백서의 대망을 혈관경으로 이식하여 생성시킨 이차적 도서형 피판

유대현,탁관철,유재덕,Lew, Dae-Hyun,Tark, Kwan-Chul,Lew, Jae-Duk 대한미세수술학회 1996 Archives of reconstructive microsurgery Vol.5 No.1

The omental pedicle based on right gastroepiploic vessels is designed new experimental model for prefabrication(revasculirization) of skin flaps in rats. A $2.5{\times}4cm$ pack of omentum with right gastroepiploic vessels was transferred under a bipediceld panniculocutaneous flap which is $2.5{\times}8cm$ size. At day 7, all four margin was divided and the flap was rasied as an secondary island flap connected only by its vascular pedicle, then the composite flap sutured back in place. The flap perfusion was examined by dermofluorometry and flap survival area was measured at day 12. The Secondary island flap demonstrated a dye fluorescence index(DFI%) of $31.38{\pm}12.33$ and survival rate $80.47{\pm}9.61$ The survival rate was increased when DFI% and contact surface between vascular carrier and skin flap was increased. An india ink injection and histologic examination provided visual evidence of revasculization. The omental pedicle is a promising and safe model for revasculirization of other tissues.

Lipo-PGE1이 이식된 지방 생존에 미치는 영향

오의선,정지은,유대현,Oh, Eui-Sun,Jung, Ji-Eun,Lew, Dae-Hyun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: With the recent recognition of the importance of soft-tissue fillers, fat grafting has been assumed an increasingly important role as both an adjunctive and a primary procedure in aesthetic and reconstructive surgery. The main problem in achieving long-term soft-tissue augmentation is partial absorption of the injected fat and hence the need for overcorrection and re-injection. The purpose of this study is to improve the viability of the injected fat by the use of Lipo-PGE1. Methods: Human adipose tissue, obtained by suctionassisted lipectomy, was re -injected into the subcutaneous layer in the scalp of ICR mice. Lipo-PGE1 ($0.5{\mu}g$/kg) was injected intravenously in experimental group for 7 days from the operation day and saline was injected in control group. There were 5 animals in each group. The animals were euthanized 4 weeks after the procedure. Graft weight and volume were measured and histologic evaluation was performed. Result: Histologic analysis demonstrated significantly less cyst formation and less inflammatory reaction in the group treated with Lipo-PGE1. No significant difference was found between the groups regarding graft volume or the other histologic parameters investigated. Significant differences were demonstrated in microvascular density count. Conclusion: Less cyst formation, less inflammation, more angiogenesis indicating improved quality of the injected fat can be obtained by the addition of Lipo-PGE1. Further studies of various dosages of Lipo-PGE1 and their long-term effect are required before these encouraging results could be applied clinically.

폐결핵을 동반한 폐암의 임상적 고찰

최영춘 ( Young Chun Choi ),유대현 ( Dae Hyun Yoo ),이진 ( Jin Lee ),최진 ( Jin Choi ),류우진 ( Woo Jin Lew ),박성수 ( Sung Soo Park ),이정희 ( Jung Hee Lee ) 대한결핵 및 호흡기학회 1989 Tuberculosis and Respiratory Diseases Vol.36 No.3

안면이식에 대한 최근 동향: 한국에서의 안면이식은 어떤 단계에 있는가?

홍종원,김영석,윤인식,이동원,이원재,노태석,유대현,김용욱,나동균,탁관철,박병윤,Hong, Jong Won,Kim, Young Seok,Yun, In Sik,Lee, Dong Won,Lee, Won Jai,Roh, Tai Suk,Lew, Dae Hyun,Kim, Yong Oock,Rah, Dong Kyun,Tark, Kwan Chul,Yun Park, Be- 대한두개안면성형외과학회 2012 Archives of Craniofacial Surgery Vol.13 No.2

The world's first face transplantation was performed in France, in 2005. Since then, 21 cases of face transplantation have been performed. Face transplantation is one of the most prominent part of composite tissue allotransplantation (CTA) along with hand transplantation. Since these fields are not deal with life-saving organs, there are many arguments about immunosuppression therapy. Recent paradigm of face transplantation shows that surgical ranges are expanded from partial face transplantation to full face transplantation. Most immunosuppression protocols are triple therapy, which consists of tacrolimus (FK-506), mycophenolate mofetil and prednisolone. Anatomical researches, immunosuppression, and immunotolerance take great parts in the researches of CTA. The medical fields directly related to face transplantation are microsurgery, immunology, and transplantation. Nowadays, each field is performed widely. Therefore people, even medical teams think face transplantation could be easily realized, sooner or later. But there are lots of things that should be prepared for not only practice and immunosuppression therapy but also for the cooperation with relevant fields. That's the reason why only 21 cases of face transplantation have been done, while more than 70 cases of hand transplantation have been done in the past years. Especially in Korea, brain death patients are not enough even for organ transplantation and furthermore there are some troubles in taking part in the society of transplantation. Face transplantation has lots of problems concerning variable medical fields, administration, society, ethics, and laws. Therefore, for the realization of face transplantation in Korea, not only medical skills but also political powers are needed.

광범위 종양절제술 후 발생한 하악 결손의 재건

설철환(Chul Hwan Seul),이영대(Young Dae Lee),탁관철(Kwan Chui Tark),유대현(Dae Hyun Lew) 대한두경부종양학회 2005 대한두경부 종양학회지 Vol.21 No.2

Background and Objectives: Fibula is the flap of choice for reconstruction of wide mandible defects after tumor ablation surgery. In mandible reconstruction, restoring the mandible frame to provide mandibular contour and dental arch while restoring masticatory function are important. Even though vascularized fibula can be osteotomized freely, proper design and flap insetting is not easy because of its three dimensional structure and difference in design according to the defect sites. We reviewed patients who underwent mandible reconstruction with fibular flaps according to the defect sites and suggest proper modification methods of fibular flap according to the various defects sites after tumor ablation surgery. Materials and Methods: Twelve consecutive mandible reconstruction with fibular free flaps were performed for defects after tumor ablation surgery. Patients were classified into 4 groups according to the type of mandibular defect(Group 1 : defect on central segment including symphysis, Group 2 : defect on lateral segment(with or without central segment) confined to body, Group 3 : defect on body and ascending ramus that does not include the condyle, Group 4 : defect including the condyle). Results: We suggest different modification methods of fibular free flap for each patient group. Group 1, 3 ; contour by using multiple closing wedge osteotomy. Group 2 ; single or double barrel reconstruction without wedge osteotomy. Group 4 ; contour using single or multiple wedge osteotomy and condylar reconstruction with costochondral graft. Conclusion: Fibular free flaps can be contoured to any desired shape after multiple osteotomies to restore various mandibular defects. It is a reliable and versatile method for reconstruction of mandibular defects after tumor ablation surgery.

후구치삼각암의 수술적 치료

이세영(Sei Young Lee),최영춘(Young Choon Choi),정의석(Eui Sok Jung),권순호(Soon Ho Kwon),유대현(Dae Hyun Lew),이원재(Won Jae Lee),최은창(Eun Chang Choi) 대한두경부종양학회 2004 대한두경부 종양학회지 Vol.20 No.2

Background and Objectives: Squamous cell carcinoma of retromolar tringone (RMT) is an uncommon head and neck tumor. RMT cancer has unique clinical feature and specific considerations for surgical treatment are needed but, reports on the treatment of RMT cancer are still lacking. Patients and Methods: From May 1997 to July 2004, 8 patients with histologically proven squamous cell carcinoma of the RMT were treated in Severance Hospital. Surgical excision of the primary lesion and neck dissection were performed in all patients. Reconstruction was accomplishing using several methods. Charts and other medical records were reviewed. Results: In early cases, lower cheek flap was appropriate but, mandibular swing or madibulectomy approach was appropriate in advanced cases. Reconstruction was needed in all patients and excision of mandible was needed in majority of patients. 6 patients were disease free status and one died from recurrence and one was lost to follow up. Conclusion: In treatment of RMT cancer, several surgical approach methods and reconstruction should be considered before treatment. Surgical treatment of RMT cancer may be one of a useful primary treatment modality.

단순 대칭성 두개골 조기유합증 환자에서의 전두 두개골 재배치술을 위한 새로운 절골술-The Bull's Osteotomy

박병윤,김성민,유대현 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Cranocsynostosis is the term that designates premature fusion of one or more sutures in either the cranial vault or cranial base. Especially scaphocephaly, brachycephaly and trigonocephaly are included in simple symmetric craniosynostosis. In simple symmetric craniosynostosis, the functional deformity is rare, but deformity in external appearance is always a serious problem. The purpose of forehead reshaping in simple symmetric craniosynostosis is recovery of normal cerebral growth and improvement of cranial cosmetic problem by restoration of normal calvarial anatomic structure. Various surgical methods have Bbeen developed in an effort to correct craniosynostosis. Cranial vault remodeling with or without supraorbital band advancement is a widely accpeted method of correcting simple symmetric craniosynostosis. However, the standardized surgical method has not yet been estabilished in reshaping the forehead during cranial vault remodeling of simple symmetric craniosynostosis. The authors developed a new osteotomy method, the bull's osteotomy, which is a limited osteotomy for cranial vault remodeling. It produces posterior tilting of a prominant forehead as well as increased biparietotemporal distance for effective forehead reshaping. We applied this techriaue in 8 scaphocephaly and 2 brachycephaly patients under 5 years of age who have not yet reached bony consolidation. All patinets obtained satisfactory results with properly corrected deformity and no relapse was observed during the follow-up period. This new osteotomy method is simple and effective and a consistant surgical outcome is expected. particularly the contour of the forehead on the frontotemporal area is corrected to have a smooth and natural curvature. Based on our experience using bull's osteotomy, we offer this new surgical technique for managing simple symmetric cranoisynostosis patients.

두피전층 결출손상의 치험례

이혜경,유대현 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.2

This infrequent avulsion injury of the scalp is a result of an accident where the long hair was caught by the roller. In such a case, the strong galeal layer of scalp resists tension, and if this tension becomes extensive, the force is transmitted to galeal attachment site eg. superior orbital rim, zygomatic arch, occipital nuchal line and avulsion finally develops along this line leading to scalp detachment in one piece. In many case, the forehead and eyebrow, the external auricles, or the pericranium were avulsed at the same time. And if the avulsed scalp is not successfully revascularized, a severe cosmetic, functional, psychologic problem may occur. So thesedays, an immediate replantation of avulsed scalp is an essential procedure.Recently.we experienced two cases of total scalp avulsion injury. We will discuss preoperative and postoperative problems and sensitive point that will lead better results.

복직근 및 박근 근피판술을 이용한 골반 및 서혜부 연부조직 결손의 재건

이재화,정윤규,김주봉,유대현,황성관,이훈범,김석원 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6

Many operations for the reconstruction of the pelvic area have been studied until now. The local muscle flap is often used for the closure of these complex wound. But, these local muscle flaps may not be available for reconstruction due to the factors of infection, radiation, and surgical trauma. Since rectus abdominis muscle and gracilis muscle were introduced, their use has been steadily increased for the reconstruction of soft tissue defect of the pelvic area. Inferiorly based rectus abdominis muscle flap and the gracilis muscle flap have been adopted for well-vascularized soft tissue coverage of the defect of pelvis and groin area. These techniques were utilized in seven patients. Of these patients, rectus abdominis muscle flap was used on four patients and three patients were treated with gracilis muscle flap. Among these, chronic osteomyelitis of pelvic bone has been managed with inferiorly based rectus abdominis muscle flap in three patients. No complication has been found. The mean postoperative follow-up period was 26 months, with a range of 12 to 39 months. In conclusion, these muscles are functionally expandable , and provide adequate tissue volume with sufficient blood supply away from the zone of injury, and readily transposed into the pelvis and groin area through subcutaneous tunnel, and serve as an antibiotic delivery system that aids in the eradication of infection. These findings suggest a reconstructive option for the defect of pelvis and groin, and/or bone infection in this area.

회전 피판을 이용한 함몰유두의 교정

오영웅,박 철,유대현,박병윤 대한미용성형외과학회 1997 Archives of Aesthetic Plastic Surgery Vol.3 No.1

The patient with unilateral or bilateral inverted nipple has both functional and cosmetic impairments. The structural and histopathologic features of inverted nipple are that inverted nipple has less fibromuscular tissue than normal nipple and has short lactiferous duct and dense fibrous tissue. For these reasons, surgical correction of inverted nipple requires release of the short lactiferous ducts and providing the bulkiness under the nipple. We conbined the concept of both adding the bulkiness under the nipple and creating a tight neck at its base without sacrificing the duct system. We rotated the bilateral diamond shaped deepithelized dermal flaps around the nipple areolar complex for providing the nipple bulkiness without division of lactiferous duct and reinforced it with the purse-string suture around the dermal flap for providing the stability. This two rotational dermal flap method was applied 12 inverted nipple in 6 patients and followed up for 2 months to 24 months. We have got the satisfatory results in cosmetic and functional aspect without any complication such as sensory change, relapse, and nipple necrosis.