개량된 McIndoe 술식을 이용한 무질증 환자의 질 재건

탁관철,최봉균,최종우,Tark, Kwan Chul,Choi, Bong Kyoon,Choi, Jong Woo 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.1

The reconstructive modalities for vaginal reconstruction include simple dilatation, skin graft, use of intestinal segments and various methods using flaps. However, skin grafting procedure is the most commonly used technique and the McIndoe procedure is a representative technique among skin grafting procedures. McIndoe procedure is easier, faster and has a lower morbidity compared to other techniques. However the conventional McIndoe procedure has several problems such as incomplete vestibule formation, excessive bleeding during dissection, possibility of recto-vaginal or urethro-vaginal fistula formation, late vaginal contracture and discomfort in wearing hard plastic mold for a long time after operation. To solve these problems, the authors modified the conventional McIndoe procedure in several perspectives. The undeveloped vestibule was incised with X-shaped mucosal incision between the urethral opening and posterior margin of the vestibule and deepened by blunt finger dissection to provide a sufficient diameter & length of the neovagina and to minimize bleeding. A sizable medium thickness split skin graft was harvested and wrapped over a roll gauze-filled condom mold. Applying multiple stab incision on the skin grafted condom mold, it was inserted into the prepared neovaginal canal. Distal margin of the skin graft was secured with tips of the mucosal flaps created by X-shaped vestibular incision to prevent accidental extrusion of the skin grafted mold. During last 15 years, we applied this modification to 20 vaginal agenesis patients and investigated results of the 12 patients who could be followed up serially including hematoma formation and skin graft survival rate, size, depth, presence of late contracture, appearance, comfortness, and hygiene of the neovagina. And they were compared with 8 patients of 20 patients who underwent conventional McIndoe procedures. The modified McIndoe procedure revealed lower complication rate, higher patient satisfaction and better functional results.

Snow-Littler Procedure를 이용한 열수의 치료

탁관철,김영석,MuradJafarov 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.4

The variation of cleft hand deformity is so wide that there are many synonyms and classifications for it. Among them the classification of Manske based on the condition of first web space is mostly important in functional perspectives. In type IIb or III of the Manske's classification, in which the thumb web space is narrowed or syndactylized, release and re-creation of the thumb web space is extremely important for functional and aesthetic reconstruction. A representative procedure for correction of the type IIb or III cleft hand is Snow-Littler procedure in which the cleft is released as a palmar-based flap and then transferred to the released first web space for creation of the commissure. During the last 10 years, the authors experienced 38 cases of cleft hand deformity in 30 patients. Among them type IIb or III cleft hand was 5 cases in 4 patients. In all patients, 3rd digit was missing except 1 case and the first web spaces were completely syndactylized. We applied the Snow-Littler procedure for correction of these 5 cases. The functional outcomes and patients' satisfaction were followed up postoperatively. Thumb abduction was possible in range of 59.6±12.3. Intermetacarpal stabilities were well maintained and average pinch power was 2.3± 0.8Kg. In one case partial necrosis of the palmar-based flap tip was occurred. Careful design and preservation of the intrinsic blood supply of the palmar-based flap is extremely important for viability of the flap and successful results.

Z-자 내안각 췌피성형술을 동반한 쌍꺼풀 수술: 그 적응증, 결과 및 주의점

탁관철,김지명 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.6

The formation of pretarsal fold without modification of the medial canthal folds may produce eyes with rounder and narrower palpebral fissures. In the last 6 years, the authors performed double eyelidplasty in 16 patients with Oriental eyelids and type III medial epicanthal fold. In 9 patients, simple double eyelidplasty was performed and in 7 patients double eyelidplasty combined with Z-epicanthoplasty were performed. The aesthetic and functional outcomes, and overall patient satisfaction were followed up in 15 patients up to 5 years.In group of double eyelidplasty only, results were equivalent to Good selectively in only 4 patients who had relatively long preoperative palpebral fissure. The epifolds were sustaining in all patients. Remaining patients showed Fair or Poor results.In group of double eyelidplasty combined with Z-epicanthoplasty, all patients showed Good or Excellent results except one who had defective scar maturation.To achieve apparent aesthetic enhancement and beautiful looking eyes with lengthy palpebral fissure in patients with Type III or IV medial canthal epifold, epicanthoplasty should be combined with double eyelidplasty. It achieves apparent aesthetic enhancement by eliminating the medial epicanthal fold and opening the lacrimal lake widely leaving minimal scar and natural supratarsal skin fold line in a single stage operation.

여섯 손가락증의 수술적 교정: 새로운 수술방법의 고안과 적용

탁관철,이명철 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.5

Purpose: Hexadactyly without thumb is a rare congenital anomaly of the hand where six triphalangeal digits are symmetrically distributed without thumb. Contrary to mirror hands, triphalangeal six digits are symmetrically distributed on each side at the midline with well - differentiated carpal bones, extensor tendons, one ulnar and one radius. The authors developed a new surgical technique based on a three - dimensional concept to correct the hexadactyly and applied to 2 cases of hexadactyly with good functional and aesthetic results. Here we document the surgical technique and its result. Methods: A 16 month old male patient visited our clinic with chief complaints of bilateral hexadactyly deformity. On physical examination most radial first and second digits showed no opposition and adduction motion on both side hands. Radiography showed 6 triphalangeal digits with normal development of carpal, radial and ulnar bone. Right side abnormality was corrected by removal of most radial side extra - digit, rotation and migration of 2nd ray to thumb position and creation of 1st web by transposing a mid - palm based rectangular palmar flap as in Snow & Littler procedure which has been being applied for correction of 1st web syndactyly in cleft hand deformity. Seven months later, left side abnormality was also corrected with the same procedure. Results: Postoperative appearances of the both hands were satisfactory. Flexion, extension, opposition and grasping were possible with the pollicized 2nd ray. Pinching power was 3.0 ㎏ 15 months after surgery and 2.5 ㎏ 22 months after in right hand respectively. Conclusion: In correction of hexadactyly deformity, satisfactory aesthetic and relevant functional results can be expected with authors’ newly developed technique: removal of most radial digit, rotation and migration of 2nd digit to thumb position as well as creation of the 1st web space by transposition of mid - palm based rectangular flap.

유리피판을 이용한 경부구축의 교정

탁관철,이충재,유재덕 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.4

혈행화 신경이식 후 신경재생에 대한 형태계측학적 연구

탁관철,안성준,김대용,이영호,Tark, Kwan-Chul,Ahn, Sung-Jun,Kim, Dae-Yong,Lee, Young-Ho 대한미세수술학회 1997 Archives of reconstructive microsurgery Vol.6 No.1

Adequate vascularization is pivotally essential for a successful nerve graft. Theoretically, the immediate vascularization will inhibit fibroblast infiltration and stimulate nerve cell regeneration. In this study, histomorphological and electrophysiological studies were performed to determine if vascularized grafts are functionally superior. In rat model, a 4cm segment of the sciatic nerve was obtained and placed as a non vascularized graft on one side, and as a vascularized graft connected to the inferior gluteal vessels on the opposite side. To determine the compound action potential of the gastrocnemius muscle, electromyography was done after 2, 3 and 4 months. Histomorphologically, the distribution of myelinated nerve fibers and Schwann cell were evaluated after toluidine blue staining, The following resutls were obtained: 1. The electrophysiological studies showed no difference between the nonvascularized and vascularized grafts. 2. Two and three months after grafting, myelinated nerve fibers were more abundant in the vascularized proximal, middle and distal areas in all nerve fibers of varying diameters. 3. In the post-nonvascularized graft 2-month group, a few myelinated nerve fibers were present in the proximal and middle areas, but none distally. In the post-vascularized graft 2 month group, myelinated nerve fibers ranging $2-8{\mu}m$ were present in all three areas. 4. In the post-nonvascularized graft 3 month group, a few myelinated nerve fibers ranging in $2-6{\mu}m$ were present in all three areas, but in the post-vascularized graft 3 month group, many myelinated nerve fibers ranging in $2-10{\mu}m$ were present in all three areas. 5. In the post-graft 4-month group, more myelinated nerve fibers were present in all three areas of the vascularized grafts. However, nerve fibers of less than $2{\mu}m$ in diameter were more abundant in the non vascularized grafts. 6. Schwann cells were more abundant in the proximal, middle and distal areas of the post-vascularized 2, 3 and 4-month grafts. Based on these findings, the immediate restoration of circulation in vascularized nerve grafts allows for the increased number of surviving Schwann cells, rapid healing of the axon and myelin sheath changes which occur during Wallerian degeneration, and thus is able to stimulate a morphologically optimal regeneration.

Z-자 내안각 췌피성형술을 동반한 쌍꺼풀 수술 : 그 적응증, 결과 및 주의점 Its Indication, Results & Pitfalls

탁관철,김지명 大韓成形外科學會 2002 Archives of Plastic Surgery Vol.29 No.6

건(腱)이식술

탁관철 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.4

유리피판을 이용한 두개기저부 재건술

卓寬哲 대한의학협회 1994 대한의학협회지 Vol.37 No.2

배양된 인체 혈관내피세포에서 유해산소군에 대한 Polyphenol의 보호 효과

탁관철,설철환,김주봉,나동균 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.6