Microvascular Reconstruction of Extensive Foot Injuries

정윤규,정섬,김주봉,Chung, Yoon-Kyu,Chung, Seum,Kim, Joo-Bong The Korean Society for Microsurgery 1994 Archives of reconstructive microsurgery Vol.3 No.1

The successful treatment of the extensively traumatized foot warrants reconstruction utilizing tissue that will provide adequate coverage, is resistant to infection, thin enough to conform to the contours of the foot as well as durable to constant frictional movement and weight bearing. Currently, free flaps offer the best means in achieving these difficult and sometimes contradictory goals. We treated twenty-one patients suffering from extensive soft tissue loss of the foot due to trauma, electric burn or postburn sequelae with free flaps. A fasciocutaneous, musculocutaneous or muscle flap with skin grafting was used based on the location, volume of tissue required, and the functional anatomical requirement of the injured region. The follow-up duration averaged twenty-nine months. From our group of patients, we believe that the muscle free flap with skin grafting offers the most favorable outcome. 해부학적으로 족부는 주위에 이용할 수 있는 연주 조직이 별로 없을 뿐 아니라 이용할 수 있더라도 크기가 제한되어 있으므로 광범위한 연부조직 결손시 이의 복원이 어렵다. 광범위하고 오염된 족부의 창상을 재건시 이상적인 조직의 조건으로서는 감염에 잘 견디고, 가능한한 원래의 모양 및 크기에 가깝게 복원해야 하며, 적절한 감각이 있어야 하고, 끊임없는 마찰력과 체중 부하에 잘 견뎌야 할 것이다. 미세혈관술을 이용한 유리조직이식은 비교적 위와같은 장점들을 제공할 수 있다. 저자들은 최근 약 4년간 외상과 전기화상 및 화상후 후유증으로 인하여 족배부, 발꿈치, Achilles건, 족저부등에 광범위한 결손 및 변형이 있었던 환자 21예에서 미세혈관술을 이용하여 Fasciocutaneous, musulocutaneous, muscle with skin graft 등으로 족부를 재건하여 추적중에 있으며 현재까지 관찰된 결과 및 장점, 단점과 문제점들을 보고하는 바이다.

구개상악재건을 위한 유리피판술에서 다양한 공여부의 선택

윤도원,민희준,김지예,이원재,정섬,정윤규,Yoon, Do-Won,Min, Hee-Jun,Kim, Ji-Ye,Lee, Won-Jae,Chung, Seum,Chung, Yoon-Kyu 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.1

Purpose: A palatal defect following maxillectomy can cause multiple problems like the rhinolalia, leakage of foods into the nasal cavity, and hypernasality. Use of a prosthetic is the preferred method for obturating a palate defect, but for rehabilitating palatal function, prosthetics have many shortcomings. In a small defect, local flap is a useful method, however, the size of flap which can be elevated is limited. In 12 cases of palatomaxillary defect, we used various microvascular free flaps in reconstructing the palate and obtained good functional results. Method: Between 1990 and 2004, 12 patients underwent free flap operation after head and neck cancer ablation, and were reviewed retrospectively. Among the 12 free flaps, 6 were latissimus dorsi myocutaneous flaps, 3 rectus abdominis myocutaneous flaps, and 3 radial forearm flaps. Result: All microvascular flap surgery was successful. Mean follow up time was 8 months and after the follow up time all patients reported satisfactory speech and swallowing. Wound dehiscence was observed in 4 cases, ptosis was in 1 case and fistula was in 1 case, however, rhinolalia, leakage of food, or swallowing difficultly was not reported in the 12 cases. Conclusion: We used various microvascular flaps for palatomaxillary reconstruction. For 3-dimensional flap needs, we used the latissimus dorsi myocutaneous flap to obtain enough volume for filling the defect. Two-dimensional flaps were designed with latissimus dorsi myocutaneous flap, rectus abdominis flap and radial forearm flap. For cases with palatal defect only, we used the radial forearm flap. In palatomaxillary reconstruction, we can choose various free flap techniques according to the number of skin paddles and flap volume needed.

피지선 모반에서 발생한 편평상피세포암

강진문(Jin Moon Kang),김홍석(Hong Sik Kim),정섬(Seum Chung),이민걸(Min Geol Lee) 대한피부과학회 1999 대한피부과학회지 Vol.37 No.9

N/A

편도암 절제후 요골측 전박 유리피판을 이용한 재건 및 술후 구음 기능의 평가

김응삼,신극선,이훈범,정섬 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.3

Four consecutive patients underwent composite resection of tonsillar cancer and reconstruction with a microvascular radial forearm free flap. Three patients had postoperative assessments of speech at six to nine months respectively. One patient could not attend for the postoperative assessment. The speech assessment was examined by same speech therapist. All the patients had an good postoperative speech assessment. Compared to conventional local or regional myocutaneous flaps, the thin forearm free flaps offers better postoperative articulatory recovery.

PGE₁(Prostaglandin E₁)의 국소도포가 Hairless Mouse 피부의 맥관형성에 미치는 영향

정섬,신극선,오승훈,설철환,박병윤 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

An important aspect of plastic surgery is skin flap survival. Among the prostaglandins, PGE₁is used clinically to improve peripheral circulatory disturbances due to its action of augmenting blood flow by vascular smooth muscle relaxation and its strong inhibitory action of platelet aggregation. Clinically, many investigators found that the effect of PGE₁was prolonged for a long period even after short-term application. So a new hypothesis emerges that the prolonged effect of PGE₁may be due to neovascularization and not due to vasodilatation alone. This study was designed to clarify the mechanism of the prolonged effect of topical PGE₁with regard to angiogenesis. A total of 9 male hairless mice were treated with a topical application of PGE₁onitment (PGE₁powder mixed in hydrogen base) on the experimental side and only a hydrogen base on the contralateral control side of the back skin, respectively, for 7 days, once a day. Then they were divided into 3 groups. In group 1, specimens were obtained on the 7th day post-treatment using 3 mm size punch biopsy from both sides. In group 2, specimens were obtained on post-treatment 14th day. In group 3, specimens were obtained on post-treatment 28th day. The number of blood vessels were compared between the experimental side and control side with respect to neovascularization after PGE₁application using an image-analysis program under hemtoxyline-eosin stain. Treatment on the experimental side did not affect its contralateral mate, since there was no evidence of a systemic effect. From our experimental data, we could conclude that PGE₁may induce angiogenesis by topical application without systemic effect.

수지첨단부 재건을 위한 원통형 서혜부 피판의 長斜方形 도안

신극선,정섬,유재덕,탁관철 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.3

The authors present a rhomboid design for the tubed inguinal flap based on the lengh and perimetry of the fingertip warranting reconstruction. Our flap is an axial type flap supplied by the superficial circumflex iliac artery and is a modification of the classic inguinal flap commonly used in fingertip reconstruction. The dimensions of the axial pattern rhomboid tubed inguinal flap are mathematically determined based on the amount of soft tissue needed. Thus a precisely tailored flap with a safe and abundant vascular pedicle is obtained. Furthemore, the rhomboid-shaped donor defect allows for easy primary closure and therefore avoids any raw surface areas and in addition also prevents kinking and tension of the tubed vascular pedicle. The rhomboid tubed inguinal flap was used in the treatment 17 patients with variety of fingertip injuries. The flap allowed for a functionally as well as aesthetically satisfying method of reconstruction for fingertip injuries.

두개하 접근법을 통한 사골 및 접형골에 발생한 섬유성 이형성증의 치험례

김균태,정섬,박병윤,이원상 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

The method for adequate treatment of fibrous dysplasia is controversial and proposed methods range from conservative to radical surgical removal. For lesions involving the skull base, intracranial transfrontal approach has been reported by some authors. While effective in tumor removal, brain edema and olfactory nerve injury are inherent risks due to the necessity for retraction of the frontal lobe and dura during this approach. In order to reduce such complications, authors have partially removed a tumor involving the ethmoid and sphenoid sinus of a 52 year-old female via a frontonasal subcranial approach with satisfactory results.

PGE1의 국소 도포가 백서의 임의형 피부판 및 혈압에 미치는 영향

신극선,정섬,정재호 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.4

Salvaging the compromised random pattern flap remains a challenge for plastic surgeons. For the purpose of augmenting blood flow, vasodilators have previously been used in an attempt to improve survival of ischemic skin flaps. One such agent, prostaglandin, a vascular smooth muscle relaxant and a inhibitor of platelet aggregation, has been widely used clinically to improve peripheral circulation. But when used intraarterially of intravenously, systemic side effects such as hypotension, nausea, dizziness, and diarrhea were frequent. This study was designed to investigate the survival of random skin flaps and blood pressure when prostaglandin E1 was applied topically. Sprague-Dawley rats (N=30) were divided into control group (N=10); hydrogen base ointemnt only aplied, intraperitoneal group (N=10); PGE1 1㎍/kg injected intraperitoneally, and topical group (N=10); PGE1 powder mixed in hydrogen-base ointment (1㎍/kg) applied topically (N=10). A classic Mcfarlane random type flap (10 ×4cm) was elevated on the dorsum of rats. Blood pressure was measured by indirect tail plethsmography every 5 minutes until normalization. After seven days each animal was evaluated for percentage area of flap survival and the following results were obtained; 1. Flap survival areas in the PGE1 intraperitoneal injected group (65.2%) and topically applied group (82.9%) were greater than the control group (55.5%). 2. Blood pressure decrease of an average of 7mmHg was seen in the PGE1 intraperitonel injected grop. 3. No blood pressure change was in the control and topical appled groups. These experimental data suggested that topical application of PGE1 increased random flap survival without lowering blood pressure and thus may offer the same benefit of increasing area of survival in the compromised random flap but without the common side effects.

계측된 도안을 이용한 Bilobed Flap의 비결손 재건술

박병윤,정섬,오승훈 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

The nose has number of characteristics that make it unique when planning or reconstruction of surgical defects. The topography of nose is complex with multiple adjacent convex and concave surfaces that must be preserved. The free margins of the alar rims are mobile and easily distorted in case of inadequate planning. The skin over the lower one third of the nose id liss mobile and, therefore, cannot be easily recruited for closure of small defects. In addition, the texture and color of this skin are so unique that neither distant nor nearby skin can always provide a good match. Finally, the function of the nose must always be considered by preserving or replacing the bony and cartilaginous framework, mucosal linig, and never compromising a patent airway. The bilobed flap is particularly suited for reconstruction of small sized or medium sized nasal defects up to 1.5 ㎝ in diameter. By definition, it is a double transposition flap and it is designed to move more skin over a longer distance than would be possible with a single transposition flap in the same location. On the lower one third of the nose where the skin is the least mobile, the bilobed flap allows the surgical site to be covered with nearby skin matched for color and texture and then allows for repair of that secondary defect with another well-matched flap whose donor site can finally be closed primarily. This flap also results in little or no distortion of the nose since the flap efficiently recruits skin from distant and more lax sites. While the standard design often results in tissue protrusions or pincushioning effect, improvements in the design are outlined herein to achieve the best results for defects of the nose.