• Archives of Plastic Surgery
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• 제45권1호
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• pp.80-84
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• 2018

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.

• 대한두개안면성형외과학회지
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• 제12권1호
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• pp.37-42
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• 2011

Purpose: Cancer arising from the external auditory canal is a rare disease. A lesion that seems harmless in someway, can be lethal when inadequately excised, the tumor may infiltrate nerves, the parotid and auditory tissues before re-invading the skin. Wide resection of the lesion surrounding the structure and reconstruction with an adequate plan is crucial for the treatment of this disease. Methods: Two patients with external auditory canal cancer were treated with muscle flaps and skin grafts. Lateral temporal bone resection (LTBR) was performed for complete resection of the cancer. The defect cavity was obliterated with highly vascularized tissue using pedicled sternocleidomastoid muscle, and temporalis muscle individually, combined with full thickness skin graft for covering the skin defect of the ear. Results: Clear resection margin was obtained, and both patients showed disease free survival during the follow up. There was no complications of hematoma, infection, flap loss, or wound problem in both patients. Both patient received radiation therapy, there was no osteoradionecrosis or any other complication related to radiation therapy. Conclusion: Utilizing pedicled muscle flaps for managing defects after wide resection of the external auditory canal cancer is an effective method for managing this difficult disease.

• 대한두개안면성형외과학회지
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• 제19권2호
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• pp.152-156
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• 2018

Mandibular defects lead to severe deformation and functional deficiency. Vascularized osteocutaneous tissue has been widely used to reconstruct the mandible. However, it is technically challenging to shape this type of grafts in such a manner that they resemble the configuration of the mandible. A 48-year-old female patient who underwent anterolateral thigh (ALT) flap coverage after a tongue cancer excision was diagnosed with a tumor recurrence during the follow-up. A wide excision mandibulectomy and mandibular reconstruction with an ALT flap and a titanium implant were performed. The prefabricated titanium implant was fixed to the condyle. Then, an ALT flap was harvested from the ipsilateral thigh and anastomosed. After confirming that the circulation of the flap was intact, the implant was fixed to the parasymphysis. On the radiograph taken after the surgery, the prosthesis was well positioned and overall facial shape was acceptable. There was no postoperative complication during the follow-up period, 1 year and 2 months. The prefabricated implant allows the restoration of facial symmetry without harvesting autologous bone and it is a safe and effective surgical option for mandibular reconstruction.

• Archives of Aesthetic Plastic Surgery
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• 제23권3호
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• pp.143-145
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• 2017

Medical leech therapy is a treatment for the venous congestion of tissue flaps, grafts, and replants. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) following leech application at a congested flap after mastectomy. A 45-year-old woman had an invasive ductal carcinoma. Modified radical mastectomy was performed. The chest wall defect was reconstructed with a local rotation flap. On postoperative day (POD) 1, congestion and color change were observed, and 10 medical leeches were applied to the congested area. On POD 4, another 10 medical leeches were applied. On POD 12, wound necrosis progressed and a pus-like discharge appeared. A wound swab culture revealed MRSA. Debridement was carried out on POD 15. From POD 16, vancomycin and piperacillin/tazobactam were injected for 18 days. The wound culture on POD 18 also revealed MRSA. A split-thickness skin graft was performed on POD 28. MRSA has not been clearly identified in the literature as a leech enteric bacterium. Although MRSA may have come from another source, the present case raises the possibility of MRSA infections following leech application at congested flaps. When medical leeches are applied at the congestion site of a flap, an aseptic cradle will be helpful. Vancomycin irrigation may be needed if infection occurs.

• Journal of Trauma and Injury
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• 제37권2호
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• pp.151-157
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• 2024

Electrical burn injuries can cause more damage than clinical evaluations initially suggest. The energy waves penetrate from the surface to the deepest layers of tissue, causing extensive harm at every level. The neck is a critical area, both functionally and aesthetically. We present a case involving a young male patient with a severe fourth-degree electrical burn on the neck, who underwent a single-stage debridement and reconstructive surgery. The pectoralis major myocutaneous flap is a versatile option for various head and neck reconstructions. However, if the donor site cannot be closed primarily and requires split-thickness skin grafting, it can result in unsightly scars and deformities. For large flap paddles, it is ideal to reconstruct the secondary defect with locoregional flaps. In this case, we successfully reconstructed the donor site's secondary defect using a contralateral internal mammary artery perforator flap, without resorting to any skin grafts. The early postoperative results demonstrated satisfactory cosmesis, patient satisfaction, and functional outcomes.

• Journal of Periodontal and Implant Science
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• 제30권2호
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• pp.241-257
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• 2000

자가골막은 골결손부에서 골형성을 자극할 수 있는 능력과 조직유도재생술의 이상적인 차폐막이 갖추어야 할 여러 조건들을 만족하고 있다. 치주조직의 재생 술식에 적용시 임상적으로 다른 차폐막을 사용한 정도의 치주낭 감소와 임상적인 부착증진을 얻었다고 보고되고 있으나 이러한 임상적인 긍정적인 결과가 치주조직의 재생을 반드시 의미하는 것이 아니므로 조직학적 평가가 필요하다. 이에 본 실험은 성견의 하악 소구치에 2급 분지부 골결손을 형성하고 상악 견치의 협측 변연치은 정상 3 mm 하방에서 채취한 자가골막을 이식한 경우와 자가골막에 Calcium carbonate 이식을 병용하였을 때 치주조직의 재생에 미치는 영향을 평가하고자 하였다. 실험은 잡종 성 견 6마리를 이용하였다. 실험군은 모두 3개 군으로 나누었다. 대조군은 골결손부의 외과적 처치 후 치주판막으로 봉합한 군, 실험 I군은 골결손부에 외과적 처치 후 자가골막만 이식한 군, 실험 II군은 골결손부에 자가골막과 Calcium carbonate 이식을 병용한 군으로 하였다. 희생은 각각 술후 2, 4, 12주에 시행하였고 광학 현미경적 관찰을 시행하여 다음과 같은 결론을 얻었다. 임상적으로 잘 치유된 소견을 보였다. 광학현미경적으로 관찰시 2주째에 대조군은 상피의 근단이동이 심하였고 홈하방 부위에서만 골조직의 개조현상이 관찰되었으나 자가골막을 이식한 실험 I, II군에서는 상피의 하방이동은 미약하였고 홈상방으로 많은 골양조직이 관찰되었다. 조직계측학적으로 상피대는 실험군과 대조군 모두 4주와 1 2주째에 큰 변화가 없었다. 치주조직의 신부착 양은 실험군 대조군 모두 1 2주에 4주보다 더 증가하였으며 실험 I, II군이 대조군에 비하여 많은 경향을 보였으나 실험 I, II군간의 차이는 없었다. 이식된 자가골막은 시간이 경과함에 따라 골막이 주위조직과 생착되어 4주이후에는 관찰되지 않았다. 이상의 결과로 보아 이식된 자가골막에 의한 치주조직 재생은 비교적 양호하였으며 상피의 하방증식을 억제할 수 있어 흡수성 차폐막으로 이용할 수 있을 것으로 사료된다.

• 대한의용생체공학회:의공학회지
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• 제16권4호
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• pp.463-470
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• 1995

사람의 내피세포는 동물내피세포에 비해 배양증식이 어려운 것으로 알려져 있어 이를 효율적으로 배양증식 시키기 위해서 배양액에 내피세포성장인자를 헤파린과 함께 첨가하는 방법이 많이 사용되어 오고 있다. 한편 최근에는 세포내 cyclic adenosine monophosphate(cAMP)을 증가시키는 물질들인 콜레라독소와 아이소부틸메틸산틴(isobutlmethylxanthine, IBMX)을 세포배양액에 첨가하여 내피세포 증식을 향상시킨 실험결과가 보고된바 있다. 이런 연구결과들을 토대로 할때 내피세포 배양액에 내피세포성장인자 및 헤파린과 함께 cAMP 증가물질을 같이 첨가하여 주면 내피세포의 성장증식을 보다 향상시킬수 있을 것이라는 가설이 가능할 것이다. 본 실험에서는 이와같은 가설을 검증하기 위해 사람의 대망 미세혈관(omental microvessel)으로부터 내피세포를 분리배양한뒤 내피세포성장인자 및 헤파린과 cAMP 증가물질들의 첨가가 내피세포의 증식에 미치는 영향을 분석하고, 궁극적으로는 사람 내피세포의 최적 배양증식 조건을 확립하고자 하였다. 실험 결과 사람의 대망 미세조직에서 내피세포를 분리하여 이를 효과적으로 배양증식하기 위해서는 내피세포성장인자와 헤파린을 첨가한 배지를 사용하거나, 또는 내피세포성장인자를 사용하지 않는 경우 콜레라독소와 IBMX를 병합 첨가하는 것이 좋은 것으로 관찰되었으며, 내피세포성장인자와 콜레라독소 및 IBMX를 동시에 병합 첨가하는 것은 효과가 없는 것으로 밝혀졌다.

• Journal of Periodontal and Implant Science
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• 제28권2호
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• pp.249-264
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• 1998

The present study evaluates the effects of calcium sulfate and DFDB on alveolar bone regeneration and cementum formation and connective tissue adhesion in intrabony angulated 1 wall defects of dogs. Four millimeter-deep angulated one-wall intrabony defects were surgically created in the mesial & distal aspects of premolars and with flap operaion alone(control group), with calcium sulfate(experimental group 1), with composit graft of 50% calcium sulfate and 50% DFDB(experimental group 2), with DFDB alone(experimental group 3). Histologic analysis following 8 weeks of healing revealed the following results: 1. The lengths of connective tissue adhesion was $1.05{\pm}0.48mm$ in the control, $1.30{\pm}0.67mm$ in the test group I, $0.97{\pm}0.22mm$ in the test group II and $0.93{\pm}0.15mm$ in the test group III. There was no statistical significance between control and all experimental groups. 2. Changes in alveolar bone level was $0.97{\pm}0.27mm$ in the control group, $1.45{\pm}0.42mm$ in the test group I, $2.00{\pm}0.33mm$ in the test group II, $1.88{\pm}0.34mm$ in the test group III. There was no statistically significant difference between control and experimental group I. There was a statistically significant difference between the control and experimental group II,III.(p<0.05). There was no statistically significant difference between all experimental group. 3. Cementum formation was $1.13{\pm}0.17mm$ in the control, $1.78{\pm}0.31mm$ in the test group I, $2.17{\pm}0.38mm$ in the test group II, $2.15{\pm}0.47mm$ in the test group III with statistically significant differences between control group and all experimental group(P<0.05). There was no statistically significant differences between all experimental group. These results suggest that the use of composit graft of 50% calcium sulfate and 50% DFDB and DFDB alone in angulated 1 wall intrabony defects has little effects on connective tissue adhesion, but has significant effects on new bone and new cementum formations.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제11권1호
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• pp.117-129
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• 1989

The commercial availability of processed heterogenous bone has provided the surgeons with almost unlimited supply, avoidance of additional operation and prevention of the postoperative complications. In addition to these merits, unnecessary bone bank, easy availibility and storage have been achieved. The purpose of this study was to compare and examine the healing capacity of Kiel bone, Pyrost and Osteovit which used as the processed heterografts for the reconstruction of bony defect. Twenty rabbits weighing about 1.7-2.0 Kg were selected and divided into two groups. In experimental group A, the left mandibular defect was allowed to fill with blood, and the right defect was filled with Kiel bone. In experimental group B, the left defect was grafted with Pyrost, and the right with Osteovit. The experimental animals were sacrified after 1, 2, 4 and 8 weeks and the grafted site was studied histologically. To evaluate the strength of healed bone, 2 rabbits from each experimental group and a nonoperated control were sacrified at the 6th week after implantation and used for biometric testing on universal testing machine. The results obtained were as follows : 1. It was considered that these heterogenous bone grafts has feeble or absent immunogenicity since all of them appeared to evoke little inflammatory or forign body reaction. 2. In all experimental groups, new bone formation began from the adjacent region of host bone and extended progressively into the defect sites. New bone was partly formed within the intertrabecular space of the implant and gradually united with the bone that formed at the margin of the host bone. 3. With Pyrost bone formation was rapid and prominent comparing with other graft materials. 4. Osteovit was begun to be absorbed from 2 weeks, and Kiel bone from 4 weeks, however Pyrost was remained to be intact until the end of 8 weeks. 5. As the results of tensile test, the mean values of maximum tensile stress were 1.11${\uparrow}$ $Kgf/mm^{2}$ in Pyrost implanted specimens, 0.85 $Kgf/mm^{2}$ in Osteovit, 0.42 $Kgf/mm^{2}$ in Kiel bone, 0.66 $Kgf/mm^{2}$ in blood filled specimens and 1..13 $Kgf/mm^{2}$ in control. These results indicate that heterogenous bones grafted have little antigenicity to the host tissue, and that they mediate effectively osteoconduction by providing the scaffold for the bone formation. Pyrost and Osteovit appeared to be suitable for the clinical use.

• Journal of Chest Surgery
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• 제37권6호
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• pp.474-481
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• 2004

배경: 암이나 협착 등의 각종 기관질환으로 광범위한 기관절제가 필요한 경우에는 기관 이식이 필요하나, 다른 장기의 이식술과 비교하여 많은 어려움이 있다. 이에 본 연구에서는 이상적인 기관 대체물을 개발하기 위한 노력의 일환으로, 조직 공학적 기법을 통하여 기관 재건에 적용할 수 있는 소장-연골 복합 이식판의 개발이 가능한가를 알아보고자 하였다. 대상 및 방법: 생후 2주 된 토끼의 기관과 이개로부터 각각 연골세포를 채취하여 8주간 배양하였다. 배양된 초자 연골세포와 탄성 연골세포를 담체(PLGA)에 심거나 플루로닉 겔에 혼합한 후에, 4 종류의 혼합체를 토끼의 위장과 대장의 점막하 조직에 이식하고 10주 후에 연골 형성 여부를 평가하였다. 결과: 육안과 촉진으로 이식 부위를 판별할 수 있었으며, 현미경적 소견상 담체의 흡수와 연골의 형성을 확인할 수 있었다. 특히 초자 연골세포-담체 혼합체에서 연골의 형태를 잘 갖추고 있었다. 결론: 장-연골 복합 이식판 개발의 전망은 밝으며, 이상적인 기관 대체물로서 기관 재건에 기여할 가능성이 있다고 사료된다.