• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.153-161
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• 2002

Purpose : Plantar surfaces, calcaneal area, and region of Achilles insertion, which are extremely related with weight-bearing area and shoes application, must be reconstructed with glabrous and strong fibrous skin. Numerous methods of reconstructing defects of these regions have been advocated, but the transfer of similar local tissue as a cutaneous flap with preservation of sensory potential would best serve the functional needs of the weight-bearing and non-weight-bearing surfaces of this region. Therefore it is recommended to use the limited skin of medial surface of foot that is similar to plantar region and non-weight-bearing area. In this paper we performed the medial plantar flap transfered as a fasciocutaneous island as one alterative for moderate-sized defects of the plantar forefoot, plantar heel, and area around the ankle in 25 cases and report the result, availability and problem of medial plantar flap. Materials and methods : We performed proximally based medial plantar flap in 22 cases and reverse flow island flap in 3 cases. Average age was $36.5(4{\sim}70)$ years and female was 3 cases. The causes of soft tissue defect were crushing injury on foot 4 cases, small bony exposure at lower leg 1 case, posterior heel defect with exposure of calcaneus 8 cases, severe sore at heel 2 cases, skin necrosis after trauma on posterior foot 4 cases, and defect on insertion area of Achilles tendon 6cases. Average follow up duration was 1.8(7 months-9.5 years) years. Results: Medial plantar flaps was successful in 22 patients. 18 patients preserved cutaneous branches of medial plantar nerve had sensation on transfered flap but diminished sensation or dysesthesia. At the follow up, we found there were no skin ulceration, recurrence of defect or skin breakdown in all 18 patients. But there was one case which occurred skin ulceration postoperatively among another 4 cases not contained medial plantar nerve. At the last follow up, all patients complained diminished sensation and paresthesia at medial plantar area distally to donor site, expecially with 4 patients having severe pain and discomfort during long-time walking. Conclusion : Medial plantar island flap based on medial plantar neurovascualr pedicle have low failure rate with strong fibrous skin and preserve sensibility of flap, so that it is useful method to reconstruct the skin and soft tissue defect of foot. But it should be emphasized that there are some complications such like pain and paresthesia by neuropraxia or injury of medial plantar nerve at more distal area than donor site. We may consider that medial plantar flap have limited flap size and small arc of rotation, and require skin graft closure of the donor defect and must chose this flap deliberately.

• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.14-23
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• 2004

Introduction: The hand and wrist are particularly susceptible to electrical burn. Skin defect with damage or exposure of underlying vital structure requires coverage by skin flap especially in case of the need for late reconstruction. We are reporting 4 cases of electrical burned hand treated by posterior tibial arterial free flap. The commonly used skin flaps such as scapular flap or groin flap are too bulky so that they are not satisfactory in function and cosmetic appearance. So we tried to cover them with a more thin skin flap. Materials and Method: From January 2002 to June 2003, four cases of hand and wrist electrical burn were covered using posterior tibial arterial free flap. All the cases were due to high voltage electrical burn. Age ranged from 31 years to 38 years old and all the cases were male patients. Recipient sites were 2 wrist, one thenar area and one knuckle of 2.3rd MP joint. Additional procedures were flexor tenolysis (simultaneous), FPL tenolysis and digital nerve graft (later) and extensor tendon reconstruction (later). Result: All the flap have survived totally without any complication including circulatory concern about the donar foot. Posterior tibail arterial free flap was so thin that debulking procedure was not required. Conclusion: For skin coverage of the hand & wrist region, posterior tibial arterial free flap have many advantages such as reliable anatomy, easy dissection and easy anastmosis with radial or ulnar artery and possibility of sensory flap. The most helpful advantage for hand coverage is its thinness. So we think this flap is one of the very useful armamentarium for reconstructive hand surgery.

• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.43-50
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• 2004

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.

• Archives of Reconstructive Microsurgery
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• 제18권2호
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• pp.62-66
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• 2009

Purpose: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. Materials and methods: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. Results: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. Conclusion: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권2호
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• pp.133-139
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• 2012

모든 환자들은 구순접합술을 시행 받았고 구순 및 구개열 유아들은 악정형장치인 Latham을 사용하였다. 수술의 기술적 변화들은 앞서 설명하였다. Columella 부위의 높은 rotation과 releasing incision은 내측 입술 부위를 충분히 길게 해주고, advancement flap이 phitral column 상방으로 최소로 침범되게 하여 균형적인 입술을 만들 수 있다. 또한 구륜근을 외번시켜 philtral ridge를 형성하고, 작은 unilimb Z-plasty을 구순측 Cupid's bow handle 높이에 맞게 시행 후, vermilion-cutaneous junction에서부터 상방으로 cutaneous closure 시행한다. 변위된 alar cartilage는 nostril rim incision을 통해 동측 upper lateral cartilage에 매달며, Alar base는 anterior-caudal septum의 위치, sill의 설정 그리고 외측 vestibular web 제거를 포함하여 3차원적으로 설계하여 치료해야 한다. 이번에 소개한 Mulliken의 치료법이 환자들과 외과의사들에게 많은 도움이 되기를 바란다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권6호
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• pp.552-558
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• 2005

Orthognathic surgery changes patient's mandibular position and environment of related anatomic structures. Many clinicians were interested in these changes and studied about this problem. However, most of them were based on two dimensional cephalogram. According to the development of image and computer system, it would be possible that the airway change is analyzed with three dimensional CT. So we tried to measure the volumetric change of airway and analyzed the relationship between the airway structure and volumetric change. Nineteen patients who experienced orthognathic surgery due to mandibular prognathism were analyzed with 3D CT data (preoperative and postoperative 6 months) and 2D lateral cephalometry. Volumetric change was measured and 3 dimensional change of related structure was assessed with simulation program ($V-works^{(R)}$, 4.0 Cybermed, Korea). Ten patients showed the decrease of airway volume change and nine showed the increase of airway volume change. Volumetric change was determined by dimensional change of mandible and hyoid bone. The dimensional positions of mandible and hyoid bone were the key factor for determining the airway change after surgery. Airway change is also predictable with the dimensional change of mandible and hyoid bone.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권3호
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• pp.294-300
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• 2000

Purpose: The aim of this study was to find the clinical characteristics of the patients who had temporomandibular joint internal derangement(ID) with disc adhesion(adhesion group) compared to only disc displacement without disc adhesion, perforation, hyperemia, and so on(ID group). Materials and methods: Thirty seven joints were included in adhesion group and 54 joints in ID group of all 174 patients(174 joints) treated surgically and had been checked periodically over 12 months at TMJ clinic of Yongdong Severance Hospital, Yonsei University, between 1992 and 1997. Mouth opening range, pain during mouth opening and biting, headache, neck/shoulder pain and TMJ sound were checked his/her every visit before and after surgery. Results: The maximum mouth opening was improved significantly after postoperative 3 months in two groups(p<0.01), but adhesion group was less improved. Pain during mouth opening was improved significantly over 3 months after surgery in adhesion group(p<0.01), but in ID group 1 month after surgery. Biting pain was improved and maintained it after surgery and not significant difference between two groups. Headache and neck/shoulder pain were much improved after surgery(p<0.01), but slight relapse was found in adhesion group after 12 months. TMJ sound was more found in adhesion group after 1 month(p<0.05), but after 3 months, no significant difference was found between two groups. Conclusions: The postoperative results of adhesion group were worse than ID group. Therefore, it is considered more carefully to diagnose and treat in cases of internal derangement with adhesion.

• 대한심미치과학회지
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• 제25권1호
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• pp.35-49
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• 2016

최근 심미성에 대한 요구가 점점 증가함에 따라, 이제는 임플란트 수복에 있어서도 기능적인 면 뿐만 아니라 심미적인 면이 더욱 강조되고 있다. 상악 전치부 임플란트 수복은 임상가들에게 항상 도전적인 과제로 다가오는데 그 이유는 다음의 세 가지 요소를 모두 필요로 하기 때문이다. 첫째, 충분한 경조직이 필요하고 둘째, 충분한 연조직이 필요하며 그리고 셋째, 심미적인 수복물이 필요하다. 연조직의 심미성은 그 하부에 있는 경조직에 의존하게 되는데 그 이유는 하부의 경조직의 골격적인 지지가 있어야만 그것을 바탕으로 그 위에 건강하고 심미적인 연조직이 안정적으로 유지될 수 있기 때문이다. 그러므로, 경조직 재건은 심미적인 임플란트 수복에 있어서 첫번째 단계이며, 특히 3차원적으로 적절한 임플란트의 식립 위치 설정은 심미성 있는 최종 수복물을 얻기 위해서 가장 중요한 단계라고 할 수 있다. 그 다음으로 두번째 단계가 순측으로 충분한 두께의 연조직을 얻기 위한 수술 기법이며, 마지막 세번쨰 단계가 적절한 출현외곽을 갖는 임시 수복물을 통해서 얻어진 심미적인 최종 수복물이다. 본 임상 증례 보고는 순측의 골 열개 결손에서의 골 증대술 과정과 전치부 영역에 주로 사용되는 VIP-CT 라고 일컫는 유경 판막술을 이용한 연조직 증대술, 그리고 임시 수복물을 통한 연조직 형태 만들기와 맞춤형 인상 코핑을 이용한 인상채득법 등을 소개함으로써 경조직, 연조직, 수복물의 세 가지 요소가 심미적인 최종 수복물을 위해 서로 어떻게 조화를 이루어내는지 알아보고자 한다.

• Journal of Chest Surgery
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• 제39권3호
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• pp.214-219
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• 2006

배경: 식도천공은 비교적 흔하지 않지만, 높은 이환율과 사망률을 나타낸다. 치료와 결과는 증상의 시간에 따라 크게 결정된다. 저자들은 식도천공 환자들을 최근의 치료방법으로 치료하여 결과를 후향적으로 조사하여 보았다 대상 및 방법: 1990년 3월부터 2005년 3월까지 식도 파열로 치료한 환자들을 후향적 분석하였다. 28명 환자들에서(남자 22명, 여자 6명: 평균나이 51세, 최소 17세에서 최고 82세)천공의 원인을 보면 이물질 9명, 외상 7명, 자연적 파열 7명, 의인성 5명이었다. 환자중 18명은 24시간 내 진단되었으며, 10명은 24시간 이후에 진단되었다. 21명($75\%$)에서 일차 봉합술을 시행하였으며, 4명에서는 식도 절제술, 3명의 환자에서는 위루술과 배농술를 시행하였다. 결과: 병원 사망률은 $18\%$이며, 그리고 의인성에서 사망률이 증가하였다(p <0.05). 천공위치, 천공 후 시간, 치료방법은 사망률에 영향을 미치지 못했다. 수술 후 누출은 4명의 환자에서 생겼으며, 보존적인 치료로 회복이 되었다. 결론: 식도 파열은 진단과 치료가 어렵기 때문에 아직도 위험한 질환이다. 대부분의 환자에서 증상의 발현시간에 관계없이 일차 재건술이 사망률을 낮출 수 있다. 정확한 진단과 조기 치료가 식도파열 환자들의 성공적인 치료에 필수적이다.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.62-67
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• 1998

전북대학교병원 정형외과에서 1994년 6월부터 1998년 3월까지 하퇴부 원위 1/3 및 족부에 시행하였던 박근 유리조직 이식술 12례에 대하여 최소 6개월부터 최고 4년 9개월까지 추시하여 다음과 같은 결과를 얻었다. 1. 하퇴부 원위 1/3의 손상원인은 개방성 골절에 의한 뼈 및 연부조직노출이 4례(33.3%)였으며, 골절수술후 연부조직 괴사로 인한 2차 뼈 및 내고정물노출이 2례(16.7%)였고, 족부의 손상원인은 압궤손상 5례(41.7%), 골절치료시 발뒤꿈치의 압박괴사 1례(8.3%)였다. 2. 수여혈관은 하퇴부 원위 1/3에서는 전경골 동맥이 4례, 비골동맥과 족배동맥이 각각 1례였으며, 족부의 수여혈관은 족배동맥이 4례, 후 경골동맥이 2례였다. 수여정맥은 2개를 봉합함을 원칙으로 하였으나 하퇴부 원위 1/3에서 총 6례중 3례, 족부에서도 총 6례중 3례에서만 2개의 수여정맥 봉합술이 가능하였다. 3. 총 12례중 11례(91.7%)에서 술후 3주까지 관류(perfusion)가 가능하여 성공하였으며, 피부 이식술은 술 후 평균 22일만에 시행하였고, 재활운동은 술후 평균 32일만에 가능하였다.