켈로이드 절제술 후 방사선치료 효과에 대한 후향적 연구

유원민,송승용,유대현,탁관철,박병윤,금기창 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.6

Purpose: Keloid is a clinical term characterized by elevation and extension of scar tissue beyond wound margin. Currently, there is no known treatment that shows consistent effect in all patients. Postoperative radiation therapy is known to prevent recurrence of keloid. Methods: We reviewed data of patients who had undergone operation or operation followed by radiation therapy at our institute for the last 12 years.Follow up was possible in 39 patients(21 patients treated only by operation and 18 treated by operation and radiation therapy) We then investigated recurrence in both groups by VAS score. By mail, patients were asked to score their current condition on the bar in 4 aspects(itching, pain, mass lesion(by patients and other persons)). Two criteria were used for defining successful treatment. One is the case which total VAS score was 0, and the other is sum of VAS score of mass lesion was 0 to 5. Results: In the former, recurrence rate is 90.5% in operations-only group but 66.7% in operations plus radiation therapy group(p<0.05). In the latter, recurrence rate is 66.7% in operation-only group but 22.2% in operations plus radiation therapy group(p<0.05).Conclusion: These results shows postoperative radiation therapy is effective method in keloid treatment.

가토에서 Ethicon과 AILEE사 Coated Vicryl의 상호비교

유원민,박상현,노태석,박철,탁관철,Yoo, Won-Min,Park, Sang-Hyeon,Roh, Tai-Suk,Park, Chul,Tark, Kwan-Chul 대한미세수술학회 2001 Archives of reconstructive microsurgery Vol.10 No.1

Sutures support wound healing during the initial phase. As the tensile strength of a wound increases, the need for the presence of sutures becomes less important. For this reason, absorbable suture materials have been sought. Nowadays, commonly used suture materials are Chromic Catgut, Coated Vicryl, and PDS. Among these materials, Coated Vicryl is the most popular. Studies were conducted to compare the handling properties, reliability of knots, wound healing, and tissue reactivity(Inflammation, Fibroblast proliferation, Collagen deposition, Giant cell reaction, Absorption) between AILEE vicryl and ETHICON vicryl. We used twelve purebred New Zealand white rabbits, and biopsied the tissue at three, seven, fourteen, and thirty days post implantation. The results showed that both were supple and easy to handle and tie, and gross and histologic differences were not apparent.

W-plasty 를 이용한 반흔 성형술

박병윤,유원민 대한미용성형외과학회 1996 Archives of Aesthetic Plastic Surgery Vol.2 No.1

The W-plastic scar revision is the surgical technique by which a straight or curved antitension line(ATL) linear scar is changed into a zigzag pattern without tissue rotation. The scar is improved mainly by breaking up the bowstring effect of the long straight scar contracture, by redirecting the course of the malaligned scar and by unscarred tissue blending into the W-shaped scar. Although this technique is not easy, takes more operation time, and sacrifices some normal skin to increase the tensil strength of skin, ATL linear scar in forehead, cheek and chin can be treated effectively with it.

인두피부누공의 치료를 위한 요골전완유리피판의 새로운 도안

황영중,유재덕,이혜경,유원민 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.6

Pharyngocutaneous fistula is a dreaded complication of ablative surgery of the aerodigestive tract such as pharynx and larynx. This is a common problem for the surgeon. We present two patients with glottic carcinoma who suffered from pharyngocutaneous fistulae which developed after total laryngectomy and radiation therapy. The fistulae were reconstructed with newly designed radial forearm free flaps. A radial -forearm free flap larger than the defect was elevated and the flap, except the central inner lining area, was deepithelized. Skin around the defect was removed and then deepithelized. The inner lining was made with the central skin paddle. The deepithelized area was placed over the deskinned area around the defect. The final outer covering of skin graft was extended to the surrounding deepithelized areas. We obtained a obliteration of the fistulae and natural neck contour using this method. This new design has the following advantages; large contact area between the flap and the inflammed surrounding tissue, discontinuity between the suture lines of the inner lining and the outer covering, and reinforcement of suture line of outer covering with skin graft. We believe that this is a useful method for reconstructing irradiated pharyngocutaneous fistulae.

TGF-β₁의 길항제인 Decorin이 백서의 창상치유에 미치는 영향

유원민,나동균,박철,박병윤 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.2

It is known that TGF- βinduces scar in fetal wound healing. The fact gives us that inhibition of TGF- β can reduce scar formation. It has been reported that neutralizing antibody of TGF- β reduced scar in rat incisional wounds. Meanwhile decorin, which is main proteoglycan of extracellular matrix, has been known as other antagonist against TGF- β. However there has been no report about effects of decorin on scar formation. This study examined the histologic findings and width of incisional wound of rat, which was treated with decorin, compsring with non treated wound. We found that scar width was narrower in wounds 2 and 8 weeks after incision and the amount of collagen fiber is less in wounds treated with decorin than in control group. The collagen fibers, especially in wound 8 weeks after incision, were thick and regularly arranged and similar to no dermis in wounds treated with decorin. These results suggest that decorin reduces scar formation and facilitates maturation in wound healing . Even though this study cannot confirm its mechanism, the effect of decorin might be due to inhibition of TGF-β.

구강 협부 점막에 생긴 국한성 림프관종(Lymphangioma circumscriptum)의 임상 증례 보고

유원민,오승훈,나동균,박병윤 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.1

Lymphangioma circumscriptum is a benign disorder of lymphatic channels. The pathologic findings consist of a collection of deep, sequestered subcutaneous lymphatic cisterns which are encircled by smooth muscle. The lymphatic cisterns are communicating with superficial clusters of vesicles through dilated lymphatic channels. The etiology of this lesion is unclear ; however, lymphatic obstruction has been suggested as a possible cause. It is characterized clinically by grouped vesicles, some of which may be filled with serosanguinous fluid. It is an unpleasant, but benign condition conventionally managed by wide local excision, which provides symptom control and often prevents recurrence. Neither long term complication nor association with squamous cell carcinoma has been previously documented. Some cases were reported following mastectomy and radiation therapy or radiation therapy for squamous cell carcinoma of the cervix. We present a 17-year-old patient with lymphangioma circumscriptum developed on buccal mucosa, which developed 3 months after innervated serratus anterior muscle free flap for functional reconstruction of cheek. We suppose that it was caused not only by lymphatic blockage resulted from wide operation but also by chronic masticating local irritation. In review of literatures, we didn't have found any report of lymphangioma circumscriptum developed on buccal mucosa.

Green-stick osteotomy를 이용한 비성형술

유원민,류창우,박병윤,이원재 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Lateral osteotomy has been chosen as a part of rhinoplasty for modification of the nasal bony vault, alteration of the base width of the lateral walls, establishment of a new profile line of the nasal dorsum and lateral profile line, and closure of the open roof. Various methods of lateral osteotomy may be employed, however Orientals have characteristically broad and flat noses Compared to caucasians and for an esthetically satisfactory result, it is important to correct both in rhinoplasty. In this study, the authors performed their devised method of lateral osteotomy in 12 patients for the correction of broad, flat nasal dorsum and deviated noses. The operations could be broadly categorized into two groups: 1) short lateral osteotomy in which the lateral osteotomy line was incomplete and short, extending to the infraorbital rim; and 2) green-stick transverse osteotomy which was induced by in-siturotation fracture by osteotomy and, if considered necessary, augmentation rhinoplasty and nasal tip plasty were also performed simultaneously. Our nasal osteotomy has limited mobilization, where as the previous method has total mobilization, and it has the advantages of repositioning the broad and deviated nose in a preferable direction and shape, as well as the capability of narrowing the preferable area selectively. Especially if there is a necessity to correct both broad and flat noses such as in Orientals, our osteotomy methods have a synergistic effect in esthetic outcome when performed with augmentation rhinoplasty with a silastic implant. There were no complications such as relapse or air-way obstruction during the 4.5-month follow-up period. However, a long-term follow-up period is needed to evaluate the complications considering the physiologic aspect of the nose.

Endoscopy-assisted Ultrasonic Liposuction for Axillary Osmidrosis

노태석,유원민 대한피부과학회 2003 초록집 Vol.41 No.20

태아피부 혈관 및 배양한 태아진피 미세혈관 내피세포에서 E-selectin 발현에 관한 연구

나동균,유원민,박병윤,이광훈 大韓成形外科學會 2000 Archives of Plastic Surgery Vol.27 No.2

Inflammation is the characteristics of scar formation which is abscent in fetal wound healing. The adhesion molecules such as selection groups are believed to have key roles for migration of inflammatory cells through the microvascular endothelial cells to the wound. The purpose of this study was to evaluate the expression of E-selection on the cultured human fetal and neonate dermal microvascular endothelial cells. The back skin of spontaneously delivered dead fetus (IUP 18-22wks) and circumcised prepuce skin of neonate were used. Human fetal dermal microvascular endothelial cells (HFDMEC) were isolated by extracting microvascular segment from trypsin treated fetal and neonate skin tissue and isolated by sieving with nylon mesh and then by 35% Perocoll gradient centrifugation. Further purification was done with the Ulex europaeus I coated magnetic dynabead. To confirm the fetal and neonatal endothelial cells, expression of factor Ⅷ antigen on cell surface and uptake of acetylated low-density lipoprotein were checked. Expression of E-selection on cultured fetal and neonatal endothelial cells in response to IL-1αTNF-αINF-rwas examined by ELISA. And the expression of E-selection on fetal and neonatal dermal microvascular endothelial cells was examined by immunohistochemical study using monoclonal 3B7 anti E-selection antibody in cultured fetal and neonatal skin. The expression of E-selection on endothelial cells was not significantly different between fetal and neonatal endothelial cells. This expression was augmented 10 times more by IL-1αTNF-αINF-r. Augmented endothelial E-selection expression by IL-1αTNF-αINF-rshowed peak level 4 hours after stimulation and return to baseline level after 48 hrs. This time course was similar in both fetal and neonatal endothelial cells. Immunohistochemically, the expression of E-selection molecule of unstimulated fetal and neonatal tissue was not observed. However, on both fetal and neonatal tissue cultured for 4 hours after stimulation by 100u/ml of IL-1 and 100u/ml of TNF, expression of E-selection molecule in microvasculature of upper dermis was observed and this expression persisted for up to 16 hours of culture. Also after culturing for 48hrs with 500u/ml of IFN, expression of E-selection was observed in the microvessels of upper dermis. In conclusion, we could not find any differences between the fetal and neonate skin in the expression of E-selection on the endothelial cell spontaneously or stimulated by IL-1αTNF-αINF-rin vivo and vitro which means the expression of E-selection may not be an important mechanism of scarless wound healing in fetus.

TGF-β의 길항제인 Decorin이 백서 태자의 반흔 형성에 미치는 영향

신극선,유원민,곽혁준 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.8

Adult wounds heal with scar-tissue formation, whereas fetal wounds heal without scarring and with a lesser inflammatory and cytokine response. The unique fetal wound repair process is not dependent on the sterile, aqueous intrauterine environment. The differences between fetal and adult wound healing appear to reflect processes intrinsic to fetal tissue, such as the unique fetal fibroblast, a more rapid and ordered deposition and turnover of tissue components, and, particularly, a markedly reduced inflammatory infiltrate and cytokine profile. Among these cytokines, the transforming growth factor-β(TGF-β) is a growth factor which plays an important role in the regulation of cell growth and differentiation. The fibrosis characteristic of adult wound repair may be associated with TGF-βexcess. Recent experimental studies have focused on the specific anti-TGF-β strategies for scarless wound healing. Decorin, a proteoglycan, is known to regulate TGF-β. This factor antagonizes the action of TGF-βin tissues. However, little is known about the functions of this factor in vivo. The objects of the present study were to analyze the effects of TGF-β, an important regulatory molecule in adult healing events, and the effects of decorin, known inhibitor against TGF-β, on the fetal tissue response following wounding. Fetal cellular and extracellular matrix response to injury were evaluated by treating the wound with TGF-β and decorin in fetal rat at 14 days gestation (term = 21 days). Histologic response and histomorphometric analysis two to eight weeks later were compared between TGF-βonly treated wound and TGF-βwith decorin treated wound. The histologic finding of the TGF-β treated wound was characterized by an early acute inflammatory response : by week 6 fibroblasts and collagen were predominant. In contrast, TGF-β with decorin treated wound had no remarkable histologic evidence of acute inflammation or fibroblast penetration and few collagen was deposited. These observations demonstrate that the fetal response becomes adultlike with fibroblast proliferation and collagen accumulation when TGF-βis added, thus documenting the responsiveness of the fetal system to adult repair signals. Such responsiveness thus suggests a critical difference in the fetal wound environment. Fetal repair may proceed in the absence of trophic factors like TGF-β, thus accounting for optimal "healing" in the absence of excessive fibrosis. And these observations also confirmed the inhibitory action of decorin against TGF-β in rat fetus model. We can suggest that the decorin minimize the inflammatory response and subsequent cellular proliferation in wound healing process, thus eventually prevent collagen deposition and scar tissue formation.