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남순열 울산대학교 의과대학 1995 울산의대학술지 Vol.4 No.2
Wister백서를 대상으로 26례의 동종 후두이식을 하였다. 공여 백서의 우측 경동맥을 수혜백서의 좌측 경동맥과 10.0prolene으로 여덟 봉합하고, 공여백서의 좌측 경동맥을 수혜백서의 외경정맥과 꼬이지 않게 10.0prolone으로 여섯 봉합을 실시하고 우측 반회신경도 수혜백서의 좌측 반회신경과 10.0prolene 한봉합을 실시하였고 마지막 2례의 기능적 회복을 보인 경우는 위에 정맥이식(vein graft)도 같이 실시하였다. 술후 수시간이내 두마리가 죽고 4례는 술후 2주이내 죽었으며, 나머지 20례중 3개월까지 추적 가능하였던 13례중 7례는 공여 후두가 소실 되었고 3례는 심한 근육위축을 보였으며 1례는 외견상 정상이었으나 기능을 보이지 않았으며 마지막 2례에서 기능적 회복을 보였다. 본 연구의 백서에서 기능적회복은 인간에서의 후두이식을 대비하여 기초가 될 것이다. Differing from other organs, the success of vascular reanastomosis and funtional reinnervation including voice are important to laryngeal transplantation. 26 cases of the Wister rat (250-300gm) were performed. The donor's right common carotid and recipient's left common carotid artery were connected by 8 stitches 10.0 prolene. The donor's left common carotid artery and recipient's left external jugular vein were connected by 6 stitches 10.0 prolene. The recurrent laryngeal nerves were connected by 1 stitch 10.0 prolene. The last two cases which showed reinnervation were connected by 1 stitch with vein graft. The results were as follows; 1) 2cases died within 2 hours. 2) 4 cases died within 2 weeks. 3) 13 cases which can be followed for 3 monthes. 7 cases lost donor larynx. 3 cases showed severe muscular atrophy. 1 case showed intact external appearance, but did not reinnervated. The last 2 cases showed spontaneous movement and reinnervation was identified through glycogen depletion and elctromyography. This study will be a cornerstone preparing for human laryngeal transplantation.
방사선 조사를 받은 두경부 병소의 재건을 위한 유리피판술
채수욱,고경석,김주봉,박상훈,한상훈,이택종,남순열,김상윤 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3
Radiation therapy is an effective cancer treatment modality as a primary treatment in early cancer and as an adjuvant treatment in advanced cancer, especially in head and neck lesions, but it also causes irreversible chronic damages to overlying normal tissues that may lead to wound complications. As well, at the microscopic level, radiation injury causes both stasis and occlusion of small vessels. Therefore, surgical reconstruction of previously-irradiated lesions in the head and neck poses a great problem. Fifth-six patients with head and neck lesions underwent 57 microsurgical reconstructions between 1990-1998. Thirteen patients were irradiated before surgery. The previous radiation dose was 30∼75.6 Gy. The free tissue transfer was successful in 52 of the 57 microsurgical reconstructions(91.2%). The success rate was 92.3%(12/13) in previously-irradiated patients and 90.9%(40/44) in nonirradiated patients. Postoperative complications, such as flap loss, fistula, and infection, developed in 4 irradiated patients and 8 nonirradiated patients. Overall complication rate was 30.8%(4/13) in previously-irradiated patients and 18.2%(8/44) in nonirradiated patients. Although the failure rate of previously-irradiated patients was higher than that of nonirradiated patients, there was no statistically significant difference between them. Thus, free tissue transfers in patients with previously-irradiated head and neck lesions are suitable for one-stage reconstruction.