저주파 펄스 전자기장 자극에 의한 피부 조직괴사 완화 효과

이자우,김준영,이용흠,Lee, Jawoo,Kim, Junyoung,Lee, Yongheum 대한의용생체공학회 2021 의공학회지 Vol.42 No.1

Objective: The aim of this study is to consider the effect of skin tissue necrosis by improving blood flow in animal skin models for low frequency pulsed electromagnetic fields (LF_PEMF) stimulation. Methods: Twenty rats (Wistar EPM-1 male, 280-320 g) were randomly divided into control groups (n=10) and the PEMF groups (n=10). To induce necrosis of the skin tissue, skin flap was treated in the back of the rat, followed by isolation film and skin flap suturing. Subsequently, the degree of necrosis of the skin tissue was observed for 7 days. The control group did not perform any stimulation after the procedure. For the PEMF group, LF_PEMF (1 Hz, 10 mT) was stimulated in the skin flap area, for 30 minutes a day and 7 days. Cross-polarization images were acquired at the site and skin tissue necrosis patterns were analyzed. Results: In the control group, skin tissue necrosis progressed rapidly over time. In the PEMF group, skin tissue necrosis was slower than the control group. In particular, no further skin tissue necrosis progress on the day 6. Over time, a statistically significant difference from the continuous necrosis progression pattern in the control group was identified (p<0.05). Conclusions: It was confirmed that low frequency pulsed electromagnetic fields (LF_PEMF) stimulation can induce relaxation of skin tissue necrosis.

The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy

Yun, Min Ho,Yoon, Eul Sik,Lee, Byung-Il,Park, Seung-Ha Korean Society of Plastic and Reconstructive Surge 2017 Archives of Plastic Surgery Vol.44 No.6

Background Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy. Methods A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups. Results Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02). Conclusions Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.

The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy

윤민호,윤을식,이병일,박승하 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.6

Background Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy. Methods A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups. Results Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02). Conclusions Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.

Skin Flap Necrosis by Bone Marking with Methylene Blue in Cochlear Implantation

김연후,조성일 대한청각학회 2015 Journal of Audiology & Otology Vol.19 No.2

One of surgical complications in cochlear implantation is the necrosis of the skin flap above the receiver-stimulator coil. We present a case of 55-year-old woman who underwent cochlear implantation and developed a bluish skin necrosis due to bone marking. The planned position for the receiver-stimulator was marked using methylene blue through skin to bone. She did not undergo skin flap thinning and underwent successful implantation with complete electrode insertion. Few weeks postoperatively, the patient developed bluish discoloration with progressive thick, blue eschar formation and skin flap necrosis. She subsequently underwent wound debridement and skin flap closure. Cochlear explantation was not necessary. Timely diagnosis and management about this complication is necessary to prevent further skin breakdown and subsequent device extrusion. This report identifies the marking using methylene blue as another possible source of skin flap necrosis in cochlear implantation, and surgeons should be aware of this potential complication.

Impending skin necrosis by filler: Initial treatment approaches within one month

( Ji Yeon Hong ),( Joon Seok ),( Eun Jung Ko ),( Beom Joon Kim ),( Myeung Nam Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

As the indications and the cases of filler injections increase, the number of complications reported is also rising rapidly. One of the most severe adverse effects is skin necrosis. The most vulnerable areas are those with a single arterial supply. A 44-year-old and a 32-year-old female patients visited our clinic with dusky red necrotic tissue and numerous pustules on the noses after the filler injection to the nasal tip. Initially, we injected hyaluronidase to remove the remnant filler materials. Then, we extracted pustules gently after KMnO4 soaking, applied hyperbaric oxygen therapy, irradiated 833-nm LED, and put occlusive dressing with topical antibiotics and hyaluronic acid gel. They were prescribed vasodilators, aspirin, antibiotics, and antihistamine for 1 week. Both patients showed improvement, as the range of skin necrosis became smaller and the hue changed to dimmer reddish color. After the acute period, we used vascular laser to eliminate the redness and pneumatic injector to reduce the scar tissue. By sharing our experience in treating a number of patients with necrotic complication, we suggest a step-wise guidance on the emergency management and afterward treatment.

피부괴사를 동반한 진행성 유두상암 1예

김지수,Jee Soo Kim 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.3

Although the majority of differentiated thyroid cancers show an indolent course, about 15% of the cancers invade via extra-thyroidal extension (ETE). ETE usually occurs through direct spreading to the strap muscles, the sternocleidomastoid muscle, the recurrent laryngeal nerve, the trachea, the larynx, the esophagus, the pharynx, and/or the major vessels. Direct invasion to the subcutaneous tissue and overlying skin is possible but a rare scenario. We report a 66-year-old patient with locally aggressive papillary thyroid cancer accompanied by skin necrosis. The tumor was resected completely without removal of the overlying skin. (Korean J Endocrine Surg 2007;7:164-167)

Skin necrosis following accidental injection of sodium bicarbonate

( Jong-kil Seo ),( Ye-jin Lee ),( In-hye Kang ),( Hye-jin Ahn ),( Ki-heon Jeong ),( Min Kyung Shin ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Intravenous sodium bicarbonate injection has been used to treat metabolic acidosis. When it was used in low amount of fluid, no common complications have been reported. It is a component with little potential for intradermal injection and rarely reported adverse effects of skin injection. Moreover, the local adverse effect resulting in a skin necrosis similar to burn is very rare. A 20-year-old female presented with a painful ulcer on the right forearm. She was a nursing student and was burned due to injection of sodium bicarbonate accidentally during intradermal injection practice. Physical examination revealed an erythematous, ulcerative patch that was 1.5 x 1 cm in diameter. We initially treated with simple dressing for 2 weeks, but lesions soon became necrotic. Therefore, the treatment with collagen sheets and EGF solution was performed for one month. And the skin lesion was re-epithelialized. Since sodium bicarbonate barely has an event for intradermal injection, we herein report a rare case of skin necrosis following an intradermal infusion of sodium bicarbonate for educational purposes.

Warfarin skin necrosis mimicking calciphylaxis in a patient with secondary hyperparathyroidism undergoing peritoneal dialysis

( Jee Eun Park ),( Seong Gyu Byeon ),( Hee Kyung Kim ),( Seong Mi Moon ),( Ji Hoon Moon ),( Kee-taek Jang ),( Byung-jae Lee ),( Hye Ryoun Jang ),( Woo Seong Huh ),( Dae Joong Kim ),( Yoon-goo Kim ),( 대한신장학회 2016 Kidney Research and Clinical Practice Vol.35 No.1

Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation. Calciphylaxis was considered first because of the host factors; eventually, the skin lesions were diagnosed as WSN by biopsy. The skin lesions improved after warfarin discontinuation and short-term steroid therapy. Most patients with end-stage renal disease have some form of cardiovascular disease and some require temporary or continual warfarin treatment. It is important to differentiate between WSN and calciphylaxis in patients with painful skin lesions.

젊은 여자에서 누소관누낭비강연결술 이후 발생한 피부 괴사 2예

조은영(Eun Young Cho),손준혁(Jun Hyuk Son) 대한안과학회 2015 대한안과학회지 Vol.56 No.11

목적: 누소관폐쇄로 진단 받은 젊은 여자 환자에서 누소관누낭비강연결술을 시행한 후 발생한 내안각 주변부 피부괴사 2예를 경험하여 이를 보고하고자 한다. 증례요약: (증례 1) 31세 여자 환자가 2년간의 우안 눈물흘림을 주소로 내원하였다. 우안 상, 하부 누소관폐쇄로 진단 후 누소관누낭비 강연결술 및 실리콘관 삽입술을 시행하였고, 0.04% mitomycin C를 1주일 동안 하루 2회 점안하도록 하였다. 수술 후 3일째, 우측 하안검 피부내측의 부종, 발적 및 통증을 호소하며 응급실로 내원하였고, 이후 가피 형성 및 삼출물이 발생하며 피부괴사로 진행되었 다. (증례 2) 23세 여자 환자가 3개월간의 우안 눈물흘림을 주소로 내원하였다. 우안 총누소관 폐쇄로 진단하고 누소관누낭비강연결술 및 실리콘관 삽입술을 시행하였다. 수술 후 7일째, 우측 상안검 통성 부종 및 발적을 동반한 구진성 농포가 내측 안각에서 관찰되었고, 이후 국소 피부괴사로 진행되었다. 결론: 젊은 여자에서 누소관누낭비강연결술을 시행 후, 드물지만 내안각 주변부 피부괴사가 발생할 수 있으므로 수술 후 국소적인 피부 증상을 호소하는 경우 주의 깊은 관찰이 필요하다. Purpose: To report 2 cases of skin necrosis over the medial canthus following canaliculodacryocystorhinostomy in young wom-en diagnosed with canalicular obstruction. Case summary: (Case 1) A 31-year-old female presented to our clinic with epiphora in the right eye that had developed 2 years prior. On examination, a right upper and lower canalicular obstruction was noted and the patient underwent canaliculodacryocy-storhinostomy with silicone tube intubation. Topical 0.04% mitomycin-C eyedrops were applied twice a day from postoperative day 1 for 7 days. The patient revisited our emergency center with swelling, redness, and tenderness in the medial canthal region that developed 3 days after the initial surgery. Furthermore, a skin ulceration had developed followed by an exudative oozing with crust. (Case 2) A 23-years-old female visited our clinic with epiphora in the right eye that had developed 3 months prior. Ophthalmic examinations revealed a common canalicular obstruction in the right eye and canaliculodacryocystorhinostomy with silicone tube intubation was performed. Seven days postoperatively, the patient developed mild pain and tenderness over the right lacrimal sac and medial canthal erythema with purulent discharge was noted. Furthermore, a localized skin necrosis had developed. Conclusions: Localized skin necrosis may rarely develop after canaliculodacryocystorhinostomy in young women. If localized skin symptoms develop postoperatively, the patient should be closely monitored.

와파린 복용에 의한 피부 괴사

안성환,김동민,임건한,김진호,김후원,추인성 대한신경과학회 2008 대한신경과학회지 Vol.26 No.2

Warfarin is widely used for the prevention of cerebral infarction, especially in patients with atrial fibrillation or artificial valve. Although hemorrhagic problems are well known, skin necrosis is a rare complication. Failures of early diagnosis or management may lead to serious results. We report a case of skin necrosis induced by warfarin therapy.