• 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.

• Archives of Plastic Surgery
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• 제50권5호
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• pp.496-500
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• 2023

Fournier's gangrene is a life-threatening infection which requires prompt recognition, early surgical debridement of unhealthy tissue, and initiation of broad-spectrum antibiotics. Relook debridement are usually performed until all the devitalized tissue has been removed. Involvement of the anal sphincter may result in significant morbidity such as permanent incontinence. Dynamic reconstruction of the anal sphincter has always been one of the holy grails in the field of pelvic reconstruction. We demonstrate a new method of camera shutter style double-opposing gracilis muscle flaps that allows dynamic sphincteric function without the need for electrostimulation. The bilateral gracilis muscles are inset in a fashion that allows orthograde contraction of the muscle to narrow and collapse the neoanal opening. With biofeedback training, the patient is able to regain dynamic continence and return to function without a stoma. There was also no need for neurotization or microsurgery techniques to restore sphincteric function to the anus. The patient was able to reverse his stoma 14 months after the initial insult and reconstruction with biofeedback training without the use of electrostimulation.

• Archives of Reconstructive Microsurgery
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• 제1권1호
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• pp.9-16
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• 1992

Volkmann's ischemic contracture is the end result of an untreated, delayed or Inadequately decompressed compartment syndrome in which muscle ischemia and necrosis have occurred. Once the muscle necrosis have happened, the involved muscle undergo permanent change into fibrous tissue. So secondary shortening and distal joint contracture will be a final outcome, which results in marked functional impairment of hand and forearm. Even though several procedures, such as muscle sliding operation has been attempted, overall results were far from satisfaction, compare to healthy opposite hand. The management of these unfavorable condition of the forearm and hand was regarded as one of challenging area in orthopedics. Recently new approach, using microsurgical technique which transfers functioning muscle unit, has been developed and its result was much better than any other methods in the aspect of an active motion. Among these musculocutaneous free flaps, gracilis has obtained special reputation due to its easiness to handle such as elevation of flap and reliable neurovascular pedicle. Other advantages are flexibility of flap size to adjust variable size of the defect in the forearm and minor morbidity of the donor site. Authors have performed 7 cases of functioning gracilis musulocutaneous free flap transplantation for the functional loss of forearm and hand due to Volkmann's ischemic contracture or muscle and skin defect due to severe trauma since November, 1981 till May, 1991. The results in most cases were satisfactory and acceptable.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.584-588
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• 2013

Background The ability to achieve a long-term, stricture-free urethral repair is one of the ongoing challenges of reconstructive urologic surgery. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps. Methods We describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair site to provide a well-vascularised soft tissue reinforcement for urethral repair. This technique promotes vascular induction, whereby a new blood supply is introduced to the repair site to improve the outcome of urethral repair or anastomotic urethroplasty. The surface contact between the muscle flap and the repair site is enhanced by the use of fibrin glue to improve adherence and promote inosculation and healing. We employed this technique in 4 patients with different urethral defects. Results After a follow-up period of 32 to 108 months, all of the urethral repairs were successful without complications. Conclusions Our results suggest that the use of a gracilis muscle flap to vascularise urethral repairs can improve the outcome of challenging urethral repairs.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.336-341
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• 2007

Purpose: The most accepted method for the reanimation of a paralyzed face is the two-stage method that combines cross-face nerve grafting with free-muscle transfer. Although the results of reconstruction with this method are satisfactory, there is an excessive delay between the stages, which prolongs the period of rehabilitation. In order to overcome this drawback, a one- stage, neurovascular free-flap reconstruction method using free neurovascular muscle flaps is introduced. Methods: From 1994 to 2004, 35 patients with longstanding facial palsy were treated. Fifteen patients underwent the single-stage reconstruction with the latissimus dorsi muscle, and 20 patients underwent the two-stage reconstruction method with the gracilis muscle. We compared the long-term results of the two methods of reconstruction. The mean follow-up period was 28.7 months for one-stage reconstruction, and 35.2 months for the two-stage, respectively. Results: In the patient group of the single stage reconstruction, both mouth corner excursion and animation grade were markedly improved at the final postoperative visit. Moreover, the first muscle contraction occurred earlier in this group, than in the two-stage reconstruction group. However, four patients in the single stage group never achieved a first muscle contraction or mouth corner excursion. Conclusion: Facial palsy is a very challenging condition for cosmetic surgeons to deal with. Traditional methods for treatment of chronic facial palsy use a two-stage muscle flap which is time-consuming and burdensome to patients, many of whom are averse to waiting 8 to 12 months to complete the two stages. The one-stage reconstruction method described herein uses a latissimus dorsi free-flap and has demonstrated consistent positive outcomes in clinical assessments.

• 대한의생명과학회지
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• 제18권2호
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• pp.112-122
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• 2012

A gradual change of molecules that are related in fission and fusion is occurred during aging process. Although aging effects on mitochondrial fusion and fission are investigated, it is still unclear that the extent of the change in mitochondria fusion and fission periodically. In this study we investigated the changes of mitochondrial proteins involved in fusion (Mfn2, Opa1) and fission (Drp1, Fis1) in the human gracilis muscle ranging from 10 to 50 years of age (n=40). The gracilis muscle showed a significant increase in muscle apoptotic changes in the age of 50s compared with 10s by using in situ terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL). The expression levels of Drp1 and Fis1 (P<0.01, P<0.05) mRNA were significantly elevated and the Mfn2 and Opa1 (P<0.01, P<0.05) levels were decreased from older individuals. The ratio of fission and fusion was altered and the level of increment of fission gene was greater than fusion gene decrement in the age of 50s. These findings suggest that changes of mitochondrial fusion and fission proteins related with aging might contribute to aged muscle apoptosis.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.571-576
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• 2010

Purpose: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. Methods: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. Results: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. Conclusion: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.

• 한국가금학회지
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• 제31권4호
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• pp.273-281
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• 2004

본 연구는 생물학적 탄산가스 고정화에 사용되는 Euglena를 단세포 단백 사료 자원으로 이용하고, DHA를 강화시킨 변종을 육계의 사료에 첨가하였을 때 그 이용성과 도체지방산에 미치는 영향에 대해 알아보고자 실시하였다. 시험 1에서는 갓 부화한 육계병아리(Ross) 210수를 반복당 10수씩 3반복으로 배치하였다. 처리구는 에너지 함량과 조단백 질함량이 전기에는 3,150 kcaHg, $22\%$, 후기에는 3,200 kcal/kg, $19\%$가 되도록 한 대조구사료에 EG(Euglena gracilis Z.)를 0.25, 0.50, $1.0\%$ 첨가한 구와 EGBD(Euglen gracilis Z. bleached and DHA enriched)를 0.5, 1.0, $2.0\%$ 첨가한 구의 7처리구로 하였다. 시험 2에서는 육계병아리(Ross) 250수를 반복당 10수씩 5반복으로 배치하였다. 처리구는 대조구 사료에 EGD(Euglena gracilis Z. DHA enriched)를 0.5, $1.0\%$ 첨가한 구와 EGBD를 0.5, $1.0\%$ 첨가한 구의 5처리구로 하였다. 사양시험은 5주간 실시하였고 매주 사료섭취량과 증체량, 사료요구율 및 폐사율을 측정하였다. 사양시험종료 후 대사시험을 실시하고, 가슴살을 채취하여 지방산을 분석하였다. 시험 1의 결과를 보면, 증체량은 시험 전 기간 동안 유의한 차이를 보이지 않았다. 사료요구율은 대조구에 비해 Euglena 첨가구들이 좋은 경향이 있었다. 단백질의 이용율은 EG를 첨가한 구들이 EGBD를 첨가한 구들보다 높은 경향이 있었다. 가슴살 내 지방산은 linoleic acid와 arachidonic acid가 $1.0\%$의 EG를 첨가한 처리구에서 유의하게 높았다. EPA는 유의한 차이는 없었지만, EGBD를 첨가한 구들에서 증가하는 경향을 보였다. DHA는 $2.0\%$의 EGBB를 첨가한 구에서 유의적으로 가장 높았고, 대조구를 포함한 다른 처리구들에 비해 EGBD를 첨가한 구들이 유의적으로 높았다. 실험 2에서도 증체량은 유의한 차이를 보이지 않았고, 사료요구율은 시험 전 기간동안 EGBD를 첨가한 구가 유의적으로 좋았다. 가슴살의 지방산 조성의 결과를 보면 linoleic acid는 대조구가 유의하게 높았다. EP4 DHA와 lignoceric acid는 모두 $1.0\%$의 EGBD를 첨가한 구가 유의적으로 가장 높았고, Euglena를 첨가한 구들 모두가 대조구보다 높았으며, 그중 EGBD를 첨가한 구들이 유의적으로 더 높게 나타났다. 결론적으로, Euglena의 첨가가 육계의 생산성에는 크게 영향을 미치지 못했지만, 시험 2에선 EGBD의 첨가가 사료효율을 개선시키는 경향.이 있었다. DHA를 강화시킨 Euglena인 EGD나 EGBD의 첨가는 계육 내의 DHA를 비롯한 $\omega$-3 계열의 지방산의 수준을 높이는데, 특히 EGBD는 DHA 강화 효과가 높았다.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.565-570
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• 2010

Purpose: Due to the closed and humid condition of the perineal area, wound problems occurring at this site are sometimes complicated, especially following postoperative radiation therapy. Moreover, the anal sphincter is a very important functional structure but reconstruction of the anal sphincter after severe trauma poses a challenging problem to plastic surgeons. In this article, we demonstrate the usefulness of the pedicled gracilis flap in the reconstruction of the perineal area. Methods: From September 2008 to November 2009, 6 patients, 4 males and 2 females, underwent surgery of the perineal area. The age of the patients ranged from 21 to 62 years (mean age was 48). The mean follow up period was 14 months. In 4 cases, the patient presented with wound problems after postoperative radiation therapy for anal cancer. In 2 cases, the patient presented with traumatic sphincter damage. Only the gracilis muscle was used in the 4 cases and a musculocutaneous flap was used in the 2 cases involving skin defects, respectively. Results: Among the 6 patients, 1 patient underwent hematoma evacuation of the donor site, and 1 patient presented with prolapse of the vaginal mucosa which recovered spontaneously. There were no report of other complications and there were no wound recurrences. Minimal incontinence was observed in all patients who underwent sphincter reconstruction, but all were satisfied with the overall results. Conclusion: The gracilis flap is useful in the reconstruction of the perineal area, such as in cases of radiotherapy induced wound problems and sphincter damage following severe trauma, due to its easy accessibility, rich vascularity, and minimal donor site morbidity.

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1997년도 제17차 학술대회
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• pp.122-122
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• 1997