단기간 면역억제제와 수지상 세포주의 전처치를 이용한 복합조직 동종이식

은석찬,백롱민,Eun, Seok-Chan,Baek, Rong-Min 대한미세수술학회 2012 Archives of reconstructive microsurgery Vol.21 No.1

Prevention of acute rejection in composite tissue allotransplantation without continuous immunosuppression lacks reports in worldwide literature. Recently dendritic cells (DC) gained considerble attention as antigen presenting cells that are also capable of immunologic tolerance induction. This study assesses the effect of alloantigen-pulsed dendritic cells in induction of survival in a rat hindlimb allograft. We performed hindlimb allotransplantation between donor Sprague-Dawley and recipient Fischer344 rats. Recipient derived dendritic cells were harvested from rat whole blood and cultured with anti-inflammatory cytokine IL-10. Then donor-specific alloantigen pulsed dendritic cells were reinjected into subcutaneous tissue before limb transplantation. Groups: I) untreated (n=6), II) DC injected (n=6), III) Immunosuppressant (FK-506, 2 mg/Kg) injected (n=6), IV) DC and immunouppressant injected (n=6). Graft appearance challenges were assessed postoperatively. Observation of graft appearance, H-E staning, immunohistochemical (IHC) study, and confocal immunofluoreiscece were performed postoperatively. Donor antigen pulsed host dendritic cell combined with short-term immunosuppression showed minimal mononuclear cell infiltration, regulator T cell presence, and could prolong limb allograft survival.

혈관경 전외측대퇴피판을 이용한 서혜부 연부 조직 결손의 재건례

구윤택,은석찬,백롱민,Koo, Youn Taek,Eun, Seok Chan,Baek, Rong Min 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.2

We present our experience of reconstruction of inguinal soft tissue defect following inguinal lymphadenectomy, because of penile squamous cell carcinoma. Malignant infiltration required wide resection, producing a defect requiring complex soft tissue reconstruction. We have used a pedicled anterolateral thigh flap as our first choice flap for this case. Patient achieved reasonable esthetic coverage. Complications were few and patient achieved durable long term coverage. We found this flap to be technically easy, reliable and effective.

전외측 대퇴부 감각 유리피판을 이용한 전족부 탈장갑 손상 재건

조혜인,은석찬,백롱민,Cho, Hye-In,Eun, Seok-Chan,Baek, Rong-Min 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.2

The forefoot reconstruction is a challenging field for plastic surgeons. Weight bearing tolerability and stability are important factor of choosing reconstruction methods, but cosmetic aspect has to be considered. 51 year old man visited our clinic with extensive degloving injury on right forefoot by roller. The soft tissue defect started from metatarsal area to the toe tip including nails. We harvested the anterolateral thigh flap and transferred it to the forefoot defect area with nerve coaptation. The flap was successful without skin necrosis or other complications. Secondary flap debulking surgery was performed after ten months from initial operation. Patient was satisfied with functional and cosmetic outcomes. The patient was able to wear shoes and walk with adequate sensory recovery. As there is few report about reconstruction of forefoot soft tissue defects, we report a unique case of the anterolateral thigh innervated free flap reconstruction in degloving injury.

전외측 대퇴부 천공지 피판을 이용한 슬관절부의 연부조직 결손의 재건

오승일,은석찬,백롱민,Oh, Seung Il,Eun, Seok Chan,Baek, Rong Min 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.2

Reconstruction of soft tissue defect of knee joint area has been remained a challenging task for plastic surgeons. The earlier the normal tissue saved and the necrotic tissue removed, the less the patients had complications and functional disability. But such defects are difficult to manage for its poor vascularity, rigid tissue distensibility, easy infectability and a relatively long healing period. The goal of flap coverage in the knee joint should not only be satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. We have treated five cases using the anterolateral thigh perforator flaps for reconstruction successfully. In conclusion, we believe that in cases of knee joint area soft tissue defects, flaps like anterolateral thigh perforator flap should be considered as the first line of treatment.

지방 근막 피판이 연장된 전외측 대퇴 유리 피판술을 이용한 신전건 활주막의 재건 - 증례 보고 -

이신철,은석찬,백롱민,Lee, Sin-Chul,Eun, Seok-Chan,Baek, Rong-Min 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.2

Purpose: In reconstructing a defect on the dorsum of the hand, there are many cases of extensor tendons exposed or even missing. The repaired or reconstructed tendons need relevant gliding environment for good functional recovery. The anterolateral thigh flap offers a vascular fascial component with large amounts that can be used for covering exposed tendons and we report a unique case of single-stage hand dorsum and gliding surface reconstruction. Methods: A 35-year-old man had severe post-traumatic scarring in his left dorsal hand and coverage of the flap with split-thickness skin graft has been done before. After scarred skin excision and extensor tendon graft for missed part, a free anterolateral thigh adipofascial flap was used to resurface the hand dorsum and to reconstruct a two-layer gliding surface of the extensor tendons. The extensor tendons were wrapped in the fascial component with the fat layer inside. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. Good overall functional recovery and tendon excursion were observed. He was also satisfied with postoperative appearance. Conclusion: A free anterolateral thigh adipofascial flap was used successfully for reconstruction of a two-layer tendon gliding surface to treat a patient with severe scarring in the dorsal hand.

전외측 대퇴 유리피판을 이용한 외상 후 족무지 재건: 증례 보고

왕재권,은석찬,백롱민,Wang, Jae-Kwon,Eun, Seok-Chan,Baek, Rong-Min 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: The great toe presents a reconstructive challenge for plastic surgeons. The big toe has much importance not only for the gait and the stability, but also for appearance aspects. Few reports have documented the reconstruction of big toe defects and we report a unique case of free flap reconstruction technique. Methods: A 41-year-old man with right great toe open fracture with soft tissue necrosis was referred from the orthopedic surgery department. On physical examination, there was the skin necrosis circumferentially and the fratured bone was severely fragmented. The metatarsophalangeal (MTP) joint of the big toe was intact. After the wound debridement, we harvested the innervated anterolateral thigh flap and transposed to the defected area. After five months, we finally retouched the flap by the dorsal defatting and distal debulking. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. He has remained asymptomatic for eight months without any recurrence such as the osteomyelitis. Finally, he kept the normal gait and posture with weight bearing on the reconstructed great toe and foot. Conclusion: The anterolateral thigh flap is described for the reconstruction of the great toe. It involves two stage procedure with the minimal donor site morbidity and provides a good cosmetic result.

방사선조사 창상에 대한 지방유래 줄기세포의 효과

허찬영 ( Chan Yeong Heo ),이은혜 ( Eun Hye Lee ),강혜인 ( Hye In Kang ),김인아 ( In Ah Kim ),은석찬 ( Seok Chan Eun ),백롱민 ( Rong Min Baek ),민경원 ( Kyung Won Minn ) 한국조직공학·재생의학회 2009 조직공학과 재생의학 Vol.6 No.4

Radiation-induced skin wound is a unwanted complication of radiation therapy in cancer patients. Because a putative potential stem cell population within the adipose tissue has been found to possess therapeutic potentials, we authors sought to determine the effect of adipose tissue-derived stem cells(ADSCs) on radiationinduce skin wound. Sprague-Dawley rats were divided into two groups. Adipose tissue-derived stem cells were isolated from the inguinal fat pads and expanded ex vivo for three passages. All groups received 25 Gy of gamma irradiation as a single dose to the back of the rats using a cobalt-60 teletherapy unit. After four weeks of radiation, syngeneic ADSCs were delivered into the subcutaneous area of irradiated wounded skin area in experimental group. Acute skin reactions were assessed and at the endpoint of the study. Light microscopic findings were assessed. Clinically and histopathologically, radiation skin reactions were lower than control group(p<0.05). ADSCs was found to be efficacious in preventing epidermal atrophy, dermal degeneration and hair follicle atrophy. In conclusion, ADSCs could be used as useful cell therapeutics to repair and regenerate the wound of irradiation damage.

지방유래 줄기세포가 이식된 Vicryl Mesh의 섬유화와 육아조직 형성에 미치는 영향

허찬영 ( Chan Yeong Heo ),하현정 ( Hyun Jung Ha ),김지회 ( Ji Hoe Kim ),정의철 ( Eui Cheol Jeong ),은석찬 ( Seok Chan Eun ),백롱민 ( Rong Min Baek ),김석화 ( Suk Wha Kim ),민경원 ( Kyung Won Minn ) 한국조직공학·재생의학회 2010 조직공학과 재생의학 Vol.7 No.1

Vicryl mesh consists of polyglactin 910, a synthetic absorbable copolymer made from 90% glycolide and 10% L-lactide. The empirical formula is (C2H2O2)m(C3H4O2)n. The mesh is knitted from uncoated and undyed fiber identical in composition to that used in Vicryl sutures, which has been found to be inert, nonantigenic, nonpyrogenic and to elicit only a mild tissue reaction during absorption. It may be used wherever temporary wound or organ support is required, particularly in instances in which compliant and stretchable support is desired. Successful use is reported for instance as support for the correction of breast deformity. Because a putative potential stem cell population within the adipose tissue has been found to possess therapeutic potentials, we authors sought to determine the effect of adipose tissue-derived stem cells(ADSCs) on Vicryl mesh implantation. Sprague-Dawley rats were divided into two groups one is control, given the surgery of simple Vicryl mesh implantation and the other is stem cell group, given the surgery of mesh implantation and ADSCs(N=12 for each group). Before the surgery ADSCs of stem cell group were isolated from the inguinal fat pads and expanded ex vivo for three passages. Control group received multi-folded Vicryl mesh implantation to the back of the rats and Stem cell group received the surgery of Vicryl mesh implantation and ADSCs. After four weeks of operation, matrix formation, capillary density and collagen production were assessed quantatively under the light microscope. ADSCs led to a statistically significant increase in fibrosis and mature scar formation compared with the control group in histologic examination (p < 0.05). ADSCs was found to be efficacious in promoting fibrosis and scar maturation leading volume replacement on experimental Vicryl mesh implantation. This study might be used as useful volume replacement with Vicryl mesh for correcting breast deformity after conservative surgery.

회음부 재건에 있어서 박근피판의 유용성

이동찬,정연우,장학,은석찬,Lee, Dong-Chan,Jeong, Yeon-Woo,Chang, Hak,Eun, Seok-Chan 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Due to the closed and humid condition of the perineal area, wound problems occurring at this site are sometimes complicated, especially following postoperative radiation therapy. Moreover, the anal sphincter is a very important functional structure but reconstruction of the anal sphincter after severe trauma poses a challenging problem to plastic surgeons. In this article, we demonstrate the usefulness of the pedicled gracilis flap in the reconstruction of the perineal area. Methods: From September 2008 to November 2009, 6 patients, 4 males and 2 females, underwent surgery of the perineal area. The age of the patients ranged from 21 to 62 years (mean age was 48). The mean follow up period was 14 months. In 4 cases, the patient presented with wound problems after postoperative radiation therapy for anal cancer. In 2 cases, the patient presented with traumatic sphincter damage. Only the gracilis muscle was used in the 4 cases and a musculocutaneous flap was used in the 2 cases involving skin defects, respectively. Results: Among the 6 patients, 1 patient underwent hematoma evacuation of the donor site, and 1 patient presented with prolapse of the vaginal mucosa which recovered spontaneously. There were no report of other complications and there were no wound recurrences. Minimal incontinence was observed in all patients who underwent sphincter reconstruction, but all were satisfied with the overall results. Conclusion: The gracilis flap is useful in the reconstruction of the perineal area, such as in cases of radiotherapy induced wound problems and sphincter damage following severe trauma, due to its easy accessibility, rich vascularity, and minimal donor site morbidity.

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.