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인공 진피(알로덤®)을 이용한 하지의 골이 노출된 연부 조직 결손의 재건
전만경,장영철,고장휴,서동국,이종욱,최재구 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.5
Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm®(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm®(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm® took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under 1 × 1 ㎝, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm® was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm® and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm®. We propose that AlloDerm® and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.
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전만경,이동철,노시영,양재원,기세휘,김진수 대한의사협회 2011 대한의사협회지 Vol.54 No.6
The purpose of this article is to review the past history of hand surgery briefly and to overview of a vision of hand surgery over next generations in republic of Korea. There were three characteristics of the past history of digit replantation in Korea. Due to the tremendous use of press machine, the replantation surgery for finger amputation had been developed rapidly from 1980’s to 1990’s period. Also new microsurgery techniques had been introduced such as toe pulp free flap for digit reconstruction. These techniques had been developed based on the medical health insurance system for the factory employees. Future of hand surgery in Korea can be anticipated as followings: operative microscopy and robotics may help surgeons to anastomosis very tiny micro-vessels; the functional recovery of fingers and hands will be more important;incidence of degenerative disease, musculoskeletal system disorder due to excessive use and injury during sports will increase; new materials such as artificial joint will be used more frequently according to the innovation of tissue engineering and regenerative medicine; specialist system for hand surgeon will be settled. Since there are a lot of hand surgeon who has a mission to alleviate patient’s pain and injury, there will be a continuous growth of hand surgery in Korea.
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Integra®를 이용한 화상 반흔구축 재건에 있어 Vacuum-Assisted Closure (VAC)의 유용성
오석준,고성훈,전만경 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.4
Purpose: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study is to evaluate usefulness of the VAC(Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra® in reconstruction of burn scar contracture. Methods: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The patient’s ages ranged from 5 to 27 with an average of 19.7 years. The surface area ranged from 24 to 1,600cm2 with an average of 785㎠. The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra® was sutured in place with skin staple and Steri-strip®. Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra®. Negative-Pressure ranging from 100 to 125mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP-site®. The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra® deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006-0.008 inches) was performed after silicone sheet removal. Result: The mean time for clinically assessed incorporation of Integra® was 10.00 days(range 9-12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra® had successful incorporation in tissue without serious complications. Conclusion: Integra® in combination with Vacuum- Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.
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지방흡입술과 병행한 복부성형술: 타 수술과 병행한 지방흡입 복부성형술과의 비교 연구
차정호,오석준,전만경,고성훈 대한미용성형외과학회 2011 Archives of Aesthetic Plastic Surgery Vol.17 No.2
Abdominoplasty may be applied to achieve aesthetic outcome and it also can be combined with other surgeries. In addition, liposuction has been offered to patients to improve contour. Liposuction combined with abdominoplasty gives us the advantage of higher patient satisfaction, better aesthetic outcome, and one-staged surgery. The authors performed a retrospective study to evaluate the outcomes. A total of 6 patients who underwent lipoabdominoplasty were included. The patients were all female and the mean age of the patients was 50.5 years old (age range, 32 to 58 years). This study surveyed lipoabdominoplasty based on the purpose of operation, type of suture, and application of quilting suture. Complication rates, patient satisfaction, and postoperative contour of the abdomen were questioned. A mild abdominal complication occurred in one patient, flap bullae, but this was healed within a week and overall flap survival was excellent with good satisfactory outcome. It appears that complication rates of simple lipoabdominoplasty group is low(1/6), and only minor complication occurs. Preservation of perforators during liposuction accounts for improved flap survival. In addition, abdominoplasty may be combined with other abdominal surgeries since other abdominal surgeries usually involve the lower abdomen, which will eventually be cut away curing the abdominoplasty stage. (Archives of Aesthetic Plastic Surgery 17: 127, 2011)
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