• Archives of Plastic Surgery
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• 제36권4호
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• pp.397-405
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• 2009

Purpose: Soft tissue defect of anterior chest wall is caused by trauma, infection, tumors and irradiation. To reconstruct damaged anterior chest wall does require to consider the patient's body condition, the cause, the location, the depth and the size of deletion, the circulation of surrounding tissue and minimization of functional and cosmetic disability. In this report, we suggest the algorithm of configuration for reconstruction methods. Methods: A retrospective study of 20 patients who underwent anterior chest wall reconstruction with pedicled musculocutaneous flap and fasciocutaneous flap was conducted. We collected the information of the patient's body condition, the cause, the size, the depth and the location of deletion, implemented flap and complication. We observed and evaluated flap compatibility, functional and cosmetic results. Patients completed survey about the extent to their satisfaction. Result: Follow up period after surgery was from 6 to 26 months, survival of flap were confirmed in all of patients' case. Two cases of local necrosis, one case of wound disruption were reported, but all these were cured by the debridement and primary closure. One hematoma and one seroma formation were observed in donor site. Longer surgery time, more bleeding amount and more transfusion volume were reported in the group of musculocutenous flap. Conclusion: Long term follow up result showed the successful reconstruction in all patients without recurrence and with minimal donor site morbidity. In addition, the patients' satisfaction for cosmetic and functional results were scaled relatively higher. This confirmed the importance of reconstruction algorithm for the chest wall reconstruction.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.238-243
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• 2013

Background Primary malignant tumors of the hand, although unusual, may present varied and often complex clinical problems. The main treatment modality of skin cancer of the hand has changed. Methods We retrospectively reviewed the medical records of 43 patients who underwent surgery for malignant skin tumors of the hand during an 18-year period, from September 1994 to February 2012. The characteristics of the tumor, methods of reconstruction, and long-term results were reviewed. Results We had 43 patients with 27 melanomas, 14 squamous cell carcinomas, and 2 sarcomas. Their ages ranged from 19 to 74 years (mean, $53.4{\pm}14.5$ years), from 46 to 79 years (mean, $59.7{\pm}9.6$ years), and from 15 to 43 years (mean, $29{\pm}19.8$ years), respectively. Thirty-four cases occurred on the fingertip (16 of those cases on the thumb), 5 cases occurred on the palm, and 4 cases on the dorsum of the hand. Amputation was most frequently used in early cases, but recently, tissue-sparing excision has been performed frequently. The incidence of local recurrence was 3 cases and distant metastasis was 1 case, and the 5-year survival rate was 100%, except in 4 cases due to follow-up loss. Conclusions The principles of treatment-to be curative and to preserve function and appearance-are important points. "Preservative surgery" preserves function and cosmesis of the involved finger or hand dorsum or palm. Preservative surgery not only emphasizes less resection and surgery of a smaller scale, but also optimal reconstruction of the soft tissue defect of the digit.

• 대한두경부종양학회지
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• 제25권1호
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• pp.39-42
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• 2009

Wide excision for curative treatment of malignant tumor on periauricular area often leads to loss of the external ear. But the auricle has rich vascular supply, Conservation of auricular contour is possible through salvage and engineering of remained auricular tissue. We experienced two cases of auricular salvage after wide excision of malignant tumor. In the first case, we performed two-staged technique. In first step, we covered soft tissue defect on periauricualr area with the anterolateral thigh free flap and remained auricle was floating over the flap after split-thickness skin graft was applied on it's posterior raw surface because it's survival was not confirmed. Second step was reposition of remained auricule on the anterolateral thigh flap. In the second case, we packed in periauricular dead space and external auditory canal with temoporalis muscle and temporoparietal fascial flap and then covered the flap with split thickness skin graft. In these two cases, there were no recurrence of tumors and we obtained cosmetically & functionally satisfactory results.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.496-498
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• 2010

Purpose: Lacerations requiring formal wound closure compose a significant number of all childhood injuries presenting to the emergency department. The problem with conventional suture technique are that suture removal is quite cumbersome, especially in children. Unwanted soft tissue damage can result in the process of suture removal, which calls for sedation, stressful for both medical personnel and child. The purpose of this study is to introduce the convenient suture technique for pediatric facial lacerations. Methods: Children under the age of four, presenting to the emergency department with facial lacerations were enrolled in the study. From March 2008 to June 2009, 63 patients (41 males and 22 females) with an average age of 1.4 years were treated with our convenient suture technique using utilized a loop suspended above a double, flat tie. Clean, tension free wounds were treated with our technique, wounds with significant skin defect and concomitant fractures were excluded. Results: The Patients were followed-up in 1, 3 and 5 days postoperatively. On the third hospital visit, suture removal was done by simply cutting the loop suspended above the wound margin and gently pulling the thread with forceps. There were no significant differences in the rates of infection and dehiscence compared with conventional suture technique. Conclusion: The use of our technique was to be simple with similar operative time compared with conventional suture technique. Removal of suture materials were easy without unwanted injuries to the surrounding tissue which resulted in less discomfort for the patient and greater parental satisfaction, minimized the complications. It can be considered as a viable alternative in the repair of pediatric facial lacerations.

• Archives of Plastic Surgery
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• 제45권1호
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• pp.62-68
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• 2018

Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated $90^{\circ}$ cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.15-19
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• 1998

Microsurgical free-tissue transfer has allowed surgeons to salvage injured limbs but choosing appropriate healthy recipient vessels has proved to be a difficult problem. Retrograde flow flaps are established in island flaps. Retrograde flow anastomosis could prevent the possible kinking and twisting of the arterial anastomosis. By not interrupting the proximal blood flow to the fracture or soft tissue defect site, the compromise of fracture or wound healing might be prevented. We wished to estabilish an animal model in rat for a retrograde arterial flow based free flap. Nembutal-anesthetized male rats; weighing 250 to 300 gm, were used. The femoral artery and common carotid artery were exposed and divided. The systemic and retrograde arterial pressure were quantified by utilizing a parallel tubing system connected with peripheral arterial line. In this study, the retrograde flow was not pulsatile and the retrograde arterial pressure was 64-65mmHg, with a mean arterial pressure of 106-109mmHg. An epigastiic skin flap, measuring $3{\times}3cm$, was raised with its vascular pedicle. The epigastric free flap was transfered in the same rat from femoral vessels to carotid vessels in end to end fashion. We anastomosed the donor arteries to the distal parts of the divided recipient arteries and the donor veins to the proximal parts of the recipient veins. Twelve experiments were performed and the transplantations succeeded in 75 percent of them. In the remaining 25 percent, the experiments failed due to thrombosis at the site of anastpmosis, or other causes. This animal model represents an excellent example of retrograde arterial flow free flap transfer that is reliable.

• 대한화상학회지
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• 제24권1호
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• pp.14-17
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• 2021

The nose is a complex three-dimensional structure and represents a major aesthetic focus of the face. As a gold standard for nasal soft tissue reconstruction, the 'forehead flap' provides reconstructive surgeons a robust pedicle and large amount of tissue to reconstruct almost any defect. However, during this process, some hair can be unintentionally introduced to the nose. Accordingly, laser hair removal is sometimes needed, but blood circulation and flap survival should be carefully monitored. Despite careful evaluation, a third-degree burn occurred in our patient that required eight weeks to heal. Here, we report on a burn resulting from epilation conducted 2 weeks after forehead flap for nasal reconstruction.

• Journal of Periodontal and Implant Science
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• 제54권1호
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• pp.25-36
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• 2024

Purpose: Mucogingival defects (MGDs), such as dental root recessions, decreased vestibular depth, and absence of keratinized tissues, are commonly seen in dental clinics. MGDs may result in functional, aesthetic, and hygienic concerns. In these situations, autogenous soft tissue grafts are considered the gold-standard treatment. This study compares the healing process of free gingival grafts (FGGs) to bacterial cellulose matrix (BCM) and human acellular dermal matrix (ADM) seeded with fibroblasts from culture supplemented with platelet-rich plasma in a rat model. Methods: Surgical defects were made in rats, which received the following treatments in a randomized manner: group I, negative control (defect creation only); group II, positive control (FGG); group III, BCM; group IV, BCM + fibroblasts; group V, ADM; and group VI, ADM + fibroblasts. Clinical, histological, and immunological analyses were performed 15 days after grafting. Clinical examinations recorded epithelium regularity and the presence of ulcers, erythema, and/or edema. Results: The histological analysis revealed the degree of reepithelization, width, regularity, and presence of keratin. The Fisher exact statistical test was applied to the results (P<0.05). No groups showed ulcers except for group I. All groups had regular epithelium without erythema and without edema. Histologically, all groups exhibited regular epithelium with keratinization, and myofibroblasts were present in the connective tissue. The groups that received engineered grafts showed similar clinical and histological results to the FGG group. Conclusions: Within the limitations of this study, it was concluded that BCM and ADM can be used as cell scaffolds, with ADM yielding the best results. This study supports the use of this technical protocol in humans.

• Journal of Periodontal and Implant Science
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• 제23권3호
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• pp.535-563
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• 1993

치주질환 진행의 최종적인 결과는 하반 지지조직의 소실로 치아상실을 초래하는 것이다. 이러한 치주질환의 이상적인 치유형태는 부착상실 예방을 비롯 상실된 조직의 재상 즉 신생 치조골과 백악질이 형성되고 두 조직사이에 치주인대가 재형성되는 것이다. 최근까지의 치주조직재생을 위한 처치법으로 이환된 병소부의 단순제거, 치관변위판막술, 약제의 치근면처리법, 조직유도재생술, 골전도물질 삽입, 골유도 혹 골형성물질 사용등 다양한 방법이 제시되었으나 아직 이상적인 치료법은 밝혀지지 않고 있다. 치아지지의 가장 중요한 역할을 하는 치조골의 재생에 대해 많은 연구들과 아울러 조직화학적 연구에서 Polypeptide Growth Factor(PGF) 가 다양한 종류의 세포증식과 이주 및 기질합성에 촉진효과가 있다고 하여 조직재생에 사용 가능성이 보고된 바 있었다. 이 PGF중 혈소판유래성장인자가 섬유아세포와 골아세포의 유사분열 및 단백질합성에 촉진작용이 있으며 조직재생에 영향을 미친다는 보고도 있었다. 본 연구의 목적은 총 8 마리의 실험동물을 이용하여 치근이개부병변을 형성한 후 혈소판유래성장인자를 처리하고 기존 조직결손부에 사용하였던 Tricalcium Phosphate(TCP) 와 콜라젠을 성장인자 함유매개체로 하여 이개부병변에 병용삽입한 경우 치유과정에 미치는 효과를 규명하여 임상적용의 가능성을 규명하고 실제 임상적용방법을 개발할 목적으로 실시하였다. 실험동물 Pentobarbital Sodium으로 전신마취를 시킨후, 초음파치석제거기등을 이용하여 구강위생을 청결하게 한 다음, 치은열구절개를 이용하여 전층판막을 형성하였다. 피질골과 치조골을 삭제하고 형성된 이개부 결손부에 치근면활택술을 시행하였으며, 구연산으로 치면처리 후, 계획된 재료를 삽입하고, 치관변위판막술과 유사한 형태의 봉합을 시행하였다. 실험동물을 2, 4, 8, 12 주에 관류고정과 아울러 회생시켜 악골을 채취하고 통법에 의해 후고정, 탈회, 탈수과정을 거쳐 파라핀으로 포매한 후 $7{\mu}m$두께로 절편하고 H & E 염색후 광학현미경으로 관찰하여 다음과 같은 결과를 얻었다. PDGF-BB 만 처리한 군에서는 2주 소견에서부터 결손부 전체에 걸쳐 활성도가 높은 조골세포들이 균일하게 분포하면서 이들로부터 생성된 골양조직이 기초적인 골소주의 형태를 이루고 있음이 관찰되었으며 그후 매우 빠른 골형성이 계속되어 8주 소견에서는 결손부 정상에 이르기까지 성숙된 치밀골이 채워져 있었다. 신생골형성의 전반적 형태는 치근면의 외형에 따라 치근이개부상단부로 형성되는 양상이었다. PDGF-BB 군에서 신생백악질의 형성은 2주소견 에서는 미약하였으나 4주이후 치근면에 수직으로 배열된 교원섬유들과 함께 균일한 두께로 형성되기 시작하여, 8주에 이르러서는 비 손상부위에서보다 더욱 두터운 신생백악질이 형성되었고 전형적인 샤피스씨 섬유가 완성되어 있음이 관찰되었다. PDGF-BB와 TCP를 병용한 경우 및 PDGF-BB와 콜라젠을 병용한 경우에서는 PDGF-BB군에 비해 신생골 및 신생백악질의 형성, 치주인대강의 발달이 상대적으로 미약하였으며 이러한 현상은 수술후 초기단계에서 더욱 두드러져 함유매개체로서의 기능을 기대하였던 이들 이식재들이 도리어 급속하게 분화 증식되는 세포들의 이동에 장애물로서 작용하는 것으로 나타났다. 결론적으로 PDGF-BB의 치근면 처리가 치근이 개부병변 치료에 있어 전반적으로 조직재생의 속도가 빠르고 그 치유양상도 시간경과에 따라 치주조직 고유형태로 진행됨이 관찰되어 동일 병소치료에 응용가능성을 확인하였다. 또한 차후 결손부에 주입방법과 성장인자의 관리법 및 적용량 그리고 적응중의 규명을 위해 연이은 연구가 있어야 할것으로 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권4호
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• pp.330-333
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• 2009

저자들은 본 증례의 경우 치근이 흡수된 전치와 매복 견치의 발치 후 심한 치조골의 흡수와 연조직의 변화가 예상되는 것을 고려하여 발치 후 즉시 임플란트 수술을 결정하였다. 초기 안정성을 확보하기 위해 가능한 적은 골삭제, 보다 큰 직경과 치근형태의 임플란트를 선택하여 발치 후 즉시 임플란트를 식립하였고, 장골에서 채취한 망상골로 골결손부를 채우고 부가적으로 상순 지지를 위해 흡수성 차폐막과 순측 골면에 onlay형태의 골이식술을 시행하여 자연스럽고 심미적인 결과를 얻을 수 있었다.