• 대한정형외과학회지
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• 제56권6호
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• pp.498-503
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• 2021

목적: 컴퓨터 단층 촬영 영상을 이용하여 한국인에서 상완골 근위부 골절 치료에 적용되는 직선형 전향적 상완골 골수 내 금속정의 이상적 삽입점 위치를 알아보고 해부학적 적합성을 분석하고자 한다. 대상 및 방법: 2014년 5월부터 2016년 10월까지 견관절 외상으로 컴퓨터 단층 촬영을 시행한 환자 중 건측 견관절을 동시에 촬영한 한국인 74예를 대상으로 하였으며, 평균 나이는 64.5세(범위, 22-95세)였다. 영상의학적 평가는 건측 근위 상완골의 컴퓨터 단층 촬영 영상을 이용하여 다면 재구성(multiplanar reconstruction) 기법을 이용하였다. 직선형 골수정의 이상적 삽입점은 상완골 골수강 내 중심축과 상완골두가 만나는 점으로 선정하였으며 삽입점과 국소 해부학적 위치와의 거리를 측정하였다. 삽입점에서 극상건 부착부의 가장 내측까지의 관상면상 거리를 임계거리(critical distance)로 정의하고 이를 이용하여 삽입점과 회전근개 부착부와의 근접성을 평가하였다. 회전근개의 손상을 피하고 충분한 고정력을 얻기 위한 임계거리는 Euler 등이 제시한 대로 8mm 이상 확보 되어야 하며, 8 mm 미만인 경우를 위험형(critical type)으로 정의하였다. 임계거리와 성별, 나이, 키, 몸무게, 신체용적지수(body mass index)와의 통계적 유의성을 확인하였다. 결과: 이 연구에서 이상적인 삽입점의 위치는 이두구 외측연에서 시상면상 거리인 전후 거리는 평균 11.5 mm (범위, 4.0-16.6), 대결절의 가장 외측연에서 관상면상 거리인 내외 거리는 평균 20.5 mm (범위, 16.3-27.4)였다. 이상적 삽입점에서 극상건 부착부의 가장 내측까지의 관상면상 거리인 임계거리는 평균 8.0 mm (범위, 4.1-16.6)이며, 임계거리가 8 mm 미만인 위험형(critical type)ㅏ이은 74예 중 41예(55.4%)였다. 결론: 한국인에서 직선형 전향적 상완골 골수 내 금속정의 사용시, 상완 이두구의 외측연에서 후방으로 11.5 mm, 대결절 외측연에서 내측으로 20.5 mm 지점이 평균적인 이상적 삽입점의 위치였다. 하지만 55.4%의 경우에서 이상적 삽입점의 위치로 삽입할 경우 회전근개의 손상을 줄 수 있는 위험형(critical type)이였으므로, 술 전 치료방법의 선택 과정에서 환자 개개인의 해부학적 특성을 충분히 고려하여야 한다.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.428-434
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• 2020

Background Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes. Methods A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Preoperative decision-making to undergo a deep inferior epigastric perforator (DIEP) versus muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap, as well as whether the decision changed during flap harvest and postoperative complications were tracked based on the preoperative imaging used. In addition, we describe three example cases showing direct application of 3D mold as an accurate model to guide intraoperative dissection in complex microsurgical reconstruction. Results Fifty-eight abdominal-based breast free-flaps performed using conventional CTA were compared with a matched cohort of 58 breast free-flaps performed with 3D model print. There was no flap loss in either group. There was a significant reduction in flap harvest time with use of 3D model (CTA vs. 3D, 117.7±14.2 minutes vs. 109.8±11.6 minutes; P=0.001). In addition, there was no change in preoperative decision on type of flap harvested in all cases in 3D print group (0%), compared with 24.1% change in conventional CTA group. Conclusions Use of 3D print model improves accuracy of preoperative planning and reduces flap harvest time with similar postoperative complications in complex microsurgical reconstruction.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.565-570
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• 2009

Purpose: Numerous techniques have been introduced to reconstruct the perineal area in order to preserve function of both the recipient and the donor site while satisfying aesthetic results. There are several advantages of using the pudendal aretery perforator based flap in that it provides thin coverage of defect area and a relatively excellent circulation through perforators. The perineal region can be divided into two areas : the urogenital triangle and the anal triangle. Since each area differs in structure and function so does its reconstructive plan. The authors of this article report clinical results obtained from pudendal artery perforator based reconstructed cases according to each differrent triangles. Methods: A total of 15 patients who underwent perineal reconstruction were enrolled in our study between the year 2002 and 2006. There were 4 cases of vaginal cancer, 4 cases of extramammary Paget's disease, 1 case of rectovaginal fistula in females and 2 cases of Paget's disease and 4 cases of Fournier's gangrene in male cases. The follow up period was on average 6 month. In female, superfical pudendal artery perforator based local flap were used to reconstruct the urogenital triangle defects, while internal pudendal artery perfoator based local flaps were used to reconstruct the anal traingle defects. In males the gracilis myocutaneous flap and internal pudendal artery perforator based local flaps were used in reconstruction of the scrotum and perineal defect. Result: In females, there was 1 case of partial flap necorsis that employed the superficial pudendal artery perforator but secondary repair through the internal pudendal artery perforator based local flap was done. In addition, there were 4 wound dehiscence cases in females and 2 cases in males. Conclusion: We believe that a better aesthetic and functional outcome can be achieved in perineal reconstruction if discrete surgical planning is carried out systematically categorizing the choice of flap employed acccording to distinct anatomical regions : the urogenital and the anal triangle.

• 대한두개안면성형외과학회지
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• 제17권3호
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• pp.146-153
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• 2016

Background: Restoring the orbital cavity in large blow out fractures is a challenge for surgeons due to the anatomical complexity. This study evaluated the clinical outcomes and orbital volume after orbital wall fracture repair using a rapid prototyping (RP) technique and intraoperative navigation system. Methods: This prospective study was conducted on the medical records and radiology records of 12 patients who had undergone a unilateral blow out fracture reconstruction using a RP technique and an intraoperative navigation system from November 2014 to March 2015. The surgical results were assessed by an ophthalmic examination and a comparison of the preoperative and postoperative orbital volume ratio (OVR) values. Results: All patients had a successful treatment outcome without complications. Volumetric analysis revealed a significant decrease in the mean OVR from $1.0952{\pm}0.0662$ (ranging from 0.9917 to 1.2509) preoperatively to $0.9942{\pm}0.0427$ (ranging from 0.9394 to 1.0680) postoperatively. Conclusion: The application of a RP technique for the repair of orbital wall fractures is a useful tool that may help improve the clinical outcomes by understanding the individual anatomy, determining the operability, and restoring the orbital cavity volume through optimal implant positioning along with an intraoperative navigation system.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.475-480
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• 2009

Purpose: To correct the facial asymmetry and to achieve symmetry and balance, not only the soft tissue restoration of deficits but also creation and facial contour line such as mandible border and angle is important. Micro fat graft has limitation such as high resorption rate and somewhat limited ability to emphasize the rigid bony characteristics of the mandible angle due to its innate soft consistency. We have investigated the advantages of dermal fat graft over micro fat graft to correct asymmetry of the lower face in patients who had undergone mandibular reconstruction or distraction, using comparative analysis. Methods: Total of 12 patients were enrolled in our study: 6 micro fat graft and 6 dermal fat graft. Postoperative results were compared and analyzed at immediate postoperative period and more than 1 year later in each group with photographs, and analysised with image J program. Result: No complications were noted both in the micro fat type and the dermal fat type of procedures such as fat necrosis or micro calcifications. All of the patients who received micro fat graft, however had considerable amount of fat resorption after the procedure which led to two additional fat graft procedures. Although minor contour obliteration due to contracture was seen in patients who had undergone dermal fat graft procedure, no definite resorption was found even after more than one year follow-up. Results of dermal fat graft patients were satisfactory in terms of mandible angle symmetry. Secondary revision was necessary in one case due to overcorrection using dermal fat graft. Conclusion: The dermal fat graft has many advantages over the conventionally more popular micro fat graft to correct asymmetry of the lower face following mandible reconstruction owing to its lower resoption rate, more effective in emphasizing the natural curvilinear anatomical contours of the mandible angle and body and lower complication rates such as fat necrosis or micro calcifications.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.154-159
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• 1998

Medial dislocation of the long head of the biceps brachii is a rare condition that usually occurs in association with tears of the subscapularis, chronic impingement, capsular defects or a fracture of the lesser tuberosity. Less commonly, a biceps tendon dislocation may occur after an acute traumatic event. Following a dislocation, the biceps tendon will assume either an intra- or extra-articular position depending on whether or not the subscapularis tendon detaches from its humeral insertion. Magnetic resonance imaging has been found to provide valuable information concerning the location of the biceps tendon and the integrity of the subscapularis tendon. We present a patient with a traumatic dislocation of the biceps brachii tendon in which the diagnosis remained elusive for an extended period of time. In this case, he was evaluated using MRI and reconstruction was performed by restoring the tendon to its anatomical position.

• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.64-71
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• 1994

해부학적으로 족부는 주위에 이용할 수 있는 연주 조직이 별로 없을 뿐 아니라 이용할 수 있더라도 크기가 제한되어 있으므로 광범위한 연부조직 결손시 이의 복원이 어렵다. 광범위하고 오염된 족부의 창상을 재건시 이상적인 조직의 조건으로서는 감염에 잘 견디고, 가능한한 원래의 모양 및 크기에 가깝게 복원해야 하며, 적절한 감각이 있어야 하고, 끊임없는 마찰력과 체중 부하에 잘 견뎌야 할 것이다. 미세혈관술을 이용한 유리조직이식은 비교적 위와같은 장점들을 제공할 수 있다. 저자들은 최근 약 4년간 외상과 전기화상 및 화상후 후유증으로 인하여 족배부, 발꿈치, Achilles건, 족저부등에 광범위한 결손 및 변형이 있었던 환자 21예에서 미세혈관술을 이용하여 Fasciocutaneous, musulocutaneous, muscle with skin graft 등으로 족부를 재건하여 추적중에 있으며 현재까지 관찰된 결과 및 장점, 단점과 문제점들을 보고하는 바이다.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.379-384
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• 2008

Purpose: Currently, using perforator artery flaps especially anterolateral thigh flaps are widely used for reconstruction of extremities, head and neck. Obtaining a precise anatomical picture prior to operation will translate to a more accurate, efficient and safe procedure. Authors used 3D-image work up via 64-slice MDCT to make a more precise preoperative plan. Methods: A total of 10 patients underwent soft tissue reconstruction with anterolateral thigh flap from December 2006 to December 2007. The 64-Channel MDCT (LightSpeed VCT, GE, USA) was used and 3D images were reconstructed. Findings from MDCT were applied to the preoperative planning and confirmed with intraoperative findings. Results: The average number of perforator arteries from lateral circumflex femoral artery was 2. The average lengths of vascular pedicle from the origin of lateral circumflex femoral artery to the first and second perforator artery were 11.0 cm and 20.0 cm, respectively. The average diameter of the pedicle artery was 2.2 mm. The locations of the perforator arteries were mapped and localized on the body surface based on the MDCT result. These were confirmed through direct visualization intraoperatively. Conclusion: MDCT has an advantage of obtaining accurate images of the general anatomy and even fine structures like perforator arteries. By using this state-of-the-art diagnostic imaging technique, it is now possible to make an operative plan safely and easily.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.160-164
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• 2020

Background Implant-based dual-plane augmentation mammoplasty requires accurate separation of the pectoralis major muscle (PMM) at its origins. The authors identified the PMM origins during breast reconstruction surgery with the goal of providing additional information on subpectoral implant insertion for reconstructive or aesthetic purposes. Methods This study was conducted on 67 patients who underwent breast reconstruction surgery at the breast center of our hospital between November 2016 and June 2018. In total, 34 left and 39 right hemithoraces were examined. The left and right hemithoraces were each divided into 15 zones to determine the percentage of PMM attachments in each zone. The distribution of PMM origins in each zone was examined to identify any statistically significant differences. Results There were no statistically significant differences in the origins of the PMM between the right and left hemithoraces. The percentage of attachments increased moving from the fourth to the sixth rib and from the lateral to the medial aspect. Conclusions The anatomical findings of this study could be used as a reference for accurate dissection of the origins of the PMM for the preparation of the subpectoral pocket for subpectoral implant placement.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권3호
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• pp.231-238
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• 1995

The scapular flap, described by dos Santos in 1986, has been used successfully for the reconstruction of a variety of defects of oro-mandible. Some have defined the gross and vascular anatomy of the lateral border of the scapula, yet useful anatomical information and a complete description of area and contour of each cut surface of lateral border of scapula, which is very important for esthetic and functional reconstruction using dental implants, are missing. These prompted us to clarify the cross-sectional area of lateral border of scapula. Twenty three scapulas of 15 fixed adult Caucasian cadavers were sectioned in every 1cm interval along the lateral border of scapular, and the metric relations and the shape of cut surface were assessed. The lateral border of the scapula, consisting of cortico-cancellous bone measuring $7.86{\pm}0.97mm$ in width, $19.6{\pm}2.86mm$ in height and $12{\pm}1.78cm$ in length, could be harvested as an osteocutaneous scapular flap or as a single vascularized bone flap. The mean thickness of cortical bone of lateral, medial, dorsal and costal surface was $0.46{\pm}1.48mm$, $1.78{\pm}1.34mm$, $1.54{\pm}1.11mm\;and\;1.35{\pm}0.87mm$, respectively. So we have thought that all scapular transplants could be supported osseointegrated implants for fixation of dental prosthesis.