측두두정근막과 견갑부근막 유리피판의 조직학적 및 임상적 고찰

강양수,천지선,나영천,이명주,양정열,이창근,Kang, Yang Soo,Cheon, Ji Seon,Na, Young Cheon,Lee, Myung Ju,Yang, Jeong Yeol,Lee, Chang Keun 대한미세수술학회 2000 Archives of reconstructive microsurgery Vol.9 No.2

Fascia and fasciocutaneous free flaps (using perforators) are adequate reconstructive options with aesthetic and functional advantages, particularly for reconstruction of variable soft tissue defects of the extremities. Although various donor sites have been used for these concerns including temporoparietal fascia, serratus fascia, scapular fascia, fascial component of lateral arm and posterior calf fascia. The authors used temporoparietal and scapular fascia as a free flap for coverage of soft tissue defects and we compare two flap mainly their histologic studies and clinical applications. In our expierience both fascia provide thin, pliable coverage for exposed bone and tendons and provide good postoperative functional restoration on the recipient area. Histologically temporoparietal fascia flap has more rich blood supply and scapular fascia flap is rich in adipose tissue in their composition. In donor site morbidity, both flaps can bring satisfactory results about the donor sites, but the donor site of the temporoparietal fascia flap sometimes revealed conspicious linear scar and transient alopecia in short-haired patients and the scapular fascia flap has a tendency to be wider and thicker in obese patients. After successful application of the both fascia flap as a free flap in 38 patients (25 temporoparietal fascia, 13 scapular fascia) since 1995 ; authors recommend using the temporoparietal fascia flap for women, who tend to have more fat and longer hair, and the scapular fascia flap for men, who tend to be leand & shorter hair.

미세수술에 의한 절단 음경의 재접합

강양수,박용남,이명주,양정열,노준,김철성,Kang, Yang-Soo,Park, Yong-Nam,Lee, Myung-Ju,Yang, Jeong-Yeol,Rho, Joon,Kim, Chul-Sung 대한미세수술학회 2001 Archives of reconstructive microsurgery Vol.10 No.1

Penile amputation results primarily from attempts at self-emasculation in the psychotic individual or from felonious assault. Because of the complex nature of patients whom perform self-emasculation and low incidence of felonious assault, large series of these individuals do not exist, and experience with amputation injuries of the genitals is confined to individual case reports. Fortunately, complete amputation of penis is quite rare but potentially devastating occurrence. The repels of the treatment of penile amputation by coporal reapproximation that have been published since 1977 indicate that microreplantation techniques are propably superior to the technically simpler nonmicroscopic coporal reapproximation techniques. As microsurgical techniques have been demonstrated to superior, the preferred method of replantation involves this routine whenever possible. We have experience of a case of successful replantation of completely amputated penis by using microneurovascular repair, with the good result of cosmetic and functional concern. Herein, we report this case with the review of the literatures.

사람의 멜라닌세포성 모반에서 면역조직화학 기법에 의한 Transforming growth factor-α와 Epidermal growth factor의 발현 비교

강양수(Yang Soo Kang),정윤영(Yoon Young Chung) 대한해부학회 2002 Anatomy & Cell Biology Vol.35 No.4

TGF-α와 EGF는 EGF-R과 작용하여 그 생물학적 효과를 나타내는 폴리펩타이드로서 사람의 정상 조직에서도 존재하 여 그 작용을 나타내는 것으로 알려지고 있는데 본 연구에서는 면역조직화학적 염색 방법을 이용하여 사람의 멜라닌세포 성 모반(melanocytic nevus)에서 TGF-α와 EGF의 발현 양상을 비교 조사하였다. 멜라닌세포성 모반에서 TGF-α는 전체적으로 강한 양성반응을 보였고 EGF는 TGF-α보다는 약한 반응을 나타냈다. 특히 진피내모반에서 TGF-α는 바닥층에서 각질층에 걸쳐 표피의 전체 층에서 양성반응을 보였고 진피내에 군집으로 모여있는 모반세포는 세포질 전체에 균등하게 강한 양성반응을 나타냈다. TGF-α는 진피내 표피부속물에서는 중등도의 양성반응을 보였으며 특히 털주머니의 바깥상피세포집에서 강한 반응을 나타냈다. TGF-α와 비교하여 볼 때 EGF는 상부 표피에서 양성반응을 나타냈는데 가시층과 과립층의 일부 각질화세포의 세포질 및 각질층에서는 양성반응을 보였으나 바닥층에서는 양성반응을 관찰할 수 없었다. 진피내의 모반세포들은 EGF에 전혀 양성반응을 나타내지 않았다. 진피내 표피부속물에서는 털주머니를 제외하고는 EGF가 TGF-α보다 약한 양성 반응을 보였다. 따라서 두 성장인자가 같은 멜라닌세포성 모반에서도 부위별 발현의 차이를 보였으며 모반의 성장과 분화에는 TGF-α가 EGF보다 밀접한 영향을 미칠 것으로 생각된다.

모체 Thyroxine 투여가 태아알코올효과를 가진 흰쥐 뇌의 BDNF함유 신경세포 생후 발달에 미치는 영향

강양수(Yang Soo Kang),정윤영(Yoon Young Chung),박영란(Young Lan Park),현영식(Young Sig Hyun),김종중(Jong Joong Kim),문정석(Jeong Seok Moon),문영민(Young Min Mun),오재욱(Jae Wook Oh),신성희(Sung Heui Shin),배춘상(Choon Sang Bae) 대한해부학회 2006 Anatomy & Cell Biology Vol.39 No.4

임부의 알코올 남용은 태아 정신발육지연의 흔한 원인이며 특히 태아의 뇌 발생에 예민한 결정적 기간 (critical period) 동안에 지속적으로 음주하는 경우 태아알코올효과를 나타내기 쉽다. 본 연구에서는 임신 기간중 지속적으로 알코올을 섭취한 모체에 thyroxine을 투여하여 알코올의 유해한 영향으로 인한 태아알코올효과를 개선시킬 수 있는지를 관찰하기 위하여 흰쥐 뇌의 생후 연령에 따라 brain-derived neurotrophic factor(BDNF)함유 신경세포의 성숙 양상을 면역조직화학염색을 이용하여 관찰하였고 BDNF 함량을 측정하였다. 실험동물은 매일 35 칼로리 정도의 알코올을 섭취한 알코올군, 알코올 대신 dextrin이 첨가된 유동액을 섭취한 정상군 및 알코올을 섭취하고 thyroxine을 매일 5 μg/kg 피하 주사한 알코올+T4군으로 나누었으며 생후 0, 7, 14, 21, 28일에 희생시켰다. 본 연구 결과 BDNF 단백 양은 알코올+T4군에서 알코올군에 비해 생후 7, 14, 21일에 증가하였으며 특히 생후 7일의 알코올+T4군에서 가장 높았다. 알코올군은 모든 연령에서 정상군보다 감소하였다. 소뇌에서는 알코올+T4군에서 생후 14일부터 정상군과 유사한 BDNF함유 신경세포들이 조롱박세포층에 분포하였다. 알코올+T4군에서는 알코올군에 비해 대뇌겉질, 시상하부 및 해마에서 생후 7일에 성숙되고 두드러진 양성반응을 나타냈으며 해마에서는 생후 28일까지도 뚜렷한 양성반응을 나타냈다. 이상의 결과는 임신 중 알코올을 음용한 흰쥐 모체에 thyroxine을 투여하면 태아알코올효과를 가지고 태어날 수 있는 후손들의 뇌에 분포하는 BDNF함유 신경세포들이 생후 발달동안 정상군과 유사하거나 더 빠르게 발달시킬 수 있을 것으로 생각된다. 이는 모체에 투여하는 지속적인 thyroxine 처치가 출생 초기에 BDNF 합성을 증가시켜 모체의 알코올 남용으로 야기되는 태아알코올효과와 같은 출생결함을 개선시킬 수 있음을 시사한다. Maternal alcohol abuse is thought to be the common cause of mental retardation. Especially, continuous alcohol consumption during critical period of brain development induce fetal alcohol effects. In this study, the authors investigated the effects of maternal alcohol drinking on the postnatal changes of BDNF contents and patterns of BDNF-containing neuron in neonatal rat brain, and, the influence of maternal thyroxine treatment on the brain of pups of alcohol abused mother. Pregnant rats were divided into three groups. Alcohol-fed group (n=4) received 35 calories of liquid alcohol diet daily from gestation day 6; control pair-fed group (n=4) was fed a liquid diet in dextrin replaced alcohol isocalorically; alcohol+T4 group (n=4) received 35 calories liquid alcohol diet and exogenous thyroxine (5 μg/kg/day) subcutaneously. The amount of BDNF was significantly higher in the alcohol+T4 group as compared to the alcohol group at P7, P14 and P21, especially, alcohol+T4-exposed pups showed a significant increase of BDNF at P7. The decrease in BDNF was found in alcohol group compared to control pair-fed group at all ages. In alcohol+T4 group, BDNF-containing Purkinje cells exhibited mature pattern and monolayer arrangement at P14. Alcohol+T4 group showed mature pattern and numerical increase of BDNF-containing cells in cerebral cortex, hypothalamus and hippocampus at P7. The BDNF immunoreactivity of hippocampus continued to show prominent configuration in alcohol+T4 group at P28. These results indicate that the increase of the BDNF-containing neurons and BDNF amount in pups of thyroxinesupplemented alcohol-exposed dams as compared to control pair-fed and alcohol-exposed pups at P7, presumably suggest the early postnatal growth stimulatory effect of the exogenously supplemented thyroxine. Therefore, the increase of BDNF synthesis caused by maternal administration of exogenous thyroxine may ameliorate fetal alcohol effects, one of the ill effects as a result of the dysthyroid state following maternal alcohol abuse.

Fournier 괴사 환자의 연부조직 결손 재건술

서성보,강양수,천지선,양정열,Seo, Sung-Bo,Kang, Yang-Soo,Cheon, Ji-Seon,Yang, Jeong-Yeol 대한미세수술학회 2003 Archives of reconstructive microsurgery Vol.12 No.1

Fournier's gangrene is a synergistic necrotizing fasciitis of the perineal, perirectal and urogenital area and can be fatal unless treated in early stage. Perianal and urogenital infections are common causes of the disease but it can occur after artificial procedure on perineal area using by surgical instruments. It is mixed aerobic and anaerobic infection and E. coli is the most common causative bacteria. Untill now many investigators have focused on early diagnosis, preserving hemodynamic stability, broad-spectrum systemic antibiotics and treatment of underlying disease in management of Fournier's gangrene. The authors have experienced five patients of chronic liver disease whose necrotizing perineal infections developed spontaneously and treated them aggressively as described above and reconstructed perineal soft tissue defects using by various surgical methods, then we got good results both functionary and cosmetically. From now on, we would better reconstruct soft tissue defect of perineum with skin graft or pedicled flap in early stage when treat Fournier's gangrene, thereafter we can get an ultimate increase in patient's life quality.

안면골 골절의 임상적 고찰

강양수,류봉수,이명주,양정열,임홍철 조선대학교 부설 의학연구소 1999 The Medical Journal of Chosun University Vol.24 No.2

Background and Objective: The facial region is defined for our purposes as the whole face, together with the underlying viscera and skeletal structure. The epidemiology of facial injuries is of practical importance for several view points, not least in planning trauma services. Materials and Method: This retrospective study include 815 patients of facial bone fractures who were treated at the Department of Plastic and Reconstructive Surgery at the Chosun University Hospital between January 1994 and December 1998. These patient's medical records were then retrospectively analysed in order to gain insight into a clinical pattern. Results and Conclusion: An analysis datas were as follow: An increase of fractures of 10.2% per year was noted. The injuries were most frequently occured in July(10.4%), Saturday(23.9%) and between 18:00 and midnight. Most injuries occured in young male with the highest incidence in the third decade of life and males were predominated more than female, 3.4 to 1. The most common cause of fractures were traffic accident(42.3%) followed by assault, fall(or slip) down and others. Among the number of fractures, the most common fractures were found in the nasal bone(25.2%) followed by zygoma, maxilla, orbit, mandible and frontal bone. Associated soft tissue injuries were combined in 58%, and the other site of fractures associated with facial bone were developed in 22.2%. The average interval between onset to arrival and onset to surgical intervention was 2.48 hours, 6.2 days, and average hospital day was 12.7 days. Treatment for fractures were consist of open reduction(52.8%), closed reduction(19.5%) and conservative treatment(15.6%). The complication rate was 15.2% and most common complication was the eye problem, followed by post-traumatic psychosis and facial asymmetry.

Ear piercing후 발생한 Earlobe keloid의 치료 및 Piercing의 재건

강양수,임홍철,류봉수,이명주,양정열 대한미용성형외과학회 1998 Archives of Aesthetic Plastic Surgery Vol.4 No.1

AlloDerm??을 이용한 하지 연부조직 결손의 재건

강양수,류봉수,양정열,나영천 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Variable methods have been using for reconstruction of soft tissue defect of feet and legs. Skin graft, local flap, and free flap have been using for this purpose. But, skin graft produced secondary contracture of recipient site and increased in donor site scarring. Local flap was limited its donor site and remained severe deformities of recipient site. Free flap was required prolonged operation time and secondary operation. Acelluar human dermal allograft, AlloDerm, was removed cellular elements of the epidermis and dermis. It was relatively immunologically inert. From August 1997 to April 1998, we have grafted acellular human dermal allograft with thin split-thickness skin graft on soft tissue defect of feet and legs in 7 cases. We concluded that cryopreserved acelluar human dermal allograft has been proposed as the solution to problems of skin graft, local flap, and free flap.

한국인 태아 및 사산아에서 얼굴신경에 대한 형태학적 연구

강양수,김종중,김복,정상봉,문영민,설경수,정윤영 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.3

It is critical that the accurate anatomy of the facial nerve IS known for uncomplicated successful facial surgery. Such an operation is hazardous because of the intimate relationship between the facial nerve and the expressional muscles. It is hoped that such basic information will be helpful to those who treat conditions involving the facial region. In order to define the detail of this relationship, many studies have been undertaken on dissected adult specimens. This study was based on Korean fetus and stillborn infant cadaveric dissections, and describes anatomical variations of the peripheral branches of the facial nerve that pose a potential danger in a number of surgical procedure on the face. The branching patterns were classified into six types: the frequencies of occurrence were: type I, 4.9%; type II, 24.4%; type III, 34.1%; type IV, 19.5%; type V, 12.2%; and type VI, 4.9%. Types II, III and IV together accounted for almost 80% of the specimens. In the discussion we compare the results of the present study with those of others and try to clarify the anatomical characteristics of the facial nerve in infants, which demand that special attention be paid to the avoidance of injuries during facial surgery.

대퇴부의 지역 차단 마취후 광범위 피부 이식 공여부의 임상적 고찰

나영천,류봉수,강양수,양정열,임홍철 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.3

In general, split thickness skin graft was done under general anesthesia. However, there was a difficulty to do general anesthesia in some cases due to poor general condition. The lateral cutaneous nerve block of the thigh(LCNBT) anesthesia the usual donor site of split-thickness skin graft in the thigh. Using 10 ㎖ of 0.5% bupivacaine, LCNBT was used thigh for harvesting split-thickness skin in 42 patients. Patients age ranged from 18 to 62 years with mean 49 years. The onset of full anesthesia took between 12 and 21 minutes. The area anesthetised ranged from 200 ㎠ to 940 ㎠ with mean 551 ㎠. The duration of full anesthesia was from 6 to 16 hours. In 6 patients, LCNBT was compared with previous lidocaine local anesthesia and all patients preferred to do LCNBT. In our experience, LCNBT is a safe, and simple method for harvesting split-thickness from the thigh and LCNBT provided good postoperative analgesia.