• Archives of Plastic Surgery
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• 제37권1호
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• pp.79-82
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• 2010

Purpose: Carcinosarcomas are rare neoplasms in which both malignant epithelial and mesenchymal elements are identified. We have found only twenty one cases of primary cutaneous carcinosarcoma in the English language literature. Therefore it has been difficult to diagnosis because its unclear etiology and low frequency. Methods: A 31-year-old young man with a protruding mass on his ankle dorsum was examined. The tumor was $7{\times}6{\times}3\;cm$ sized and arose from a burn scar. The mass was wide excised and applied split thickness skin graft. Characteristic pathologic finding was a mixture of squamous cell carcinoma and malignant fibrous histiocytoma. Results: Three months after the operation, the patient died of multiple metastasis to the liver, lung and finally of sepsis despite adjuvant chemotherapy and adjuvant radiotherapy. Conclusion: If a metastatic cutaneous carcinosarcoma is diagnosed, wide excision is required. There should be more aggressive management to minimize the risk of recurrence. Further research into the etiology and pathophysiology of the disease and a more careful differential diagnosis may allow improvement in treatment.

• Tuberculosis and Respiratory Diseases
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• 제60권6호
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• pp.653-662
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• 2006

연구배경 : 흡입화상은 폐렴, 호흡부전 등의 폐합병증으로 인해 이환율 및 사망률 증가에 기인하는 것으로 알려져 있다. 화기 흡입에 의한 기도 손상이 폐기능에 영향을 줄 것으로 예상되나 이에 대한 연구는 빈약한 실정이다. 흡입화상으로 인한 폐기능 검사소견의 변화를 알아보고자 하였다. 방 법 : 2002년 8월부터 2005년 8월까지 기관지내시경검사에 의해 흡입 폐 손상이 확인된 환자들을 대상으로 급성기 및 회복기에 폐기능 검사를 시행하여 비교 및 분석하였다. 초기 폐기능 검사에서 FVC, FEV1, FEV25-75% 및 PEF의 정상 추정치는 흡입화상에 대한 내시경적 중증도와의 상관성을 알아보았다. 사망환자, 연기 흡입으로 뇌손상을 입은 환자 및 선행 만성 호흡기질환자는 제외하였다. 결 과 : 화상체표면적이 0-18%의 범위에 있는 총 37명(남 28, 여 9)의 환자를 대상으로 하였다. 내원 당시의 $PaO_2/FiO_2$ 비는 $286.4{\pm}129.6mmHg$, COHb은 $7.8{\pm}6.6%$ 였으며, 기관내 삽관은 9예(24.3%), 기계호흡은 3예(8.1%)에서 이루어졌다. 초기 방사선 소견에서 이상 소견을 보인 18예(48.6%) 중 15예(83.3%)는 정상화되었으나 3예(16.7%)는 잔흔을 남기고 치유되었다. 초기 폐기능 검사에서 19예(51.4%)가 정상 소견이었다. 폐쇄성 장애가 9예(24.3%) 있었으며 이 중 4예(44.4%)는 기관지 확장제에 양성반응을 보였다. 제한성 장애도 9예(24.3%) 관찰되었다. DLco를 시행한 23예 중 4예(17.4%)만이 감소된 소견을 보여 주었다. 추적 폐기능 검사에서 초기에 이상 폐기능 소견을 보인 대부분이 정상으로 회복되었으며, 폐쇄성 및 제한성 장애가 각각 1예(2.7%)씩 관찰되었다. DLco는 전부 정상화 되었다. 결 론 : 흡입화상 이후 생존한 환자를 대상으로 급성 호흡기 증상이 안정된 상태에서 시행한 초기 폐기능 검사상 정상, 폐쇄성 및 제한성 장애로 나타나 특이적인 환기장애 양상은 관찰되지 않았다. 또한 초기에 이상소견을 보여주었다 하더라도 추적검사에서 대부분 정상으로 회복되는 것을 관찰할 수 있었다. 그리고, 기관지확장제 양성을 보이는 일부 환자는 기관지 확장제 치료를 적극적으로 시도해 볼 수 있을 것으로 사료된다.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.593-598
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• 2007

Purpose: Talipes equinus deformity is defined as impossibility of heel weight-bearing and lacking of improvement of toe-tip gait despite sufficient duration of conservative treatment. The incidence of equinus deformity induces post-traumatic extensive soft tissue defect and subsequently increases it. Severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using achilles Z-lengthening and free-tissue transfer. Methods: Free radial forearm flap was done in nine cases of eight patients from January 2000 to November 2006. Causes of deformity were post-traumatic contracture (one patient) and post-burn scar contracture (seven patients). Seven patients were male, one patient was female. Mean age was 32.1 (range, 10-57). Flap donors were covered with artificial dermis ($Terudermis^{(R)}$) and split thickness skin graft (five cases), and medium thickness skin graft only (four cases). Results: The size of flaps varied from $6{\times}12$ to $15{\times}12cm$ (average, $12{\times}7.8cm$). Achilles tendon was lengthened 4.2cm on average. Free radial forearm flap was satisfactory in all cases. All patients could ambulate normally after the surgery. Cases having donor coverage with $Terudermis^{(R)}$ were aesthetically better than those having skin grafts only. Conclusion: This study suggested that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively free radial forearm flap and Achilles tendon lengthening.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.587-592
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• 2007

Purpose: In case of postburn flexion contracture of the fingers, skin graft, geometrical relaxation techniques, local flap, and free flap have been used. Among these procedures, full-thickness skin grafts from the inguinal area are widely used to reconstruct a postburn flexion contracture in the fingers. But there are many esthetic and functional problems in this procedure. Especially, hyperpigmentation of the skin-grafted fingers poses a troublesome problem, particularly in the patients who have dark colored skin. To solve the problem, we have used pulp graft which was harvested from the lateral aspect of great toe. In the present study, we report pulp graft, with which we have obtained a good result in the treatment of postburn flexion contracture of the fingers. Methods: Between September of 2004 and August of 2006, great toe pulp graft was performed to 20 sites of 15 patients. After release of the postburn flexion contracture using Z-plasty, the composite tissue (pulp) harvested from the lateral aspect of great toe was grafted on the raw surface. Moisture dressing with ointment and foam dressing material was performed. Stratum corneum of the graft got stripped off in two to four weeks after pulp graft. The color of the pulp graft was slightly reddish, then it became similar to the adjacent tissue. Results: There was complete take in all the patients who were treated with pulp graft. Great toe pulp graft provided similar color and texture to the adjacent skin, high rate of graft take, and left only a minimal scar at donor site. Conclusion: Thick keratin layer and inelastic nature of the pulp make this type of the graft much easier and simpler, and ensure a better take. Pulp graft is useful method for the reconstruction of the postburn flexion contracture in fingers.

• 대한후두음성언어의학회지
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• 제25권1호
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• pp.31-35
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• 2014

Objectives : The aim of this study was to evaluate the effectiveness and feasibility of coblation resection for the treatment of laryngotracheal disease. Methods : We conducted a retrospective review, evaluating 7 patients with laryngotracheal disease treated using coblator. Information collected included demographic data of the patients, diagnosis, size and location of the disease, procedure time, the number of previous operation, and the postoperative complication. Results : Among the etiology, granulation is most frequent (n=4), followed by recurrent repiratory papillomatosis (n=2) and tracheal stenosis (n=1). The location of lesions was peristomal area (n=2), glottis (n=2), subglottis (n=2) and mid-trachea. Coblation resection could remove the lesions completely and there was no significant complication including local burn, bleeding, and hypertrophic scar. The procedure time was shorter than the previous operation using $CO_2$ laser. Conclusion : Coblation resection is an effective and safe method for layngotracheal disease and can substitute the classic method such as $CO_2$ laser.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.163-168
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• 2001

The defects of the abdominal wall could be brought about either congenitally, for instances in such cases as omphalocele or gastroschisis, or by various acquired causes-trauma, excision of tumors, excision of burn scar, tissue necrosis caused by infection, hematoma after abdominal surgery, tissue necrosis after radiation therapy and so on. As for the techniques of the reconstruction of the abdominal wall defects, many authors have developed and reported diverse methods. To summarize, primary closure, skin graft, local skin flaps, various myocutaneous flaps, free flap, fascia graft, artificial mesh, tissue expansion, etc could be used in the reconstruction of the abdominal wall defects. The periumbilical perforator-based island skin flap has a many advantages such as no significant sacrifice of the rectus abdominis muscle, wide rotation arc, reliable blood flow of the perforator, short elevation time for flap, and for middle-aged, obese patients, the donor site may be the best from the cosmetic point of view. We used perforator-based island skin flap in 5 cases with reasonable result from March 1999 to May 2001. There were no significant complications and donor sites could be repaired primarily.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.226-231
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• 2013

Background The reconstruction of volar surface defects is difficult because of the special histologic nature of the tissue involved. The plantar surface is the most homologous in shape and function and could be considered the most ideal of reconstructive options in select cases of volar surface defects. In this paper, we evaluate a single institutional case series of volar tissue defects managed with second toe plantar free flaps. Methods A single-institution retrospective review was performed on 12 cases of reconstruction using a second toe plantar free flap. The mean age was 33 years (range, 9 to 54 years) with a male-to-female ratio of 5-to-1. The predominant mechanism was crush injury (8 cases) followed by amputations (3 cases) and a single case of burn injury. Half of the indications (6 cases) were for soft-tissue defects with the other half for scar contracture. Results All of the flaps survived through the follow-up period. Sensory recovery was related to the time interval between injury and reconstruction-with delayed operations portending worse outcomes. There were no postoperative complications in this series. Conclusions Flexion contracture is the key functional deficit of volar tissue defects. The second toe plantar free flap is the singular flap whose histology most closely matches those of the original volar tissue. In our experience, this flap is the superior reconstructive option within the specific indications dictated by the defect size and location.

• 대한두개안면성형외과학회지
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• 제21권3호
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• pp.161-165
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• 2020

Background: Microstomia is defined as a condition with a small sized-mouth that results in functional impairment such as difficulty with food intake, pronunciation, and poor oral hygiene and cosmetic problems. Several treatment methods for microstomia have been proposed. None of them are universally applicable. This study aims at analyzing the cases treated at our institution critically reviewing the pertinent literature. Methods: The medical records of all microstomia patients treated in our hospital from November 2015 to April 2018 were reviewed retrospectively. Of these, all patients who received surgical treatment for microstomia were included in the study and analyzed for etiology, chief complaint, surgical method, and outcomes. The functional outcomes of mouth opening and intercommissure distance before and after the surgery were evaluated. The cosmetic results were assessed according to the patients' satisfaction. Results: Five patients with microstomia were corrected. Two cases were due to scar contracture after chemical burn, two cases derived from repeated excision of skin cancer, and one patient suffered sequela of Stevens-Johnson syndrome. The following surgical methods were applied: one full-thickness skin graft on the buccal mucosa, three buccal mucosal advancement flaps after triangular excision of the mouth corner, and one local buccal mucosal flap. Mouth opening was increased by 6.0 mm, and the intercommissure distance improved by 7.2 mm on average. Follow-up was 9.6 months (range, 5-14 months). Cosmetic assessment was as follows: two patients found the results excellent, three judged it as good. Conclusion: Microstomia has several causes. In order to achieve optimal functional recovery and aesthetic improvement it is important to precisely evaluate the etiologic factors and the severity of the impairment and to carefully choose the appropriate surgical method.

• 생명과학회지
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• 제25권5호
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• pp.523-532
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• 2015

맥문동(Liriope platyphylla)은 염증(inflammation), 당뇨(diabetes), 신경퇴행성질환(neurodegenerative disorder), 비만(obesity), 변비(constipation), 아토피질환(atopic dermatitis) 등의 다양한 임상질환에 매우 우수한 치료효과를 나타내는 것으로 알려져왔다. 또한, 하이드로콜로이드막(hydrocolloid membranes, HCM)은 피부경화증 피부궤양(scleroderma skin ulcers), 피부궤양(cutaneous ulcers), 영구적 고막천공(permanent tympanic membrane perforations), 욕창(pressure sores), 욕창궤양(decubitus ulcers)과 같은 피부질환 치료에 많이 사용되고 있다. 따라서 본 연구에서는 기능성이 우수한 맥문동 추출물을 HCM에 혼합하여 맥문동 혼합 하이드로콜로이드막(HCM-LP)을 제조하고, 물리화학적 특성을 분석한 뒤 2도 화상을 유발한 SD 랫드에 14일 동안 처리하여 치료효과를 분석하였다. 그 결과, 일반 하이드로콜로이드막(HCM)에 비하여 HCM-LP에서 인장강도와 흡수성은 각각 38.4%, 46.3% 감소하였으나 표면거칠기는 38.1% 증가하였다. 화상을 유발한 SD 랫드에서 HCM-LP를 처리한 결과, 화상 유발 14일 후에 HCM-LP처리그룹은 GZ처리그룹에 비하여 유의적으로 화상크기 감소를 나타내었을 뿐만 아니라 흉터감소, 재상피화, 신생혈관형성 그리고 세포외기질의 침적을 유도하였다. 따라서 이러한 결과는 HCM-LP가 신생혈관형성과 연결조직형성 조절을 통해 SD 랫드에서의 화상 치료를 향상시킴을 의미한다. 또한, 본 연구는 HCM-LP가 피부상처의 치료에 적용할 수 있는 다른 기능성 물질을 포함하는 HCM의 개발에 대한 가능성을 제시하고 있다.

• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.43-50
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• 2004

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.