Analysis of Intraoral Squamous Cell Carcinoma Reconstructed with Radial Forearm Flap

박명철(Myong Chul Park),David S Soutar 대한두경부종양학회 1994 대한두경부 종양학회지 Vol.10 No.1

미세외과 수술에 의한 유리 피판술의 도입은 두경부 종양제거후 재건에 괄목할 만한 진보를 가져왔다. 특히 광범위한 종양의 제거가 필요하며 인근의 조직으로 수복이 어렵고 기능 및 외모상의 재건이 문제가 되는 경우 유리 피판은 절대적인 적응이 된다. 구강은 언어구사 와 연하(deglutition)기능을 담당하므로 재건을 위해서는 얇고 부드러운 조직으로 수복하여 주어야 한다. 전완부 유리피판은 혈관경의 위치가 대부분 일정하고 종양 제거후 결손의 모양에 따라 피판을 계획할 수 있기 때문에 구강암 제거후 가장 많이 이용되는 유리피판이다. 저자는 1982년 부터 1988년까지 영국 글라스고우 소재 서부 스코틀랜드 성형 및 구강외과 병원에서 구강의 편평상피암환자로 암종제거 후, 전완부 피판에 의한 재건 및 방사선 치료를 받은 151명의 치료결과(재발율 및 생존율)를 분석하였다. 절제연의 종양조직의 양성(P<0.05), 경부 임파절의 extracapsular node spread여부(P<0.001), 경부 임파절 곽청술의 종류(P<0.05) 등은 재발율과 관련하여 통계적으로 유의하였다. 반면에 종양의 구강내 위치, 하악골의 침범여부등은 통계적의의가 없었다. 생존율에 관하여는 종양의 구강내 위치 (P<0.05), 종양절제연 종양여부(P<0.005), 하악골의 침범여부(P<0.05), 경부 임파절의 extracapsular node spread여부(P<0.001) 등이 통계적으로 유의할 만한 요소로 밝혀졌다. 젊은 나이의 환자들에서(50세이하) 특징적으로 높은 사망율을 보였다. 하악골절제방법의 차이는 환자의 생존예후에 통계적으로 유의할 만한 영향을 주지 못했다.

손가락 끝의 손상에 쓰이는 새로운 도서형 피판술

박명철 ( Myong Chul Park ),차진한 ( Jin Han Cha ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.1

Department of Plastic and Reconstructive Surgery, College of Medicine, Konkuk University, Seoul, Korea Fingertip is the part of the hand most frequently injured. Nail bed and fingertip injuries often result in time lost from work and even can be permanently disabling if imporperly repaired. The ideal fingertip reconstruction should attempt to maintain length, preserve nail functon, and provide sensate soft tissue covering without pain during use. Two kinds of island flaps based on single neurovascular bundle were used for fingertip reconstruction. The step-advancement island flap incorperated the step ladder principle with full tactile sensibility in the required position with the good soft tissue support. Innervated reverse vascular pedicle digital island flap is based on the digital palmar arch which is the anastomosis between the radial and ulanr sides of the finger at the level of 1/2 of middle finger.Sensation could be provided by the anastomosis between divided digital nerve and dissected digital nerve branch of the island flap. We report 25 cases of fingertip inj ury repaired with two kinds of new island flap techniques.

외측 상완 피판 : 그 응용과 우수성

박명철,박동하,이병민,김관식,Park, Myong-Chul,Park, Dong-Ha,Lee, Byeong-Min,Kim, Kwan 대한미세수술학회 1996 Archives of reconstructive microsurgery Vol.5 No.1

Lateral arm flap has been used for the reconstruction of the various defects in hand, head and neck region. This flap is highly dependable as a free flap because of its thin flap thickness, constant vascular anatomy and possibility of osteocutaneous flap and fascial flap. Recently, many authors tried extended approach for vascular pedicle and distal flap extension for bigger defects. In this study, we review previous articles and 14 cases used lateral arm flaps for coverage of the varying defect on head and neck, upper and lower extremities succesfully. In conclusion, lateral arm flap has constant anatomical structure and can overcome the disadvantages such as short pedicle length and limited flap size, then the range of its application can be very widened.

배꼽주위 관통지를 이용한 유리 피판

박명철,신예식,이병민,김관식,Park, Myong-Chul,Shin, Ye-Shik,Lee, Byeong-Min,Kim, Kwan 대한미세수술학회 1996 Archives of reconstructive microsurgery Vol.5 No.1

The rectus abdominis myocutaneous flap is frequently used in the field of plastic and reconstructive surgery such as breast reconstruction and as a donor of free tissue transfer. Major problems with this flap is bulkiness, the possibility of postoperative abdominal herniation and muscle weakness following the removal of the rectus abdominis muscle. We used paraumbilical perforator based skin flap fed by a muscle perforator from the deep inferior epigastric artery, with no or little muscle and fatty tissue, in three patients for the resurfacing of relatively wide and thin defects. This technique has all of the advantages of the conventional rectus abdominis myocutaneous flap with decreased possibility of postoperative abdominal herniation or muscle weakness. Another challenging merit is possibility of skin flap thinning.

전외측 대퇴 유리피판술을 이용한 연부조직 결손의 재건

박명철,이영우,이병민,김관식,Park, Myong-Chul,Lee, Young-Woo,Lee, Byeong-Min,Kim, Kwan-Sik 대한미세수술학회 1997 Archives of reconstructive microsurgery Vol.6 No.1

Since R.Y. Song(1982) has reported anatomic studies about septocutaneous perforator flap, various experiences especially on thigh flaps pedicled on septocutaneous artery were reported. Baek(1983) reported an anatomic study through the cadavers dissections on medial, lateral thigh area and provided the first new cutaneous free flap of thigh for clinical use. Song, et a1.(1984) reported anterolateral thigh free flap, Koshima, et al.(1989) reported pedicle variations and its versatile clinical usages. According to their reports, accessory branches of lateral femoral circumflex artery are placed in comparatively constant location and proved to be the effective pedicle of this flap. The advantages of anterolateral thigh free flap are 1) comparatively thin 2) can obtain sufficiently large flap 3) can contain cutaneous nerve 4) can be easy to approach anatomically because pedicle is located in comparatively constant position 5) minimal donor site morbidity. We report the experience of 10 cases of anterolateral thigh free flap coverage for soft tissue defects: 4 cases of soft tissue defects on foot area, 2 cases of soft tissue defects on hand, 3 cases of partial tongue defects owing to tongue cancer ablation, and 1 case of soft tissue defect on nasal alar.

유리 횡복직근피판술을 이용한 유방의 재건에서 수혜부 혈관으로 내유방혈관 천공지의 사용

박명철,이정훈,정재호,이승헌,Park, Myong-Chul,Lee, Jung-Hoon,Chung, Jae-Ho,Lee, Sung-Hun 대한미세수술학회 2001 Archives of reconstructive microsurgery Vol.10 No.2

Breast reconstruction is an aesthetically critical procedure and should be peformed to match the opposite breast in shape, contour, and position. Many methods were introduced to reconstruct the breast with autogenous tissue. But, free tissue transfer for breast reconstruction has become common method. The transverse rectus abdominis myocutaneous flap technique has been a widely accepted method of breast reconstruction after mastectomy, since the first introduction of free abdominoplasty flap in 1979. In breast reconstruction with a free flap the selection of suitable recipient vessels remains one of the most critical decision for surgeon. The most common recipient site for free flap breast reconstruction is the axillar system. But, the use of the axillary system as a recipient site limits flap movement and flexibility in breast shaping. The use of internal mammary vessels as a recipient site be able to achieve ideal breast symmetry, but that technique require the rib resection. The selection of suitable recipient vessels is most important for successful free tissue transfer. We have performed breast reconstruction with TRAM flaps anastomozed to the internal mammary vessel perforator. We came to the conclusion that this vessel perforator is useful as a recipient site in cases of immediate breast reconstruction with free TRAM flap.

입천장성형술 시 발생한 골 노출부의 피복을 위한 협지방대 유경피판의 경험

김치선,박명철,박동하,Kim, Chee-Sun,Park, Myong-Chul,Park, Dong-Ha 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: The primary goal of palatoplasty is to enable normal speech with harmonious growth of face. Some children who had palatoplasty display typical findings of transverse maxillary deficiency requiring orthodontic widening of the maxilla. Levi (2009) described a cleft palate repair coupled with pedicled buccal fat pad flaps to cover bone exposed areas of the hard palate. Hence we report clinical experiences of cleft palate repair using pedicled buccal fat pad flap. Methods: Four Veau class II and a Veau class I cleft palate patients underwent palatoplasty with buccal fat pad flap by single surgeon from April 2009 to August 2009. Two patients received 2-flap palatoplasty and three patients 1-flap palatoplasty, respectively. After the cleft palate repair, sharp mosquito scissors was placed in the superior buccal sulcus just lateral to the maxillary tuberosity and inserted directly through the mucosa resulting in buccal fat pad extrusion. The elevated flap was moved to cover mucoperiosteal defect in hard palatal area. Results: Five patients underwent primary palatoplasty using buccal fat pad flap. Flap harvest and inset took on average 9 minutes per flap. Mucosal epithelization took 18 days on average. No patients had complications related to the buccal fat pad flap. Conclusion: Buccal fat pad pedicled flap has significant potential to function as an added vascularized tissue layer in cleft palate repair and we can expect better growth of maxilla with this method although longer duration of follow-up was unavailable.

광배근-전거근 유리피판술을 이용한 광범위 복합조직 결손의 재건

신예식,박명철,이병민,김관식,Shin, Ye-Shik,Park, Myong-Chul,Lee, Byeong-Min,Kim, Kwan-Sik 대한미세수술학회 1995 Archives of reconstructive microsurgery Vol.4 No.1

Frequently, a single muscle flap is not enough to cover a large compound defects after extensive trauma or ablation of tumor. For a extensive defects, several kinds of flaps are available for various needs of reconstruction. The combined latissimus dorsi and serratus anterior flaps provide the largest possible soft tissue coverage. Two flaps composed of latissimus dorsi and serratus anterior muscles are consistently nourished through the subscapular-thoracodorsal vessels and their many branches, and thus the two flaps can be isolated with one vascular pedicled free flap. We experienced 4 cases of reconstruction in closure of extensive compound defects using the combined latissimus dorsi and serratus anterior muscles with one vascular pedicled free flap. The advantages of using these flaps are : 1) its versatlity and excellent malleability 2) easy to dissection 3) long-stalked pedicle 4) the use of a vascularized rib 5) negligible motor dysfunction from the muscle removal.

분만성 상완 신경총 손상, 선천성근성사경 및 구개열의 병발

이한별(Han Byul Lee),박명철(Myong Chul Park),김치선(Cheesun Kim),한재덕(Jae Deok Han),이승재(Seung Jae Lee),김세온(Se Yon Kim),임신영(Shin-Young Yim) 대한의학유전학회 2011 대한의학유전학회지 Vol.8 No.1

임신성 당뇨 및 조기양막파수를 보인 산모의, 다른 산전 병력 없이 과체중아로 태어난 생후 17일된 남아에서, 분만성 상완 신경총 손상, 선천성근성사경 및 구개열의 병발이 진단되었다. 동시에 세 질환의 병발이 단순 병발일 수 있으나, 세 질환을 동시에 유발할 수 있는 병인에 의한 것일 수 있으므로, 증례의 분석을 통하여 어머니의 임신성 당뇨에 의하여 이세 질환의 발생이 가능할 것으로 가정하였다. 모체의고혈당증은 주로 신경능선 조직에서 발생하는 태아구조에 영향을 주는 것으로 알려져 있고, 신경능선 조직에서 분화하는 조직들 중 하나인 구개골의 형성에 영향을 주어 구개열의 발생이 가능할 것으로 보이며, 임신성 당뇨에서 과체중아의 출생 빈도가 증가하므로, 이와 관련된 분만 손상 중 분만성 상완 신경총 손상 및 선천성근성사경의 발생이 가능할 것으로 판단된다. 따라서 임신성 당뇨가 있는 산모의 태아에서 구개열등의 선천성 기형의 위험성이 높으므로 산전 검사 시 유의해야하며, 과체중아에서 분만성 상완 신경총 손상과 선천성근성 사경의 위험성이 높으므로 이에 대한 주의와 확인이 필요할것으로 판단된다. 그러나, 분만성 상완 신경총 손상, 선천성 근성사경 및 구개열의 병발이 산모의 임신성 당뇨와 연관된 합병증일 수 있다는 것을 증명하기 위하여 향후 더 많은 증례를 통한 심화된 연구가 필요하다. A male infant was diagnosed with obstetric brachial plexus injury, congenital muscular torticollis and cleft palate 17 days after birth. His mother presented with gestational diabetes and premature rupture of membranes. Although it is possible that these three disorders arose independently, it is very likely that all three have the same etiologic cause, and we propose that a possible mechanism for this concurrence is related to maternal gestational diabetes. Maternal hyperglycemia mostly affects fetal structures deriving from the neural crest, including the palatine bone, and may have caused the cleft palate observed in this case. Gestational diabetes is also associated with increased frequency of large for gestational age infants and, by extension, with increased risk of birth injuries such as obstetric brachial plexus injury or congenital muscular torticollis associated with large for gestational age infants. Since the children of mothers with gestational diabetes are at increased risk for congenital defects such as cleft palate as well as being large for gestational age, precautions indicated for each respective disorder must be taken during prenatal testing and during birth. However, further studies of more cases are required to evaluate whether the concurrence of obstetric brachial plexus injury, congenital muscular torticollis and cleft palate in this case are complications specifically associated with gestational diabetes or just a simple coincidence.

귀에 발생한 가성낭종의 수술 후 실리콘 자석 압박 치료 사례 1예

설성훈(Seong Hoon Seol),정찬민(Chan Min Chung),박명철(Myong Chul Park) 대한두경부종양학회 2022 대한두경부 종양학회지 Vol.38 No.1

Endochondral pseudocyst of the ear is a rare, benign, non-inflammatory cystic disease. It is known that there are a variety of treatment methods for pseudocyst, which is mainly common in the scaphoid or triangular fossa of the ear. Pseudocyst formation is prevalent in the residual cavity of the ear. So, to prevent a recurrence, a surgical approach is also required, but management through compression is necessary after surgery. Applying a cube magnet to the lesion to press provides patient convenience and facilitates continuous management.