배곧은근의 혈관 주행에 관한 시신해부 및 컴퓨터단층촬영

손대구,박병주,김진한,최태현,김준형,한기환 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.6

Purpose: Pedicled transverse rectus abdominis myocutaneous(TRAM) flap has been a gold standard for breast reconstruction and one of surgical techniques preferred by many surgeons. The authors examined the course of deep epigastric artery focusing on distance from margins of rectus abdominis to pedicle and location of choke vessels to get minimal muscles during pedicled TRAM flap operation. Methods: Eleven rectus abdominis muscle from nine cadavers were used in this study. Rectus abdominis was separated from the cadavers, deep inferior and superior epigastric artery were isolated and then 8 anatomical landmarks in medial and lateral margins of rectus abdominis were designated. Distance to a pedicle meeting first horizontally was measured and vertical location from umbilicus to choke vessel was determined. In addition, 32 rectus abdominis images of 16 women(average age: 37.2 years old) from 64 channel abdomen dynamic computerized tomography were also examined with the same anatomical landmarks with those of cadavers. Results: Average distance from four landmarks on lateral margin of rectus abdominis to pedicle was 1.9- 3.4cm and 1.8-3.8 cm on medial margin. Choke vessel was located between middle and inferior tendinous intersection in all cases and average distance between two tendinous intersection was 6.7-7.0cm on medial margin and 6.2cm on lateral margin. Location of inferior tendinous intersection was on umbilicus or superior of it in all cases and its average distance from umbilicus was 1.8-5.6cm on medial margin and 2.7- 6.2cm on lateral margin. Conclusion: Distance from medial and lateral margins of rectus abdominis muscle to pedicle was the shortest in inferior tendinous intersection and that was averagely 1.8cm on medial margin and 1.9cm in average on lateral margin. All choke vessels were located between middle and inferior tendinous intersection.

복합조직이식을 이용한 갈고리 손톱 변형 교정의 임상례

손대구,손형빈,김현지 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.3

Purpose: Hook nail deformity is caused by inadequately supported nail bed due to loss of distal phalanx or lack of soft tissue, resulting in a claw-like nail form. A composite graft from the foot bencath the nail bed gives adequate restoration of tip pulp.Methods: From September of 1999 to March of 2004, six patients were treated for hook nail deformity and monitored for long term follow up. Donor sites were the lateral side of the big toe or instep area of the foot. We examined cosmetic appearance and nail hooking and sensory test. The curved nail was measured by the picture of before and after surgery.Results: In all cases, composite grafts were well taken, and hook nail deformities were corrected. The curved nail of the 4 patients after surgery were improved to average 28.7° from average 55.2 before surgery. The static two point discrimination average was 6.5mm and the moving two point discrimination average was 5.8mm in the sensory test. Conclusion: Composite graft taken from foot supports the nail bed with the tissue closely resembling the fingertip tissue, making it possible for anatomical and histological rebuilding of fingertip.

당뇨병성 족부병변의 부위에 따른 전략적 재건

손대구,박병주,한기환 啓明大學校 醫科大學 2002 계명의대학술지 Vol.21 No.1

당뇨병 환자의 사망률과 하지절단의 주요 원인이 되는 족부병변은 내과분야와 재건외과분야의 협진을 통하여 예방 및 치료할 수 있다. 즉, 초기에 적극적인 혈당조절과 환자에 대한 적절한 교육으로 궤양이 발생하지 않도록 예방하며, 일단 발생하더라도 조기에 발견하여 적극적으로 치료하면 하지를 절단하지 않고 보존할 수 있다. 저자들은 4년간 보존적 방법으로 치료가 어려운 20명의 환자에서 병변의 정도와 범위 및 부위에 따라 적절한 수술방법을 선택하고 적용하여 보행에 불편이 없도록 치료할 수 있었다. 절단이 필요한 2례에서 유리피판술을 시행하여 하지절단을 막고 보행이 가능하게 하였으며, 조기 재활치료를 할 수 있게 하였다. Diabetic foot is one of the most frequent complications with nephropathy and retinopathy in patients with diabetes mellitus. Approximately 4.9% of diabetic patients admitted suffer from foot problems and it tends to increase every year. The major causes of diabetic foot have been known to be diabetic neuropathy and peripheral vascular diseases. The objective of this study was to devise a strategic surgical treatment of the diabetic foot for limb salvage and early ambulation. We studied 22 cases of diabetic foot of 20 patients for 4 years since May, 1998. The patients in cluded 13 males and 7 females in age ranging from 37 to 68 (mean 52) years. According to the sites of the wound involved, we classified the patients into 4 groups and the surgical operations were performed for resforation of the function of the site involved. Except one patient who had received skin graft, all the patients had primary wound healing in operated sites without specific complications and they were able to do early ambulation. We concluded that, with appropriate preoperative evaluation and operation, effective postoperative care would reduce amputation rate and help to achieve early rehabilitation.

족배동맥 유리피판술을 이용한 수부 재건: 공여부 이환율 최소화 방법

손대구,김현지,김준형,한기환,Son, Dae Gu,Kim, Hyun Ji,Kim, Jun Hyung,Han, Ki Hwan 대한미세수술학회 2004 Archives of reconstructive microsurgery Vol.13 No.1

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.

Large Auricular Chondrocutaneous Composite Graft for Nasal Alar and Columellar Reconstruction

손대구,Minho Kwak,Sangho Yun,Hyeonjung Yeo,김준형,한기환 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.4

Background Among the various methods for correcting nasal deformity, the composite graft is suitable for the inner and outer reconstruction of the nose in a single stage. In this article, we present our technique for reconstructing the ala and columella using the auricular chondrocutaneous composite graft. Methods From 2004 to 2011, 15 cases of alar and 2 cases of columellar reconstruction employing the chondrocutaneous composite graft were studied, all followed up for 3 to 24months (average, 13.5 months). All of the patients were reviewed retrospectively for the demographics, graft size, selection of the donor site and outcomes including morbidity and complications. Results The reasons for the deformity were burn scar (n=7), traumatic scar (n=4), smallpox scar (n=4), basal cell carcinoma defect (n=1), and scar contracture (n=1) from implant induced infection. In 5 cases of nostril stricture and 6 cases of alar defect and notching, composite grafts from the helix were used (8.9×12.5 mm). In 4 cases of retracted ala, grafts from the posterior surface of the concha were matched (5×15 mm). For the reconstruction of the columella,we harvested the graft from the posterior scapha (9×13.5 mm). Except one case with partial necrosis and delayed healing due to smoking, the grafts were successful in all of the cases and there was no deformity of the donor site. Conclusions An alar and columellar defect can be reconstructed successfully with a relatively large composite graft without donor site morbidity. The selection of the donor site should be individualized according to the 3-dimensional configuration of the defect.

얕은 지방층을 포함한 피부복합조직이식을 이용한 손화상 반흔구축의 교정

손대구,정회준,최태현,김준형,한기환 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.6

Purpose: Split or full thickness skin graft is generally used to reconstruct the palmar skin and soft tissue defect after release of burn scar flexion contracture of hand. As a way to overcome and improve aesthetic and functional problems, the authors used the preserved superficial fat skin(PSFS) composite graft for correction of burn scar contracture of hand. Methods: From December of 2001 to July of 2007, thirty patients with burn scar contracture of hand were corrected. The palmar skin and soft tissue defect after release of burn scar contracture was reconstructed with the PSFS composite graft harvested from medial foot or below lateral and medial malleolus, with a preserved superficial fat layer. To promote take of the PSFS composite graft, a foam and polyurethane film dressing was used to maintain the moisture environment and Kirschner wire was inserted for immobilization. Before and after the surgery, a range of motion was measured by graduator. Using a chromameter, skin color difference between the PSFS composite graft and surrounding normal skin was measured and compared with full thickness skin graft from groin. Results: In all cases, the PSFS composite graft was well taken without necrosis, although the graft was as big as 330mm2(mean 150mm2). Contracture of hand was completely corrected without recurrence. The PSFS composite graft showed more correlations and harmonies with surrounding normal skin and less pigmentation than full thickness skin graft. Donor site scar was also obscure. Conclusion: The PSFS composite graft should be considered as a useful option for correction of burn scar flexion contracture of hand.

복합피부조직이식술을 이용한 외상성 수지만곡증의 교정

손대구,박성철,김현지 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.5

The electrical burn or amputation of fingers gives damages not only to the soft tissue, but also to the bone, tendon and joint structure and causes severe deformity. To correct severe deformity, surgeons perform osteoplasty, tenolysis, capsulotomy, arthro- plasty, and flap surgery. However, such surgery can not be performed under some circumstances because patients wish to undergo surgery step-by-step, in stead of taking all at once. The deformity would have been more severe if the corrective surgery had been delayed without any treatment. The authors have reconstructed only soft tissue using the preserved superficial fat skin graft taken from the medial side of the foot or great toe. Nine patients who had deviated fingers were corrected from June 2001 to June 2002. Seven patients had deformity due to electrical burn, one due to amputation and the other due to congenital syndactyly. The period of follow-up was from 19 to 31 months. At surgery, a skin incision on the scar vertical to the finger and release of contraction of the deviated finger was performed. The soft tissue defect was reconstructed with a composite graft taken from medial side of the foot or great toe, with a preserved superficial fat layer. To accelerate healing of the grafted tissue, antibiotic ointment was applied to preserve the moisture environment. The composite graft was well taken without complication, and especially, there was no necrosis although the composite tissue was as big as 18×15mm to 33×11mm. The preoperative deformity was corrected better than we expected after surgery. The color and tissue texture were excellent and well harmonized with the surrounding skin, and the donor site healed without complication. We also observed a new bone formation in some cases.

Overview of Surgical Scar Prevention and Management

손대구,Aram Harijan 대한의학회 2014 Journal of Korean medical science Vol.29 No.6

Management of incisional scar is intimately connected to stages of wound healing. Themanagement of an elective surgery patient begins with a thorough informed consentprocess in which the patient is made aware of personal and clinical circumstances thatcannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. Inscar prevention, the single most important modifiable factor is wound tension during theproliferative and remodeling phases, and this is determined by the choice of incisiondesign. Traditional incisions most often follow relaxed skin tension lines, but no such linesexist in high surface tension areas. If such incisions are unavoidable, the patient must beinformed of this ahead of time. The management of a surgical incision does not end whenthe sutures are removed. Surgical scar care should be continued for one year. Patientparticipation is paramount in obtaining the optimal outcome. Postoperative visits shouldscreen for signs of scar hypertrophy and has a dual purpose of continued patient educationand reinforcement of proper care. Early intervention is a key to control hyperplasticresponse. Hypertrophic scars that do not improve by 6 months are keloids and should bemanaged aggressively with intralesional steroid injections and alternate modalities.

1년 이상 냉동 보관한 흡인 지방조직 내의 세포 생존

손대구,오재훈,김준형,한기환,최태현 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.2

Purpose: The use of an autogenous fat graft has become a common procedure in plastic surgery. However, questions remain concerning on the viability of fat cells and preservation method of aspirated fat. The purpose of this study was to examine the viability of fat cells stored at -20℃ in the freeze for 1 year after harvest from abdominal liposuction. Methods: Eighteen adults (aged 24 to 65 years old, 16 female and 2 male) were recruited for this study. Harvested aspirated fat tissues were obtained by suction - assisted lipectomy and frozen at -20℃ commercial refrigerator for one year (average 12.5 months). The viability off at cells in specimens were measured after thawing. The numbers of viable cells were measured on a fluorescence microscope after staining with fluorescein diacetate and propidium iodide. GPDH (Glycerol - 3 - phosphate dehydrogenase) activity was measured. Cell culture was done for 3 weeks. Results: There were no viable cells under the fluorescence microscope, no detectable GPDH activity, and no cultured cells. Conclusion: These findings suggest that aspirated fat after frozen storage for one year at -20℃ freezer is inadequate to reuse.

표준화된 화상 모델에서 화상 후 첫 24시간 내의 화상 깊이의 변화

손대구,최태현,권선영 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.4

Purpose: In full thickness burn, the depth of burn is known to increase until around 1-3 days after the burn. However, no study on how the depth increase during the first 24 hours has been conducted. Therefore, the authors investigated how the depth of burn changes within the first 24 hours after the burn by using the standardized burn model. Received April 8, 2008 Revised May 6, 2008 Accepted May 22, 2008 Address Correspondence: Dae Gu Son, M.D., Department of Plastic and Reconstructive Surgery, Keimyung University, Dongsan Medical Center, 194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea. Tel: 053)250-7636/Fax: 053)255- 0632/E-mail: handson@dsmc.or.kr * 본 연구는 2005년도 계명대학교 삼성안과 연구비로 이루어졌음. * 본 논문은 2007년 제 63차 대한성형외과학회 학술대회에서 포스터 발표되었음. Methods: A total of four experiments on pigs were carried out for this study. Experiment 1 was performed to examine how temperature affects the depth of burn. The digitally controlled aluminum thermal block was set at different temperatures-80, 90 and 100 degrees in Celsius, respectively. Then the pig was exposed to the block for 15 seconds each time. The time exposed to heat was set as a variable for the Experiment 2. The temperature was maintained at 80 degrees Celsius, and the pig was contacted with the thermal block for 5, 10 and 20 seconds, respectively. The biopsy of the tissues were performed in one hour, 6 hours, 24 hours, and 7 days after the burn. After hematoxylin and eosin staining a percentage of the depth from a basement membrane of epidermis to the deepest tissue damaged by the burn against total dermal thickness was measured. Results: In Experiment 1, the depth of burn increased considerably as time passed by. At all three temperatures, differences in depths measured in 6 and 24 hours, and in 1 hour and 7 days were both significant. In addition, the depth deepened as the temperature went higher. In the case of Experiment 2, the depth of burn also increased significantly as time passed by. At all three times, differences in depth measured in 6 and 24 hours, and in 1 hour and 7 days were also significant. Moreover, the depth extended with longer contact time when it was compared according to the time. Conclusion: Full thickness burn progressed rapidly from 6 to 24 hours after the burn and the depth of burn was almost decided within the first 24 hours after the burn. On the other hand, partial thickness burn also advanced from 6 to 24 hours after the burn but the depth deepened at slower level.