• Archives of Plastic Surgery
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• 제50권4호
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• pp.335-339
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• 2023

It is undeniable that a significant number of patients who want to improve their facial appearance is increasingly interested in nonsurgical procedures. Without a doubt, the use of autologous fat could not be left out as a magnificent alternative for nasal modeling simply because of four influential factors: ease of collection, compatibility, the temporality of the results, and safety. This work describes an innovative alternative technique for nasal modeling using micrografts enriched with adipose-derived mesenchymal stem cells (ASCs). With this technique, fat was collected and divided into two samples, nanofat and microfat. Nanofat was used to isolate the ASCs; microfat was enriched with ASCs and used for nasal modeling. Lipoinjection was performed in a supraperiosteal plane on the nasal dorsum. Through a retrolabial access, the nasal tip and base of the columella were lipoinjected. We consider that nonsurgical nasal modeling using micrografts enriched with ASCs can be an attractive and innovative alternative. This technique will never be a substitute for surgical rhinoplasty. It can be performed in a minor procedure area with rapid recovery and return to the patient's daily activities the next day. If necessary, the procedure can be repeated.

• Archives of Plastic Surgery
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• 제50권4호
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• pp.361-369
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• 2023

The latissimus dorsi (LD) flap is a reliable option for breast reconstruction. This is particularly true in patients with contraindications to abdominally based autologous breast reconstruction. A systematic review of patient satisfaction and health related quality of life following LD breast reconstruction using the BREAST-Q survey was conducted. The scope of the review was to determine the degree of patient satisfaction following the procedure and to examine how patient satisfaction from the pedicled LD flap compares to other breast reconstructive procedures. A literature search on BREAST-Q in LD flap reconstruction was performed. Only articles written in English and in published peer-reviewed journals were included. Studies with less than 20 patients in their sample and those with a follow-up period of less than 1 year were excluded. Five articles representing 331 patients were reviewed, including one case-control study and four retrospective cohort studies. Level of evidence was either III (4) or IV (1). The average age was 53 with average body mass index of 25. Most reconstructions were delayed (67%) and unilateral (88%), and most patients required radiation (79%). The average length of follow-up was 36 months, and the response rate was 75%. Overall, patients who underwent LD flap reconstruction reported favorable outcomes in satisfaction domains and quality of life domains with few complications. A meta-analysis also demonstrated higher satisfaction in LD flap without implants compared with LD flap with implants. Patient-reported outcomes following LD breast reconstruction compare favorably with other techniques of breast reconstruction.

• 대한정형외과학회지
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• 제54권6호
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• pp.478-489
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• 2019

골관절염은 관절연골 침식의 진행을 특징적으로 보이는 질환으로 관절운동 중에 통증을 증가시키고 기계적 스트레스를 견디는 능력을 감소시켜 결과적으로 관절의 가동성과 기능을 저하시킨다. 외상 또는 퇴행성으로 인한 관절연골의 손상이 일반적 관절염의 주요 원인으로 생각되며 이러한 관절연골 손상의 재생에 관한 수많은 연구와 시도들이 현재까지 진행되어 오고 있다. 현재까지 연골 손상의 경우 미세골절술과 자가연골세포 이식술이 일반적인 수술적 치료방법으로 제시되어 왔으나 비교적 양호한 임상 결과에도 불구하고 정상 유리연골의 생성이 미흡하여 시간이 경과하면서 결과가 악화되는 등 단점이 있다. 이를 보완하기 위하여 줄기세포 기반 치료법이 개발되었다. 이 종설에서는 현재 사용되는 다양한 연골 재생 방법들의 장단점 및 결과에 대해 요약하고 특히 중간엽 줄기세포(mesenchymal stem cells) 기반 연골 재생 치료법을 논하고 나아가 이상적인 미래 연골 재생 치료법에 대해서도 고민해보고자 한다.

• Restorative Dentistry and Endodontics
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• 제47권4호
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• pp.35.1-35.9
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• 2022

Although the success rates of microsurgery and micro-resurgery are very high, the influence of a recurrent perforation combined with radicular cyst remains unclear. A 21-year-old white female patient had a history of root perforation in a previously treated right maxillary lateral incisor. Analysis using cone-beam computed tomography (CBCT) revealed an extensive and well-defined periapical radiolucency, involving the buccal and palatal bone plate. The perforation was sealed with bioceramic material (Biodentine) in the pre-surgical phase. In the surgical phase, guided tissue regeneration (GTR) was performed by combining xenograft (lyophilized bovine bone) and autologous platelet-rich fibrin applied to the bone defect. The root-end preparation was done using an ultrasonic tip. The retrograde filling was performed using a bioceramic material (Biodentine). Histopathological analysis confirmed a radicular cyst. The patient returned to her referring practitioner to continue the restorative procedures. CBCT analysis after 1-year recall revealed another perforation in the same place as the first intervention, ultimately treated by micro-resurgery using the same protocol with GTR, and a bioceramic material (MTA Angelus). The 2-year recall showed healing and bone neoformation. In conclusion, endodontic micro-resurgery with GTR showed long-term favorable results when a radicular cyst and a recurrent perforation compromised the success.

• Tuberculosis and Respiratory Diseases
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• 제86권4호
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• pp.304-318
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• 2023

Background: Cancer-associated fibroblasts (CAFs) are key components of the tumor microenvironment and significantly contribute to immune evasion. We investigated the effects of CAFs on the immune function of CD4+ and CD8+ T cells in non-small cell lung cancer (NSCLC). Methods: We isolated CAFs and normal fibroblasts (NFs) from tumors and normal lung tissues of NSCLC patients, respectively. CAFs were co-cultured with activated T cells to evaluate their immune regulatory function. We investigated the effect of CAF conditioned medium (CAF-CM) on the cytotoxicity of T cells. CAFs were also co-cultured with activated peripheral blood mononuclear cells and further incubated with cyclooxygenase-2 (COX2) inhibitors to investigate the potential role of COX2 in immune evasion. Results: CAFs and NFs were isolated from the lung tissues (n=8) and lymph nodes (n=3) of NSCLC patients. Immune suppressive markers, such as COX2 and programmed death-ligand 1 (PD-L1), were increased in CAFs after co-culture with activated T cells. Interestingly, CAFs promoted the expression of programmed death-1 in CD4+ and CD8+ T cells, and strongly inhibited T cell proliferation in allogenic and autologous pairs of CAFs and T cells. CAF-CM decreased the cytotoxicity of T cells. COX2 inhibitors partially restored the proliferation of CD4+ and CD8+ T cells, and downregulated the expression of COX2, prostaglandin E synthase, prostaglandin E2, and PD-L1 in CAFs. Conclusion: CAFs promote immune evasion by suppressing the function of CD4+ and CD8+ T cells via their effects on COX2 and PD-L1 in NSCLC. The immunosuppressive function of CAFs could be alleviated by COX2 inhibitors.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.62-66
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• 2024

Gestational gigantomastia is characterized by the rapid growth of breasts during pregnancy. The treatment method of gestational gigantomastia is unclear; if the medical treatment is ineffective, surgery is considered. However, sufficient research on which method is best to perform breast reconstruction for the gestational gigantomastia patient has not yet been conducted. Our patient was young and had aesthetic needs; thus, we did not recommend modified radical mastectomy. However, it was difficult for the patient to consider active reconstruction using an implant or autologous tissue because of the expected complications and economic problems. The patient had a thin body shape and very large breasts compared with the trunk. Therefore, breast volume was not significantly required after reconstruction. Additionally, we expected that a considerable portion of skin would remain after mastectomy as a tubular-shaped breast. It was expected that the Goldilocks technique would be sufficient to meet the patient's volume needs. Therefore, we proceeded with total mastectomy and reconstruction using the Goldilocks procedure. No complications were recorded after the operation; most of the patient's discomfort was resolved, and the shape and size of the breasts were satisfactory.

• Archives of Plastic Surgery
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• 제51권2호
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• pp.156-162
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• 2024

Background Perioperative management in autologous breast reconstruction has gained focus in recent years. This study compares two pain management protocols in patients undergoing abdominal-based free flap breast reconstruction: a past protocol (PP) and a current protocol (CP)-both intended to reduce opioid consumption postoperatively. The PP entails use of a pain catheter in the abdominal wound and the CP consists of an intraoperative nerve block in addition to refinements in the oral pain management. We hypothesize that the CP reduces opioid consumption compared to PP. Methods From December 2017 to January 2020, 102 patients underwent breast reconstruction with an abdominal-based free flap. Two postoperative pain management strategies were used during the period; from December 2017 to September 2018, the PP was used which entailed the use of a pain catheter with ropivacaine applied in the abdominal wound with continuous distribution postoperatively in addition to paracetamol orally and oxycodone orally pro re nata (PRN). From October 2018 to January 2020, the CP was used. This protocol included a combination of intraoperative subfascial nerve block and a postoperative oral pain management regime that consisted of paracetamol, celecoxib, and gabapentin as well as oxycodone PRN. Results The CP group (n = 63) had lower opioid consumption compared to the PP group (n = 39) when examining all aspects of opioid consumption, including daily opioid usage in morphine milligram equivalents and total opioid usage during the stay (p < 0.001). The CP group had shorter length of hospital stay (LOS). Conclusion Introduction of the CP reduced opioid use and LOS was shorter.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.36-41
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• 2024

Background Among breast reconstruction methods, implant-based breast reconstruction has become the mainstream. However, periprosthetic infection is still an unresolved problem. Although published articles have revealed that limited use of antibiotics is sufficient to reduce infection rates, the number of surgeons still preferring elongated usage of antibiotics is not less. The aim of our study is to validate the appropriate duration of antibiotic use to reduce infection rate after implant-based breast reconstruction. Methods A retrospective study reviewed medical record of 235 patients (274 implants for reconstruction) who underwent prepectoral direct to implant breast reconstruction using acellular dermal matrix wrapping technique. Infection rates were analyzed for the patients administered postoperative prophylactic antibiotics until drain removal and those who received only perioperative prophylactic antibiotics for 24 hours. Results Of the 274 implants, 98 who were administered prophylactic antibiotics until drain removal had an infection rate of 3.06% (three implants) and 176 who received prophylactic antibiotics no longer than 24 hours postoperatively had an infection rate of 4.49% (eight implants). A total of 11 patients diagnosed with postoperative infection clinically, 8 were salvaged by antibiotic treatment, and 3 had implant removal and replacement with autologous flap. Postoperative antibiotic prophylaxis duration had no statistically significant effects in the risk of infection (p = 0.549). Conclusion The duration of prophylactic antibiotics after surgery was not related to infection risk. Further study with a large number of patients, randomized control study, and route of antibiotics is needed.

• 대한골관절종양학회지
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• 제10권1호
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• pp.13-21
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• 2004

목적: 골수에서 분리한 기질 세포를 단독으로 또는 동종 망상골과 함께 이식하여 치료했던 양성 골 병변 소파 후 발생한 골 결손에 대한 치료 결과를 보고 하고자 한다. 대상 및 방법: 1996년 7월 이래 장관골 양성 골 병변에 대해 병변이 작거나 소아여서 소파술과 함께 자가 골수 기질 세포를 단독으로 이식하였던 2명 3례와, 자가 골수 기질 세포와 동종 망상골 이식을 병행하여 치료하였던 6명 6례 등 총 8명 9례를 대상으로 수술 후 임상증상의 해소, 신생 골 형성 및 주변 정상골과의 유합 과정을 추시하였다. 남자가 6례, 여자가 2례였으며 평균 연령은 24세(8세~47세)였다. 조직학적 진단은 섬유성 골 이형성증이 5례로 많았고, 단순 골 낭종 2례, 연골모세포종과 섬유성 피질 결손이 각각 1례씩 이었다. 수술 후 평균 추시기간은 16.3개월(3개월~84개월) 이었다. 결과: 수술 전 병소 부위에 통증을 호소했던 4례 모두에서 술 후 2주 이내에 증상이 소실되었으며, 수술 후 촬영한 단순 방사선 사진 상 약 4주경부터 병변 부위에 신생 골 형성이 관찰되고 약 8주경에는 골 결손 부위가 신생 골로 충전되고 주변 정상골과 유합된 소견을 보였다. 합병증으로는 1례에서 술 후 3주에 병소 부위를 통과하는 골절이 발생했으며, 단순 골 낭종 1례에서 술 후 5개월에 병소가 재발하였다. 결론: 장관골 양성 골 병변에 대해 소파 후 골수에서 분리한 골수 기질 세포를 단독으로 또는 동종 망상골과 함께 이식할 때 빠른 치유과정을 보여, 비록 단 기간의 추시 결과이기는 하나 골수 기질 세포 이식술이 향후 골 낭종이나 양성 골 병변의 치료에 크게 이용될 수 있을 것으로 보인다. 골 낭종 수술 후 재발 원인은 낭종내벽 섬유조직의 불완전 소파의 결과로 보이며, 골절 발생 가능성이 높은 대퇴골 전자간 골 낭종 등에 대하여는 금속판 등을 이용한 예방적인 고정이 필요할 것으로 판단되었다.

• 대한관절경학회지
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• 제14권1호
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• pp.20-24
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• 2010

목적: 전방 십자 인대 재건술 후 7에서 22년의 장기 추시 결과를 관절염의 관점에서 분석하여 보고하고자 한다. 대상 및 방법: 1986년 4월부터 1999년 4월까지 전방 십자 인대 재건술을 시행한 최소 7년 이상 추시가 가능하였던 31예를 대상으로 하였으며 평균 추시 기간은 10.1년(7~22년)이었다. 이식건은 슬근건이 11예, 슬개건이 20예였고, 대퇴골 터널 형성 술기는 경골 터널을 통한 방법이 11예, 소 관절 절개술을 이용한 전내측 구멍을 통한 방법이 20예였으며, 임상적, 방사선학적 평가를 시행하였다. 결과: Lysholm 점수는 평균 $89.2{\pm}11.7$점이었고, IKDC 점수는 A군이 12예(38.7%), B군이 15예(48.3%), C군이 2예(6.5%), D군이 2예(6.5%)였으며, 터널의 위치는 경골 터널을 통한 방법은 11시 또는 1시, 전내측 구멍을 통한 방법은 10시에서 10시 반 또는 2시에서 2시 반 사이에 위치하였다. 관절염의 방사선학적 검사상 대퇴골 터널 형성 술기에서는 전내 측 구멍을 통한 방법이 우수 50.0%, 양호 25.0%, 경골 터널을 통한 방법이 우수 18.2%, 양호 18.2%였다. 관절염의 위치는 슬근건이 내측 구획 45.5%, 슬개 대퇴 관절 36.4%, 외측 구획 18.2%, 골슬개건이 내측 구획 65.0%, 슬개 대퇴 관절 50.0%, 외측 구획 40.0%였고, 전내측 구멍을 통한 방법이 내측 구획 45.0%, 슬개 대퇴 관절 35.0%, 외측 구획 25.0%, 경골 터널을 통한 방법이 내측 구획 81.8%, 슬개 대퇴 관절 63.6%, 외측 구획 45.5%였다. 결론: 전방 십자 인대 재건술의 장기 추시에서 IKDC 점수상 전 예의 87.1% 정도가 양호 이상의 좋은 결과를 보였고, 특히 전내측 구멍을 이용한 터널 사용시 관절염 면에서 나은 결과를 보였다.