당뇨백서에서 Pentoxifylline 투여가 미세혈관문합후 개존율과 혈관내피재생에 미치는 영향

강윤제,임풍 가톨릭대학 (가톨릭신학대학) 대학원 1993 가톨릭大學醫學部 論文集 Vol.45 No.4

표피 성장인자의 국소도포가 화학적 박피술후 창상치유에 미치는 영향

강윤제 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3

Chemical peeling is a procedure of the application of a caustic chemical onto the skin to produce a controlled partial-thickness injury and reduce fine wrinkles of skin. The agent, usually a chemical solution, removes various amounts of the epidermis and, depending on the strength of the agent, affects dermal collagen. Wound repair consists of epidermal regeneration by migration from adnexa and replacement of new dermal connective tissue, resulting in a "rejuvenation" of the skin. Wound healing is a complex biologic process that involves chemotaxis and division of cells, neovascularizition, synthesis of extracellular matrix proteins, and remodeling of scar. Peptide growth factors appear to play key roles in initiating and sustaining the phases of tissue repair. Epidermal growth factor (EGF) promotes wound healing by stimulating mitosis of keratinocytes. EGF also increases the number of fibroblasts in wounds through chemotaxis and mitosis, resulting in more collagen production. This study was conducted to clarify the effect of topically applied epidermal growth factor on wound healing after chemical peeling. Forty-four guinea pigs were underwent chemical peeling with 60 % trichloroacetic acid solution on the back of each animal (3 cm in diameter) and they were divided into 3 groups : (1) control group (18 animals treated with EGF ointment (59㎍/g) twice a day for 6 weeks after chemical peeling). To compare the epithelial healing rate, the unhealed areas of the chemical peeling wounds were measured on the 7th, 10th, 14th, and 17th days after peeling. We also obtained pathologic specimens and observed the microscopic changes weekly from 2 weeks through 6 weeks after chemical peeling. And the long-term gross appearances of the wounds such as scars and hair growths were observed at 6 weeks after chemical peeling. The results were as follows; 1. The healing rate of the EGF-treated group was increased compared with that of the control group (unpaired t-test, 7th day : P=0.0001, 10th day : p=0.0063, 14th day : p=0.026, 17th day : p=0.042). 2. Microscopically, there were more abundant and regularly arranged dermal collagen fibers in the EGF-treated group than in the control group at 2 weeks. But at 3 weeks and thereafter, there were more abundant collagen fibers, which showed characteristics of scar tissues locally, in the control groups than in the EGF-treated group. 3. Microscopical appearance of the long-term EGF group did not show more abundant collagen fibers compared with that of the EGF-treated group and the control group at 4 and 6 weeks. But skin adnexa were well preserved, and scar tissue was not found in the long-term EGF-treated group. 4. AT 10 weeks, the gross appearances of EGF-treated group and the long-term EGF-treated group were indistinguishable from that of the normal skin, but the gross appearance of the control group showed atrophic changes and alopecia partially. These results suggest that topical application of EGF promotes wound healing and reduces complications such as alopecia and scara after chemical peeling, but it does not increase dermal collagen fibers that enhance the rejuvenation effect of chemical peeling.

도서형 피판에서 정맥경의 위치가 피판의 생존에 미치는 영향

최종우,안상태,신승엽,강윤제 大韓成形外科學會 2000 Archives of Plastic Surgery Vol.27 No.2

It has been known that the improved drainage of a flap increased its survival and the increasing number of draining vein improves survival of flaps. But recently, researches have proved that the different orientation of venous outflow on the island flap is more important than the number of outflow tracts. The purpose of this study is to investgate the survival rates of flaps with various numbers or locations of draining veins. An 6 x 7cm flap was raised on the abdomen of 40 white rats (Sprague Dowley, 350-400 gm). Rats were divided into 4 groups and each group consisted of 10 rats. In group 1 (AV), flaps were based on the inferior epigastric artery and vein on the ipsilateral side. In group 2(A-V), flaps were based on the inferior epigastric artery on the ipsilateral side and the inferior epigastric vein on the contralateral side. In group 3(AV-V), flaps were based on the inferior epigastric artery and vein on the ipsilateral side and the inferior epigastric vein on the contralateral side. In group 4 (Av-V), flaps were based on the inferior epigastric artery and lateral thoracoepigastric vein on the ipsilateral side and the inferior epigastric vein on the contralateral side. A definite assessment was made on the seventh day after flap elevation. The necrotic areas of flaps were determined with Computer Image Analysis System and barum-sulfate microangiographys were performed. The necrotic area was 38.14% in group 1, 18.73% in group 2, 33.53% in group 3, and 31.94% in group 4 respectively. The microangiographs showed striking differences in the vascular pattern in the flaps, and number , and proper location of the draining vein allows the recruitment of an adjacent angiosome and can improve the survival rates of island flap.

소아의 비골(鼻骨) 골절 진단에 있어 전산화 단층 촬영의 유용성

정현권,최종우,천지훈,김인중,강윤제 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.1

The incidence of nasal bone fracture in children is relatively uncommon compared with that in adults. But nasal injuries in children merit special attention, because the disturbance of the growth centers essential to the normal development may cause significant cosmetic or functional disabilities, the patients should be carefully examined and properly treated. Because the injured nose swells more quickly and more diffusely in children than in adults, the diagnosis is more difficult. The pediatric patient does not permit even the most gentle examination at times and x-ray examination is often inconclusive. Because of these reasons, the diagnosis of nasal fractures in children is often difficult. The authors have performed facial bone CT in accurate diagnosis of the nasal bones fractures in such children. Conclusively, facial bone CT is useful in early accurate evaluation of the nasal bones fractures in children.

인와저 파열골절 치료에 사용된 자가골 및 인공삽입물질들의 비교 고찰

주권,정상훈,한기택,권호,임진수,강윤제 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

We developed an animal model to recreate the condition of an open fracture in communication with the maxillary sinus. We then studied wound healing of the sinus wall structures following fracture in the presence of autogenous bone and alloplastic implant. This model is designed to simulate the repair of an orbital floor fracture in humans. The New Zealand White rabbit was used as the animal model. Standardized 8mm defects were made bilaterally in the maxillary sinuses to include bone and mucosa in 36 rabbits. Two different implants and autogenous calvarial bone graft were placed in the soft-tissue pockets to obturate the defects, exposing one surface of the implant to the open sinus. Medpor porous polyethylene, silicone and calvarial bone implant were compared. Animals were killed at 1, 2 and 8 weeks after implantation. Gross examination of the specimens for the amount of mucosal closure and implant tissue fixation was performed. Histological sections were evaluated for bone and soft-tissue morphology juxtaposed to the implant. Complete closure of the mucosal defect was demonstrated with each type of implant. Medpor implants showed both vascular and soft-tissue ingrowth into pores by week 1. Bone ingrowth was seen by week 2. Closure of the Medpor obturated defects occurred more rapidly than in the silicone group. The Medpor implants and calvarial bone demonstrated bone and soft-tissue fixation, callus formation and maturation, while mature overlying mucosa was reconstituted over the defects. Silicone implants demonstrated a fibrous tissue reaction within 1 week of implantation and they never became fixed to bone or soft tissue. Maxillary sinus wall regeneration occurred in all defects. This study supports clinical observations of maxillary sinus wall regeneration in humans.

당뇨백서에서 Pentoxifylline 투여가 미세혈관문합에 미치는 영향

임풍,강윤제 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.3

Diabetes mellitus is known as the most common endocrine disease and its true frequency is difficult to ascertain, but it occupies probably between 1 and 2 percent of the general population. Reconstructive surgery for injuries due to traffic or industrial accidents and diabetic foot ulcers have increased recently. For reconstruction of such diseases, the need for microvacular surgery continues to expand because it has several advantages, but it is known that the risk of anastomotic failure remains high in diabetic patients. Late diabetic complications such as nephropathy and retinopathy occur mainly due to the microangiopathy, and atherosclerotic dieseases such as coronary heart disease and peripheral vascular disease are accelerated in diabetes mellitus. The mechanism of development of deabetic vascular disease is incompletely understood. Hemorrheological changes, i.e. the blood hyperviscosity and the reduced erythrocyte deformability, occur frequently in diabetic patents. In recent years, several investigations have presented evidence that diabetic hemorrheological alterations may be involved in the occurence of microvascular and macrovascular degenerative complications. The xanthine derivative, i.e. pentoxifylline, has been used successfully in the treatment of pathohemorrheological alterations associated with diabetic vascular complications. In fact, pentoxifylline is able to improve erythrocyte deformability and to reduce blood viscosity an plasma fibrinogen levels. This study was undertaken to evaluate the efficacy of pentoxifylline on microvascular anastomotic failure in a diabetic animal model. One hundred and twenty male Wistar rats were divided into three groups; control group, diabetic group and diabetic-pentoxifylline treated group. Diabetes mellitus was induced by streptozotocin(50㎎/kg body weight intravenous injection) and microvacualr ananstomoses of the right femoral artery were performed at 2 weeks after induction of diabetes. The diabetic-pentoxifylline treated group received intraperitoneal injections of pentoxifylline in does of 20mg/kg/day beginning at 24 hours prior to operation, which was continued daily for 14 days postoperatively. Body weight and blood glucose level were recorded preoperatively and on the 14th postoperative day. Patency of the anastomotic site was examined grossly using patency test and the anastomotic vessel segments were obtained for histologic study on the 14the postoperative day. The endothelial changes were observed with scanning electron microscope. The results were as follows; 1. Pentoxifylline had no effect on glucose level and body weight. 2. The patency rate of the diabetic group(81.08%) was decreased(chi-square test, P=0.0054) compared with that of the control group(100%), but the patency rate of the diabetic-pentoxifylline treated group(97.14%) was significantly increased(P=0.0301) compared with that of the diabetic group. 3. The average non-reendothelialized area of microvascular anastomotic site of the diabetic group(8,465±8,319㎛²) was increased compared with that of control group(273±401㎛²) electron-microscopically. Pentoxifylline accelerated reendotheliali-zation significantly in the diabetic-pentoxifylline treated group(1,940±1,334㎛²,P=0.0002). 4. On the 14th postoperative day, endothelial cells covered the suture thread completely in the control group, but they appeared around the suture sparsely and irregularly in the diabetic group. In the diabetic-pentoxifylline treated group, endothelial cells covered the suture thread partially and they were arranged in regular fashion similar to the findings of the control group on the 14th postoperative day. These results suggest that diabetes mellitus has an adverse influence on anastomotic patency and endothelial healing after microvascular surgery, which can be improved by pentoxifylline treatment.

정맥의 선조작이 도서형 정맥 피판의 생존에 미치는 영향

강윤제,우장호,최종우,김동진,임풍,김인중 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.3

There are some attempts to improve the survival of venous island flap, such as delay procedure and pharmacological agents. This study includes prefabrication of vein which could enhance the survival of the venous island flap. The venous island flap was created by a branch of the central vein in rabbit auricle. At 1.5 cm away from the distal margin of the designed flap, the central vein was dissected and transferred under the random part of the future venous flap for 1 week. The survival of prefabricated venous flap was compared with unprefabricated flap 1 week after the flap elevation. The vasculature in the flap were also visualized by microfil cast. The results were as follows: 1. The prefabrication improved the survival of the venous flap significantly. 2. The transferred veins in the prefabricated flap were well visualized 1 week after the flap elevation. In conclusion, it is inferred that the prefabrication enhance the survival of the venous island flap.

연장인두피판을 이용한 편평상피암 절제 후 발생한 연구개 거대결손의 치험예

강윤제,김진철,임 풍,조승호,서병도 大韓成形外科學會 1987 Archives of Plastic Surgery Vol.14 No.2

Cancer of the oral cavity represents about 3 per cent of all cancers. The palate is found to be the primary site of origin in 5 to 12 per cent of all oral cancers. Curative treatment methods utilized were limited to radiation, surgery or the combination. Largely owing to concern for the potential of palatal incompetence, radiation has been recommened as the treatment of choice in all but the smallest soft palate epidermoid cancers. The recurrence rate after radiation has been found to be excessive in many previous reports. Excessive defect of the soft palate is difficult to close using local tissues. Palatal prosthesis is often very effective in restoring palatal competence. However, it causes some problems like that local irritation and difficulties in oral hygiene. Authors report a case of squamous cell carcinoma of soft apalate who have been successfully treated with transoral resection and reconstruction. For reconstruction of surgical defect, elongated pharyngeal flap was adapted to the nasal defect and island lapatal flap was transferred to cover the oral aspect of the defect.

Crouzon氏病의 治驗例

康允濟,金鎭喆,林 豊,姜俊基,金城年 大韓成形外科學會 1987 Archives of Plastic Surgery Vol.14 No.2

Crouzon's disease, described first by Crouzon in 1912, is one of the craniofacial dysostoses and has been known to be transmitted as an autosomal dominant trait. The main clinical characteristics of this disease are varing degree of craniosynostosis, exophthalmos and midface recession according to the severity of the involvement. Because of the increased intracranial pressure caused by the premature synostosis of the cranial sutures, neurologic disorders, such as hydrocephalus, epilepsy and mental retardation, are often present. The shallowness of the orbital cavities is the cause of exophthalmos which accompanies many ophthalmologic complications. The midface in general is both retruded and hypoplastic, and pseudoprognathic mandible is seen. The surgical treatment varies depending on it's severity and patient's age. Authors performed Le Fort Ⅲ osteotomy in 16 year-old male patient and obtained acceptable results. Them we report the case with brief discussion and review of the literatures.

산소유리기의 억제가 도서형 정맥피판에 미치는 영향

강윤제,김인중,임풍 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.3

Venous island flap has many advantages over other flaps, such as random pattern flap, island flap or free flap. It can cover the defect with wide arc of rotation and does not require vessel anastomosis and arterial pedicle, hence more sites are available for donor. The procedure is a time saving and simple procedure and can be performed even by two operating members. But it is not frequently used because of the poor survival of the flap. In this study, we attempted to know whether pharmacological or delay procedure can enhance the survival of the venous island flap and the mechanism of the delay flap survival. We devised a model of venous island flap whose pedicle was a branch of central vein on the auricle of Newzeland white rabbit. SOD, allopurinol and SOL and allopurinol were given as pharmacological treatment and delay procedure was carried out to enhance the survival of the flap. For the study of survival mechanism of the delay flap, SOD levels of the delay and non-delay flap were observed by SOD 525 method. The results were as follows: 1. Allopurinol, SOD and, SOD and allopurinol improved the survival of the flap significantly. 2. Delay procedure improved the survival of the flap significantly. 3. the level of SOD in delay flap was higher than that of non-delay flap regardless of the site within the flap or time passage. In conclusion, it is inferred that the administration of allopurinol and SOD and surgical delay can enhance the survival of the venous island flap. In delay venous island flap, increased level of SOD within the flap seem to contribute to the increased survival of the flap.