• 대한골관절종양학회지
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• 제12권2호
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• pp.161-164
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• 2006

원위 경골에 발생하는 악성 종양은 드물고 치료에 있어서도 절단술이 많이 시행되어왔다. 최근 사지 구제술이 많이 시행되고 있지만 발목 관절이 포함 되는 경우 재건 방법이 용이치 않다. 저자들은 원위 경골에 발생한 골육종 1례에 대해서 역행성 골수내 정과 저온 열처리 자가골을 이용하여 치료하였기에 문헌 고찰과 함께 보고하고자 한다.

• Journal of Gastric Cancer
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• 제19권3호
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• pp.365-371
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• 2019

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.

• 대한골관절종양학회지
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• 제14권2호
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• pp.140-145
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• 2008

사지 구제술이 보편화된 후 슬 관절 주위 골육종 환자의 재건 방법은 술자의 선호도에따라 차이가 있을 수 있으나 비교적 표준화 되어 있다. 현재 주로 시행되는 사지 구제술 방법으로는 크게 인공관절 치환술, 동종골 이식술이 있다. 인공관절 치환술의 경우 매우 안정적이며 술후 기능적으로도 양호한 방법으로 알려져 있으나, 궁극적으로 파손에 의한 제거술 시행이 필수적인 단점이 있다. 장기적인 관점에서 볼때 이식골을 이용한 재건술은 큰 장점을 갖고 있다. 하지만, 동종골의 사용은 요구되는 크기와 모양을 쉽게 구하기 어렵다는 단점이 있으며, 자가골 이식술은 수술 절제연이 안전하고, 그 적응증이 확립된 경우에만 사용해야 한다는 단점을 갖고 있다. 사지 구제술에 있어 분절 절제법은 골간의 병변에 있어 그 유용성이 확립되어 있으나, 골간단의 병변에 있어서는 시행 적응증이 널리 알려져 있지 않다. 저자들은 17세 환자의 근위 경골 내측과에 국한적으로 발생한 골육종의 증례에서 내측과 절제만으로도 안전한 절제연을 얻을 수 있을 것으로 사료되어 내측과 절제술 및 저온 열처리 자가골 이식술을 시행하였다. 본 술식은 추가적인 성장이 예상되는 소아환자에게 시행하였을 경우, 추후 파손 발생시에도 반측 치환술로 치환 가능한 방법으로 생각되어 보고하는 바이다.

• Archives of Reconstructive Microsurgery
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• 제4권1호
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• pp.9-15
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• 1995

Free vascularized composite tissue transfer is more frequently underwent for reconstruction of complicated tissue defects with the recent advance of microsurgery. But postoperative result was not satifactory because of donor site morbidity, flap bulkiness and cosmetic problem. So would no longer be a problem if we can obtain the exact donor tissue required for the recipient site as allotransplantation and designing the flap. Allotransplantation has been resolved with the recent development of immunosuppressive agents, while reconstruction has made great progress with the refinement of microsurgical techniques in the last 20 years. The final sucess or failure of the operative procedure in transplantation is so utterly dependent no the availability of strategies that can control the immune system effectively, selectively, safely to allow allotransplantation of a nonvital body part. 1 used 2 strains of rats, BUF and LEW, for the limb allotransplantation as a composite tissue transfer. The primary goal of this program is to improve results in clinical transplantation by accelerating the transformation of new immunological knowledge into useful medicine. Two of the most promising new immunosuppressive compounds are FK-t06(FK) and rapamycin(RPM). Both drugs are antibiotic macrolide fungal fermentation products that presumably suppress the immune system in ways similar to cyclosporin(CyA). This study shows that two new immunosuppressive drugs compare the immunosuppressive activity and effectiveness of FK-506 and RPM for prevention of the limb allograft rejection in the rat. Additional experiments investigate the dose, route of administration and histologic findings. These data demonstrates that rapamycin is far more potent and effective than FK-506 when both compounds are administered by the intraperitoneal route, as well as prolonged graft survival significantly in a dose-route dependent manner. These results lead to the view that vascularized allograft composite tissue transfer can become a reality with the expectation of possible future application in reconstructive surgery of humans.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.597-604
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• 2009

Purpose: Compound tissue defects remain a challenge to reconstructive surgeons. The objective of this study was to introduce examples of successful reconstruction of compound defects of the head and neck and upper and lower limbs, using chimeric flaps based on the subscapular vascular system. Methods: We report 19 reconstruction cases using chimeric flaps based on the subscapular vascular system. The scapular flap, scapular fascia, scapular bone, parascapular flap, latissimus dorsi, latissimus dorsi perforator flap, latissimus dorsi myocutaneous perforator flap, serratus anterior, serratus anterior fascia, and rib bone were used as components for chimeric flaps. 12 cases had defects of the upper limb, three in the lower limb, three in the head and neck area, and one case had a defect of the thoracoabdominal wall. Results: Defect sizes ranged from $6{\times}8cm$ to $20{\times}22cm$. The component used most often for skin coverage was the latissimus dorsi perforator flap; for soft tissue bulk, the latissimus dorsi; for fascia coverage, the serratus anterior fascia flap; and for bone reconstruction, the scapular bone flap respectively. All cases were successfully reconstructed without additional operative procedures or flap necrosis. Conclusion: Because it is fairly easy to employ vascular pedicles of sufficient length and diameter, enabling the use of diverse types of tissue with various shapes and sizes, the use of chimeric flaps based on the subscapular vascular system allows one - stage reconstruction tailored to the characteristics of the defect area.

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1993년도 제13차 학술대회
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• pp.105.2-106
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• 1993

• 한국임상수의학회지
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• 제36권6호
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• pp.301-305
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• 2019

Wii^® balance board (WBB, Nintendo, Japan) is a device that can measure and record the center of pressure path length (CPPL) and 95% confidence ellipse area (Area 95) in relation to body sway. For evaluating measure of improvement after reconstruction of medial patellar luxation (MPL) in small sized dogs, A total of 6 dogs with limping and lameness gait attributed to Grade II, III or IV MPL were evaluated. Dogs were measured for difference of extension and flexion range of motion in the stifle (dROM), muscle mass, lameness, willingness to bear weight on the affected limb while standing, and willingness to lift the contralateral limb scores, CPPL and Area 95 of WBB on pre-surgery, post-surgery 4, 8 weeks. CPPL was significantly different on pre-surgery compared with post-surgery 8 weeks (p < 0.05). Except for CPPL, measured variables were significantly different on pre-surgery compared with post-surgery 4 and post-surgery 8 weeks (p < 0.01).

• 대한골관절종양학회지
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• 제20권1호
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• pp.36-40
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• 2014

사지에 발생한 골육종에서의 사지구제술은 광범위 절제술을 기본으로 한다. 수술 전 항암 치료를 한 뒤에 시행하는 경우가 대부분이라 수술전에 빈혈인 경우가 많고 수술로 인한 출혈이 많아서 수술 전 후 빈혈 교정의 필요성이 대부분 존재한다. 수혈이 암 환자의 예후와 합병증 및 수술 후 치료 결과에 나쁜 영향을 미친다는 다양한 보고들이 있음에도 불구하고 사지 구제술에서 빈혈을 교정하기 위한 방편으로 수혈은 여전히 통상적인 치료로 간주되고 있다. 이에 저자들은 대퇴골 원위부에 발생한 골육종 환자의 사지구제술을 무수혈로 시행하였기에 문헌 고찰과 함께 증례 보고 한다.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.782-784
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• 2022

Diabetic foot ulcers are a severe complication of diabetes, and their management requires a multidisciplinary approach for optimal management. When treating these ulcers, limb salvage remains the ultimate goal. In this article, we present the "hanging" free flap for the reconstruction of chronic lower extremity diabetic ulcers. This two-staged approach involves standard free flap harvest and inset; however, following inset the "hanging" pedicle is covered within a skin graft instead of making extraneous incisions within the undisturbed soft tissues or tunnels that can compress the vessels. After incorporation, a second-stage surgery is performed in 4 to 6 weeks which entails pedicle division, flap inset revision, and end-to-end reconstruction of the recipient vessel. Besides decreasing the number of incisions on diabetic patients, our novel technique utilizing the "hanging" pedicle simplifies flap monitoring and inset and allows reconstruction of recipient vessels to reestablish distal blood flow.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.187-193
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• 2020

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.