두개저 결손의 미세수술적 재건술

민경원,김인철,이민구,Minn, Kyung-Won,Kim, In-Chul,Lee, Min-Goo 대한미세수술학회 1999 Archives of reconstructive microsurgery Vol.8 No.1

Until recently, the cranial base tumors were deemed unresectable due to the inability to diagnose the extent of the involvement accurately and to approach and excise the tumor safely. With refinements in CT and NMR scanning and development of craniofacial techniques, reconstruction becomes absolutely crucial in allowing successful resection of these tumors. Resection of these tumors may sometimes result in massive and complex extirpation defects that are not amendable to local tissue closure. In such cases, the free tissue transfer was a useful alternative because it can provide large amount of well-vascularized tissues and reliable separation of intracranial space from bacterial flora of the upper airway. The microvascular free tissue transfer was used in 9 patients at our center to reconstruct the cranial base defects. Of these, 8 were free rectus muscle flaps, and 1 was free latissimua dorsi muscle flap. There were 1 case of partial flap loss and 1 case of postoperative wound infection. The large, complex defects were successfully reconstructed by one stage operation and the functional and aesthetic results were satisfactory with acceptable complication rates.

역행성 동맥 혈류를 이용한 원위 유리피판술의 실험적 연구

이민구,민경원,Lee, Min-Goo,Minn, Kyung-Won 대한미세수술학회 1998 Archives of reconstructive microsurgery Vol.7 No.1

Microsurgical free-tissue transfer has allowed surgeons to salvage injured limbs but choosing appropriate healthy recipient vessels has proved to be a difficult problem. Retrograde flow flaps are established in island flaps. Retrograde flow anastomosis could prevent the possible kinking and twisting of the arterial anastomosis. By not interrupting the proximal blood flow to the fracture or soft tissue defect site, the compromise of fracture or wound healing might be prevented. We wished to estabilish an animal model in rat for a retrograde arterial flow based free flap. Nembutal-anesthetized male rats; weighing 250 to 300 gm, were used. The femoral artery and common carotid artery were exposed and divided. The systemic and retrograde arterial pressure were quantified by utilizing a parallel tubing system connected with peripheral arterial line. In this study, the retrograde flow was not pulsatile and the retrograde arterial pressure was 64-65mmHg, with a mean arterial pressure of 106-109mmHg. An epigastiic skin flap, measuring $3{\times}3cm$, was raised with its vascular pedicle. The epigastric free flap was transfered in the same rat from femoral vessels to carotid vessels in end to end fashion. We anastomosed the donor arteries to the distal parts of the divided recipient arteries and the donor veins to the proximal parts of the recipient veins. Twelve experiments were performed and the transplantations succeeded in 75 percent of them. In the remaining 25 percent, the experiments failed due to thrombosis at the site of anastpmosis, or other causes. This animal model represents an excellent example of retrograde arterial flow free flap transfer that is reliable.

두경부 유리피판 수술에 있어서의 비천공성 혈관 클립을 이용한 미세혈관 문합술

장학,민경원,김우람,신현우,고경석,Chang, Hak,Minn, Kyung-Won,Kim, Woo-Ram,Shin, Hyun-Woo,Koh, Kyung-Suck 대한미세수술학회 2005 Archives of reconstructive microsurgery Vol.14 No.1

Microvascular anastomosis with suture technique is a basic skill but there are several problems such as stenosis, thrombosis and long operating time. Recently plastic surgeons have developed non-suturing mechanical coupling devices for microvascular anastomosis. The authors applied non-penetrating vascular clips (VCS clips) in the field of free flap surgery of head and neck area. Between August of 2004 and January of 2005, we performed 9 free flaps (16 vessels) using small-sized VCS clips. Four stay sutures were applied first and then VCS clips were placed between sutures about 1 mm apart. Vascular pedicle of free flap included the descending branch of lateral circumflex femoral vessel, thoracodorsal vessel, deep inferior epigastric vessel and cephalic vein. The recipient vessels were the superior thyroid artery, superficial temporal artery, internal jugular vein, external jugular vein, and superficial temporal vein. We performed 13 end-to-end (4 arteries and 9 veins) and 3 venous end-to-side anastomoses. No flap related complication occurred but we applied additional clips or sutures in two cases due to blood leakage after completion of anastomosis. Primary patency rates seemed to be good and more rapid anastomosis could be done than conventional suture technique. Advantages of VCS technique are high patency rate, low thrombogenecity and rapidity. Although the high cost of VCS instrument may be a problem, this clip could be applied safely in microvascular free tissue transfer.

Sebaceous Carcinoma Associated with Breast Cancer, Stomach Cancer, and Colon Cancer: Muir-Torre Syndrome

윤민지,민경원,Yun, Min Ji,Minn, Kyung Won Korean Cleft Palate-Craniofacial Association 2013 Archives of Craniofacial Surgery Vol.14 No.1

Muir-Torre syndrome is defined by concurrent or sequential development of internal malignancy and sebaceous neoplasm or multiple keratoacanthomas. Muir-Torre syndrome is very rare, with only 205 cases reported in the literature. We reported a patient with Muir-Torre syndrome with three internal malignancies. A 64-year-old patient with a history of breast cancer, stomach cancer and colon cancer visited our department for treatment of the skin lesion that occurred five years before on the left cheek. The lesion was excised completely with a resection margin of 1 cm, followed by full-thickness skin graft from left postauricular area for reconstruction. Histopathology revealed a $0.2{\times}0.2{\times}0.1cm$ sized sebaceous carcinoma with 4 mm safety margin. The skin graft was well taken within 7 days after surgery and the patient was discharged to outpatient follow-up. There was no complication related with surgery. Muir-Torre syndrome is very rare, as are sebaceous gland tumors. So if a cancer of the sebaceous gland is diagnosed, screening workup for internal malignancy is recommended. Because of its good prognosis, surgical removal of primary or metastatic cancers may be curative and should be attempted where possible.

요추부 천공지 유리피판을 이용한 대전자부 결손의 재건 - 증례보고 -

허찬영,백룡민,민경원,은석찬,Heo, Chan-Yeong,Baek, Rong-Min,Minn, Kyung-Won,Eun, Seok-Chan 대한미세수술학회 2007 Archives of reconstructive microsurgery Vol.16 No.1

There could be several methods for trochanteric reconstruction including local flap, pedicled perforator flaps, free flap, etc. We performed greater trochanteric reconstruction with lumbar artery perforator free flap in some aberrant method. So we report this experience with review of literatures. A 42-year-old man visited our hospital with a large soft tissue defect in his left greater trochanteric area by traffic accident. The patient had wide skin and soft tissue defect combined with open femur fracture. During one month period of admission, he underwent femur open reduction and wound debridement four times. After that we planned thoracodorsal perforator free flap reconstruction. The flap was outlined as large as $20{\times}15\;cm$ and elevated in a suprafascial plane from the lateral border. During intramuscular perforator dissection, we found that two 1.5 mm diametered perforator vessels coursed inferomedially toward second lumbar region. Finally the flap became lumbar artery perforator flap based on second lumbar artery perforator as a main pedicle. After flap transfer, the perforator vessels were connected with inferior gluteal artery and vein microsurgically. The operation was successful without uneventful course. We found no significant postoperative complication and donor site morbidity during six months follow up periods. Lumbar artery perforator flap could be an alternative procedure for thoracodorsal perforator flap in some patients with anatomic variant features.

두개저 종양 절제술 후 유리 피판술을 이용한 재건

최재훈(Jaehoon Choi),민경원(Kyung Won Minn),장학(Hak Chang) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.1

In the past, cranial base reconstruction after tumor ablation involved prostheses or local and pedicled flaps, often creating a functionally unappealing outcome. The complications that arose in the case of reconstructive failure were the potentially life-threatening, and a failed reconstruction deferred the initiation of adjuvant therapy such as a radiation therapy. With the advent of microvascular surgical techniques, free flaps have become an attractive alternative in the reconstruction of cranial base defects. Free flaps were highly vascularized and, thus, could be used in an irradiated site or in patients who planned to receive adjuvant therapy. The vascularity of free flaps enhanced the potential for delivery of chemotherapeutic agents to the resected area. Furthermore, its large size and freedom for insetting facilitated obliteration of dead space and separation of the oropharynx from the meninges. Compared with local or pedicled flaps, free flaps were more successful and were associated with fewer complications. In conclusion, free flaps were safe and effective in skull base reconstruction and provided an opportunity for wide surgical excision of dura and skull base structures to obtain tumor-free margins.

외이도 악성 종양의 경과

최재훈(Jaehoon Choi),민경원(Kyung Won Minn),장학(Hak Chang) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.2

Cancer of the external auditory canal is infrequent, with an incidence of approximately 1 to 6 per million populations per year, but ominous aggressive tumor with a poor prognosis. According to the classification of skull base tumor, proposed by Irish et al., the cancer is region Ⅲ, which arise within or around the temporal bone and extend intracranially into the posterior fossa or middle cranial fossa. The surgical treatments varied from local canal to total temporal bone resection for en bloc removal of the tumor. Radiotherapy was used either alone or in combination with surgery. But the managements lack uniformity, largely due to the rarity of the disease, the demanding extirpative surgery and the lack of a universally accepted staging system. The important anatomic structures around the temporal bone have precluded global clearance of radical surgery, which has been associated with considerable morbidity and mortality in patients who are often old and frail. Also, in many series there were insufficient times of follow-up to permit a valid assessment of results. Therefore, in spite of the small number of cases the authors’experience might be helpful for determining the treatment modality for cancer of the external auditory canal

A Retrospective Analysis of Eight Cases of Merkel Cell Carcinoma

오승일,진웅식,장학,권성택,민경원,Oh, Seung Il,Jin, Ung Sik,Chang, Hak,Kwon, Sung Tack,Minn, Kyung Won Korean Cleft Palate-Craniofacial Association 2013 Archives of Craniofacial Surgery Vol.14 No.1

Background: Merkel cell carcinoma (MCC) is a rare locally aggressive cutaneous neuroendocrine carcinoma with a high incidence of local recurrence, regional lymph node metastasis, followed by distant metastasis. Because of shortage of the retrospective study, standard treatment has not been established. The purpose of this study was to present the surgical treatment and outcome of 8 patients with MCC. Methods: We report our experiences with 8 patients who underwent treatment for MCC at our institution from 2000 through 2012. Two men and 6 women received treatment for MCC. The mean age was 76.4 years (range, 53 to 93 years). Results: The follow-up period ranged from 7 to 26 months (mean, 22.9). During the follow-up period, three of 8 patients had a relapse (mean time before recurrence, 10 months; 1 month, 7 months, and 22 months). After primary surgery, 3 patients underwent radiotherapy, and 1 patient received chemotherapy. Conclusion: MCC is an aggressive skin cancer with a high rate of local recurrence. Complete surgical excision is the mainstay of local treatment, but adjuvant radiotherapy should be considered for better local control.

유방 절제술 후의 즉시 유방재건술

강희준(Hee Joon Kang),김성원(Sung-Won Kim),노동영(Dong-Young Noh),윤여규(Yeo-Kyu Youn),오승근(Seung Keun Oh),최국진(Kuk Jin Choe),한상백(Sang-Baek Han),민경원(Kyung Won Minn) 대한외과학회 2000 Annals of Surgical Treatment and Research(ASRT) Vol.59 No.5

생체 부분 간이식에서 수여자의 우 위대망동맥을 이용한 간동맥 문합

이승은(Seung Eun Lee),이남준(Nam-Joon Yi),서경석(Kyung-Suk Suh),권준혁(Choon Hyuk Kwon),민경원(Kyung Won Minn),이건욱(Kuhn Uk Lee) 한국간담췌외과학회 2005 한국간담췌외과학회지 Vol.9 No.2