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족배부 복합 피부-건 유리피판을 이용한 Achilles건의 일단계 재건술
김석원,이원재,서동완,정윤규,탁관철,Kim, Sug Won,Lee, Won Jai,Seo, Dong Wan,Chung, Yoon Kyu,Tark, Kwan Chul 대한미세수술학회 2000 Archives of reconstructive microsurgery Vol.9 No.2
The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.
후 경골 동맥에서 분지한 비 특이성 비골 골피 유리 피판에서의 관통 혈류 미세 문합을 통한 피부판의 구제
김민수,유대현,이원재,탁관철,Kim, Min Soo,Lew, Daei Hyun,Lee, Won Jai,Tark, Kwan Chul 대한미세수술학회 2004 Archives of reconstructive microsurgery Vol.13 No.1
The vascularity of a skin island in fibula osteocutaneous free flap often depends on musculocutaneous perforators that find their origin in the proximal peroneal artery. But a potential drawback has been reported on the unreliability of the skin paddle. The perforating vessels to the skin paddle of the fibula osteocutaneous free flap were rarely derived from a common tibio-fibula trunk, an anterior tibial artery and a posterior tibial artery. Previous studies have emphasized total loss of the overlying skin paddle, if the expected perforating vessels are not present. We report here on our experience that the skin paddle of the fibula osteocutaneous free flap was vascularized not by a peroneal artery but a direct branch of the posterior tibial artery. There were no intraseptal nor intramuscular pedicles in the posterior crural septum which connected to the overlying skin island. Therefore, we performed microsurgical anastomoses between distal peroneal vessels of the fibula and the perforating branches of the posterior tibial vessels of the skin paddle. The anastomosed skin paddle was salvaged with a peroneal flow through vascular anastomosis and was transferred to the bone and intraoral soft tissue defects with the fibula graft. The patient had no evidence of vascular compromise in the postoperative period and showed good healing of the intraoral skin flap.
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.
Relaxin을 분비하는 아데노바이러스가 피판의 생존에 미치는 영향
윤인식,박용순,전영우,전여름,이원재,윤채옥,나동균,Yun, In-Sik,Park, Yong-Sun,Cheon, Young-Woo,Jeon, Yeo-Reum,Lee, Won-Jai,Yun, Chae-Ok,Rah, Dong-Kyun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5
Purpose: Of various effects of relaxin, we assumed that anti-fibrotic effects, neovascularization effects and vasodilatation effects of relaxin might enhance the survival rate of skin flap. In the current study, we used adenovirus expressing relaxin genes to examine whether these genes could enhance the survival rate of a skin flap. Methods: A total of 30 Sprangue-Dawley rats were divided into three groups: RLX group (10; relaxin virus injected group), CTR group (10; no gene coded virus injection group), and PBS group (10; PBS injected group). Each group was intradermally injected with the virus ($10^7$ PFU) and PBS 48 hours before and immediately before the flap elevation. A distally based flap $3{\times}9\;cm$ in size was elevated on the dorsal aspect of each rat. Following this, a flap was placed in the original location and then sutured using a #4-0 Nylon. A surviving area of the flap was measured and then compared on postoperative days 3, 7 and 10. Using a laser Doppler, the amount of blood flow was measured. On postoperative day 10, tissues were harvested for histologic examination and the number of blood vessels was counted. Results: There was a significant increase in the area of the flap survival in the RLX group on postoperative days 3 and 7. The Doppler measurement also showed significantly increased blood flow immediately after the operation and on postoperative days 7 and 10. The number of blood vessels was significantly greater in the RLX group in the tissue harvested on postoperative day 10. The VEGF concentration was significantly higher in the RLX group than others in the tissues harvested on postoperative day 10. Conclusion: Following an analysis of the effects of relaxin-secreting adenovirus on the survival of a flap, the surviving area of the flap and the blood flow also increased. A histopathology also showed an increase in the number of blood vessels and the concentration of VEGF.
Seok-Cheol Choi(최석철),Jai-Young Kim(김재영),Heun-Young Kwon(권헌영),Tae-Un Kim(김태운),Soo-Myung Hwang(황수명),Won-Jae Lee(이원재) 대한의생명과학회 2000 Biomedical Science Letters Vol.6 No.2
혈액 전해질 성분들에 대한 대장균 내독소의 영향을 조사하기 위해 토끼를 대상으로 한 동물실험을 실시하였다. 대장균 내독소 (혈청형 O55 : B5)를 토끼의 귀정맥을 통해 0.10 ㎎/㎏ 혹은 0.50 ㎎/㎏ 농도로 주입한 후 3, 6, 12, 24시간대에 채혈하여서 Ca??, Mg??, Na?, K?, Cl? 농도를 측정하였다. 대조군에 비해, 내독소투여 토끼의 Ca?? 농도는 6시간대에 증가하였고, Mg?? 농도는 3, 6, 12시간대에, Na?과 K?는 모든 채혈시간대에, 그리고 Cl? 농도는 3, 12, 24시간대에 각각 유의하게 높았다 (p<0.05). 흥미롭게도, 고 Mg? 혈증 (약 4.0 ㎎/dL)을 보인 내독소투여 토끼들은 심각한 임상징후들로 인식되는 분비불의 증가, 쇼크, 빈호흡, 경련, 혹은 설사와 같은 증세를 보였다. 본 연구의 결과들은 대장균 내독소가 혈액 전해질 농도의 항상성 혼란을 유도하며 이러한 생리적 불균형은 치명적 상황과 그로 인한 죽음을 야기할 수도 있음을 시사하고 있다. We studied the effects of Escherichia coli (E. coli) endotoxin on blood electrolytes levels in rabbits. Endotoxin (E. coli serotype O55 : B5) was injected via rabbits' ear vein : 0.10 ㎎/㎏ (Group A) or 0.50 ㎎/㎏ (Group B). Blood samples were taken at postendotoxemic 3, 6, 12 and 24 hrs and were analyzed for detections of the levels of blood electrolytes such as Ca??, Mg??, Na?, K? and Cl?. As compared to control group, in endotoxin-treated rabbits Ca?? levels elevated at 6 hrs but decreased at 24 hrs, Mg?? levels were high at 3, 6 and 12 hrs, Na? and K? levels increased at all sampling times and Cl? levels rose at 3, 12 and 24 hrs (p<0.05). Interestingly, endotoxic rabbits having hypermagnesemia (about 4.0 ㎎/dL) showed severe syndromes such as increased secretion, shock, tachypnea, seizure and/or diarrhea, suggesting that these may be clinical signs of imminent death in rabbits. These observations testify that bacterial endotoxin leads to dyshomeostasis of blood electrolytes and the physiological imbalances may cause fatal disorders and subsequent death.