Educational Lecture 2-2 (EL 2-2) : Surgical instruments, suture and dressing materials

김경문 ( Gyong Moon Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Scalpel, scissors, forceps, skin hooks and hemostats, needle holders, curettes constitute the basic armamentarium. Scalpel handles and blades are basic instruments. Bard-Parker and Beaver handle typeare available. There are many types of scissors available to the dermatologic surgeon, short or long, straight or curved, smooth or serrated, sharp or blunt. Many subtypes such as iris scissor, Gradle scissor, Westcott scissor, Metzenbaum scissor, LaGrange scissor, Supercut scissor, are used according to various purposes. Forceps may have tips of smooth, serrated, or toothed. Toothed forceps were developed to allow firm grasp of tissue with reduced crush injury. Adson, Brown-adson forceps, Bishop-Harmon forceps, Dejardin Graefe forceps are examples of commonly used forceps. Skin hooks are used for manipulating tissue that is to be sutured or to stimulate flap movements, or planning and removing dog ear defects with single or multiple prongs. Hemostats are used for hemostasis of bleeding. Its main use is in clamping off vessels either for electrocoagulation or ligation with suture. Jacobson hemostat is well known for easy grasping of small vessels. In cases of needle holders, a general rule is to use a small needle holder with small needle and a large needle holder with large needle. Crile-Wood needle holder is used for larger suture materials, Webster needle holder is used for fine suture work. Castroviejo needle holder has a detachable spring handle and is used for extremely delicate procedures such as those on the eyelid. Curettes are used for the treatment of benign or low grade malignant tumors and debulking tumors prior to Mohs micrographic surgery. Other instruments for dermatologic surgery are towel clamps, periosteal elevators, bone chisels, nail splitters. Suture and needle selection depends upon the type and location of wound closure as well as the size of associated suture materials. Smaller 5-0 and 6-0 sutures are used on the face and the neck, while 3-0 and 4-0 sutures are used on the trunk and extremities. Wounds with a great deal of tension will require 3-0 or 4-0 sutures. The broadest disctinction in suture materials is between absorbable and nonabsorbable sutures. Absorbable suture losed most of its tensile strength within 60 days of placement and used for buried stitches to close the dermis and decrease the epidermal wound tension. Surgical gut, polyglycolic acid (Dexon), polyglactin 910 (Vicryl), polydioxanone (PDS), and polyglyconate (Maxon). Nonabsorbable sutures are resistant todegradation and will retain most of their tensile strength at 60 days after placement. The most common are silk, nylon, polypropelene, polyester, and stainless steel. Needles are designed to carry suture material through the skin with minimal tissue trauma. The needle is divided into shank, body, sharp point. The curvature of the needle arc are from 3/8 to ½ circle. The needle point is divided in three variants like as conventional cutting, reverse cutting(minimize the risk of tearing), and round with a tapered point(fascia, muscle, aponeurosis). The material and caliber of the suture and the type and size of the needle influence execution of the buried vertical mattress suture. In most cases, a dissolving rather than a permanent suture is ideal for buried sutures. Dressing materials cover the wound, absorb drainage, apply pressure, and provide moist environment. Dressings should be selected to keep wound moist, but not too wet nor too dry. Moist wound healing enhances epithelial migration, stimulates angiogenesis, helps in retention of growth factors, facilitates autolytic debridement and fibrinolysis, protects against exogenous organisms and maintains voltage gradients. Healing of acute wound is accelerated in a moist environment. In chronic wounds, moist dressing can relieve pain, promote autolytic debridement, and decrease the frequency of dressing changes. Various types of occlusive dressings, as well as skin grafts and skin substitutues, are currently available as dressing options. Various types of occlusive/moisture-retentive wound healing dressings (such as foams, films, hydrocolloids, hydrogels, alginates) are available.

Educational Lecture 2-2 (EL 2-2) : Surgical instrumentation, suture, dressing materials

김경문 ( Gyong Moon Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

비소가 함유된 환약복용 후 발생한 것으로 추정되는 편평상피세포내암과 기저세포암

김병직 ( Byung Jik Kim ),김시용 ( Si Yong Kim ),김경문 ( Gyong Moon Kim ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.9

Not legally, arsenic has been used for various medical purposes. Chronic exposure to arsenic can induce different kinds of cutaneous diseases, including arsenic keratosis, Bowen`s disease, squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and other pigment disorders. Also, arsenic induces internal malignancies, including tumors of the pulmonary and urogenital systems. To prevent these malignancies, the use of arsenics should be strictly prohibited. We describe a 72-year-old man who developed SCC in situ and BCC after chronic exposure to arsenics. (Korean J Dermatol 2009;47(9):1071∼1073)

성인에서 발생한 Still`s Disease 1예

김병직 ( Byung Jik Kim ),김시용 ( Si Yong Kim ),김경문 ( Gyong Moon Kim ) 大韓皮膚科學會 2009 大韓皮膚科學會誌 Vol.47 No.10

Adult-onset Still`s disease (AOSD) is a systemic inflammatory disease of an unknown etiology, and AOSD is characterized by high fever, skin rash, arthritis, lymphadenopathy, hepatomegaly, sore throat and serositis. The typical skin rash of AOSD patients is an evanescent, erythematous maculopapular lesion. There is no single diagnostic test; therefore, the diagnosis is based upon the clinical criteria. Treatment consists of anti-inflammatory medications such as aspirin, NSAIDs, corticosteroids, anti-rheumatics and immunosuppressants. We report here on a case of AOSD in which a 53 year-old female patient presented with a high fever, a typical rash, arthritis, a sore thoat and mild splenomegaly. (Korean J Dermatol 2009;47(10):1203∼1205)

웹 스크래핑을 이용한 소셜 미디어 속 백반증 환자의 인식과 경험에 대한 연구

김수형 ( Soo Hyung Kim ),이로우 ( Ro Woo Lee ),이서경 ( Seo Gyeong Lee ),주현정 ( Hyun Jeong Ju ),이지혜 ( Ji Hae Lee ),김경문 ( Gyong Moon Kim ),배정민 ( Jung Min Bae ) 대한피부과학회 2020 大韓皮膚科學會誌 Vol.58 No.10

Background: In recent years, large amounts of data generated by patients have been accumulated on social media. We explored patients’ perspectives and experiences with vitiligo using web scraping data from the open internet community, NAVER Cafe. Objective: To understand patients’ real concerns and thoughts about vitiligo. Methods: Using vitiligo as a keyword, 1000 posts on NAVER Cafe were collected and categorized as follows: requests for recommendations for dermatology clinics; inquiries regarding vitiligo diagnosis, disease characteristics of vitiligo, and management of vitiligo; and advertisements. Essential contents were collected for each category to summarize patients’ perspectives and experiences. Results: Of the 1000 posts, 284 were requests for clinical recommendations, 203 inquiries for diagnosis of their white spots, 132 inquiries regarding characteristics of vitiligo, 118 described experiences and emotions related to vitiligo, 105 inquiries regarding management of vitiligo, 103 advertisements, and 55 not related to vitiligo. Concerning the authors, 209 and 522 posts were written by patients and parents of children with vitiligo, respectively. Conclusion: Patients with vitiligo have considerable concerns regarding their condition and actively communicate with each other through social media. Data mining on social media can provide a deeper understanding of patients’ thoughts and emotional distress with vitiligo as well as their families’. (Korean J Dermatol 2020;58(10):656∼661)

뒤통수에 발생한 모공성 편평태선 1예

최광현 ( Koang Hyun Choi ),이은 ( Eun Lee ),김경문 ( Gyong Moon Kim ),김시용 ( Si Yong Kim ) 大韓皮膚科學會 2008 大韓皮膚科學會誌 Vol.46 No.7

두피에 발생한 소낭성 피부부속기암

주혜영 ( Hye Young Ju ),김시용 ( Si Yong Kim ),강석진 ( Seok Jin Kang ),김경문 ( Gyong Moon Kim ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.10

Microcystic adnexal carcinoma is a rare, locally aggressive tumor with a high potential for local recurrence. It usually presents in elderly patients as a solitary, slowly growing, firm, indurated plaque on the face, and particularly on the upper lip or central face. It has occasionally been found in extra-facial locations, including the nipple, axilla and lower extremities, yet scalp involvement has been rarely reported. Histopathologically, it is a poorly circumscribed dermal tumor that shows both follicular and ductal differentiation, and it may extend into the subcutis and skeletal muscle. We report here on a case of microcystic adnexal carcinoma at an unusual site: the scalp. A 42-year-old woman presented with a 6-month history of a painful, solitary, 1 cm-sized, firm, fixed, dome-shaped nodule on the scalp, and this was accompanied by ulceration and oozing. A biopsy specimen demonstrated features of microcystic adnexal carcinoma, with both follicular and ductal differentiation. Immunohistochemical staining for CEA (carcinoembryonic antigen) was positive in the ductal structures, but this was negative in the follicular structures. (Korean J Dermatol 2008;46(10):1376∼1380)

피부외과 수술에서 Rhombic Transposition Flap과 그 변형들의 임상적 적용 경험

최광현 ( Kwang Hyun Choi ),김시용 ( Si Yong Kim ),김경문 ( Gyong Moon Kim ) 대한피부과학회 2010 大韓皮膚科學會誌 Vol.48 No.1

Background: There is currently an increasing demand in the field of dermatology for surgical therapy for treating skin cancers, including premalignant and malignant lesions. The rhombic (often referred to as rhomboid) flap is a transposition flap that is an excellent option for reconstructing small to medium-sized defects after skin surgery. Objective: We analyzed our clinical results of using the rhombic flap for reconstruction after skin cancers, and especially in regard to the aspects of cosmesis, complete surgical excisions, recurrence and the scope of dermatosurgical care. Methods: From July 2004 to May 2008, forty one patients who were diagnosed with non-melanoma skin cancer or benign tumor on the face, trunk and extremities were treated with a rhombic flap or its modified form for the reconstruction of primary cutaneous defects following the excision of tumor. The cases were divided into groups according to the cosmetic units and the clinical outcomes were reviewed, and cosmetic results were scored as excellent, good, fair or poor. Results: Forty-two rhombic transposition flaps were done in 41 patients. Among these patients, 16 were men and 25 were woman. There were 23 cases of malignant tumor and 19 cases of premalignant and benign tumors. Thirty two cases were located on the face (12 on the cheek, 7 on the nose, 5 on the forehead and periorbital area, 2 on the mouth and 1 on the ear) and 10 cases were located on the other sites (4 on the trunk, 2 on the buttock, 2 on the finger, 1 on the arm and 1 on the leg). There was tumor recurrence in one case. The cosmetic results of reconstructions were satisfactory, and 29 cases out of the 42 (69%) cases showed good to excellent results after 6 months. Conclusion: Rhombic transposition flap can be a simple and good choice for reconstructing cutaneous defects on the face, trunk and extremities after skin tumor surgery. It could also be applied to the defect with limited skin laxity without tension or distortion, and it especially showed excellent and good cosmetic results in most of the cases. (Korean J Dermatol 2010;48(1):8∼16)

Isotretinoin으로 치료한 피부 사르코이드증 1예

최광현 ( Kwang Hyun Choi ),김시용 ( Si Yong Kim ),김경문 ( Gyong Moon Kim ) 대한피부과학회 2009 大韓皮膚科學會誌 Vol.47 No.5

Sarcoidosis is a multisystem disorder that`s characterized by non-caseating granuloma that involves the lung, lymphatic system, skin, eye and other visceral organs. There are many treatment modalities such as corticosteroid, antimalarial agents and methotrexate, but only a few cases treated with isotretinoin have currently been reported. A 31-year-old male patient presented with a two month history of solitary erythematous plaque on the philtrum without other systemic symptoms. The histopathologic findings revealed several naked noncaseating granulomas in the dermis. Special staining such as PAS and AFB showed negative findings. The patient was diagnosed with cutaneous sarcoidosis, and this showed complete remission after a 4-months of therapy with oral isotretinoin (20 mg/day). (Korean J Dermatol 2009;47(5):629~631)

발바닥에 발생한 모낭 낭종

신지연 ( Ji Yeon Shin ),이지현 ( Ji Hyun Lee ),김시용 ( Si Yong Kim ),김경문 ( Gyong Moon Kim ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.8

Trichilemmal cyst is a common, benign, cutaneous tumor, which originates from the external root sheath. It usually occurs on the scalp of middle-aged women. It is rarely found on the face, neck, trunk and extremities. A 33-year-old male presented with a tender, skin-colored, hyperkeratotic, subcutaneous nodule on the right sole for 6 months, without any history of trauma. We clinically diagnosed this skin lesion as a callus. The histopathologic examination showed a well demarcated cystic mass that is lined by a stratified squamous epithelium, without granular layers, and is filled with eosinophilic, amorphous, and homogeneous keratins. The patient was diagnosed with a trichilemmal cyst. Herein, we report a case of trichilemmal cyst of unusual predilection site.