Integra®를 이용한 화상 반흔구축 재건에 있어 Vacuum-Assisted Closure (VAC)의 유용성

오석준,고성훈,전만경 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.4

Purpose: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study is to evaluate usefulness of the VAC(Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra® in reconstruction of burn scar contracture. Methods: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The patient’s ages ranged from 5 to 27 with an average of 19.7 years. The surface area ranged from 24 to 1,600cm2 with an average of 785㎠. The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra® was sutured in place with skin staple and Steri-strip®. Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra®. Negative-Pressure ranging from 100 to 125mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP-site®. The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra® deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006-0.008 inches) was performed after silicone sheet removal. Result: The mean time for clinically assessed incorporation of Integra® was 10.00 days(range 9-12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra® had successful incorporation in tissue without serious complications. Conclusion: Integra® in combination with Vacuum- Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.

선천성 소이증의 이개성형술

吳錫俊 한국의학사 1983 診斷과治療 Vol.3 No.5

수무지 재건

정철훈,오석준 大韓成形外科學會 1989 Archives of Plastic Surgery Vol.16 No.5

Reconstructive surgery is indicated for taumatic loss and congenital anomaly of the thumb because total loss of a thumb constiutes about 40% disability in that hand. Reconstruction can be accomplished by a variety pollicization, free toe-to-thumb tranfer, wrap-around procedure, and so on. The choice of technique depends on the level of amputation, damage or loss of adjacent digital and soft tissue, the patient's age, patient's occupation and patient's sex. We reconstructed 22 traumatic loss of the thumb and I congenital absence of the thumb with osteoplastic reconstruction(10), index finger pollicization(3), greater toe-to-thumb transfer(1), wrap-around pprocedure(4), and free plantar flap with bone graft(5).

요도하열을 동반한 남성반음양 1례 보고

진한식,유재덕,신극선,오석준 大韓成形外科學會 1979 Archives of Plastic Surgery Vol.6 No.1

Male hermaphroditism may be defined as a process of incomplete masculinization of the internal or external genital organs or both in subjects with male gonads and male sex chromatic distribution. In the differential diagnosis of genital ambiguity, the important points include history, physical examination. sex chromatin pattern, and determination of the urinary steriod excretion pattern, and also, of help in selected cases are endoscopy, X-ray contrast studies, laparotomy with gonadal biopsy and chromosomal analysis. Cases of male hermaphroditism with ambiguous external genitals can be devided into those with absence of breast development which are usually called PPSH(Pseudovaginal Perineoscrotal Hypospadia) and those with breast development which are usually called incomplete or partial testicular feminization. The former is characterized by a phallus of intermediate size and a perineal urethral meatus, and blindly ending "vagina" which may poen either into the urethra or the perineum. A labia majora-like cleft scrotum frequently contains normally developed testes, and Wolffian-duct derivatives show normal male differentiation. Masculinization at puberty results in masculine body build, axillary, facial and pubic hair, and deepening of the vioce. Breast development is minimal or absent. We have experienced recently a case of male hermaphroditism which was concerned to be a PPSH with the characteristics of external genitals, sex-chromatin pattern(sex-chromatin mass positive), chromosome study(karyotype 46XY) urinary steriod excretion (17-KS; normal value), laparoscopy(no Mullerian-duct structure), IVP (normal), and gonadal biopsy (atrophy of seminiferous tubule and decreased spermatogensis). Extragenital malformations were not detected and he was of normal intelligence. His sex was assigned male, and treatment consists of urethroplasty and resection of urogenital sinus.

上願骨에 發生한 Fibrous Dysplasia의 治驗例

李道鉉,李世一,吳錫俊 대한성형외과학회 1981 Archives of Plastic Surgery Vol.8 No.1

Fibrous dysplasia was first described as a disease entity by Leichtenstein in 1938. Fibrous dysplasia is characterized by proliferation of connective tissue within a bone, which may produce cortical expansion. When facial bones are involved, considerable esthetic deformity may result. Monostotic fibrous dysplasia affects the maxilla more frequently than the mandible. Someone reported an equal predilection for male and female, but others a greater incidence in female. Monostotic fibrous dysplasia is more common in children and young adults. The lesion grown very slowly, causing expansion of the involved bone which may produce a nontender facial asymmetry. As a role, the lesion stops growing when skeletal growth ceases. Historical clinical radiographic and histological data are all essential to confirm the diagnosis of fibrous dysplasia. The treatment of choice is surgical, depending upon the size and consistency of the lesion as ascertained by the radiographic picture and by biopsy. In the osteolytic type, radical curretage is indicated, whereas in the more mature, solid type, surgical shaving or recontouring is indicated. Authors report a case of monostotic fibrous dysplasia on the left maxilla. Surgical shaving of the involved left midfacial area through intraoral approch was done in good result.

하복지 근피판을 이용한 광범위 서혜부 결손의 재건

오석준 大韓成形外科學會 1986 Archives of Plastic Surgery Vol.13 No.3

Rectus abdominis flap offers versatile variety of donor tissue to the reconstructive surgeon for local or free flap transfer. An inferiorly based rectus abdominis myocutaneous flap has been used for reconstruction in two cases of inguinal sqnamous cell carcinioma. The flap for wide defect in contralateral groin was obliquely designed on the area above umbilicus which would give sufficient pedicle lenght as well as prevention of ventral hernia. The postoperative results were favourable.

대흉근 근피판을 이용한 경부 및 안면부의 재건

조세흠,오석준 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.2

Cosmetic and functional reconstruction of the cervical and facial defects resulting from trauma or ablative resection of tumor has been challenging task to palstic surgeon. Among many available myocutaneous flaps, the pectoralis major myocutaneous flap has many advantages such as abundant tissue with an excellent vascularity, anatomic proximity, long arc of rotation, reliability and versatility. So it is used most frequently in head and neck reconstruction. By applying a pectoralis major myocutaneous flap, authors had achieved good result from coverage of defects which were resulted from resection of 3 cases of thyroid carcinoma; 3 cases of squamous cell carcinoma of tonsil, lower lip and cervical esophagus; and 3 cases of posttraumatic soft tissue defects of left orbit, left mandibular area and large oro-cutaneous fistula of left neck.

미세수술을 이용한 재접합술과 유리조직 이식술의 실제

吳錫俊 대한의학협회 1993 대한의학협회지 Vol.36 No.9

5-FU연고의 국소도포법에 의한 각화극세포종 치험례

서동보,오석준 大韓成形外科學會 1988 Archives of Plastic Surgery Vol.15 No.2

Keratoacanthoma is a benign neoplasm that develops as a protruding mass especially on the central part of face. We experienced a case of keratoacanthoma that developed on the nasal columella. Excision of this lesion would have required reconstructive surgery with the likelihood of permanant deformity. We treated it with 5-FU ointment daily for 4 weeks. This treatment suggests that topical application of 5-FU ointment is an effective alternative to conventional methods of treating keratoacanthoma.

86년도 추계 연수강좌 강의록 : 상지의 재접합 수술

오석준 대한외과학회 1986 대한외과학회 학술대회자료집 Vol.- No.-