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Chest Wall Reconstruction for Chronic Intrathoracic Wounds Using Various Flaps
Hong, Joon Pio,Cho, Pil-Dong,Kim, Sug Won,Chung, Yoon-Kyu,Kim, Eun-Gi The Korean Society for Microsurgery 2000 Archives of reconstructive microsurgery Vol.9 No.1
The treatment of chronic chest wounds should be focused on eradicating the infection and obliterating the dead space thus providing improved pulmonary function. Chronic chest wounds, although the incidence has decreased over the years, is still associated with high morbidity and prolong hospitalization. In cases where the disease is advanced and conventional measures fail, aggressive approaches achieve adequate resolution or significant improvement. This paper reports four cases of chronic chest wound including bronchopleural fistula and osteomyelitis managed by debridement followed by muscle coverage using latissimus dorsi, rectus abdominis, and omental flap. The intrathoracic reconstruction entails thorough debridement of empyema cavities, bronchpleural fistulas and infection focus. The infection must be completely eradicated prior to or at the time of flap transposition. The flaps used for obliteration of dead spaces provided adequate bulk, abundant blood supply, and minimal donor morbidity. The results were satisfactory with improved respiratory function without complications.
두겹의 실리콘 판을 이용한 새로운 도서형 피막피판에 대한 연구
홍준표,정윤규,김석원,이훈범 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4
The search for a new flap with minimal donor morbidity has been pursued by many plastic surgeons. Numerous donor sites available for microsurgical composite tissue transplantation have been described owing to the tremendous advances made in the field of microsurgery. To be suifable for use as a free flap, a sizable vessel must be included within the tissue, leading to significant donor morbidity. There have been studies for prefabrication of an axial pattern flap in an effort to create a new flap, but most of these methods relied solely on revascularization of a preexisting composite tissue. Our experiment, using an isolated femoral artery and vein as the main pedicle, led to formation of a capsule flap through a normal foreign body reaction between 2 silastic sheet implants. On this induced capsule flap, a skin graft was performed and a total of 40 axial pattern capsulo-cutaneous flaps from 20 Sprague-Dawley rats were successfully obtained after nearly 12 weeks through 4 stages of experiment, including a delay procedure at the second stage. Pathology revealed neovascularization, and abundantly impregnated vascular structures near the pedicle were observed along with random pattern collagen fibers. The skin graft took 100% on this newlyformed axial pattern capsular flap and thus implied that the capsule structure was able to survive on it`s own and was able to support skin grafts. This new flap using only the isolated artery and vein structure can be induced according to various needs with minimal donor morbidity.
홍준표,정윤규,정순희,Hong, Joon Pio,Chung, Yoon Kyu,Chung, Soon-Hee The Korean Society for Microsurgery 2000 Archives of reconstructive microsurgery Vol.9 No.2
본 연구는 백서 복직근피판에 있어 허혈-재혈류 손상에 미치는 prostaglandin E1(PGE-1)의 예방효과를 분석 실험하였으며, 그 기전으로 내피세포의 intercellular adhesion molecule-1(ICAM-1)이 down regulation 됨을 확인하였다. 기존의 PGE-1은 혈관 확장 및 혈소판 응고 저하 등의 기전으로 피판 이식술 후 주로 사용하였으나, 허혈-재혈류 손상 시에 PGE-1 역할에 대한 연구는 잘 알려진바 없다. 허혈-재혈류 손상에 대한 기전은 현재 여러 가설로 설명되고 있으나, 최근 내피 세포와 백혈구의 역할이 주목을 받고 있다. 장시간 허혈 상태의 피판은 재혈류시 백혈구가 내피세포에 접착함으로써 직간접적인 경로로 독소를 생성하며, 결국 내피세포 및 주변조직의 괴사로 이어진다. 본 연구는 면역조직학 염색을 통한 내피세포의 ICAM-1 발현 억제와 그로 인한 백혈구의 내피세포 접착 억제를 그 기전으로 볼 수 있었으며, PGE-1을 술 중 투여함으로써 피판의 생존율을 향상시킬 수 있었다.
Hyojeong Kwon,Hyunwook Kwon,Joon Pio Hong,Youngjin Han,Hojong Park,Gi-Won Song,Tae-Won Kwon,Yong-Pil Cho 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.89 No.1
Major peripheral arterial graft infection is a potentially devastating complication of vascular surgery, associated with significant mortality and high amputation rates. Autologous saphenous veins are considered optimal arterial conduits for lower extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients. This study describes two patients with major peripheral graft infection, but without available autologous veins, who underwent graft excision and cryopreserved cadaveric arterial allograft reconstruction. Although long-term graft durability is unclear because of gradual deterioration and degeneration, these findings suggest that cadaveric allografts may be good options for patients with major peripheral graft infection.
Thin elevation: A technique for achieving thin perforator flaps
Jeong, Hyung Hwa,Hong, Joon Pio,Suh, Hyun Suk Korean Society of Plastic and Reconstructive Surge 2018 Archives of Plastic Surgery Vol.45 No.4
Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.