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홍승은,변재경 이화여자대학교 의과학연구소 2007 EMJ (Ewha medical journal) Vol.30 No.1
Purpose : Microvascular anastomosis has become an essential technique m reconstructive surgery. A patent microvascular anastomosis is required for the success of a free tissue transfer. As the application of microsurgery grows, the desirability of performing an end to end and end to side anastomosis continues to be debated. This experimental study presents the comparison of patency rate of two types of microvascular anastomosis techniques : side to side anastomosis and end to end anastomosis. Methods : A comparative study was undertaken to evaluate side to side micro anastomosis technique using intraluminal catheter. In this study, two clinical metods of microvascular anastomosis were compared. We compared the patency rate and time required for anastomosis. Histological changes (postoperative 1 weeks) were also invsetigated. Results : Postoperative patency rate was 90% by side to side technique compared to 100% by end to end technique at immediate postoperative and postoperative two weeks. This study revealed that there was no significant difference in patency rate among end to end suture method group and side to side suture method group. Microscopically, we found the relatively smooth surface of the anastomosis site with endothelial regeneration and partial hyaline degeneration in the group using side to side anastomotic method. Conclusion : We believe there are many advantages in this side to side technique by using intraluminal catheter in perforater flap field and can be highly competitive to the other microvascular anastomisis techniques.
Surgical Treatment of Angiosarcoma of the Scalp With Superficial Parotidectomy
Lim, So-Young,Pyon, Jai-Kyong,Mun, Goo-Hyun,Bang, Sa-Ik,Oh, Kap-Sung Lippincott Williams Wilkins, Inc. 2010 Annals of plastic surgery Vol.64 No.2
Angiosarcomas of the scalp area are rare tumors mostly affecting elderly patients. In many series, potential treatment options for patients with scalp angiosarcoma have included surgery, radiation, and chemotherapy. Surgery combined with radiation therapy, however, did not appear to cure many patients. For these reasons, there is a serious need for the development of new approaches. We report our experience of 8 patients presenting angiosarcoma solely of the scalp. Our procedure consisted in radical tumor resection or the scalp with minimal 5-cm safety margins from the most peripheral scatted lesions with burring of the external table of the cranium, ipsilateral superficial parotidectomy, and ipsilateral upper neck dissection. After resection of the tumor of the scalp, the latissimus dorsi free flap was used for coverage of the defect. With prophylactic dissection of these regional lymph nodes, we could achieve better results and, at least, prolonged time to local recurrence and distant metastasis.
Reconstructive Surgical Treatment of Tuberculosis Abscess in the Chest Wall
Lim, So-Young,Pyon, Jai-Kyong,Mun, Goo-Hyun,Bang, Sa-Ik,Oh, Kap-Sung Lippincott Williams Wilkins, Inc. 2010 Annals of plastic surgery Vol.64 No.3
Tuberculosis is presently an important health problem throughout the world. Despite its progressive decrease in developed countries, the situation has changed in recent years due to the AIDS pandemic. Among these, tuberculous abscess of the chest wall is a rare disease and an optimal treatment plan remains controversial. The authors experienced recalcitrant cases of chest wall cold abscess involving ribs and sternum recurring after local debridement treatment.Nine patients between March 2004 and December 2008 were retrospectively analyzed, focusing on their clinical features, surgical treatment consisting of wide resection and flap coverage, and long-term outcome. There was a past history of pulmonary tuberculosis in 2 patients, but no one had concomitant active pulmonary tuberculosis. Radical resection of soft tissue and the bone resulted in wide defect, which could be covered by a local myocutaneous flap.In all patients, histologic findings of the debrided specimen showed typical lesions of tuberculosis, caseous necrosis with a tuberculoid granulomatous inflammatory infiltrate. Postoperative progress was good and there was no complication of donor site. The patients were started on antituberculosis therapy. They remain well during follow-up period (mean: 22 months).We conclude that cold abscess of the chest wall must be treated more aggressively, and meticulous debridement and wide resection including involved bones and cartilages is required followed by coverage with local muscle or musculocutaneous flaps.
Changes in Korean National Healthcare Insurance Policy and Breast Cancer Surgery Trend in Korea
Rayzah Musaed,Ryu Jai Min,Lee Jun-Hee,Nam Seok Jin,Kim Seok Won,Lee Se Kyung,Yu Jonghan,Lee Kyeong-Tae,Bang Sa-Ik,Mun Goo-Hyun,Pyon Jai-Kyong,Jeon Byung-Joon,Lee Jeong Eon 대한의학회 2021 Journal of Korean medical science Vol.36 No.29
Background: Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). Methods: We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into “uninsured” and “insured” groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. Results: Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38–48] vs. 45 [40–50] years; P < 0.001). Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. Conclusion: IBR rate in patients undergoing TM increased after NHI reimbursement.
A method to prevent cerebrospinal fluid leakage: Reinforcing acellular dermal matrix
Lee, Hojune,Eom, Ye Seul,Pyon, Jai-Kyong Korean Cleft Palate-Craniofacial Association 2020 Archives of Craniofacial Surgery Vol.21 No.1
In neurosurgical cases, problems related to wound healing can vary from simple wound dehiscence to multilayer defects. This study demonstrates an effective method to prevent persistent cerebrospinal fluid (CSF) leakage using reinforcing acellular dermal matrix in neurosurgical patients with wound dehiscence. A 52-year-old woman was admitted for management of recurrent glioblastoma. After tumor removal surgery, the patient experienced sustained CSF leakage from the wound despite reparative attempts. The plastic surgery team performed wound repair procedure after remnant tumor removal by the neurosurgery team. Acellular dermal matrix was applied over the mesh plate to prevent CSF leakage and the postoperative status of the patient was evaluated. No sign of CSF leakage was found in the immediate postoperative period. After 3 years, there were no complications including CSF leakage, wound dehiscence, and infection. We hereby propose this method as a feasible therapeutic alternative for preventing CSF leakage in patients experiencing wound problem after neurosurgical procedures.
Microsurgical Foot Reconstruction Using Endoscopically Harvested Muscle Flaps
우경제,임소영,변재경,방사익,오갑성,문구현,Woo, Kyong-Je,Lim, So-Young,Pyon, Jai-Kyong,Bang, Sa-Ik,Oh, Kap-Sung,Mun, Goo-Hyun Korean Society of Plastic and Reconstructive Surge 2010 Archives of Plastic Surgery Vol.37 No.5
Purpose: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. Methods: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. Results: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. Conclusion: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.