorporation of cellular and vascular components into its collagen sponge due to dehydrothermal cross linking which is very weak. It is very suitable biological material especially in the reconstruction of the deep skin defects without dermis. From Jun 1996 to April 1997, we have grafted this artificial dermis on bony exposures after the trauma in 2 cases, and the deep skin and the soft tissue defects after the release of burn scar contracture in 1 case. Patients follow-up period ranged from 6 months to 10 months. A week after Terudermis grafting neovasculization took place and the granulation tissues appeared in 2-3 weeks. Then the split-thickness skin graft was applied secondarily resulting in the reproduction of enough volume of skin. For this matter, Terudermis is very useful for deep skin defects especially where primary local flap or free flap can not be used.

편평한 피부이식면에 Silicone Gel Sheet를 이용한 봉합드레싱의 유용성

장원철,정두성,최준 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.5

Success of skin grafts depends on sufficient immobilization and early intervention for hematoma, seroma, or infection. To stabilize and cover skin grafts with a tie-over technique was used with translucent silicone gel sheet on flat surface. Skin defect was resurfaced with skin grafts. A sterile silicone gel sheet was placed over the skin graft. Gel was fixed to the wound edges with skin sutures. Skin graft healed without any complications.Using silicone gel sheet in skin graft on flat surface is an effective method for stabilization, which also allows direct visualization of the graft designed to inspect hematoma-like complications.

Rapid Expansion and Auto-Grafting Efficiency of Porcine Full Skin Expanded by a Skin Bioreactor Ex Vivo

허만일,안선희,김휘강,송윤정,최은창,안상현,최우성,허증수,임정옥 한국조직공학과 재생의학회 2016 조직공학과 재생의학 Vol.13 No.1

Full skin auto-grafts are required for reconstruction of skin burns and trauma scars. However, currently available clinical approaches such as sheet skin graft, mesh skin grafts, artificial skin graft, and in vivo skin expansion have limitations due to their potential danger for secondary damage and scar formation at the donor site, and discomfort during skin expansion. We developed an advanced bioreactor system and evaluated its function in skin expansion using porcine full skin. The reactor was designed as a pneumatic cylinder type, was programmed to adjust the pressure and the operating time. The system was composed of culture chamber unit, environmental control unit, and monitoring unit. Skins were expanded at 200 kPa pneumatic force and the expanded skins were analyzed by immunohistochemistry and histology. Furthermore we carried out auto-grafting experiment of the expanded skins in vivo using Yucatan pigs and skins were harvested and histologically analyzed after 8 weeks. The results showed that the bioreactor expanded skins to 160% in 4 hours. Histological analysis of the expanded skins revealed that epidermal cells and dermal fibroblasts were viable and remained integrity. The results of auto-grafting experiment indicated that fibrosis and scars were not detected in the grafted skins. This study demonstrates that the newly developed skin bioreactor enabled to obtain large sized full skin rapidly and successful grating.

A Comparison of the Local Flap and Skin Graft by Location of Face in Reconstruction after Resection of Facial Skin Cancer

이경석,김준오,김남균,이윤정,박영지,김준식 대한두개안면성형외과학회 2017 Archives of Craniofacial Surgery Vol.18 No.4

Background: Surgery for reconstruction of defects after surgery should be performed selectively and the many points must be considered. The authors conducted this study to compare the local flap and skin graft by facial location in the reconstruction after resection of facial skin cancer. Methods: The authors performed the study in patients that had received treatment in Department of Plastic Surgery, Gyeongsang National University. The cases were analyzed according to the reconstruction methods for the defects after surgery, sex, age, tumor site, and tumor size. Additionally, the authors compared differences of aesthetic satisfaction (out of 5 points) of patients in the local flap and skin graft by facial location after resection of facial skin cancer by dividing the face into eight areas. Results: A total of 153 cases were confirmed. The most common facial skin cancer was basal cell carcinoma (56.8%, 87 cases), followed by squamous cell carcinoma (37.2%, 57 cases) and bowen’s disease (5.8%, 9 cases). The most common reconstruction method was local flap 119 cases (77.7%), followed by skin graft 34 cases (22.3%). 86 patients answered the questionnaire and mean satisfaction of the local flap and skin graft were 4.3 and 3.5 (p=0.04), respectively, indicating that satisfaction of local flap was significantly high. Conclusion: When comparing satisfaction of patients according to results, local flap shows excellent effects in functional and cosmetic aspects would be able to provide excellent results rather than using a skin graft with poor touch and tone compared to the surrounding normal skin.

확장된 귀 앞 및 이마 피부를 이용한 얼굴 피부 재건술

민경원,김진환,이윤호,한상백,김석화,박철규 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

Skin graft has been widely used for facial skin reconstruction. Inguinal area is the common donor site for full-thickness skin graft of various area. Especially for facial skin graft, retroauricular area or upper eyelid skin has been used as a donor site. But these donor sites have some limitations as perfect ones in terms of size, color and texture when applied onto facial area. Even retroauricular skin shows color and texture differences from normal facial skin after it is grafted. Authors performed expansion of the skin of preauricular area or forehead where minimal scars would come out after final operation. We harvested this expanded skin and performed skin graft following excision of nevus, poor scar, or hemangioma in face. We achieved satisfactory results in terms of color and texture by applying this method in 11 clinical cases; 4 cases of hemangioma, 4 nevus, and 3 cases of traumatic scar. Donor site scars were clinically inspicuous in all these 11 cases.

적절한 항생제를 이용한 공여부 잉여 피부편의 보관

박재구,민경원 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

Todays, remnant split-thickness skin graft is stored for graft failure or for delayed grafting. Refrigerated skin is usually stored for 3 weeks, after which, cellular respiration ceaces. Even though the refrigerated skin can be used before 3 weeks after harvest, the success rate of the skin graft is usually lower than in case of fresh skin. One of the most reliable explanations is multiplication of microorganisms on the stored skin, that is, the more microorganisms on the refrigerated skin, the less the success rate of grafts. For this reasons, some kind of antibiotics have been used for storage of the split-thickness skin piece. But there is no report about the effect of antibiotics on stored skin. We want to know the effect of the antibiotics on stored skin. For this purpose, we did three experiments for qualititative bacteriology of refrigerated skin. Experiment 1 was qualititative identification of microorganisms colonizing split-thickness skin after 2 weeks storage in low temperature, and sensitivity tests for identified microorganisms. On the basis of experiment 1, the proper antibiotics were selected and samples of split-thickness skin were stored using this antibiotics. At 2 weeks after storage in low temperature, samples of split-thickness skin were cultured for identification of bacterial growth. This is experiment 2. Experiment 3 is histologic examination of the split-thickness skin involved in experiment 1 and 2. In the experiment 1, we found five kinds of microorganisms in 9 out of 30 split-thickness skin samples. The most common microorganism was coagulase negative Staphylococcus which was found in 4 samples. Through the antibiotics sensitivity test, teicoplanin was selected as the most proper antibiotics. In experiment 2, we could not find any microorganisms in 30 split-thickness skin samples. In experiment 3, there were no histologic differences in the split-thickness skin samples whether antibiotics were used or not. Through these results, we have confirms that split-thickness skin pieces are more safely stored using proper antibiotics.

스테플러와 고무밴드를 이용한 간편하고 빠른 봉합고정 드레싱

이성준,김용욱,박병윤 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.3

The tie-over dressing is a time consuming work because the long silk sutures get tangled and one must spend time on securing the ends. However it is a necessary procedure for a better take of the skin graft.The skin graft was prepared as a split-thickness graft with or without meshing. After hemostasis of the recipient defect, the prepared skin was placed and tailored for the defect. The skin stapler hold the skin margin, split- thickness graft and a round rubber band in one stitch. And the mesh gauze with ointment was applied over the grafted skin and the bulky moist dressing was applied with fluffy gauze and cotton. Over the bulky dressing the rubber bands crossed over and fixed on the other side of the surrounding edge on the normal skin area by the skin stapler. In case of need, splint and compressive dressing with elastic bandage was applied. From January, 2002 to September, 2002, in 15 patients, this method has been used and proven satisfactory. Skin graft was well taken and the time for tie-over dressing can be reduced markedly. We can ensure the adherence of a skin graft to the bed of the wound by continuous pressure dressing. This technique is simple, fast, and no needs of any special device or dressing materials.