후경흉부의 결손부의 가로목동맥을 이용한 유리 피판 재건술

이내호,서두헌,노시균,장석주,신진용 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.4

후경흉부에 있는 큰 결손 부위의 재건술은 여전히 성형외과 의사들에게 어려운 과제로 남아 있다. 이 부위에는 보통 주변부 피판을 이용한 재건술이 선호되지만, 유리 피판술을 이용한 재건은 주변 수혜부 혈관의 부족 등을 이유로 많은 의사들이 꺼리고 있는 상황이다. 저자들은 후경흉부에 만성 창상을 가지고 있는 60세 환자를 보고하고자 한다. 결손부의 크기와 주변 혈관 손상 가능성 때문에 전외측 대퇴 유리 피판술이 고려되었다. 유리 피판술의 수혜부 혈관으로는 가로목동맥 및 목정맥이 사용되었으며, 주변 피판을 이용한 수술보다 좋은 결과를 보였다. 저자들은 해당 부위 수술에서 잘 사용되지 않는 가로목동맥을 이용하여 유리 피판술을 시행하였으며, 이를 통해 재건이 어려운 후경흉부 결손부 재건에 있어서 가로목동맥이 믿을 만하고, 여러 장점이 있는 수혜부 혈관으로서 역할을 할 수 있음을 확인하였다. Reconstructions of large defects located in the posterior cervicothoracic region still present challenges to plastic surgeons. The local or regional flap is preferred in the posterior cervicothoracic region and many surgeons are reluctant to perform reconstruction using a microvascular free flap because of various reasons including vascular paucity. We report a case of a 60-year-old patient with the chronic wound at posterior cervicothoracic region. An anterolateral thigh free flap was considered the best available reconstructive method due to the size of the defect and the possibility of damaging the dorsal scapular artery. We used the transverse cervical artery and jugular vein as recipient vessels and the better result was shown than that of regional or local flaps. In our report, we presented that the transverse cervical artery which didn’t have commonly used can provide a reliable and advantageous recipient artery for the microvascular free flap reconstruction of posterior cervicothoracic defects.

수지첨부 재건 후 거머리 사용시 발생하는 문제점에 대한 고찰

이내호,양경무,Lee, Nae Ho,Yang, Kyoung Moo 대한미세수술학회 2000 Archives of reconstructive microsurgery Vol.9 No.2

Over the past several years, countless patients have benefitted from the use of leeches in microsurgery. As we know, leeches are used to overcome the problem of venous congestion by creating prolonged localized bleeding uniquely characteristics of leech bite. Venous congestion, a common complication of digital replantation, often has been treated through surgical repair like arteriovenous anastomosis. The leech produces a number of important substances which contribute to the special property of the bite, including an anticoagulant, a local vasodilator and local anesthetics. The bite usually bleeds for 1 to 2 hours and under special circumstances may bleed for up to 24 hours. So venous congestion is relieved. However, leeches increase the possibility of infection through their gut content. Infection associated medical leech application is significant risk. Other risk include allergic reaction, adverse psychologic reaction and blood loss requiring transfusion. The 65 cases of medical leech application were performed between August, 1997 and May, 2000 according to an established protocol. The complication were 18 cases ; infection (13 cases), hemorrhage (2 cases), allergic reaction (1 case), psychologic problem (1 case) and hypochromic anemia (1 case). Then our study was performed on the base of indication. As a result, Aeromonas hydrophilia was cultured from gut of medical leech and Klebsiella, Staphylococcus and Pseudomonas were cultured from media. We present the clinical risk-benefit of the medical leech therapy through several cases following digital replantation.

외측대퇴 유리피판을 이용한 두경부 결손의 재건

이내호,양경무,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 1998 Archives of reconstructive microsurgery Vol.7 No.2

저자들은 1997년 1월부터 1998년 7월까지 두경부 악성종양 및 반안면왜소증과 같은 선천성 안면기형을 주소로 본원에 내원하였던 환자 9명을 대상으로 하여 9례의 외측대퇴 유리피판술을 시행하여 다음과 같은 결과를 얻을 수 있었다. 첫째, 두경부 재건에 있어서 외측대퇴 유리피판은 다른 유리피판술에 비해 여러 장점을 가지고 있었다. 특히, 공여부 추형이 노출되지 않는 부위이며 동시에 두팀이 수술에 참여할 수 있어서 수술시간이 단축될 수 있었다. 둘째, 술후 방사선치료를 시행하면 피판의 모발은 사라지지만 모공의 과각화증 및 색조 침착이 증가하므로, 외측대퇴부에 모발이 많은 환자는 술후 방사선치료의 여부와 관계없이 미용적인 금기사항에 해당한다. 셋째, 악성종양 절제후에 발생하는 결손의 재건시 피판의 두께가 문제시 되지 않았으며, 피판의 두께는 피판을 도안할 때의 위치, 성(sex), 피하지방층의 제거정도, 근육의 포함 정도, 술 후 피판의 위축정도에 따라 조절 가능하였다. 넷째, 모든 증례에서 정맥이식없이 혈관문합이 가능하였으므로 두경부 재건시 혈관경의 길이는 충분한 것으로 사료된다. 다섯째, 가능한 피판을 장축으로 길게 도안하여 두 번째 또는 네 번째 관통동맥을 포함시켜 수술 후 발생할지도 모르는 혈류부전에 대비하는 것도 피판의 생존률을 높이는 좋은 방법으로 사료된다. Microvascular surgery has been widely used clinically for over 30 years. Although many types of free skin and myocutaneous flap are being used at present, surgeons are still looking for new flaps to suit the specific requirements of different recipient sites, to reduce the deformity at the donor site, to ease the management of the flap and to increase the success rate of those operations. The lateral thigh free flap was designed and reported simultaneously with the medial thigh free flap by Baek in 1983. The flap, based on the third perforator of the profunda femoris artery. is designed on the posterolateral aspect of the distal thigh. Clinically, the vascular variations and the locations of perforators of this system can be determined preoperatively with simple angiograms and Dopper audiometry. The lateral thigh free flap is suitable for reconstruction of defects in an oral floor with tongue and esophageal deficits, scalp defects with dural defects, and large full thickness defects of the lip. The advantages of this flap are safe elevation, a long vascular pedicles with a large lumen, skin that is generally thin, and good pliability. Furthermore, the skin territory is very wide and long. The donor site is hidden and therefore more acceptable to the patient. The disadvantage of this flap is that the anatomy of the pedicle vessels has irregular derivation from the main vessel. We had reconstructed lateral thigh free flap to the nine patients from January, 1997 to July, 1998 and got satisfactory results. In this paper we illustrate the arterial anatomy of the thigh and usefulness of this flap for the reconstruction of the head and neck.

유리피판술을 이용한 하지 연부조직 결손의 재건

이내호,박병화,양경무 의과학연구소 1997 全北醫大論文集 Vol.21 No.1

Doppler Flowmeter를 이용한 허혈지수와 Wagner 임상 분류를 이용한 만성 허혈성 족부괴저의 임상적 분석

오명록,양경무,이내호 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

It is currently necessary to manage chronic ischemic foot gangrene because the rate of hospitalization and operations is increasing as a result of diet change and the growth of an aging population. Chronic ischemic foot gangrene is caused by Buerger`s disease, atherosclerosis and particularly, diabetes. In this study, we used the Wagner ischemic index with Doppler flowmeter and Wagner classification on 62 patients over 8 years from 1991 to 1998 as an index for treatment and prognosis. We measured the systolic pressure to determine the ischemic index, and according to Wagner the blood flow was inadequate in cases of diabetic foot gangrene and nondiabetic foot gangrene when it was below 0.45 and 0.35, respectively. According to the observation of clinical symptoms, we divided the cases by Wagner classification. Based on the above data, we performed conservative treatment, skin graft, local flap, superficial sural arterial island flap and amputation. We then followed up the patients and observed the treatment results. We concluded that the Wagner ischemic index with Doppler flowmeter and Wagner classification was useful in determining, selecting, and predicting the rate of survival or death as a result of amputation and graft when a surgical operation is performed.

초음파 생체계측에 의한 전시안의 안축장에 관한 고찰

이내호,조윤애,김기산 啓明大學校 醫科大學 1983 계명의대학술지 Vol.2 No.1

1782년 2월 1일부터 1982년 8월 31일까지 본원 안과에 내원한 15안 이상의 정상인 86명, 170안의 안축장을 측정한 결과 1. 최단 안축장은 21.73㎜이고 최장 안축장은 25.47㎜였다. 2. 안축장의 평균치는 23.62㎜이고 이중 남자가 평균 23.87, 여자가 23.22㎜로서 남자가 여자보가 0.65㎜ 더 길었다. 3. 안축장이 23.00~24.50㎜인 것은 170안 중 103만(60.6%)이었고, 22㎜ 미만은 170안중 5안(2.9%) 25㎜ 이상은 170안중 6안 (3.5%)이었다. We measured the axial length of 170 normal emmetropic eyes using the A-mode of the Ocuscan-400 from Feb. 1, 1982 to August 31. 1982. The results were as follows; 1. The range of the axial length of the eyeball was from 21.73mm to 25.47mm. 2. The mean axial length was 23.62mm, that of males was 23.87mm and 23.22mm in femaies. 3. The eyes with axial length from 23.00 to 24.50mm were found in 103 eyes of 170 eyes (60.6%) and axial lengths below 22.00mm were found in 5 of 170 eyes (2.9%) and above 25.00mm in 6 of 170 eyes (35%)

레이저를 이용한 비후성 반흔의 치료

이내호 ( Nae Ho Lee ),최하영 ( Ha Young Choi ),김민호 ( Min Ho Kim ) 전북대학교 의과학연구소 2009 全北醫大論文集 Vol.33 No.1

Hypertrophic scars are relatively common, but they remain very difficult to treat and induce functional and psychologic morbidity. Many treatment modalities have been advocated in the past. But none of these are satisfactory with unpredictable result, long treatment interval and sometimes unacceptable side effects. recent use of the flashlamp-pumped pulsed-dye laser(585nm) has been shown to be effective in the treatment of various traumatic and surgical scars with improvement in scar texture, color and pliability with minimal side effects. 80 patients with 95 hypertrophic scars which had little response to usual conservative treatment and resulted from trauma, operation, skin graft donor sites, and burns were treated with Vbeam ®(595nm) pulsed dye laser(Candele Laser Corporation, Wayland, Mss). The mean number of treatment was 2.2. Period of follow-up vary from 2 month to 9 months. The 595nm Pulsed Dye Laser can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results. Complications such as hypopigmentation, ulcer and infection were not seen.

성전환증에서 음경 및 고환피판을 이용한 질성형술

이내호,하이메 호예,멜빈 시블로,박성웅,양경무,도밍고 레이스 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

Transsexuals are those who have appropriate chromosomal, hormonal and anatomical characteristics corresponding to their sexual phenotype but feel strongly with respect to their sexual identity, that they belong to the opposite sex. For this reason, they wish to be reassigned to their psychological sex by means of endocrinological and surgical treatment. Although its etiology is unknown, the majority of modern psychiatrists and behavioral scientists agree that the transsexualism is a disease entity belonging to gender identity disorder or gender dysphoria but not to be confused with the transversite, honosexualism or psychiatric problem. Three kinds of hermaphroditism have been defined according to the histology of the gonad : female pseudohermaphroditism, male pseudohermaphroditism and true hermaphroditism. It is very difficult, if not possible to assign sex especially in neonate and young children. Once sex assignment has been decided and accepted by the patient, surgical intervention should be undertaken as soon as possible. For adults there are many kinds of operative techniques. We have operated 28 cases of transexualism patients by using the penile and scrotal skin flap. This technique is superb for improving sexual appearance and function, and finally for a good opportunity for social activity. We report the results of surgery.

측두부에 발생한 피부림프상피양 암종 증례보고

오광진,이내호,양경무 대한두개안면성형외과학회 2008 Archives of Craniofacial Surgery Vol.9 No.1

Introduction: Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare cutaneous tumor of low grade malignancy and microscopically resembles lymphoepitheliomatous malignancies in the nasopharynx, palatine tonsils, salivary glands and uterine cervix. LELCS presents as scarlet-colored firm nodules or plaques on the face, scalp, or shoulder of middle-aged to elderly individuals. Material and Methods: A 72 year-old female had complained a papule like lesion with intermittent pruritis on the left temple for 2 years. But the lesion was changed to scarlet-colored firm nodule with ulceration. The mass was diagnosed as LELCS on the biopsy. And to confirm that the mass is not metastatic lymphoepithelioma-like carcinoma from other sites or direct tumor extension from the nasopharynx, selective radiographic and laboratory tests were done carefully. Results: Wide excision was performed with general endotracheal anesthesia. The tumor is composed of island of large epithelial cells surrounded by as dense infiltrate of lymphocytes. Immunohistochemical staining with cytokeratin and epithelial membrane antigen(EMA), the tumor cells were positive reaction for stain. And Epstein-Barr virus genome was not detected by in situ hybridization. So, the tumor was confirmed as LELCS. Conclusion: LELCS was described by Swanson at 1988, but has not been reported in the field of plastic surgery of Korea. We report a case of primary LELCS that occurred in the left temple with clinical characteristics, histologic features and references.

상지에서 발생한 Computed Tomography 조영제의 혈관 외 유출: 임상적 특징과 치료 전략

김효인,이내호,노시균,양경무 대한수부외과학회 2013 대한수부외과학회지 Vol.18 No.1

목적: 조영제를 이용한 영상 진단이 많아짐에 따라 혈관 외 유출 손상도 증가하고 있다. 합병증으로 국소적 부종, 감각이상, 홍반, 손가락운동제한, 구획증후군 등이 생길 수 있다. 본 연구에서 조영제에 의한 혈관 외 유출 손상의 임상적특징 및 치료 방법에 대해 고찰하고자 한다. 대상 및 방법: 2005년 1월부터 2011년 12월까지 조영제에 의한 혈관 외 유출이 발생한 26명의 환자에 대하여 후향적 병록지 검증법을 시행하였다. 연령, 증상 및 증후, 주입된 조영의 종류와 용량, 치료 방법 및 결과를 조사하였다. 결과: 85% 환자에서 100 mL 미만의 혈관 외 유출이 발생하였다. 23%에서 즉각적인 수술적 치료가 필요하였으며, 수술후 후유증은 보이지 않았고 나머지 77%에서는 보존적인 치료를 시행하였다. 결론: 예방이 중요하며 심각한 손상을 피하기 위해서 진단과 치료가 즉시 이루어져야 한다. 6시간 이내에 수부전문의를통한 수술적 치료 여부 결정이 환자의 예후에 중요하다고 할 수 있다. Purpose: Incidence of radiographic contrast media extravasation has increased owing to the escalating availability of contrast enhanced imaging. Potential complications of extravasation include localized swelling, itching sensation,hypesthesia, erythema, limitation of finger movement, compartment syndrome,skin sloughing, and necrosis. We describe clinical characteristics and treatment of computed tomography contrast media extravasation. Methods: A retrospective chart review was performed on 26 consulted patients experiencing contrast extravasation, between January 2005 and December 2011. Age, signs, symptoms, types of contrast administered, volume of extravasation,treatment and patient outcomes were documented and evaluated, retrospectively. Results: Extravasation of less than 100 mL occurred in 85%. Immediate surgical therapy was necessary in 23% of cases. There were no postoperative complications and it rendered excellent cosmetic outcomes. In 77% of cases, conservative management was recommended, such as elevation and immobilization of extremity, application of ice pack, and careful monitoring. Conclusion: Prevention is the most important for extravasation injuries. Diagnosis and treatment must be made on the spot in order to avoid severe soft tissue damage. Hand surgeons’ decision on the necessity of surgical treatment within 6 hours is important in the prognosis of patients.