Young-Chul Jang

Use of the artificial dermis for free radial forearm flap donor site.

The radial forearm free flap has been popular in many area of reconstructive surgery. Despite the many attributes of this flap in surgical reconstruction, one of the clear disadvantages has been the morbidity of the donor site. To solve problems associated with closure of the radial forearm flap donor site, the artificial dermis was used for better outcome in the donor site. From July of 2001 to October 2003, 13 patients (12 male, 1 female) ranging in age from 27 to 67 years underwent free radial forearm transfers. Flap size measured 49 to 144 cm2. Donor-site defects secondary to the flap elevation was closed first with the artificial dermis (Terudermis), marketed by Terumo Inc, Japan, and secondary split-thickness skin graft to the artificial dermis was performed in 15 days (range, 13 to 17 days) on average. There was no flap failure in all cases. Partial loss of the artificial dermis graft was noticed in 2 cases, but it was negligible. Secondary skin graft take was noticed in about 7 days, and there was no remarkable skin graft loss. The artificial dermis was used successfully in 13 patients with the donor defects of free radial forearm flap. Despite the disadvantage to need the secondary split-thickness skin graft, use of the artificial dermis gave us not only soft-tissue augmentation and graft-skin quality similar to full-thickness skin graft but also fast graft healing and diminished morbidity of the skin-graft donor site.

The optimal management of pediatric steam burn from electric rice-cooker : STSG or FTSG?

The steam burn caused by an electric rice-cooker is a unique mode of burn injury in Asian countries, especially Korea and Japan. This type of burn injury is characterized by 1) occurring most frequently on the volar aspect of the hand in toddlers younger than 2 years of age (92.8%); 2) the depth of burns are normally deep second-degree to third-degree (98%) and usually need surgery at the time of injury; 3) flexion contractures of multiple finger joints and web space contracture are common sequelae. We hypothesized that primary full-thickness skin graft (FTSG) would give more reliable results and eliminate the late reconstructive procedures. Between January 1997 and September 1999, 36 patients underwent primary FTSG, and the results of this primary FTSG group were compared with 124 patients who were treated with split-thickness skin graft (STSG; 79/124; 63.7%) or by conservative management (45/124; 36.3%), and readmitted for the correction of hand deformities between September 1995 and September 1999. In the primary FTSG group, 11.1% (4/36) of mild web contractures and 5.5% (2/36) of finger joint contractures were documented, and these did not require the reconstructive procedure during a follow-up period of 8.8 +/- 4.8 months. In 124 patients of the primary STSG or conservative group, the mean time interval to reoperation was 8.9 +/- 4.0 months and all patients received FTSG for correction of late hand deformities. In a retrospective study of the primary STSG group, 42 of 53 patients (79.2%) received reconstructive procedure during a 5-year follow-up period. In this report, we introduce the nature of steam burn caused by electric rice-cooker and propose that primary FTSG may be a reliable method for the treatment of this more severe type of acute burn in pediatric patients.

Clinical and Histological Correlation in Post-Burn Hypertrophic Scar for Pain and Itching Sensation

Background Hypertrophic scar following a burn is caused by the excessive deposit of collagen resulting in an exaggerated wound healing response. The burn patient complains of pain and itching over the scar, which can give rise to cosmetic and functional problems. Objective The aim of this study was to investigate the clinical and histological correlation of a hypertrophic burn scar for itching and pain sensations. Methods Thirty-eight patients underwent a scar release and skin graft. the modified Vancouver scar scale and the verbal numerical rating scale were recorded. All biopsies were taken from scar tissue (scar) and normal tissue (normal). Histologically, tissues were observed in the epidermis, the monocytes around the vessels, the collagen fiber, elastic fiber, and the mast cells. Results The mean total score of MVSS was 8.4±2.7 (pliability 2.0±0.9; thickness 1.8±0.9; vascularity 2.0± 0.9; and pigmentation 2.1±0.9). Pain and itching were 2.4±2.0 and 2.9±3.0. Epidermis were 7.9±2.8 layers (scar) and 4.0±0.8 layers (normal). The collagen fibers were thin and dense (scar) and thicker and loose (normal). The elastic fibers were thin and nonexistent (scar) and thin and loose (normal). Mast cells were 11.2±5.8/high power field (scar) and 7.4±4.1 (normal). Conclusion As the scar tissue thickens, the itching becomes more severe. The stiffness of the scar with the pain appeared to be associated with the condition of the tissue. The correlation between clinical and histological post-burn hypertrophic scars will help further studies on the scar. This helped with the development of the base material for therapeutic strategies.

Face burns caused by flambé drinks.

This study was conducted to identify the epidemiology of face burns in Korean adults caused by flambé drinks in the hope of developing preventive programs. We reviewed the medical records of 25 patients with burns caused by flame drinks that were admitted to the Hallym Burn Centre, Hangang Sacred Heart Hospital, Seoul, Korea, during the 30-month period of July 2002 to December 2004. The injuries occurred while drinking and spilling the whisky on the flame (68%) during the hours of social gathering and festivity. There were more men than women (male:female ratio = 21:4); the mean age was 27.5 ± 5.7 years (mean 27, range 21–43 years). Alcohol flames inflicted superficial (56%) to mid-second-degree burns in a relatively small area of body (TBSA 3.2 ± 3.0%). The head was most commonly involved, followed by the upper extremity and trunk. All patients except two were treated with observation and daily dressing changes only. The mean length of hospital stay was 12.1 ± 6.5 (10, 5–25) days. Long-term cosmetic outcomes were excellent. Some victims suffered mild corneal (n = 4) and ear (n = 6) burns, without permanent sequelae. Post-traumatic stress disorder and depression also were reported. Burn injuries induced by flambé drinks may be prevented by increasing public awareness about its danger and the potential risk for corneal and facial burns and by implementing a safety policy. All the involved parties—public, distillers, and bar and restaurant management—need to coordinate their efforts achieve a reduction in injuries.

Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience

Background This paper discusses the treatment protocol for patients with frostbite. Methods We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012. Results Our clinical series of patients (n=17) included 13 men and four women, whose mean age was 42.4±11.6 years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of 12.7±3.3 days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of 35±4.3 days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation. Conclusions With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.

Clinical features and treatment outcomes of skin cancer arising from burn scar: a single-institution experience.

Aims and Background This study was conducted to investigate the clinicopathological features and long-term outcomes of patients with skin cancer arising from burn scar (SCBS). Patients and Methods We retrospectively reviewed the medical records of patients diagnosed with SCBS between January 2000 and May 2012. A total of 44 patients were enrolled in this study. Results The median latent period between burn injury and development of SCBS was 32 years (range, 8–78 years). The most frequent sites of SCBS were the lower limbs (68.2%) followed by the upper limbs (15.9%) and trunk (11.4%). Most patients (95.4%) had squamous cell carcinoma. Of 34 patients with localized disease at the time of diagnosis, 33 patients are alive with no evidence of recurrence. Of 10 patients with regional lymph node metastasis (referred to as locally advanced disease), 4 died of disease progression and 5 are alive with metastatic disease in the lymph nodes, bone or lung. Patients with localized disease survived longer than patients with locally advanced disease (P = 0.000). In patients with locally advanced disease, the median overall survival time was 16 months (95% CI, 2.88–29.4 months). Conclusions While localized SCBS is a potentially curable disease, locally advanced SCBS has a poor prognosis in spite of aggressive treatment. These results suggest that early recognition and aggressive treatment are essential to improve the outcomes of SCBS.

Correction of postburn equinus deformity.

Background Equinus deformity is characterized by an abnormal tiptoe gait and does not allow normal walking, hence needing correction. Congenital causes of equinus deformity include neurological diseases such as cerebral palsy and poliomyelitis. Acquired causes include injuries such as extensive trauma. We have corrected equinus deformity from extensive lower leg burns by a single operation through excisional release of the scar, Achilles lengthening, and radial forearm free flap. Methods Fifteen patients with postburn equinus deformity who were treated between January 2000 and March 2012 were retrospectively studied. We investigated their age, sex, cause and severity of burn injury, equinus degree, ankle range of motion and the changes in the activity, extent of Achilles lengthening, flap size, complication, and the recurrence in these patients. Results The average degree of equinus deformity before the operation was 45 degrees. With an average Achilles lengthening of 4.6 cm, all patients achieved neutral position. The patients who had poor activity due to tiptoe gait before the operation showed good to fair levels of walking ability postoperatively. During an average follow-up period of 3 years and 9 months, no patients had a recurrence. Conclusions Equinus deformity causes significant restrictions to walking and the reconstruction is a challenging problem. Although prevention is more important during the initial stages of treatment, we have successfully corrected patients with existing equinus deformity by scar release, Z-tenoplasty of Achilles, and radial forearm free flap.