Bilateral Vulvar Reconstruction Using Two Different Types of Perforator Flap: A Case Report

기세휘,Seung Hyun Sim,Sang Hwan Lee 대한수부외과학회 2018 대한수부외과학회지 Vol.23 No.1

We reconstructed an extensive vulvar defect with the internal pudendal artery and the anterior obturator artery perforator flap and compared the two types of flaps. A 57-year-old female patient had a 15×13 cm2 defect on both sides around the vagina after vulvectomy. Due to the injury in the internal pudendal artery, we used the internal pudendal artery perforator on the right side, and the anterior obturator artery perforator flap on the left side. The internal pudendal artery perforator flap could be rotated easily 120 degrees toward the vulvar defect. However, as the anterior obturator artery perforator flap was difficult to rotate, reconstruction was performed by rotation and advancement. The anterior obturator artery perforator flap is a viable alternative method that can be used when it is difficult to use the internal pudendal artery perforator flap during vulvar reconstruction.

Evaluation of the Forearm Dominancy Artery for Invasive Vascular Procedure with 3D-CT Angiography

기세휘,최종환 대한의학회 2015 Journal of Korean medical science Vol.30 No.9

The aim of this study was to evaluate the vascular dominance in the forearm as a factor in determining the choice of invasive vascular procedures in arteries of the forearm, using 3D-computerized tomography (3D-CT) angiographies of 92 forearms. The diameters of the ulnar and radial arteries were measured just distal to the bifurcation of the brachial artery, at the midpoint between the bifurcation and the wrist, and at the wrist crease. In 79 cases, the ulnar artery was larger than the radial artery after the bifurcation of the brachial artery. However, no statistically significant difference was observed at either the midforearm or the wrist crease. In the remaining 13 cases, the diameter of the radial artery was larger or the same as that of the ulnar artery after the bifurcation, but at the more distal sites no regular pattern could be detected. The findings suggest that 3D-CT angiography offers valuable preoperative details of the forearm vessels for cases requiring invasive vascular procedures on the forearm.

Fractional Photothermolysis of a Replanted Nose: A Case Report

기세휘,오재윤 대한미용성형외과학회 2015 Archives of Aesthetic Plastic Surgery Vol.21 No.1

Although several cases of successful reconstruction of complete nasal amputationshave been reported, reconstruction of a traumatic amputated nose remains a challengeboth aesthetically and functionally. Even if replantation of the nasal tip is successful,the scar on the nose may develop an irregular appearance, an ill-fitting contour, atrap door deformity, or discoloration. In the predominant nasal tip, these suboptimalresults are very stressful for patient. There are no guidelines for both management andpostoperative care of traumatic nasal amputation. At the completion of laser scar revisionafter successful replantation, we present an excellent aesthetic outcome usingthe 1,550-nm fractional erbium–glass laser (MOSAIC®, Lutronic Co. Ltd, Seoul, Korea). Based on our experience, a microvascular replantation followed by fractional non-ablativelaser therapy was not harmful and was available to maximize the aesthetic outcomes.

Reconstructive Trends in Post-Ablation Patients with Esophagus and Hypopharynx Defect

기세휘,최종환,심승현 대한두개안면성형외과학회 2015 Archives of Craniofacial Surgery Vol.16 No.3

The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of ‘esophagus’ and ‘free flap’, ‘microsurgical’, or ‘free tissue transfer’. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.

태아 간 적혈구형성에서 형질전환성장인자의 발현

기세휘(Se Whi Kee),김용욱(Yong Wook Kim),김성수(Sung Soo Kim),김경용(Kyung Yong Kim),이원복(Won Bok Lee) 대한체질인류학회 1999 해부·생물인류학 (Anat Biol Anthropol) Vol.12 No.1

태아 간에서 간 적혈구형성세포와 간세포에 대한 형정전환성장인자의 발현에 관한 변화를 관찰하고자 태령 제21주부터 제26주의 태아 간 3예를 연구재료로 삼아 TGF-βl, β2, β3의 항체를 이용한 면역조직화학염색을 시행한 후 다음과 같은 결론을 얻었다. 1. TGF-β1은 뭇 색듬 적혈구모세포에서 처음으로 약하게 발현되었고 호산성적형구모세포에서는 중등도로 더 강하게 발현되었으나 세망적혈구와 성숙 적혈구에서는 발현이 관찰되지 않았다. 또한 간세포와 동글 모세혈관의 내피세포에서는 TGF-β1이 발현한 세포가 부분적으로 출현하였다. 2. TGF-β2는 풋 적혈구모세포부터 뭇 색듬 적혈구모세포까지 다른 형질전환성장인자에 비해 가장 강하게 발현 되였으며, 이후 적혈구모세포의 성숙단계에서는 일부분의 호산성적혈구모세포에서만 약하게 발현되었다. 간세포와 동굴모세혈관의 내피세포에서는 TGF-β2의 발현은 관찰되지 않았다. 3. TGF-β3 는 풋 적혈구모세포나 호산성적혈구모세포에서만 약하게 발현되었다. 간세포에서는 TGF-βl에 비해 약간 강하게 과립형태로 발현되었다. 둥글 모세혈관의 내피세포는 TGF-β3가 발현되지 않았으나 문맥의 내피세포나 결합조직에서는 약하게 발현되기도 하였다. 이상을 종합하연 태아 간에서 형질전환성장인자인 TGF-β1, β2, β3는 간세포와 적혈구형성세포의 성숙단계에 따라 다양한 발현을 보였으며, 세망적혈구와 성숙한 적혈구에서는 형질전환성장인자들이 모두 발현되지 않았다 태아 간에 있어 적혈구형성세포와 간세포외 성숙단계에 따라 TGF-βl, β2, β3가 특징적으로 발현됨으로써, 형질 전환성장인자는 간 척형구형성세포나 간세포의 성숙에 밀접한 관련성이 있다고 생각되었다.

Analysis of the Chest Wall Reconstruction Methods after Malignant Tumor Resection

조강연,기세휘 대한성형외과학회 2023 Archives of Plastic Surgery Vol.50 No.1

Background The chest wall defects can be caused by various reasons. In the case of malignant tumor resection of the chest wall, it is essential to reconstruct the chest wall to cover the vital tissue and restore the pulmonary function with prevention of paradoxical motion. With our experience, we analyzed and evaluated the results and complications of the chest wall reconstructions followed by malignant tumor resection. Methods From 2013 to 2022, we reviewed a medical record of patients who received chest reconstruction due to chest wall malignant tumor resection. The following data were retrieved: patients’ demographic data, tumor type, type of operation, method of chest wall reconstruction of the soft and skeletal tissue and complications. Results There were seven males and six female patients. The causes of reconstruction were 12 primary tumors and one metastatic carcinoma. The pathological types were seven sarcomas, three invasive breast carcinoma, and three squamous cell carcinomas. The skeletal reconstruction was performed in six patients. The series of the flap were eight pedicled latissimus dorsi (LD) myocutaneous flaps, two pectoralis major myocutaneous flap, two vertical rectus abdominismyocutaneous free flap, and one LD free flap. Among all the cases, only one staged reconstruction and successful reconstruction without flail chest. Most of the complications were atelectasis. Conclusion In the case of accompanying multiple ribs and sternal defect, skeletal reconstruction would need skeletal reconstruction to prevent paradoxical chest wall motion. The flap for soft tissue defect be selected according to defect size and location of chest wall. With our experience, we recommend the reconstruction algorithm for chest wall defect due to malignant tumor resection.

선천성 피부 형성부전증에 동반한 이중신우, 뇨관 및 두개골결손(1례보고)

정창은,기세휘,김은령 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.3

Aplasia cutis congenita represents a congenital absence of all skin layers, and it may occasionally extend through the bone and dura of the skull. Since the first report was described in the extremity by Cordon 1767, and Campbell 1826, approximately over 500 cases have been reported. About eighty five percents of all cases are found in the scalp, with 15 to 30 percents involving the skull as well. Fifteen percents of all cases involve nonscalp locations and are often bilateral symmetrical. It has been relatively rarely reported disorder abroad as well as domestically. It has several clinical subtypes classified by the location and pattern of skin absence, the presence of associated malformation and the mode of inheritance with unknown cause. We had a new born female infant with this disorder, who presented with a full thickness skin defect on scalp and skull defect. No skin defect were reported in other family members, including a first child born several years previously. Chromosomal analysis revealed as normal female karyotype, but she had double pelvis and double ureter of both kidney. The legions healed for five weeks by conservative treatment as moist wound dressing and systemic antibiotic administrations. As a relatively uncommon skin anomaly with congenital anomaly, one case of aplasia cutis congenita involving scalp and skull is reported with the review of reference.

무지 첨부 절단 환자 재건에서 Moberg Flap과 2족지 수질부 유리피판술의 비교

정강재,기세휘,김진수,이동철,노시영,양재원 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.5

Purpose: Transverse type or volar oblique type of defect of thumb tip can be covered by Moberg flap or second toe pulp free flap. We compared these two methods in functional result, patients’ satisfaction, and sensation, etc. to find a better way to cover the defect of the thumb tip. Methods: From 2003 to 2006, we chose the patients randomly with preoperative pictures. The patients had the defect of the thumb tip which is either transverse or volar oblique type. The 6 patients were treated with Moberg flap and other 6 patients were treated with second toe pulp free flap. We have analyzed the results by 2 point discrimination, side pinching power test, pulp to pulp pinching power test, pain scales (visual analogue scale), satisfaction scales of the patients (functional and aesthetic), the degree of the range of motion, etc. Results: All flaps survived without any complications. In the cases of Moberg flaps, the value of static 2 point discrimination test was 5.6mm, and the value of moving 2 point discrimination test was 4.8mm. In the cases of second toe pulp free flaps, the values were 9.6mm and 9.3mm. In the cases of Moberg flaps, the value of the Side pinch power test was 6.6kg, 4.4kg. In the case of second toe pulp free flaps, the values were 4.8kg and 2.5kg. The value of aesthetic satisfaction scale of the patients in Moberg flaps was 5.6, the value of functional satisfaction scale of the patients was 3.6. In cases of second toe pulp free flaps, the values were 5.6 and 3.6. The active range of motion of Interphalangeal joint in the cases of Moberg flaps was 46.6 degree, and the active range of motion of metacarpophalangeal joint was 55 degree, in the cases of second toe pulp free flaps, the values were 36.6 degree and 59 degree. Conclusion: As a result, when the defect of the thumb tip is transverse or volar oblique type, we suggest that the operators choose Moberg flap to cover the defect of the thumb tip.

토끼 정낭 평활근 세포에 존재하는 포타슘 통로 활동도에 미치는 식물성 에스트로겐의 효과

최준,기세휘,김유찬,김태형 대한남성과학회 2007 The World Journal of Men's Health Vol.25 No.2

Reconstruction of a large chest wall defect using bilateral pectoralis major myocutaneous flaps and V-Y rotation advancement flaps: a case report

조강연,윤진명,기세휘 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.1

Bilateral pectoralis major myocutaneous (PMMC) flaps are commonly used to reconstruct large chest wall defects. We report a case of large chest wall defect reconstruction using bilateral PMMC flaps augmented with axillary V-Y advancement rotation flaps for additional flap advancement. A 74-year-old male patient was operated on for recurrent glottic squamous cell carcinoma. Excision of the tumor resulted in a 10×10 cm defect in the anterior chest wall. Bilateral PMMC flaps were raised to cover the chest wall defect. For further flap advancement, V-Y rotation advancement flaps from both axillae were added to allow complete closure. All flaps survived completely, and postoperative shoulder abduction was not limited (100° on the right side and 92° on the left). Age-related skin redundancy in the axillae enabled the use of V-Y rotation advancement flaps without limitation of shoulder motion. Bilateral PMMC advancement flaps and the additional use of V-Y rotation advancement flaps from both axillae may be a useful reconstructive option for very large chest wall defects in older patients.