두경부 유리피판 수술에 있어서의 비천공성 혈관 클립을 이용한 미세혈관 문합술

장학,민경원,김우람,신현우,고경석,Chang, Hak,Minn, Kyung-Won,Kim, Woo-Ram,Shin, Hyun-Woo,Koh, Kyung-Suck 대한미세수술학회 2005 Archives of reconstructive microsurgery Vol.14 No.1

Microvascular anastomosis with suture technique is a basic skill but there are several problems such as stenosis, thrombosis and long operating time. Recently plastic surgeons have developed non-suturing mechanical coupling devices for microvascular anastomosis. The authors applied non-penetrating vascular clips (VCS clips) in the field of free flap surgery of head and neck area. Between August of 2004 and January of 2005, we performed 9 free flaps (16 vessels) using small-sized VCS clips. Four stay sutures were applied first and then VCS clips were placed between sutures about 1 mm apart. Vascular pedicle of free flap included the descending branch of lateral circumflex femoral vessel, thoracodorsal vessel, deep inferior epigastric vessel and cephalic vein. The recipient vessels were the superior thyroid artery, superficial temporal artery, internal jugular vein, external jugular vein, and superficial temporal vein. We performed 13 end-to-end (4 arteries and 9 veins) and 3 venous end-to-side anastomoses. No flap related complication occurred but we applied additional clips or sutures in two cases due to blood leakage after completion of anastomosis. Primary patency rates seemed to be good and more rapid anastomosis could be done than conventional suture technique. Advantages of VCS technique are high patency rate, low thrombogenecity and rapidity. Although the high cost of VCS instrument may be a problem, this clip could be applied safely in microvascular free tissue transfer.

두피에 발생한 혈관육종의 수술시 Mapping Biopsy의 유용성

강민구(Min Gu Kang),박종림(Jong Lim Park),김명국(Myung Good Kim),장 학(Hak Chang),민경원(Kyung Won Minn),고경석(Kyung Suck Koh) 대한두경부종양학회 2007 대한두경부 종양학회지 Vol.23 No.1

Objectives :Cutaneous angiosarcoma is an infrequent but aggressive neoplasm involving the skin of the face and scalp. Unfamiliarity with the clinical manifestations of cutaneous angiosarcoma frequently leads to misdiagnosis and delay in treatment. Complete surgical resection requires the performance of preoperative staging biopsies to determine the true extent of the neoplasm. Intraoperative frozen section analysis to determine the adequacy of the surgical resection is unreliable due to the high false negative rate. Material and Methods :In five scalp angiosarcoma cases, mapping biopsies were performed at far from the suspected edge of the neoplasm. On permanent pathology, we obtained tumor free margin with occasional focal involvement of the tumor. Results :Frozen-section analysis of the resected margins is inconclusive, for the subtle diagnostic features of angiosarcoma are distorted by the tissue processing required for frozen-section analysis. The characteristic dermal vessels lined by their malignant cells are collapsed by the freezing process. This results in a high rate of false-negative reports and possibly leads to incomplete resection of the neoplasm. Conclusion :Our recommendation is to establish the margins of the tumor by performing preoperative eval-uations by mapping biopsies.

두경부종양 수술적 접근시 두개안면절골술의 응용

윤근철,김창진,홍윤기,김상윤,고경석 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

Access to the craniofacial skeleton and skull base requires osteotomies. An adequate exposure of neoplasms occupying the skull base and the oral cavity and oropharynx, especially retromolar trigone, is very important for precise tumor ablation. The demonstration by Tessier of the capacity for large segments of bone to survive removal and replacement has enabled skull base tumor surgery to grow into a subspeciality. Through the refined craniofacial exposure osteotomies, the surgery is safer, the operation shorter, and the result better both oncologically and reconstructively. We experienced 24 cases of exposure osteotomies consisting of 12 cases transzygomatic approaches, 1 case tranglabellar osteotomy, 1 case lateral transmaxillary approach, 1 case Le Fort Ⅱ & midline splitting, and 9 cases mandibulotomy. There was no significant complication except a local wound infection in transzygomatic approach and one case of minimal malocclusion after parasymphyseal mandibulotomy. The orthotopic bone graft and the rigid fixation enables the postoperative morbidity to decrease. It seems that the previously inaccessible craniofacial tumors can be treated through the various exposure osteotomies.

자궁암치료후 천골부에 발생한 방사성 궤양의 처치

김석화,고경석 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.4

Radiation therapy is one of the principal modalities for cancer therapy, but radiation induces vascular sclerosis and hypoxia. In some patients, usually 10 to 20 years after radiation therapy the skin may break down and an ulcer may develop in response to minor trauma or spontaneously. The ulcer may widen to encompass the area of radiation damage in spite of the daily dressing. Although improvements in the treatment techniques and equipment for radiation have occured, ulcers still develop and continue to be a vexing problem for the patients and reconstructive surgeons. The only therapy previouslly available for radiation ulcer was debridement of the nevrotic area and the introduction of fresh, well- vascularized tissue, but it is believed that hyperbaric oxygen, when used together, can shorten a long and expensive clinical course with a low incidence of serious complications. We experienced three cases of radiation ulcer developed at the sacral area after the treatment of uterine cancer. Bilateral gluteus maximus V-Y advancement myocutaneous flaps in two cases and the latissimus dorsi emyocutaneous free flap in one case were used for coverage of the sacral defects combined with hyperbaric oxygen therapy. The preoperative hyperbaric oxygen therapy is very helpful to the management of radiation ulcer.

연골동종이식의 임상 경험

강정훈,한상훈,오두영,윤근철,고경석 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

Bony defect is one of the most common problems in craniomaxillofacial surgery. Although aurogenous bone graft is the best choice for the treatment of bone defect, it provides many problems such as donor site morbidity, irregular absorption, and limited amount of harvest. To overcome the shortcomings of autogenous bone graft many bone substitutes have been introduced. The ideal bone substitution is to have characteristics such as cheap, easy to obtain, rapid fusion to recipient bone, hard structure, long maintenance of shape and volume, low infection rate, and low exposure rate. Among those bone substitutes which have been widely used we chose lyophilized cartilage allograft because of low antigenecity, low resorption rate, easiness of carving and ling term preservation. From August 1993 to August 1997, 66 patients had been performed craniomaxillofacial reconstruction with lyophilized cartilage allograft. Orbital wall reconstruction and correction of enophthalmos were 24, correction of cleft lip and nose deformity were 19, temporal augmentations were 7, and others 16. Complications such as infection, exposure were not common. And partially removed cartilage was proved some calcification. Radiologic follow-up presented well positioned lyophilized cartilage allograft. Two radiologic works revealed haziness of bone density at the site of cartilage allograft. This suggests the ossification of lyophilized cartilage allograft. Together with liw infection rate, low exposure rate, and good framework for osteoconduction, lyophilized cartilage allograft are regarded as one of the good bone substitutes.

백서의 서혜부 유경 피판의 혈관 차단시 조직내 ATP, Glucose 및 Lactate의 초기 변화에 대한 실험적 연구

고경석 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.1

Despite continuous improvement in the understanding of the anatomic patterns of cutaneous circulation, skin-flap failure remains a frequent clinical reality. Flap hemodynamics have been studied most intensively, but vasodilators, with few exceptions, have been ineffective. in several tissues a fall in ATP levels is related to irreversible damage. The survival of experimental skin flaps may by assessed by following the early changes in tissue ATP. An island skin flap, 3cm x 4cm, was made in the groin and lower abdmen of thee rat. The basal level of ATP was 1.48??0.15μmol/g dry weight. Following vascular occlusion in the island skin flap, the level of tissue ATP fell rapidly, especially during the first 2 hours. However, thereafter the ATP level remained constant. The level of lactate and glucose changed rapidly during the first 2 hours.

전두골 전방이동을 이용한 Crouzon 질환의 치료

고경석,김진환,이동락 大韓成形外科學會 1985 Archives of Plastic Surgery Vol.12 No.2

In 1950, Gilies reported the first successful correction of a Crouzon's deformity by means of a total facial osteotomy. To obtain a better correction of the exorbitism, Converse and Wood-Smith advanced the complete orbits and the face in one piece. Simultaneous advancement of frontal bones, orbit, and fane as described by Tessier and Ortiz-Monasterio, can lead to infection caused by opening the anterior cranial fossa to the nasal cavity. This early or later complication can be avoided by a two-stage procedure, consisting of advancement of upper orbit and frontal bone and a LeFort Ⅲ osteotomy in a separate operation, or by other procedures advocated by Whitker, Ortiz-Monasterio and Anderl. we obtained a fairy good result by fiontal bone advancement for the 8 year old patient of Crouzon's deformity to decompress the intracranial pressure and correct the exorbitism.

새로 고안한 풍선박리기를 사용한 임상경험

최문수,고경석,박상훈 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

A new balloon dissector, a modification of a Foley catheter, was devised and it can be used either as a dissector or a tissue expander. Since most operating time was spent in balloon manipulation (inflation/deflation), the duct for saline injection was made to be wider than the Foley catheter. As a result, the balloon could be inflated faster than before. In order to reduce the scar at the donor site, harvest of the sural nerve using endoscopic technique is currently applied, but utilization of this method is technically difficult and requires a long operating time. For these reasons, new our method of using a balloon dissector was devised. The balloon dissector can also be used for immediate intraoperative tissue expansion for the reconstruction of small skin defects without distortion. We have found that the advantages of using the new balloon dissector include a reduction in operating time, preservation of the perforating vessels, and primary closure with less tension. In addition, this simple and inexpensive instrument is cost-beneficial to patients.

방사선 조사를 받은 두경부 병소의 재건을 위한 유리피판술

채수욱,고경석,김주봉,박상훈,한상훈,이택종,남순열,김상윤 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

Radiation therapy is an effective cancer treatment modality as a primary treatment in early cancer and as an adjuvant treatment in advanced cancer, especially in head and neck lesions, but it also causes irreversible chronic damages to overlying normal tissues that may lead to wound complications. As well, at the microscopic level, radiation injury causes both stasis and occlusion of small vessels. Therefore, surgical reconstruction of previously-irradiated lesions in the head and neck poses a great problem. Fifth-six patients with head and neck lesions underwent 57 microsurgical reconstructions between 1990-1998. Thirteen patients were irradiated before surgery. The previous radiation dose was 30∼75.6 Gy. The free tissue transfer was successful in 52 of the 57 microsurgical reconstructions(91.2%). The success rate was 92.3%(12/13) in previously-irradiated patients and 90.9%(40/44) in nonirradiated patients. Postoperative complications, such as flap loss, fistula, and infection, developed in 4 irradiated patients and 8 nonirradiated patients. Overall complication rate was 30.8%(4/13) in previously-irradiated patients and 18.2%(8/44) in nonirradiated patients. Although the failure rate of previously-irradiated patients was higher than that of nonirradiated patients, there was no statistically significant difference between them. Thus, free tissue transfers in patients with previously-irradiated head and neck lesions are suitable for one-stage reconstruction.

자기공명 분석법을 이용한 백서 피판의 대사에 대한 연구

이윤,이대근,임태환,윤근철,고경석,이춘신,정복성 대한성형외과학회 1992 Archives of Plastic Surgery Vol.19 No.3

Innumerable techniques have been used to measure, index, or predict the viability of skin flaps after elevation. However, these are largely indirect and don't accurately reflect the events that occur at kthe cellular level. A method was sought that gives direct, reproducible, and accurate data about physiological and biochemical changes that occur during flap elevation. Because of its ability to monitor changes in the levels of high energy phosphorus metabolites(ATP, or adenosine triphosphate, PC or phosphocreatine, Pi or inorganic phosphate), 31-P magnetic resonance spectroscopy (MRS) holds promise of providing direct assessment of the metabolic status and biochemical changes that occur during skin flap elevation. MRS monitoring was performed on three portions of raised random pattern skin flaps of 5 rats. The spectrometer used for 31-P nuclear magnetic resonance analysis was a Bruker Biospec(4.7 Tesla) system, and a modified surface coil constructed of two layers of copper coil was used. The results have validated the ability of 31-P MRS to : 1. define the regional flxes in the levels of ATP, PCr, and Pi in skin flaps. 2. demonstrate that, of these, PCr levels represent the most sensitive indicator of flap well being. 3. measure intracellular pH through the chemical shift of the Pi resonance. 4. establish predictive correlations between profile of normal, compromised, and failing skin flaps and have thus prepared the way for noninvasive in vivo topical magnetic resonance investigations of flaps.