하이알로매트릭스를 이용한, 두개골결손을 동반한 선천성피부무형성증의 치료: 1례 보고

이석현,홍종원,노태석,김영석,나동균,Rhee, Suk-Hyun,Hong, Jong-Won,Roh, Tai-Suk,Kim, Young-Seok,Rah, Dong-Kyun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

제2족지 수질부 유리피판을 이용한 수지첨부재건 치험례

박용순,홍종원,김영석,노태석,나동균,Park, Yong-Sun,Hong, Jong-Won,Kim, Young-Suk,Roh, Tai-Suk,Rah, Dong-Kyun The Korean Society for Microsurgery 2010 Archives of reconstructive microsurgery Vol.19 No.1

Purpose: First introduced by Buncke and Rose in 1979, the neurovascular partial $2^{nd}$ toe pulp free tissue transfer has been attempted to reconstruct posttraumatic finger tip injuries. Although some surgeons prefer other reconstructive methods such as skin graft and local flap, we chose the partial $2^{nd}$ toe pulp flap owing to its many advantages. We report three successful surgical cases in which the patients had undergone this particular method of reconstruction. Methods: We retrospectively examined three cases of fingertip injury patients due to mechanical injury. Bone exposure was seen in all three cases, All had undergone partial toe pulp free flap for soft tissue defect coverage. Results: All flaps survived without any complications such as partial necrosis, hematoma or dehiscence. Although tingling sensation has returned in both cases, two-point discrimination has not returned yet. Currently no patient is complaining of any pain which gradually improved during their course of recuperation. All stitches were removed on postoperative 2 weeks. Patients are satisfied with the final surgical result and there are no signs of any edema or hematoma. Conclusion: The homodigital reconstruction of finger tip injury using the partial $2^{nd}$ toe pulp flap has numerous advantages compared to other reconstructive modalities such as its resistance to wear and tear and in that it provides a non-slip palmar digital surface. However it requires microsurgery which may not be preferred by surgeons. Advanced age of the patient can be a relative contraindication to this approach since atheromatous plaque from the donor toe can compromise flap circulation after surgery. We report three successful cases which patient age was considered appropriate. Further investigation with a larger number of cases and long term follow-up is deemed necessary.

돼지진피조직(Porcine Dermal Matrix, $Permacol^{(R)}$)을 이용한 보형물 유방재건술: 무세포성 사체 진피 (Acellular Cadaveric Dermis, $AlloDerm^{(R)}$)와 비교 연구

정보람,노태석,김영석,홍종원,나동균,Jeong, Bo-Rham,Roh, Tai-Suk,Kim, Young-Seok,Hong, Jong-Won,Rah, Dong-Kyun Korean Society of Plastic and Reconstructive Surge 2011 Archives of Plastic Surgery Vol.38 No.5

Purpose: The use of tissue expander/implant in breast reconstruction using tissue expander-implant is one of the most common surgical procedures. The use of AlloDerm as a sling to reestablish the lower pole of the pectoralis major muscle results a decrease in morbidity compared with more invasive procedures. However the use of AlloDerm is more expensive than other options. We decided to compare AlloDerm with Permacol, which has been safely used in human body reconstruction and is less costly than AlloDerm. Methods: After mastectomy, the inferolateral origin of the pectoralis major muscle was elevated. Either AlloDerm or Permacol was sutured to the chest wall at the level of the previously marked inframammary fold. The lower border of the pectoralis major muscle and the upper portion of the crescent-shaped piece of either AlloDerm or Permacol was sutured together using a tension free technique, and a tissue expander was subsequently inserted into the subpectoral-subAlloDerm (or Permacol) dual pocket. Results: AlloDerm was used in twenty-one patients (28 breasts) and Permacol was used in six patients (11 breasts) for tissue expander-implant breast reconstruction. During the mean follow-up period of 17 months (8~25 months). Two infections (7%) occurred in AlloDerm cases and four infections (36%) occurred in Permacol cases. Conclusion: This study is the first comparison of tissue expander/implant breast reconstruction using AlloDerm and Permacol. The use of Permacol resulted in more postoperative infection compared with the use of AlloDerm. This report is still limited with the small number of cases studied.

Relaxin을 분비하는 아데노바이러스가 피판의 생존에 미치는 영향

윤인식,박용순,전영우,전여름,이원재,윤채옥,나동균,Yun, In-Sik,Park, Yong-Sun,Cheon, Young-Woo,Jeon, Yeo-Reum,Lee, Won-Jai,Yun, Chae-Ok,Rah, Dong-Kyun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Of various effects of relaxin, we assumed that anti-fibrotic effects, neovascularization effects and vasodilatation effects of relaxin might enhance the survival rate of skin flap. In the current study, we used adenovirus expressing relaxin genes to examine whether these genes could enhance the survival rate of a skin flap. Methods: A total of 30 Sprangue-Dawley rats were divided into three groups: RLX group (10; relaxin virus injected group), CTR group (10; no gene coded virus injection group), and PBS group (10; PBS injected group). Each group was intradermally injected with the virus ($10^7$ PFU) and PBS 48 hours before and immediately before the flap elevation. A distally based flap $3{\times}9\;cm$ in size was elevated on the dorsal aspect of each rat. Following this, a flap was placed in the original location and then sutured using a #4-0 Nylon. A surviving area of the flap was measured and then compared on postoperative days 3, 7 and 10. Using a laser Doppler, the amount of blood flow was measured. On postoperative day 10, tissues were harvested for histologic examination and the number of blood vessels was counted. Results: There was a significant increase in the area of the flap survival in the RLX group on postoperative days 3 and 7. The Doppler measurement also showed significantly increased blood flow immediately after the operation and on postoperative days 7 and 10. The number of blood vessels was significantly greater in the RLX group in the tissue harvested on postoperative day 10. The VEGF concentration was significantly higher in the RLX group than others in the tissues harvested on postoperative day 10. Conclusion: Following an analysis of the effects of relaxin-secreting adenovirus on the survival of a flap, the surviving area of the flap and the blood flow also increased. A histopathology also showed an increase in the number of blood vessels and the concentration of VEGF.

구순열 환자 코변형(cleft lip nose deformity) 영상의 통계적 평가

남기창(Ki-Chang Nam),김진태(Jin-Tae Kim),홍현기(Hyun-Ki Hong),나동균(Dong-Kyun Rah),김덕원(Deok-Won Kim) 대한전기학회 2005 정보 및 제어 심포지엄 논문집 Vol.2005 No.1

안면이식에 대한 최근 동향: 한국에서의 안면이식은 어떤 단계에 있는가?

홍종원,김영석,윤인식,이동원,이원재,노태석,유대현,김용욱,나동균,탁관철,박병윤,Hong, Jong Won,Kim, Young Seok,Yun, In Sik,Lee, Dong Won,Lee, Won Jai,Roh, Tai Suk,Lew, Dae Hyun,Kim, Yong Oock,Rah, Dong Kyun,Tark, Kwan Chul,Yun Park, Be- 대한두개안면성형외과학회 2012 Archives of Craniofacial Surgery Vol.13 No.2

The world's first face transplantation was performed in France, in 2005. Since then, 21 cases of face transplantation have been performed. Face transplantation is one of the most prominent part of composite tissue allotransplantation (CTA) along with hand transplantation. Since these fields are not deal with life-saving organs, there are many arguments about immunosuppression therapy. Recent paradigm of face transplantation shows that surgical ranges are expanded from partial face transplantation to full face transplantation. Most immunosuppression protocols are triple therapy, which consists of tacrolimus (FK-506), mycophenolate mofetil and prednisolone. Anatomical researches, immunosuppression, and immunotolerance take great parts in the researches of CTA. The medical fields directly related to face transplantation are microsurgery, immunology, and transplantation. Nowadays, each field is performed widely. Therefore people, even medical teams think face transplantation could be easily realized, sooner or later. But there are lots of things that should be prepared for not only practice and immunosuppression therapy but also for the cooperation with relevant fields. That's the reason why only 21 cases of face transplantation have been done, while more than 70 cases of hand transplantation have been done in the past years. Especially in Korea, brain death patients are not enough even for organ transplantation and furthermore there are some troubles in taking part in the society of transplantation. Face transplantation has lots of problems concerning variable medical fields, administration, society, ethics, and laws. Therefore, for the realization of face transplantation in Korea, not only medical skills but also political powers are needed.

photo-plethysmography를 이용한 정상과 재접합 수지 혈류량의 비교

남기창(Ki-Chang Nam),김성우(Sung-Woo Kim),나동균(Dong-Kyun Rah),김덕원(Deok-Won Kim) 대한전기학회 2004 대한전기학회 학술대회 논문집 Vol.2004 No.11

구순열 환자 코변형(cleft lip nose deformity)의 정량적 평가를 위한 진단 요인 분석

남기창(Ki-Chang Nam),김수찬(Soo-Chan Kim),김성우(Sung-Woo Kim),지효철(Hyo-Chul Ji),나동균(Dong-Kyun Rah),김덕원(Deok-Won Kim) 대한전기학회 2004 대한전기학회 학술대회 논문집 Vol.2004 No.11

Cobalt 60 감마선 조사가 미세혈관 문합에 미치는 영향

박병윤,이영호,나동균 大韓成形外科學會 1988 Archives of Plastic Surgery Vol.15 No.3

The effects previous irradiation to the famoral artery on the patency rate of microvascular anastomosis was evaluated in an experimental study in rats. Pre-operative radiation was given in a groin field using a Cobalt 60 unit, 1.25 Mev, SSD 80cm in a fractionated dose corresponding 3600rad in 3 weeks and 5400 rad in weeks. The femeral artery of each rat was cut and reapproximated using microvascular surgical techniques following 1,2,4,8,12 weeks irradiation. Two weeks after surgery, the same femoral artery was evaluated for patency and pathologic changes. There was no notable effects of irradiation on the patency of subsequently performed anastomosis of these femoral arteries which was 8-10 mm in dameter. Radiation effects were obvious on histological examination, but the anatomical and physiological alterations apparently were not severe enough to cause early thrombosis after microsurgical mainpulation of these vessels.

태아와 성인의 배양된 섬유아세포의 교원질 합성양상의 비교

나동균,노태석,박병윤,이광훈 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

With the development of antenatal diagnostic tools such as ultrasonography, some congenital anomalies or diseases can be detected in early fetal life. Routine serial antenatal check-ups have made it possible to predict the prognosis of these problems, and a few life-threatening single anatomic malformations have been treated by open fetal surgery. The experience of fetal surgery revealed that the human fetus appears to heal without any scarring. In contrast to adult animals, the response to tissue injury in the fetus is conspiciously devoid of acute inflammation. Indeed, the absence of neutrophils is perhaps the most consistent observation in fetal wounds and seems to be followed by absent or scanty fibroblast infiltration, which results in healing with sparse and well organized collagen deposition. Actually, the amount and quality of the collagen deposition were decided by the fibroblasts which infiltrated the wound. It is well known that fetal wounds have sparse collagen deposition, however, the mechanisms are still unclear. This study was designed to evaluate the role of fibroblast activity in the differences of the scar formation between the fetus and neonate. Fibroblast activity such as the cell growth rate, the amount of collagen synthesis and the synthesized collagen types of fetus(IUP 18-22 weeks) was compared with that of neonate. The amount of collagen synthesis was measured by H-proline uptake and the amount of collagen type Ⅲ was measured by Western blot using antihuman procollagen typeⅢ. The cell growth rate as determined by cell proliferation from the initial cell count of 5x10? to cell confluence was 3.6 x 10 in the fetal fibroblasts compared to 2.5x10? in neonatal fibroblasts. Fetal fibroblast synthesize 16.9 x 10⁴ cpm of collagen and neonatal fibroblasts synthesize 2.7 x 10⁴ cpm of collagen. The synthesized amount of type Ⅲ collagen was 2.1x10⁴ ug/ml, and 1.5x10⁴ ug/ml by fetal and neonatal fibroblasts, respectively. In conclusion, fetal fibroblasts grow faster and synthesize a smaller amount of collagen, but produce more type Ⅲ collagen than neonatal fibroblasts.