• 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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• 제35권3호
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• pp.279-282
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• 2008

Purpose: It is known that the chronic absence of unilateral breast can cause spine curvature. The artificial breast manufactures take up the position of that possibility. This study was designed to evaluate the influence of the mastectomy on the spine and appearance of scoliosis among women who wanted delayed breast reconstruction. ted delayed breast reconstruction. Methods: The study population consisted of 47 women who underwent delayed breast reconstruction at our Department of Plastic Surgery from April 2001 to May 2007. The whole spine anteroposterior and lateral X-ray was taken to evaluate the Cobb's angle. As a general rule a Cobb angle of 10 is regarded as a minimum angulation to define scoliosis. We evaluated Cobb's angle and drew a correlation between the duration of the mastectomy state and the weight of the mastectomy specimen. Results: There were no family history of scoliosis, and no numbness or weakness in the upper or lower extremities. They had normal reflex and experienced no tenderness of the perispinal area. The Spearman Correlation Coefficient between Cobb's angle and the period that took time from the mastectomy to the X-rays and analysis between Cobb's angle and specimen weight was 0.032 and-0.115. there were no correlation between Cobb's angle and time, or between Cobb's angle and specimen weight. Conclusion: lthough the patients attribute their back pain and distorted posture to having received an one-sided mastectomy, it is unlikely that one-sided mastectomy causes spinal deformity and scoliosis.

• Archives of Reconstructive Microsurgery
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• 제24권1호
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• pp.1-6
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• 2015

Purpose: The main cause of flap loss in microsurgical tissue transfer is venous insufficiency. Whether or not multiple venous anastomoses prevents vascular thrombosis and reduces the risk of flap failure remains controversial. Some researchers are in favor of performing dual venous anastomoses, but the counterargument holds that performing a single venous anastomosis does provide advantages. Materials and Methods: We carried out a retrospective analysis of 15 cases of anterolateral thigh free flap for extremity reconstruction performed between January 2011 and December 2013. The patients were categorized into two groups: group A that received a single venous anastomosis and group B that received dual venous anastomoses. The time of the anastomosis, size of the flap, complications of the flap, and survival rate of each group were analyzed. Results: The total microsurgical time in the single venous anastomosis group ranged from 28 to 43 minutes (mean 35.9 minutes). The total time in the dual anastomoses group ranged from 50 to 64 minutes (mean 55.7 minutes). No statistically significant difference was found between the two groups with regards to postoperative complications and flap failure. Conclusion: Our study suggests that the use of a single venous anastomosis in the venous drainage of anterolateral thigh free flaps is a safe and feasible option for extremity reconstruction and provides shorter operative time and easy flap dissection.

• Archives of Reconstructive Microsurgery
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• 제9권1호
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• pp.1-5
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• 2000

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.62-69
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• 1996

Lateral arm flap has been used for the reconstruction of the various defects in hand, head and neck region. This flap is highly dependable as a free flap because of its thin flap thickness, constant vascular anatomy and possibility of osteocutaneous flap and fascial flap. Recently, many authors tried extended approach for vascular pedicle and distal flap extension for bigger defects. In this study, we review previous articles and 14 cases used lateral arm flaps for coverage of the varying defect on head and neck, upper and lower extremities succesfully. In conclusion, lateral arm flap has constant anatomical structure and can overcome the disadvantages such as short pedicle length and limited flap size, then the range of its application can be very widened.

• Journal of Chest Surgery
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• 제26권11호
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• pp.881-885
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• 1993

In the last few years there has been a resurgenceof interest in in-situ saphenous vein arterial bypass for lower extremity revascularization because of improved patency rates. we performed 1 in situ bypass oreration using the intraluminal valve-disruption tecnique. A 65-year-old female who had ztherosclerotic obstruction in the superficial and popliteal arteries underwent in situ saphenous vein arterial bypass. After harvesting of saphenous vein, we used LeMaitre retrograde valvulotome for valve-disruption technique. Completion of the arterrigraphy was performed to evaluate bothh the anastomoses. The two side brances were all ligated. In situ saphenous vein arterial bypass has become the procedure of choice for distal reconstruction in severely ischemic lower extremities because of improved long-term patency compared with reversed-saphenous vein bypass procedure.

• Journal of Chest Surgery
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• 제37권10호
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• pp.892-895
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• 2004

유척삭종(parachordoma)은 팔, 다리, 가슴에 주로 발생하며 천천히 자라는 저등급 악성 종양으로 알려져 있다. 대표적인 감별진단으로는 척삭종(chordoma), 뼈외 점액양 연골육종(extraskeletal myxoid chondrosarcoma) 등이 있으며, 조직학적 검사와 함께 면역조직화학적 검사가 감별진단에 도움이 된다. 저자는 우측 흉벽에 발생한 유척삭종을 광범위 절제 및 흉벽 재건술 후 16개월 동안 재발없이 추적 관찰한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 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.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.337-343
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• 2014

Background The reconstruction of large skin and soft tissue defects on the lower extremities is challenging. The skin graft is a simple and frequently used method for covering a skin defect. However, poor skin quality and architecture are well-known problems that lead to scar contracture. The collagen-elastin matrix, Matriderm, has been used to improve the quality of skin grafts; however, no statistical and objective review of the results has been reported. Methods Thirty-four patients (23 male and 11 female) who previously received a skin graft and simultaneous application of Matriderm between January 2010 and June 2012 were included in this study. The quality of the skin graft was evaluated using Cutometer, occasionally accompanied by pathologic findings. Results All 34 patients showed good skin quality compared to a traditional skin graft and were satisfied with their results. The statistical data for the measurement of the mechanical properties of the skin were similar to those for normal skin. In addition, there was no change in the engraftment rate. Conclusions The biggest problem of a traditional skin graft is scar contracture. However, the dermal matrix presents an improvement in skin quality with elastin and collagen. Therefore, a skin graft along with a simultaneous application of Matriderm is safe and effective and leads to a significantly better outcome from the perspective of skin elasticity.

• Archives of Plastic Surgery
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• 제41권2호
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• pp.126-132
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• 2014

Background Extensive degloving injuries of the extremities usually result in necrosis of the flap, necessitating comprehensive skin grafting. Provided there is a sufficient tool to evaluate flap viability, full-thickness skin can be used from a nonviable avulsed flap. We used a Wood's lamp to determine the viability of avulsed flaps in the operation field after intravenous injection of fluorescein dye. Methods We experienced 13 cases during 16 months. Fifteen minutes after the intravenous injection of fluorescein dye, the avulsed skin flaps were examined and non-fluorescent areas were marked under Wood's lamp illumination. The marked area was defatted for full-thickness skin grafting. The fluorescent areas were sutured directly without tension. The non-fluorescent areas were covered by defatted skin. Several days later, there was soft tissue necrosis within the flap area. We measured necrotic area and revised the flap. Results Among all the cases, necrotic area was 21.3% of the total avulsed area. However, if we exclude three cases, one of a carelessly managed patient and two cases of the flaps were inappropriately applied, good results were obtained, with a necrotic area of only 8.4%. Eight patients needed split-thickness skin grafts, and heel pad reconstruction was performed with free flap. Conclusions A full-thickness skin graft from an avulsed flap is a good method for addressing aesthetic concerns without producing donor site morbidity. Fluorescein dye is a useful, simple, and cost-effective tool for evaluating flap viability. Avulsed flap injuries can be managed well with Wood's lamp illumination and a full-thickness skin graft.