Chan Yeong Heo

Longitudinal change of treatment‐related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: A prospective cohort study

To investigate the prevalence of upper limb dysfunction (ULD) and subtypes after breast cancer surgery and to identify factors associated with late ULD.

Current applications of adipose-derived stem cells and their future perspectives

Adult stem cells have a great potential to treat various diseases. For these cell-based therapies, adipose-derived stem cells (ADSCs) are one of the most promising stem cell types, including embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs). ESCs and iPSCs have taken center stage due to their pluripotency. However, ESCs and iPSCs have limitations in ethical issues and in identification of characteristics, respectively. Unlike ESCs and iPSCs, ADSCs do not have such limitations and are not only easily obtained but also uniquely expandable. ADSCs can differentiate into adipocytes, osteoblasts, chondrocytes, myocytes and neurons under specific differentiation conditions, and these kinds of differentiation potential of ADSCs could be applied in regenerative medicine e.g., skin reconstruction, bone and cartilage formation, etc. In this review, the current status of ADSC isolation, differentiation and their therapeutic applications are discussed.

Surgical suture assembled with polymeric drug-delivery sheet for sustained, local pain relief

Surgical suture is a strand of biocompatible material designed for wound closure, and therefore can be a medical device potentially suitable for local drug delivery to treat pain at the surgical site. However, the preparation methods previously introduced for drug-delivery sutures adversely influenced the mechanical strength of the suture itself - strength that is essential for successful wound closure. Thus, it is not easy to control drug delivery with sutures, and the drug-delivery surgical sutures available for clinical use are now limited to anti-infection roles. Here, we demonstrate a surgical suture enabled to provide controlled delivery of a pain-relief drug and, more importantly, we demonstrate how it can be fabricated to maintain the mechanical strength of the suture itself. For this purpose, we separately prepare a drug-delivery sheet composed of a biocompatible polymer and a pain-relief drug, which is then physically assembled with a type of surgical suture that is already in clinical use. In this way, the drug release profiles can be tailored for the period of therapeutic need by modifying only the drug-loaded polymer sheet without adversely influencing the mechanical strength of the suture. The drug-delivery sutures in this work can effectively relieve the pain at the surgical site in a sustained manner during the period of wound healing, while showing biocompatibility and mechanical properties comparable to those of the original surgical suture in clinical use.

Comparison of Quality of Life Based on Surgical Technique in Patients with Breast Cancer

OBJECTIVE More than 80% of women with breast cancer survive for more than 5 years; quality of life is an important issue in these patients. The aim of this study was to assess differences in quality of life among patients who have undergone breast-conserving surgery, total mastectomy and immediate reconstruction after total mastectomy. METHODS A cross-sectional study was conducted during follow-up visits. Women who underwent surgical treatment at least 2 years prior were eligible if they were aged 20-70 years and had a diagnosis of breast cancer (Stages 0-III). Quality of life was evaluated based on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire breast cancer-specific module, Rosenberg Self-esteem Scale, Beck Depression Index, Body Image Scale and sexual scale of the Cancer Rehabilitation Evaluation System. RESULTS A total of 407 patients completed the questionnaires; 254 were treated with breast-conserving surgery, 122 with total mastectomy and 31 with reconstruction after total mastectomy. The mean period between surgery and the survey was 49 months. Women in the breast-conserving surgery group showed better outcomes than women in the total mastectomy and reconstruction after total mastectomy groups with respect to emotional-social function, nausea/vomiting, financial difficulty, body image, arm symptoms and self-esteem. Patients in the reconstruction after total mastectomy group had significantly better outcomes on the sexual scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire breast cancer-specific module and arm symptoms than the total mastectomy group. CONCLUSIONS Quality of life was better in the breast-conserving surgery group than in the total mastectomy or reconstruction after total mastectomy groups, and the total mastectomy and reconstruction after total mastectomy groups had similar quality of life. Efforts to evaluate and improve the quality of life of patients with breast cancer should be continued.

Distally based anterolateral-thigh (ALT) flap with the aid of multidetector computed tomography

The applicability of the proximally based pedicled anterolateral thigh (ALT) flap has been well described with good results, but the use of a distally based ALT flap around the knee has not been fairly presented. The case of a male patient with a soft-tissue defect around the knee who underwent skin reconstruction based on an ipsilateral distally based ALT flap is presented. Multidetector-computed tomography (MDCT) was used to study the vessels of the lower extremity, which allowed easy interpretation as it provided anatomical images with three-dimensional anatomy reconstructions. Because of the knowledge of the anatomical connections with the lateral femoral circumflex artery (LFCA) and the superior lateral genicular artery (SLGA), the distally based ALT flap could be safely transferred. Soft-tissue reconstruction around the knee using the distally based ALT flap could also be performed safely and reliably with the aid of MDCT.

Scar-Free Technique for Inverted-Nipple Correction

BackgroundInverted nipples are associated with aesthetic, functional, and psychological problems. In moderate to severe cases, triangular areolar dermal flap-based methods can effectively correct the condition. A triangular areolar dermal flap supports the nipple base as a result of a hammock-like action and fills the dead space beneath the nipple. However, these flaps leave visible scars on or deform the areola.MethodsThe authors describe a new technique based on the use of two triangular flaps. Compared with other techniques that use triangular flaps, the described technique does not involve areolar skin. Instead, triangular dermal flaps are elevated under the areolar skin, which overcomes the visible scarring issue. The devised technique has been used to correct 87 inverted nipples of 46 patients at our institute.ResultsNo complications or recurrences were encountered, and resulting scars were almost invisible. All patients were satisfied with their postoperative results.ConclusionThe described technique is straightforward and reliable and does not leave visible scars on areolar skin. In particular, it has been found to be especially useful for treating moderately to severely inverted nipples.

A randomized comparison of nitrous oxide versus intravenous ketamine for laceration repair in children.

Objective Ketamine is used intramuscularly or intravenously as a sedative when repairing the skin lacerations of children in many emergency departments (EDs). Nitrous oxide (N2O) has the advantages of being a sedative agent that does not require a painful injection and that offers shallower levels of sedation and a rapid recovery of mental state. We evaluated the clinical usefulness of N2O compared with intravenous ketamine when used for the repair of lacerations in children in the ED. Methods From January to December 2009, we performed a prospective, randomized study at a single academic ED enrolling pediatric patients aged 3 to 10 years who needed primary repair of a laceration wound. The primary outcome was recovery time, which was defined as the time from completion of procedure to recovery of mental state. Other outcomes were sedation depth, pain scale, adverse effects, and satisfaction with sedation. Results There were 32 children who were randomly assigned. Recovery times were shorter in the N2O group compared with those in the ketamine group (median [interquartile range (IQR)], 0.0 minutes, [0.0–4.0 minutes] vs 21.5 minutes [12.5–37.5 minutes], P < 0.05). Sedation levels were deeper in the ketamine group than in the N2O group, but pain scales were comparable between groups. No difference was observed in the satisfaction scores by physicians, parents, or nurses. Conclusions Nitrous oxide inhalation was preferable to injectable ketamine for pediatric patients because it is safe, allows for a faster recovery, maintains sufficient sedation time, and does not induce unnecessarily deep sedation.

Acute suppression of TGF-ß with local, sustained release of tranilast against the formation of fibrous capsules around silicone implants

We propose the acute, local suppression of transforming growth factor beta (TGF-ß), a major profibrotic cytokine, to reduce fibrosis around silicone implants. To this end, we prepared silicone implants that were able to release tranilast, a TGF-ß inhibitor, in a sustained manner for 5 days or 15 days. We performed histologic and immunohistochemical analyses for 12 weeks after the implantation of the implants in living rats. The capsule thicknesses and collagen densities significantly decreased compared with those around the non-treated silicone implants. Notably, early suppression of TGF-ß affected the fibrogenesis that actually occurs at the late stage of wound healing. This change may be ascribed to the decrease in monocyte recruitment mediated by early TGF-ß during the acute inflammatory reaction. Thus, a significant decrease in differentiated macrophages was observed along with a decrease in the quantity of TGF-ß and fibroblasts during the subsequent inflammation stage; these changes led to a diminished fibrotic capsule formation.

Effects of Polydeoxyribonucleotide in the Treatment of Pressure Ulcers

This study aimed to examine the positive effects of polydeoxyribonucleotide (PDRN) on the wound-healing process in pressure ulcers. In this randomized controlled trial, the effects of PDRN were compared over time between an experimental group (n=11) and a control group (n=12). The former was administered the same dose of PDRN intramuscularly (1 ampule, 3 mL, 5.625 mg, for 5 days) for 2 weeks and perilesionally (1 ampule, 3 mL, 5.625 mg, twice a week) for 4 weeks. The primary endpoint for determining efficacy was wound healing in the pressure ulcers, which was reflected by the wound surface area determined using VISITRAK Digital (Smith & Nephew, Largo, FL). The secondary endpoint was the pressure ulcer scale for healing score, determined using pressure ulcer scale for healing (PUSH Tool 3.0 developed by the National Pressure Ulcer Advisory Panel). After the 4-week treatment period, PDRN therapy was found to significantly reduce the wound size and PUSH score, without adverse effect during the treatment. The findings indicate that PDRN can positively modify the wound healing process in pressure ulcers, and its use could improve the clinical outcomes of patients and lower the need for additional therapies or hospital stay. Graphical Abstract

Analysis of multiple risk factors affecting the result of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes mellitus

BACKGROUND The limb-threatening large soft tissue defects that occur on the feet of type 2 diabetic patients have complex causes and are less likely to be corrected by free flap reconstruction compared to those in non-diabetic patients. We retrospectively analysed factors affecting the success of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes. METHODS This study included 33 diabetic patients whose feet were treated with free flap transfers. All patients had limb-threatening large soft tissue defects with tendon or bone exposure. The operative results were divided into three groups at 1 month post-operatively: the complete healing group, and the complication group, with either partial necrosis requiring additional simple procedures or flap failure with total necrosis. Nine preoperative factors were analysed: (1) ankle brachial index, (2) HbA1c, (3) BMI, (4) the smoking factor, (5) atherosclerotic calcifications (6) serum creatinine levels (>1.28 mg dL(-1) vs. <1.28 mg dL(-1)), (7) GFR, (8) wound infection and (9) wound defect size. RESULTS Of the 33 patients, 15 showed complete healing and 18 showed complications of the free flap (eight partial necrosis and 10 flap failure). No atherosclerotic calcifications were found in the patients in the complete healing group, although they were found in 12 patients in the complication group, and this difference was significant (p = 0.002). Patients with serum creatinine levels >1.28 mg dL(-1) had significantly higher free flap transfer complication rates than those with serum creatinine levels <1.28 mg dL(-1) (p = 0.038). CONCLUSIONS This study analysed the risk factors of free flap reconstruction for limb-threatening large soft tissue defects on the feet of type 2 diabetic patients. Serum creatinine levels >1.28 mg dL(-1) and atherosclerotic calcifications were confirmed as risk factors for flap survival.