• Archives of Plastic Surgery
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• 제46권2호
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• pp.122-128
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• 2019

Background The masseter nerve is a useful donor nerve for reconstruction in patients with established facial palsy, with numerous advantages including low morbidity, a strong motor impulse, high reliability, and fast reinnervation. In this study, we assessed the results of masseter nerve-innervated free gracilis muscle transfer in established facial palsy patients. Methods Ten patients with facial palsy who received treatment from January 2015 to January 2017 were enrolled in this study. Three patients received masseter nerve-only free gracilis transfer, and seven received double-innervated free gracilis transfer (masseter nerve and a cross-face nerve graft). Patients were evaluated using the Facial Assessment by Computer Evaluation software (FACEgram) to quantify oral commissure excursion and symmetry at rest and when smiling after muscle transfer. Results The mean time between surgery and initial movement was roughly 167.7 days. A statistically significant increase in excursion at rest and when smiling was seen after muscle transfer. There was a significant increase in the distance of oral commissure excursion at rest and when smiling. A statistically significant increase was observed in symmetry when smiling. Terzis' functional and aesthetic grading scores showed significant improvements postoperatively. Conclusions Masseter nerve innervation is a good option with many uses in in established facial palsy patients. For some conditions, it is the first-line treatment. Free gracilis muscle transfer using the masseter nerve has excellent results with good symmetry and an effective degree of recovery.

• Archives of Plastic Surgery
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• 제49권5호
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• pp.652-655
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• 2022

Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.

• 대한두경부종양학회지
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• 제9권1호
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• pp.3-9
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• 1993

저자들은 뉴질랜드산 흰 가토의 대퇴부에 총 대퇴동맥의 분지를 영양혈관으로 하는 비복근을 이용한 유경 근피판을 만든 후에 영양혈관을 차단 직전과 12시간 동안의 허혈 기간을 가진 후 이 영양혈관으로 생리 식염수로 관류하여 씻어낸 대조군과 urokinase로 관류한 비교군 I, 최근 개발된 인체의 장기 이식시 사용되는 장기(organ) 보존용제인 UW용액을 이용한 비교군 II, UW용액과 pentoxifylline용액으로 관류한 비교군 III에서 재관류 12시간 후에 허혈 및 괴사 정도를 육안적인 관찰과 근육의 전기 자극 검사, TTC 염색, Wet/Dry 무게비 등으로 비교 분석하여 다음과 같은 결과를 얻었다. 육안적 소견상 대조군과 urokinase 사용군에 비해 비교군 II와 III에서 괴사가 적었으며(p<0.05) 근육 조직의 전기 자극 심사에서도 대조군과 비교군 I 은 각각 $1.76{\pm}1.01,\;2.36{\pm}\1.02$로 차이가 없었으나 비교군 II와 III에서 각각 $3.54{\pm}0.93,\;3.49{\pm}1.37gm/mm^2$으로서 대조군에 비해 근육의 강직도가 의의있게 강하게 나타났다(p<0.05). 그리고 TTC 염색에서 대조군의 7례에서 허혈성 괴사 소견이 보였고 비교군 I도 3례에서 허혈성 괴사 소견이 있었으나 비교군 II과 III에서는 허혈성 괴사가 없었으며(p<0.05) 근피판의 wet/dry 무게비에서 대조군과 비교군 I은 각각 $4.55{\pm}0.37,\;4.33{\pm}0.36$으로 차이가 없었으나 비교군 II와 III는 각각 $3.84{\pm}0.29,\;3.75{\pm}0.48$로 대조군과 비교군 I에 비해 부종이 적음을 나타내었다(p<0.05).

• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.24-31
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• 1994

저자들은 1980년 1월부터 1993년 5월까지 종골부위의 피부결손이나 또는 골결손을 동반한 연부조직 손상이 있었던 총 22례 환자에 대하여 유리피판술 또는 생골및 생피부편 이식술을 시행하고 최저 1년 이상 추시하여 다음과 다음과 같은 결과를 얻었다. 1. 유리 피부편의 크기는 최저 $7cm{\times}6cm$에서 최대 $28cm{\times}10cm$로 평균 $12.1cm{\times}9.2cm$였고, 유리 골편의 크기는 각각 $4cm{\times}3cm$, $5cm{\times}4cm$였다. 2. 재건술에 이용된 방법으로 유리 피부피판술은 족배 비판 11례, 서혜부 피판 2례, 전완부 피판 2례였고, 유리 피부근피판술은 활배근 피부근피판 3례, 대퇴근막장근 피부근피판 2례였으며, 골결손을 동반한 연부조직 손상인 경우 2례에서 생장골 피부편을 이식하였다. 3. 총 22례중 19례에서 유리편이 생존하여 86.4%의 성공율을 보였으며, 수술후 혈전증 2례와 감염이 발생하였던 1례에서 실패하였다. 이상의 결과로 볼 때, 고식적인 방법으로 치료하기 어려운 발뒤꿈치의 연부조직 또는 골결손의 치료로서 미세수술을 이용한 유리편 재건술이 유용한 방법으로 사료되며, 발뒤꿈치의 감각신경 회복에 대하여는 향후 지속적인 연구가 필요한 것으로 사료된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권2호
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• pp.143-149
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• 2005

Objects : With the advancement of tissue engineering techniques, the effort to develop bioartificial mucosa have been actively delivered. The problem we met with this technique is the lack of mechanical strength between kerationocyte layer and dermal layer, where in the normal skin and mucosa, they are tightly bound with rete ridge structure. The purpose of this study is to understand the 2D and 3D structure of rete ridge of mucosa and skin paddle for rendering more biomimetic structure to the artificial mucosa. Materials and Methods : Oral mucosa and skin from the patients who received the oral surgery and maxillofacial reconstruction were harvested. The epidermis was separated from the dermis after treating with dispase for 12-16 hours. H&E staining was performed for 2D(dimensional) structure study and confocal LASER and SEM study were performed for 3D structure. Mean height(Sc) and arithmetic mean deviation(Sa) of all surface height were calculated. Results : The average height of rete ridge of skin flap was between $67.14{\mu}m$ and $194.55{\mu}m$. That of oral mucosa was between $146.26{\mu}m$ and $167.51{\mu}m$. Pressure bearing area and attached gingiva of oral mucosa showed deeper rete ridges. Conclusion : To obtain the adequate strength of artificially cultured keratinocyte skin and mucosa flap, it is necessary to imitate the original skin and mucosa structure, especially rete ridge. Through this study, 2D and 3D rete ridge structure of normal mucosa and skin was obtained. These results can be used as basis for substrate morphology for keratinocytes culture.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.761-766
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• 2009

Purpose: Secondary breast reconstruction is defined as a whole reconstructive procedure to correct complications and to improve the aesthetics when a patient is dissatisfied with her initial reconstruction. We would like to present these particular procedures on previously failed breast reconstruction with analysis of unsatisfactory results. Methods: From June 2002 to August 2008, we performed secondary breast reconstructions for 10 patients with failed breasts. Six patients with implant failure underwent secondary breast reconstructions using free TRAM flaps after the removal of implants. Two patients with partial loss of pedicled TRAM flaps underwent secondary breast reconstruction using Latissimus Dorsi flaps. Two patients with 1 total loss of free TRAM flap and 1 extensive fat necrosis underwent secondary breast reconstruction using implants. Results: The average age of the patients were 36.4 years (26 ~ 47 years). All flaps survived completely and had relatively good aesthetic results in free TRAM cases. There was breast asymmetry in one patient using cohesive gell implants in total loss of previously free TRAM patient, which was corrected by exchanging the implants and placing dermofat grafts. Conclusion: Secondary breast reconstruction differs from primary procedures in several aspects; there are changes in the anatomy and tissue environment of the breasts, and various limitations in choosing reconstruction methods. In addition, the patients may be uncomfortable with previous complication. It is important to consider various factors before deciding to undergo a secondary breast reconstruction carefully with informed consent.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.261-264
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• 2007

Purpose: Extranodal marginal zone B cell lymphoma of MALT type represents approximately 8% of non-Hodgkin's lymphomas and this lymphoma is present in extranodal sites. Although the presentation of this lymphomain in stomach is usually associated with H. pylori infection in 95% of cases, MALT lymphoma found in soft tissue has been reported very rarely in the field of plastic surgery. We report a case of MALT lymphoma in the submandibular gland without any involvement of other organs such as the stomach. Methods: A 49-year-old man complained of a huge neck mass sized about $10{\times}12cm$. It started about 2 years ago and grew rapidly for the late 6 months. It was of hard nature with erythematous skin overlying it. Under the diagnosis of possible malignant lymphoma or sarcoma, radical resection was performed and the defect was reconstructed using transverse rectus abdominis musculocutaneous free flap. Results: The mass was well demarcated from the normal tissue, $11{\times}10.5{\times}10cm$ in size and whitish-gray color. Immunohistochemical analysis demonstrated that the tumor cells were LCA(+), CD20(+), CD3(-) and CD5(-). The tumor was diagnosed as extranodal marginal zone B cell lymphoma. The patient was treated with prophylactic radiation therapy after surgery, there was no complication for 1 year. Conclusion: We reported that very rare form of MALT lymphoma in 49-year-old male patient was experienced with clinical characteristics, histologic features and references.

• Korean Journal of Radiology
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• 제24권7호
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• pp.640-646
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• 2023

Objective: Prospective studies on postoperative residual breast tissue (RBT) after robotic-assisted nipple-sparing mastectomy (R-NSM) for breast cancer are limited. RBT presents an unknown risk of local recurrence or the development of new cancer after curative or risk-reducing mastectomies. This study investigated the technical feasibility of using magnetic resonance imaging (MRI) to evaluate RBT after R-NSM in women with breast cancer. Materials and Methods: In this prospective pilot study, 105 patients, who underwent R-NSM for breast cancer at Changhua Christian Hospital between March 2017 and May 2022, were subjected to postoperative breast MRI to evaluate the presence and location of RBT. The postoperative MRI scans of 43 patients (age, 47.8 ± 8.5 years), with existing preoperative MRI scans, were evaluated for the presence and location of RBT. In total, 54 R-NSM procedures were performed. In parallel, we reviewed the literature on RBT after nipple-sparing mastectomy, considering its prevalence. Results: RBT was detected in 7 (13.0%) of the 54 mastectomies (6 of the 48 therapeutic mastectomies and 1 of the 6 prophylactic mastectomies). The most common location for RBT was behind the nipple-areolar complex (5 of 7 [71.4%]). Another RBT was found in the upper inner quadrant (2 of 7 [28.6%]). Among the six patients who underwent RBT after therapeutic mastectomies, one patient developed a local recurrence of the skin flap. The other five patients with RBT after therapeutic mastectomies remained disease-free. Conclusion: R-NSM, a surgical innovation, does not seem to increase the prevalence of RBT, and breast MRI showed feasibility as a noninvasive imaging tool for evaluating the presence and location of RBT.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.596-600
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• 2015

Background The uptake of breast reconstruction is ever increasing with procedures ranging from implant-based reconstructions to complex free tissue transfer. Little emphasis is placed on scarring when counseling patients yet they remain a significant source of morbidity and litigation. The aim of this study was to examine the scarring preferences of men and women in breast oncoplastic and reconstructive surgery. Methods Five hundred men and women were asked to fill out a four-page questionnaire in two large Irish centres. They were asked about their opinions on scarring post breast surgery and were also asked to rank the common scarring patterns in wide local excisions, oncoplastic procedures, breast reconstructions as well as donor sites. Results Fifty-eight percent of those surveyed did not feel scars were important post breast cancer surgery. 61% said that their partners' opinion of scars were important. The most preferred wide local excision scar was the lower lateral quadrant scar whilst the scars from the deep inferior epigastric artery perforator (DIEP) flap were most favoured. The superior gluteal artery perforator flap had the most preferred donor site while surprisingly, the DIEP had the least favourite donor site. Conclusions Scars are often overlooked when planning breast surgery yet the extent and position of the scar needs to be outlined to patients and it should play an important role in selecting a breast reconstruction option. This study highlights the need for further evaluation of patients' opinions regarding scar patterns.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권2호
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• pp.62-66
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• 2014

Osteoradionecrosis is one of the most serious complications of patients receiving radiation therapy. It is characterized by hypovascularity, hypocellularity, and hypoxia-inducing necrosis of bone and soft tissue following delayed healing. In this case, a 72-year-old man was referred to the Department of Oral and Maxillofacial Surgery complaining of trismus following extraction three months before first visit. He had a history of right tonsillectomy, radical neck dissection and radiotherapy performed due to right tonsillar cancer seven years prior. After the diagnosis of osteoradionecrosis on right mandibular body and angle, conservative antibiotic therapy was used first, but an orocutaneous fistula gradually formed, and extensive bony destruction and sequestrum were observed. Sequestrectomy, free particulated iliac bone and umbilical fat pad graft were performed via a submandibular approach under general anesthesia. Preoperative regular exams and delicate wound care led to secondary healing of the wound without vascularized free flap reconstruction.