다양한 피판술을 이용한 후족부 연부조직의 결손

이정환,이종욱,고장휴,서동국,최재구,오석준,장영철,Lee, Jung-Hwan,Lee, Jong-Wook,Koh, Jang-Hyu,Seo, Dong-Kook,Choi, Jai-Koo,Oh, Suk-Jun,Jang, Young-Chul 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.2

Purpose: Anatomically, the foot is provided with insufficient blood supply and is relatively vulnerable to venous congestion compared to other parts of the body. Soft tissue defects are more difficult to manage and palliative treatments can cause hyperkeratosis or ulcer formation, which subsequently requires repeated surgeries. For weight bearing area such as the heel, not only is it important to provide wound coverage but also to restore the protective senses. In these cases, application of flaps for hind foot reconstruction is widely recognized as an effective treatment. In this study, we report the cases of soft tissue reconstruction for which various types of flaps were used to produce good results in both functional and cosmetic aspects. Methods: Data from 37 cases of hind foot operation utilizing flaps performed between from June 2000 to June 2008 were analyzed. Results: Burn related factors were the most common cause of defects, accounting for 19 cases. In addition, chronic ulceration was responsible for 8 cases and so forth. Types of flaps used for the operations, listed in descending order are radial forearm free flap (18), medial plantar island flap (6), rotation flap (5), sural island flap (3), anterolateral thigh free flap (2), lattisimus dorsi muscular flap (2), and contra lateral medial plantar free flap (1). 37 cases were successful, but 8 cases required skin graft due to partial necrosis in small areas. Conclusion : Hind foot reconstruction surgeries that utilize flaps are advantageous in protecting the internal structure, restoring functions, and achieving proper contour aesthetically. Generally, medial plantar skin is preferred because of the anatomical characteristics of the foot (e.g. fibrous septa, soft tissue for cushion). However alternative methods must be applied for defects larger than medial plantar skin and cases in which injuries exist in the flap donor / recipient site (scars in the vicinity of the wound, combined vascular injury). We used various types of flaps including radial forearm neurosensory free flap in order to reconstruct hind foot defects, and report good results in both functional and cosmetic aspects.

화상 반흔에서 생긴 궤양을 동반한 이소성 석회화의 치료

강상구,이종욱,고장휴,서동국,최재구,장영철,Kang, Sang-Gu,Lee, Jong-Wook,Ko, Jang-Hyu,Seo, Dong-Kook,Choi, Jai-Koo,Jang, Young-Chul 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Heterotopic calcification is a pathological event in which deposits of calcium salts build up, usually in the joint area or soft tissues. It can occur under many conditions and in some rare cases may develop in burn scars. In particular, ulcerations in burn scars accompanied by heterotopic calcification are difficult to treat through conservative treatment. This study reports methods for accurate diagnosis and adequate treatment of ulceration in burn scars accompanied by heterotopic calcification. Methods: Fourteen patients who visited our hospital from March 2008 to January 2010 were subjected to this study. Their sex, age, modes of burn, degree, TBSA (%), ulcerated area, the time of occurrence of the ulcerations in the burn scars were investigated. In addition, radiological examination and biopsy was performed to diagnose heterotopic calcification. Results: Among the 14 cases, 6 were male and 8 were female. The average age of the patients was 48.2 (27 - 69 yrs). As for the mode of burn, 11 were flame burns and 3 were scalding burns. The average time of occurrence of the ulcerations in the burn scars was 4.5 months. The ulcerated areas were situated in the legs in 12 cases, arms in 1 case, and torso in 1 case. The diagnosis was confirmed through X-ray and biopsy, and skin graft was performed after wide excision. Conclusion: Diagnosis of the ulceration in burn scars accompanied by heterotopic calcification is possible through radiological and pathologic studies. Surgical treatment is the most reliable method of treatment, and we chose to perform skin graft after wide excision. Also, we learned that the complete removal of the calcified tissue and the inflammatory fibrotic tissues is crucial in preventing recurrence. Also, in contrast to Marjolin's ulcer, heterotopic calcification had a small size, little or no granulation tissue, and lacked fungating type ulceration. Therefore, favorable prognosis could be achieved through adequate treatment.

Reconstruction of Post Burn Auricular Defect

조동필,이종욱,고장휴,서동국,최재구,장영철,Cho, Dong-Pill,Lee, Jong-Wook,Koh, Jang-Hyu,Seo, Dong-Kook,Choi, Jai-Koo,Jang, Young-Chul Korean Society of Plastic and Reconstructive Surge 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Patients with serious burns are prone to chondritis due to lack of soft tissue in the auricle, which can cause severe defects in the auricular morphology. In addition, skin damage occurs frequently in the vicinity of post-burn wounds, presenting difficulties in reconstruction surgery. An auricular reconstruction has functional and cosmetic significance. The aim of this study is to develop appropriate reconstruction methods for auricular defects. Methods: Thirty seven patients, who were treated for auricular defects from 2005 to 2009, were enrolled in this study. A local flap, multiple regional flaps and cartilage framework with or without a temporal fascial flap were applied in reconstruction surgery according to the location of the auricular defect. Results: The age of the subjects ranged from 11 to 56. Some subjects had defects that cover more than half of the helical rim with most exhibiting post-burn scars in the vicinity, for whom a multiple regional flap was used. A single use of a tubed flap was sufficient for subjects with defects that covered less than half of the helical rim. A regional flap was also used for reconstruction in subjects with defects covering both the helical rim and antehelix. Conclusion: Achieving satisfactory results from the skin flaps and skin grafts for post-burn auricular defects in both functional and cosmetic aspects is a difficult task. Therefore, selecting an appropriate surgical method through proper diagnosis of the auricular defect and the state of the available skin in the vicinity is essential.

The Effect of Forsythia suspensa Extract on the Wound Healing of Rats

배진우,김헌준,장조욱,김영욱,조성배,최재구,Bae, Jin-Woo,Kim, Heon-Joon,Chang, Cho-Ook,Kim, Young-Wook,Cho, Seong-Bae,Choi, Jai-Koo The Korean Society of Pharmacology 1995 대한약리학잡지 Vol.31 No.3

We examined the wound healing effect and toxicity of Forsythia suspensa extract to verify the therapeutic usefulness on wound treatment. Additionally, we examined its antibacterial effect. The wound healing effect of Forsythia suspensa extract was compared with the tetrachlorodecaoxygen anion complex (TCDO), protein free haemodialysate (Haemyl), and physiological saline. The wound areas on the 4th, 11th, 14th day of treatment with Forsythia suspensa extract, TCDO, and Haemyl were significantly smaller than with the saline treatment. The wounds on the 8th day of treatment with Forsythia suspensa extract were only siginificantly smaller than the saline treatment. On the 8th day of treatment with Forsythia suspensa extract, TCDO, and Haemyl accerlerlated the wound epithelization more than saline treatment. There was not a significant difference in liver enzyme activity (GOT, GPT) and blood cell count between the Fosythia suspensa extract and the saline treatment. In addition, the Forsythia suspensa extract did not inhibit bacterial proliferation. These results suggest that Forsythia suspensa extract has great possibility of being developed into new wound healing drugs. Its pharmacological effects seem to have no relation with antibacterial effect. 연교액기스가 창상치료제로서의 사용가능성을 검증하기 위하여 연교의 창상치유 효과와 독성에 대하여 조사하였으며 아울러 연교액기스가 항생작용이 있는지도 조사하였다. 연교의 창상치유 효과를 Tetrachlorodecaoxygen anion complex(TCDO) 및 단백질을 제거한 혈액투석액(Haemyl)과 생리식염수의 창상치료 효과와 비교하였다. 4일, 11일, 14일째의 창상면적은 연교액기스, TCDO, Haemyl의 치료에 의하여 대조구인 생리식염수의 치료구에 비해 유의하게 적었다. 그러나 8일째의 창상면적은 다만 연교액기스의 치료구만 유의하게 적었다. 조직학적 검사에서도 연교액기스, TCDO, Haemyl의 치료구가 생리식염수의 치료구에 비해 표피화가 촉진되었다. 간 효소활성도(GOT, GPT), 혈구의 수에 있어서 연교액기스의 투여가 대조구에 비하여 어떤 유의적 차이가 보이지 않았으며 그외에도 연교액기스는 병원균의 증식을 억제하지 않았다. 이런 결과들은 연교액기스가 장차 창상 치료제로서의 개발 가능성이 시사하였으며 그의 약리작용은 항생작용과 무관한 것으로 추정된다.

백서의 창상치유에 미치는 연교액기스의 효과

배진우(Jin Woo Bae),김헌준(Heon Joon Kim),장조욱(Cho Ook Chang),김영욱(Young Wook Kim),조성배(Seong Bae Cho),최재구(Jai Koo Choi) 대한약리학회 1995 대한약리학잡지 Vol.31 No.3

연교액기스가 창상치료제로서의 사용가능성을 검증하기 위하여 연교의 창상치유 효과와 독성에 대하여 조사하였으며 아울러 연교액기스가 항생작용이 있는지도 조사하였다. 연교의 창상치유 효과를 Tetrachlorodecaoxygen anion complex(TCDO) 및 단백질을 제거한 혈액투석액(Haemyl)과 생리식염수의 창상치료 효과와 비교하였다. 4일, 11일, 14일째의 창상면적은 연교액기스, TCDO, Haemyl의 치료에 의하여 대조구인 생리식염수의 치료구에 비해 유의하게 적었다. 그러나 8일째의 창상면적은 다만 연교액기스의 치료구만 유의하게 적었다. 조직학적 검사에서도 연교액기스, TCDO, Haemyl의 치료구가 생리식염수의 치료구에 비해 표피화가 촉진되었다. 간 효소활성도(GOT, GPT), 혈구의 수에 있어서 연교액기스의 투여가 대조구에 비하여 어떤 유의적 차이가 보이지 않았으며 그외에도 연교액기스는 병원균의 증식을 억제하지 않았다. 이런 결과들은 연교액기스가 장차 창상 치료제로서의 개발 가능성이 시사하였으며 그의 약리작용은 항생작용과 무관한 것으로 추정된다. We examined the wound healing effect and toxicity of Forsythia suspensa extract to verify the therapeutic usefulness on wound treatment. Additionally, we examined its antibacterial effect. The wound healing effect of Forsythia suspensa extract was compared with the tetrachlorodecaoxygen anion complex (TCDO), protein free haemodialysate (Haemyl), and physiological saline. The wound areas on the 4th, 11th, 14th day of treatment with Forsythia suspensa extract, TCDO, and Haemyl were significantly smaller than with the saline treatment. The wounds on the 8th day of treatment with Forsythia suspensa extract were only siginificantly smaller than the saline treatment. On the 8th day of treatment with Forsythia suspensa extract, TCDO, and Haemyl accerlerlated the wound epithelization more than saline treatment. There was not a significant difference in liver enzyme activity (GOT, GPT) and blood cell count between the Fosythia suspensa extract and the saline treatment. In addition, the Forsythia suspensa extract did not inhibit bacterial proliferation. These results suggest that Forsythia suspensa extract has great possibility of being developed into new wound healing drugs. Its pharmacological effects seem to have no relation with antibacterial effect.

충북지역 안검하수증에 관한 임상적 고찰

최재구 건국대학교 의과학연구소 1994 건국의과학학술지 Vol.4 No.-

The blepharoptosis has many causes and may be congenital or acquired, and due to a weakness of the levator or Muller's muscle. The management of blepharoptosis mainly depends on the degree of ptosis and the amount of levator function. The result of surgical correction of the blepharoptosis is determined by the nature of ptosis, methods of operation and surgeon's skill. Authors had experienced 24(30 eyed) patients of blepharoptosis from August, 1989 to March, 1994. The results were obtained as follows: Most of the patients were congenital in origin. The ratio of congenital versus acquired blepharoptosis was 18:6, monocular versus biocular was 12:6, male versus female was 9:9 and right versus left was 7:5. In the function of the levator muscle, 9 eyes were less than 2mm, 21eyes were between 2mm to 6mm. In review of postoperative complications, incases, these symptomes were improved postoperatively after 5 months. Overcorrection was found in 3 cases, undercorrection was found in 2 cases, eyelid fold deformity was found 1 case, exposure keratitis was found 1 case.

전기 화상으로 인한 심부 조직괴사에서의 유리피판술의 적용

김준범,최재구 건국대학교 의과학연구소 1996 건국의과학학술지 Vol.6 No.-

The commercial use of the electricity began in 1849. Since that time there has been progressive increase in the incidence of accidents due to electricity. In high voltage electrical burn, it may resulted in deep destruction of the underlying muscle, nerves, bone, and vessels under viable skin. Entrance site and output site of electrical burn are usually etremities, and so we experienced exposure or bone and joint, loss of function, and amputation in a significant number of cases. Microvascular procedures under these circumstances may well represent the most expeditious methods of salvaging an extremity even when more conventional techniques are available such as skin graft, local flap etc. We have treated 4 cases of eletrical injury with free flap : 2 lateral arm flap, 1 scapular flap, 1 radial forearm flap. Although existence of minor complication, the result were excellent.

소아 수부 화상의 임상적 고찰

최재구 건국대학교 의과학연구소 1995 건국의과학학술지 Vol.5 No.-

From March 1991 to December 1994, 243 burn patients under the age of fifteen visit to Kon-Kuk university medical college Hospital. Among of them, 75 burn sites were hand. In these pediatric hand burn patients, retrospective study was done for the review of following issues : ago and sex distribution, cause of burn, hourly distribution of accident, depth of burn and method of treatment. The summary of results were as follows: 1) Pediatric hand burn was 30.86% of all visited burn patients under 15 years old. 2) The most common cause of burns was scalding burn as 44 cases(58.66%), followed by contact burn as 12 cases(16.00%) and steam burn 12 cases(16.00%), electrical burn as 4 cases(5.33%) and flame burn as 3 cases(4.00%). 3) The most prevalent age group was under 1 year old 25 cases(33.33%). 4) The most common injured time range was between 4 p.m. and 8p.m. 29 cases(38.66%). 5) The depth distribution was as follows: 2nd degree 60 cases(80.00%), 3rd degree 11 cases(14.66%), 1st degree 3 cases(4.0%) and 4th and degree 1 case(1.33%). 6) The method of treatment was as follow distribution: conservative treatment 73 cases(96%) and operative treatment 3 cases(4%) and admission was 18 cases(14.00%). 7) The 2 cases(2.66%) (were complicated as scar contracture with syndactyly in one case.

수지첨부 손상의 임상적 고찰

강창균,김준범,최재구 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.8 No.-

One hundred and twenty five cases of the fingertip injuries were operated at the Department of Plastic Surgery of Konkuk Medical Center of Chungju from Jan. 1994 to Nov. 1998. There were 129 patients with 138 fingertip injuries. Patients were most commonly occurred in their fourth decade which was 34(27%)cases and male to female ratio was 2.7:1. Third finger was the most frequently affected site which was shown in at 41 cases(29.7%), next 2nd finger and 4th came in order. The most common levels of digit injured were nail bed and nail matrix. The injuries were chiefly caused by a kinds of press, door, and cultivator belt. The crushing injury was the most common type of wound. Local anesthesia was mainly used to operate the fingertip injuries.

Modified Free Wrap-around Flap을 이용한 수무지 재건술의 치험 1예

김순흠,김준범,최재구 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

Traumatic loss of the thumb presents significant functional disability because thumb makes 40% to 50% functional capacity of the hand. So, its loss results in severe dysfunction of the hand especially for pinching and grasping. There are several microsurgical methods to reconstruct the amputated and severely injured thumb such as toe-to-thumb transfer and free wrap-around flap surgery.Development of precise operating microscope, microneedles, sutures and the basic principles of microvascular physiology initiate the early era of thumb reconstruction by free microvascular single transfer of toe with or without adjacent tissue to hand. The free wrap-around flap has been taken from big toe including nail, skin, soft tissue and neurovascular pedicle with or without bone graft and used for the reconstruction of circumferential soft tissue loss of the thumb with some preservation of skeletal structure. We experienced the degloving injury of left thumb from the base of proximal phalanx. The bony skeleton was relatively intact except the proximal phalange bone fracture at interphalangeal joint level. The degloved soft tisssue was heavily crushed. So, we harvested the free wrap around flap from left greater toe including distal phalange bone. And then, transfered to injured left thumb. The oppositional function of the reconstructed thumb was good for pinching and grasping. The patient had no gait problem and he could keep his weight in standing position. The result was satisfactory functionally and cosmetically, and the goal of wrap-around flap to minimize donor site morbidity was well accomplished. Here, we report the clinical experience of modified free wrap around flap for the thumb reconstruction.