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하지 연부조직 종양의 절제 후 발생한 결손의 재건을 위한 도서형 유경 피판술로서의 족배동맥 피판술
한정수,신동준,문지수,박현철,Han, Chung-Soo,Shin, Dong-Jun,Moon, Jee-Soo,Park, Hyun-Chul 대한미세수술학회 2003 Archives of reconstructive microsurgery Vol.12 No.1
Purpose : Various free flaps and pedicled island flaps are effective for reconstruction of soft tissue defect developed after tumor excision. We want to know the advantage of dorsalis pedis island flap for reconstruction of soft tissue defect caused by soft tissue tumor excision. Materials and Methods : Between 1992 and 2002, we performed 4 dorsalis pedis island flap procedure for reconstruction of soft tissue defect of lower limb developed after soft tissue tumor excision. Average age was 54.7 years old $(40{\sim}68)$, and male 2 cases, female 2 cases. The kinds and number of soft tissue tumors were 2 squamous cell carcinoma and 2 malignant melanoma. The procedures that we performed were all dorsalis pedis island flap. The analysis for the result of treatment was retrospectively accessed by physical examination and questionnaire for whether the change of symptom after operation, range of adjacent joint motion. Also we reviewed associated complication after operative treatment. Results : All dorsalis pedis island flaps were alive. There is no problem for activity of daily living, no skin necrosis and no limitation of motion of adjacent joint. In 1 case of them, the patients died of distant metastasis. Conclusion: Dorsalis pedis island flap procedure as a pedicled island flap procedure is very effective and easy operative procedure for reconstruction of soft tissue defect of lower limb developed after tumor excision compared to free flap procedure because there is no need for microvascular surgery, we can obtain relatively large flap and the lesion and flap donor site locate in the same limb.
정비오(Bi O Jeong),윤경호(Kyoung Ho Yoon),배대경(Dae Kyung Bae),문지수(Jee Soo Moon),송상준(Sang Jun Song) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.2
목적: 슬관절의 동반 병변이 있는 연골결손 환자에서 시행한 자가 연골 이식술의 결과를 보고하고자 한다. 재료 및 방법: 자가 연골세포 이식술을 시행한 슬관절 연골결손 환자 36명, 39예, 67 연골결손을 대상으로 하였다. 단일 연골결손의 4예를 Ⅰ군, 다발성 연골결손의 3예를 Ⅱ군, 박리성 골 연골염으로 인한 골병변이 있는 5예를 Ⅲ군, 단일 연골결손 및 동반 손상의 9예를 Ⅳ군, 다발성 연골결손 및 동반손상의 18예를 V군으로 하여 최소 2년 이상 추시하였다. IKDC 주관적, 객관적 평가와 ICRS 기능적 평가를 사용하였으며 12예, 21 연골결손에서 이차적 관절경술을 시행하였다. 결과: IKDC 주관적 평가점수는 평균 39.8점에서 64.1점으로 증가되었고, IKDC 객관적 평가에는 C 54%, D 46%에서 A 74%, B 23%, C 3%로 호전되었다(p<0.001). ICRS 기능적 평가에서는 Ⅲ 82%, Ⅳ 18%에서 Ⅰ 15%, Ⅱ 85%로 향상되었다. 이차적 관절경술 시 ICRS 연골평가에서는 Ⅰ 9%, Ⅱ 67%, Ⅲ 24%의 결과를 보였으며 단독 연골결손의 경우와 동반 병변이 있는 경우에서의 결과의 차이는 없었다(p>0.05). 결론: 동반 병변을 가진 다발성 연골결손의 경우에도 자가 연골세포 이식술과 동반 병변에 대하여 치료를 동시에 시행하여 단독 연골결손의 경우와 마찬가지로 우수한 결과를 얻을 수 있었다. Purpose: To evaluate the results of autologous chondrocyte implantation with a concomitant injury. Materials and Methods: Sixty-seven chondral defects (39 cases, 36 patients), which were treated with autologous chondrocyte implantation, were analyzed with a minimum follow-up of 2 years. The cases were divided into the following five groups: 4 cases of a single chondral defect (group Ⅰ), 3 cases of multiple chondral defects (group Ⅱ), 5 cases of osteochondritis dissecans (group Ⅲ), 9 cases of a single chondral defect with a concomitant injury (group Ⅳ), and 18 cases of multiple chondral defects with a concomitant injury (group Ⅴ). The clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores and the International Cartilage Repair Society (ICRS) functional evaluation system. Arthroscopic examinations were performed on 12 cases and 21 chondral defects. Results: The mean IKDC subjective score was 39.8 preoperatively, which improved to 64.1 postoperatively, and the IKDC objective score was C in 54% and D in 46%, which improved to A in 74%, B in 23% and C in 3%. The ICRS functional evaluation system was Ⅲ in 82% of cases, and Ⅳ in 18% preoperatively, which improved to Ⅰ in 15% and Ⅱ in 85%, postoperatively. At the arthroscopic evaluation, the results of the ICRS system were Ⅰ in 9%, Ⅱ in 67%, and Ⅲ in 24%. There was no significant difference between the single chondral defect and chondral defects with a concomitant injury. Conclusion: In the treatment of the multiple chondral defects with a concomitant injury, autologous chondrocyte implantation produced similar excellent clinical results to those of a single chondral defect.