흉벽 재건에서 합성 물질의 피복을 위한 부분 근피판 조합의 효용성

류석태,변재경,임소영,문구현,방사익,오갑성 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.3

Purpose: Reconstruction of chest wall has always been a challenging problem. Muscle flaps for chest wall reconstruction have been helpful in controling infection, filling dead space and covering the prosthetic material in this challenge. However, when we use muscle flaps, functional and cosmetic donor site morbidities could occur. The authors applied and revised various partial muscle flaps and combination use of them to cover the prosthetic material for the chest wall reconstruction and evaluated the usefulness of partial muscle flaps. Methods: This study included 7 patients who underwent chest wall reconstruction using partial muscle flap to cover prosthetic material from 2004 to 2008. The pectoralis major muscle was used in anterior 2/3 parts of it leaving lateral 1/3 parts of it. The anterior 2/3 parts of the pectoralis major muscle were used while lateral 1/3 parts were left. In case of the rectus abdominis muscle flap, we used upper half of it, or we dissected it around its origin and then advanced to cover the site. The latissimus dorsi muscle flap was elevated with lateral portion of it along the descending branch of the thoracodorsal artery. If single partial muscle flap could not cover whole prosthetic material, it would be covered with combination of various partial muscle flaps adjacent to the coverage site. Results: Flap coverage of the prosthetic material and chest wall reconstructions were successfully done. There occurred no immediate and delayed post operative complications such as surgical site infection, seroma,deformity of donor site and functional impairment. Conclusion: When we use the muscle flaps to cover prosthetic material for chest wall reconstruction, use of the partial muscle flaps could be a good way to reduce donor site morbidity. Combination of multiple partial flaps could be a valuable and good alternative way to overcome the disadvantages of partial muscle flaps such as limitation of volume and size as well as flap mobility.

Usefulness of Partial Muscle Flaps and Combination Method for Coverage of Prosthetic Material in Chest Wall Reconstruction

류석태,변재경,임소영,문구현,방사익,오갑성,Ryoo, Suk-Tae,Pyon, Jai-Kyong,Lim, So-Young,Mun, Goo-Hyun,Bang, Sa-Ik,Oh, Kap-Sung Korean Society of Plastic and Reconstructive Surge 2011 Archives of Plastic Surgery Vol.38 No.3

Purpose: Reconstruction of chest wall has always been a challenging problem. Muscle flaps for chest wall reconstruction have been helpful in controling infection, filling dead space and covering the prosthetic material in this challenge. However, when we use muscle flaps, functional and cosmetic donor site morbidities could occur. The authors applied and revised various partial muscle flaps and combination use of them to cover the prosthetic material for the chest wall reconstruction and evaluated the usefulness of partial muscle flaps. Methods: This study included 7 patients who underwent chest wall reconstruction using partial muscle flap to cover prosthetic material from 2004 to 2008. The pectoralis major muscle was used in anterior 2/3 parts of it leaving lateral 1/3 parts of it. The anterior 2/3 parts of the pectoralis major muscle were used while lateral 1/3 parts were left. In case of the rectus abdominis muscle flap, we used upper half of it, or we dissected it around its origin and then advanced to cover the site. The latissimus dorsi muscle flap was elevated with lateral portion of it along the descending branch of the thoracodorsal artery. If single partial muscle flap could not cover whole prosthetic material, it would be covered with combination of various partial muscle flaps adjacent to the coverage site. Results: Flap coverage of the prosthetic material and chest wall reconstructions were successfully done. There occurred no immediate and delayed post operative complications such as surgical site infection, seroma, deformity of donor site and functional impairment. Conclusion: When we use the muscle flaps to cover prosthetic material for chest wall reconstruction, use of the partial muscle flaps could be a good way to reduce donor site morbidity. Combination of multiple partial flaps could be a valuable and good alternative way to overcome the disadvantages of partial muscle flaps such as limitation of volume and size as well as flap mobility.

눈 주위 근육 피판의 선택적 이용에 의한 안검하수의 교정 및 합병증

한동길,송철홍,장경수,박대환,이재욱,안기영 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.3

Eighty-three cases with severe blepharoptosis were treated by the superiorly based muscle flaps around eye including orbicularis oculi muscle, frontalis muscle, levator muscle. The selection of the muscle flaps were done in accordance with the levator function of patients. The orbicularis oculi muscle flap technique in 32 patients who have 2-5 mm levator function, 21 cases of the interdigitated orbicularis oculi-frontalis muscle flap for 1-3 mm levator function, frontalis muscle flap technique for less than 2 mm levator function, 22 cases of levator muscle resection for 2-8 mm levator function, 7 cases of levator plication for 5-9 mm levator function. The majority of patients recorded as satisfactory results. There has been no complete failure but there were 14 cases of undercorrection, 4 cases of overcorrection, 2 cases of exposure keratitis, 3 cases of corneal erosion, 2 cases of sensory loss, hematoma, loss of wrinkle and a few cases of eyelid deformity such as notching, entropion, fading or unnatural fold. The orbicularis oculi muscle technique or the interdigitated orbicularis oculi-frontalis muscle flap technique offers several advantages over conventional frontalis muscle flap technique such as being a simple with a good operative field, single incision on supratarsal fold, no depression on the forehead, no risk of neurovascular injury and relatively easy technique with less complication. The levator resection or levator plication could offer good results by careful selection of patients. In conclusion, we would like to say that the interdigitated frontalis orbicularis oculi muscle flap technique is best in cases with less than 2 mm levator function, orbicularis oculi muscle flap technique in 2-4 mm levator function, levator resection in 4-8 mm levator function, levator plication in more than 8mm levator function.

백서의 복직근판에 있어 Prostaglandin E₁이 근판생존에 미치는 영향

정지원,양호직,신영진 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

Flap survival is critical to the success in reconstructive surgery, there have been many investigations to increase the blood supply to the flaps such as surgical delay and pharmacologic delay. Prostaglandin(PG) is released from various tissues including blood vessel in response to physical stimulus. Among the Prostaglandins, PGE₁ has been proven to be a vasodilatation property and many authors have demonstrated its effect to increase blood supply after random cutaneous flap surgery. Clinically, however, muscle flap or musculocutaneous flap is more significantly used in reconstructive surgery and hemodynamic effects of PGE₁ of this type of flap are still not documented. The authors designed the random muscle flap to study the hemodynamic effects of PGE₁ of the muscle flap. Superior based rectus muscle flap was elevated from rats and the superior epigastric artery, its major vascular pedicle, was ligated to create the random-type muscle flap. Twenty two rats were divided into two experimental groups and each group had 11 rats ; Group Ⅰ : No drugs Group Ⅱ : PGE₁ injection group for 7 postoperative days intraperitoneally The average muscle flap survival rate of group Ⅰ was 46±3.0 precent and it had a higher survival rate than the control group(23±4.3%). The muscle flap survival rates showed significant differences between the two groups (p < 0.005) This study shows that the administration of the PGE₁, in clinical usage of the rare random muscle flap with a pedicle injury or musculocutaneous flap with the risk of distal cutaneous flap necrosis, such as TRAM flap, which might be much safer and popular.

교차하지 (Cross-Leg Fashioned) 유리 근육피판술의 신생혈관 형성에 관한 고찰

서만군,탁관철,박철,이혜경 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

For the reconstruction of soft tissue defect combined with open fracture in the lower leg, free flap, especially muscle free flap which has abundant blood supply, is considered to be the most suitable method. Sometimes, however, injury to the main vessels in the lower leg makes it impossible to use a principal vessel as a recipient vessel. In such cases, vein graft or end-to-side anastomosis can be employed. To acquire a healthier vessel as a recipient,the authors performed crossleg muscle free flap, using a non-injured healthy vessel of the contralateral leg as a recipient vessel. Controversy still lingers over the angiogenesis of cross-leg muscle free flap and thus safety after flap detachment. There have been some clinical case reports on cross-leg muscle free flap, but flap survival after pedicle detachment has been known to be variable according to different authors. Because of the uncertainty of neovascularization in muscular free flap at the time of flap delay procedure,many surgeons hesitate to use a pure muscle free flap as a delay flap. Eight cases of cross-leg muscular free flap were performed by the authors using the rectus abdominis muscle, latissimus dorsi muscle and a combination of the latissimus dorsi and serratus anterior muscle flap. During the operation, the authors estimated the ratio of poorly vascularized bed in recipient soft tissue defect. Despite the high ratio of non-vascularized bed, there was no flap necrosis after pedicle detachment and ample neovascularization within the muscle was confirmed by post-division angiogran. As well, there was no recurrence of osteomyelitis. Conclusively, enough neovascularization in cross-leg free muscle flap, even placed on a poorly vascularized bed, could be induced through a delayed procedure.

안검하수에서 세 갈개로 가른 전두근판전위술과 전두근-근막판전진술의 사진계측학적 비교

김현지,한기환 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.4

Lately, both the frontalis muscle flap transposition and the frontalis myofascial advancement flap have been used mainly for the correction of blepharoptosis with poor levator function. Therefore, the purpose of this study is to know the functional differences of these two methods by objective method. During the past 16 years, the 43 patients, aged 5 to 68 years(mean 32.4 years) have been undergone the tripartite frontalis muscle flap transposition(unilateral 16 patients; bilatral 12 patients, 24 eyelids) and the frontalis myofascial advancement flap(unilateral 8 patients; bilateral 7 patients, 14 eyelids). To compare these two methods, this study was done with the anthropometry using photogrammetric analysis with an average follow-up of 5.5 years. Ptosis ratio on the primary gaze and the upward gaze, and the height of palpebral fissure on the downward gaze and the closing eyes were measured. The results were statistically analysed using Wilcoxon signed ranks test. In conclusion, there is no difference on the primary gaze, the downward gaze, and the closing eyes between the tripartite frontalis muscle flap transposition and the frontalis myofascial advancement flap, but ptosis degree on the upward gaze was less severe in the tripartite frontalis muscle flap transposition. This difference may result from disparity in contractile power of the frontalis muscle due to not only anatomical structure but also size of the flap. Second, the orbicularis oculi muscle is atropied by denervation of the temporal branch of the facial nerve in frontalis myofascial advancement flap.

이차성 구순열 환자에서 상구순 구륜근 피판중첩을 이용한 인중주의 재건

권석민,박준,양원용,유영천,강상윤 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.5

Purpose: Philtral deformity is a stigma of secondary cleft lip nose. It occurs from the false arrangement of orbicularis oris muscle and the scar of previous operation. Various methods have been used to correct this deformity. We successfully corrected philtral deformity using overlapping of orbicularis oris muscle flap. Received April 25, 2008 Revised May 22, 2008 Accepted August 12, 2008 Address Correspondence: Won Yong Yang, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Kyung Hee University Medical Center, 1 Hoegi-dong, Dong- daemun-gu, Seoul 130-702, Korea. Tel: 02)958-8431/Fax: 02)963-5638/E-mail: psyang@khmc.or.kr *본 논문은 2005년 제 58차 대한성형외과학회 학술대회에서 발표되었음. Methods: From November 2000 to August 2007, we performed 39 cases of correction of philtral deformity in secondary cleft lip nose with overlapping of orbicularis oris muscle flap. Their age ranged from 5 to 53 years old. Existing scar tissue of previous operation was deepithelialized and preserved as scar flap. Lateral orbicularis oris muscle flap was elevated, advanced and overlapped upon medial muscle flap after dissection of orbicularis oris muscle of both sides. Reconstruction of philtral column was made from overlapping area by fixation of end part of lateral muscle flap to the point between philtral dimple and column. The degree of muscle flap advancement was decided by correction state of lateral muscle bulging. Correction of nostril floor depression or whistle deformity was also performed with preserved scar flap, if necessary. Results: Realignments of orbicularis oris muscle were possible in the majority of the patients and final results of philtral reconstruction were satisfactory mostly. Correction of nostril floor depression and whistle deformity was also achieved. Additional correction was performed later to 4 patients in whom insufficient reconstruction was noted. No significant complication was observed. Conclusion: More natural and symmetric philtrum was acquired with overlapping of orbicularis oris muscle flap. To the authors' knowledge, it is an easy and effective method for correction of philtral deformity through anatomical rearrangement of distorted orbicularis oris muscle with relatively simple procedure.

흉배혈관 천공분지에 기초한 유리피판술의 임상적 이용

남영오,고성훈,어수락,Nam, Yeoung-O,Koh, Sung-Hoon,Eo, Su-Rak 대한미세수술학회 2005 Archives of reconstructive microsurgery Vol.14 No.2

Perforator flaps have become increasingly popular in microsurgery nowadays and are being used widely for many cases of reconstruction after trauma and cancer ablation. And thoracodorsal perforator based free flap is one of them having the merits of carrying a large skin paddle with leaving intact innervation and function of the remaining latissimus dorsi muscle. We made a homogeneous thin flap excluding the main muscle with a long vascular pedicle and tried to decrease the donor site morbidity. But, it needs a long learning-curve and we have met marginal flap necrosis frequently. Besides, prolonged operation time for complete perforator dissection may be a tedious job to the microsurgeon. To overcome these disadvantages, we usually included very small portion of the latissimus dorsi muscle during this flap elevation around the pedicled 2-3 thoracodorsal perforators during this flap elevation. We performed 3 cases of thoracodorsal perforator based free flap at Hallym university sacred heart hospital between May and August 2005 for the soft tissue defect of the scalp and feet. The average flap size was $8{\times}14\;cm$. Although it is not a true perforator flap, we can get the reliability for the flap survival with much better blood circulation and save the time of one or two hours to dissect the perforators completely. All cutaneous flaps survived completely without any complication except one fatty female who had the very small superficial fat necrosis due to flap bulkiness. We believe the thoracodorsal perforator based free flap can be extended its versatility and reliability by including the very small portion of the muscle around the perforators.

단지 신근 근피판을 이용한 수족부 결손부의 피복

김철규,김승환,백무현,민대홍,김진수 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

The extensor digitorum brevis muscle flap is a versatile and robust flap able to provide adequate bulk and coverage in soft-tissue defects of the hand and lower limb. The donor site deformity is limited to the necessary scar needed to approach. The extensor digits.un brevis muscle flap is valuable in covering defects of the distal tibia and both malleoli as an island and rotation muscle flap and covering defects of the distal portion of the foot as a reverse flow island muscle flap. It can also be used as a free vascularized muscle transfer for more distant problems. The extensor digitorum brevis muscle flap offers several advantages: 1) dissection is not technically dificult, 2) There is limited donor foot morbidity, with the exception of the loss of the dorsalis pedis blood supply to the foot, 3) this thin muscle offers adequate bulk in the hand and lower extremity, 4) the arterial pedicle can be lengthy if the anterior tibial artery is included, 5) its are of rotation allows the solution of several common problems in the area and 6) donor scar is hidden by normal clothing. We have reported the clinical applications of these flaps. Our experience using these flaps has shown successful healing of the defects on hand and lower extremity good aesthetic and functional results on both recipient and donor sites.

전기화상 환자에서 족부에 유리 광배근판을 이용한 재건 시기와 방법에 대한 연구

오성균,이종욱,장영철,오석준 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.6

High-voltage electrical injury results in progressive deep tissue necrosis, often resulting in amputation when foot is involved. Complete surgical debridement and coverage with a vascularized free flap, when local flaps and skin graft are unsuitable, may protect partially devitalized structure, preserve function, and reduce the incidence of amputation. The free latissimus dorsi muscle flap for coverages of extensive soft tissue defect of foot has advantages over the musculocutaneous flap or perforator flap. The flap is less bulky, flexible, contoured easily, long pedicle and less donor morbidity. Well- vascularized muscle may be effective in getting under control infection. Vein anastomosis was performed to the venae comitantes and thoracodorsal vein, because electrical current produces tissue damage accompanied by valve fibrosis and coagulation of superficial blood vessel. The timing of surgical debridement remains controversial. Thus, we compared result of flap survivor with operation less than 3 weeks after injury and operation more than 3 weeks after injury, anastomosis of recipient vein that venae comitantes and saphenous vein from January 1997 to April 2002, 21 patients injured by electrical burn of foot treated reconstruction using the free latissimus dorsi muscle flap with meshed split- thickness skin graft coverage. As a result, we think that delayed debridement(more than 3 weeks after electrical burn injury) may result in increased saving of free flap, because it relatively makes demarcation of devitalized tissues and selection of uninjured recipient vessel clear. We suggest that using delayed operation and anastomosis of venae comitantes in electrical burn injury increase of survival rate free latissimus dorsi muscle flap.