• 제목/요약/키워드: RECONSTRUCTION

검색결과 7,667건 처리시간 0.029초

Current status of and trends in post-mastectomy breast reconstruction in Korea

  • Song, Woo Jin;Kang, Sang Gue;Kim, Eun Key;Song, Seung Yong;Lee, Joon Seok;Lee, Jung Ho;Jin, Ung Sik
    • Archives of Plastic Surgery
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    • 제47권2호
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    • pp.118-125
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    • 2020
  • Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.

안와내벽골절의 해부학적 복원술 (Anatomical Reconstruction of the Medial Orbital Wall Fracture)

  • 최우경;강동희;오상아
    • 대한두개안면성형외과학회지
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    • 제13권1호
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    • pp.29-35
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    • 2012
  • Purpose: In surgical treatment of the medial orbital wall fractures, restoring the original position of the orbital wall is difficult in some cases. Under such condition, the orbital wall is often reconstructed with synthetic material, without bony reduction, which is considered to be the conventional reconstruction. The purpose of this study is to compare the outcomes of anatomical reconstruction, which restores the bony wall to the anatomical position, from that of the conventional reduction in the isolated medial orbital wall fractures. Methods: Thirty patients, who underwent reconstruction surgery for the isolated medial orbital wall fractures from March 2007 to August 2011, were reviewed retrospectively. The surgical outcomes of two groups, the conventional reconstruction group (15 patients) and the anatomical reconstruction group (15 patients), were studied in 2 measurements, a one day before and 6 months after the surgery. The changes of orbital volume were calculated by the images from a computed tomography scan and enophthalmos was measured by a Hertel exophthalmometer. Results: The orbital volume ratio was decreased by an average of 1.05% in the conventional reconstruction group, while in the anatomical reconstruction group, the ratio decreased by 5.90% (p<0.05). The changes in the Hertel scale were 0.20 mm in the conventional reconstruction group, and 0.70 mm in the anatomical reconstruction group. However, the difference in the Hertel scale was statistically insignificant (p>0.05). Conclusion: In conclusion, the anatomical reconstruction technique of the isolated medial orbital wall fracture results in a better outcome than that of the conventional reconstruction, in terms of restoring of the original orbital volume and anatomic position. Thus, it can be considered as a useful method for the isolated medial orbital wall fractures.

One-stage nipple and breast reconstruction using a deep inferior epigastric perforator flap after a skin-sparing mastectomy

  • Cho, Hyun Jun;Kwon, Hyo Jeong;Moon, Suk-Ho;Jun, Young Joon;Rhie, Jong Won;Oh, Deuk Young
    • Archives of Plastic Surgery
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    • 제47권1호
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    • pp.26-32
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    • 2020
  • Background Nipple reconstruction is usually performed as a delayed procedure in patients with breast cancer who undergo skin-sparing mastectomy and breast reconstruction surgery using a deep inferior epigastric perforator (DIEP) flap. The authors designed this study to evaluate the utility of breast reconstruction based on a DIEP flap and immediate nipple reconstruction. Methods A retrospective review was conducted of all patients who underwent breast reconstruction performed by a single plastic surgeon from October 2016 to June 2018. Through a questionnaire and chart review, we compared surgical results and complications in cases of single-stage nipple reconstruction after skin-sparing mastectomy (n=17) with patients who underwent delayed nipple reconstruction after skin-sparing mastectomy, modified radical mastectomy, or simple mastectomy (n=7). Results In a subjective analysis using clinical photos, the immediate nipple reconstruction group had higher scores than their counterparts in an evaluation of the nipple-areolar complex (NAC) (NAC placement, 3.34 vs. 3.04; nipple projection, 3.05 vs. 3.03; nipple size, 3.30 vs. 3.29). No significant differences between the groups were found in terms of complications. Conclusions Simultaneous nipple reconstruction is a reliable surgical method with economic advantages. No differences were found in terms of outcomes and complications in comparison to delayed reconstruction. Therefore, surgeons can consider simultaneous nipple reconstruction without particular concerns about asymmetry or necrosis.

횡복직근 유리피판술에 의한 양측 유방 재건 (Bilateral Breast Reconstruction with Free TRAM Flaps)

  • 안희창
    • Archives of Reconstructive Microsurgery
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    • 제9권2호
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    • pp.127-133
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    • 2000
  • Free TRAM flap is now increasingly suggested to patients requiring breast reconstruction after the mastectomy. This study is to introduce the experiences of bilateral free TRAM flaps for reconstruction of bilateral breasts and to suggest the way of getting the more satisfactory results. A total of 6 breasts were reconstructed in 3 patients using bilateral free TRAM flaps immediately following the mastectomy. Average operative time for bilateral breast reconstruction was 8 hours comparing to 6.5 hours for unilateral breast reconstruction. Partial or total flap loss did not occur in 6 flaps. Abdomen was repaired directly with muscle and fascia sparing technique without necessity of mesh graft. There was no complication in donor site like abdominal hernia. Bilateral breast reconstruction can achieve exceptionally good aesthetic result with low complication if it is performed with skillful technique and experience. The reason for this is that fairly good symmetry usually is obtained in the initial surgery and in most cases only minimal additional surgery is required to achieve a satisfactory aesthetic result. The one disadvantage of bilateral reconstruction with autologous tissue is the length of the surgical procedure. Although the initial bilateral breast reconstruction can be a long, tedious procedure if free flaps are used, it must be a valuable treatment option for bilaterally mastectomized patients.

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구강암 환자의 재건술 (Reconstruction of oral cancer patients)

  • 유상일;안강민
    • 대한치과의사협회지
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    • 제48권8호
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    • pp.607-614
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    • 2010
  • Reconstruction after ablative oral cancer surgery is challenging mission. Soft tissue and hard tissue could be resected in case of advanced oral cancer. The final goal of oral reconstruction is to gain normal swallowing, chewing and speech. Nowadays, free flap reconstruction after oral cancer resection is more popular than pedicled flap. Microsurgical reconstruction with free flap could be used effectively in complicated cases of oral cavity defect. However, complications could be happened. So not only meticulous preoperative study about the extent of defects but also the donor site dressing after surgery were performed to prevent postoperative complication. The most favorite free flap for soft tissue reconstruction is radial forearm flap. It has a lot of advantages such as pliable, hairless, reliable vessels, appropriate diameter of radial artery and diverse flap design. And the most popular free flap for jaw reconstruction is free fibular flap. In this article, we report the classification of flap for reconstruction and reveal the pits and falls of radial forearm free flap and free fibular flap.

후방 십자 인대 손상 치료의 개관(over view) (Overview of the PCL Reconstruction)

  • 정영복
    • 대한관절경학회지
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    • 제2권1호
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    • pp.1-3
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    • 1998
  • The PCL reconstruction in chronic isolate PCL reconstruction was still controversy. 1) In isolate PCL deficient knee, functionally not so bad as like ACL deficient knee. 2) The result of the PCL reconstruction was not as good as ACL reconstruction. Therefore, isolate PCL injuries has been treated as nonoperatively. Hey Grovere, who was the first to attempt an intra-articular reconstruction of the PCL, utilized the semi-tendinous tendon other static procedures have been described in only a few cases with very limited follow-up. Dynamic procedures utilizing the medial head of the gastrocnemius has been reported by Hugston and Degenhardt, Kennedy and Grainger, and Insall and Hood. These procedures did not improve static stability. Dr Clancy, who was introduce the use of BPTB for the PCL reconstruction transtibial and femoral tunnel. From 1995, untill early 1990 PCL reconstruction was done as tend as placement of the isometric point. Physiometic placement of Anatomical placement of the femoral tunnel in PCL reconstruction were introduced in 1995. Tibial Inlay Technique was reported by Dr Berg in 1995. The main advantage of the tibial Inlay Technique was to avoid fraying of the graft at the posterior tibial tunnel orifice. In complete PCL ruptured and severely posterior unstable knee, dual femoral tunnel technique will be to get better result than one bundle technique. To achieve restoration of normal posterior laxity, it is critical to address the posterior as well as the posterolateral structures. Futher research is necessary to evaluate new surgical approches such as double-bundle reconstructions and tibial inlay techniques as well as improved techniques for capsular and collateral ligament injuries.

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두경부 재건에 있어서 천공지 피판의 다양한 유용성 (Various Utility of Perforator Flaps in Head and Neck Reconstruction)

  • 김정태;이철용;김순진
    • Archives of Plastic Surgery
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    • 제32권3호
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    • pp.271-280
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    • 2005
  • There are various types of flap in head and neck reconstruction. We chose the appropriate flap considering the indication and patient's condition. In case of conventional flaps, its type is decided according to the reconstruction site. In other words, the types of considerable flaps are limited in a way. But, perforator flaps can reduce donor limitation and harvest flaps depending on the condition of the recipient. Therefore, the flap is very useful for the head and neck reconstruction needed for 2-dimensional or 3-dimensional reconstruction. We report the 29 cases of perforator-based flap including 8 cases of latissimus dorsi perforator free flap, 5 thoracodorsal perforator free flap, 4 anterolateral thigh perforator free flap, 3 peroneal osteocutaneous perforator free flap and 9 submental perforator island flap for the head and neck reconstruction. Free flaps include 2 cases of chimeric pattern, 7 controlled resurfacing pattern, 4 3-D pattern, 3 dermoadiposal pattern, 1 folded pattern and 3 osteocutaneous pattern. The flaps were successfully used for the head and neck reconstruction. But one patient died during a follow up period because of the recurrence of tumor. Various perforator flaps(island/free pattern) can be highly competitive to the conventional flaps in the head and neck reconstruction, considering a thin character for resurfacing, more flexible and versatile option, variable composition, long pedicle with donor structures saved, and less prominent donor morbidity.

유리 복직근 및 복직근피판술을 이용한 사지의 재건술 (Reconstruction of the Extremity Injury using by Free Rectus Abdoninis Muscle or Myocutaneous Flap)

  • 안기영;장경수;한동길
    • Archives of Reconstructive Microsurgery
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    • 제4권1호
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    • pp.23-32
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    • 1995
  • Severe upper and lower extremity trauma may result in soft tissue loss with exposed bone and the subsequence of risk of chronic osteomyelitis or malunion of fracture fragments. Such injuries present a major reconstructive problem. But Since the introduction of microsugical technique, free muscle and myocutaneous flaps were employed to provide coverage of severely injured defects. Since Tai and Hasegawa(1974) first reported a breast reconstruction using by rectus abdominis myocuraneous flap, the free rectus myocutaneous flap has been widely employed for breast reconstuction, head and neck reconstruction, and extremity reconstruction in these days. The authors present their successful experience with free rectus abdominis muscle and rectus abdominis myocutaneous flaps for upper and low extremity reconstruction. From Nov. 94, to May 95, Five cases of severely injured extremites due to trauma or contact burn were treated with free rectus abdominis muscle flap or free rectus abdominis myocutaneous flap. All flaps except 1 case were survived without severe complications. As free muscle or myocutaneous flap, the free rectus abdominis flap has the advantages of a reliable pedicle, easy dissection, and an acceptable donor site, so it seems logical to apply the free rectus abdominis flap to apply in upper and lower extremity reconstruction.

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음파를 이용한 덕트 내 불균일 단면적의 역문제적 재구성 (Inverse Reconstruction of Sectional Area in Nonuniform Ducts by Using the Acoustical Measurement)

  • 김회전;이정권
    • 한국음향학회지
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    • 제20권6호
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    • pp.9-16
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    • 2001
  • 본 논문에서는 음파를 이용하여 덕트 내 길이 방향으로의 불균일 단면적을 역문제적으로 측정하는 방법에 대해서 연구하였다. 음파를 사사용하여 덕트 단면적을 구하는 이론 및 실험방법 등에 대해서 많은 연구가 되어왔으나, 본 연구에서는 덕트 내 충격응답을 구하고 이를 재구성 알고리즘에 대입하여 덕트 내 단면적을 구하는 방법을 채택하였다. 충격 가진을 통하여 덕트 내 충격응답을 구하는 기존 방법의 문제점을 살펴보았고, 광대역 가진 방법을 새로 제안하였다. 실험 및 이론적 고찰을 통하여 새로운 방법이 기존의 방법보다 면적 재구성 오차가 적음을 보였다. 덕트 단면적을 재구성 할 때의 오차 원인과 불규칙 잡음에 의한 오차범위를 파악하기 위하여 오차해석을 수행하여 음파를 이용한 면적 재구성 방법의 적용범위 및 대상을 명확히 하였다.

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유리 횡복직근피판술을 이용한 지연 유방재건술; 즉시 유방재건술과의 비교 (Delayed Breast Reconstruction using Free Transverse Rectus Abdominis Myocutaneous(TRAM) Flap; Comparison with Immediate Breast Reconstruction)

  • 전명곤;안희창
    • Archives of Reconstructive Microsurgery
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    • 제10권1호
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    • pp.28-33
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    • 2001
  • The numbers of breast cancer are increasing in Korea and the needs for breast reconstruction are also parallel with cancer frequency. The purpose of the study is to define the different state and condition between the delayed reconstruction and the immediate reconstruction of breasts and to suggest how to get more satisfactory outcome. The study included 22 patients who underwent delayed breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) free flap from December, 1990 to January, 2001. Their ages ranged from 28 years to 58 years. We have used internal mammary artery and vein as a recipient vessel in 13 patients because of fibrosis and severe scarring in the axillary region and thoracodorsal artery and vein in 9 patients. When we used internal mammary artery with recipient vessel, we would use contralateral deep inferior epigastric artery with donor vessel. We obtained satisfactory result without any flap loss, and most patients satisfied with shape and volume of reconstructed breast. We found that delayed breast reconstruction have some differences compared with immediate breast reconstruction. First, we remove fibrotic and scar tissue as much as possible to achieve satisfactory shape of breast. Second, we plan preoperative design in standing position to obtain symmetrical recreation of inframammary fold. Third, we use internal mammary vessel in many cases with recipient vessel for microvascular anastomosis. Fourth, patients with delayed breast reconstruction feel more satisfaction than patients with immediate breast reconstruction do. Finally, economic burden is much higher in the delayed case than in the immediate case because of no coverage with insurance.

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