• Maxillofacial Plastic and Reconstructive Surgery
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• 제14권1_2호
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• pp.105-116
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• 1992

저자들은 악안면부에 발생한 종양 절제 후 광배근피판(유정 피판, 5례 : 유리 피판, 1례)으로 재건하여 5례에서 성공하였다. 큰 피판 형성의 잠재성은 두경부에서 충분한 종물제거와 재건을 가능하게 하였으며, 피판 형성이 빠르고 용이하며 긴 혈판경(약 45cm)을 채득할 수 있었다. 공여부 합병증과 기능 상실이 적어 두경부의 커다란 결손부 재건에 매우 유용한 피판으로 판단되었으며, 경부곽청술 후 노출되는 심부 조직에 대해 심미적이며 기능적인 보호를 제공할 수 있었다.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2008년도 추계학술대회
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• pp.176-176
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• 2008

• Archives of Plastic Surgery
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• 제48권5호
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• pp.494-497
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• 2021

Bronchopleural fistula is a severe complication with a high mortality rate that occurs after pulmonary resection. Several treatment options have been suggested; however, it is a challenge to treat this condition without recurrence or other complications. In this case report, we describe the successful performance of a pedicled latissimus dorsi myocutaneous flap transfer, with no recurrence or donor site morbidity.

• 대한두경부종양학회지
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• 제11권1호
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• pp.41-46
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• 1995

저자들은 14례의 구인두암례에서 원발병소를 절제한 후 그 결손을 대흉근피판을 이용하여 동시에 재건하였다. 합병증으로는 근피판의 전괴사가 1례, 부분괴사가 3례, 창상감염이 1례, 혈종 2례, 하악골수염 및 불유합이 각 1례, 공여부위의 혈종이 1례 있었다. 인두피부누공 3례는 피판의 전괴사 및 부분괴사의 3례이었으며 변연절제(debridement)시 인두피부누공을 만든 예이었다. 8례에서는 합병증이 없었으나 6례에서 총 12건의 합병증이 발생하였다. 대부분의 합병증은 변연절제를 제외하고는 이차적인 재건술식 없이 치유되었다. 편도주위의 결손은 재건을 필요로하는 면적은 많으나 그 부피가 작아 재건이 어려웠으며 경부피부 혹은 구강 등 타 부위보다 합병증이 많음을 경험하였으나 대흉근피판은 안전하고 쉽게 사용할 수 있는 유용한 재건방법이었으며 특히 구강과 경부가 통하는 경우에도 경동맥을 안전하게 보호할 수 있는 방법이었다. 하지만 편도주위의 재건에는 피판이 필연적으로 접히게 되므로 대흉근피판의 부피가 큰 것이 단점으로 사료되었다. 따라서 편도주위의 재건에 있어서는 대흉근의 두께 및 피하조직의 두께, 근피판의 적응, 디자인, 술기, 수술후 처치 등 선택에 보다 신중을 기해야 할 것으로 사료되었다. 이를 위하여 저자들이 사용하는 bilobular모양이 피판의 부피를 줄일 수 있는 한 방법으로 사료되었다.

• 대한두경부종양학회지
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• 제6권2호
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• pp.79-84
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• 1990

본 논문은 구강암의 근치적 절제술후 결손부위 재건을 위한 근피부판(myocutaneous flaps)이 환자의 생존율에 미치는 의의를 알아보고자 저자들의 경험을 살펴본 것이다. 1974년부터 1988년까지, 만 15년간 98명의 환자들이 구강 및 구인두 부위에 발생한 암으로 절제술을 받았다. 이 중 14명은 하악골 절제술없이 근치적 복합적 절제술(composite resection)을 받았으며, 4명은 방사선 조사후 재발한 경우로서 경부곽청술없이 광범위 단순절제술(enbloc resection)만을 시행받았다. 이들을 제외한 근피부판을 사용또는, 사용하지 않은 COMMANDO를 시행받은 84명의 나머지 환자들을 대상으로 여러가지 술식에 따른 재발율 및 생존율을 비교 분석하여보았다. 1) 술기에 있어서 국소 또는 근피부판을 사용하지않은 표준 COMMANDO술식이 24 예, 전두피부판(forehead flap)을 사용하여 재건한 경우가 12 예, 후경부피부판(Nape flap)을 사용한 경우가 19 예, 큰피부판 또는 골근피부판(osteomyocutaneous flap)을 사용한 경우가 27 예였으며 두 종류의 피부판 복원을 시행한 경우가 2 예였다. 2) 비교정(uncorrected) 2년 무병생존율은 표준 COMMANDO가 14%, 전두피부판을 이용한 COMMANDO가 17%, 후경부피부판 사용 COMMANDO가 35% 이었으며 근피부판을 이용한 COMMANDO에서도 역시 35% 이었다. 3) 병기(stage)에 따른 2년 무병생존율은 제 1병기가 100%, 제 2병기가 45%, 제 3병기가 41% 이었으며, 제 4병기에서는 18% 이었다. 4) 근피부판을 사용한 경우와 조직학적으로 이에 상응하는 제 1대조군, 즉 표준 COMMANDO를 시행했거나 국소피부판(전두피부판 빛 후경부피부판)을 사용한 COMMANDO 경우 들과 비교하였을 때 ,2년 무병생존율은 큰 차이가 없이 대조군 양쪽 모두에서 공히 40% 이었다. 5) 근피부판을 사용한 경우를 제 2대조군, 즉 국소피부판(전두피부판 및 후경부피부판) 복원만을 시행한 경우들과 비교했을 때에도 역시 차이가 없이대조군 양쪽 모두에서 27%의 2년 무병생존율을 보였다. 6) 근피부판을 사용한 경우를 제 3대조군 즉 어떠한 종류의 피부판도 사용하지않고 단순한 표준 COMMANDO만을 시행한 경우들과 비교했을 때는 큰 차이를 보였다. 즉, 근피부판을 사용하여 복원했던 경우는 50%의 2년 무병생존율을 보인데 비해, 표준 COMMANDO만을 시행했던 경우는 25%의 생존율을 보였다. 7) 국소재발율은 표준 COMMANDO에서 25%, 후경부피부판 사용 경우에서 26%, 전두 피부판 사용경우에서 33% 이었으나 근피부판을 사용한 경우는 재발율이 가장 낮아 22% 이 었다. 이러한 결과들을 병기가 진행된 예(stage III & IV)에서 본다면, 표준 COMMANDO에서 67%가 제 3, 제 4병기이었고, 후경부피부판을 사용한 경우는 79%에서 제 3, 제 4병기이었다. 전두피부판을 사용한 예에서는 100% 모두가 제 3, 제 4병기이었고, 근피부판을 사용했던 경우는 96% 에서 제 3, 제 4병기이었던 점을 고려한다면 매우 중요한 의미가 있다고 하겠다.

• Archives of Plastic Surgery
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• 제42권1호
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• pp.40-45
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• 2015

Background The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps. Methods Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury. Results Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes. Conclusions The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity.

• Archives of Plastic Surgery
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• 제39권2호
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• pp.154-157
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• 2012

Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.504-508
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• 2012

Background The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation. We investigated any statistically significant differences in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of the latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction after skin-sparing partial mastectomy. Methods A total of 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedure without fibrin sealant and the other 23 were administered the fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed to evaluate the potential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U test were used for analyzing the drainage volume according to age, weight of the breast specimen, and body mass index. Results Although not statistically significant, the cumulative drainage fluid volume was higher in the control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage beginning on postoperative day 3. The donor site comparisons showed the fibrin sealant group had more drainage beginning on postoperative day 3 and the drain was removed 1 day earlier in the control group. Conclusions The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with patients before its use as a part of informed consent.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.298-302
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• 2006

Various method of insetting the transverse rectus abdominis myocutaneous flap for breast reconstruction has been reported in literature. The Bostwick's principle is commonly applied, which utilizes contralateral pedicle in a vertical or oblique flap inset position and ipsilateral pedicle in the transverse position. But it is relatively a complex and difficult technique, thus requires a more simplified strategy. We have formulated a new insetting method, in which the contralateral pedicled TRAM flap with an oblique($0^{\circ}-90^{\circ}$) flap inset was carried out. We used this method in 100 cases from July 2001 to June 2003. This maneuver places Hartrampf's zones I and III with good vascularity in the medial side, and zone II in lateral side of breast. Fat necrosis was observed in 14 patients(14%) and of these, only three cases needed surgical excision. This simplified method is easy to learn. Specifically, fat necrosis removal is easy with more tolerable aesthetic results, especially in Asian patients with smaller breasts.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.70-79
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• 1996

From January 1980 to May 1995, ninety-six patients had been treated by free-flap transfer for the soft tissue defects of the extremities. Ninety-eight cases of free-tissue transfer were reviewed to evaluate the clinical reliability in terms of survival and quality of long-time function after reconstructive surgery. Among these 98 cases(27 cases in latissimus dorsi myocutaneous flap, 25 in dorsalis pedis flap, 20 in forearm fasciocutaneous flap, 9 in groin flap, 7 in gracilis myocutaneous flap, 6 in 1st web space flap of foot and 4 cases in tensor fascia lata flap), 92 cases of then were survived. 7 cases were performed with vein grafts. We ananalyzed the reconstruction of the extremities on 98 cases with the soft tissue defects which had been reconstructed free-flap transfer and followed for minimum 1 year period at Korea University Hospital. 1. 92 cases(93.9%) of the total 98 cases were successful and can be obtained the excellent results in soft tissue free-flap transfer. 2. While there were no clinically significant differences in survival rate of flaps transferred from different potential flap donor sites,3 cases of 9 groin flaps were showed higher failure rate due to the complications such as arterial thrombosis, infection and anatomical variation of vessels. 3. Postoperative thrombectomy was performed in 30 cases to be occured in the arterial and venous thrombosis. The revision was failed in 2 cases due to persistent arterial thrombosis and infection, then treated with skin graft. 4. Vein graft was frequently required in severely compromised-soft tissue defects resulted from high-energy trauma. The vein graft was not stitistically significant on the frequency of flap failure rate(P<0.04). 5. Meticulous monitoring, careful planning, early revision and technical considerations will provide for a high clinical success of the free-flap transfer.