저분자량 헤파린이 쥐 서혜부 유리피판 이식술에 미치는 영향

이준모,이강욱,이동근,Lee, Jun-Mo,Lee, Gang-Wook,Lee, Dong-Geun 대한미세수술학회 1993 Archives of reconstructive microsurgery Vol.2 No.1

Free tissue transplantation is commonly performed with the brilliant achievement in microsurgery and anticoagulants and antithrombotic agents have been prescribed in the procedures. However, there is no clean-cut indication as to which agents would be more effective in every steps and final consequences. Low molecular weight heparins inhibiting coagulation in plateletrich plasma and acting on the vascular endothelium have antithrombotic and fibrinolysis action. The experiment with rat groin free flap transplantation after 6-hour ischemia and injection of the low molecular weight heparin was performed and the results between the injection and non-injection group were analysed as follows, 1. Both of the 24-hour groups, vessel patency was not proportional to color change of the groin flap. 2. On the second day after anastomois, heparin-injection group showed intact intima, patent lumen without thrombus, and mild granulomatous inflammation around the suture material and control group with doubtful patency revealed intimal loss and thrombus formation. 3. On the 5th, 7th, and 9th postoperative day, heparin group was patent in anastomosis and showed acute inflammatory cells. 4. The 7th-week period, heparin-injection group showed intact flap color, patent lumen with intact intima and persistent foreign body granuloma.

고전적 및 삼각조각 기법을 이용한 단-측면 미세동맥 접합술의 실험적 연구

이준모,이강욱,이동근,Lee, Jun-Mo,Lee, Gang-Wook,Lee, Dong-Geun 대한미세수술학회 1992 Archives of reconstructive microsurgery Vol.1 No.1

Problems of composite tissue transfer commonly arise when a single indispensable recipient vessel receives the graft vssel, and the graft vessel must be sutured in end-to-side fashion so as not todisturb the vascularity of the recipient vessel. The triangular flap in the recipient vessel wall gives an intact endothelial surface when the flow of blood stream is presented and may reduce the chance of anastomosis. We selected mature Wistar rats weighing over 450 grams to compare the conventional longitudinal slit from the triangular flap in the recipient carotid artery over bloood pressure and blood flow when the donor carotid artery was anastomosed in end-to-side fashion. In 30 minutes after anastomosis, maximum blood pressure measured in the donor carotid arterial side when the recipient arterial wall was fasioned with the longitudinal slit was recorded 114 mmHg and with the triangular flap 100mmHg. Minimum blood pressure with the longitudinal slit was 98mmHg and with the triangular flap 88mmHg. The amount of blood collected for 30 seconds in the conventional longitudinal slit was 1.18mg and in the triangular flap 0.78mg. Histology study in 30 minutes, the conventional longitudinal slit demonstrated the more hemorrhagic features around the suture material compared to that of the triangular. flap and, in the 7th day, the conventional longitudinal slit demonstrated the more prominent granulomatous reactions and vascular proliferations around the suture material compared to that of the triangular flap.

허혈성 유리조직 접합술에서 Urokinase의 효용성 - 토끼 이개를 이용한 실험 -

이준모,Lee, Jun-Mo The Korean Society for Microsurgery 1995 Archives of reconstructive microsurgery Vol.4 No.1

장시간 허혈상태의 토끼 이개를 실험대상으로 하여 유로키나제와 헤파린을 병용 또는 단독으로 사용시와 또한 약물을 사용하지 않았을 때, 이들이 모세혈관의 개존성과 아울러 미세수술후의 조직 생존율에 미칠 수 있는 효과를 보기 위하여 허혈상태의 토끼 이개를 미세수술로 접합한 후 모세혈관으로의 혈류를 측정하기 위하여 레이저 초음파 혈류측정기(Laser doppler flowmetry)를 이용하였으며 방사선 구슬들(Cobalt-57 with plastic material with average diameter 15 micron)을 주입한 결과 유로키나제 조합에서 통계적으로 유효한 성적을 얻었다. 광학현미경 소견은 유로키나제와 헤파린을 병용한 조합에서 모세혈관내 내피세포의 배열이 유지되어 있었으며 헤파린을 사용한 조합에서도 유사한 소견을 보였으나 약물을 사용하지 않은 조합에서는 국소적인 내피세포의 배열이 결핍되어 있었다. 전자현미경 소견에서 유로키나제와 헤파린을 병용한 조합에서 내피세포가 혈관내벽에 배열되어 있었고 또 불규칙한 세포질이 돌출되어 있었다.

복직근 유리 조직 이식술

이준모,장기영,Lee, Jun-Mo,Chang, Ki-Young 대한미세수술학회 1994 Archives of reconstructive microsurgery Vol.3 No.1

1. 교통사고 등으로 인한 외상성 골노출이 8례로 가장 많았으며, 원인으로서는 교통사고가 7례이었고 1례는 기계사고 이었으며, 부위 별로는 하지 경골이 7례, 종골이 1례이었다. 2. 2례의 만성 골수염에서는 유리조직 이식술과 함께 골소파술 및 정주 항생제 요법을 병행하였다. 3. 총 10례중 9례에서 완전 생존하여 90%의 성공률을 보였다. 4. 공여부위에 대한 합병증은 소량의 혈종을 형성한 1례에서 2차 탐구술과 흡인술을 시행하였으며 합병증없이 치유되었다. The rectus abdominis muscle is versatile alone or as a musculocutaneous flap and useful for defects of moderate size requiring well vascularized tissue in the extremities. The muscle is long, thin and thus well suites for the hand, anterior tibial and ankle defects. The anatomical location makes dissection convenient for the working teams simultaneously in the same field. Authors have performed rectus abdominis free muscle transplantation in 10 cased to fit defects or cavities in the lower extremities at Chonbuk National University Hospital from June 1992 through August 1994. The results were as follows: 1. 7 cases of the 10 were exposed lower extremities from the vehicle trauma and rectus abdominis free muscles were transplanted at average of the 40th hospital day. 2. In chronic osteomyelitis, saucerization and parenteral antibiotics infusion therapy were combined with in 2 cases. 3. 9 of 10 cases were in complete success except 1 case, 67-yrs-old female, who was sustained the high-energery motor vehicle trauma. 4. Split thickness skin graft was performed on the well-grown surface of the rectus abdominis muscle in the extremities at the 4th postoperative week and taken well without any complications.

하지의 만성 골수염에 시행된 근 유리 판 이식술

이준모,송광훈,박종혁,Lee, Jun-Mo,Song, Kwang-Hun,Park, Jong-Hyuk 대한미세수술학회 2009 Archives of reconstructive microsurgery Vol.18 No.2

Purpose: To evaluate the result of muscle free flap transplantation in chronic osteomyelitis of the tibia and calcaneus occurred from open fractures and exposed bones and internal fixatives. Materials and Methods: The free muscle flap were transferred in the tibia and calcaneus and followed up average 7.3 years at the department of orthopedic surgery from March 1997 to September 2009. Six patients were male and 1 case female averaged 50.3 years of age. Two latissimus dorsi myocutaneous free flaps were transplanted to the exposed 2/3 of the tibia with soft tissue defect, one rectus abdominis muscle free flap to the mid 1/3 of the tibia and four gracilis muscle free flaps to the distal 1/3 of the tibia and calcaneus. Results: At average 7.2 years follow-up, all of the 7 cases obtained solid bone union in the X-ray and kept sound soft tissues without pus discharges. The overall result of bone union, healed soft tissues defect and normal knee and ankle joint range of motion were excellent. Conclusion: The free muscle flap transferred to the chronic osteomyelitis of the tibia and calcaneus showed excellent results in bone union and eradication of the pus forming bacteria by its abundant blood flow.

유리조직 이식술 99례 분석

이준모,김기남,Lee, Jun-Mo,Kim, Ki-Nam 대한미세수술학회 2001 Archives of reconstructive microsurgery Vol.10 No.1

Free flap transplantation demands meticulous microsurgical technique to cover the exposed vital structures which is important to restore and maintain functions of the extremities. From July 1992 through December 2000, 99 patients were received reconstructive microsurgery in the upper and lower extremity at Department of Orthopedic Surgery, Chonbuk National University Hospital. The most common cause in the upper extremity was industrial accident, 8 cases of total 15 cases and in the lower extremity was traffic accident, 66 cases of total 84 cases. The most commonly involved site was thumb and finger, 8 cases of total 15 cases and in the lower extremity was leg, 65 cases of total 84 cases. In upper extremity, the wrap around free flap was carried out in 4 cases(4.0%), first dorsal metatarsal artery flap and lateral arm flap were 3 cases(3.0%) each in 15 cases and in lower extremity, latissimus dorsi myocutaneous flap were 23 cases(23.2%), gracilis 20cases(20.2%), and rectus abdominis muscle flap 18(18.2%) in 84 cases. Overall 89 cases(89.9%) of 99 cases were survived and maintained and revealed good cosmetic results.

외측 상완 유리 판을 이용한 사지 재건술

이준모,이주홍,김학지,Lee, Jun-Mo,Lee, Ju-Hong,Kim, Hak-Ji 대한미세수술학회 2004 Archives of reconstructive microsurgery Vol.13 No.1

Introduction: To cover the exposed tendons and bones in the foot and hand which need coverage and abundant vascular flow, lateral arm flaps were transferred. Lateral arm flap is a thin and innervated fasciocutaneous flap with a lower lateral cutaneous nerve and posterior radial collateral artery. Materials and methods: From October 1992 through September 2003, we have performed 5 lateral arm flaps for reconstruction of the exposed achilles tendons in 2 cases and the exposed forearm extensors, 2nd to 5th metacarpal bones and scaphoid each 1 case. The causes were traffic accident in 2 cases and machinary injury in 3 cases. Age range was between 31 to 74 (average 50) and all male except 1. Posterior lateral collateral artery and venae comitantes were anastomosed by end to end in 3 cases and vena comitante in 2 cases. Lower lateral cutaneous nerve was anastomosed with a branch of superficial radial nerve in 2 cases. Results: The results were evaluated by survival of the flap, sensory discrimination, cosmesis and comfort in the activities of the daily living. All flaps were survived. Sensory recovery was graded as deep cutaneous pain sensibility in 2 cases. Cosmesis was moderately satisfied and comfort was good except 1 as moderate. Postoperative defatting procedure was done in 1 case and skin abrasion was occurred in 1 case. Conclusion: Lateral arm flap was suitable for coverage of the exposed achilles tendons and exposed forearm extensors, metacarpals and scaphoid in the wrist.

백색 가토 좌골 신경의 신경 결손부위에서 자가 골격근 충진 도관을 이용한 신경재생 연구

이준모,신성진,서정환,송창호,Lee, Jun-Mo,Shin, Sung-Jin,Seo, Jeong-Hwan,Song, Chang-Ho 대한미세수술학회 2003 Archives of reconstructive microsurgery Vol.12 No.1

The bridging of nerve gaps is still one of the major problems in peripheral nerve surgery. To evaluate the role of silicon tube in nerve regeneration, gaps were made by resection of tibial components of sciatic nerves of twenty-five New Zealand rabbits. The gaps were divided into five groups. In group I, the tibial components of sciatic nerves were isolated and the incision immediately closed. In group II, 1-cm segments of the nerve were removed and the silicon tubes filled with autogenous skeletal muscle were sutured in place. In group III, 1-cm segments of the nerve were removed and the silicon tubes filled without muscle were sutured in place. In group IV, 2-cm segments of the nerve were removed and the silicon tubes filled with autogenous skeletal muscle were sutured in place. In group V, 2-cm segments of the nerve were removed and the silicon tubes filled without muscle were sutured in place. At 16th week, the eletromyography, the light and transmission electron microscopy were performed. Nerve conduction study stimulating sciatic nerve proximal to the lesion and recording at gastrocnemius muscle showed that the compound muscle action potentials of the group II with 1 cm nerve defect filled with muscle were higher amplitudes than the group III without muscle. Compound muscle action potentials of the group IV with 2 cm defect filled with muscle showed similar results in comparison with the group V. The light and transmission electron microscpy showed that a good morphological pattern of nerve regeneration in 1 cm gap than 2 cm and in gap with muscle than gap without muscle.

상완골 골절과 동반된 요골 신경 손상에서 자가 비복 신경 이식술의 결과

이준모,임영진,박종혁,Lee, Jun-Mo,Lim, Young-Jin,Park, Jong-Hyuk 대한미세수술학회 2005 Archives of reconstructive microsurgery Vol.14 No.2

In the high radial nerve palsy caused by displaced humeral shaft fracture, radial nerve have to be explored in the fracture site. 5 cases of the ruptured radial nerve at the fracture site of the humerus from January 1993 through January 2005 were treated at first by open reduction and internal fixation with plates and screws fixation and then defective radial nerves were grafted with autogenous sural nerves by microsurgical epineurial and or perineurial neurorrhaphy. At average 30.4 months follow-up, 5 cases were recovered from motor and sensory deficit with solid bony union of the humerus shaft fracture. Authors have confirmed that ruptured radial nerve in the humerus shaft fracture grafted with autogenous sural nerve with microsurgical epineurial and or perineurial neurorrhaphy would be expected good motor and sensory recovery.

쥐에서 대퇴 동맥 문합술시 투여한 혈관내피성장인자의 효과에 대한 형태학적 연구

이준모,이영근,Lee, Jun-Mo,Lee, Young-Keun 대한미세수술학회 2004 Archives of reconstructive microsurgery Vol.13 No.2

Purpose : This study evaluated the effect of VEGF in the arterial anastomosis by using light and electron microscopy. Marerials and method : Rats underwent femoral arterial end-to-end anastomosis after transection and topical VEGF treatment. The proximal and distal segments of the femoral arteries was drenched with 1 drop of VEGF $(100ng/100{\mu}l/bottle)$. and when half of the repair was finished, the other 1 drop was drenched and then the repair was continued to complete the anastomosis. Gross and histologic characteristics of arterial wall were assessed after 3 days, 1, 3 and 5 weeks. In the control group, normal saline solution instead of VEGF was dropped with the same method in the anastomosis. Results : The histologic findings of the arterial wall were the vascular remodeling with the infiltration of inflammatory cells at early stages and the tissue fibrosis at lately stages in the anastomotic sites of the control and the VEGF-treated groups. The scanning electron microscopic results were; (1) the anastomotic sites were covered by many irregular cells with long cytoplasmic processes at the early stages. (2) After 1 week, endothelial cells started to cover the anastomotic sites. (3) After 3 weeks, the anastomotic sites were partially covered by endothelial cells in the control group. (4) After 5 weeks, the anastomotic sites were completely covered by endothelial cells in the control and VEGF-treated groups. (5) In the VEGF-treated group, the anastomotic site was completely covered by endothelial cells which directed parallel to longitudinal axis of arteries after 3 weeks. Conclusion : Topical VEGF maintained luminal integrity by decreasing fibrosis and increasing re-endothelialization. These findings suggest that topical VEGF may be a promising new strategy to enhance healing and improve the outcome of vascular anastomosis.