융비술을 이용한 외상성 비변형의 교정

손경동,위성신,안상태,임 풍 대한미용성형외과학회 1997 Archives of Aesthetic Plastic Surgery Vol.3 No.1

Nasal dorsal support may be weakened or lost during the corrective rhinoplasty procedures such as resection of dorsal deviation, osteotomies and reposition of deviated nasal bones, and incision, fracture, resection or scoring of the dorsal septal strut especially in the small flat noses. Partial or total augmentation of the nasal dorsum has an important role in the correction of asymmetry and restoration of aesthetic balance in the considerable amount of traumatic nasal deformities. We reviewed medical records, pre- and postoperative photographs of 53 patients with traumatic nasal deformities, which had been corrected by augmentaion rhinoplasties. The majority of the patients were male (70%), ages of twenties and thirties (79%), injured by automobile accident, fist blows, and sports activites (76%), and were operated more than 3 years after injury(74%). Types of deformities were deviation only (47%), depression only (23%), deviation and depression (19%), deviation and hump (8%), and depression and widening (6%). At least two corrective procedures were needed in the deviated deformities and one procedure in the depressed deformities. Materials for augmentation were silicone implants in 55% and autogenous tissues in 45%. In terms of postoperative complications, displacement and/or absorption were observed in 6 of 24 (25%) autogenous augmentations and displacement and/or swelling in 8 of 29 (27.6%) silicone augmentations.

당뇨쥐에서 pentoxifylline의 투여가 동.정맥 허혈후 피판 관용도에 미치는 영향

손경동,강낙헌,임풍,안상태 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.7

Skin flaps are less tolerant to secondary ischemia thant o primary ischemia after the free tissue transfer. Although microvascular procedures are not contraindicated in the patients with diabetes, postoperative venous occlusion is common and the flap tolerance to secondary ischemia is decreased in the diabetic patients. Pentoxifylline effectively lowers blood viscosity and therefore has a salutary effect on teh movement of blood especially within small vessels. To the best of our knowledge, the effects of pentoxifylline on the flap tolerance to the ischemia caused by arterial and venous occlusion have not been evaluated in the diabetic animal. The purpose of this study is to evaluate the effects of pentoxifylline on the flap tolerance to secondary arterial and venous ischemia in the diabetic rats. Fifty-eight male Sprague-Dawley rats weighing average 250 g were used. The rats were randomly divided into eight groups : normal arterial ischemia (NA), normal venous ischemia (NV) normal arterial with pentoxifylline (NAP), normal venous ischemia with pentoxifylline (NVP), diabetic arterial ischemia (DA), diabetic venous ischemia (DV), diabetic arterial ischemia with pentoxifylline (DAP), diabetic arterial ischemia with pentoxifylline (DVP). Diabetes was induced by an intravenous injunction of streptozotocin (50 mg/Kg) through the penile vein. Blood glucose levels an body weight changes were monitored every other days. Blood glucose levels were maintained between 250 to 450 mg/dl. The pentoxifylline treated groups received intraperitoneal injection of pentoxifylline (10 mg/kg) twice a day. Four weeks after induction of diabetes and pentoxifylline administration, a 5 x 3 cm sized island skin flap was made on the right abdomen. The epigastric pedicle was occluded for 1 hour by microvascular clamps. Eighteen hours after reperfusion, the pedicle was reoccluded for 6 hours and then the flap was reperfused. AT the seven days after secondary ischemia, percentage of flap survival was assessed by computerized planimetry (image analysis system) and erythrocyte deformability was measured by the filtration method. The results were as follows : 1. The flap survival fates were significantly decreased in the diabetic rats compared to those in the normal rats (p < 0.05). 2. Venous ischemia was more detrimental than arterial ischemia in the flap survival (P < 0.05). 3. Pentoxifylline administration improved flap survival rats significantly in the diabetic rats (p < 0.05) but not in the normal rats. (p > 0.05). 4. The erythrocyte deformability was decreased significantly in the diabetic rats compared to that in the normal rats (p < 0.05). 5. The erythrocyte deformability was increased significantly in the groups given pentoxifylline (P < 0.05). These results demonstrate that pentoxifylline improved erythrocyte deformability and flap tolerance to secondary ischemia in the diabetic rats. On the basis of this experiment, we recommend the administration of pentoxifylline to the diabetic patients who is anticipating free flap surgery to prevent the flap necrosis after microvascular thrombosis.

CD18 단일클론항체와 Superoxide Dismutase을 이용한 재관류 손상의 예방

강낙헌,손경동,한기택,임풍,김환묵 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.1

Prolonged ischemia results in cellular necrosis and only prompt restoration of blood flow will prevent this type of injury. However, reperfusion itself can cause significant injury of previously ischemic tissue, i.e. "reperfusion injury'. This is an issue of concern in many areas of reconstructive surgery including free tissue transfer and replantation. Many factors have been implicated in the cause of reperfusion injury. Oxygen free radicals have enjoyed increasing popularity recently, but leukocytes had been thought to have a role only in the healing process that follows ischemic injury. Current studies in myocardium, liver and intestine have shown a dramatic increase in tissue leukocytes after ischemia-reperfusion and evidence implicating leukocytes in pathogenesis of ischemia-reperfusion injury has come from studies demonstrating significant injury reduction by depletion of circulating neutrophils. Therefore, increased neutrophil adhesiveness is a critical early step in the sequence of events leading to neutrophil-mediated injury. The purpose of this study is to evaluate the effect of CDl8 monoclonal antibody(CDl8 mAb), blocking antibody of neutrophil adherence, and superoxide dismutase (SOD), free radical scavenger, on reperfusion injury in rat epigastric island skin flap. The epigastric pedicle was occluded for six hours with ambient temperature at 22±1℃. The epigastric nerve was carefully dissected out and left intact to minimize autocannibalization. The flaps were sutured back down to their beds over interposed silicone sheets to prevent plasmatic imbibition. Fifteen minutes before reperfusion, the flaps were perfused with saline, CDl8 mAb(1 mg/kg), SOD(20,000 unit/kg) or CDl8 mAh/SOD(1 mg/kg + 20,000unit/kg). Percentage of flap survival was assessed by computerized planimetry on the seventh day. Tissue biopsies for myeloperoxidase(MPO) and malonyldialdehyde (MDA) were obtained at 24 hours after reperfusion. The results were as follows. 1. Percentage of flap survival was significantly increased in CDl8 mAb/SOD, CDl8 mAb and SOD groups in order, compared to the control(P < 0.05). Percentage of flap survival was significantly increased in CDl8 mAb group as compared with SOD group(p < 0.05). Percentage of flap survival significantly increased in CDl8 mAb/SOD group as compared with CDl8 mAb and SOD groups(p < 0.05) 2. MPO activity was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups(p < 0.01). MPO activity was significantly decreased in CDl8 mAb group as compared with SOD group. (p < 0.01). 3. MDA content was significantly decreased in CDl8 mAb/SOD, CDl8 mAb and SOD groups (p < 0.01), but the difference between CDl8 mAb and SOD groups was not significant. From those above results, we get to the conclusion that blocking neutrophil adherence and/or aggregation with monoclonal antibodies to CDl8 as compared with radical scavenger significantly ameliorates reperfusion injury. It is suggested that combination of modalities with antiadhesion therapy and radical scavenger may have a synergistic effect of improving flap survival and may be the optimal prevention of ischemiareperfusion injury.

안와주변의 봉와직염을 동반한 전두동 골종의 치험례

조성필,강장석,손경동,안상태 大韓成形外科學會 2001 Archives of Plastic Surgery Vol.28 No.4

청피반성 혈관염(livedo vasculitis)의 수술적 치험례

이종건,장도명,김영진,손경동,이백권,임풍 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

Livedo vasculitis is thought to be a thrombogenic disorder that is related to the autoimmune disease. It clinically shows purplish mottling and recurrent painful ulcers in the lower extremities, leaving atrophie blanche after healing of the ulcers. Histopathologic finding are thrombotic occlusion in the mid-dermal vessels without necrotizing vasculitis. The therapeutic approach has largely been made by the use of drugs that stimulate endogenous fibrinolytic activitiy, that inhibit thrombus formation, or that cause vasodilation, but surgical intervention by excision and skin graftion has rarely been reported as a primary treatment. In our experience, two patients with livedo vasculitis, who had been unresponsive to various medications, were treated with wide excision and several times of skin grafting. And they experienced complete healing without recurrence.