• Archives of Plastic Surgery
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• 제38권5호
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• pp.627-635
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• 2011

Purpose: Advanced breast cancer traditionally has been perceived as a contraindication to immediate breast reconstruction, because of concerns regarding adjuvant treatment delays and the cosmetic effects of radiotherapy to breast reconstruction, so delayed reconstruction is usually preferred in advanced breast cancer patients undergoing mastectomy. However, with the improved outcome using multimodality therapy, consisting of perioperative chemotherapy and radiotherapy, immediate breast reconstruction is now being performed as surgical option for selected advanced breast cancer patients. Additionally, advanced breast cancer patients may be needed soft tissue coverage of an extensive skin and soft tussue defect after mastectomy. Current authors have experienced several types of immediate breast and chest wall reconstruction for advanced breast cancer. Methods: From December of 2007 to June of 2009, 14 women performed for immediate breast and chest wall reconstruction for advanced breast cancer. They had been treated with neoadjuvant chemotherapy or chemoradiotherapy followed by modified radical mastectomy or radical mastectomy. Four different techniques were used immediate breast and chest wall reconstruction, which are pedicled TRAM flap (4 cases), extended LD flap with STSG (3 cases), thoracoabdominal flap (4 cases) and thoracoepigastric flap (3 cases). Results: The mean age was 53 years and mean follow up period was 9 months. Patients' oncologic status ranged stage IIIa to stage IV. Two patients had major complications: partial flap necrosis of TRAM flap and one distal necrosis of thoracoabdominal flap. Three patients with stage IV disease died from metastases. Conclusion: The result of this study suggests that immediate breast and chest wall reconstruction can be considered as surgical option for advanced breast cancer. But we need long term follow up and large prospective studies for recurrence and survival.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.346-351
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• 2022

Background Postmastectomy breast reconstruction (PMR) increases patient satisfaction, quality of life, and psychosocial well-being. There is scarce data regarding the safety of PMR in chronic anticoagulated patients. Perioperative complications can reduce patient satisfaction; therefore, it is important to elucidate the safety of PMR in these patients. Methods A retrospective case-control study of patients who underwent PMR with implants and were on chronic anticoagulation was performed at our institution. Inclusion criteria were women ≥ 18 years old. Exclusion criteria included autologous reconstructions, lumpectomy, and oncoplastic procedures. Two controls for every one patient on anticoagulation were matched by age, body mass index, radiotherapy, smoking history, type of reconstruction, time of reconstruction, and laterality. Results From 2009 to 2020, 37 breasts (20 patients) underwent PMR with implant-based reconstruction and were on chronic anticoagulation. A total of 74 breasts (40 patients) who had similar demographic characteristics to the cases were defined as the control group. Mean age for the case group was 53.6 years (standard deviation [SD] = 16.1), mean body mass index was 28.6 kg/m² (SD = 5.1), and 2.7% of breasts had radiotherapy before reconstruction and 5.4% after reconstruction. Nine patients were on long-term warfarin, six on apixaban, three on rivaroxaban, one on low-molecular-weight heparin, and one on dabigatran. The indications for anticoagulation were prior thromboembolic events in 50%. Anticoagulated patients had a higher risk of capsular contracture (10.8% vs. 0%, p = 0.005). There were no differences regarding incidence of hematoma (2.7% vs. 1.4%, p = 0.63), thromboembolism (5% vs. 0%, p = 0.16), reconstructive-related complications, or length of hospitalization (1.6 days [SD = 24.2] vs. 1.4 days [SD = 24.2], p = 0.85). Conclusion Postmastectomy implant-based breast reconstruction can be safely performed in patients on chronic anticoagulation with appropriate perioperative management of anticoagulation. This information can be useful for preoperative counseling on these patients.

• Journal of Gastric Cancer
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• 제13권1호
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• pp.34-43
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• 2013

Purpose: The intracorporeal reconstruction after laparoscopic gastrectomy can minimize postoperative pain, and give better cosmetic effect, while it may have technical difficulties and require the learning curve. This study aimed to analyze the surgical outcome of intracorporeal reconstruction according to the surgeon's experience comparing with extracorporeal procedure. Materials and Methods: From January 2009 to September 2011, intracorporeal reconstruction in laparoscopic surgery for gastric cancer was performed for 71 patients (Intra group). During same period, 231 patients underwent laparoscopy-assisted gastrectomy (Extra group). These patients were classified into initial (1st to 20th case of intra group), intermediate (21th to 46th case), and experienced (after 47th case) phases. Results: Intracorporeal procedures included 35 cases of Billroth-I, 30 Billroth-II and 6 Roux en Y reconstructions. In the initial phase, operation time (P=0.022) were significantly longer for the patients of intra group than them of extra group. Although the difference was not significant, the length of hospital stay was longer and complication rate was higher in the intra group. In intermediate and experienced phases, there was no difference between two groups in operation time and hospital stay. In these phases, complication rate was lower in the intra group than the extra group (3.9% versus 9.7%). The pain scale was significantly lower post operation day 5 in the intra group. Conclusions: Intracorporeal reconstruction after laparoscopic distal gastrectomy was feasible and safe, and the technique was stabilized after 20th case if the surgeon has sufficient experiences when we compared it with extracorporeal reconstruction.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.535-543
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• 2019

Background A high incidence of breast animation deformity (BAD) has been reported following immediate breast reconstruction with subpectorally placed implants. The aim of this study was to assess and compare the incidence of BAD in women who underwent either subpectoral or prepectoral immediate breast reconstruction. Therefore, we developed a grading tool and tested its reproducibility in a clinical setting. Methods Video recordings of 37 women who had undergone unilateral or bilateral immediate breast reconstruction were evaluated by two consultant plastic surgeons. The degree of BAD was assessed by our grading tool, named the Nipple, Surrounding Skin, Entire Breast (NSE) grading scale, which evaluates the degree of tissue distortion in three areas of the breast. Blinded assessments were performed twice by each observer. Results Eighteen patients were reconstructed with subpectoral implant placement and 19 with prepectoral implant placement. Using the NSE grading scale, we found a significant difference in the degree of BAD between the groups, in favor of patients who underwent prepectoral immediate breast reconstruction (0.2 vs. 4, P=0.000). Inter- and intraobserver agreement was moderate (74%) to strong (88%). Conclusions The incidence and severity of BAD was significantly lower in women reconstructed with a prepectorally placed implant than in those who underwent subpectoral immediate breast reconstruction. All patients reconstructed using the subpectoral technique had some degree of BAD. The inter- and intraobserver agreements were high when using the NSE grading scale, suggesting it is an easy-to-use, reproducible scale for assessing BAD in women who undergo immediate breast reconstruction.

• Asian Pacific Journal of Cancer Prevention
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• 제15권11호
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• pp.4535-4538
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• 2014

Objective: To explore the value of porous titanium alloy plates for chest wall reconstruction after resection of chest wall tumors. Materials and Methods: A total of 8 patients with chest wall tumors admitted in our hospital from Jan. 2006 to Jan. 2009 were selected and underwent tumor resection, then chest wall repair and reconstruction with porous titanium alloy plates for massive chest wall defects. Results: All patients completed surgery successfully with tumor resection-induced chest wall defects being $6.5{\times}7cm{\sim}12{\times}15.5$ cm in size. Two weeks after chest wall reconstruction, only 1 patient had subcutaneous fluidify which healed itself after pressure bandaging following fluid drainage. Postoperative pathological reports showed 2 patients with costicartilage tumors, 1 with squamous cell carcinoma of lung, 1 with lung adeno-carcinoma, 1 with malignant lymphoma of chest wall, 2 with chest wall metastasis of breast cancers and 1 with chest wall neurofibrosarcoma. All patients had more than 2~5 years of follow-up, during which time 1 patient with breast cancer had surgical treatment due to local recurrence after 7 months and none had chest wall reconstruction associated complications. The mean survival time of patients with malignant tumors was ($37.3{\pm}5.67$) months. Conclusions: Porous titanium alloy plates are safe and effective in the chest wall reconstruction after resection of chest tumors.

• 대한두경부종양학회지
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• 제16권1호
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• pp.26-32
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• 2000

Background and Objectives: Various flaps are using for reconstruction of hypopharyngeal and esophageal defect. However, complication and indication of each flap are not fully analyzed. Patient and Methods: Records of 52 hypopharyngeal cancer patients who had surgical treatment and 13 other head and neck cancer patients who underwent hypopharyngeal and/or esophageal reconstruction with flap were retrospectively analyzed. Eighty three percent(54 cases) of patients needed reconstruction other than primary pharyngeal closure. Five split thickness skin graft, 1 pectoralis major myocutaneous flap, 20 forearm free flap, 13 jejunal free flap, 15 gastric pull up were used. Result: Flap failure was noted in 2 cases who had subsequent gastric transposition. Wound dehiscence and fistula were most common problem of forearm free flap. Most fistulas were developed in patients with conduit type reconstruction of forearm flap while there wasn't any fistula in patient with patch type reconstruction. Stenosis of lower anastomosis was the frequent problem of jejunal transfer. Gastric pull-up has frequent com-plication of stomal stenosis. All but three patients had reached oral feeding postoperatively. Conclusion: Based on this study, forearm flap is effective in partial hypopharyngeal defect while jejunum is the choice for circumferential defect. Gastric pull-up is for combined esophageal defect.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.147-153
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• 2000

Soft tissue defects of the dorsum of foot and ankle can be covered from skin graft to free tissue transfer. The extent of injury which may be complex including the exposure of paratenons or bones requires free flap reconstruction. Some of the precautions for reconstruction are providing minimal bulkiness and well conforming to irregular contour thus making normal footwear possible. Though the muscle flap having its advantages and versatility, the fascial flap such as temporoparietal fascial flap has been considered the choice for reconstruction of the dorsum of foot and ankle. The purpose of our study is to utilize the advantages and versatility of the muscle flap as a first choice for reconstruction for the defects involving the dorsum of foot and ankle. The gracilis muscle with its anatomic and donor characteristics, it can be utilized to maximal effect by expanding its slim muscle width removing the epimysium and reducing its bulk by muscle atrophy through denervation. We present our experience with ten cases of reconstruction for the dorsum of foot and ankle using the gracilis muscle free flap. Results were satisfactory without flap loss, skin loss and infection. The contour and aesthetic aspect of the foot was satisfactory. Gait analysis showed near normal gait without limitations from everyday activities. Normal footwear was tolerable in all the cases. The keys to consider in the reconstruction of the dorsum of foot and ankle are appropriate bulkiness, conforming to its contour and able to apply normal footwear. With minimal donor morbidity and satisfying results, the extended gracilis muscle should be considered as the first line for reconstruction of the ankle and dorsum of foot.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.565-570
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• 2010

Purpose: Due to the closed and humid condition of the perineal area, wound problems occurring at this site are sometimes complicated, especially following postoperative radiation therapy. Moreover, the anal sphincter is a very important functional structure but reconstruction of the anal sphincter after severe trauma poses a challenging problem to plastic surgeons. In this article, we demonstrate the usefulness of the pedicled gracilis flap in the reconstruction of the perineal area. Methods: From September 2008 to November 2009, 6 patients, 4 males and 2 females, underwent surgery of the perineal area. The age of the patients ranged from 21 to 62 years (mean age was 48). The mean follow up period was 14 months. In 4 cases, the patient presented with wound problems after postoperative radiation therapy for anal cancer. In 2 cases, the patient presented with traumatic sphincter damage. Only the gracilis muscle was used in the 4 cases and a musculocutaneous flap was used in the 2 cases involving skin defects, respectively. Results: Among the 6 patients, 1 patient underwent hematoma evacuation of the donor site, and 1 patient presented with prolapse of the vaginal mucosa which recovered spontaneously. There were no report of other complications and there were no wound recurrences. Minimal incontinence was observed in all patients who underwent sphincter reconstruction, but all were satisfied with the overall results. Conclusion: The gracilis flap is useful in the reconstruction of the perineal area, such as in cases of radiotherapy induced wound problems and sphincter damage following severe trauma, due to its easy accessibility, rich vascularity, and minimal donor site morbidity.

• Archives of Plastic Surgery
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• 제37권3호
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• pp.277-280
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• 2010

Purpose: The resection of locally advanced or recurred breast cancers frequently result in large chest wall defects and it leads to a great challenges to cover. Generally simple skin grafts are not a practical option for patients because of their poor cosmetic appearance and prognosis. The latissimus dorsi and rectus abdominis musculocutaneous flap have traditionally been recommended for closure of these large defects. Though the cosmetic result of reconstruction using these flaps is often excellent, but has significant drawbacks. Therefore, we thought that chest wall reconstruction using the external oblique musculocutaneous flap can be an alternative method for extensive chest wall defect related to large, locally advanced breast carcinoma. Methods & Results: We present a case of a 50-year-old Korean female, refered to our department with a left breast tumor for 10 months. CT demonstrate a large tumor on the left anterior chest wall and multiple nodules of varying size in the cervical areas and liver. FDG-PET showed areas of hot uptake throughout the left chest wall, mediastinum and liver. Biopsy was consistent with invasive ductal carcinoma (Grade III). The initial tumor was considered inoperable, so a series of chemotherapy was initiated. Though the size of the breast mass was slightly decreased, the patient continued to suffer from purulent discharge, unpleasant odor and contact bleeding of the mass, the salvage mastectomy was performed. Conclusion: We could reconstruct $23{\times}16\;cm$ sized large chest wall defect, resulting from the resection of a locally advanced breast carcinoma, using an external oblique musculocutaneous flap successfully. Immediate postoperatively checked flap was healthy. Overall result was good without any significant complications and discharged 3 weeks after operation.

• 한국HCI학회:학술대회논문집
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• 한국HCI학회 2009년도 학술대회
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• pp.625-630
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• 2009

영상기반의 3차원 복원(reconstruction)에 대한 연구가 최근 좋은 결과를 많이 내고 있지만, 이는 복원의 목적이 되는 영역이 각 입력영상으로부터 미리 정확하게 추출되어있다고 가정하기 때문이다. 본 논문에서는 다시점 영상에서 세그멘트(segment)라 불리는 초기 분할된 영역을 기반으로 전경물체 추출과 3차원 복원을 EM형식으로 반복적으로 수행하는 정교한 전경물체 추출방법을 제안한다. 본 논문에서 세그멘트는 수행시간을 최소화하기 위해 사용된 3차원 복원방법인 visual hull에 의해 발생한 외곽선 오류를 보상해야 하며, 사용자의 입력을 최소화하기 위해 적은 수의 집합으로 구성되어야 한다. 이를 위해 데이터 항과 스무드 항으로 구성된 에너지 함수를 최적화할 수 있는 그래프 컷 방법을 이용하는 영상분할을 초기단계로써 수행하며, 전경물체 추출과 3차원 복원은 에너지 함수가 최적화될 때까지 반복 수행한다. 실험에서 간단한 3차원 복원 방법을 이용함에도 불구하고 전경물체의 외곽선에서 정확한 결과를 보였다.