두경부암종 수술 후 결손부위 재건에 사용된 유리피판술 51예의 고찰

이승원(Seung Won Lee),김재욱(Jae Wook Kim),김용배(Yong Bae Kim),탁민성(Min Sung Tak),신호성(Ho Sung Shin),장혁순(Hyuck Soon Chang),오천환(Cheon Hwan Oh),박진규(Jin Gyu Park),고윤우(Yoon Woo Koh) 대한두경부종양학회 2007 대한두경부 종양학회지 Vol.23 No.1

Background and Objectives :Microvascular free flap reconstruction has been revolutionized in last two deca-des, and became a standard option in the reconstruction of head and neck defects. We intended to review our experiences of 51 microvascular free flap for head and neck defects during 5-year period and to analyze the types of flaps according to primary sites, success and complication rates. Subjects and Methods :From Oct. 2001 through Dec. 2005, fifty one free flap reconstructions were performed in forty nine patients at ENT department of Soonchunhyang university bucheon hospital. Primary sites, pathology, T-stage, operative time, time interval of oral feeding, and various reconstructive factors such as recipient and donor vessels, free flap related complications, failure rates and salvage rates were retrospectively analyzed. The relation between complication rates and preoperative risk factors were statistically analyzed. Results :Methods of reconstruction were radial forearm free flap(RFFF)(n=28, 54.9%), anterolateral thigh free flaps(n=9, ALTFF)(17.6%), rectus abdominis free flap(n=7, RAFF)(13.7%), jejunal free flap(n=5, JFF) (9.8%), and miscellanous(n=2, 4.0%) in order. In free flap related complications, failure of free flap occurred in seven cases(13.7%) and pharyngocutaneous fistula occurred in five cases(9.8%) among fifty one free flaps. The overall success rate of free flaps was 86.3%. Salvage of free flaps was possible only one among eight cases(12.5%). In positve preoperative risk factor groups, failure of free flap was higher than in negative risk factor group. However, it was not statistically significant. Conclusion :We confirmed that free flap reconstructions are highly versatile and reliable options for use in the reconstruction of various soft tissue defects of the head and neck. Free flaps have gained great popularity given its versatility, ability for a two-team approach, and minimal donor site morbidity. However, complications related to microvascular surgery may be overcome by increased surgical experience and by intensive flap monitoring in early postoperative period.

우측 하악의 치성 각화성 낭종 수술 후 발견된 암으로 내원한 63세 환자 1예

오재은(Jae Eun Oh),이찬영(Chan Yeong Lee),김경민(Kyeong Min Kim),탁민성(Min Sung Tak),변형권(Hyung Kwon Byeon) 대한두경부종양학회 2022 대한두경부 종양학회지 Vol.38 No.2

Odontogenic keratocyst (OKC) accounts for 3-11% of all odontogenic cysts. OKC is a benign intra-osseous odontogenic tumor, but what makes this cyst special is its aggressive behavior and high recurrence rate. OKC is relatively aggressive compared to other odontogenic cysts, but its malignant transformation is considered extremely rare. Squamous cell carcinoma associated with odontogenic keratocysts have rarely been reported in the medical literature. We recently experienced a case of a 63-year-old man finally confirmed with squamous cell carcinoma of the mandible, which was initially diagnosed as a benign odontogenic keratocyst. Surgical resection was performed as definitive treatment. Therefore, we present this unique case with a review of the literature.

근막피판을 이용한 하지의 재건

탁민성,양순재,김재훈,김용배,강상규 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.6

The soft tissue injuries of the lower extrimities are increasing and reconstruction is sometimes complicated. The status of the wound, time and method of the operation must be reevaluated before conducting surgery. For the good result of the reconstruction, we must preserve injured tissue as intact condition as much as possible, protect the wound infection and reduce amount of scar tissue. The cutaneous blood supply of the thigh comes from two groups of vessels. The first group is variously referred to as "direct" or "fasciocutaneous" or "septocutaneous" while the second group are indirect, musculocutaneous vessels. Cormark and Lamberty have described the regional arrangement of the cutaneous blood supply of the thigh as follows : The anteromedial region is supplied by the superficial femoral artery passing round sartorius muscle. The anterolateral region is supplied by the lateral femoral circumflex system through the vastus lateralis muscle and rectus femoris muscle. The posterior thigh region is supplied by musculocutaneous and fasciocutaneous branches of deep femoral artery The blood supply of the lower leg skin is divided into three divisions. First ; direct cutaneous artery from popliteal artery: superficial sural artery and from decending genicular artery:asphenous artery. Second; musculocutaneous branches from underlying muscle and, third; septocutaneous artery from posterior tibial, peroneal and anterior tibial artery. The superficial sural artery originate at the point of 4cm below of posterior knee fold from popliteal artery, and running through midline to lower quarter of leg. According to their origin, septocutaneous vessels from three groups; anteromedial from the posterior tibial vessels; anterolateral from the anterior tibial vessels; posterolateral from the peroneal vessels. The medial septocutaneous vessels are enclosed in the deep transverse fascial septum of the leg that seperates the soleus and gastrocnemius muscular compartment from the deep muscular compartment of the posterior leg. We found from four to five of these vessels. Their origin and the points at which they pierce the fascia were quite variable.Where these vesseles were most frequently present: between 4-6cm, 9-12cm, 17-19cm, and 22-24cm from the tip of the medial malleolus. The external diameter of the arteries varied from 0.5 to 1.5mm. The posterolateral septocutaneous vessels originate from the peroneal artery and veins. They run though the posterior intermuscular septum, first passing between the fibular shaft and the flexor hallucis longus and then between the soleus and peroneus longus. Their number varies between three to five. Their external diameters range between 0.4 and 1.3mm. The anterolateral septocutaneous arteries originate from the anterior tibial vessels. The vessels of this group are enclosed in the lower half of the anterior intermuscular septum, between the extensor digitorum longus and peroneus brevis. We have found the average 8 number in this group. The anterolateral and posterolateral septocutaneous perforators originate at the variable levels. The three groups of septocutaneous vessels intercommunicate widely at the margins of their respective territories. The fasciocutaneous flap is indicated on occasion for severe medical illness or multiple system trauma that contraindicates microsurgical reconstruction. These flaps should be considered when an alternative flap is needed to salvage a failed free flap or local muscle flap. the authors have experienced 38 fasciocutaneous flaps including 3 anterolateral thigh falps, 2 anteromedial flaps, 3 posterior thigh flaps, 8 anteromedial fasciocutaneous flaps and 7 sural fasciocutaneous flaps, 10 reversed type fasciocutaneous flap and 5 distally based posterior calf fasciocutaneous island flap in lower extrimity reconstruction and have found these fasciocutaneous flaps to be a very versatile reconstrictive procedure.

수직 기저 심부 근막 역전피판을 이용한 하지 연부조직 손상의 재건

김철한,이주헌,탁민성,김재훈,김용배,이영만,양순재 大韓成形外科學會誌 2000 Archives of Plastic Surgery Vol.27 No.1

The reconstruction of soft tissue defects on the leg remains a difficult challenge for plastic surgeons. If the defect is large and complicated by bone or joint defects, and excellent result can be obtained with free tissue transfer. In cases with no bony problem, no severe osteomyelitis and small medium-sized defects local flap is more acceptable than free tissue transfer because of its simple onestage and reliable operation. Fasciocutaneous turnover flaps revolve around the lack of criteria for safely designing these random pattern flaps as well as the risk of donorsite problems. Vertically-based deep fascia turnover flaps nourished by the subfascial plexus within deep fascia were used successfully for reconstruction of the leg in 5 patients. A vertically-based deep fascia turnover flap consists of deep fascia of the leg and its subfascial and epifascial plexus. As musculofascial, septofascial and periosteofascial branches these contribute to a richly anastomosing vascular network within deep fascia. Unlike adipofascial turnover flaps, the transversely-oriented deep fascia turnover flap keeps its subcutaneous layer with its intact vascular plexus so that the overlying skin is adequately perfused, even in patients with sizable flaps or extremely thin skin. Between March 1998 and February 1999, five cases underwent this procedure to reconstruct soft tissue defect on the leg. The advantages of this method are fast, safelyelevated preservation of the superficial vascular plexus, thus preserving the shape of the leg minimizing donor site scar and hypertrophy.

유리 피판술을 이용한 하퇴재건 47례에 대한 임상적 고찰

김용배,안형식,정현교,양순재,탁민성,김재훈 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Traumatic injury to the lower legs has been increasing in Korea and often leads to skin and soft tissue loss, exposing blood vessels, nerves, tendons or bones. Salvaging these legs often requires free flaps. Over the past two decades, the use of free tissue transfer has produced an increasing salvage rate for severely injured lower leg. Between April. 1988 to July, 1997, 47 cases of lower soft tissue defects were reconstructed with free flaps, and retrospective analysis was performed to determine more about the factors associated with free flap failure or immediate vascular complications. We evaluated wound status before operation, operation time after injury, vascular status of recipient site, use of vein graft, use of reverse flow, salvage protocol in compromised anastomosis, survival rate and complications. There were 9 cases of venous thrombosis and 2 cases of arterial insufficiency while 7 out of 9 cases of venous thrombosis were reexplorated. However, 2 cases of partial flap necrosis and 1 case of total necrosis. Two cases of arterial insufficiency were necrotized, so the overall free flap failure rate was 9.6%. The results were analyzed to determine the factors promoting either failure or vascular complication, Many factors which are often blamed for failure (trauma cause, preoperative general condition, preoperative infection status, intraoperative ischemic time) were not significant in this study, but prolonged time after injury correlated with free flap failure, We concluded the adequate debridement and infection control, adequate selection of recipient vessel, accurate vascular anastomosis and most of all, early free flap transfer after injury, will improve the success rate.