• 제목/요약/키워드: 미세수술

검색결과 984건 처리시간 0.021초

다양한 부위의 재건에 있어 유리복직근 피판술의 이용 (Free Rectus Muscle or Myocutaneous Flap for Reconstruction on the Various Sites)

  • 안기영;이재욱;한동길
    • Archives of Reconstructive Microsurgery
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    • 제5권1호
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    • pp.80-91
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    • 1996
  • A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

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흉강내 식도재건시 늑간동맥을 이용한 유리 공장 전이술 (Free Jejunal Transfer Used by Intercostal Artery in the Intrathoracic Esophageal Reconstruction)

  • 김한수;최상묵;정찬민;서인석
    • Archives of Reconstructive Microsurgery
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    • 제5권1호
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    • pp.99-105
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    • 1996
  • The reconstruction of esophageal defect after ablative surgery have more difficult than other digestive tract tumor because the restoration of anatomical and physiologic function is difficult, the risk of tumor invasion into the adjacent tissue is large. The reconstruction of cervical esophus was depended on the degree of resection of the esophagus, various reconstruction method was developed to minimize functional deficiency and deformity of cervical region. Recently, the free jejunal transfer or free radial forearm flap was commonly utilized for esophageal reconstruction due to development of technique of the microvascular anastomosis. After the esophageal reconstruction used by free jejunal transfer was reported by Seidenberg in 1951, jejunum is most commonly used for reconstruction of esophgus. Becaue of, it have been tubed anatomical similarity with muscular layer, relative small risk of complication, possible of oral intake within 10 days after operation, and early rehabilitaion. Authors have been treated esophageal defect with free jejunal transfer in 7 patients after resection of lesion in 6 eshageal cancer and 1 esophageal stricture from December 1994 to January 1996. We were transferred jejunum used by intercostal artery as recipient artery in 3 cases, it was satisfied with results. If intercostal artery was utilized as recipient artery for free jejunal transfer, we believe that any site of intrathoracic or intraabdominal esophageal defect is possible to recontruction.

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유리피판 이식에서 정맥이식의 임상적 의의 (The Clinical Significance of Vein Graft in Free-Flap Transfer)

  • 이광석;우경조;정대철;정재효
    • Archives of Reconstructive Microsurgery
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    • 제5권1호
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    • pp.70-79
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    • 1996
  • From January 1980 to May 1995, ninety-six patients had been treated by free-flap transfer for the soft tissue defects of the extremities. Ninety-eight cases of free-tissue transfer were reviewed to evaluate the clinical reliability in terms of survival and quality of long-time function after reconstructive surgery. Among these 98 cases(27 cases in latissimus dorsi myocutaneous flap, 25 in dorsalis pedis flap, 20 in forearm fasciocutaneous flap, 9 in groin flap, 7 in gracilis myocutaneous flap, 6 in 1st web space flap of foot and 4 cases in tensor fascia lata flap), 92 cases of then were survived. 7 cases were performed with vein grafts. We ananalyzed the reconstruction of the extremities on 98 cases with the soft tissue defects which had been reconstructed free-flap transfer and followed for minimum 1 year period at Korea University Hospital. 1. 92 cases(93.9%) of the total 98 cases were successful and can be obtained the excellent results in soft tissue free-flap transfer. 2. While there were no clinically significant differences in survival rate of flaps transferred from different potential flap donor sites,3 cases of 9 groin flaps were showed higher failure rate due to the complications such as arterial thrombosis, infection and anatomical variation of vessels. 3. Postoperative thrombectomy was performed in 30 cases to be occured in the arterial and venous thrombosis. The revision was failed in 2 cases due to persistent arterial thrombosis and infection, then treated with skin graft. 4. Vein graft was frequently required in severely compromised-soft tissue defects resulted from high-energy trauma. The vein graft was not stitistically significant on the frequency of flap failure rate(P<0.04). 5. Meticulous monitoring, careful planning, early revision and technical considerations will provide for a high clinical success of the free-flap transfer.

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건 이전술 및 유리피편 이식술을 이용한 소아 외상성 족부 손상의 재건 (Tendon Transfer with a Microvascular Free Flap in Ijured Foot of Children)

  • 한수봉;이진우;정재훈
    • Archives of Reconstructive Microsurgery
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    • 제5권1호
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    • pp.112-120
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    • 1996
  • We peformed tendon transfer with a microvascular free flap for recovery of handicapped function and reconstruction for the skin and soft tissue loss. We review the clinical data of 11 children who underwent these operation due to injured foot by pedestrian accident from January, 1986 to June, 1994. The mean age of patients was 5.6 years old(3-8). Five cases underwent tendon transfer and microvascular free flap simultaneously. Another 6 cases underwent operations separately. The time interval between tendon trasnfer and microvascular free flap was average 5.6 months(2-15 months). The duration between initial trauma and tendon transfer was average 9.6 months(2-21 months). The anterior tibial tendon was used in 6 cases. Among these, the technique of splitting the anterior tibial tendon was used in 5 cases. The posterior tibial tendon was used in 3 cases and the extenosr digitorum longus tendon of the foot in 2 cases. Insertion sites of tendon transfer were the cuboid bone in 3 cases, the 3rd cuneiform bone in 3 cases, the 2nd cuneiform bone in 1 case, the base of 4th metatarsal bone in 1 case, and the remnant of the extensor hallucis longus in 3 cases. The duration of follow-up was average 29.9 months(12-102 months). The clinical results were analysed by Srinivian criteria. Nine cases were excellent and 2 cases were good. The postoperative complications were loosening of the tranferred tendon in 2 cases, plantar flexion contracture in 1 case, mild flat foot deformity in 1 case and hypertrophic scar in 2 cases. So we recommend the tendon transfer with a microvascular free flap in the case of injured foot of children combined with nerve injury and extensive loss of skin, soft tissue and tendon.

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요추 협착증에 대한 일측성 추궁절개술을 통한 미세 수술적 감압술 (Microsurgical Decompression for Lumbar Stenosis via Unilateral Laminotomy)

  • 심용진;하호균;이종선;김용석;박문선;김주승
    • Journal of Korean Neurosurgical Society
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    • 제29권11호
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    • pp.1505-1513
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    • 2000
  • Objectives : Many surgical procedures have been introduced to a symptomatic lumbar stenosis. Most of these procedures still have been regarded as an extensive surgical intervention with respect to normal aging process of the lumbar spine. We adopted a microsurgical decompression procedure via unilateral exposure as a minimally invasive intervention for symptomatic lumbar stenosis without instability. Materials and Methods : Fifty-seven patients with symptomatic lumbar stenosis underwent microsurgical decompression via unilateral laminotomy between March 1998 and December 1999. The conceptual modification and technical refinements were added to the previously reported microsurgical decompression procedure. Bilateral decompression through a unilateral laminotomy hole was performed in 11 patients. These patients profile also included 9 cases of degenerative spondylolisthesis(Grade I) without instability. Results : Preoperative neurogenic intermittent claudication(NIC) was more notably improved than low back pain, 60% to 82% during the follow-up period. Overall clinical results were excellent in 20(35%), good in 29(51%), fair in 6(11%) and poor in 2(3%). Conclusions : Microsurgical decompression for lumbar stenosis with stable spine provided a satisfactory symptomatic improvement without extensive destruction of the weight-bearing structures and functional mobile segments, even bilateral symptoms existed.

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미세수술적 난관복원술을 시행받은 36세 이상 환자에서의 임신율에 관한 연구 (Reproductive Outcomes after Microsurgical Reversal of Tubal Sterilization in Women 36 Years Age or Older)

  • 김석현;이규창;최수희;최영민;신창재;김정구;문신용;이진용;장윤석
    • Clinical and Experimental Reproductive Medicine
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    • 제25권3호
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    • pp.341-348
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    • 1998
  • Objective: To determine the reproductive outcomes of women undergoing microsurgical reversal of tubal sterilization at age 36 years or older. Materials and Methods: A series of 133 patients who received microsurgical reversal of the previously sterilized fallopian tubes at Seoul National University Hospital from July, 1980 to January, 1992 was reviewed and evaluated for clinical characteristics, pregnancy rates, and factors influencing the outcome of tubal reversal. Results: Of 133 patients, 78 (58.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading cause for tubal reversal. The mean interval from tubal sterilization to tubal reversal was 65.0 months. The overall pregnancy rate was 52.6% (70/133), and the mean interval was 9.4 months from tubal reversal to pregnancy. Excluding 7 patients who were lost to follow-up, 76 pregnancies were confirmed in 63 patients with the delivery rate per patient of 66.7% (42/63). There were no significant differences in age, duration of tubal sterilization, postoperative tubal length between pregnant and non-pregnant groups. Conclusions: Microsurgical reversal of tubal sterilization could be a justifiable method in women 36 years age or older.

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관절 연골 손상의 병태 생리 (Pathophysiology of Articular Cartilage Injury)

  • 박정호
    • 대한정형외과스포츠의학회지
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    • 제4권1호
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    • pp.6-11
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    • 2005
  • 관절 연골 손상은 급성 손상과 만성 손상인 퇴행성 관절염으로 구분되며, 급성 손상은 연골 손상의 깊이에 따라서 미세 손상, 연골 골절, 골연골 골절의 세 종류로 구분할 수 있고 각 손상의 종류별로 서로 다른 양상의 치유 반응과 예후를 보인다. 만성 관절 연골 손상은 다양한 원인으로 인해서 발생하며 관절 연골의 전반적인 퇴행성 관절염의 형태를 보인다. 관절 연골 손상 시 초기 손상의 정도가 예후를 결정짓는데 가장 중요하고 이외에도 손상의 크기, 부위, 나이, 활동성, 비만 정도, 하지 정렬 상태등도 예후를 결정하는 중요한 요소들이다. 본 논문에서는 관절 연골 손상 시 발생하는 관절 연골 내의 병태 생리적 변화에 대하여 기술하고 비수술적인 치료 방법을 생역학적인 측면과 생물학적인 측면으로 구분하여 그 효과를 알아보고자 한다.

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손목의 스포츠 손상 (Sports Injuries of the Wrist)

  • 김종필;김성진
    • 대한정형외과스포츠의학회지
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    • 제11권1호
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    • pp.8-16
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    • 2012
  • 스포츠 활동에 대한 참여도가 높아짐에 따라 스포츠 손상의 발생빈도도 증가되고 있으며 특히 손목 부위는 상지의 다른 부위에 비해 손상의 빈도가 높다. 손목 스포츠 손상은 일반적으로 과다 사용 손상과 외상성 손상으로 분류되고 있는데 이 중 외상성 손상은 과격한 접촉이나 충돌이 필요로 하는 운동에서 나타나며 주로 골절, 탈구 및 인대 파열과 같은 급성 손상을 의미한다. 과다사용 손상은 미세한 외상이 반복적으로 가해져 결국은 생체내 회복 능력을 벗어나 정상적인 조직에 손상을 주게 되어 나타나는 드 꿰르벵 병, 척 수근 신건염, 교차 증후군 등의 염증성 병변은 물론 유구골구 피로 골절, 척 수근 신건의 아탈구, 만성 주상 월상골간 불안정, 삼각섬유연골 복합체의 퇴행성 파열 등과 같은 만성 외상성 병변을 포함한다. 저자는 손목의 과다사용 및 외상성 병변과 관련된 스포츠 손상을 기술하고 특히 각 손상의 진단, 보존적 및 수술적 치료의 장점과 단점 등에 초점을 맞추어 기술하고자 한다.

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요추간판 미세 현미경 수술 후 재입원 환자의 분석 (Analysis of Readmission Patients after Lumbar Microdiscectomy)

  • 지용철;손병길;최은석;이시우;신종현;차영훈
    • Journal of Korean Neurosurgical Society
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    • 제29권6호
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    • pp.772-777
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    • 2000
  • Objectives : After lumbar microdiscectomy there are relatively higher incidence of readmission because of various postoperative discomfort. Analyzing these readmitted patients in our private hospital where the patients can be readmitted more easily, we expect to find out which factors are associated with improvement of the surgical outcome. Patients and Methoes : After discharge all significant patient's clinical data were registered to our computerized data bank system and periodic follow-up were performed. The authors analysed 651(97.7%) cases followed up over 2 years(average 3 years) out of 666 patients who underwent a initial lumbar microdiscectomy from May, 1994 to April, 1997. Among them, 63 patients(9.7%) were readmitted. Results : Among the patients readmitted, 29 patients(4.5%) were reoperated because of recurred disc herniation, 17 patients were myofascial pain syndrome, 4 patients were discitis, 3 patients were adhesion and one patient was epidural abscess. Treatment results of these readmitted patients showed that success rate of all readmitted patients was 68.3%, reoperation was 58.6% and myofascial pain syndrome was 82.4%. Conclusion : Treatment results of the patients readmitted because of a continuous lumbago or leg pain after microdiscectomy were acceptable through the careful analysis of the causes of the recurrent symptom. Therefore, the incidence of the chronic failed back syndrome can be reduced by efforting a more active management through readmission.

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경골에 시행한 유리 생 비골 및 피부편 이식 (Free Vascularized Osteocutaneous Fibular Graft to the Tibia)

  • 이광석;박종웅;하경환;한상석
    • Archives of Reconstructive Microsurgery
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    • 제6권1호
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    • pp.63-72
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    • 1997
  • We have evaluated the clinical results following the 46 cases of free vascularized osteocutaneous fibular flap transfer to the tibial defect combined with skin and soft tissue defect, which were performed from May 1982 to January 1997. Regarding to the operation, flap size, length of the grafted fibula, anastomosed vessels, ischemic time of the flap and total operation time were measured. After the operation, time to union of grafted fibula and the amount of hypertrophy of grafted fibula were periodically measured through the serial X-ray follow-up and also the complications and results of treatment were evaluated. In the 46 consecutive procedures of free vascularized osteocutaneous fibular flap transfer, initial bony union were obtained in the 43 grafted fibulas at average 3.75 months after the operation. There were 2 cases in delayed unions and 1 in nonunion. 44 cutaneous flaps among the 46 cases were survived but 2 cases were necrotized due to deep infection and venous insufficiency. One necrotized flap was treated with latissimus dorsi free flap transfer and the other was treated with soleus muscle rotational flap. Grafted fibulas have been hypertrophied during the follow-up periods. The fracture of grafted fibula(15 cases) was the most common complication and occurred at average 9.7 months after the operation. The fractured fibulas were treated with the cast immobilization or internal fixation with conventional cancellous bone graft. In the cases of tibia and fibula fracture at recipient site, the initial rigid fixation for the fibula fracture at recipient site could prevent the fracture of grafted fibula to the tibia.

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