Osseointegration을 이용한 절단된 수지 재건의 임상치험례

방사익,박양수,문구현 충북대학교 의과대학 충북대학교 의학연구소 1998 忠北醫大學術誌 Vol.8 No.2

연구목적 : 절단된 무지의 재건시 족지 유리전이술,무지형성술등이 시행되어왔으나 이는 숙련된 기술을 요하고 공여부의 희생이 문제되어왔다. 보다 기술적으로 용이하고 간편하며 쉽게 적용할 수 있는 수술법을 찾고자 골통합술을 무지결손환자에게 시도하였다. 재료 및 방법 : 수지절간 관절부위의 외상성 무지절단환자에서 골통합 티타늄 고정기을 이용하여 무지보형물을 무지근위지골에 접합시키려 2단계 수술을 시행하였다. 1단계로 장골 해면 질골이식과 같이 고정기를 근위지골 원위단 골수강래에 삽입시켰다. 고정기가 주변골과 통합이 되는 3개월째에 고정기를 노출시키고 그 위에 접합체를 고정시키는 수술을 실시하였다. 2주후 무지보형물을 접합체를 이용 고정기에 고정시킬수 있었다. 결과 : 술후 12개월간 추적관찰한 결과 고정기의 골통합이 유지되었고, 피부괴사 등의 합병증은 발생하지 않았으며 어느정도의 식별촉각을 보였다. 결론 : 절단된 수지의 재건에 있어서 골통합을 이용한 보형물법이 선택적 경우에 효과적인 대안이 될 수 있겠다 Purpose : Reconstruction of amputated finger is challenging field. Free toe-to-finger transfer, pollicization are well-known useful methods but require skillful techies, sacrifice of donor digit. To find and evaluate more readily appliable method, we tried to reconstruct amputated finger using osseointegration. Materials and Methods : A case with traumatic amputation of the thumb at the interphalangeal joint level underwent two stage reconstruction aimed at fixation of a thumb prosthesis to the first proximal phalangeal bone via an osseointegrated titanium fixture. The first stage included insertion of the fixture into the medullary cavity of the first proximal phalanx in combination with transplantation of cancellous bone from the iliac crest. After 3 months. when the fixture was firmly integrated into the bone, a skin-penetrating abutment was placed on top of the fixture, the surrounding skin being thinned to the thickness of a split-thickness skin graft to minimize relative mobility. A thumb prosthesis could then be firmly attached to this fixture. Results : At follow-up examination at 12 months postoperatively, good osseointegration of the implant persisted. There was no skin problems. Some extent of tactile discrimination was achieved in the prosthesis hypothetically based on transfer of tactile stimuli to endosteal nerves in the bone via the titanium fixture. Conclusion : Amputated finger can be successfully reconstructed using osseointegrated implant without sacrifice of donor toe or finger.

좌골부 및 전자부 욕창의 재건을 위한 후대퇴근막 피판술

문구현,방사익 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적: 욕창은 장기적으로 반복되는 압박으로 인해 피부 및 연부조직에 생긴 괴사를 말하며 이는 주로 골 돌출부 주위에 잘 발생한다. 이러한 욕창은 교통사고 및 산업재해의 증가로 척추손상 및 지체마비 환자가 늘어나고 집중 치료를 요하는 의식불명, 만성병증의 환자수가 증가하면서 그 발생 빈도도 증가 하고 있다. 그리고 욕창은 천골부, 대전자부 및 좌골부 등에서 호발한다. 추후에 보행이 가능한 환자의 경우 근피판보다는 근육을 보존할 수 있는 근막피판을 사용하는 것이 수술 후 보행에 더 도움을 줄 수가 있다. 그러므로 기존에 수술적 치료를 시행한 환자의 경우나, 욕창의 크기가 큰 경우, 추후에 보행이 가능한 환자에게 있어서 사용할 수 있는 술식의 유용성을 확인하고자 했다. 대상 및 방법 : 1999년 9월부터 2000년 8월까지 본원에 입원 중이던 6 례의 전자부 욕창과 5례의 좌골부 욕창을 가진 남자환자 7명, 여자환자 4명을 대상으로 하였으며, 원인별로 볼 때는 하반신 마비가 가장 많았다. 하둔부동맥 및 대퇴 심동맥의 제 1, 2 심부관통동맥으로부터 혈액공급을 받는 후대퇴근막피판을 작성한 후 피판을 전위하는 방법을 사용하였다. 결과: 피부 괴사등의 합병증 없이 모른 예에서 결손 부위을 막을 수가 있었으며 적당한 연부조직을 함께 전위 시켜줌으로 해서 추적관찰 기간 동안 욕창의 재발을 방지 할 수 있었으며 보행이 가능한 환자에 있어서도 보행에 문제가 없었다. 결론: 하둔부동맥 및 대퇴 심동맥의 제 1, 2 심부관통동맥으로부터 혈액 공급을 받는 후대퇴근막피판술은 수술이 쉽고, 출혈이 비교적 적으며 수술시간이 짧고, 피판 공여부의 봉합이 쉬우며, 보행 가능한 환자에서는 하지 근육의 기능을 보존할 수 있고, 만약 욕창이 재발 시 피판을 재거상 하여 전진시킴으로서 치료가 가능하며, 근육의 손상을 주지 않으므로 재발시 다른 수술 적 방법을 고려할 수 있는 여러가지 장점이 있는 술식이라 판단된다. Purpose : Pressure sore is an area of ischemic tissue loss resulting from prolonged or often repeated pressure, usually over a bony prominence of body. There has been recent reports describing superior durability of fasciocutaneous flap in sore reconstruction over musculocutaneous flap. Contrary to common musculocutaneous flap using gluteus & harmstring muscle, posterior fasciocutaneous flap does not incorporate any muscle, making it useful especially in ambulatory patients. Material and Methods : From September 1999 to October 2000 we have used posterior thigh fasciocutaneous flap for coverage of six trochanteric sores and five ischial sores. Posterior thigh fasciocutaneous flap is perfused by first & second profunda femoris perforating arteries. Results: All the patients recovered without any serious complications. Three cases developed minimal hematoma but it was corrected by simple evacuation. During the follow up period none of the patients were recurred and for those patients who were able to walk, there was no problem in walking. Conclusion : Posterior thigh fasciocutaneous flap has several advantages. It is easier to elevate, less operation time, less hematoma formation, good donor site morbidity and making possible to preserve the muscle component.

안면골 골절에 대한 임상 통계학적 고찰

방사익,문구현,이종희 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

This retrospective study comprise 595 patients with facial bone fractures in various accidents and treated in the department of Plastic and Reconstructive Surgery, the Chung Buk National University Hospital between September 1991 and December 1997. The medical records of these 595 patients were reviewed and analyzed in order to obtain the clinical pattern and understand the therapeutic modalities. The following results were obtained. 1. The most prevalent age group was the third decade(35.1%). 2. The monthly incidence was the highest in September and the most common accident time was between 6:00 p.m. and midnight. 3. The most common etiology was motor vehicle accidents(59.5%) followed by assault(26.2%), fall(11.4%), sports(2.7%). 4. The male predominated over female in 4.27:1 ratio. 5. The most common fracture site was nose(30.0%) followed by mandible(26.7%), zygoma(23.3%), orbit(8.6%), maxilla(8.1%), frontal sinus(3.2%). 6. The most common fracture site of mandible was parasymphsis(34.9%) followed by angle(27.1%), condyle(23.4%), symphysis(14.5%). 7. The soft tissue injury was the most common associated injury(51.1%). Fcial soft tissue injuries were sustained by 53.3% in the highest rate associated with the associated injuries. 8. Open reduction was used for 63.7% of total cases while 33.8% of total cases required closed reduction, and 2.5% of total cases treated conservatively. 9. The complication rate was 14.1% and the ophthalmologic complication rate comprise 44.9% of all complications.

전두동 골절 환자의 치료

방사익,문구현,이종희 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

The frontal sinus has importance from the aesthetic and functional points of view, so management of the frontal sinus should be conducted. The management may differ with the severity of displacement, the extent of displacement, as well as the involvement of the brain and nasofrontal duct. Fifteen patients with frontal sinus fracture were managed differently depending on the severity of their injuries for between 14 and 31 months, and then evaluated. During the follow-up period, encountered no complications and the overall result of the foreh ead contour was satisfactory.

천골부 욕창의 재건을 위한 둔부 V-Y 전진 근막 피판의 임상적 응용

방사익,문구현,이태섭 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

For treatment of the pressure sore, varieties of methods have been developed such as skin graftings, local flap, myocutaneous or fasciocutaneous flap, etc.. Except mild cases, myocutaneous flaps have been used commonly for the best coverage and padding of the wound. But the gluteus maximus muscle is not an expendable muscle, so the myocutaneous flaps using gluteus maximus muscle result in significant functional loss in ambulatory patients. Various methods as fasciocutaneous flap to reserve a function of the gluteus maximus muscle have been developed. We especially designed a bilateral fasciocutaneous flap in the fashion of interdigitating extended V-Y advancement in sacral sore when the defect is fusiform transversely in shape. With this design, we obtained reduced tension in the midline suture with less dissection in medial portion of the fasciocutaneous flap and made the flap more rleliable by including more parasacral perforators within the flap. We have experienced the eight cases of gluteal fasciocutaneous V-Y advancement flap and obtained the excellent results without flap necrosis. We conclude that a bilateral fasciocutaneous flap in the fashion of interdigitating extended V-Y advancement is useful in sacral sore when the defect is fusiform transversely in shape.

조직확장술에 의한 어린 가토 전두골의 침식과 그의 회복에 대한 관찰

방사익,이의태,박철규 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.8

Among the complications associated with tissue expansion, bony depression under the expander is frequently observed clinically, especially under the tough skin like scalp. To investigate the bony change during the expansion and its reversability, we divided 21 young rabbits into 7 groups. After the insertion of tissue expander on the frontal bone, each groups are sacrificed at 1,2,3 weeks after tissue expansion, 1,2,3 months after removal of tissue expander, and for control, 4 weeks after insertion of expander without expansion. Bony changes are evaluated by gross findings, radiographic findings, and histologic findings. Progressive tissue expansion induces significant gross bony changes in skull of young rabbit. This bony changes consist of erosion underlying tissue expander, with bony ridging and bone deposition at the periphery of the expander. These gross findings correlates with the histomorphologic findings; osteoclastic bone resorption under the expanders with periosteal reation at the periphery of the expanders. The bony changes is not simply a pressure deformation, but also is a remodeling effect. Increased bone resorption and inhibition of bone formation occur until the pressure is removed. After removal of the expanders, reparative bone remodeling begins and nearly complete healing of the cranial defects occurs. On the basis of this study, we conclude that tissue expansion causes significant but reversible effects on cranial bone of young rabbit.

하악골 골절 처치에 관한 임상적 연구

방사익,진홍률,조용석 충북대학교 의과대학 충북대학교 의학연구소 1999 忠北醫大學術誌 Vol.9 No.2

연구목적: 하악골 골절의 치료법은 매우 다양한 방법들이 시도되고 발전되어져 왔는데 최근에는 관혈적 정복술과 소형금속판과 나사못을 이용한 내고정 수술법이 주류를 이루고 있다. 본 연구는 이러한 방법으로 충북대학교병원에서 하악골 골절 치료를 시행한 환자들의 치료 결과와 합병증등을 분석하여 이 방법의 유용성을 검정하고자 하였다. 재료 및 방법: 1991년 3월부터 1998년 12월까지 충북대학교병원에서 하악골 골절하에 치료를 받은 환자 중 소형금속판을 사용하여 치료한 총 177명이 이 연구에 포함되었다. 연구 방법은 환자들의 의무기록지와 방사선사진을 토대로 성별, 연령, 손상원인, 동반된 손상, 골절부위 수술결과 및 술후 합병증 등을 후향적으로 조사하였다. 결과: 하악골 골절은 젊은 남자에서 호발하였다. 골절부위는 하악골 우각부에서 가장 빈번하였는데 흔히 하악결합방 골절을 동반하였다. 술후 합병증은 10.7%에서 나타났는데 부정교합이 가장 흔하였다. 결론: 하악골 골절의 처치로, 관혈적 정복술과 소형금속판과 나사못을 이용한 내고정을 시행하는 것은 매우 신뢰할만한 효과적인 방법이었다. Purpose: Various methods have been tried and developed for the treatment of mandibular fracture, and recently open reduction and internal fixation using miniplates and screws is the most common modality of treatment. To determine clinical usefulness of this method, we evaluated results and complications of the patients who were treated for the mandibular fracture with this method in Chungbuk National University Hospital. Materials and Methods: We performed a retrospective study of 177 consecutive patients of Chungbuk National University Hospital, from May 1991 to Sept 1997, to analyze and evaluate the mandibular fractures. All of them were treated using miniplates. Outcome was measured by analyzing age, sex, etiology, associated injuries, associated other facial bone fracture, fracture site, and postoperative complications. Results: The occurrence of mandibular fracture was frequent in young male and mandibular angle fracture was the most common and frequently associated with parasymphysis fracture. Postoperative complication occurred in 10.7% of cases and malocclusion was the most common. Conclusion: Open reduction and internal fixation with miniplate was a reliable and effective technique for the treatment of mandibular fractures.

동양인에서의 골막 견인에 의한 주름 제거술

방사익,박철규,오창현 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.4

Oriental faces have following characteristics, which are different from Caucasians; 1) more square and wider face, 2) more protruding zygoma, 3) thicker and heavier facial skin and soft tissues. Therefore, it is more difficult to correct the sagging soft tissue of the face and the deepened nasolabial fold by simple subcutaneous dissection and streching the skin flap in orientals. In addition, the thicker the skin, the more the undermined skin flap resists against physical tension. Moreover the denser the connection between skin and deep tissue, the harder it is to perform dissection. Nowadays we are doing subperiosteal face lift more frequently in orientals than before and have obtained following conclusions. 1. After subperiosteal dissection, we can lift the sagging facial soft tissue more easily in aging oriental face as compared to subcutaneous dissection. 2. In spite of extensive upper and middle face dissection, the rate of complications are minimal. 3. There is no visible scar widening in the face following subperiosteal dissection, due to the minimal skin resection.

Monoclonal Antibody를 이용한 확장 피부의 조직학적 변화에 대한 연구

방사익,민경원 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.2

Skin expansion is a clinical technique of providing localized donor tissue for reconstructive surgery, This technique provides good quality tissue of adjacent defects. It is known that the expanded skin shows constant histologic changes including thickening of epidermis, flattening of rete ridge, thinning of dermis and subcutaneous tissue, and an increase in vascularity within dermis and capsule. But to our knowledge there have been little studies directed to determine the effect of expansion on the blood supply o human skin. The present study was done to investigate the histological changes of the expanded human skin: the changes of the microvascular system and the distribution of the myofibroblast and fibronectin under the light microscope using monoclonal antibodies(Anti-α₁-actin antibody, Anti- factor Ⅷ antibody, Anti-fibronectin antibody). The results are as follows: 1. There was an established vascular layer with dilated blood vessels and newly formed small vessels in the outer zone of the capsule of the expanded skin. 2. Abundant myofibrobalsts were found in the central zone of the capsule in expanded skin. In conclusion, we can use the expanded skin flap with reliability, owing to increment of the blood supply in the expanded skin. Further studies are needed to reduce the contractile effect of the myofibroblast after transposition of the flap.

Clinical Implication of Allogenic Implantation of Adipogenic Differentiated Adipose-Derived Stem Cells : Alloimplantation of Adipogenic Differentiated ASCs

Kim, Inok,Bang, Sa Ik,Lee, Sung Koo,Park, Soo Young,Kim, Mihyung,Ha, Hunjoo unknown 2014 Stem cells translational medicine Vol.3 No.11