• Archives of Plastic Surgery
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• 제50권1호
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• pp.3-9
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• 2023

Background In breast reconstruction, synthetic meshes are frequently used to replace acellular dermal matrix (ADM), since ADM is expensive and often leads to complications. However, there is limited evidence that compares the types of substitutes. This study aimed to compare complications between materials via a network meta-analysis. Methods We systematically reviewed studies reporting any type of complication from 2010 to 2021. The primary outcomes were the proportion of infection, seroma, major complications, or contracture. We classified the intervention into four categories: ADM, absorbable mesh, nonabsorbable mesh, and nothing used. We then performed a network meta-analysis between these categories and estimated the odds ratio with random-effect models. Results Of 603 searched studies through the PubMed, MEDLINE, and Embase databases, following their review by two independent reviewers, 61 studies were included for full-text reading, of which 17 studies were finally included. There was a low risk of bias in the included studies, but only an indirect comparison between absorbable and non-absorbable mesh was possible. Infection was more frequent in ADM but not in the two synthetic mesh groups, namely the absorbable or nonabsorbable types, compared with the nonmesh group. The proportion of seroma in the synthetic mesh group was lower (odds ratio was 0.2 for the absorbable and 0.1 for the nonabsorbable mesh group) than in the ADM group. Proportions of major complications and contractures did not significantly differ between groups. Conclusion Compared with ADM, synthetic meshes have low infection and seroma rates. However, more studies concerning aesthetic outcomes and direct comparisons are needed.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.288-294
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• 2015

Background Surgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps. Methods Among 25 local flaps in 24 patients, 6 were bilateral advancement (BA) flaps, 9 were thoracoabdominal (TA) flaps, and 10 were thoracoepigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy. Results The mean defect size was $436.2cm^2$. Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02). Conclusions Three types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.461-464
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• 2008

Purpose: Although the demand for the mammoplasty including reduction or reconstruction is remarkably increasing, the anthropometric measurement for the breast, especially about the nipple areola complex(NAC) of Korean women has not been reported recently. Therefore, the anthropometric measurement about the NAC was performed to suggest the standard size of NAC for Korean women. Methods: Two hundred and twenty five female volunteers in 20's through 50's were included for the study. Questionnaires including the diameter of NAC, the diameter, height of nipple, age, marital status, delivery and lactation history were distributed to the volunteers and collected. Results: The mean values of our study are as follows: the areola diameter is $30.93{\pm}10.07mm$, the nipple diameter is $10.21{\pm}4.14mm$ and the height of nipple is $6.54{\pm}3.74mm$. The diameter of nipple areola complex(NAC) is bigger in old ages. If the volunteers have the history of marriage, delivery and lactation, it is bigger, as well. The height of nipple closely related to individual characters except the correlation between height of nipple and age. Conclusion: It is important to have standard data for the nipple areola complex in order to have good aesthetic results of mammoplasty. Despite the importance, there are a few measurement data for the nipple areola complex(NAC) of Korean women. The result of our study is not the absolute parameter for breast surgery, however it can be used as the standard size for NAC in the Korean female during breast surgery.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.246-253
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• 2021

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient's pathology, the treatment plan should be carefully decided and individualized. At the authors' institution, the treatment plan is made individually based on each patient's symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient's pathophysiology, optimal outcomes can be achieved. Depending on each patient's pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.490-492
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• 2007

Purpose: Nipple reconstruction is an important step in breast reconstruction after mastectomy. There are considerable number of reconstructive methods developed over the past years. Each of these has not only its own special advantages, but also limitations. Therefore, no single method has become the overwhelming favorite. Sometimes it seems to be compromised when the nipple must be located directly over a linear scar. Methods: A 48-year-old female patient received a central lumpectomy with circumareolar resection of the nipple areolar complex 4 months ago. The newly designed nipple must be positioned directly astride a scar. We drew two equal-sized rectangular flaps sharing a common limb on a transverse scar and the result was two opposing plow form. Each flap size was about 1.3 cm wide and 2.5 cm long. First we elevated the flap from the distal part at a deep dermal plane, then deepened the level of dissection to raise the dermal-fat flaps. The donor site could be closed directly without any dog-ear deformity. Then we folded down the elevated flaps and loosely sutured skin with nonabsorbable materials. Each flap inner side was approximated side by side. Finally we made new natural nipple with 6 mm projection. We applied tattooing in the areola area with micropigmentation device after three months. Results: After ten months of follow-up periods, the nipple projection was stable and symmetric. The nipple projection was 3.1 mm, compared with 2.8 mm for the opposite nipple. Conclusion: Our experiences shows that this double opposing plow flap is a particularly useful and simple technique when there is a traverse scar crossing the center of the proposed nipple area.

• 한국의학물리학회지:의학물리
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• 제25권4호
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• pp.271-280
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• 2014

최근에 디지털 유방촬영술(digital mammography, DM)의 해부학적 구조의 겹침 현상과 컴퓨터단층촬영영상(computed tomography, CT)의 높은 환자 선량을 해결하기 위해 디지털 유방단층영상합성장치(digital breast tomosynthesis, DBT)에 대한 연구 개발이 활발하게 수행되고 있다. 하지만 DBT 시스템은 제한된 각도로 영상을 획득하면서 급격한 데이터 결핍으로 인해 다른 층의 간섭으로 인한 인공물(artifacts)이 발생한다. 이를 완화시키기 위해 적절한 필터가 필요하다. 본 논문에서는 DBT 시스템에서 FBP 알고리즘을 이용하여 영상재구성 시 발생되는 인공물을 줄이기 위해 적절한 필터조합을 찾는 것이 궁극적인 목적이다. 시뮬레이션과 실제 실험을 통해 동일한 영상 획득조건에서 FBP 알고리즘을 이용해 재구성된 영상을 분석하여 다양한 필터 조합들의 특성을 조사했다. 필터 특성에 대한 평가를 하기 위해 영상 및 프로파일의 분석과 COV (coefficient of variation)를 이용하여 인공물과 잡음에 대한 평가를 하였다. 본 연구 결과를 통해 분광필터(spectral filter)의 파라미터 인자 값들을 조절하여 cut-off frequency를 설정함으로써 고주파 영역에 있는 영상의 잡음을 줄일 수 있었다. DBT 시스템에서 유방팬텀을 재구성한 영상들을 비교했을 때 분광필터의 파라미터 인자를 0.25로 적용한 영상의 결과는 분광필터를 적용하지 않았을 때보다 영상의 잡음을 10%로 감소시킬 수 있었다. 절편두께필터(slice thickness filter)의 파라미터 인자의 값들을 조절하여 정보들의 불균형을 줄임으로써 다른 층의 간섭으로 인한 인공물을 감소시킬 수 있었다. 결론적으로, 본 연구를 통해 FBP 알고리즘으로 재구성했을 때 필터들의 기본 특성을 확인 할 수 있었으며, 적절한 필터 조합이 실제 화질 개선에 기여한 것으로 확인할 수 있었다. 이 연구 결과는 다양한 필터 조합에 따른 잡음과 데이터 결핍에 의한 인공물에 대한 정보를 제공하여 DBT 시스템의 개발 및 임상화적용 연구에 기반이 될 것으로 기대된다.

• 대한의용생체공학회:의공학회지
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• 제28권4호
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• pp.471-476
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• 2007

Various active microwave imaging techniques have been developed for cancer detection for past several decades. Both the microwave tomography and the UWB radar techniques, constituting functional microwave imaging systems, use the electrical property contrast between normal tissues and malignancies to detect the latter in an early development stage. Even though promising simulation results have been reported, the understanding of the functional microwave imaging diagnostics has been relied heavily on the complicated numerical results. We present a computationally efficient and physically instructive analytical electromagnetic wave channel models developed for functional microwave imaging system in order to detect especially the breast tumors as early as possible. The channel model covers the propagation factors that have been examined in the previous 2-D models, such as the radial spreading, path loss, partial reflection and transmission of the backscattered electromagnetic waves from the tumor cell. The effects of the system noise and the noise from the inhomogeneity of the tissue to the reconstruction algorithm are modeled as well. The characteristics of the reconstructed images of the tumor using the proposed model are compared with those from the confocal microwave imaging.

• 대한두개안면성형외과학회지
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• 제14권1호
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• pp.65-68
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• 2013

Muir-Torre syndrome is defined by concurrent or sequential development of internal malignancy and sebaceous neoplasm or multiple keratoacanthomas. Muir-Torre syndrome is very rare, with only 205 cases reported in the literature. We reported a patient with Muir-Torre syndrome with three internal malignancies. A 64-year-old patient with a history of breast cancer, stomach cancer and colon cancer visited our department for treatment of the skin lesion that occurred five years before on the left cheek. The lesion was excised completely with a resection margin of 1 cm, followed by full-thickness skin graft from left postauricular area for reconstruction. Histopathology revealed a $0.2{\times}0.2{\times}0.1cm$ sized sebaceous carcinoma with 4 mm safety margin. The skin graft was well taken within 7 days after surgery and the patient was discharged to outpatient follow-up. There was no complication related with surgery. Muir-Torre syndrome is very rare, as are sebaceous gland tumors. So if a cancer of the sebaceous gland is diagnosed, screening workup for internal malignancy is recommended. Because of its good prognosis, surgical removal of primary or metastatic cancers may be curative and should be attempted where possible.

• 한국감성과학회:학술대회논문집
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• 한국감성과학회 2009년도 추계학술대회
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• pp.99-102
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• 2009

본 연구에서는 실제 기증받은 시체를 이용하여 인체의 각 구조물을 실제 모습 그대로 3D 이미지화하는 과정에 대해 알아보았다. 인체의 구조물을 3D 로 이미지화하는 과정은 다음과 같다. 먼저 시체를 0.2mm 간격으로 절단하여 절단면의 사진을 찍은 후, 각 절단면의 사진에서 각각의 구조물을 구역화하여 색칠을 한 후, 구역화한 이미지에서 외곽선을 추출하여 벡터 이미지를 만든다. 이 외곽선을 1mm 간격으로 쌓아 올린 후 그 표면을 재구성하여 3D 이미지로 변환하는 과정으로 진행되었다. 3D 이미지의 제작은 가슴 부위에 한정하여 이루어졌다. 인체의 해부학적인 모형을 3D 이미지로 시각화함으로써 얻는 효과는 일반인을 대상으로 인체의 내부에 대한 시각적인 호기심을 충족시켜주고 의학 상식을 넓히는데 도움을 줄 수 있을 것 이다. 또한 의대생들을 비롯한 의학 전문가들에게는 생생한 해부학 강의용으로도 활용 가능하다. 향후 Haptic 시스템을 이용한 의료 실습 어플리케이션과 접목될 수도 있을것이고, fMRI 데이터를 비롯한 타 데이터와의 융합을 통해 시각화하여 서비스 할 수도 있다. 이처럼 인체의 3D 모형은 의료분야에서 광범위하게 활용될 수 있는 데이터로써 그 가치를 지닐 것이다.

• Archives of Plastic Surgery
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• 제44권3호
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• pp.234-237
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• 2017

Paraffinoma is a destructive complication of paraffin oil injection, usually associated with massive tissue destruction, thus requiring radical surgery and subsequent complex reconstruction. Although breast and penile paraffinomas have been widely described and their management is quite standardized, paraffinomas of the knee are still rare and only few case reports or small case series are available in the current literature. We describe the case of a 77-year-old man with a large paraffinoma of the right knee that occurred after self-injection of paraffin oil, 58 years before. He underwent wide surgical resection of the soft tissues overlying the knee and subsequent two-stage reconstruction by using acellular dermal matrix and, after 20 days, split-thickness skin grafts. Follow-up after 16 months showed no signs of skin ulcerations or inflammation, with an overall improvement in function. Even though conventional flap reconstructions may be still useful, the authors believe that acellular dermal matrices represent a safe, reliable, and less invasive alternative for challenging soft tissue reconstructions even in elderly patients with multiple medical problems.