The Clinical use of Adipose tissue in Plastic and Reconstructive Surgery

Rhie, Jong Won(이종원) 대한기계학회 2014 대한기계학회 춘추학술대회 Vol.2014 No.4-4

다축 적층 시스템을 이용한 인공지지체 제작 및 골 형성 능력 평가

김종영(Jong Young Kim),김광진(Jin Guang Zhen),박인수(In Su Park),김상헌(Sang-Heon Kim),이종원(Jong-Won Rhie),강태연(Taeyun Kang),조동우(Dong-Woo Cho) 대한기계학회 2010 대한기계학회 춘추학술대회 Vol.2010 No.4

자유 형상 제작 방식의 다축 적층 시스템 개발 및 쥐 모델을 이용한 PCL/PLGA/TCP 인공지지체의 골 형성 능력 평가

김종영(Jong Young Kim),심진형(Jin-Hyung Shim),김상헌(Sang-Heon Kim),이종원(Jong-Won Rhie),조동우(Dong-Woo Cho) 대한기계학회 2010 대한기계학회 춘추학술대회 Vol.2010 No.5

We investigated the validity of using SFF(solid free-form fabrication)-based scaffolds seeded with osteoblasts, and human umbilical vein endothelial cells (HUVECs) to enhance bone regeneration capacity. To accomplish this goal, SFF-based polycaprolactone (PCL)/poly-lactic-co-glycolic acid (PLGA)/tri-calcium phosphate (TCP) scaffolds were fabricated using a multi-head deposition system (MHDS). The blended PCL/PLGA/TCP scaffolds were seeded with osteoblasts and HUVECs and implanted into calvaria defect model in rats. At 8 and 12 weeks after implantation, micro-computed tomography (μ-CT), reverse transcription polymerase chain reaction (RT-PCR), and histological assays were conducted to know the effects of SFF-based scaffolds on osteogenesis. In vivo results indicated scaffolds in the osteoblast-HUVEC group had the largest area of new bone tissue. Therefore, we demonstrated through μ-CT and histological assays that scaffolds seeded with both human osteoblasts and HUVECs were superior to other groups.

척수 신경 자극기 삽입부 감염의 치험례

김종석,오득영,서제원,이중호,이종원,안상태,Kim, Jong-Sok,Oh, Deuk-Young,Seo, Je-Won,Lee, Jung-Ho,Rhie, Jong-Won,Ahn, Sang-Tae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: Nowadays spinal cord stimulator is frequently used for the patients diagnosed as complex regional pain syndrome. The lead is placed above the spinal cord and connected to the stimulation generator, which is mostly placed in the subcutaneous layer of the abdomen. When the complication occurs in the generator inserted site, such as infection or generator exposure, replacement of the new generator to another site or pocket of the abdomen would be the classical choice. The objective of our study is to present our experience of the effective replacement of the existing stimulation generator from subcutaneous layer to another layer in same site after the wound infection at inexpensive cost and avoidance of new scar formation. Methods: A 50-year-old man who was diagnosed as complex regional pain syndrome after traffic accident received spinal cord stimulator, Synergy$^{(R)}$ (Medtronic, Minneapolis, USA) insertion 1 month ago by anesthetist. The patient was referred to our department for wound infection management. The patient was presented with erythema, swelling, thick discharge and wound disruption in the left upper quadrant of the abdomen. After surgical debridement of the capsule, the existing generator replacement beneath the anterior layer of rectus sheath was performed after sterilization by alcohol. Results: Patient's postoperative course was uneventful without any complication and had no evidence of infection for 3 months follow-up period. Conclusion: Replacement of existing spinal cord stimulation generator after sterilization between the anterior layer of rectus sheath and rectus abdominis muscle in the abdomen will be an alternative treatment in wound infection of stimulator generator.

코헤시브 실리콘 젤 보형물을 이용한 유방확대술시 보형물 크기에 따른 유방 크기 변화 예측

이중호,서제원,이백권,오득영,이종원,안상태,Lee, Jung-Ho,Seo, Je-Won,Lee, Paik-Kwon,Oh, Deuk-Young,Rhie, Jong-Won,Ahn, Sang-Tae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Predicting the change in breast size for a specific patient's need is a challenging problem in breast augmentation. We intended to investigate the postaugmentation degree of breast size according to the size of cohesive silicone gel implant. Methods: To predict post-augmentation breast size, we measured 100 patients' pre-and postoperative 3 month's bust circumference. All patients were performed by total subfascial breast augmentation with moderate profile cohesive silicone gel implant through areolar omega (transareolar-perinipple) incision. Results: According to this study, each additional one pair of 100 mL in implant size yielded an approximate 1.5 cm increase in bust circumference (p=0.006). Conclusion: From this result, we conclude that each additional one pair of 100 mL in implant volume yielded about 1.5 cm increase in bust circumference. Although this result may not be applied to every patient, we believe that it yields a practical chart that can help to predict the amount of increase in breast size with the use of cohesive silicone gel implant of a specific size preoperatively.

보행 환자에서의 위볼기동맥천공지뒤집기피판을 이용한 허리엉치 부위 연부조직 결손의 치료

문석호,김동석,오득영,이중호,이종원,서제원,안상태,Moon, Suk-Ho,Kim, Dong-Seok,Oh, Deuk-Young,Lee, Jung-Ho,Rhie, Jong-Won,Seo, Je-Won,Ahn, Sang-Tae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Extensive lumbosacral defects after removal of spinal tumors have a high risk of wound healing problems. Therefore it is an effective reconstructive strategy to provide preemptive soft tissue coverage at the time of initial spinal surgery, especially when there is an instrument exposure. For soft tissue reconstruction of a lumbosacral defect, a variation of the gluteal flap is the first-line choice. However, the musculocutaneous flap or muscle flap that is conventionally used, has many disadvantages. It damages gluteus muscle and causes functional disturbance in ambulation, has a short pedicle which limits areas of coverage, and can damage perforators, limiting further surgery that is usually necessary in spinal tumor patients. In this article, we present the superior gluteal artery perforator turn-over flap that reconstructs complex lumbosacral defects successfully, especially one that has instrument exposure, without damaging the ambulatory function of the patient. Methods: A 67 year old man presented with sacral sarcoma. Sacralectomy with L5 corpectomy was performed and resulted in a $15{\times}8\;cm$ sized complex soft tissue defect in the lumbosacral area. There was no defect in the skin. Sacral stabilization with alloplastic fibular bone graft and reconstruction plate was done and the instruments were exposed through the wound. A $18{\times}8\;cm$ sized superior gluteal artery perforator flap was designed based on the superior gluteal artery perforator and deepithelized. It was turned over 180 degrees into the lumbosacral dead space. Soft tissue from both sides of the wound was approximated over the flap and this provided in double padding over the instrument. Results: No complications such as hematoma, flap necrosis, or infection occurred. Until three months after the resection, functional disturbances in walking were not observed. The postoperative magnetic resonance imaging scan shows the flap volume was well maintained over the instrument. Conclusion: This superior gluteal artery perforator turn-over flap, a modification of the conventional superior gluteal artery perforator flap, is a simple method that enabled the successful reconstruction of a lumbosacral defect with instrument exposure without affecting ambulatory function.

하악에 발생한 중심성 거대세포육아종의 치험례

정진욱,오득영,서제원,문석호,이중호,이종원,안상태,김창현,Chung, Jin-Wook,Oh, Deuk-Young,Seo, Je-Won,Moon, Suk-Ho,Lee, Jung-Ho,Rhie, Jong-Won,Ahn, Sang-Tae,Kim, Chang-Hyun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Central giant cell granuloma is a rare, benign giant cell tumor which commonly develops in areas near the teeth. It accounts for approximately less than 7% of benign tumors of the mandible. Clinically, central giant cell granuloma is classifed into aggressive and non-aggressive type, and usually requires surgical treatment. There has been no report of central giant cell granuloma in plastic surgery field of the country, and we report a case with a brief review of the diagnosis and treatment of the disease. Methods: A 23-year-old male presented with a hard, non-tender, growing mass with the size of $4.0{\times}3.0\;cm$ on mandible for several months. Computed tomography scan showed a solid mass within thinned outer cortex on mandible. The thinned outer cortex was excised with the mass and the inner cortex was partially removed burring. After the tumor removal, mandible was fixed by reconstruction plate. Results: Pathologic report showed numerous large multinucleated giant cells, diffusely distributed in a background of ovoid-to-spindle-shaped mononuclear cells. There was no evidence of recurrence after 1 year follow up. Bony defect was regenerated and we removed the reconstruction plate. Conclusion: Removal of central giant cell granuloma results in defect of outer cortex, which can be reconstructed by using reconstruction plate, autologous bone graft or bone cement. We used reconstruction plate as a conservative method to induce secondary healing of the outer cortical defect area, which resulted in normal mastication and occlusion with no recurrence.

척수수막류 결손 재건을 위한 양측 V-Y 전진피판술

신종원,오득영,이중호,문석호,서제원,이종원,안상태,Shin, Jong-Weon,Oh, Deuk-Young,Lee, Jung-Ho,Moon, Suk-Ho,Seo, Je-Won,Rhie, Jong-Won,Ahn, Sang-Tae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Meningomyelocele is the most common type of neural tube defect disease. Early surgical treatment is recommended to prevent central nervous system infection. Several reconstruction methods were reported previously regarding surgical wound defect closure following meningomyelocele excision. In this article, we report two successful patients using the bilateral fasciocutaneous sliding V-Y advancement flap as a covering for meningomyelocele defects. Methods: Two patients with meningomyelocele were evaluated. Both patients were male and received their operations on the 1st and 4th day of life. After neurosurgeons completed their part of the operation, the V-Y advancement flap was used to close the defect. Initially a bilateral V-shape incision design was made on the skin such that the base of the V-flap measures identical to the size of the wound defect. An incision was made down to the fascia in order to allow the V-flaps to slide into the defect. Subfascial dissection was performed up to 1/3 to 1/4 the length of the V-flap from the wound while minimizing injury to the perforating vessels. Results: Both patients were treated successfully and there was no evidence of complication in 2 months follow up. Conclusion: Several reconstruction methods such as local flaps, skin graft and myocutaneous flaps were reported regarding meningomyelocele surgical wound defect closure. Bilateral fasciocutaneous sliding V-Y advancement flap is an easy method without involving the underlying muscles or a secondary skin graft in a short operation time. Therefore we recommend this treatment option for reconstruction of the wound defect following meningomyelocele excision.

과다 체중 감량 환자에서의 허리띠 피부지방절제술의 치험례

김종석,서제원,오득영,이중호,안상태,이종원,Kim, Jong-Sok,Seo, Je-Won,Oh, Deuk-Young,Lee, Jung-Ho,Ahn, Sang-Tae,Rhie, Jong-Won 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Obese proportion is increasing universally, estimating more than a billion. So reducing the weight became one of the topic in medical market. Not only diet, exercise, medication, but also many surgical procedures are being developed, such as sleeve gastrectomy, gastric bypass surgery. After massive weight loss, skin excess and laxity occurs, leading to unsatisfying body contour. Body contouring surgery including abdominoplasty, breast reduction is performed when skin excess is present in abdomen and breast. When skin excess is present circumferentially, belt dermolipectomy is the treatment of choice. Methods: A 23-year-old man had weight gain since he was 12 of age. A year before visiting to our department, his height was 168 cm, weight was 150 kg and body mass index (BMI) was 53.15 kg/$m^2$. The patient lost 55 kg of his weight through exercise and diet control. When he visited again, his weight was 95 kg and BMI was 33.66 kg/$m^2$. In physical examination, skin excess and laxity was seen in both breast and abdomen circumferentially and lateral folds were seen in the back. Abdominal contour deformity (Pitman classification type 6) and pseudogynecomastia (grade 3) were present in both breast. Belt dermolipectomy of abdomen, both breast and lateral folds was performed, resecting 6,400 g of tissue and additive 1,200 g through revisional operation. Results: The patient lost 6,500g of his weight and BMI reduced by 2.3 kg/$m^2$. The patient's hospital course was uneventful during 5 weeks of hospitalization and he was satisfied with his final body contour. Conclusion: Body contouring with belt dermolipectomy in patient who has circumferential skin excess and laxity after massive weight loss can be a treatment of choice.

신속 조형 모델을 이용한 안와바닥 골절 정복술

김혜영,오득영,이우성,문석호,서제원,이중호,이종원,안상태,Kim, Hye-Young,Oh, Deuk-Young,Lee, Woo-Sung,Moon, Suk-Ho,Seo, Je-Won,Lee, Jung-Ho,Rhie, Jong-Won,Ahn, Sang-Tae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Orbital bone is one of the most complex bones in the human body. When the patient has a fracture of the orbital bone, it is difficult for the surgeon to restore the fractured orbital bone to normal anatomic curvature because the orbital bone has complex curvature. We developed a rapid prototyping model based on a mirror image of the patient's 3D-CT (3 dimensional computed tomography) for accurate reduction of the fractured orbital wall. Methods: A total of 7 cases of large orbital wall fracture recieved absorbable plate prefabrication using rapid prototyping model during surgery and had the manufactured plate inserted in the fracture site. Results: There was no significant postoperative complication. One patient had persistent diplopia, but it was resolved completely after 5 weeks. Enophthalmos was improved in all patients. Conclusion: With long term follow-up, this new method of orbital wall reduction proved to be accurate, efficient and cost-effective, and we recommend this method for difficult large orbital wall fracture operations.