• Archives of Reconstructive Microsurgery
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• 제6권1호
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• pp.63-72
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• 1997

We have evaluated the clinical results following the 46 cases of free vascularized osteocutaneous fibular flap transfer to the tibial defect combined with skin and soft tissue defect, which were performed from May 1982 to January 1997. Regarding to the operation, flap size, length of the grafted fibula, anastomosed vessels, ischemic time of the flap and total operation time were measured. After the operation, time to union of grafted fibula and the amount of hypertrophy of grafted fibula were periodically measured through the serial X-ray follow-up and also the complications and results of treatment were evaluated. In the 46 consecutive procedures of free vascularized osteocutaneous fibular flap transfer, initial bony union were obtained in the 43 grafted fibulas at average 3.75 months after the operation. There were 2 cases in delayed unions and 1 in nonunion. 44 cutaneous flaps among the 46 cases were survived but 2 cases were necrotized due to deep infection and venous insufficiency. One necrotized flap was treated with latissimus dorsi free flap transfer and the other was treated with soleus muscle rotational flap. Grafted fibulas have been hypertrophied during the follow-up periods. The fracture of grafted fibula(15 cases) was the most common complication and occurred at average 9.7 months after the operation. The fractured fibulas were treated with the cast immobilization or internal fixation with conventional cancellous bone graft. In the cases of tibia and fibula fracture at recipient site, the initial rigid fixation for the fibula fracture at recipient site could prevent the fracture of grafted fibula to the tibia.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.147-150
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• 1996

미세수술의 발달과 더불어 악성 및 양성 종양의 치료로서 병소 조직 절제후에 결손부에 혈관 부착 골이식술을 시행하는 골종양재건술이 많이 이용되고 있으나 원래 병소가 이식골에 전이되는 보고는 많지 않다. 본 교실에서는 양성 골종양인 섬유성 골이형성증에서 종양조직 절제술후에 생비골 이식술을 시행한 후, 이식골에 원래 종양이 재발한 예를 체험하였기에 적출술 후 생골이식술로서 결손부를 대치하는 수술시에 충분한 병소의 제거 및 지속적인 추시를 통하여 재발 여부를 확인하는 것이 필요하다고 제안하는 바이다.

• Archives of Reconstructive Microsurgery
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• 제4권1호
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• pp.43-51
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• 1995

In certain low-grade malignant bone tumors such as chondrosarcoma or frequent recurrent benign bone tumors as ossifying fibroma, radical treatment may provide a good chance for cure. And large bony defect after the radical treatment can be filled with the massive bone graft. Recent advances in clinical microsurgery have made free vascularized bone graft a clinical reality, and Taylor in 1975, first reported the technique of free vascularized fibula graft for the reconstruction of large tibial defect with excellent clinical results. We tried wide excision and free vascularized fibula graft in 5 patients with ossifying fibroma and one patient with chondrosarcoma from January 1984 to December 1994 and followed for more one year. The shortest bony defect was 7cm and the longest bony defect was 20cm and mean bony defect was 13cm. All patients were evaluated clinically and roentgenographycally on basis of functional recovery and bony union. All patients showed satisfactory functional recovery with sound bony union and showed bony hypertrophy. And, local recurrence was not seen.

• Archives of Reconstructive Microsurgery
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• 제1권1호
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• pp.31-38
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• 1992

The management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In certain some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. The traditional bone grafts have high incidence in recurrence rate, delayed union, bony resorption, stress fracture despite long immobilization and stiffness of adjuscent joint. We have attemped to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle as a living bone graft. From Apr. 1984 to Nov. 1990, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 4 cases, using Vascularized Fibular Graft, which occur at the distal radius in 3 cases and at the proximal tibia in 1 case. An average follow-up was 2 years 8 months, average bone defect after wide segmental resection of lesion was 11.4cm. These all cases revealed good bony union in average 6.5months, and we got the wide range of motion of adjacent joint without recurrence and serious complications.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.100-107
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• 2007

Treatment of giant cell tumor of distal radius can be treated in several ways according to the aggressiveness of the tumor. But the management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. We have attempted to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle or anterior tibial vessel as living bone graft. From April 1984 to July 2005, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 14 cases, using Vascularized Fibular Graft, which occur at the distal radius. VFG with peroneal vascular pedicle was in 8 cases and anterior tibial vessel was 6 cases. Recipient artery was radial artery in all cases. Method of connection was end to end anastomosis in 11 cases, and end to side in 3 cases. An average follow-up was 6 years 6 months, average bone defect after wide segmental resection of lesion was 6.8 cm. All cases revealed good bony union in average 6.5 months, and we got the wide range of motion of wrist joint without recurrence and serious complications. Grafted bone was all alive. In functional analysis, there was good in 7 cases, fair in 4 cases and bad in 1 case. Pain was decreased in all cases but there was nearly normal joint in only 4 cases. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence.

• Archives of Reconstructive Microsurgery
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• 제13권2호
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• pp.130-135
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• 2004

Purpose : To observe the patency of anastomosis site and the findings of circulation of grafted fibula in osteonecrosis of femoral head treated with vascularized fibular graft by use of digital subtraction angiography. Materials and Methods : 17 cases of 11 patients who underwent vascularized fibula graft for osteonecrosis of femoral head. We performed digital subtraction angiography(DSA) for them at second week postoperatively in 12 cases, at sixth week in 1 case, at sixth month in 2 cases, at twelfth month in 1 case, and eighteenth month in 1 case which had been got DSA at second week before. We observe the patency of pedicle, and the circulation of grafted fibula such as periosteal and intraosseous vessels with time. Results : All cases except one which were thought failure of selective angiogram showed good passage of blood flow through anstomosed pedicle on DSA. We found the differences in appearance of circulation of grafted fibula with time. DSA at 2nd and 6th week postoperatively revealed both of periosteal and intraosseous vessels along the fibula and blood pooling at the tip of fibula. DSA at 6th month showed maintenance of periosteal and intraosseous vessels along the fibula but did not clearly reveal blood pooling at the tip of fibula. The findings of DSA at 12th and 18th month were similar each other. The periosteal vessels were not seen as the grafted fibular bone were incorporated into surrounding femoral bone but intraosseous vessels were still seen. Conclusion : It was thought that DSA could be used for evaluation of the status of pedicle including anastomsed site and vessels of grafted fibula with time. The periosteal vessels of fibula were decreased with time but intraosseous vessels were still seen until 18th month after vascularized fibula graft.

• 대한골관절종양학회지
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• 제10권2호
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• pp.96-106
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• 2004

목적: 악성 골, 연부 조직 종양 환자에게 시행한 자가골 재이식술을 이용한 사지 구제술의 치료 결과를 분석하여 그 유용성을 알아보고자 하였다. 대상 및 방법: 1990년 2월부터 2003년 1월까지 악성 골, 연부 조직 종양으로 자가골 재이식술을 이용한 사지 구제술을 시행 받은 환자 중에서 최소 18개월 이상 장기 추시가 가능했던 29예를 대상으로 하였다. 남자가 18예, 여자가 11예로 환자의 평균 연령은 33세(범위, 10~65세)였고, 평균 추시 기간은 51.8개월(범위, 18~117개월)이었으며 Enneking의 분류에 따른 병기는 IIA가 10예, IIB가 19예였다. 자가골의 재처리 방법은 동결 처리법(deep freezing)이 6예, 고온-고압 처리법(autoclaving) 11예, 저온 처리법(pasteurization이) 7예였으며, 5예 에서는 고온-고압 처리법과 혈관 부착 비골 이식술을 병행하였다. 단순 방사선 검사를 통하여 골 유합을 평가하였고, 1993년에 국제 사지 보존 회의(International Symposium On Limb Salvage; ISOLS)에서 수정 보완한 방법을 이용하여 기능을 평가하였다. 결과: 골 유합 기간은 평균 7.2개월(범위, 3~15개월)로, 동결 처리법은 5.8개월(범위, 4~8개월), 고온-고압 처리법은 9.7개월(범위, 6~15개월), 저온 처리법은 5.9개월(범위, 4~8개월)이었고, 고온-고압 처리법과 혈관 부착 비골 이식술을 병행한 경우는 5개월(범위, 3~7개월)이었다. 기능 평가 백분율은 평균 76.8% (범위, 40~90%)로, 동결 처리법은 65.8% (범위, 40~85%), 고온-고압 처리법은 76.6%(범위, 40~90%), 저온 처리법은 81.6%(범위, 70~90%)였고, 고온-고압 처리법과 혈관 부착 비골 이식술을 병행한 경우는 83.4%(범위, 75~90%)였다. 6예에서 합병증이 발생하였는데 국소 재발, 폐 전이, 감염, 골절이 각각 1예였고, 절골부의 불유합이 2예였다. 결론: 자가골 재이식술을 이용한 사지 구제술은 악성 골, 연부 조직 종양의 유용한 치료 방법이며, 특히 고온-고압 처리법을 이용한 자가골 재이식술은 국소 재발을 방지할 수 있는 확실한 방법이었으며, 혈관 부착 비골 이식술을 병행하면 재처리된 자가골의 기계적 강도나 골유도 능력이 감소하는 단점을 보완할 수 있을 것으로 판단된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.138-141
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• 2006

Introduction : In recent years, vascularized, i.e., living bone grafts, have been widely applied in the field of oral and maxillofacial surgery, as a method of treatment of congenital or acquired non-unions, and a large defects in mandible. The vascularized fibular graft has been especially used for this purpose because of its shape and mechanical strength. The postoperative hypertrophy of grafted fibula is of particular interest to us. Material and methods : This study was undertaken to determine the volume change(indirect methods) and radiographic appearance of a free vascularized fibular graft as it responds to the mechanical and physiologic features of its new environment. In order to elucidate the long term effect on fibular mass after mandibular reconstruction, change in various method of volume change was utilized as indirect measure of change in long-term. Results : The younger the patient, the more prominent and rapid the hypertrophy of the graft. the hypertrophy of the graft never exceeded the diameter of the recipient bone, except for callus enlargement after stress fracture of the grafted bone. Conclusion : Etiologic explanations for this phenomenon have not been clarified in the previeous literature. some of the factors implicated include a periosteal reaction or new bone formation, as seen at the onset of bone union after a fracture in a child, a reaction to the mechanical loading on the graft and a reaction to the circulatory changes resulting from the grafting procedure.

• 대한골관절종양학회지
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• 제12권1호
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• pp.47-51
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• 2006

골섬유성 이형성증은 10세 이전에 드물게 발생하는 골종양으로 소파술이나 변연부 절제 후 흔한 재발 및 활성의 증가를 보이며 광범위 골막외 절제술 후에도 재발하는 경우가 있어 치료에 어려움이 따른다. 저자들은 소파술 후 거듭된 재발을 보인 경골의 골섬유성 이형성증에 대하여 광범위 골막외 절제와 함께 유리 생비골 이식술을 시행하여 치유를 얻은 골섬유성 이형성증 1예를 치험 하였기에 문헌 고찰과 함께 보고하고자 한다.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.106-111
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• 1996

Purpose : Propose a surgical technique in donor harvesting method in free vascularized proximal fibular epiphysis. Methodology : Concerned about growth potentials of the transplanted epiphysis in our long term results of the epiphyseal transplanted 13 cases more than 4 years follow-up, anterior tibial artery which contains anterior tibial recurrent artery is most reliable vessel to proximal fibular epiphysis which is the best donor of the free vascularized epiphyseal transplantation. In vascular anatomical aspect proximal fibular epiphysis norished by latearl inferior genicular artery from popliteal, posterior tibial recurrent artery and anterior tibial recurrent artery from anterior tibial artery and peroneal artery through metaphysis. The lateral inferior genicular artery is very small and difficult to isolate, peroneal artery from metaphysis through epiphyseal plate can not give enough blood supply to epiphysis itself. The anterior tibial artery which include anterior tibial recurrent and posterior tibial recurrent artery is the best choice in this procedure. But anterior tibial recurrent artery merge from within one inch from bifucating point of the anterior and posterior tibial arteries from popliteal artery. So it is very difficult to get enough vascular pedicle length to anastomose in recipient vessel without vein graft even harvested from bifucating point from popliteal artery. Authors took recipient artery from distal direction of anterior tibial artery after ligation of the proximal popliteal side vessel, which can get unlimited pedicle length and safer dissection of the harvesting proximal fibular epiphysis. Results : This harvesting procedure can performed supine position, direct anterolateral approach to proximal tibiofibular joint. Dissect and isolate the biceps muscle insertion from fibular head, micro-dissection is needed to identify the anterior tibial recurrent arteries to proximal epiphysis, soft tissue release down to distal and deeper plane to find main anterior tibial artery which overlying on interosseous membrane. Special care is needed to protect peroneal nerve damage which across the surgical field. Conclusions : Proximal fibular epiphyseal transplantation with distally directed anterior tibial artery harvesting technique is effective and easier dissect and versatile application with much longer arterial pedicle.