미세유방재건술시 깊은 아래 배벽 동맥의 해부학적 변형에 대한 임상 보고

장서윤,김덕우,동은상,윤을식,류우상,손길수,Jang, Seo-Yoon,Kim, Deok-Woo,Dhong, Eun-Sang,Yoon, Eul-Sik,Ryu, Woo-Sang,Son, Gil-Soo 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.1

Autologous breast reconstruction after mastectomy in breast cancer patient is now increasing. The deep inferior epigastric artery (DIEA) free flap is well known as an ideal donor site for the microsurgical breast reconstruction. The branching pattern of the DIEA was well described in the literature. In that study, DIEA has three branching patterns near the arcuate line. We describe a case in which branching variation of the DIEA before entering the posterior surface of the rectus abdominis muscle. In three cases, DIEA originated from the external iliac artery ascended as a double trunk at 1cm, 2cm, and 4cm above the originating point, respectively. In one case, DIEA ascended as a single trunk along the linea alba toward to the umbilicus until it supply overlying subcutaneous tissue. Preoperative 3D computed tomographic angiography to identify the anomaly is recommended and meticulous dissection to the originating point of DIEA is needed.

삼각형 V-Y피판 및 장사방형피판을 이용한 매몰귀의 교정

이준문,서동린,동은상,윤을식,Lee, Joon-Moon,Seo, Dong-Lin,Dhong, Eun-Sang,Yoon, Eul-Sik 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Cryptotia is a congenital deformity in which the upper third of the auricle is buried under the temporal skin. It is rare in Caucasians, yet it is more common in Asians. Although a variety of methods to treat cryptotia have been introduced, there is still no acceptable single procedure that can successfully manage this deformity in its entity. We present a triangular V-Y advancement flap and rhomboid flap for correcting cryptotia that can overcome the diverse shortcomings of the conventional methods. Methods: This operative method was used to correct 18 auricles in patients ranging in age from 4 to 33 years. A triangular flap was prepared over the auricle by making a skin incision according to Ohmori's method. Then a rhomboid flap with a side length of about 8 to 10 mm that sets the lower portion as a pedicle in the anterior region was prepared to supplement the contracted portion of the helix. The cartilage deformity was corrected by the banner flap or the radiating cartilage incisions with cartilage graft or high density polyethylene graft. Results: We have treated 16 patients with severe cryptotia using this method and have obtained good aesthetic results. All cases showed widened scaphoid fossa and smooth triangular fossa of antihelix. There were no major postoperative complications, such as necrosis or infection of the flaps. Conclusion: Correction of cryptotia using the triangular V-Y advancement flap and rhomboid flap is useful a method for certain conditions, when a severe contraction of the helix is present.

내족저변 격막 피판의 해부학적 고찰 및 임상적 적용

윤을식,김정배,계민석,동은상,한승규,이병일,구상환,박승하,김우경,Yoon, Eul-Sik,Kim, Jung-Bae,Kae, Min-Seok,Dhong, Eun-Sang,Han, Seung-Kyu,Lee, Byung-Il,Koo, Sang-Hwan,Park, Seung-Ha,Kim, Woo-Kyung 대한미세수술학회 2002 Archives of reconstructive microsurgery Vol.11 No.1

Several investigators have reported clinical experience of medial plantar septo-cutaneous flap for reconstruction for soft tissue defect of the hand and digits. Jayme and Hamilton first described the anatomy of superficial branch of medial division of the medial plantar artery used in this flap through cadavaric study in 1997. But, they had a few cases for this flap and there was no anatomic study in Korean. We experienced the reliability of medial plantar septo-cutaneous flap for reconstruction for soft tissue defect of hand and digits through an anatomic study (20 fresh specimens dissected) and clinical application (17 patients). An anatomic study revealed that there were differences in diameter and length of the vessels between Korean and Caucasian. The diameter of vessels in Korean is larger than Caucasian one in each area. Based on this anatomic knowledge, we could harvest this flap safely, and have performed reconstruction on 17 patients with soft tissue defects of hand and digits using a thin, flexible medial plantar septo-cutaneous flap similar to the volar aspect of the hand and digits in anatomical characteristics of the skin and subcutaneous tissue covering. The vessels used for this flap were superficial branches of medial division of the medial plantar artery and vena comitants, or the subcutaneous veins. The mean size of the flap was $2.82cm{\times}4.15cm$. All the flaps survived without significant complications. A medial plantar septo-cutaneous flap possesses several advantages : (1) It is very thin in comparison with other standard free flap; (2) it has two draining venous pathways; (3) it provides a good color and texture match for hand and finger; (4) a good recovery of protective sensation is achievable.

협부피부를 침범한 상악암에서 광범위 절제술 후 광배근 이중도서형 유리피판을 이용한 재건술 1예

권윤환(Yun Hwan Kwon),서규환(Kyu Hwan Seo),이승훈(Seung Hoon Lee),동은상(Eun Sang Dhong),권순영(Soon Young Kwon) 대한두경부종양학회 2004 대한두경부 종양학회지 Vol.20 No.1

An advanced maxillary sinus cancer requires an extensive ablation that results an extensive facial deformity, including a skin defect. Reconstruction has to be considered in a radical maxillectomy, especially with skin defect may be accomplished in one stage with a microsurgical free transfer of a latissimus dorsi flap. A man of right maxillary sinus cancer, squamous cell carcinoma, 47 years old of age, had soft tissue invasion of the cheek region. He underwent a radical maxillectomy with extensive skin excision. The maxillectomy and skin defects were reconstructed with the double skin island latissimus dorsi myocutaneous free flap. The cosmetic result and the functional outcome of the nose were thought to be considerably satisfied.

은호기성 Nucleolar Organizer Regions(Ag-NoRs)을 이용한 세포의 증식능과 피부종양의 악성도와의 상관관계에 대한 연구

동은상,김우경,한상규,이종문 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.2

Skin neoplasms have been easily diagnosed by clinical findings and histopathologic findings. But skin neoplasms have variable clinical characteristics according to individual variations. Recently, several markers for proliferating cells have been found and, with antibodies to these markers, immunohistochemical studies have been performed. However, almost all of these markers require freshly frozen tissues for evaluation; therefore retrospective study of formalin fixed tissues is impossible. Nucleolar organizer regions(NORs) are DNA Ioops encoding ribosomal RNA production detectable by the argyrophilia(Ag-NORs) of associated proteins. This enables us to investigate paraffin embedded tissues and thus retrospective studies is possible, and the simplicity of stain method enables us to access easily. The mean number of Ag-NORs are correlated with the growth fraction and may have diagnostic and prognostic value in other tumors(such as prostatic cancer, breast cancer, lymphomas and skin neoplasms etc.) Materials were as follows; 20 cases of Seborrheic keratosis as benign neolasms. 15 cases of Actinic keratosis and 13 cases of Bowen's disease as precancerous lesions, 22 cases of Basal cell carcinoma and 27 cases of Squamous cell carcinoma as malignant neoplasms. And the calculation of Ag-NORs was based on visual summatioin of dark-stained dots in randomly selected 100 uncleuses, and statistic analysis was done by t-test and Scheffe's test. The result was as follows; 1. The mean mumbers of Ag-NORs was turned out to seborrheic keratosis 3.2, actinic keratosis 4.7, bowen's disease 4.5, basal cell carcinoma 5.1 and squamous cell carcinoma 5.9. 2. The cell proliferating activities were significantly increased as degree of malignancy increassed as observed by Ag-NORs (P<0.05)

한국인의 미소에 대한 계측지와 분석

동은상,박승하,구상환,김우경 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.4

Smile reconstruction for facial paralysis is one of the most difficult fields of plastic and reconstructive surgery. The purpose of this study is to analyze the directional amount and degree of normal smiles; the movement of the upper lip and the nasolabial fold. The author has measured 40 normal subjects using a mask type ruler. The vectors of indicated points were measured on the upper lip and the nasolabial fold. Besides the intrasubjective and intersubjective variations, the author was able to get the following meaningful outcomes through this study. The results of this study : 1) The average movements of the oral commissure, upper lip and nasolabial fold were 11.2mm, 7.4mm, and 8.3mm respectively. 2) The average angles of the movements of the above-mentioned parts to the horizontal line were 40.4, 40.2 45.4 respectively. 3) The greatest movement occurred at the oral commissure and the differences between left and right side were negligible and insignificant. It is the author's conclusion that the study results provide quite useful guiding references in planning reconstructive surgery of facial paralysis as it presents fundamental data on the normal smiles of the Koreans.

변형된 늑골교정술과 유방삽입물을 이용한 흉벽기형 재건의 치험례

강동희,동은상,한승규,김우경 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.8

The chest wall and breast asymmetry varies from severe pectus deformities to an isolated breast hypoplasia. In addition to the chest abnormality, a natural-looking breast is the aesthetic challenge in women. Considering that the most common indication of operations is an aesthetic one, any procedures leaving much scars and deformities at the donor site aren't preferred by patients. A 31-year-old female had a 4 x 10 x 2.5 cm sized pectus-excavatum deformity on her right chest, and a slightly hypoplastic breast compared with the left one. The nipple of her right breast was located supero-medially and pectoralis muscles were preserved to some degree at the right side. Through a bilateral submammary and subxiphoid incision, the deformed cartilage was resected from 3th to 7th rib bilaterally and chondrotomy was done at the sternum partially. After this modified Ravitch's technique, two-metal pins were fixated between right 4th~5th ribs and left 4th rib, and the depressed sternum was elevated over the metal pins. The deficient volume of her right breast was corrected by inserting a siliconegel breast implant (120 cc) submuscularly to restore a adequately projected breast. The results of twelve months' follow-up demonstrated a symmetric and well- projected breast. There were no significant chest wall depression or capsular contracture. Restoring a fundamental bony structure would decrease the amount of augmentation needed in the soft tissues. And a silicone-gel breast implant may be used as an the alternative material for whose axillary fold is preserved to some degree.

교원질 제재(Zyderm^(�))가 백서의 두개골 결손 치유에 미치는 영향

이병일,정하영,동은상,한승규,구상환,박승하,김우경 大韓成形外科學會 2004 Archives of Plastic Surgery Vol.31 No.1

코끝의 경도 측정을 위한 경도기 고안 : A New Device

김정배,이치호,동은상,윤윽식 大韓成形外科學會 2004 Archives of Plastic Surgery Vol.31 No.1

백서에서 단-측면 신경문합술의 실험적 연구

이동근,김우경,이병일,김응구,동은상 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.7

We investigate the efficacy of the end-to-side neurorrhaphy, and an alternative reconstructive method for the wide nerve gap comparing with the state of normal, denervated,and nerve graft. Thirty Sprague-Dawley rats were divided into 3 group of each 10 rats. In the right side of all groups, nerve branch to the gastrocnemius muscle was severed and the distal ending of the nerve was sutured was sutured to the lateral side of the tibial nerve after round excision of the epineurium. In the first group(normal control group), left side was untouched. In the second(denervated group), left side was sectioned at the distal 5mm from bifurcation of branch to gastrocnemius from sciatic nerve. In the third group(nerve graft group), left side was sectioned at two points, 5 mm and 15 mm distal to bifurcation of the branch to gastrocnemius nerve from sciatic nerve, and then cut ends were anastomosed again as a nerve graft. 5 months later, all animals were subject to electrophysiologic tests and histologic examination including the number of nerve fibers and the changes of muscle fibers. In the group I, the conduction velocity of the end-to-side neurorrhaphy side was delayed comparing to the normal control side(p < 0.05). But, there was no significant difference between end-to-end neurorrhaphy and nerve graft. In histologic finding, the amount of nerve fibers in the end-to-side neurorrhaphy was 50.8% of normal control(p <0.01), and 48.6% of nerve graft side(p <0.006). The histolgic findings of the gastrocnemius muscle in the stat of the end-to-side neurorrhaphy were similar to findings of the nerve graft side, and though slightly decreased size and deformed shape of the muscle fibers were noted, the architecture of the normal muscle configuration was sustained. In conclusion, these results demonstrated the end-to-side neurorrhaphy conducted the electrical stimuli and allowed the regeneration of axons from lateral surface of healthy main peripheral nerve. Therefore, end-to-side neurorrhaphy was thought to be and alternative method for the reconstruction of the wide nerve gap.