얕은 지방층을 포함한 피부복합조직이식을 이용한 손화상 반흔구축의 교정

손대구,정회준,최태현,김준형,한기환 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.6

Purpose: Split or full thickness skin graft is generally used to reconstruct the palmar skin and soft tissue defect after release of burn scar flexion contracture of hand. As a way to overcome and improve aesthetic and functional problems, the authors used the preserved superficial fat skin(PSFS) composite graft for correction of burn scar contracture of hand. Methods: From December of 2001 to July of 2007, thirty patients with burn scar contracture of hand were corrected. The palmar skin and soft tissue defect after release of burn scar contracture was reconstructed with the PSFS composite graft harvested from medial foot or below lateral and medial malleolus, with a preserved superficial fat layer. To promote take of the PSFS composite graft, a foam and polyurethane film dressing was used to maintain the moisture environment and Kirschner wire was inserted for immobilization. Before and after the surgery, a range of motion was measured by graduator. Using a chromameter, skin color difference between the PSFS composite graft and surrounding normal skin was measured and compared with full thickness skin graft from groin. Results: In all cases, the PSFS composite graft was well taken without necrosis, although the graft was as big as 330mm2(mean 150mm2). Contracture of hand was completely corrected without recurrence. The PSFS composite graft showed more correlations and harmonies with surrounding normal skin and less pigmentation than full thickness skin graft. Donor site scar was also obscure. Conclusion: The PSFS composite graft should be considered as a useful option for correction of burn scar flexion contracture of hand.

안면부 화상 환자에서 천공이개 복합조직 이식술을 이용한 인중재건

김민규,서현호 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

The surgical correction of postburn nose and lips deformities still remains a difficult task domain to be done by plastic surgery. Consequently, the performance of autogenous cartilage graft and ear cartilage graft to maintain a better philtral form were found to raise the problem of a defect in the unnatural form due to consecutive tension in the region. Recently, focus had been placed on composite graft, including auricular cartilage, to obtain a unique dimple in the philtrum, and concurrently with this, part of its natural form has been acknowledged. However, composite graft on scar beds with poor circulation on the recipient site dose not represent safe survival, has increased risk allotment, which laeds to difficult application. From Jan. 1992 to Dec. 1998, the authors have experienced auricular composite graft in 15 patients who had a defect on the philtrum due to postburn scar contractures. As types of this operation, in method I, the subcutaneous pocket is made at the midline of the upper lip. The next step is cartilage insertion into subcutaneous tissue. The cartilage graft is fixed to be overlying skin by the bolus sutures. In Method Ⅱ, the recipient site is excavated by some excision of the soft tissue in the central upper lip after scar tissue excision. The obtained auricular skin composite graft is placed and fixed to the philtral area. In Method Ⅲ the auricular skin composite graft is harvested, and 2 or more 2mm-sized multiple holes are made along the midline of cartilage. Then composite graft is fixed to the defects of philtrum. The elongated portion of the distal tip of cartilage is embedded into the vermilion tubercle for sprouting and fullness. The most effective method was Method Ⅲ, which enhanced the survival of auricular cartilage graft and its overlying skin, by trimming the margin of grafts, and enhancement of the connecting vessels through fenestrated holes of cartilage between the recipient site and composite graft. The authors hereby report the results of the present study along with study findings based on literature surveys.

창상 환경에 따른 돼지 복합피부조직이식의 생착에 관한 연구

원동철,손대구,한기환,박관규 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.6

Composite grafts have served as a versatile tool in plastic surgery, but their usefulness has been limited by unpredictable survival in the case of larger defects. We compared composite grafts take rates in a wet environment, known to be ideal for wound healing, a moist environment with mild compression, and a dry environment in an established porcine model. The subjects of this study were 7 female Yorkshire pigs with 54 composite grafts. These 3×3cm sized composite grafts, composed of skin and subcutaneous fat, were harvested as samples on the back of the subjects to be reimplanted based on random patterns. Group I was introduced to a wet environment with sufficient antibiotic ointment and semi-occlusive polyurethane film(Opsite??) coverage, while group II was introduced to a moist environment and mild compression with hydrocellular foam dressing(Allevyn??) and Opsite?? coverage. Meanwhile, group III was applied simply with dry. Two weeks after the grafting, the survival rates of groups I(89%) and II(83%) were significantly higher than those of group III(31%)(p<0.05). The degrees of inflammation and fibrosis in groups I and II were less than in group III. Epithelial connections between the grafts and the recipients were the fastest in group II.According to the results of this study, maintaining a wet environment and mild compression may not only increase the composite graft take rate but also increase the size of grafts that could be transferred successfully.

가토의 이개에서 복합조직 이식의 크기에 따른 생착율 변화와 조직학적 관찰

이세일,김종환,박종범,홍인표,장효죽 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

Composite tissue grafts have been used as a convenient, aesthetic means of head and neck reconstruction for more than a century. However, their use has been limited by their often unpredictable survival, particularly large sized composite graft. To observe the survival rate of composite graft according to size change, we used a rabbit model. Triangular-shape composite graft was incised on the medial and lateral side of auricle(skin-cartilage-skin), was reapproximated. The following 8 groups of composite graft (total 64) were prepared (size:5,7,9,11,13,15,17,19mm). The microscopic examination was obtained at postoperative 5th day and 10th day. At 21 days, all grafts were assessed for survival area. Our results demonstrated that 1) From 5mm to 15mm, the percent survival area was not decreased according to increased graft size. But the percent survival area was decreased at the size of 17,19mm 2) The percent survival area was greater in composite grafts on thick cartilage area (medial) than on thin cartilage area (lateral). 3) Microscopic finding; 5th days-there was blood clot and inflammation reaction between donor and recipient 10th days-the epitheilal connection was found. The thickness of donor catilage was not changed but wraped, the perichondrium and connective tissue inigrety was partially destructed

Results of Infrainguinal Bypass with a Composite Graft Combining Polytetrafluoroethylene and Vein Graft in Absence of Appropriate Saphenous Vein Graft

진명재,박의준,김형태,노영남 대한혈관외과학회 2017 Vascular Specialist International Vol.33 No.2

Purpose: Use of a composite graft combining a polytetrafluoroethylene graft with an autogenous vein is an option for limb salvage in the absence of an adequate single segment vein graft. We aimed to investigate the results of infrainguinal bypass with a composite graft. Materials and Methods: We retrospectively reviewed 11 infrainguinal arterial bypasses on 11 limbs which underwent surgery from March 2012 to November 2016. Results: Critical limb ischemia was common (63.6%) indication of bypass surgery and most (90.9%) of the patients had history of failed previous treatment including endovascular treatment (36.4%) and bypass surgery (72.7%). At the 2 years after graft implantations, primary patency and amputation-free survival of below-knee bypasses using composite graft were 73% and 76%, respectively. Conclusion: Infrainguinal arterial bypasses with composite graft had an acceptable patency. In patients without other alternative conduits for revascularization, bypass with a composite graft can be an option.

성견의 3면 골내낭에 calcium carbonate와 calcium sulfate의 혼합이식이 치주조직 치유에 미치는 영향

최미령,조규성,채중규,김종관,Choi, Mi-Ryung,Cho, Kyoo-Sung,Chai, Jung-Kiu,Kim, Chong-Kwan 대한치주과학회 1994 Journal of Periodontal & Implant Science Vol.24 No.3

Synthetic bone graft materials have been used for the regeneration of periodontal tissue lost due to periodontal disease, but the limitations of these materials had prompted the use of composite grafts. Among those, a composite graft of calcium carbonate(CC) and calcium sulfate(CS) is one of those materials that has not been studied extensively. CC, which is extracted from a natural coral, is known to possess osteoconductive property. SC can play an adjunctive role in the regeneration of bone tissue, and has shown good resorbability and biocompatibility. This study was conducted in order to investigate the effects of CC and CS composite graft to the regeneration of bone in the intrabony defects of dogs. 3-wall intrabony defects ub size of $4mm{\times}4mm{\times}4mm$ were created in the alveolar bone in the premolar areas. Then those defects that were treated with root planning only were designated as control, while the experimental group 1 and 2 each received the CC and CS composite grafts in the ratio of 8 : 2 and 5 : 5 the animals were sacrificed after 8weeks and the specimens were histologically analyzed. The results were as follows ; 1. No inflammation or foreign body reaction were observed in all subjects. CS has not been seen due to complete resorption, and resorption pattern of CC was observed. 2. Significant differences(p<0.05) in new cementum formation were observed between control($1.42{\pm}0.64mm$) and experimental groups(group 1 ; $2.53{\pm}0.94mm$, group 2 ; $2.23{\pm}0.96mm$) but the difference between the two experimental groups was not significant. 3. Significant differences(p<0.01) in new bone formation were observed between control($0.59{\pm}0.55mm$) and experimental groups(group 1 ; $2.27{\pm}0.61mm$, group 2 ; $2.05{\pm}0.56mm$) but the difference between the two experimental groups was not significant. 4. The extent of apical epithelial migration has shown no significant difference between control($1.18{\pm}1.24mm$) and experimental groups(group 1 ; $0.51{\pm}0.54mm$, group 2 ; $0.73{\pm}0.70mm$). 5. The extent of bone formation was generally limited to the extent of cementum formation for all groups, and significant correlation was found in the amount of bone formation and cementum formation in experimental group 1.(Co.=0.86, p<0.01) These results suggest that the composite graft of CC and CS is biocomplatible and effective in the new bone and new cementum formations. In the case of 3-wall intrabony defects of dogs, the composite ratio of 8 : 2 and 5 : 5 had shown no significant differences in the healing.

습윤 개방드레싱을 이용한 손가락끝 복합조직이식술

손대구,추호준,여현정,김준형,한기환 대한수부외과학회 2012 대한수부외과학회지 Vol.17 No.1

목적: 손가락끝 절단에서 복합조직이식술을 시행한 후 습윤 환경의 유지가 이식의성공에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 1997년부터 2010년까지 1세에서 73세 사이의 93명의 환자 100개의손가락끝 절단을 대상으로 복합조직이식술을 시행하였다. 수술 후 수지를 거상하고이식 부위에 항생제 연고를 도포하여 습윤 환경을 유지하였다. 이식 후 성공률을 환자의 나이와 절단 수준, 손상 원인별로 분석하였다. 결과: 100개 중에 65개에서 완전히 생존하였다. 6세 이하에서는 18개 중 13개, 6-15세에서는 5개 중 4개 그리고 16세 이상에서는 77개 중 48개가 완전생존하였다. 절단수준별로는 1구역 56개 중 37개 손가락, 2구역 19개 중 12개, 3구역 25개 중 16개에서 성공하였다. 통계학적으로 분석하였을 때 나이와 절단 수준, 손상 원인별로 의미있는 차이는 없었다. 결론: 손가락끝 절단에서 습윤 환경을 유지하였을 때 성공률을 향상시킬 수 있었고소아뿐만 아니라 성인에서도 복합조직이식이 가능하였다. Purpose: The purpose of this study was to determine whether keeping the wound moist improves the results of composite grafting of amputated fingertip. Materials and Methods: Between 1997 and 2010, 93 patients with traumatic amputation of 100 digits have undergone composite finger tip graft. The hand was kept elevated and a topical antibiotics was frequently applied to avoid desiccation. Their ages ranged from 10 months to 73 years. We assessed the success rate based on age, amputation level, ischemic time and etiology. Results: Of these 100 composite grafts, grafting had been successful in 65. Evaluation by age revealed that grafting had been successful in 13 of 18 fingers among patients less than 6 years old, in four of five fingers among those 6 to 15years old and in 48 of 77 fingers among those 16 years of age and older. Assessment by level of amputation showed that grafting had been successful in 37 of 56 fingers amputated in zone I, in 12 of 19 fingers amputated in zone II and in 16 of 25 fingers amputated in zone III. No statistically significant differences in graft survival were found in relation to age, amputation level, ischemic time or type of amputation. Conclusion: Our results demonstrate that composite finger tip graft in adult is feasible and a very high rate of survival is obtained. We believe that moist-exposed dressings should improve the success rate associated with fingertip composite grafting.

Fabrication of polyketone-grafted multi-walled carbon nanotubes using Grignard reagent and their composites with polyketone

Nam, Jeong Ung,Choi, Eun Yeob,Park, Hye Jin,Kim, C.K. Elsevier 2018 Composites science and technology Vol.167 No.-

<P><B>Abstract</B></P> <P>A Grignard reagent containing pyrene, 1-pyrenylmethylmagnesium bromide (PMgBr), was explored as a novel reactive compatibilizer for producing aliphatic polyketone (PK) composites with multi-walled carbon nanotube (MWCNT) that had improved interfacial adhesion and mechanical strength. 1-Bromomethylpyrene (PBr) was adsorbed on MWCNTs and reacted with Mg to produce PMgBr on MWCNTs (MWCNT-PMgBr). PK-grafted MWCNT (PK-g-MWCNT) was prepared by reacting MWCNT-PMgBr with PK, and its composite with PK was fabricated by melt extrusion. The formation of PK-g-MWCNT was examined by spectroscopy, electron microscopy, and thermal analysis. The PK interfacial adhesion energies with MWCNTs were quantified, and the mechanical strengths of their composites examined. PK-g-MWCNT had the highest interfacial adhesion energy with PK among the MWCNTs. The PK/PK-g-MWCNT composite showed better MWCNT dispersion in PK and interfacial adhesion between MWCNT and PK than the PK/pristine MWCNT composite. Consequently, the PK/PK-g-MWCNT composite exhibited higher mechanical strength than the PK/pristine MWCNT composite when the composite contained the same amount of MWCNTs.</P>

발톱의 복합조직이식을 이용한 손톱 재건술

김우경,박승하,박현 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.6

Although nail injuries are among the most common of those of the hand, they have received little attention in the literature until recently. Absence of nail has both a functional and a cosmetic problem, in that causes decreased tactile sensibility of finger tip and elicits finger pain when catches on objects, and produces psychic disturbance due to its abnormal shape. Previously introduced nail reconstructive procedures such as insertion of artificial nail, split thickness nail bed graft, composite nail graft, microvascular free toe nail transfer, have each own advantages and disadvantages, and the results have been variable. The authors operated 11 digit with 10 patients that each has total absence of nail by method of toe nail composite graft. Operative procedure was performed by elevation of toe nail bed with paronychium, grafted with tie-over dressing, and hyperbaric oxygen therapy for five days postoperatively. All of these grafts were survived and followed up to 18 months, the results were satisfactory. This method has many advantages of simplicity, available with local anesthetics, less scar formation on donor site, and then the toe nail composite graft provides useful reconstructive method of nail deformity.

비중격 연골-점막 복합조직이식과 상안검 피판을 이용한 하안검의 재건

배용찬,김상호,황소민,김기태,오창근 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.3

Although various procedures for reconstructing the lower eyelid have been reported, their basic principle is always to build a new eyelid that is composed of three elements: an outer cutaneous layer, an inner mucosal layer, and a semirigid supporting tissue between the two layers. Mustard cheek rotation flap over a chondromucosal graft has been used often to reconstruct the full thickness defect of the lower eyelid. However, Mustard cheek flap leaves a large unacceptable scar on the face. Therefore we have repaired three cases of lower eyelid defect after resection of the basal cell carcinoma using monopedicled or bipedicled upper eyelid musculocutaneous flap over a septal chondromucosal composite graft. In addition, in case of wide defect including overall tarsal plate, the authors increased indication of mucochondral composite graft by halving method of mucochondral composite tissue. As a result, we made a minimal donor site scar and get the effect of upper blepharoplasty as well by using upper eyelid musculocutaneous flap. Based on follow-ups of 10 to 19 months, the functional and aesthetic results were found to be good in all cases. This procedure may be applicable for total or subtotal reconstruction of the lower eyelid.