• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.92-100
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• 2006

Radial forearm free flap (RFFF) has been established itself as a versatile and widely used method for reconstruction of the head and neck, although it is still criticized for high mortality of donor site. Delayed wound healing, cosmetic deformity, vascular compromise and potentially reduced wrist function have many plastic surgeons hesitate to adapt it as a first choice in micro-reconstruction. To overcome these drawbacks, some techniques for donor-site repair such as V-Y advancement with full thickness skin graft (FTSG), application of artificial dermis ($Terudermis^{(R)}$) or acellular dermal matrix ($AlloDerm^{(R)}$), and double-opposing rhomboid transposition flap have been reported. Authors performed 4 cases of RFFF in old-aged patients of the head and neck cancer from April 2005 to February 2006. We compared the outcomes of donor site of RFFF which were resurfaced with split thickness skin graft (STSG) only and STSG overlying an $AlloDerm^{(R)}$. Patients were all males ranging from 59 to 74 years old (mean, 67.5). Three of them had tongue cancers, and the other showed hypopharyngeal cancer. All cases were pathologically confirmed as squamous cell carcinomas. We included the deep fascia into the flap, so called subfascially elevated RFFF in three cases, and in the other one, we dissected the RFFF suprafascially leaving the fascia intact. The donor site of the suprafascially elevated RFFF was resurfaced with STSG only. Among three of subfascially elevated RFFFs, donor-sites were covered with thin STSG only in one case, and STSG overlying $AlloDerm^{(R)}$ in two cases. All RFFFs were survived completely without any complication. The donor site of the suprafascially elevated RFFF was taken well with STSG only. But, the partial graft loss exposing brachioradialis and flexor carpi radialis muscle was unavoidable in all the subfascially elevated RFFFs irregardless of $AlloDerm^{(R)}$ application. Considering that many patients of the head and neck cancer are in old ages, we believe the RFFF is still a useful and versatile choice for resurfacing the head and neck region after cancer ablation. Its reliability and functional characteristics could override its criticism for donor site in old-aged cancer patients.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.578-582
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• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.629-636
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• 2009

Purposes: Wide scars occurring on the lower face and neck are a source of both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. Methods: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil$^{(R)}$ tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule-formed by the tissue expander-was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst$^{(R)}$ facial garment in order to stabilize the operation site at least twelve months. Results: The most prevalent location of the scar was the cheek (15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was $55.7{\pm}39.4cm^2$. Conclusions: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

• 한국임상수의학회지
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• 제30권5호
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• pp.371-375
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• 2013

체중 3.5 kg 11년령 요크셔 테리어가 대변실금, 뒤무직(이급후증), 회음부의 종괴를 동반하는 증상으로 내원하였다. 신체 검사상 비대 유선, 질 분비물과 정복이 가능한 회음부의 종괴가 발견되었다. 임상증상과 방사선검사를 바탕으로 배쪽 양측 회음 허니아와 자궁축농증으로 진단하였다. 자궁난소 적출술 후 양측 회음 허니아는 결장 고정술과 방광 고정술 후 반힘즐 근육 전위술을 이용하여 정복하였다. 수술 후 방사선과 컴퓨터 단층 촬영 검사상에 배쪽 양측 회음 허니아의 정복을 확인할 수 있었다. 술 후 10일째 정상적인 활동을 보였고 1년 동안에 검사상 수술과 관련된 부작용은 관찰되지 않았다. 배쪽 양측 회음 허니아는 결장 고정술과 방광 고정술 후 반힘즐 근육 전위술을 이용하여 성공적으로 치료 되었다.

• Journal of Chest Surgery
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• 제25권6호
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• pp.630-636
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• 1992

From August 1990 through December 1991, 14 patients[all males] underwent int-rathoracic muscle transposition of extrathoracic skeletal muscles to treat empyemas, 6 patients had tuberculous empyemas, 4 had chronic empyemas of unknown etiology, 3 had pos-tpneumonectomy empyemas, and 1 had postlobectomy empyema. 9 patients had associated bronchopleural fistulas, Their ages ranged from 22 to 67 years, with mean age of 45.1$\pm$17. 6[$\pm$S.D] years. The serratus anterior was transposed in 13 patients, the latissimus dorsi in 12. In 11 patients, both the serratus anterior and the latissimus dorsi were transposed. The omental flap also transposed in 3 patients. To reduce the dead space in the thoracic cavity, thr-oacoplasty was also carried out in 10 patients. The number of the partially resected ribs was 3.0$\pm$0.8[$\pm$S.D.]. All operations were single stage procedures, and all wounds were closed primarily, with no permanent tubes or chest wall openings. There was no hospital mortality, and so no subsequent operation has been required. Follow-up of the patients ranged from 5 to 16 months with a mean of 9.2$\pm$3.1[$\pm$S.D] months, All the patints had no further signs or symptoms of the original infection after discharge. We conclude that intrathoracic transposition of extrathoracic skeletal muscle is an excellent method of treatment for persistent, life-threatening intrathoracic infections.

• Journal of Chest Surgery
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• 제34권9호
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• pp.729-732
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• 2001

49세 남자 환자가 객혈을 주소로 입원하였다. 단순 흉부방사선 소견과 흉부단층촬영 소견에서 우측 폐첨부에 연부조직 덩어리가 있는 큰 공동이 관찰되었으며 또한 혈청진균검사상 국균증에 대해 양성이었다. 폐국균종 의심하에 폐우상엽절제술을 계획하였으나 폐첨부와 종격동 흉막의 심한 유착으로 페엽절제술이 불가능하여 공동절개술과 전거근을 이용한 근육충진술을 동시에 시행하였다. 환자는 수술직후 객혈이 멈추었고 특별한 합병증없이 술후 20일만에 퇴원하였으며 8개월간 추적관찰 중에 객혈의 소견은 없었다.

• Annals of Clinical Neurophysiology
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• 제8권2호
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• pp.171-173
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• 2006

Marcus Gunn jaw winking phenomenon has been thought to result from a congenitally abnormal innervation of the levator palpaebrae muscle by a branch of the trigeminal nerve. A 22-year old man presented with bilateral eyelid elevation on the chewing or eating since infancy. Neurological examination showed bilateral Marcus Gunn Jaw wingking phenomenon in this patient. We referred this patient to the department of ophthalmology and plastic surgery for levator resection or orbicularis oculi muscle flap. We report bilateral Marcus Gunn jaw winking phenomenon, although unilateral disorder is the most common form of trigemino-oculomotor synkinesis. Neurologists should be aware of this phenomenon for decision of proper management and take detailed neurologic examination for elucidating the association of other cranial nerves.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권3호
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• pp.226-237
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• 2005

Purpose : Extensive defect of oral and maxillofacial area is usually reconstructed with composite flap including skin paddle. However, if the defects are lined with only skin components, the mucosa's role in mastication and texture are not restored. Furthermore, stiffness and hair-growing prevent denture rehabilitation and good oral hygiene. This study was performed to overcome the disadvantages of composite soft tissue flaps including the skin and to make a model for myo-mucosal flaps. Materials and methods : Buccal mucosa sized $0.5\times1.0\;cm^2$ from New Zealand rabbit (around 1.5kg) was harvested and cultivated by the modification of Rheinwald and Green's keratinocyte culture method. Cultured mucosa was grafted on the fascia of latismus dorsi as form of mucosal sheet. After 7, 10, 14 days, the myomucosal flap was excised and evaluated under light microscope with H & E and immunohistochemical staining. As control group, harvested buccal mucosa from rabbit was transplanted to gracilis muscle(n=6). Results : From 7 days after prelamination, the basal layer of the grafted mucosa resembled that of normal mucosa. As control group, transplanted mucosa had original shape but there's slight inflammatory reaction. Prelaminated mucosa has 19.8$\pm$4.59 cell layers and some samples have more than 20 layers. The expression rate of PCNA was relatively strong (42.9%$\pm$14.1) at the basal layer of grafted mucosa and the laminin was found at the basal layer. On the contrary, prelaminated mucosa at 10 days showed moderate expression rate of PCNA(32.4%$\pm$4.62). We found the mucosal layer was somehow disappeared and there is strong inflammatory reaction. After 14 days prelamination, the grafted oral keratinocytes were almost disappeared and expression of PCNA was not observed. Conclusion : We can make 75 fold large mucosal($3850mm^2$) sheet from small samples of mucosa $(50mm^2)$. Epithelial sheet that grafted on the fascia of muscle underwent differentiation and proliferation. But after 10, 14 days, there was strong inflammatory reaction and the grafted mucosa was destroyed from surface layer. In rabbit model, transfer of fascio-mucosal flap should be done from 7 to 10 days after prelamination.

• 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).

• 대한소아치과학회지
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• 제31권4호
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• pp.665-670
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• 2004

영구치의 맹출지연이 발생하는 원인은 다양하다. 유치의 만기 잔존과 조기 상실, 과잉치나 치아종과 같은 이형물의 존재등과 같이 비정상적인 경조직 인자에 의해 발생할 수 있고, 치은 판개 조직(opercula)과 같은 상부 치은 조직의 섬유성 비후나 소대의 과증식과 같은 연조직성 인자에 의해 발생하기도 한다. 영구치의 맹출지연시의 공간의 상실 및 영구치의 비정상적인 맹출 그리고 그에 따른 치열궁의 비대칭과 같은 교정적 문제와 대합치의 정출 등에 의한 교합적인 문제 등이 발생할 수 있어 조기에 진단하여 처치하는 것이 중요하다. 본 증례에서는 12세 남자아이가 충치가 많고 치아가 나오지 않는다는 것을 주소로 내원하여 진단한 결과, 하악 좌측 소구치들이 맹출하지 못하고 매복되어 있는 것을 알 수 있었다. 원인은 맹출 공간이 부족하였고 동시에 거대 협소대가 치아의 맹출을 방해하는 것으로 파악되었다 이에 대한 처치로 우선 공간을 획득하고 난 후, 부착치은의 회복과 맹출 촉진을 위해 근단 변위부분층 판막술을 시행하였다.