부분 탈상피화 둔부 전위 피판을 이용한 천미골 털둥지굴의 수술적 치료

남두현,신호성,박은수,김용배 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.4

Purpose: Pilonidal sinus is a frequent disease that occurs mostly in hairy young men, defined as chronic inflammation and infection of the postsacral sinuses. Wide excision of the affected area is the treatment of choice. Many techniques have been described to cover the defect. However none appears to be the ideal procedure to prevent infection, recurrence, and delayed wound healing. We present the results of an alternative technique that we performed by using partial deepithelized gluteal transposition flap for reconstruction of the defect following wide excision. Methods: From October 2004 to September 2007, we performed the partial deepithelized gluteal transposition flap method on 6 patients. We modified the transposition flap techniques by deepithelialising the medial parts of the flap and burying them under the opposing edge of the flap. The results were compared with previous studies and evaluated regarding duration of surgery, size of defect, hospitalization periods, and complications. Results: All the flaps were healed well with no partial or complete loss of the flap. Hospitalization and immobilization periods were acceptably shortened. Recurrence was not seen. The aesthetic outcome was also satisfactory and all patients were satisfied with the results. Conclusion: The main advantage of our techniques is using healthy tissues to obliterate the dead space, to provide an extra-cushion, and to prevent deep dehiscence. We believe that the partial deepithelized gluteal transposition flap is a good alternative method for treatment of pilonidal sinus.

The clinical features and optimal treatment of anorectal malignant melanoma

Soomin Nam,Chang Woo Kim,Se Jin Baek,Hyuk Hur,Byung Soh Min,Seung Hyuk Baik,Nam Kyu Kim 대한외과학회 2014 Annals of Surgical Treatment and Research(ASRT) Vol.87 No.3

Anorectal malignant melanoma (AMM) is a very rare and aggressive disease. The purpose of this article is to review the clinical features of AMM, to understand treatment options, and optimal therapy by reviewing pertinent literature. Traditionally an abdominoperineal resection (APR) sacrificing the anal sphincter has been performed for radical resection of cancer, but recently, wide excision of AMM is attempted since quality of life after surgery is an important issue. Some authors reported that there was no difference in five-year survival between the patient who underwent an APR and wide excision. The goal of both APR and wide excision was to improve survival with R0 resection. Adjuvant chemoradiation therapy can be performed to achieve an R0 resection. AMM shows very poor prognosis. At this time, research on AMM is insufficient to suggest a treatment guideline. Thus, treatment options, and a therapeutic method should be selected carefully.

절제후 단기간에 발생한 악성섬유조직구종

김기훈(Ki Hoon Kim),김진수(Jin Su Kim),박성진(Sung Jin Park),김운원(Woon-Won Kim),오상훈(Sang Hoon Oh),최수임(Su Im Choi) 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.2

MFH is rare with just a few thousand cases diagnosed each year. We report a case of right flank malignant fibrous histiocytoma (MFH) in the short-term after tumor excision. A 47-year-old woman visited hospital after being diagnosed with MFH. Resection margin was positive, so we planned for wide excision. While awaiting surgery, 1.5 ㎝ sized new mass occurred adjacent to the incision site. The patient underwent wide excision. Postoperative pathologic findings observed a 1.0 ㎝ diameter mass with infiltrative borders in the subcutaneous fat. It was composed of spindle or epithelial cell showing severe polymorphism. Many mitotic cells were observed including atypia. In immunohistochemical study, tumor cells were negative for smooth muscle actin, desmin, myoglobin, S100, cytokeratin, and positive for CD68, and thus diagnosed as pleomorphic MFH. With the purpose of improving local tumor control, radiation therapy was performed after wide excision.

Secondary intention healing after surgical exteriorization of hidradenitis suppurativa

( Jimyung Seo ),( Young In Lee ),( Jihee Kim ),( Jun Young Kim ),( Zhenlong Zheng ),( Kyoung Ae Nam ),( Kee Yang Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Hidradenitis suppurativa (HS) is a chronic, debilitating skin disease, characterized by recurrent inflammatory boils and abscesses, mainly located in the inverse body areas. Early wide surgical excision is important and effective in order to prevent complications, however, reconstruction is quite challenging, often requiring skin graft or skin flap. Objectives: To evaluate the efficacy of secondary intention healing after wide exteriorization for treating severe HS Methods: Over the last 10 years, 9 patients with severe HS (Hurley grade II and III) underwent surgical excision/wide exteriorization with reconstruction using secondary intention healing and artificial collagen insertion. We evaluated and compared intraoperative and post-operative data, retrospectively. Results: Seven patients (77. 77 %) showed no recurrence after surgery. The mean treatment time to complete wound healing was 115 【 110 days (range, 36 - 339 days). The mean disease-free duration after treatment was 665 【 283 (range, 123 - 924 days). Conclusion: Based on our experience, secondary intention healing after exteriorization is an effective treatment option for patients with severe HS presenting multipleinterconnected tracts and abscesses.

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.

자가윤부결막이식술을 이용한 군날개 제거술에서 결막하 섬유혈관 조직의 광범위절제술의 효과

배성근,이진기,박대진 대한안과학회 2012 대한안과학회지 Vol.53 No.2

Purpose: To evaluate the efficacy of wide excision of subconjucntival fibrovascular tissue after conjunctivo-limbal autograft of primary and recurrent pterygium. Methods: Sixty-five eyes of 59 patients underwent pterygium excision with conjunctivo-limbal autograft. Thirty-six eyes of 33 patients had wide excision of pterygium, 29 eyes of 26 patients did not have wide excision of pterygium. All patients underwent follow-up for more than one year. Complications, recurrence rate, and operation time were evaluated. Results: With a minimum of one year of follow-up, there was no recurrence in either group. Six cases (17%) of subconjunctival fibrosis at the donor site, one case (3%) of subconjunctival neovascularization at the donor site, and one case (3%) of wound gapping at the recipient site were noted in the wide excision group. In the non-wide excision group, there were two cases (7%) of subconjunctival fibrosis at the donor site, one case (3%) of granuloma at the donor site, and one case (3%) of retention cyst at the recipient site. Mean operating time in the non-wide excision group (45.2 ± 6.9 minutes) was significantly shorter than that in the wide excision group (62.4 ± 6.2 minutes). Conclusions: Non-wide excision with conjunctivo-limbal autograft in pterygium surgery can be considered an effective treatment with shorter operating time than the wide excision method. Both of these methods show low recurrence rates and few complications for both primary and recurrent pterygia. J Korean Ophthalmol Soc 2012;53(2):215-222

Melanoma: wide local excision vs Mohs micrographic surgery

( Jimyung Seo ),( Young In Lee ),( Jihee Kim ),( Jun Young Kim ),( Zhenlong Zheng ),( Kyoung Ae Nam ),( Kee Yang Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Wide local excision (WLE) depending on the maximum Breslow thickness of the tumor is the standard of care for primary cutaneous melanoma. Mohs micrographic surgery (MMS) is used increasingly to treat this tumor. Objectives: To study the authors`` experience with these 2 approaches Methods: Primary cutaneous melanomas treated at the authors`` institution from January 1, 1996, through December 31, 2014, were studied retrospectively. Main outcome measures were recurrence and disease-free and overall survival. Results: With respect to locoregional and distant metastases, the MMS group showed comparable result to the WLE group. The WLE group needed larger excision margins than those of the MMS group. One stage of WLE was sufficient to achieve clearance in the majority of cases, however, the mean stages of MMS needed to completely remove the tumor were 2.16 【 0.93 stages. Conclusion: This follow-up study of surgical treatments for cutaneous melanoma shows comparable outcomes for wide excision and MMS. Because this is a nonrandomized retrospective study, no direct comparisons between the 2 treatments can be made. Surgical treatments, either standard excision or MMS, can be successfully made considering tumor location and functional and cosmetic outcomes.

융기성 피부섬유육종의 치료를 위한 광범위절제술과 모즈 미세도식 수술의 비교 연구: 단일 기관의 경험

송기훈 ( Ki Hun Song ),박진 ( Jin Park ),윤석권 ( Seok Kweon Yun ),김한욱 ( Han Uk Kim ),노시균 ( Si Gyun Roh ),이내호 ( Nae Ho Lee ) 대한피부과학회 2013 대한피부과학회지 Vol.51 No.1

Background: Dermatofibrosarcoma protuberans is a mesenchymal tumor of the skin of intermediate-grade which is a rare condition. The slow growing and aggressive invasion on local tissues are characteristic features of dermatofibrosarcoma protuberans. The treatment for dermatofibrosarcoma protuberans is mainly a surgical excision such as a wide excision and Mohs micrographic surgery. Objective: The aim of this study was to compare the result of wide excision and Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans at a single institution in Korea. Methods: A retrospective review was done for 24 patients diagnosed with dermatofibrosarcoma protuberans and treated surgically from 1999 to 2010 at Chonbuk National University Hospital. Patient demographics, tumor features, surgical features, and recurrence during the follow-up period were evaluated. Results: 13 patients were treated with wide excision, and 11 with Mohs micrographic surgery. There was no metastasis for all the cases. Mean operation time for the wide excision group was 83 minutes whereas 182 minutes for the Mohs micrographic surgery group, and it was a statistically significant difference. However, no significant difference was observed in post-operative defect size, advanced surgical repair and local recurrence in our study. Conclusion: We suggest that wide excision and Mohs micrographic surgery are both successful modalities for the surgical treatment of dermatofibrosarcoma protuberans. Hence, individualized patient and tumor characteristics should be concerned when determining the surgical options for dermatofibrosarcoma protuberans. (Korean J Dermatol 2013;51(1):13∼20)

Slow mohs micrographic surgery and wide local excision for melanoma treatment in Korean patients

( Jimyung Seo ),( Jee Eun Kim ),( Jihee Kim ),( Dae San Yoo ),( Kyoung Ae Nam ),( Sang Kyum Kim ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: It is not always possible to use conventional wide local excision (WLE) for melanoma in areas that have anatomical complexity and lack a local skin Also, considering the prominent radial growth features of acral melanomas common in darker-pigmented individuals, a new strategy for entire margin evaluation is needed. Objectives: We aimed to show the potential benefits of slow Mohs micrographic surgery (MMS) for treatment of melanoma. Methods: This retrospective study evaluated 244 melanoma patients treated using slow MMS (n = 72) or WLE (n = 144) by a single dermatologic surgeon from 2005 to 2015. We performed slow MMS in melanomas that showed features of radial growth phase or had high recurrence risks; conventional melanomas were treated using WLE. Results: The slow MMS group had greater proportions of acral lentiginous and lentigo maligna melanomas and had more patients with melanoma in situ, suggesting the preferential use of Slow MMS in radial growth feature melanomas. Cox regression analysis of the study cohort revealed that melanoma stage and acral location were the significant factors for recurrence and survival. Kaplan-Meier analysis showed that patients treated with slow MMS had significantly higher disease-free proportions, compared with those treated using WLE. Conclusion: Slow MMS may be a useful alternative in treating difficult-to-manage melanomas for WLE, providing better local control with maximum conservation of surrounding skin.

5- & 10-year survival rate of 95 extramammary Paget’s disease: Focused on wide local excision

( Gi Ung Ha ),( Jin Seon Bang ),( Dae-lyong Ha ),( Jun Young Kim ),( Kyung Duck Park ),( Yong Hyun Jang ),( Weon Ju Lee ),( Seok-jong Lee ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.73 No.1

Background: Surgical procedures such as wide local excision (WLE) and Mohs micrographic surgery (MMS) are the only treatment of choice to eradicate extramammary Paget’s disease (EMPD). MMS is applauded as successful treatment lately, however, there were few recent studies analyzing the efficacy of WLE of EMPD in terms of survival rate following excision in South Korea. Objectives: This study aims to analyze the EMPD-specific survival rates (ESS), overall survival (OS) and recurrence rate (RR) of patients with EMPD in South Korea, focused on WLE. Methods: We retrospectively reviewed the medical records of patients with EMPD from 1993 to 2020 at Kyungpook National University Hospital. We calculated the ESS, OS of EMPD patients and RR after WLE. Results: Total 95 patients whose medical records including surgical and survival data are observable were included, with a mean age of 67.8 years. The 5-year ESS/OSs were 91.8℅/79.3℅ and 10-year ESS/OSs 81.6℅/64.7℅ and there was no difference between sex. Seventy-five patients underwent WLE by either dermatologists (64℅), gynecologists (25℅), or plastic surgeons (11℅). The RR was 16 % in patients who treated with WLE: 7 local recurrence, 2 regional and 3 distant metastases, with mean 39.2 months of recurrence-free interval. Conclusion: From the point of view of ESS, OS and RR, as a surgical treatment by WLE also has fair enough curative effacement for EMPD, comparable to MMS.