SangHun Cho

Vacuum-assisted closure improves the incorporation of artificial dermis in soft tissue defects: Terudermis(®) and Pelnac(®).

As a dermal scaffold, artificial dermal substitutes allow the body to accomplish its own tissue regeneration through infiltration of cells and neovascularisation. However, they show not only rather lower take rates compared to autologous skin grafts alone, but they also require more time for sufficient vascular ingrowth to overlay the skin graft. To accelerate this overlaying, we applied vacuum‐assisted closure negative‐pressure settings over the artificial dermis: Terudermis® and Pelnac® grafts. Fourteen patients with complex tissue defects were treated, including bone exposure in two cases, tendon exposure in seven cases and soft tissue defects in five cases. Nine cases had combined wound infections. The time interval between the first artificial dermis graft and the second split‐thickness skin graft over it was 7·64 days on average. Dermal substitutes took place completely in all cases and there were no graft failures.

Microsurgical reconstruction for canalicular laceration using Monostent and Mini-Monoka.

Many surgical techniques are available for repairing a lacerated canaliculus, such as, Worst pigtail probing, and monocanalicular or bicanalicular procedures involving silicone intubation. Despite this, controversy still exists regarding the best surgical method in terms of subjective and objective outcomes. We report the experience of microscopic canalicular repair using monocanalicular stents; Monostent (Eagle Vision Inc., Memphis, TN) and Mini-Monoka stents (FCI Ophthalmics, Marshfield Hills, MA) and compare these 2 products. Seventeen cases of canalicular lacerations in 15 consecutive patients underwent microscopic canalicular repair using a monocanalicular procedure with either a Monostent (Eagle Vision Inc.) (5 cases) or a Mini-Monoka stent (FCI Ophthalmics) (12 cases). Microscopic anastomosis of the canalicular mucosa was performed following the placement of a juxta canalicular suture to reduce tension. Subjective and objective flows of repaired lacrimal drainage systems were checked by saline injection using a Healon needle (Advanced Medical Optics, Inc., Santa Ana, CA) and dacryocystogram. Patent lacrimal drainage systems were achieved in 16 of the 17 cases, and mild epiphora was acceptable in 14 patients during follow-up. No cases of spontaneous punctal plug migration, stent displacement, eyeball irritation or inflammation, or granuloma formation were encountered. However, in one case, a Mini-Monoka stent (FCI Ophthalmics) was repeatedly extruded or clogged internally and replaced by Monostent (Eagle Vision Inc.). Although the latter had a larger conduit diameter, it was more flexible and had potentially folded on itself in the lacrimal sac, thus, obstructing flow in this case. Microscopic canalicular reconstruction using a Monostent (Eagle Vision Inc.) or Mini-Monoka stent (FCI Ophthalmics) offers a safe, effective, and straightforward means of acute lacrimal system injury treatment.

Successful composite graft for fingertip amputations using ice-cooling and lipo-prostaglandin E1

In distal fingertip amputations where microanastomosis may not be possible, composite grafting might offer the possibility of maintaining digital length and function using the patients own tissue. Many trials such as ice-cooling, pharmacologic enhancement and hyperbaric oxygenation have been reported to improve the survival rate of the composite graft. Twenty-four cases of unreplantable fingertip amputation were classified as types I to III according to the level of injury. We performed the composite grafting followed by immediate ice-cooling for 2 weeks and intravenous lipo-prostaglandin E(1) (lipo-PGE(1)) injection for 8.8 days each on average. Twenty-two fingertips in 24 patients survived completely with acceptable appearance and sensibility over the 8 month follow-up period. Confirming that therapeutic angiogenesis using ice-cooling and lipo-PGE(1) can increase the survival rate of the composite graft in unreplantable fingertip amputation, we describe the procedures and postoperative care in detail.

The Surgical Release of Dupuytren's Contracture Using Multiple Transverse Incisions

Dupuytrens contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytrens contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytrens contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytrens contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytrens contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytrens contracture.

Rabbit Achilles Tendon Reconstruction with a Tissue-Engineered Silk Scaffold

MethodS: The silk scaffold was constructed using a weaving machine and dry-coated with collagen-hyaluronan (HA), whereas the composite silk scaffold was made by covering a silk scaffold with a lyophilized collagen-HA substrate. We implanted the tendon prostheses into Achilles tendon defects in 16 white New Zealand rabbits. We established the following three experimental groups based on the replacement substitutes used: group I (silk scaffold alone); group II (composite silk scaffold); and group III (composite silk scaffold ensheathed in a human amniotic membrane). Implants were harvested 2, 8, and 12 weeks post-implantation. Histological examinations were conducted using hematoxylin-eosin, Masson’s trichrome, and by performing immunohistochemical staining for CD34. Tenocytes were cultured in vitro to compare cell populations in the three groups.