• 대한골관절종양학회지
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• 제14권1호
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• pp.33-43
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• 2008

목적: 족관절 및 족부에 발생한 악성 연부 조직 종양의 광범위 절제술 후 시행한 재건술의 임상적 효용성에 대하여 알아보고자 한다. 대상 및 방법: 2000년 3월에서 2007년 3월까지 족관절 및 족부에 악성 연부 조직 종양이 발생하여 광범위 절제술을 시행한 후 재건술을 시행한 15례(14명)을 대상으로 하였다. 폐 전이로 사망한 1례를 제외하고 평균 36.4개월(7~72개월)의 추시기간을 가졌고, 평균 연령은 56.8세(26~77세), 남자가 11명, 여자가 3명이었다. 원발병소는 악성 흑색종 12례, 편평상피 세포암 3례이었다. 최종 추시점에서 종양학적, 수술적 그리고 기능적인 결과를 비교하였다. 결과: 재건술의 방법은 전외측 대퇴부 천공지 피판 5례, 역행성 표재 비복동맥 피판 4례, 족배 동맥 피판 3례와 국소 피판 3례였다. 결손의 크기는 평균 $5.5{\times}5.7\;cm$, 피판의 크기는 평균 $5.9{\times}6.0\;cm$이었다. 회전 피판술 결손의 크기는 평균 $4.6{\times}4.7\;cm$, 피판의 크기는 평균 $4.9{\times}4.8\;cm$이었고 유리 피판술 결손의 크기는 평균 $7.2{\times}7.8\;cm$, 피판의 크기는 평균 $8.2{\times}8.8\;cm$이었다. 평균 수술 시간은 310분(120~540분)이었고, 회전 피판술은 256분, 유리 피판술은 420분이었다. 1례가 폐전이로 사망하였고 국소 재발한 4례와 원격 전이가 발견된 4례를 제외한 7례에서는 최종 추시상 병변이 발견되지 않았다. 피판의 국소적인 울혈외에 수술적 합병증은 없었고, 술 후 MSTS 점수는 평균 68.8%였다. 결론: 족관절 및 족부에 발생한 악성 연부 조직 종양의 광범위 절제술 후 결손의 크기가 비교적 작을 경우($5{\times}5\;cm$ 이하)인 경우 족배 동맥 피판술, 역행성 표재 비복 동맥 피판술과 같은 회전 피판술을 일차적으로 고려해 볼 수 있다. 결손이 더 크거나 복합 조직이 필요한 경우 전외측 대퇴부 천공지 피판술을 포함한 유리 피판술이 더 유용할 것으로 사료된다. 그리고 악성 흑색종의 경우 재건 방법은 종양학적인 결과에 영향을 미치지 않는 것으로 보인다.

• 대한두개안면성형외과학회지
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• 제11권1호
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• pp.13-18
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• 2010

Purpose: Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps. Methods: From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor (18 cases), trauma (11 cases), inflammation from foreign body reaction (5 cases) and congenital malformation (2 cases). The sites of the defects were ala (22 cases), nasal tip (8 cases) and dorsum (6 cases). The thickness of the defects was skin only (5 cases), dermis and cartilagenous layer (7 cases) and full-thickness (24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below $0.25 cm^2$ were covered with composite graft or full-thickness skin graft. Results: The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match. Conclusion: The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.288-294
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• 2015

Background Surgical ablation for locally advanced breast cancer results in large chest wall defects, which can then be managed with local flaps or skin grafts. The purpose of this article is to evaluate the outcomes of three types of local skin flaps. Methods Among 25 local flaps in 24 patients, 6 were bilateral advancement (BA) flaps, 9 were thoracoabdominal (TA) flaps, and 10 were thoracoepigastric (TE) flaps. Clinical outcomes were compared including complications, the need for a secondary surgical intervention, and the timing of adjuvant therapy. Results The mean defect size was $436.2cm^2$. Two patients with TA flaps and 6 patients with TE flaps developed distal flap necrosis, and skin grafts were needed to treat 2 patients with TE flaps. Radiation was administered to the BA, TA, and TE patients after average postoperative durations of 28, 30, or 41 days, respectively. The incidence of flap necrosis tended to be higher in TE patients, which lead to significant delays in adjuvant radiation therapy (P=0.02). Conclusions Three types of local skin flaps can be used to treat large chest wall defects after the excision of locally advanced breast cancer. Each flap has its own merits and demerits, and selecting flaps should be based on strict indications based on the dimensions and locations of the defects.

• 대한골관절종양학회지
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• 제5권1호
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• pp.63-69
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• 1999

Recently we experienced four cases of soft tissue Ewing sarcoma, developed in the calf muscles in two cases, and one case each in the foot and suprascapular region. We also found that the clinical course in all cases was rather rapid, because of local recurrence and metastatic lesions developing within a few months, followed by the patients' death in about 2 years after the primary tumor was excised. These cases were improperly treated initially as some kind of benign soft tissue tumor. The delay led to missed early accurate diagnosis and was thought to be one of the main causes for the rapid local recurrence and metastasis after tumor excision. The pulmonary metastasis was the most common cause of death.

• 대한두개안면성형외과학회지
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• 제17권3호
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• pp.158-161
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• 2016

Primary cutaneous mucinous carcinoma (PCMC) is a rare malignant tumor of eccrine origin. Clinically, the carcinoma presents as a solitary, slow growing, and painless nodule. For this reason, this tumor is often considered to be a benign mass in the preoperative setting. The lesion is, however, malignant in nature and has a tendency for local recurrence and infrequent metastasis. Wide local excision is the treatment of choice. However, few reports exist with information regarding surgical margins and clinical outcomes. Herein, we report a case of PCMC excised with a narrow surgical margin and review the relevant literature. A 49-year-old man presented with a small cutaneous nodule of the right cheek. The mass was excised without any margin, but pathologic examination revealed histology of mucinous carcinoma. Because of this, the operative site was re-excised with a 5-mm margin, and the wound was closed using a V-Y advancement flap. Systemic work-up did not reveal other potential metastatic primary, for a final diagnosis of PCMC. We report this case of PCMC, treated with relatively narrow margin in a patient with good prognostic factors.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.319-322
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• 2011

Purpose: Glomus tumor is a benign neoplasm of the normal glomus body, occurring as painful subcutaneous nodules, frequently located in the subungual area. There are few cases of facial glomus tumor reported and we report a case of glomus tumor developing on the columella of nose. Methods: A 68-year-old female presented with a mass of the columella grown for 2 years. The nodule was 0.6 cm in diameter, red-colored without any symptoms such as pain, tenderness and cold hypersensitivity. The pathologic result after punch biopsy was hemangiopericytoma. Excision with local anesthesia was executed. Results: The postoperative recovery of the patient was uneventful, Histopathological examination indicated a glomus tumor. Immunostaining revealed positivity for vimentin, actin, and negativity for desmin, CD-34. After 8 months follow up, there is neither complication nor evidence of local recurrence on clinical examination. Conclusion: To accomplish an accurate diagnosis of glomus tumor, the histopathological examination is essential together with immunochemical studies. The differential diagnosis include hemangioma, lipoma, epidermal inclusion cyst, dermoid cyst and arteriovenous malformation in this region. We report a case of glomus tumor on the face with uncommon clinical features.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권1호
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• pp.67-71
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• 2011

Myxofibrosarcoma, also known as a myxoid variant of a malignant fibrous histiocytoma (MFH), is one of the most common sarcomas in the extremities of elderly people. The lesion is characterized by a high frequency of local recurrence but is uncommon in the head and neck regions. Low-grade myxofibrosarcoma, which is commonly misinterpreted as being benign, has a tendency for histological and biological progression in local recurrences, highlighting the importance of an accurate diagnosis and wide surgical excision of the primary lesion. We report a rare case of low-grade myxofibrosarcoma of the mandible located in the left mandibular body and angle area. The tumor was first diagnosed as a myxofibroma and was resected initially. After the final biopsy the patient underwent combined chemo-radiotherapy. The progress of the patent was uneventful until the one year follow up.

• 대한두경부종양학회지
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• 제27권1호
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• pp.80-83
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• 2011

Paraganglioma is a relatively rare, generally benign and slow growing tumor arising from widely distributed paraganglionic tissue thought to originate from the neural crest. In the head and neck region, paraganglionic tissue is distributed in the superior and inferior paraganglia such as the carotid body, the vagal body, and the jugulotympanic region. Approximately 10% of patients with paraganglioma have a family history of such tumors. Multiple lesions can be found in 26% of patients with family history. It is important to distinguish between paraganglioma and atypical carcinoid tumor and medullary thyroid cancer. This can be done with histopathologic evaluation and immunohistochemical markers. Complete excision is recommended for the treatment of this tumor. Paraganglioma is particularly aggressive and rapid recurrence of paraganglioma is common after local resection. We present a case of malignant paraganglioma in the neck which recurred 2 months after local resection. We suppose that radiation therpay could be the last option for the treatment in this clinical setting.

• 대한두경부종양학회지
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• 제25권1호
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• pp.33-35
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• 2009

Purpose : Granular cell tumour(GCT) is a rare benign tumour that can arise in anywhere throughout the body. Histopathological diagnosis of malignancy is difficult. We report a case of a granular cell tumor which developed on lower lip. Methods : A 58-year-old male had a palpable mass and whitish plaque in the oral mucosa for three months. Results : Under local anasthesia, the tumor was removed through wide excision including normal skin margin. Immediate reconstruction using local flap was done. Pathologic observation showed nests of polygonal cells with abundant granular, eosinophilic cytoplasm and round nuclei. Immunohistopathologic staining showed positive reaction on S-100 protein Conclusion : The results support the hypothesis that granular cell tumor is derived from Schwann cells. We report here on a case of granular cell tumor of lower lip that was successfully treated with radical resection.

• 대한골관절종양학회지
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• 제3권2호
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• pp.89-97
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• 1997

Twenty hundred and five out of 266 patients who were registered in Korea Cancer Center Hospital from Mar. 1985 to Jan. 1994, were analyzed in the aspect of survival and local recurrence. Fifty one patients were excluded due to inadequate data and follow up. Prognostic factors for survival were evaluated statistically. One hundred and four cases were male, 101 female. Average age was 39.7(range 1 to 77) year with a peak incidence around 4th decade. The most frequent diagnosis was malignant fibrous histiocytoma(MFH)(24.1%). Liposarcoma, synovial sarcoma, rhabdomyosarcoma, malignant peripheral nerve sheath tumor and fibrosarcoma were relatively common diagnostic entities, in decreasing order. In location, extremity was 179(87.3%) and trunk 26(12.7%). Average follow up period was 7.5 years(6 months to 10 years). Actuarial 5 years and 10 years survival rate were 64.0% and 40.8% respectively. In univariate analysis with log-lank test, significant differences in survival rate were noted in histopathological diagnosis, size(10 cm), stage and metastasis. Age, sex, tumor location, tumor depth and local recurrence didn't affect the survival rate. Adjuvant chemotherapy and/or radiotherapy did not affect overall survival rate, but lowered the local recurrence rate when compared with surgery only. Surgical margin did not affect the survival rate, but local recurrence rate was different according to each margin; 5.7% in more than wide; 39.5% in marginal; and 60.0% in intralesional excision. In multivariate analysis for results of univariate analysis with Cox's propotional model, metastasis was a meaningful factor for survival of soft tissue sarcoma.