내시경적 점막절제술 후 발생한 위천공의 성공적인 보존적 치료 1예

양정채,박은하,이준행,이풍렬,김재준,백승운,이종철 대한내과학회 2004 대한내과학회지 Vol.66 No.5

위장관 천공은 내시경적 점막절제술 후 발생할 수 있는 중대한 합병증으로 현재까지 이에 대한 치료 방법은 정립되지 않은 상태이다. 본 증례는 점막층에 국한된 위선암에 대한 내시경적 점막절제술 후 위천공이 발생한 경우로서 아주 작은 미세천공(microperforation)이었고, 최근 시도되고 있는 내시경적 클립 시술의 적응이 되지 못했다. 하지만 임상적인 복막염 발생 및 진행의 징후가 보이지 않아 금식, 광범위 항생제 투여 등의 보존적 요법으로 치료를 시행하였고, 시술 일주일 후 복막염의 발생이나 진행 없이 호전되어 퇴원하였다. 본 증례는 내시경적 점막절제술 후 발생한 미세 천공의 제한적인 경우에 한하여 수술이나 내시경적 치료를 하지 않고 보존적 요법만으로 성공적인 치료를 시행한 예로 문헌고찰과 함께 보고하는 바이다. The serious complication after endoscopic mucosal resection (EMR) was bleeding and perforation. Most of bleedings could be controlled by endoscopic procedure. However, the strategy of treatment for perforation was not established. A 60- year-old man was admitted to our center for EMR of gastric adenomatous lesion. After EMR, perforation in stomach was detected by peumoperitoneum on plain upright chest X-ray. We treated with conservative management such as withholding of oral intake, adminstration of broad-spectrum antibiotics, parenteral nutrition and close monitoring. There were no worsening clinical sings of peritoneal inflammation except mild leukocytosis during the in-hospital course. On the third hospital day after EMR, the patient resumed oral intake. The seventh hospital day, he was discharged. Our experience showed that selected small microperforation in stomach after EMR could be treated by not endoscopic procedures or surgical interventions but conservative management.

Fabrication of Stable Cartilage Framework for Microtia in Incomplete Synchondrosis

조병채,이정헌,최강영,양정덕,정호윤 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.2

The synchondrosis between the sixth and seventh costal cartilage is usually used for the base frame in autogenous ear reconstruction. If the synchondrosis is loose, a variety of modifications can be devised. This report introduces new methods for these problems. In cases of incomplete synchondrosis, only the surface of the base block margin was smoothly tapered without carving for the removal of the conchal deepening. The secure fixation of the two segments (helix and antihelix) to the base block using fine wire sutures gave stability to the unstable basal frame. After confirming that all the segments were assembled in one stable piece, the remaining conchal deepening of the basal framework was removed, and the outer lower portion of the basal cartilage was trimmed along its whole length. A total of 10consecutive patients with microtia, ranging from 8 to 13 years old, were treated from 2008 to 2009. The follow-up period was 6 months to 2 years. Despite incomplete synchondrosis, the stable frameworks were constructed using the authors’ method and aesthetically acceptable results were achieved. The proposed method can provide an easy way to make a stable cartilage framework regardless of the variable conditions of synchondrosis.

진행성 유방암에서 즉시 유방 및 흉벽 재건술

양정덕,김학태,정호윤,조병채,최강영,이정훈,박호용,이정우 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.5

Purpose: Advanced breast cancer traditionally has been perceived as a contraindication to immediate breast reconstruction, because of concerns regarding adjuvant treatment delays and the cosmetic effects of radiotherapy to breast reconstruction, so delayed reconstruction is usually preferred in advanced breast cancer patients undergoing mastectomy. However, with the improved outcome using multimodality therapy, consisting of perioperative chemotherapy and radiotherapy, immediate breast reconstruction is now being performed as surgical option for selected advanced breast cancer patients. Additionally, advanced breast cancer patients may be needed soft tissue coverage of an extensive skin and soft tussue defect after mastectomy. Current authors have experienced several types of immediate breast and chest wall reconstruction for advanced breast cancer. Methods: From December of 2007 to June of 2009, 14 women performed for immediate breast and chest wall reconstruction for advanced breast cancer. They had been treated with neoadjuvant chemotherapy or chemoradiotherapy followed by modified radical mastectomy or radical mastectomy. Four different techniques were used immediate breast and chest wall reconstruction, which are pedicled TRAM flap(4 cases), extended LD flap with STSG(3 cases), thoracoabdominal flap(4 cases) and thoracoepigastric flap(3 cases). Results: The mean age was 53 years and mean follow up period was 9 months. Patients’ oncologic status ranged stage IIIa to stage IV. Two patients had major complications: partial flap necrosis of TRAM flap and one distal necrosis of thoracoabdominal flap. Three patients with stage IV disease died from metastases. Conclusion: The result of this study suggests that immediate breast and chest wall reconstruction can be considered as surgical option for advanced breast cancer. But we need long term follow up and large prospective studies for recurrence and survival.

측두삼각 V-Y 전진피판을 이용한 매몰이의 수술적 교정

조병채,양정덕 대한미용성형외과학회 2005 Archives of Aesthetic Plastic Surgery Vol.11 No.1

A new approach is introduced for the correction of cryptotia using a large triangular flap, which is designed on the temporal scalp and skin over the auricle. The posterior limb of the triangular flap was continued to the mastoid area at the mid-portion of the auricle. The abnormal insertion of the auricular intrinsic muscles was detached. A sharply curved antihelical crus or a contraction of helical cartilage was corrected. After providing ample skin to maintain the auriculocephalic sulcus by inferior advancement of the flap, the donor was closed primarily. From 1999 to 2003, a total of 13 cases of 11 patients with cryptotia were treated. Nine were unilateral and two bilateral. In the nine patients of unilateral cryptotia, three were on the left and six were on the right side. The follow-up period was three months to one year with relatively favorable results. There were no postoperative complications, such as necrosis or infection of the flaps. In conclusion, the main advantages of the author's proposed technique are simple and easy design, provision of enough skin to the upper and posterior portion of the auricle, sufficient depth of the auriculocephalic sulcus, correction of cartilage deformities with unrestricted access, and no need for additional skin grafting. Problems encountered were the development of a visible scar on the donor site and lowered hairline by advancement of the temporal triangular flap.

Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

양정덕,Min Chul Kim,이정우,Young Kyoo Cho,최강영,정호윤,조병채,박호용 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.5

Background In Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases,oncoplastic volume replacement techniques are more useful. Methods From January 2007 to December 2011, 104 women underwent a total of 107 breastconserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD) myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP) flap or a thoracodorsal artery perforator (TDAP) flap. Results The mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9), thoracoepigastric flap (n=7), ICAP flap (n=25), TDAP flap (n=12), and LD flap (n=54). There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results. Conclusions Oncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

Our Experiences in Nipple Reconstruction Using the Hammond flap

양정덕,류정엽,류동완,권오현,배성건,이정우,최강영,정호윤,조병채 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5

Background: Nipple reconstruction following breast mound reconstruction is the final step inbreast reconstruction. Although nipple reconstruction is a simple surgery, the psychologicalaspects of nipple reconstruction are thought to be important. Nipple projection is a key factorin determining patient satisfaction with the surgery. In the present study, the Hammond flaptechnique was introduced for nipple reconstruction. Methods: Twenty-six patients who had undergonebreast reconstruction from February 2008to March 2012 were enrolled in this prospectivestudy. All patients were evaluated based onpreoperative photos, and their nipple diametersand heights were measured. Postoperativeevaluation was conducted 3, 6, 9, and 12 months following nipple reconstruction. Aquestionnaire on patient satisfaction with the nipple reconstruction was administered 12months after nipple reconstruction. Moreover, the same plastic surgeon scored nippleprojection and overall cosmetic result of the new nipple. Results: The mean projection was 4.4 mm (range, 3–6 mm), and it well matched the contralateralnipple. Twelve months following nipple reconstruction, the mean reduction rate inthe nipple projection was 43.6%. Patients were satisfied or very satisfied with the nippleprojection and the overall cosmetic result in 80.7% cases. Conclusions: In the present study, compared with other techniques, the use of the Hammondflap technique in nipple reconstruction showed competitive results with regard to nippleprojection and patient satisfaction.

Biosynthesis of Poly(2-hydroxybutyrate-co-lactate) in Metabolically Engineered Escherichia coli

채철기,이상엽,이혁,박시재,김유진,이세진,오영훈,양정은,주정찬,강경희,장영아,박아름,송봉근 한국생물공학회 2016 Biotechnology and Bioprocess Engineering Vol.21 No.1

We have previously reported in vivo biosynthesis of polyhydroxyalkanoates containing 2-hydroxyacid monomers such as lactate and 2-hydroxybutyrate in recombinant Escherichia coli strains by the expression of evolved Clostridium propionicum propionyl-CoA transferase (PctCp) and Pseudomonas sp. MBEL 6-19 polyhydroxyalkanoate (PHA) synthase 1 (PhaC1Ps6-19). Here, we report the biosynthesis of poly(2-hydroxybutyrate-co-lactate)[P(2HB-co- LA)] by direct fermentation of metabolically engineered E. coli strain. Among E. coli strains WL3110, XL1-Blue, and BL21(DE3), recombinant E. coli XL1-Blue strain expressing PhaC1437 and Pct540 produced P(76.4mol%2HB-co- 23.6mol%LA) to the highest content of 88 wt% when it was cultured in a chemically defined medium containing 20 g/L of glucose and 2 g/L of sodium 2-hydroxybutyrate. When recombinant E. coli XL1-Blue strain expressing PhaC1437 and Pct540 was cultured in a chemically defined medium containing 20 g/L of glucose and varying concentration of sodium 2-hydroxybutyrate, 2HB monomer fraction in P(2HB-co-LA) increased proportional to the concentration of sodium 2-hydroxybutyrate added to the culture medium. P(2HB-co-LA)] could also be produced from glucose as a sole carbon source without sodium 2-hydroxybutyrate into the culture medium. Recombinant E. coli XL1-Blue strain expressing the phaC1437, pct540, cimA3.7, and leuBCD genes together with the L. lactis Il1403 panE gene, successfully produced P(23.5mol%2HB-co- 76.5mol%LA)] to the polymer content of 19.4 wt% when it cultured in a chemically defined medium containing 20 g/L of glucose. The metabolic engineering strategy reported here should be useful for the production of novel copolymer P(2HB-co-LA)].

유전자 재조합으로 만든 T-CAM(Tetra Cell Adhesion Molecule)이 창상치유에 미치는 효과

양정덕,박재우,이신일,정재영,정호윤,조병채,백봉수,김인산 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.4

T-CAM(Tetra cell adhesion molecule) is new recombinant mixture of fibronectin and βig-h3. Fibronectin and βig-h3 are extracellular matrix protein involved in each phase of wound healing and sum of these materials may play synergistic effect on the wound healing. In order to evaluate wound healing effect of T-CAM on open wound in rabbit, we made four round full thickness skin defects, 3 cm in diameter, bilaterally on the dorsolateral aspect of New Zealand white rabbit's trunk. We divided the wound into four groups, according to the content of topocally applied onitments: Group A treated with ointment base only; Group B with ointment containing fibronectin 300μg/ml; Group C with ointment containing βig-h3 300μg/ml; Group D with ointment containing T-CAM 300μg/ml. These ointments were applied daily on the wound. We compared each group with gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area with surface tracing the remained wound area on the 0, 6,th 12th, 18th day after wound formation and wound biopsy were performed on the 3rd, 6th, 10th, 14th, and 21st day after wound formation.The T-CAM group shows statistically significant (p< 0.05 ANOVA test and Scheffe's test) in wound contraction and total wound healed area than other groups on the 6th day after wound formation, and equally significant on the 12th and 18th day after wound formation except in group C. In histological examination, T-CAM group shows less inflammatory cell infiltration, faster angiogenesis and marked fibroblast proliferation than other groups in early inflammatory period, and more matured, thickened reepithelization and regularly aligned collagen formation on the 14th and 21st day.This study suggest recombinant T-CAM shows synergistic effect on wound healing, and is expected as new potent material for treatment of wound healing.

Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

양정덕,류동완,이정우,최강영,정호윤,조병채,박호용,변진석 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.4

Background Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer. Methods From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons. Results The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15), the lower lateral quadrant (n=2), and the central lateral area (n=3). Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes. Conclusions Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

Contralateral Breast Management Related to Breast Reconstruction in Korean Females

양정덕,이정훈,정호윤,조병채,박호용,정진향 한국유방암학회 2010 Journal of breast cancer Vol.13 No.2

Purpose: The final purpose of post mastectomy reconstruction is a balanced, symmetrical, pleasing appearance for both breasts. However, in cases where women have an unattractive breast, which may be small, ptotic or huge, remodeling of the contralateral breast may be desirable. Surgical options available for the contralateral breast included breast augmentation using implants, mastopexy, and reduction mammoplasty. Methods: All patients who underwent unilateral breast reconstruction at Kyungpook National University Hospital from September of 2006 to February of 2008 were included in this study. The methods of reconstruction included transverse rectus abdominis musculocutaneous flap, latissimus dorsi flap, and the use of implants. Contralateral procedures to achieve symmetry included augmentation,mastopexy, and reduction. Results: A total of 57 patients were evaluated, including 45 immediate, and 12 delayed reconstructions. Twenty-six of these patients underwent contralateral breast management (augmentation [12], mastopexy [11], and reduction [3]). The average age was 44.9 years and the mean follow up interval was 13 months. Most of the patients were satisfied with the symmetry, clothed appearance, nude appearance, aesthetics, and consistency. Sixtysix percent (8 of 12) of delayed reconstruction patients had a symmetry procedure performed on the opposite breast, compared with 40 percent (18 of 45) of the immediate-reconstruction patients. No complications were observed on the contralateral breasts undergoing symmetrization. Conclusion: Contralateral management in breast reconstruction can provide symmetry with the reconstructed breast contour and aesthetically satisfactory results in a safe manner. Immediate symmetrization procedure also can avoid secondary operations and offer psychological benefits without delaying adjuvant therapy.