PRS Korea 2016 in Its 50th Anniversary

탁민성,최환준 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.5

냉동보관한 동종혈관이식에 대한 실험적 연구

탁민성,오혁수 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

Autologous vein transplantation is a common microsurgical procedure for correcting vascular defects but requires the availability and harvesting of the vein. Use of stored allogenic grafts would deliminate these requirements, but tissue antigenicity remains a problem. It Is well-known that the antigenicity of allogenic tissues can be reduced after storage at very low temperatures. With this in mind, Cryopreserved allogenic vessel transplantation was performed in the rat model to determine the possible clinical potential of allogenic vessel transplantation without immunosuppression. METHOD : Sprague Dawley rats were used, anesthetized with pentobarbital at a dose of 2mg/100gm, administered intraperitoneally. About 8mm of left femoral artery was harvested. The vessels were immersed in 10% DMSO for 30minutes. The Temperature in the freezer was dropped in a stepwise fashion from 20°C to -70°C, according to the freezing plan. Then the vessel were preserved in liquid nitrogen at -196°C for 2months. For the thawing method, the vessels were thawed at 37°C for Iminutes. the donor arteries were transplantated into another rat's femoral artery. At various times from the first to the twelfth week after surgery, gloss and histopathological study were carried out. CONCLUSION : The vessel were found to be in good condition at the end of the 8week observation period. The cryopreserved specimens showed no sign of infiltration by inflammatory cell and retained a normal three-layer structure of intima, media and adventitia. and sufficient intimal regeneration was observed over the entire graft. These results suggest that prolonged cryopreservation of vessels makes allotransplantation without immunosuppression possible.

Jong Sub Park, M.D., 1932 to 2016

탁민성 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.6

Primary Cutaneous Mucinous Carcinoma of the Eyelid

탁민성,조성은,강상규,김철한,김동원 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.3

Primary cutaneous mucinous carcinoma (PCMC) is a rare low-grade malignant neoplasm derived from the eccrine glands. PCMC most commonly arises in the head and neck, with the eyelid being the most common site of origin. This case report describes a 51-year-old male with a painless, pigmented superficial nodular lesion over his right lower eyelid. The lesion was considered to be benign, and the initial treatment was simple excision with a 3-mm margin. However, histologic examination revealed the diagnosis of PCMC, and the patient underwent re-excision of the tumor site with an additional 3-mm margin from the initial scar. Histologic study of this second margin was free of any malignant cells. The patient experienced no postoperative complication or recurrence after 2 years. In our case, the skin lesion had benign morphologic findings and was strongly suspected to be a benign mass. Physicians should be aware of this tumor and be able to differentiate it from benign cystic or solid eyelid lesions.

근막피판을 이용한 하지의 재건

탁민성,양순재,김재훈,김용배,강상규 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.6

The soft tissue injuries of the lower extrimities are increasing and reconstruction is sometimes complicated. The status of the wound, time and method of the operation must be reevaluated before conducting surgery. For the good result of the reconstruction, we must preserve injured tissue as intact condition as much as possible, protect the wound infection and reduce amount of scar tissue. The cutaneous blood supply of the thigh comes from two groups of vessels. The first group is variously referred to as "direct" or "fasciocutaneous" or "septocutaneous" while the second group are indirect, musculocutaneous vessels. Cormark and Lamberty have described the regional arrangement of the cutaneous blood supply of the thigh as follows : The anteromedial region is supplied by the superficial femoral artery passing round sartorius muscle. The anterolateral region is supplied by the lateral femoral circumflex system through the vastus lateralis muscle and rectus femoris muscle. The posterior thigh region is supplied by musculocutaneous and fasciocutaneous branches of deep femoral artery The blood supply of the lower leg skin is divided into three divisions. First ; direct cutaneous artery from popliteal artery: superficial sural artery and from decending genicular artery:asphenous artery. Second; musculocutaneous branches from underlying muscle and, third; septocutaneous artery from posterior tibial, peroneal and anterior tibial artery. The superficial sural artery originate at the point of 4cm below of posterior knee fold from popliteal artery, and running through midline to lower quarter of leg. According to their origin, septocutaneous vessels from three groups; anteromedial from the posterior tibial vessels; anterolateral from the anterior tibial vessels; posterolateral from the peroneal vessels. The medial septocutaneous vessels are enclosed in the deep transverse fascial septum of the leg that seperates the soleus and gastrocnemius muscular compartment from the deep muscular compartment of the posterior leg. We found from four to five of these vessels. Their origin and the points at which they pierce the fascia were quite variable.Where these vesseles were most frequently present: between 4-6cm, 9-12cm, 17-19cm, and 22-24cm from the tip of the medial malleolus. The external diameter of the arteries varied from 0.5 to 1.5mm. The posterolateral septocutaneous vessels originate from the peroneal artery and veins. They run though the posterior intermuscular septum, first passing between the fibular shaft and the flexor hallucis longus and then between the soleus and peroneus longus. Their number varies between three to five. Their external diameters range between 0.4 and 1.3mm. The anterolateral septocutaneous arteries originate from the anterior tibial vessels. The vessels of this group are enclosed in the lower half of the anterior intermuscular septum, between the extensor digitorum longus and peroneus brevis. We have found the average 8 number in this group. The anterolateral and posterolateral septocutaneous perforators originate at the variable levels. The three groups of septocutaneous vessels intercommunicate widely at the margins of their respective territories. The fasciocutaneous flap is indicated on occasion for severe medical illness or multiple system trauma that contraindicates microsurgical reconstruction. These flaps should be considered when an alternative flap is needed to salvage a failed free flap or local muscle flap. the authors have experienced 38 fasciocutaneous flaps including 3 anterolateral thigh falps, 2 anteromedial flaps, 3 posterior thigh flaps, 8 anteromedial fasciocutaneous flaps and 7 sural fasciocutaneous flaps, 10 reversed type fasciocutaneous flap and 5 distally based posterior calf fasciocutaneous island flap in lower extrimity reconstruction and have found these fasciocutaneous flaps to be a very versatile reconstrictive procedure.

전방접근법을 이용한 보존적 이하선 적출술

노봉일,이영만,양순재,탁민성 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.2

The principle of surgery of the parotid gland is adequate removal of the tumor with functional and anatomical preservation of all branches of the facial nerve. There are two main surgical approaches to superficial or total conservative parotidectomy : Anterior approach and posterior approach. Preliminary identification of the main trunk of the facial nerve is probably the most favoured techniques, but identification of the peripheral branches of the facial nerve, with subsequent proximal dissection to the main trunk, is long established but less popular technique. We have prospectively experienced the low incidence of facial nerve damage in series of 55 conservative parotidentomies performed using the anterior approach. The techniques employed is described with a report of results obtained in the belief that this approach warrants greater popularity and safe technique.

완전 절단된 성인음경의 미세수술학적 재접합 치험례

김준혁,탁민성,이영만 大韓成形外科學會 2004 Archives of Plastic Surgery Vol.31 No.1

상외측 구인두암 절제술 후 구개인두기능의 재건

이형교,탁민성,김철한,신호성,강상규,이영만 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.5

Purpose: The reconstruction of oropharyngeal defect after cancer surgery is very difficult because of their complicated structure and the functional importance to prevent velopharyngeal incompetence. In this article we investigated affecting factors of velopharyngeal function after reconstruction and a fundamental rule of reconstruction for saving their functions such as swallowing, speeching and breathing. Methods: We classified 18 patients into three group under Kimata's grouping. Type I defect(6 patients) was healed by primary closure or secondary intention. In Type II or III defect, two operation methods were used - the folded flap(8 patients) and modified Gehanno method(4 patients), which include a lateral-posterior pharyngeal rotation-advancement flap. We evaluated wound dehiscence between the flap and the soft palate, speech intelligibility using Hirose's method, regurgitation during oral feeding, and hypernasality. Results: Most of type I or II defects patients recovered satisfactory velopharyngeal function. But, in patients with type III defects we found wound dehiscence, worse speech function, and common velopharyngeal incompetence.Conclusion: The large defect size and presence of wound dehiscence are major factors of postoperative velopharyngeal function. We conclude that folded flap or modified Gehanno method is a good reconstructive operation method for broad contact between the flap and defect site, preventing wound problem.

넓은 입천장갈림증에서 협근 근점막피판을 이용한 입천장성형술

남승민,탁민성,김철한,박은수,강상규,김용배 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.6

Purpose: The goal of palatoplasty is focused on two points. One is to close the palatal defect completely, and the other to create a velopharyngeal system for normal speech. While established methods such as pushback palatoplasty or double opposing Z palatoplasty are used in wide cleft palate repair, sequelae such as maxillary hypoplasia or oronasal fistula may result. Therefore, when palatoplasty with buccinator myomucosal flap is used in the case of wide cleft palates, maxillary hypoplasia and oronasal fistula is reduced and optimal results are obtained. Methods: From October 2005 to December 2006, four children with wide complete cleft palate underwent unilateral buccinator myomucosal flap and intravelar veloplaty. Mean age at cleft repair was 15 months, and mean cleft size was 2.15cm. The patients underwent intravelar veloplasty and palatoplasty was done using unilateral buccinator myomucosal flap.Results: The patients, after mean 10 months of follow- up observation, showed no signs of oronasal fistula resulting from flap tension. The shape and color similar to normal oral mucosa was obtained, and velopharyngeal function was acquired.Conclusion: When intravelar veloplasty and palatoplasty with unilateral buccinator myomucosal flap is done on wide cleft palates, postoperative speech function is optimal, velopharyngeal incompetence is effectively corrected, and sequelae resulting from pushback palatoplasty and double opposing Z-plasty, such as maxillary hypoplasia and oronasal fistula, is reduced.

하악지 시상 분리 절골술 후 발생한 후기 혈관성 합병증의 치험례

남두현,탁민성,김철한,강상규,이영만,박성태 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.1

Purpose: The mandibular ramus sagittal split osteotomy is a common procedure in cosmetic surgery. A late complication of this procedure, pseudoaneurysm rarely happens. The purpose of this case is to present our experience that is rare late vascular complication after mandibular ramus sagittal split osteotomy.Methods: A 21-year-old male was operated by local plastic surgeon for treatment of mandibular prognathism. After 9 days, the man was transferred to our hospital with persistent bleeding and swelling on the mandibular area. We operated the man three times and failed to control hemorrhage. Therefore, we did angiography and found the pseudoaneurysm on the buccal and pterygoid branches of internal maxillary artery. Then we did selective embolization for removal of the pseudoaneurysm. Results: The man was operated using the therapeutic embolization, and the pseudoaneurysm was removed. The results were successful, and we couldn't find any bleeding and the pseudoaneurysm during the follow-up of 12 months.Conclusion: The selective embolization is the good therapeutic method of late vascular complication after mandibular ramus sagittal split osteotomy.