족배동맥 유리피판술을 이용한 수부 재건: 공여부 이환율 최소화 방법

손대구,김현지,김준형,한기환,Son, Dae Gu,Kim, Hyun Ji,Kim, Jun Hyung,Han, Ki Hwan 대한미세수술학회 2004 Archives of reconstructive microsurgery Vol.13 No.1

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.

신체 부위에 따른 지방조직의 특성: 컴퓨터단층촬영 및 조직학적 소견

신동우,손대구,박무식,김준형,한기환,Shin, Dong-Woo,Son, Dae-Gu,Park, Mu-Shik,Kim, Jun-Hyung,Han, Ki-Hwan 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: The subcutaneous fat tissue is separated into 2 layers by the subcutaneous fascia: the superficial and deep fat layers. The two fat layers have different structures according to the body regions. The purpose of this study is to evaluate the distribution and pattern of the two fat layers in the human body by computed tomography (CT) and histological analysis according to age, sex, anatomical region, and body mass index (BMI). Methods: This study included 200 males and 200 females who underwent 64-channel dynamic CT in our hospital. The patients were divided into 5 groups according to 10 years of their ages separately in either male or female gender. The thickness of the superficial and deep fat layers was measured in the abdominal, pelvic, and femoral regions, and we analyzed the values. Statistical analyses were performed using SPSS software. The $3{\times}3$-cm whole fat layers were harvested from the same sites of 3 cadavers for histological examination, and one cadaver was dissected for gross evaluation. Results: The total thickness of subcutaneous fat tissue was greater in females than in males, and the ratio of the superficial fat layer to the whole fat layer was higher in females. The superficial fat layer became thinner with increasing age in males. As BMI increased, the total fat layer became thicker, and the superficial fat layer became thicker than the deep fat layer. On histological examination, the superficial fat layer had small adipose lobules and showed a densely distributed pattern in the abdominal region, whereas in the femoral region, it had large adipose lobules and showed a sparsely distributed pattern. There were no significant differences in the histological findings of the deep fat layer between the 3 body regions. Conclusion: Significant differences in histological findings of the two fat layers were found in relation to age, sex, anatomical region, and BMI. The superficial fat layer became thinner with increasing age in males, but it was constant in females. As BMI increased, the total thickness of subcutaneous fat tissue became greater, and the superficial fat layer became thicker than the deep fat layer. Our measurements can be used to understand the characteristics of the fat layers in relation to age, sex, anatomical region, and BMI.

사지의 미용적 미세수술적 재건

여현정,손대구,김준형,한기환,Yeo, Hyeon-Jung,Son, Dae-Gu,Kim, Jun-Hyung,Han, Ki-Hwan 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.1

The aim of extremity reconstruction has focused on early wound coverage and functional recovery but rarely aesthetics. As the quality of life improves, however, the request for aesthetics has been growing. The authors has conducted retrospective reviews on the 86 cases that had extremity reconstruction using free flap, considering the characteristics of parts that had been assessed in primary operation between May 1996 and December 2010. Aesthetic grading was performed in four categories; color, texture, contour and marginal scar. Recipient sites were 42 hands, 19 feet, 14 lower extremities excluding feet and 10 upper extremities apart from the hand. Types of free flap were 16 latissimus dorsi free flaps, 13 anterolateral thigh free flaps, 12 dorsalis pedis free flaps, 8 transvers rectus abdominis free flaps, 7 gracillis free flaps, and 5 superficial temporal fascia free flaps. Total flap necrosis was seen in 8 cases(9.3%) and partial necrosis in 5 cases(5.8%). Secondary revision was done in 24 cases(27.9%) and the most common revision, debulking was done in 14 cases(16.3%). The authors has considered cosmetic aspects along with wound coverage and functional recovery in primary reconstruction. The results of aesthetic grading was 16.2 out of 20, and the secondary revision rate was reduced.

유리피판술에 있어서 자동혈관문합기의 적용

정영진,김현지,손대구,Jung, Young-Jin,Kim, Hyun-Ji,Son, Dae-Gu 대한미세수술학회 2006 Archives of reconstructive microsurgery Vol.15 No.2

Free flap having been used for reconstruction of skin and soft tissue defect in various areas in a body is spreading up its application for not only functional reconstruction but also aesthetic reconstruction. Authors met with good results minimizing the demerits of anastomosis using suture through microvascular anastomotic device, hereupon, we intend to report this. We worked with 27 cases that used microvascular anastomotic device for venous anastomoses among patients who were processed free flap in our hospital. Age ranged from 12 to 63 (average 43.2), and there were 12 females and 15 males. As a result of a follow-up by 3 months - 5years (average 11.3 months), there was no particular complication in the anastomosed vein except 1 cases among 27 cases that sutured their veins through microvascular anastomotic device. Use of microvascular anastomotic device at free flap shortened the time required for vascular anastomoses to reduce ischemic time of tissue, and minimized the damage of intima during anastomoses and made easy anastomoses possible even in case the difference of diameters of blood vessels being sutured is wide. As well, even for survival rate of flap, satisfactory results were obtained compared with using suture. Consequently, it is concluded that use of microvascular anastomotic device in free flap is a useful way that can substitute existing anastomosis using suture.

감염된 만성창상에서 국소음압세척치료의 이용

정진욱,김준형,정영진,박무식,손대구,한기환,Jeong, Jin-Wook,Kim, Jun-Hyung,Jung, Yung-Jin,Park, Mu-Sik,Son, Dae-Gu,Han, Ki-Hwan 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Continuous irrigation method is an important step in managing wound infection. V.A.C. devices have been used in intractable wounds for reducing discharge, improving local blood flow, and promoting healthy granulation tissue. We expect synergistic effects of reduced infection and more satisfactory, accelerated wound healing when using both methods simultaneously. This study evaluated continuous irrigation combined with V.A.C. appliance for treatment of infected chronic wounds. Methods: We reviewed data from 17 patients with infected intractable chronic wounds. V.A.C. device (Group A) was used in 9 patients, and V.A.C. with antibiotics irrigation (Group B) was used in 8 patients. We placed Mepitel$^{(R)}$ on the surface of wound and placed an irrigation and aspiration tube on each side. A sponge was placed on the Mepitel$^{(R)}$ and covered with film dressing. The wound was irrigated continuously with mixed antibiotics solution at the speed of 200 cc/hr and aspirated through the wall suction at the pressure of -125 mmHg. V.A.C. applied time, wound culture and wound size were compared between the two groups. Results: No complication were seen in two groups. Compared with Group A, in the Group B, V.A.C. applied time was shortened from 32.7 days to 25.6 days and showed efficacy in the reduction rate of wound size. No statistical differences were shown in bacterial reversion. Conclusion: V.A.C. appliance with continuous irrigation is an effective new method of managing infected chronic wounds and useful to reduce treatment duration and decrease wound size. Moreover it could be applied more widely to infected wound.

다양한 자가조직을 활용한 비성형술

한기환,여현정,최태현,김준형,손대구,Han, Ki-Hwan,Yeo, Hyeon-Jung,Choi, Tae-Hyun,Kim, Jun-Hyung,Son, Dae-Gu 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: In Korean rhinoplasty, alloplasts such as silicone rubber have been used for dorsal and tip augmentations. However, alloplasts have produced complications such as deviation, exposure, and infection. Although autogenous tissue is an ideal material, the amount of the cartilage in Korean is not sufficient. Therefore, the authors developed a method to harvest the maximum amount of the septal and conchal cartilage. The authors first performed a complete septal extension graft for short and retruded columella and then performed nasal augmentation using various autogenous tissues. Methods: These surgical techniques were performed on 11 patients. Their average age was 27 years. An open approach with a V-shaped columellar labial incision was performed. At first, the complete septal extension graft was fixed on the entire caudal margin of the septum, and the alar cartilage was suspended to the septal extension graft to make the tip projected and the columella advanced caudally. A temporal fascial ball was used for radix augmentation. For dorsal augmentation, a batten-shaped septal cartilage graft wrapped with or without the temporal fascia or a diced cartilage graft wrapped with the temporal fascia was performed. For nasal tip augmentation, a shield graft and a cap graft or a folded conchal cartilage graft was performed.Results: The mean follow-up period was 11.2 months. The overall results were natural and satisfactory. Two patients underwent slight absorption and caudal displacement. With the exception of these cases, no complications were observed. Conclusion: Korean rhinoplastic surgeons are accustomed to using the alloplasts despite of serious complications. When rhinoplasty using autogenous tissue was performed, some complications occurred such as the displacement of the diced cartilage graft wrapped with the fascia, but many of the complications of alloplastic rhinoplasty were avoided. Therefore, we propose that by this time Korean rhinoplastic surgeons need to change their preference from alloplastic rhinoplasty to autogenous rhinoplasty.

전비중격연장이식술을 이용한 일측 구순열비변형교정술: 다공성 고밀도폴리에틸렌 판과 비중격연골의 사진계측학적 비교

한기환,정진욱,박무식,김준형,손대구,Han, Ki-Hwan,Jeong, Jin-Wook,Park, Mu-Sik,Kim, Jun-Hyung,Son, Dae-Gu 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Complete septal extension grafts have been widely used in rhinoplasty for effective projection of the short retruded columella in Asian patients. Autologous septal cartilages and porous high-density polyethylene sheets are frequently used as septal extension grafts. This study was conducted to compare the postoperative results of porous polyethylene sheets and septal cartilages used for correction of unilateral cleft lip nasal deformities by using photogrammetric analysis. Methods: This study investigated a total of 49 patients with cleft lip nasal deformities who underwent corrective surgery, and were followed up for at least 6 months. Septal cartilages were used in 39 patients, and porous polyethylene sheets were used in 10 patients. In all patients, through the open rhinoplasty, complete septal extension grafts were sutured to the caudal margin of the septal cartilage, and the alar cartilage was sutured with suspension. The cleft side alar cartilage was overcorrected by approximately 3 - 5 mm. Postoperative outcomes were evaluated by using photogrammetric analysis. Five indices and 4 angles were measured on their photographs taken before and after the surgery. In patients with unilateral cleft lip nasal deformities, symmetry was also evaluated by means of columellar length index. Results: The postoperative values obtained in photogrammetric analysis showed improvements in comparison with the preoperative ones. The polyethylene group produced more improved outcomes than the septal cartilage group but also resulted in more complications at the same time. Conclusion: The results of this study indicates that complete septal extension grafts are efficient for the correction of unilateral cleft lip nasal deformities. However, since postoperative complications occur more frequently in the polyethylene group than in the septal cartilage group, caution is advised in using porous high-density polyethylene sheets in patients with cleft lip nasal deformities.

비중격 골절을 동반한 단순 비골 골절의 치료에 있어 비중격 교정술의 중요성: 비강 통기도 검사를 이용한 평가

김준형,신동우,최태현,손대구,한기환,Kim, Jun-Hyung,Shin, Dong-Woo,Choi, Tae-Hyun,Son, Dae-Gu,Han, Ki-Hwan 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Nasal bone fractures are often classified as minor injury. However, the incidence of posttraumatic nasal deformity remains alarmingly high. It is because of unnoticed septal fracture. This study was conducted to determine the necessity of septoplasty for patients with nasal bone fracture accompanying grade I septal fractures. Methods: Among 105 patients with nasal bone fractures, 52 who had grade I septal fracture were diagnosed based on physical examination and computed tomography. Patients' age ranged from 14 to 65 years (mean 29.25 years), and 35 were male and 17 female. Patients were divided into 2 groups according to surgical treatment methods: patients who underwent closed reduction only (group 1, n=28) and those who underwent simultaneous closed reduction and septoplasty (group 2, n=24). The treatment outcomes were evaluated by comparing changes in nasal airway volume measured by acoustic rhinometry before the surgery, 3 months and 6 months after the surgery according to the timing of surgical repair and surgical treatment methods. Results: Nasal airway volume increased after the surgery by 17.8% in 3 months after the surgery, 25.2% in 6 months in group 1 and by 22.7% in 3 months, 35.8% in 6 months in group 2. The increase in airway volume after the surgery by 26.3% in 3 months after the surgery, 34.2% in 6 months after the surgery in operation within 1 week after trauma and by 12.1% in 3 months, 22.2% in 6 months after the operation later 1 week after trauma. The difference was statistically significant. Three patients in group 1 complained of intermittent nasal obstruction, two of whom showed a decrease in nasal airway volume by acoustic rhinometry. Conclusion: Most patients with nasal bone fractures accompanying grade I septal fractures have been treated with closed reduction in clinical settings. However, the results of this study suggest that septoplasty be performed after a correct diagnosis of septal fracture is made through comprehensive physical examination and computed tomography. Septoplasty is important to obtain more favorable outcomes and reduce complication.

표면 근전도 센서 기반 Ptosis 진단 시스템 및 알고리즘 개발

권미성(Mi Sung Kwon),이종하(Jong-Ha Lee),손대구(Dae Gu Son),김아람(A Ram Kim) 대한전자공학회 2015 대한전자공학회 학술대회 Vol.2015 No.6

If the lifting power of eyelid from the levator palpebrae muscle becomes weak, eyelid is drooped and the edge of eyelid cannot be lifted on normal level. This phenomenon is called the ‘Ptosis’. If the person has the ptosis, they use the forehead muscle when the eyes open. In this research, the frontalis EMG was measured for the gaze angle. People with the ptosis was confirmed for the use frontalis muscle more than normal people. Therefore, we propose a system to quantify the presence the ptosis as EMG levels of frontalis muscle.

스마트혈관문합기(AnaFix™)의 개발 : 전임상 안전성?유효성 검증을 위한 기초실험

윤정흠(Jung-Heum Yoon),김철웅(Cheol-Woong Kim),이호상(Ho-Sang Lee),박민형(Min-Hyung Park),박종웅(Jong-Woong Park),손대구(Dae-Gu Son) 한국정밀공학회 2009 한국정밀공학회 학술발표대회 논문집 Vol.2009 No.6월