개방창 감염에 대한 Flomoxef의 임상 효과

윤강모,안호범,김대영,이삼용,조백현,이민철 최신의학사 1995 最新醫學 Vol.38 No.5

횡복직근피판을 이용한 치험례

김대영,이삼용,안호범,조백현,류봉수,윤강모 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.2

Adequate soft tissue coverage is a primary requisite for the reconstruction of the large soft tissue defect of body. The rectus abdominis muscle is long and flat and it can be used as transverse or vertical myocutaneous flap. The TRAM flap is useful for moderate sized defects requiring a muscle or well vascularized tissue between Gracilis and Latissimus dorsi in size. We have experienced 6 cases of large soft tissue defect of the body using transverse rectus abdominis myocutaneous free flap. Advantages of this method are:enough available donor tissue, effect of abdominolplasty, no deformity of the donor site, hidden donor site scar, and blood supply by two arteries. Six patients showed successful results except one case of flap necrosis. The flap necrosis was due to hematoma around the vascular anastomotic site. We think reconstruction with TRAM flap is appropriately available for moderate sized soft tissue defect.

융기성 피부섬유육종의 치험2례

이삼용,안호범,조백현,윤강모 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3

Dermatofibrosarcoma protuberans is an uncommon soft tissue neoplasm that usually presents as a painless, often long standing mass arising in the dermis of the skin. In most patients, the nodule enlarges slowly and painlessly for a period of 3 months to 2 years as it infiltrates the adjacent tissue and becomes multinodular. At the later stage, however, its growth rate accelerates, and it can ulcerate, bleed, or become painful. Histologically, on light microscopy, this tumor shows the characteristic cartwheel patterns, with the fibroblasts arranged radially about a small central hub of fibrous tissue, and on electron microscopy, fairly monotonous population of spindle-shaped cells with a few stellate cells. Many of the spindle cells contained intracytoplasmic aggregates of microfilaments with dense bodies and were partially surrounded by basal lamina, interpreted as being typical of myofibroblasts. Other cells showed typical features of fibroblasts Dermatofibrosarcoma protuberans typically arises on the trunk and proximal extremities. head and neck and scalp lesions have also been described. It is more frequent in men with a peak incidence during the third decade of life. We have encountered 2 cases, develpoed on the both ear lobules of a 25-year-old woman and the right lower of a 7-year-old child ; but there were no evidence of metastasis. A scapular fasciocutaneous free flap and a skin graft covered large defects resulting from wide tumor excision. Follow-up at 1 year showed the patient doing well with no evidence of local or regioal recurrence.

역방향 전박골 유리 피판을 이용한 쇄골 부위의 재건 1례

윤강모,이삼용,김대영,조백현 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

The ideal modalities of reconstruction for head and neck should pursue excellent function and should be immediate, reliable and vesatile, not resulting deformities in appearance. Microvascular free tissue transfers have facilitated immediate reconstruction of various complex defects after radical ablation of head and neck cancer. Since first described by Yang et all.(1981) in the chinese literature, the redial forearm or chinese flap based on the radial and ulnar arteries has undergone a great deal of modification. The flap is widely used in microsurgical reconstruction with antegrade venous anastomosis or retrograde because of its ease in harvesting and versatility in covering complex defect, especially those requiring soft tissue and bone. We here introduce a new modified technique, i.e. "the counterwise", compared antegrade and retrograde method, the proximal artery was anastomosed in an antegrade direction but the distal vein was anastomosed in a retrograde direction. After the radical ablation of the squamous cell carcinoma and the mid portion of clavicle, the reconstruction with the radial forearm osteocutaneous free flap was done. The proximal radial artery of the flap was anastomosed to lateral thoracic artery. And the distal vena comitante of the radial artery was anastomosed to external jugular vein by end-to-side instead of left subclavian vein which was resected with tumor ablation. At postoperative 2 days, the flap developed mild venous congestion but it was resolved and the flap survived well. This case demonstrates that the counterwise radial forearm Osteocutaneous free flap is considered as a valuable technique for reconstruction of defects.

신경섬유종증의 혈관병변에 대한 병리학적 고찰

최광림,이삼용,윤강모,김광석,조백현,이민철 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.1

Clinical manifestations caused by vascular complications including stenosis, occlusion, aneurysm and arteriovenous malformation were rarely developed in patients with neurofibromatosis. We reviewed 23 cases of neurofibromatosis type I to identify the histopathologic features of yessels in neurofibromatosis associated with clinical features. The results were as follows: 1.The age of patients ranged from 4 to 61 years(mean; 23years)at diagnosis and sex ratio of male to female was 1.3:1. The family history was present in 52%(12/23) of the patients. Angiographically, 3 cases of atherosclerosis, 1 case of arteriovenous malformation, and 1 case of aneurysm were seen. 2. Peculiar vascular alternations were found in 7 of 23 cases of neurofibmatosis, which were classified as 4 types: 6 cases of pure intimal; 1 case of intimal-aneurysmal; 3 cases of nodular type. The most frequent type of vascular lesions was observed in the patients with neurofibromatosis was pure intimal, and the most uncommon one was intimal-aneurysmal. 3. Immunohistochemically, the positivity to S-100 protein was noted in the tumor cells arranged in the periphery of vessels, but no reaction was seen the spindle or epithelioid cells within the vascular wall. In conclusion, the vascular lesions associated with neurofibromatosis may result from abnormal proliferation of cells in the vascular wall, possibly smooth muscle cells, not Schwann cells in origin. The various types of lesions described previously appear to be of stage of development.

대둔근피판술의 임상적 이용

최광림,김광석,윤강모,이장혁,이삼용,조백현 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.1

Ulcer in buttock is mainly a pressure sore, which is frequently occurred at the sacral region in Korea and its surgical treatment is chiefly the operation using gluteus maximus myocutaneous flaps. For the treatment of ulcerated lesion in gluteal area, various methods using gluteus maximus muscle have been developed. We reviewed and analyzed the 100 cases using gluteus maximus myocutaneous flaps in our department since 1980. The results were summarized as follows.; 1)The ratio between male and female was 3:1. 2)The prevalent age groups were between third and fifth decades. 3)The main cause was the trauma. 4)The wound culture showed the pattern of mixed infections in most cases, consisting of Staphylociccus, Pseudomonas, Enterococcus, Streptococcus, and others. 5)The postoperative complications were noted in about thirty percent of the cases. The complications were flap tip necrosis, wound infection, wound disruption, and others. 6)For thetreatment of small ulcers, a pure skin flap or myoplasty may be used, but for the treatment of large one, a kind of myocutaneous flap should be selected. 7)Gluteus maximus myocutaneous flaps can be used as variable methods, but of which the island flap is ideal in deep and large ulcerated lesion.