Yang Woo Kim

Correction of inverted nipples by strong suspension with areola-based dermal flaps

The goal of inverted nipple correction is both aesthetically satisfactory projection of the nipple and functional preservation of the lactiferous ducts. To achieve this outcome, many surgeons1–7 have used areolar dermal flap techniques that add bulk or struts underneath the nipple and tighten the nipple neck. However, the base of these flaps is placed at the nipple neck, which cannot provide a rigid, immobile fulcrum. If the nipple neck is not reconstructed tightly, these flaps can be pulled down simultaneously with the nipple because of scarring or retraction forces. Consequently, these techniques have a risk of nipple inversion or flattening recurrence, especially in severely inverted nipples (Fig. 1, above), indicating the need for a stronger supporting system. If the bases of the dermal flaps are placed on the areola and thereby supported by the compact subcutaneous tissue and the mammary gland, these flaps may strongly resist scarring and retraction forces and may support the nipple more effectively (Fig. 1, below). In this article, we present a strong nipple suspension technique using areola-based dermal flaps for correcting moderately and severely inverted nipples.

Better Survival of Random Pattern Skin Flaps Through the Use of Epigallocatechin Gallate

BACKGROUND Surgical skin flaps are useful, but flap necrosis is a common problem. Epigallocatechin gallate (EGCG), the major polyphenol of green tea, has been investigated as a neovascularization agent to counteract necrosis. OBJECTIVES To evaluate the effect of EGCG on random pattern skin flap survival. MATERIALS AND METHODS The rat dorsal skin flap model was employed. One hundred rats were divided into five groups of equal size. Experimental Group A received local injection of EGCG to the flap, experimental Group B received topical application of EGCG, control Group C received local injection of saline, control Group D received topical application of an acetone–olive oil mixture, and control Group E received no treatment. The surviving area of the flap, regional blood perfusion, capillary density, and vascular endothelial growth factor (VEGF) expression were evaluated. RESULTS We observed a larger area of skin flap survival in Groups A and B than in the control groups. Doppler measurement showed greater perfusion in Groups A and B, and the capillary density and VEGF expression were significantly higher in the experimental animals. CONCLUSION The EGCG treatment enhanced neovascularization and regional perfusion and, as a result, improved skin flap survival.

Reverse gracilis muscle flap: an alternative means of skin coverage for recurrent infection after TKA

PurposePoor wound-healing and skin necrosis are serious but not unusual complications after total knee arthroplasty, and when skin or soft tissue necrosis occurs, reconstructions in the knee area need thin, pliable, tough skin flaps.MethodsA 62-year-old man, who previously underwent multiple TKR operations due to recurrent infection, was transferred from another hospital after a gastrocnemius muscle rotation flap failed. We decided to treat the affected area with a reverse gracilis muscle flap. After confirming that the secondary pedicle was intact by Doppler sonography, muscle dissection was extended to the entry of the secondary pedicle. The proximal tendon of the gracilis muscle was transected, and the muscle was rotated 180° and placed at the recipient site.ResultsThe aim is to report a case of reconstruction at the anterior knee using a reverse gracilis muscle flap that achieved an excellent final clinical result.ConclusionThis case suggests that the indications for a reverse gracilis muscle flap could be broadened when other flaps are not available for knee prosthesis coverage.Level of evidenceTherapeutic study, Level IV.

Effect of Platelet-Rich Plasma on Ischemia-Reperfusion Injury in a Skin Flap Mouse Model

Background:Ischemia-reperfusion (I/R) injury is a leading cause of surgical skin flap compromise and organ dysfunction. Platelet-rich plasma (PRP) is an abundant reserve of various growth factors. Activated platelets play a role in endothelial damage during I/R injury; however, exogenous PRP could inhibit the production of reactive oxygen species. The goal of this study was to investigate the effect of PRP on I/R injury. Methods:Four groups (n=30) of C57BL/6N mice with lateral thoracic artery island flaps were used. Group A, the control group, received flap elevation and repositioning. Group B received PRP and repositioning. Group C had 4 hours of ischemia and then were reperfused. Group D received PRP, had 4 hours of ischemia, and then were reperfused. The survival area of flap tissue and blood perfusion were assessed. Histological evaluation included neutrophil counts. Reactive oxygen species and proinflammatory cytokines were measured to evaluate I/R injury. Protein expression of phosphorylated apoptosis signaling regulating kinase-1 (pASK-1), p38MAPK, and pNF-κB was measured by western blot. Results:PRP treatment enhanced the survival area and perfusion of the flap, reduced neutrophil accumulation in mice subjected to I/R injury. PRP treatment also showed a protective effect, with decreases in nitric oxide, myeloperoxidase, malondialdehyde concentrations. Additionally, PRP suppresses monocyte chemotactic protein-1, TNF-α, IL-1β, and IL-6. Finally, PRP decreased ASK-1 and NF-κB expression in tissues with I/R injury. Conclusion:PRP acts as a protective factor during flap I/R injury by reducing reactive oxygen species level and proinflammatory cytokines via decreased expression of pASK-1 and pNF-κB.

Development of Scar Improving Materials using Enkephalin Derivatives

Although demand for scar treatment has been rising as our quality of life is improved, most scar treatment products rely on importation. Enkephalin is one of the neuropeptides secreted from neuronal ends. As both skin and neuron are derived from the exoderm during the development process, skin cells express opioid receptors as neuronal cells do. Opioid receptors are categorized into three types, mu(m)-, delta(d)-, and kappa(k)- opioid receptors, all of which are directly involved in the wound healing process. In this study, enkephalin derivatives are synthesized by Alanin Scan and their efficacy was evaluated and compared. In vitro wound healing effects, stimulatory effects of collagen synthesis, and skin hydration effects were also evaluated and confirmed. Among Enkephalin derivatives, AS13 showed highest wound healing effect.