Microsurgical Free-tissue Transfer in Super-Elderly Patients with Cancer: Outcomes and an Interview Study of Patients and Their Caregivers

고주영,문구현,Go, Ju Young,Mun, Goo-Hyun The Korean Society for Microsurgery 2012 Archives of reconstructive microsurgery Vol.21 No.2

Background: Increasing numbers of super-elderly patients (>80 years old) with cancer now require microvascular-free tissue transfer. The objectives of this study were to evaluate potential applications of microvascular tissue transfer in this patient population, and post-surgical changes in quality of life. Methods: The records of cancer patients 80 years or older who had undergone microsurgical tissue transfer were retrospectively reviewed. Structured interviews were conducted with patients and family caregivers after surgery, and the patients' quality of life was qualitatively assessed. Results: The study cohort consisted of seven patients with a mean age 87.6 years (range, 81 to 95). Wound and medically-related complications were minimal. During the patient interviews, eight of the nine respondents reported remarkable improvements in quality of life following surgery and expressed a high level of satisfaction with their surgical results. Conclusions: Our study showed that microsurgical reconstruction performed in super-elderly patient not only appropriately repairs post-oncologic defects but also significantly improves the patients' quality of life.

안면부 모세혈관기형에 따른 광범위 안면부 결손의 유리피판술을 이용한 치험례

김도훈,변재경,문구현,방사익,오갑성,임소영,Kim, Do-Hoon,Pyon, Jai-Kyong,Mun, Goo-Hyun,Bang, Sa-Ik,Oh, Kap-Sung,Lim, So-Young 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.1

Capillary malformation is common vascular malformation. In case of facial capillary malformation, patients' cosmetic and functional deficits are quite significant. The standard treatment which has been applied so far for capillary malformation is pulsed dye laser with 585nm. But in case of advanced capillary malformation, surgical interventions are inevitable. The problem of large size facial capillary malformation is how to cover the remnant defect, which occurs after resection. In this case, authors have experienced surgical treatment of large size facial capillary malformation and covered the large facial defect with free thoracodorsal artery perforator flap. The flap was thick, so facial asymmetry remained after the first surgery. But with the secondary procedure, authors have made more symmetric figures. The patient was satisfied with the result. Using free flap to replace the defect after resection due to capillary malformation is useful for these kinds of cases.

전 상악골 절제술 후 양경 유리 견갑 골-피부 피판을 이용한 재건 3례

김정민,하범준,문구현,현원석,방사익,오갑성,Kim, Jung-Min,Ha, Bom-Jun,Mun, Goo-Hyoun,Hyun, Won-Sok,Bang, Sa-Ik,Oh, Kap-Sung 대한미세수술학회 2003 Archives of reconstructive microsurgery Vol.12 No.1

We used bipedicled scapular osteocutaneous free flap for total maxillectomy defect reconstruction in 3 cases of malignant maxillary tumor. We elevated two flaps of the skin paddle and the bone flap with one common pedicle - the subscapular artery - which was devided to the angular branch of the thoracodorsal artery and the circumflex scapular artery to reconstruct the nasal cavity, the palate and the zygoma. The angle between the two flaps was free enough so that we could transfer the two flaps through a single microanastomosis. After the operation, patients could swallow and pronounce well, and the wound contracture was minimal so that we could get aesthetically good result.

Usefulness of Partial Muscle Flaps and Combination Method for Coverage of Prosthetic Material in Chest Wall Reconstruction

류석태,변재경,임소영,문구현,방사익,오갑성,Ryoo, Suk-Tae,Pyon, Jai-Kyong,Lim, So-Young,Mun, Goo-Hyun,Bang, Sa-Ik,Oh, Kap-Sung Korean Society of Plastic and Reconstructive Surge 2011 Archives of Plastic Surgery Vol.38 No.3

Purpose: Reconstruction of chest wall has always been a challenging problem. Muscle flaps for chest wall reconstruction have been helpful in controling infection, filling dead space and covering the prosthetic material in this challenge. However, when we use muscle flaps, functional and cosmetic donor site morbidities could occur. The authors applied and revised various partial muscle flaps and combination use of them to cover the prosthetic material for the chest wall reconstruction and evaluated the usefulness of partial muscle flaps. Methods: This study included 7 patients who underwent chest wall reconstruction using partial muscle flap to cover prosthetic material from 2004 to 2008. The pectoralis major muscle was used in anterior 2/3 parts of it leaving lateral 1/3 parts of it. The anterior 2/3 parts of the pectoralis major muscle were used while lateral 1/3 parts were left. In case of the rectus abdominis muscle flap, we used upper half of it, or we dissected it around its origin and then advanced to cover the site. The latissimus dorsi muscle flap was elevated with lateral portion of it along the descending branch of the thoracodorsal artery. If single partial muscle flap could not cover whole prosthetic material, it would be covered with combination of various partial muscle flaps adjacent to the coverage site. Results: Flap coverage of the prosthetic material and chest wall reconstructions were successfully done. There occurred no immediate and delayed post operative complications such as surgical site infection, seroma, deformity of donor site and functional impairment. Conclusion: When we use the muscle flaps to cover prosthetic material for chest wall reconstruction, use of the partial muscle flaps could be a good way to reduce donor site morbidity. Combination of multiple partial flaps could be a valuable and good alternative way to overcome the disadvantages of partial muscle flaps such as limitation of volume and size as well as flap mobility.

유리공장 이식을 이용한 인두 및 경부식도 재건술의 결과

추무진,염창섭,김용진,진홍률,문구현,박진우,Choo, Moo-Jin,Yum, Chang-Seop,Kim, Yong-Jin,Jin, Hong-Ryul,Mun, Goo-Hyun,Park, Jin-Woo 대한기관식도과학회 2000 大韓氣管食道科學會誌 Vol.6 No.1

The reconstruction for the pharynx and cervical esophagus after wide resection in essential procedures and the several methods have the reported. Each method has advantages and disadvantages relatively. Five cases of free jejunal graft were analyzed retrospectively for the reconstruction of pharynx and cervical esophagus at Chungbuk National University Hospital from May 1996 through December 1998. Primary sites were one oropharyngeal cancer, three hypopharyngeal cancers and one subglottic cancer involved the cervical esophagus. Two grafts had necrosis. Postoperative minor complications were dysphagia, fistula, stricture of anastomosis site, and pneumonia in the order. There were not possible voice rehabilitation in three success cases.

체형 교정 시술 후 발생한 비정형 마이코박테리아 감염, 증례 보고

정재연,임소영,변재경,문구현,방사익,오갑성,Jeong, Jae-Yeon,Lim, So-Young,Pyon, Jai-Kyong,Mun, Goo-Hyun,Bang, Sa-Ik,Oh, Kap-Sung 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: NTM (non tuberculous mycobacteria) is rare cause of surgical site infection after plastic surgery in immunocompetent patients. There are some reports about NTM infection after body contouring procedure from Latin America. But, there is no report in Korea. The purpose of this article is to report 2 patients with soft tissue infection caused by NTM after body contouring procedure. Methods: Two young female patients exhibited signs of inflammation and abscess after body contouring procedure. One patient underwent liposuction. The other underwent HPL (hypotonic pharmacologic lipo-dissolution) injection. Results: The result of tissue cultures were positive for NTM. All patients responded to the combined therapeutic approach. Conclusion: The goal of this article is to raise awareness among plastic surgeons who may encounter such patients in their practice. NTM should be included in the differential diagnosis of surgical site infection after body contouring surgery.

부이주 및 큰이주를 동반하는 비전형적인 이주의 재건술

유원재,오갑성,임소영,변재경,문구현,방사익,Yoo, Won-Jae,Oh, Kap-Sung,Lim, So-Young,Pyon, Jai-Kyong,Mun, Goo-Hyun,Bang, Sa-Ik 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Tragus is one of the key structure of the normal shape of auricle. We experienced several cases of hypoplastic tragus with preauricular appendage. This article describes the methods of reconstruction of atypical tragus using accessory tragus or macrotragus to make better aesthetic results rather than simple excision. Methods: From April, 2004 to March, 2009, 21 patients got operations by our method. Seven patients had bilateral deformity of tragus. Mean age was 12.7 years. For 17 cases of accessory tragus, simple excision, z-plasty and interpolation flap was performed. For 11 cases of macrotragus, debulking and z-plasty was performed. Mean follow-up period was 9.4 months. Results: Reconstructed tragus looked symmetric with the opposite side in contour, size, direction and partial coverage of auditory meatus. There was no enlargement of remnant appendage for the follow up period and there was no complication such as hematoma, infection and chondritis. Conclusion: In cases of small and deformed tragus, preauricular tissue such as accessory tragus and macrotragus could be a good source of tragal reconstruction.

Usefulness of Full-thickness Skin Graft from Anterolateral Chest wall in the Reconstruction of Facial Defects

유원재,임소영,변재경,문구현,방사익,오갑성,Yoo, Won-Jae,Lim, So-Young,Pyon, Jai-Kyong,Mun, Goo-Hyun,Bang, Sa-Ik,Oh, Kap-Sung Korean Society of Plastic and Reconstructive Surge 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. Methods: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. Results: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. Conclusion: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.

Microsurgical Foot Reconstruction Using Endoscopically Harvested Muscle Flaps

우경제,임소영,변재경,방사익,오갑성,문구현,Woo, Kyong-Je,Lim, So-Young,Pyon, Jai-Kyong,Bang, Sa-Ik,Oh, Kap-Sung,Mun, Goo-Hyun Korean Society of Plastic and Reconstructive Surge 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. Methods: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. Results: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. Conclusion: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.

Extended Application of Endoscopic Repair for Frontal Sinus Fractures

정재연,임소영,변재경,방사익,오갑성,문구현,Jeong, Jae-Yeon,Lim, So-Young,Pyon, Jai-Kyong,Bang, Sa-Ik,Oh, Kap-Sung,Mun, Goo-Hyun Korean Society of Plastic and Reconstructive Surge 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: The coronal approach for repair of frontal sinus fractures is associated with significant adverse sequelae including a long scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. To minimize these complications, an endoscopic approach for repair of frontal sinus fractures was developed. The authors now present the results of an endoscopy-assisted approach for the treatment of frontal sinus fractures. Methods: From 2002 to 2009, five patients with frontal sinus fracture underwent endoscopic repair. Two slit incisions were placed in the scalp, and one or two stab incisions directly over the fractures were placed in the forehead. After subperiosteal dissection, fracture segments were reduced under direct vision and fixed with microplates or fibrin glue. Results: All patients had good cosmetic results and remained free of sinus complaints. There were no perioperative complications reported. Conclusion: Endoscopic repair of frontal sinus fractures is an efficacious technique that significantly reduces patient morbidity. A relatively wide range of anterior table fractures can be reduced using an endoscope. In cases of complicated comminuted fractures, fibrin glue helps to achieve satisfactory endoscopic reduction. Endoscopic repair is an alternative treatment for various anterior table fractures of the frontal sinus.