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정재호,이상원,설정현,김효헌 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5
There are several methods for the reconstruction of partial urethral defect, including split-thickness skin graft, full-thickness skin graft, and preputial flap and free flap. Despite partial success using these methods, most results are unsatisfactory due to frequent complications such as postoperative infection, fistula formation, hair growth and stricture. There have been several pioneering experiments in this field using autogenous vein graft and the results have been controversial. However, the fact that the endothelial lining is replaced by natural urethral epithlium is generally accepted as a positive effect of this method. This experiment was designed to identify the possibility of using vein graft for the reconstruction of partial urethral defect. Two different types of vein graft method were performed in a total of 20 New Zealand White rabbits with partial urethral defect. Firth, for the patch-graft group, a 1×1 cm rectangular vein graft was sutured at a defective area of the same size. Second, for the tubed-graft group, a vein graft segment 1 cm long was replaced at a segmental urethral defect of the same length. Histologic study was performed at three and eight weeks postoperatively in each group. The process of transitional ell epithelial replacement within the grafted vein was uniformly observed in both experimental groups at three weeks postoperatively. At eight weeks postoperatively, the epithelial replacement was almost complete and histologically undistinguishable. In the retrograde urethrogram performed after 8 weeks, the urinary flow in the patch-graft group was normal and showed no stricture, and two of five rabbits in the tubed-graft group showed partial stricture at the graft site. In conclusion, natural urethral epithelium was restored in grafted venous segments irrespective of the type of graft. Partial stricture was observed in 40% of the tubed-graft group while complete reconstruction was possible in the patch-graft group.
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김효헌,김용하,정재호,설정현 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.1
Although frontal sinus fractures were less common than other facial bone fractures, there have been an increase in frequency. When frontal sinus fracture has developed, depressed anterior wall fracture causes severe deformity and posterior wall fracture may be associated with severe neurosurgical complications. As the importance of external feature increased due to the improvement of life quality and social life style, so accurate diagnosis and appropriate treatment become more important for the prevention of deformity. Mucocele which is one of the most common complication of frontal sinus fracture results in cosmetically serious deformity due to inappropriate treatment Therefore, systematic classification of the fracture and reliable methods of treatment according to the types of fractures are necessary. There has not been any uniform treatment modality according to the types of the frontal sinus fracture. We present the result of 24 patients who were treated at the department of plastic and reconstructive surgery in Yeungnam University Medical Center from Apr. 1994 to Apr. 1996. Anterior wall fracture was reduced by mosaic fixation, mucosal stripping and nasofrontal duct obliteration. Posterior wall fractures were treated by cranialization and naso frontal duct obliteration reinforced with galeal flap. There were no reoperation and the results were good in terms of both function and cosmetics without any major complications.
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류민희,김효헌 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.6
Purpose: The main advantages of the perforator flap are minimal donor site morbidity, preservation of any main source artery and its thin characteristics. Most perforator flaps for hand reconstruction need primary and secondary procedures such as a flap debulkiness and liposuction etc. However, flap thickness of calf area is thinner than any other perforator flaps.Methods: We performed an anatomical study and clinical application of medial sural artery perforator flap. We found that there are two or more medial sural perforators located on a straight line drawn from the mid-point of popliteal crease to the mid-point of medial malleolus. Most pathway of medial sural artery comes along with this line. It is possible to observe the first perforators almost exactly 8cm from midpoint of popliteal crease in a distal half circle drawn with a radius of 2cm.Results: We report 12 cases in 11 patients of hand reconstruction with medial sural perforator free flap from Febrary 2003 to Febrary 2006. Complete healing was possible in 11 cases. Total flap loss for venous insufficiency was in 1 patient. During the follow-up, good contour and full range of motion was observed on hand reconstruction with medial sural perforator free flap.Conclusion: In the authors' experience, this anatomical study made it possible to prepare a diagram of the exact location of the medial sural perforators. This flap can be used to achieve acceptable functional and aesthetic results for hand reconstruction because of its thin characteristics.
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임영국,김효헌,김용하 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.5
Surgical treatment of post-traumatic enophthalmos is one of the most challenging procedures following facial injury. The purpose of this study is to evaluate the advantage of transconjunctival approach and/or medial and lateral extension in reconstruction of orbit in patient with severe post-traumatic enophthalmos. This study includes 7 patients. All operative procedures were performed through preseptal transconjunctival approach and/or medial and lateral extension. After release of scar tissues around orbital contents, reconstruction of orbit was performed using titanium dynamic mesh and silastic sheet. In 5 patients, repositioning of the malunited zygoma was done as concomitant surgery. The aesthetic and functional results were satisfactory. The results were good in 5 patients(72%) and fair in 2 patients(28%). Postoperative improvement of enophthalmos and ocular dystopia were statistically significant by paired t-test(p-value<0.05). No patients complained of postoperative lower lid ectropion. Finally, this approach is much advantageous in patient with severe post-traumatic enophthalmos as wide exposure of lesion and no visible scar on lower lid.
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류민희,김효헌,정재호 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.2
Purpose: Breast reconstruction with deep inferior epigastric perforator(DIEP) free flap is known to be the most advanced method of utilizing autologous tissue. The DIEP free flap method saves most of the rectus abdominis muscle as well as anterior rectus sheath. Therefore, the morbidity of the donor site is minimized and the risk of hernia is markedly decreased. Methods: We chose the internal mammary artery and its venae comitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels. The number and location of the perforators derived from medial or lateral branch of deep inferior epigastric artery(DIEA) in 23 DIEP flaps were identified. Ten patients underwent evaluation of their abdominal wall function preoperatively and 6 months postoperatively by using Lacote's muscle grading system.Results: Of the 23 patients, a patient with one perforator from lateral branch of DIEA experienced partial necrosis of flap. Total flap loss occurred in one patient. Mild abdominal bulging was reported in one patient 4 months postoperatively probably because of early vigorous rehabilitational therapy for her frozen shoulder. Postoperative abdominal wall function tests in 10 patients showed almost complete recovery of muscle function upto their preoperative level of upper and lower rectus abdominis and external oblique muscle function at 6 months postoperatively. All patients have been able to resume their daily activities.Conclusion: The breast reconstruction with DIEP free flap is reliable and valuable method which provide ample soft tissue from abdomen without compromising the integrity of abdominal wall. Selection of reliable perforators is important and including more than two perforators may decrease fat necrosis and partial necrosis of flap.
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미세수술을 이용한 하지의 재건시 삼차원 컴퓨터 혈관조영술의 유용성
성용덕,김효헌 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.2
Preoperative angiography is frequently used in the planning of microsurgical reconstruction for identification of vascular abnormality that influence the planning of operation. But, recently 3D CT angiography is considered as new technique that can provide detailed information about vascular anatomy as well as soft and bony tissue without the risks of invasive angiography. 3D CT angiograms were performed in 19 patients before microsurgical reconstruction for the lower extremity and hand between May of 2003 and Oct of 2004. Sixteen of the studies were of the donor site and all of 19 studies were of the recipient site. No complications were found from the 3D CT angiograms. In one case of the bone exposed open wound, the injury of anterior tibial artery was identified and the zone of injury was adequately demonstrated. With the improvement in quality of CT imaging, 3D CT angiograms may provide a favorable alternative to invasive angiography. It is capable of providing high-resolution, three dimensional vascular imaging without the need for arterial puncture and prolonged post-procedure observation. The relation among blood vessels, bones, and soft tissue is well demonstrated in 3D CT angiogram. Also The acquisition time and examination cost were considerably lower in comparison with invasive angiography. In conclusion, this study demonstrates that 3D CT angiography may provide accurate, safe, and cost-effective preoperative imaging. The 3D CT angiography with relatively low morbidity, low cost, ease of image acquisition can have an broader role in microsurgical reconstructive surgery
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