외측대퇴 유리피판을 이용한 두경부 결손의 재건

이내호,양경무,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 1998 Archives of reconstructive microsurgery Vol.7 No.2

저자들은 1997년 1월부터 1998년 7월까지 두경부 악성종양 및 반안면왜소증과 같은 선천성 안면기형을 주소로 본원에 내원하였던 환자 9명을 대상으로 하여 9례의 외측대퇴 유리피판술을 시행하여 다음과 같은 결과를 얻을 수 있었다. 첫째, 두경부 재건에 있어서 외측대퇴 유리피판은 다른 유리피판술에 비해 여러 장점을 가지고 있었다. 특히, 공여부 추형이 노출되지 않는 부위이며 동시에 두팀이 수술에 참여할 수 있어서 수술시간이 단축될 수 있었다. 둘째, 술후 방사선치료를 시행하면 피판의 모발은 사라지지만 모공의 과각화증 및 색조 침착이 증가하므로, 외측대퇴부에 모발이 많은 환자는 술후 방사선치료의 여부와 관계없이 미용적인 금기사항에 해당한다. 셋째, 악성종양 절제후에 발생하는 결손의 재건시 피판의 두께가 문제시 되지 않았으며, 피판의 두께는 피판을 도안할 때의 위치, 성(sex), 피하지방층의 제거정도, 근육의 포함 정도, 술 후 피판의 위축정도에 따라 조절 가능하였다. 넷째, 모든 증례에서 정맥이식없이 혈관문합이 가능하였으므로 두경부 재건시 혈관경의 길이는 충분한 것으로 사료된다. 다섯째, 가능한 피판을 장축으로 길게 도안하여 두 번째 또는 네 번째 관통동맥을 포함시켜 수술 후 발생할지도 모르는 혈류부전에 대비하는 것도 피판의 생존률을 높이는 좋은 방법으로 사료된다. Microvascular surgery has been widely used clinically for over 30 years. Although many types of free skin and myocutaneous flap are being used at present, surgeons are still looking for new flaps to suit the specific requirements of different recipient sites, to reduce the deformity at the donor site, to ease the management of the flap and to increase the success rate of those operations. The lateral thigh free flap was designed and reported simultaneously with the medial thigh free flap by Baek in 1983. The flap, based on the third perforator of the profunda femoris artery. is designed on the posterolateral aspect of the distal thigh. Clinically, the vascular variations and the locations of perforators of this system can be determined preoperatively with simple angiograms and Dopper audiometry. The lateral thigh free flap is suitable for reconstruction of defects in an oral floor with tongue and esophageal deficits, scalp defects with dural defects, and large full thickness defects of the lip. The advantages of this flap are safe elevation, a long vascular pedicles with a large lumen, skin that is generally thin, and good pliability. Furthermore, the skin territory is very wide and long. The donor site is hidden and therefore more acceptable to the patient. The disadvantage of this flap is that the anatomy of the pedicle vessels has irregular derivation from the main vessel. We had reconstructed lateral thigh free flap to the nine patients from January, 1997 to July, 1998 and got satisfactory results. In this paper we illustrate the arterial anatomy of the thigh and usefulness of this flap for the reconstruction of the head and neck.

수지첨부 재건 후 거머리 사용시 발생하는 문제점에 대한 고찰

이내호,양경무,Lee, Nae Ho,Yang, Kyoung Moo 대한미세수술학회 2000 Archives of reconstructive microsurgery Vol.9 No.2

Over the past several years, countless patients have benefitted from the use of leeches in microsurgery. As we know, leeches are used to overcome the problem of venous congestion by creating prolonged localized bleeding uniquely characteristics of leech bite. Venous congestion, a common complication of digital replantation, often has been treated through surgical repair like arteriovenous anastomosis. The leech produces a number of important substances which contribute to the special property of the bite, including an anticoagulant, a local vasodilator and local anesthetics. The bite usually bleeds for 1 to 2 hours and under special circumstances may bleed for up to 24 hours. So venous congestion is relieved. However, leeches increase the possibility of infection through their gut content. Infection associated medical leech application is significant risk. Other risk include allergic reaction, adverse psychologic reaction and blood loss requiring transfusion. The 65 cases of medical leech application were performed between August, 1997 and May, 2000 according to an established protocol. The complication were 18 cases ; infection (13 cases), hemorrhage (2 cases), allergic reaction (1 case), psychologic problem (1 case) and hypochromic anemia (1 case). Then our study was performed on the base of indication. As a result, Aeromonas hydrophilia was cultured from gut of medical leech and Klebsiella, Staphylococcus and Pseudomonas were cultured from media. We present the clinical risk-benefit of the medical leech therapy through several cases following digital replantation.

레이저를 이용한 비후성 반흔의 치료

이내호 ( Nae Ho Lee ),최하영 ( Ha Young Choi ),김민호 ( Min Ho Kim ) 전북대학교 의과학연구소 2009 全北醫大論文集 Vol.33 No.1

Hypertrophic scars are relatively common, but they remain very difficult to treat and induce functional and psychologic morbidity. Many treatment modalities have been advocated in the past. But none of these are satisfactory with unpredictable result, long treatment interval and sometimes unacceptable side effects. recent use of the flashlamp-pumped pulsed-dye laser(585nm) has been shown to be effective in the treatment of various traumatic and surgical scars with improvement in scar texture, color and pliability with minimal side effects. 80 patients with 95 hypertrophic scars which had little response to usual conservative treatment and resulted from trauma, operation, skin graft donor sites, and burns were treated with Vbeam ®(595nm) pulsed dye laser(Candele Laser Corporation, Wayland, Mss). The mean number of treatment was 2.2. Period of follow-up vary from 2 month to 9 months. The 595nm Pulsed Dye Laser can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results. Complications such as hypopigmentation, ulcer and infection were not seen.

유리 피판을 이용한 인두식도 결손의 재건

문지현,이내호,양경무,Moon, Ji-Hyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 1999 Archives of reconstructive microsurgery Vol.8 No.2

저자들은 1990년 12월부터 1999년 2월까지 48례의 경우에서 하인두에 발생한 악성종양을 광범위 절제한 후 유리피판 또는 근피판을 이용하여 재건하였다. 39례에서 유리공장 피판, 5례에서 유리전박 피판을 tubing 형태로 사용했으며, 2례에서는 유리전박 피판을 patch 형태로 사용하였고, 2례에서는 대흉근 근피판을 이용하여 경부식도를 재건하여 다음과 같은 결과를 얻을 수 있었다. 1. 하인두의 악성종양이 고령의 나이에 발생한다는 사실을 감안했을 때 유리전박 피판에 비해 급양공장루를 통해 조기에 영양섭취가 손쉬운 유리공장 피판이 환자의 상태를 정상으로 회복시키는데 장점이 있었다. 2. 술후 가장 흔한 합병증인 누공의 발생은 문합을 제대로 시행했을 경우 우려할 필요 없으며, 따라서 술후에 시행하는 식도조영검사는 누공의 증상이 있는 경우에만 선별적으로 실시해야 할 것이다. 3. 문합부 내경의 협착이 우려될 때는 직경이 큰 비강영양튜부(nasogastric tube)를 조기에 삽입하여 극단적인 협착을 감소시키고, 영양섭취 경로를 확보해야 한다. 4. 문합부 협착을 예방하기 위해 상하부 문합부 모두를 파형으로 도안하여 피판을 문합 봉합해야 하며, 협착이 의심스러울 때는 내시경검사를 시행하여 확진해야 한다. 5. 혈관문합은 유리전박 피판을 시행하는 경우에 있어서 수월하였으며, 유리공장 피판을 시행할 때는 술전에 정맥이식을 고려해야 한다. The laryngopharyngectomy for tumor ablation is the most common indication for pharyngoesophageal reconstruction in our country. Most of these cases are advanced laryngeal cancer that has spread beyond the larynx, pharynx and cervical esophagus. Such patients are obviously unable to breathe, swallow, or speak in the normal manner. The ideal reconstruction would restore normal anatomy, permitting patients to breathe and swallow without aspiration, and would not require a permanent tracheostomy. Reconstruction of the pharyngoesophageal defect traditionally been carried out with tubed local random flap, deltopectoral or musculocutaneous flap. Another approach is the pedicled enteric flap. But microsurgical reconstruction of the pharyngoesophagus, using either the free jejunal or the tubed radial forearm flap, have now become the preferred technique. Among them, we used jejunal free flap in 39 cases, tubed radial forearm free flap in 5 cases, patched radial forearm free flap in 2 cases and pectoralis major myocutaneous island flap in 2 cases from December 1990 to Febrary 1999. In this paper we illustrated that both forearm and jejunal free flap is a usful alternative in reconstruction of hypopharynx and cervical esophagus.

유리 비골 전이술을 이용한 하악골 재건술

오명록,이내호,양경무,Oh, Myung-Rok,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 1999 Archives of reconstructive microsurgery Vol.8 No.1

The need for reconstruction of large bone, soft tissue defect of mandible has greater emphasis due to development of industry, traumatic accident and increase of tumor. The mandibular reconstruction had greatly progressed through the first and the second World Wars. The Fibular free flap by using microscope was reported in 1970 and many maxillofacial reconstructive surgeons had used. In 1988, Dr. Hidalgo first reported mandibular reconstruction by using fibular free flap. Mandibular reconstruction by using fibular free flap has several advantages. First, it provides up to 25 cm of bone, enough to reconstruct any length of mandible defect. Second, a skin island, based on a septocutaneous blood supply, is available in a size large enough to simultaneously reconstruct internal and external soft tissue defect. Third, The fibular donor site morbidity is low, fourth, it provides a esthetic effect of mandible line. And finally bone viability is good. The Fibular osteocutaneous free flap was performed after COMMANDO operation due to squamous cell cancer in oral cavity (15 cases). Therefore we report out successful operation of the mandible reconstruction by using fibular osteocutaneous free flap.

천공분지에 기저를 둔 도서형 피부피판을 이용한 천골부 욕창의 재건

문지현,이내호,Moon, Ji Hyun,Lee, Nae Ho 대한미세수술학회 2000 Archives of reconstructive microsurgery Vol.9 No.1

저자들은 1998년 1월부터 2000년 2월까지 1 5례의 천골부 욕창 환자를 대상으로 천공분지에 기저를 둔 도서형 피부피판을 욕창 재건에 적용하였다. 피판의 공여부의 기능적 소실을 최소화하며 특별한 합병증 없이 좋은 결과를 얻었으며 현재까지 추적조사한 결과 재발은 관찰되지 않았다. 천공분지에 기저를 둔 도서형 피판은 신체 여러부위의 재건에 고려될 수 있을 것으로 사료되며 다양한 모양과 깊이의 창상재건에 유용한 방법이라고 사료된다. Recently, the incidence of pressure sore has been increased, due to increased number of patients with central nervous system injuries after traffic and industrial accidents or with long term loss of consciousness due to drug intoxication. The management of sacral pressure sore has been improved through the development of myocutaneous flap. However, sacrifice of the deep muscle cause some problems such as intraoperative bleeding, functional disabilities of donor site and further limitation of reconstruction for recurrent pressure sores in paraplegic patients. The development of perforator-based island skin flap introduce a new treatment modality for sacral pressure sores. We used perforator-based island skin flap in 15 cases with reasonable result from January 1998 to February 2000. This flap has a many advantages such as no significant sacrifice of the gluteus maximus muscle, wide rotation arc, reliable blood flow of the perforator, short elevation time for the flap, and no post-operative hindrance to walking in patients who are not paraplegic. There was no significant complication without significant sequelae and donor sites could be repaired primarily.

수지 첨부 절단의 재접합술

강홍대,김종진,이내호,양경무,문지현,Kang, Hong-Dae,Kim, Johng-Jin,Lee, Nae-Ho,Yang, Kyung-Moo,Moon, Ji-Hyun 대한미세수술학회 2007 Archives of reconstructive microsurgery Vol.16 No.2

Introduction: Microsurgical replantation of amputated digit have become common procedure in recent years. However replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. So, fingertip amputation was covered by volar V-Y flap, composite graft, cross finger flap and groin flap. But patients who have been treated by these methods experience shortening of digit, nail deformity, excessive tenderness and persistent pain. Replantation could solve most of these problems. Material & Methods: In our department, from March 2004 to August 2007, 36 digits in 32 patients with complete amputation at distal to nail base were replanted using a microsurgical technique. Results: The overall survival rate of the replanted finger was 75%. Venous anastomosis was possible in 8 cases and impossible in 28 cases. In latter cases external bleeding technique was applied with medical leech. Conclusion: After replantation, a few patient complained decreased sensibility, nail deformity and cold intolerance. But most of patients were satisfied with the functional and cosmetic appearance of the viable replanted digits. We believe the replantation should be the first choice in fingertip amputation.

광배근 유리 피판술을 이용한 두피 및 두개골 결손의 재건

김성기,노시균,이내호,양경무,Kim, Seong-Ki,Roh, Si-Gyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 2013 Archives of reconstructive microsurgery Vol.22 No.1

Purpose: Reconstruction of scalp and calvarial defects should provide both aesthetic and functional aspects. The inelastic nature of the scalp and previous surgery or radiation preclude the use of primary closure or a local flap. With development of microsurgical technique, a free tissue transfer is a good option. We use the latissimus dorsi myocutaneous free flap for reconstruction. Materials and Methods: A review of all latissimus dorsi free flap reconstructions performed in nine patients from 2009 to 2012 was conducted. There were six males and three females, ranging in age from seven to 69 years, and nine different regions, including five temporal regions, two occipital regions, and two frontoparietal regions. The flaps ranged in size from $9.0{\times}10.0cm$ to $14.0{\times}15.0cm$. Recipient vessels available for microanastomosis were most often the superficial temporal vessels and two patients had anastomoses to the external carotid artery and internal jugular vein. Results: All flaps survived postoperatively. With a median follow-up period of 14 months, no major complications were noted. However, two patients developed minor wound dehiscence, and a hematoma was observed in one patient. Conclusion: We performed the latissimus dorsi myocutaneous free flap reconstruction, which is one of the most popular reconstructive methods. The latissimus dorsi myocutaneous free flap reconstruction has been proven successful in our patients with satisfactory results. During the long term follow-up period, even though depressions were observed on the defect area in some patients, they were treated successfully with cranioplasty. Therefore, we recommend the latissimus dorsi myocutaneous free flap for reconstruction of scalp and calvarial defects.

두개골 골이식을 이용한 전두골 골종의 치험례

신진용,노시균,이내호,양경무,Shin, Jin-Yong,Roh, Si-Gyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: An osteoma is one of the common benign tumors that penetrate the nasal portion, paranasal and frontal sinus. This tumor is mostly found by radiation test accidentally, however in rare cases; it can be found to be touched or with its symptoms as the tumor grows. We report this case since we found and healed the benign tumor which was affecting orbit and the both sides of fronal sinus. Methods: A 19 year old female patient visited to our hospital due to the mass on her forehead. The symptoms began 3 years ago but no special symptom was found except for touchable mass. She was diagnosed as the osteoma of superior orbital parts and both sides of frontal sinus using X-ray and CT scanning. The size of osteoma was $5{\times}2.5{\times}3.5\;cm$ and indicated the patterns penetrated to the right side of orbital region. The osteoma excision was conducted with coronal incision and wide area of defect part in frontal sinus and superior orbital part were reconstructed by cranial bone graft and resorbable fixation plates. Results: The patient recovered without any postoperative infections or complications and symptoms. Dysaesthesia was found on her frontal area but improved in 1 month after the surgery. Conclusion: The occurrences of osteoma in frontal sinus are rare and can be treated with conservative methods if there are no infections and symptoms. We report this case since we found the benign tumor, which was affecting orbit and the both sides of fronal sinus and healed it with coronal resectomy without any complications.

수부의 고압 분사 손상

김성기,노시균,이내호,양경무,Kim, Seong-Ki,Roh, Si-Gyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: High-pressure injection injury is caused by accidental injection of the high-pressure injection devices in industry. The initial benign appearance of the wound fools patients into delays in an adequate treatment. And it can result in disastrous outcomes such as necrosis and amputation. To avoid the poor prognosis, the injuries require a prompt surgical intervention. The purpose of this article is to recognize the poor outcome of the highpressure injection injury and to introduce an adequate treatment in need. Methods: We have 4 cases of the high-pressure injection injuries in the hand from April, 2005 to March, 2009. Average age is 39 years (30 - 49 years old), 2 cases are the palm of dominant hand, 1 case is the thumb of dominant hand, and 1 case is the palm of non-dominant hand, respectively. We followed up these patients for 20 months on average. In 3 cases, the immediate, aggressive surgical intervention was carried out, but the other one was delayed in early adequate treatment. The wounds were covered by local advancement flap, anterolateral thigh free flap, conservative treatment with antibiotics and dressing. Results: No pathogens after culture were found nor any findings of fracture in imaging study. Conservative treatment, local advancement flap and anterolateral thigh free flap for the open wound resulted in a desirable aesthetic outcome. In a long-term follow up, functional capability of the patient was also satisfactory. Conclusion: Upon initial evaluation, most high-pressure injection injuries present as innocuous wounds with very few symptoms and result in delaying the proper management. And the majority of high-pressure injection injuries will produce significant morbidity to the hand, amputation. And the initial aggressive surgical debridement was needed to prevent the poor outcome. The key to success in treating high-pressure injection injuries of the hand is the prompt aggressive surgical intervention.