확장광배근피판을 이용한 유방재건

방사익,양은정 대한의사협회 2011 대한의사협회지 Vol.54 No.1

The latissimus dorsi myocutaneous flap was one of the first methods of breast reconstruction described. However, a standard latissimus dorsi flap alone often does not provide sufficient volume for breast reconstruction and has been performed with an implant to achieve adequate breast volume. The design of an extended latissimus dorsi flap has evolved to include the paras-capular and scapular fat-fascia extension in addition to lumbar fat for additional volume. The main advantage of the extended latissimus dorsi flap is that it can provide autologous tissue to the reconstructed breast without an implant and with an acceptable donor site contour and scar. The extended latissimus dorsi flap elevation is of dissection in plane just beneath the fascia superficialis, leaving the deep fat attached to the surface of the muscle. The fat left attached to the surface of the muscle is well vascularized by the perforators coming from the muscle itself. Division of the humeral attachment of the muscle is performed for an adequate excursion of the flap. Denervation of the thoracodorsal nerve is recommended for preventing postoperative involuntary muscle contraction. Patients should be warned of the potential donor site seroma. The extended latissimus dorsi flap proved to be a reliable option for totally autologous breast reconstruction in selected patients. The flap is reliable, and the procedure is technically straight-forward and consistent.

의료기관 중심의 컨설팅 네트워크 플랫폼

방사익 한국생물공학회 2011 한국생물공학회 학술대회 Vol.2011 No.10

어린이에게 완전 절단된 음경의 미세 수술학적 재접합 : A CASE REPORT

김광명,백재승,김석화,최황,이종국,방사익 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.2

Amputation of the penis is rare. It may occur by self-mutilation in psychotics, iatrogenically at the time of surgery, or as the result of industrial accidents or criminal acts. Aside from its sexual aspect the loss of the phallus incurs a definite handicap in body image and voiding. Before the era of microvascular surgery, the replantation of the amputated penis was done without vascular repair. The fact that the penile replantation is possible without the microvascular repair is a testament to the unique anatomy of the penile vasculature. But the most common complications after replantation without vessel repair were distal skin necrosis, fistula formation, and stricture of urethra. Among these complications, skin necrosis was most common, Microvascular repair avoids extensive skin necrosis because it establishes immediately subcutaneous circulation rather than relying on blood flow across corpora cavernosa and subcutaneous tissue, as occurs when no attempt at vascular anastomosis is made. Cohen(1977)and Tamai(1977)were the first to achieve successful replantation of the penis using microsurgical techniques. Their works were followed by many further cases of microsurgically treated patients, but they were almost all in adults and amputations at the middle of penile shaft. We report a successful microsurgical repair following iatrogenic amputation at the subcoronal area of the penis in a boy who is 11 years old.

Osseointegration을 이용한 절단된 수지 재건의 임상치험례

방사익,박양수,문구현 충북대학교 의과대학 충북대학교 의학연구소 1998 忠北醫大學術誌 Vol.8 No.2

연구목적 : 절단된 무지의 재건시 족지 유리전이술,무지형성술등이 시행되어왔으나 이는 숙련된 기술을 요하고 공여부의 희생이 문제되어왔다. 보다 기술적으로 용이하고 간편하며 쉽게 적용할 수 있는 수술법을 찾고자 골통합술을 무지결손환자에게 시도하였다. 재료 및 방법 : 수지절간 관절부위의 외상성 무지절단환자에서 골통합 티타늄 고정기을 이용하여 무지보형물을 무지근위지골에 접합시키려 2단계 수술을 시행하였다. 1단계로 장골 해면 질골이식과 같이 고정기를 근위지골 원위단 골수강래에 삽입시켰다. 고정기가 주변골과 통합이 되는 3개월째에 고정기를 노출시키고 그 위에 접합체를 고정시키는 수술을 실시하였다. 2주후 무지보형물을 접합체를 이용 고정기에 고정시킬수 있었다. 결과 : 술후 12개월간 추적관찰한 결과 고정기의 골통합이 유지되었고, 피부괴사 등의 합병증은 발생하지 않았으며 어느정도의 식별촉각을 보였다. 결론 : 절단된 수지의 재건에 있어서 골통합을 이용한 보형물법이 선택적 경우에 효과적인 대안이 될 수 있겠다 Purpose : Reconstruction of amputated finger is challenging field. Free toe-to-finger transfer, pollicization are well-known useful methods but require skillful techies, sacrifice of donor digit. To find and evaluate more readily appliable method, we tried to reconstruct amputated finger using osseointegration. Materials and Methods : A case with traumatic amputation of the thumb at the interphalangeal joint level underwent two stage reconstruction aimed at fixation of a thumb prosthesis to the first proximal phalangeal bone via an osseointegrated titanium fixture. The first stage included insertion of the fixture into the medullary cavity of the first proximal phalanx in combination with transplantation of cancellous bone from the iliac crest. After 3 months. when the fixture was firmly integrated into the bone, a skin-penetrating abutment was placed on top of the fixture, the surrounding skin being thinned to the thickness of a split-thickness skin graft to minimize relative mobility. A thumb prosthesis could then be firmly attached to this fixture. Results : At follow-up examination at 12 months postoperatively, good osseointegration of the implant persisted. There was no skin problems. Some extent of tactile discrimination was achieved in the prosthesis hypothetically based on transfer of tactile stimuli to endosteal nerves in the bone via the titanium fixture. Conclusion : Amputated finger can be successfully reconstructed using osseointegrated implant without sacrifice of donor toe or finger.

Polyurethane 합성혈관을 이용한 미세혈관 재건술에서 혈관내막 두께 변화에 대한 실험적 연구

민경원,방사익 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.4

Rapid endothelization is one of the most important factor in the success of microvascular prostheses. Intimal hyper- or hypoplasia can contribute to occlude the reconstructed vessel. Expanded polytetrafluoroethylene(ePTEE) artificial vessels have been used for replacement of the major arteries, but lack of endothelization has made them occluded. Senior author has reconstructed rat femoral veins successfully using non-biodegradable polyurethane-silicone-heparin composite microvascular prostheses. Purpose of this study was to evaluate the intimal change after reconstruction of rat femoral veins with poyurethane composite graft. As time goes by, there were continuous, even growth of the endothelial cells. Ratios of the thickness of intima and graft(I/G ratio) were 0.9833±0.3408 at 4th week, 1.1683±0.3860 at 12th week and 0.7867±0.3655 at 24th week. There were no significant difference in I/g ratios between 4th week and 12th week and between 4th week and 24th week(p>0.05). However, there was significant difference in I/G ratio between 12th week and 24th week(p<0.05).

조직확장술에 의한 어린 가토 전두골의 침식과 그의 회복에 대한 관찰

방사익,이의태,박철규 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.8

Among the complications associated with tissue expansion, bony depression under the expander is frequently observed clinically, especially under the tough skin like scalp. To investigate the bony change during the expansion and its reversability, we divided 21 young rabbits into 7 groups. After the insertion of tissue expander on the frontal bone, each groups are sacrificed at 1,2,3 weeks after tissue expansion, 1,2,3 months after removal of tissue expander, and for control, 4 weeks after insertion of expander without expansion. Bony changes are evaluated by gross findings, radiographic findings, and histologic findings. Progressive tissue expansion induces significant gross bony changes in skull of young rabbit. This bony changes consist of erosion underlying tissue expander, with bony ridging and bone deposition at the periphery of the expander. These gross findings correlates with the histomorphologic findings; osteoclastic bone resorption under the expanders with periosteal reation at the periphery of the expanders. The bony changes is not simply a pressure deformation, but also is a remodeling effect. Increased bone resorption and inhibition of bone formation occur until the pressure is removed. After removal of the expanders, reparative bone remodeling begins and nearly complete healing of the cranial defects occurs. On the basis of this study, we conclude that tissue expansion causes significant but reversible effects on cranial bone of young rabbit.

전두동 골절 환자의 치료

방사익,문구현,이종희 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

The frontal sinus has importance from the aesthetic and functional points of view, so management of the frontal sinus should be conducted. The management may differ with the severity of displacement, the extent of displacement, as well as the involvement of the brain and nasofrontal duct. Fifteen patients with frontal sinus fracture were managed differently depending on the severity of their injuries for between 14 and 31 months, and then evaluated. During the follow-up period, encountered no complications and the overall result of the foreh ead contour was satisfactory.

하악골 골절 처치에 관한 임상적 연구

방사익,진홍률,조용석 충북대학교 의과대학 충북대학교 의학연구소 1999 忠北醫大學術誌 Vol.9 No.2

연구목적: 하악골 골절의 치료법은 매우 다양한 방법들이 시도되고 발전되어져 왔는데 최근에는 관혈적 정복술과 소형금속판과 나사못을 이용한 내고정 수술법이 주류를 이루고 있다. 본 연구는 이러한 방법으로 충북대학교병원에서 하악골 골절 치료를 시행한 환자들의 치료 결과와 합병증등을 분석하여 이 방법의 유용성을 검정하고자 하였다. 재료 및 방법: 1991년 3월부터 1998년 12월까지 충북대학교병원에서 하악골 골절하에 치료를 받은 환자 중 소형금속판을 사용하여 치료한 총 177명이 이 연구에 포함되었다. 연구 방법은 환자들의 의무기록지와 방사선사진을 토대로 성별, 연령, 손상원인, 동반된 손상, 골절부위 수술결과 및 술후 합병증 등을 후향적으로 조사하였다. 결과: 하악골 골절은 젊은 남자에서 호발하였다. 골절부위는 하악골 우각부에서 가장 빈번하였는데 흔히 하악결합방 골절을 동반하였다. 술후 합병증은 10.7%에서 나타났는데 부정교합이 가장 흔하였다. 결론: 하악골 골절의 처치로, 관혈적 정복술과 소형금속판과 나사못을 이용한 내고정을 시행하는 것은 매우 신뢰할만한 효과적인 방법이었다. Purpose: Various methods have been tried and developed for the treatment of mandibular fracture, and recently open reduction and internal fixation using miniplates and screws is the most common modality of treatment. To determine clinical usefulness of this method, we evaluated results and complications of the patients who were treated for the mandibular fracture with this method in Chungbuk National University Hospital. Materials and Methods: We performed a retrospective study of 177 consecutive patients of Chungbuk National University Hospital, from May 1991 to Sept 1997, to analyze and evaluate the mandibular fractures. All of them were treated using miniplates. Outcome was measured by analyzing age, sex, etiology, associated injuries, associated other facial bone fracture, fracture site, and postoperative complications. Results: The occurrence of mandibular fracture was frequent in young male and mandibular angle fracture was the most common and frequently associated with parasymphysis fracture. Postoperative complication occurred in 10.7% of cases and malocclusion was the most common. Conclusion: Open reduction and internal fixation with miniplate was a reliable and effective technique for the treatment of mandibular fractures.

다수의 확장된 피판을 이용한 이마외측 및 안와외측 부위의 재건에 관한 연구

반재상,이윤호,방사익 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

The tissue expansion technique has been widely used for coverage of various soft tissue defect since it was introduced to plastic & reconstructive surgery by Dr. Randovan. It is advantageous in facial reconstruction because it makes it possible to resurface even wider defects with neighboring skin similar in color and texture, and superior to skin obtained elsewhere. However, there still remain some problems relating to procedural details, patient selection, design, where to insert it, the number of tissue expanders, the type and size of them, the management of free margines, such as lateral canthus, eye lid, nose, lip. In particular, it is difficult to reconstruct the defect of lateral forehead and lateral orbital area using single conventional tissue expansion technique without distortion of anatomical landmark such as lateral canthus, eye lid, eye brow. Recently we experienced 5 cases of patients who had defects over lateral forehead and lateral orbital area We were able to reconstruct the defects using simultaneous multiple tissue expansion without distortion of such anatomical landmark. So we report our resets and chemical cases along with a review of some literature.

안면골 골절에 대한 임상 통계학적 고찰

방사익,문구현,이종희 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

This retrospective study comprise 595 patients with facial bone fractures in various accidents and treated in the department of Plastic and Reconstructive Surgery, the Chung Buk National University Hospital between September 1991 and December 1997. The medical records of these 595 patients were reviewed and analyzed in order to obtain the clinical pattern and understand the therapeutic modalities. The following results were obtained. 1. The most prevalent age group was the third decade(35.1%). 2. The monthly incidence was the highest in September and the most common accident time was between 6:00 p.m. and midnight. 3. The most common etiology was motor vehicle accidents(59.5%) followed by assault(26.2%), fall(11.4%), sports(2.7%). 4. The male predominated over female in 4.27:1 ratio. 5. The most common fracture site was nose(30.0%) followed by mandible(26.7%), zygoma(23.3%), orbit(8.6%), maxilla(8.1%), frontal sinus(3.2%). 6. The most common fracture site of mandible was parasymphsis(34.9%) followed by angle(27.1%), condyle(23.4%), symphysis(14.5%). 7. The soft tissue injury was the most common associated injury(51.1%). Fcial soft tissue injuries were sustained by 53.3% in the highest rate associated with the associated injuries. 8. Open reduction was used for 63.7% of total cases while 33.8% of total cases required closed reduction, and 2.5% of total cases treated conservatively. 9. The complication rate was 14.1% and the ophthalmologic complication rate comprise 44.9% of all complications.