정맥주위조직이 단일정맥을 혈관경으로 하는 정맥피판의 생존에 미치는 영향

어수락,김광석,김대영,이삼용,조백현 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.1

For the venous flap to survive, it apparently needs to be a flow-through of venous blood.1 Nevertheless, controversy remains, regarding the fact that an island flap based on a terminating venous pedicle is capable of maintaining viability.2-15 This study was designed to investigate the role of perivenous areolar tissue in the viability of island flaps with an exclusively venous pedicle in the rabbit ear model as described by Inada et al.16 Ten groups of flaps were studied: Group A-flaps based on a proximal venous pedicle; group B-flaps based on a distal venous pedicle; group C- nonvascularized grafts; each subgroup A1-, B1-flaps with perivenous areolar tissue; each subgroup A2-, B2-flap which was skeletonized pedicle; each subgroup A3-, B3-flap was same as A1-, B1-flap, which was sutured over a silastic sheet; each subgroup A4-, B4-flap with a skeletonized venous pedicle sutured over a silastic sheet; subgroup C1-control, placed directly on bed; subgroup C2-control which was sutured over a silastic sheet. Groups A3, A4, B3 and B4 had 20 flaps and the remaining groups had 10 flaps each. Flaps in group A1, A3, B3 had total survival. In groups A4, B4, C2, no flaps were survived. The survived flaps in groups A3 and B3 had tissue oxygen content values between those of arterial and venous levels. Histological examination of the pedicle of survived flaps in groups A3 and B3 showed small vascular channels present in the areolar tissue surrounding the venous pedicle. Static and dynamic computerized radioactive tracer experiments showed that the survived flaps in groups A3 and B3 were promptly perfused and drained through their pedicles. This study confirms the importance of the perivenous areolar tissue for survival of the venous skin flap in the rabbit ear model.

Revisiting the Posterior Interosseous Artery Flap

어수락,Seung Hwan Hwang,홍기용,Soo A Lim,Gi Jun Lee 대한수부외과학회 2018 대한수부외과학회지 Vol.23 No.3

The posterior interosseous artery (PIA) flap is one of the options for hand and upper extremity reconstruction. It does not sacrifice the main arteries of the hand, the radial and ulnar arteries and could be used even when either artery was damaged. The PIA is a branch of the common interosseous artery, which is about 1 cm in distance from the ulnar artery, and runs down longitudinally in the intermuscular septum between the extensor carpi ulnaris and extensor digiti minimi. PIA appears to be relatively constant in position, and pro a reliable blood supply in the posterior aspect of the forearm. The PIA flap is reliable in its designs, even to making it possible to close the donor site primarily. It provides not only a thin, pliable coverage of the hand and upper extremity, but also a neurosensory flap. Technically, the dissection of the PIA pedicle along its course needs a high learning curve, because it might present the risk of venous congestion, ischemic flap necrosis, and injury to the PIN. Although the flap dissection seems to be difficult, it still offers increased versatility in reconstructions of the hand, foot, and upper extremity.

후대퇴부 전위피판을 이용한 좌골욕창의 재건

어수락,고준혁,김광석,김대영,이삼용,조백현 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.4

Wrist Pain due to Abnormal Extensor Carpi Ulnaris Tendon

어수락,박수진,Neil F. Jones 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.4

기저세포암 및 편평세포암에서 미세혈관밀도와 p53 단백 발현에 관한 연구

어수락,조규성,안호범,김대영,이삼용,조백현 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

Basal cell carcinoma(BCC) and squamous cell carcinoma (SCC) are very prevalent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well-established mutagen of the p53 gene and is one of basal cell carcinoma and squamous cell carcinoma. The newly-formed vascular network is important for neoplasms to grow beyond a size of about 1 ㎣. Recent reports have suggested the hypothesis that a mutant p53 protein is closely related with capillary density. Immumohistochemistry for p53 protein and CD34 was performed in 20 cases of BCCs and 14 SCCs to evaluated the relationship between p53 protein and capillary density. The results were as follows:1. The microvessels stained by CD34 were mainly located in the interface of tumor cells and stroma. 2. There was no difference in the microvessel density according to the histologic types and age of the patients, but a higher microvessel density was noted in male patients. 3. The aggressive BCCs and the less-differentiated SCCs showed higher p53 immunostaining. 4. The mean microvessel density of cases showing strong positive immunostaining of the p53 gene(54.73±17.75) was higher than that of others(39.75±18.30). These results suggested that p53 protein expression and microvessel density are not related to the histologic types and age of the patients, but that differentiation and biologic behavior such as the infiltrating property of tumors and the microvessel density are closely related to p53 protein expression.

이물 육아종 제거 후 음낭 피판을 이용한 음경 재건

권순범,어수락,조상헌,이광수,이해원 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

이물질 주사를 통한 음경 확대술은 비교적 흔히 행하여 지고 있는 시술로, 바셀린,실리콘과 파라핀 등이 주로 사용되고 있으며, 이로 발생하는 심각한후유증에 대한 경각심이 커짐에도 불구하고 음경의 둘레를 확대하기 위해 비의료인에 의해 행하여지고 있다. 합병증으로는 음경모양의 변형, 염증반응,피부괴사,육아종, 색전증과 악성 종양 등이 발생할 수 있다. 음경의 이물 육아종세 대한 치료는 이물질에 의하여 침윤된 피부,피하 조직의 완전한 제거와 다양한 국소 피판 또는 피부이식에 의한 음경 재피복으로 이루어 진다. 광범위한 음경 피부 결손의 경우 부분층 피부 이식이 우선 고려될 수 있으나, 음경해면체(corpora cavernosa)까지 이물질이 침윤한 경우 육아종의 완전한 제거가 불가능할 수 있으며, 수술 후 잔류 육아종은 피부이식의 생착을 어렵게 한다. 이러한 경우에는 안전한 음경 재피복을 위하여 음낭 피판을 사용할 수 있다. 음낭 피부는 이소성 모발성장을 보이는 경향에도 불구하고, 뛰어난 신축성과 풍부한 혈관 분포로 안해 마피 음경체(denuded penis)의 재피복을 위한 훌륭한 재료로 판단된다. 저자들은 음경의 이물 육아종 제거 후 발생한 광범위한 피부 결손이 었는 3명의 환자를 음낭 피판으로 치료하였다. 3명 모두에서 별다른 합병증 없이 만족스런 결과를 보였다. Penile augmentation with foreign body injection is a relatively common practice. Materials such as vaseline, silicone and paraffin are usually injected. Despite awareness of the potentially damaging effects of these practices, they are still being used by laymen in attempts to increase the circumference of the penile shaft. Penile deformity, inflammation, tissue necrosis, granuloma, embolism and malignant tumor are some of the complications that may follow. Treatment plan for patients with large penile foreign body granuloma include complete removal of foreign body infiltrated skin and subcutaneous tissue, followed by penile resurfacing with skin graft or various local flaps. Thick, nonmeshed, split-thickness skin grafts are preferred for extensive penile reconstruction. But, sometimes the foreign body infiltration of corpora cavernosa makes complete removal of foreign body granuloma impossible, and the remnant foreign body granuloma does not permit skin graft coverage. For patients with such problems, scrotal flaps can be utilized for safe coverage. The scrotal skin, with high elasticity and vascularity, has proven to be a good material for reconstruction of denuded penis, despite its hair bearing nature. We have treated 3 patients with penile foreign body granuloma using scrotal flaps. The postoperative course was uneventful. All flaps survived with no significant complications.

외측대퇴회선동맥 상행가지의 천공지피판을 이용한 대전자부 욕창의 재건

김준형,어수락,조상헌,Kim, Jun-Hyung,Eo, Su-Rak,Cho, Sang-Hun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Trochanteric pressure sores management has been improved through the development of musculocutaneous flaps. But it has many drawbacks such as donor site morbidity and functional muscle sacrifice. With the introduction of perforator flap, it is possible to use in every location where musculocutaneous perforators are present. We have reconstructed trochanteric pressure sores using perforator-based flaps from the ascending branch of lateral circumflex femoral artery. Methods: Between May of 2006 and April of 2008, we performed six cases of perforator-based flap from the ascending branch of lateral circumflex femoral artery for the coverage of trochanteric pressure sores. For identifying perforators, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella as the vertical axis, from the pubis to the trochanteric prominence as the horizontal axis. In the lateral aspect of the intersection of these two axes, various flap were designed according to its defects. The flap was raised in the subcutaneous plane above the fascia and the pedicle was traced by doppler and identified. The pedicle was meticulously dissected not to injure the periadventitial tissues and transposed to the defect. The donor site was closed primarily. Results: The mean age of patients was 56.2 years. Four male and two female patients were studied. Five patients were paraplegic. The mean defect size was $6{\times}4\;cm$. The largest flap dimension was $14{\times}7\;cm$. Donor sites were closed primarily without any complications. All flaps survived completely without necrosis, hematoma or infection. There were no recurrence during the follow-up period. Conclusion: Trochanteric pressure sores using perforator-based flap from the ascending branch of lateral circumflex femoral artery can be performed safely and it would be a reliable option for coverage of trochanteric pressure sores with minimal donor site morbidity.

가토모델에서 Lipo-PGE1이 복합조직이식편의 미세혈관신생에 미치는 영향

박지웅,어수락,조상헌,최종순,김어진,Park, Ji-Ung,Eo, Su-Rak,Cho, Sang-Hun,Choi, Jong-Sun,Kim, Eo-Jin 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: The survival of composite graft is dependent on three steps, (1) plasmatic imbibitions, (2) inosculation, and (3) neovascularization. Among the many trials to increase the survival rate of composite graft, prostaglandin E1 (PGE1) has beneficial effects on the microcirculatory level with vasodilating, antithrombotic, anti-inflammatory and neoangiogenic properties. Lipo-PGE1 which is lipid microspheres containing PGE1 had developed to compensate the systemic and local side effects of PGE1. This study was proposed to determine whether Lipo-PGE1 administration enhanced the survival of composite graft through neovascularization quantitatively in a rabbit ear model. Methods: Fourteen New Zealand White Rabbits each weighing 3~4 kg were divided in two groups: (1) intravenous Lipo-PGE1 injection group and (2) control group. A $2{\times}1\;cm$ sized, full-thickness rectangular composite graft was harvested in each auricle. Then, the graft was reaaproximated in situ using a 5-0 nylon suture. For the experimental group, $3{\mu}g$/kg/day of Lipo-PGE1 ($5{\mu}g$/mL) was administered intravenously through the marginal vein of the ear for 14 days. The control group was received no pharmacologic treatment. On the 14th postoperative day, composite graft of the ear was harvested and immunochemistry staining used Monoclonal mouse anti-CD 31 antibody was performed. Neoangiogenesis was quantified by counting the vessels that showed luminal structures surrounded by the brown color-stained epithelium and counted from 10 random high-power fields (400x) by independent blinded observer. Statistical analysis (Wilcoxon Signed Ranks test for nonparametric data) was performed using SPSS v12.0, with values of p<0.05 considered significant. Results: The mean number of the microvessels was $15.48{\pm}8.65$ in the experimental group and $9.82{\pm}7.25$ in the control group (p=0.028). Conclusion: The use of Lipo-PGE1 facilitated the neoangiogenesis, resulted in the improvement of the survival rate of graft. On the basis of this results, we could support wider application of Lipo-PGE1 for more effective therapeutic angiogenesis and successful survival in various cases of composite graft in the human.

오각형피판과 최소한의 피부이식을 이용한 합지증의 교정

배병만,어수락,김인규,고성훈,Neil F. Jones 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.1

Purpose: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. Methods: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. Results: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss.Conclusion: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.

이엽피판술을 이용한 비부 결손의 재건

김준형,어수락,조상헌 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

이엽피판술은 비첨부 결손에 처음 적용된 이래로, 안면부 결손에 다양한 쓰임새로 이용되어 왔다. 이엽피판술은 공통된 혈관줄기를 포함한 두 개의 엽으로 구성된 피판의 한 종류로, 본 저자들은 암종의 제거 후 발생한 안면부결손의 재건에 있어 이엽피판술의 유용함에 대해 보고하고자한다. 본 연구는 2005년 3월부터 2007년 9월까지 비부 결손에 이엽피판술을 이용하여 치료받은 환자를 대상으로 하였다. 총 7례의 비부에 발생한 기저세포 암 환자중, 비배부에 4례, 비첨부에 2례, 우측 비익연에 1례였으며,약 5 mm의 경계를 포함하여 병변을 완전 절제하였다. 비부에 발생한 결손을 피복하기 위해,첫 번째 엽은 결손부와 같은 크기로 도안하고,두 번째 엽은 첫번째 엽의 크기와 같거나 폭을 20~40% 감소된 크기로 도안하였다. 근육하층까지 박리한 뒤 60~90˚로 회전하여 결손부위를 피복하였다. 공여부는 일차봉합술을 시행하였다. 평균 결손의 크기는 1.5 cm이었고, 1례에서 일시적인 정맥울혈 소견을 보인 것 외에 피판들은 모두 생존하였으며, 혈종,감염,괴사와 같은 합병증은 발생하지 않았다. 추적 관찰기간 동안 환자들도 술 후 결과에 만족스러워 하였다. 이엽피판술은 적절한 색조와 질감을 제공할 뿐만 아니라,최소화된 견이변형, 회전축의 왜곡과 같은 합병증의 발생이 적어 안면부, 특히 비부결손의 재건에 있어 유용한 방법으로 사료된다. Since its first application on nasal tip defect, bilobed flap has been consistently applied in numerous practical uses for the reconstruction of various facial defects. It involves a plain flap, composed of two lobes forming an angle and with a common skin pedicle. We have corroborated the usefulness of bilobed flap in the reconstruction of nasal defects through cancer extirpation. This study was based on the patients who had been treated with the bilobed flap on nose between March 2005 and September 2007. There were seven cases of basal cell carcinoma, comprised of four on dorsum, two on tip, and one on right ala. The lesions were completely ablated along with sufficient safe margins. The primary lobe closest to the defect was drawn tangentially and the secondary lobe was designed for the primary lobe's defect. Both lobes were planned to be the same length as the width of the secondary lobe's defect was 20-40% narrower than the secondary defect. These flaps were dissected from the nasal framework to the submuscular layer and rotated at a range varying from 60-90°. The donor site of the flap was then closed primarily. The mean defect following cancers ablation was 1.5 cm in diameter. All the flaps were successfully survived but one case showed venous congestion temporarily at the wound margin. There were no hematoma, infection, necrosis. During the follow-up period, all patients were satisfied with the final results. For the reconstruction of nasal defects, bilobed flap provides adequate skin with good color and texture match, minimum of dogear formation, and little distortion at the pivot point compared with other local flaps.