황하 칼슘염을 함유하는 주사형 키토산 제형이 신연골 형성시 골경화에 대한 영향

김귀락,조병채,양정덕,이동걸,정호윤,박재우,김인산,박낭운,장광호,장환수,권익찬,노경호,이동신 大韓成形外科學會 2004 Archives of Plastic Surgery Vol.31 No.3

황화 칼슘염을 함유하는 주사형 키토산 제형이 신연골 형성시 골경화에 대한 영향

김귀락,조병채,양정덕,이동걸,정호윤,박재우,김인산,박낭운,장광호,장환수,권익찬,노경호,이동신 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.3

The purpose of this project was to study the effect of injectable chitosan bead encapsulating calcium sulfate, which makes sustained release of chitosan and calcium sulfate after implantation, on early bony consolidation in distraction osteogenesis of a dog model. Forty five dogs were used for this study. An external distraction device was applied to the mandibular body after vertical osteotomy and the mandibular distraction was started five days after the operation at a rate of 1mm per day up to a 10mm distraction. The experimental group was divided into a control group(I), hyaluronic acid group(II), chitosan group(III), calcium sulfate group(IV), and injectable chitosan bead encapsulating calcium sulfate group(V). Normal saline was injected in the group I. In the group II, a 1-ml volume of hyaluronic acid solution was injected into the distracted area. In the group III, a 1-ml of injectable solution of chitosan mixed with hyaluronic acid was implanted. In the group IV, a 1-ml of injectable solution of calcium sulfate mixed with hyaluronic acid was implanted. In the group V, injectable form of powders of chitosan bead encapsulating calcium sulfate mixed with a 1-ml volume of hyaluronic acid was implanted. Bone mineral density was measured in each group at third and sixth week. The mean three point failure load was measured in each group. In histological findings, new bone was generated in all groups. In the group IV and V, the formation of active woven bone was observed throughout the distracted area at sixth week. The amount of new bone formation in the distracted zone was in the order of the group IV and V, group III and group II, and control group. In conclusion, these findings suggest that injectable chitosan bead encapsulating calcium sulfate appears to be effective in early bony consolidation in distraction osteogenesis.

2003년 대구 지하철 화재 사고 시 흡입 손상에 대한 고찰

김귀락,이동걸,정호윤,박재우,조병채,이경우 대한화상학회 2003 대한화상학회지 Vol.6 No.2

유방암 환자에서 피부보존 유방절제술 후 실리콘 보형물을 이용한 즉시 유방재건술

조영규,양정덕,김귀락,정호윤,조병채,박호용,Cho, Young-Kyoo,Yang, Jung-Dug,Kim, Gui-Rak,Chung, Ho-Yun,Cho, Byung-Chae,Park, Ho-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Since skin sparing mastectomy removes the mammary gland and the nipple-areolar complex preserving all mammary skin, it makes the widespread use of implants in immediate reconstruction. This article reports our experience in immediate breast reconstruction after skin sparing mastectomy by using the silicone implants in patients especially who have small to moderate sized and minimal ptotic breast. Methods: From September of 2007 to July of 2009, we performed breast reconstruction for 44 breasts of 40 women with silicone implant after mastectomy. Tumors were divided into 5 malignant types (21 IDC, 18 DCIS, 2 ILC, 2 phylloides tumor, 1 mucinous carcinoma). The implant is placed in a submuscular pocket or in a submuscularsubfascial pocket depending upon the condition of the muscles and skin flaps after mastectomy. Results: The mean age was 47 years and the average follow-up period was 11 months. Cosmetic outcome was assessed by evaluation of photographs and assessment of breast volume and shape, breast symmetry, and overall outcome. About 80% of each of these parameters was scored as good or excellent. Breast complication was developed in a total of 6 cases including 2 capsular contracture, 2 partial skin necrosis due to blue dye injection and 2 implant infection. Conclusion: The use of definitive implants in a skin sparing mastectomy is a one-stage immediate breast reconstruction with low morbidity and acceptable result. This method is considered reliable with favorable aesthetic result.

진행성 유방암에 있어 유방절제술 후 발생한 광범위 피부결손 부위의 가슴배피판을 이용한 흉벽재건술

김학태,양정덕,정호윤,조병채,김귀락,최강영,이정훈,박호용,Kim, Hak-Tae,Yang, Jung-Dug,Chung, Ho-Yun,Cho, Byung-Chae,Kim, Gui-Rak,Choi, Kang-Young,Lee, Jung-Hun,Park, Ho-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Radical surgical extirpation in advanced breast cancer patients produces extensive loss of skin with large defects requiring plastic surgical procedures for the closure. Many reconstructive methods exist, the choice of which depends upon the characteristic of the wound, extent of resection and patient comorbidities. For adequate coverage of the large skin defects following resection of advanced breast cancer, current authors have performed a thoracoabdominal flap. Methods: From August 2008 to June 2009, 4 cases of thoraco-abdominal flap were performed for chest wall reconstruction after mastectomy of advanced breast cancer. Flap dissection was entirely performed in a subfascial plane and the flap involving the external oblique abdominal muscle. The flap was rotated clockwise in left chest wall defects and counterclockwise in right chest defects and the donor site was closed directly. Results: Their mean age, 55.7 years and the average follow-up interval was 9 months. Patients' oncologic status ranged from stage IIIc to stage IV, it was classified according to the TNM staging system. Flap dimensions ranged between $15{\times}15$ and $25{\times}25\;cm$. One flap sustained a partial loss at the distal margin and revision with pectoralis major musculocutaneous island flap. Conclusion: Large chest wall reconstructions are usually required after radical excision of advanced cancer stages patients with poor general conditions. Thoracoabdominal flap is a simple, quick single-stage procedure, and offer to patient fast recovery, low complication rate, enabling further concomitant adjuvant therapy.

유두상 혈관내막 증식증의 임상적 보고

이정우,정호윤,이석종,김귀락,최강영,양정덕,조병채,Lee, Jeong-Woo,Chung, Ho-Yun,Lee, Seok-Jong,Kim, Gui-Rak,Choi, Kang-Young,Yang, Jung-Dug,Cho, Byung-Chae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's pseudoangiosarcoma, is a rare disease which is now considered as a reactive process of the endothelium rather than a benign neoplasm. It can occur in any blood vessels in the body but more common in the head and neck region as a solitary, often tender, bluish or reddish nodule. IPEH is characterized by the development of endothelial-lined papillary projections in a vascular lumen, usually associated with thrombotic material, the endothelial cells in the papillary structures showing only slight atypia and occasional mitotic Figures, the absence of tissue necrosis. Methods: 8 patients with IPEH were enrolled in the study from 2002 to 2007. All 8 lesions were surgically excised for histopathologic diagnosis. Results: 4 patients were female. The duration of the lesions ranged from 3 months to 15 years. The tumors were first noted between the ages of 20 and 72 years. 4 patients had lesions on the head; 2 on the toe; 1 on the back; and 1 on the finger, respectively. All lesions were solitary, ranged in size from 2 mm to 27 mm. There were no recurrences. Conclusion: The clinical appearance of IPEH is not specific, presented as a primary neoplasm, and the diagnosis can be established by microscopic examination. Complete surgical excision is the best choice of therapy for patients with IPEH, and is both diagnostic and curative. Awareness of this lesion will prevent incorrect diagnosis and overly aggressive treatment.

과다 유두(Supernumerary Nipple) 2례

이정우,양정덕,이정훈,최강영,김귀락,정호윤,조병채,Lee, Jeong-Woo,Yang, Jung-Dug,Lee, Jung-Hun,Choi, Kang-Young,Kim, Gui-Rak,Chung, Ho-Yun,Cho, Byung-Chae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Supernumerary nipple or polythelia is one of the developmental anomalies occurring at the embryonic stage and this anomaly usually arises from the milk line. While this atypical feature is determined during early developmental stage, it may not come out obviously or become troublesome until puberty or lactation. Moreover, sometimes it is confused with a pigmented nevus. Methods: Case 1, a 18-year-old woman with intramammary supernumerary breast consisted of another nipple with middle sized areola on the right lower breast was admitted for a $2.8{\times}3.1\;cm$-sized mass on the right breast which was starting appeared 1 year earlier. The preliminary cytological examination of the material obtained by needle aspiration biopsy from the mass was revealed by fibroadenoma with no malignant change. The patient had the surgical excision of the mass and accessory breast. Case 2, a 16 year-old woman admitted for intra-areolar polythelia of the left breast, even she doesn't have any family history of polythelia. Since she wanted surgical correction of her atypical nipple for aesthetic and psychological reasons, we reconstructed the areola using transposition flaps in an S-plasty design. Results: Case 1, the excised supernumerary nipple showed following histological features. In the superficial layer, an acanthotic and hyperpigmented epithelium with elongated rete ridges was found. In the dermis, there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type were observed. Case 2, follow-up visits 3 months after the procedure showed a satisfactory result with good shape and projection of the nipple. Conclusion: We report two cases of aberrant mammary tissue who underwent surgical correction, including complete breast (with nipple, areola, and glandular tissue) and intra-areolar polythelia according to the Kajava's classification, and the results were satisfactory.