ROM(Reducing Opposed Multilobed) 피판을 이용한 중간 크기 피부병변의 치험례

조종제,홍윤기,서상원,장충현 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.6

Purpose: Circular skin lesions between 10 and 35 mm in diameter generate problems often. Direct closure of the lesion risks excessive wound tension or wound dehiscence. Skin grafts heal slowly and often remain unsightly. Traditional skin flaps have a limited role. We treated this circular medium-sized skin lesion(10-35mm sized) by reducing opposed multilobed(ROM) flap.Methods: ROM flap involves a series of semicircular lobes extending both cephalic and caudal from the defect. Direction of the semicircular multilobed flap is set parallel to relaxed skin tension line(RSTL) to minimize scar formation. First semicircle is drawn 60% in diameter of the defect. Second semicircles are drawn at the cephalic and caudal aspects of the original semicircles. These semicircles are 60% in diameter of the first semicircle. Additional semicircles are repeatedly drawn until the tension of skin flaps becomes free. ROM flap has a length-to-base ratio of 0.5 resulting in lower theoretical risk of end flap necrosis than a random pattern flap with a large ratio. The technique involves lobes most distant from the primary defect being transposed in turn closer to the defect. Results: The ROM flap reduces skin tension concerns, lowers the risk of flap necrosis and allows for quicker and more aesthetic healing. Results were generally good and major complications, such as dehiscence, infection, or delayed healing, did not occur. Conclusion: ROM flap repair allows the plastic surgeon an additional option when faced with a circular medium-sized skin lesion.

이마피판술과 후이개부 전층피부이식술을 이용한 안면부 연부조직 결손 재건 후 피부 색상의 비교

조성후,유성인,노복균,김의식,황재하,김광석,이삼용 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.1

Purpose: For facial reconstruction, skin color match is crucial to achieve great aesthetic result. Forehead flap and full thickness skin graft have been used for many years to reconstruct facial defect. Their results are aesthetically valuable with remarkable resemblance and harmony of the skin color between donor and recipient sites. The purpose of this study is to evaluate and compare the aesthetic outcome of the two methods as the analysis of skin color match.Methods: From January 1995 to December 2005, ten forehead flaps and ten full thickness skin grafts were performed. The reconstructed areas of forehead flaps were five noses and five eyelids. Recipient sites of full thickness skin grafts were seven eyelids, two noses and one forehead. In order to obtain the objective validity, the skin color of flap(or graft) and the recipient sites were measured by chromameter. The skin colors were quantified according to a three-dimensional coordinate system used in chromameter, L*(brightness), a*(redness), and b*(yellowness).Results: There was no significant color difference between forehead flap site and adjacent skin in all color values. On the other hand, the L* and b* values of graft sites were significantly lower than those of the adjacent skins. The a* values of graft sites were higher than those of the adjacent skins.Conclusion: This study reveals that skin color match of forehead flap is greater than that of full thickness skin graft. As forehead flap has adequate volume and great color match, it can be useful to reconstruct deep facial defect such as nasal defect. On the other hand, full thickness skin graft can be used for superficial defect like partial eyelid defect.

고압산소 처치와 allopurinol 투여가 국소 방사선 조사를 받은 백서피판의 생존에 미치는 영향

박병윤,서창옥,나동균,서만군 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

The objectives of this study sere to investigate how the local irradiation affect the survival of random pattern skin flap, and whether or not hyperbaric oxygen and allopurional can improve the survival of the irradiated rat skin flap. There have been many reports about the effects of hyperbaric oxygen and allpurinol on skin flaps. However, very few reports have been presented on the effects of hyperbaric oxygen and allpurinol in treating irradiated skin flaps. The author examined the local irradiation effect on rat skin flap survival after irradiation of 20 Gy, 3 days postoperatively, on cranially based random pattern dorsal skin flap, which was 3 x 9㎝ in size. The flap survival length was measured in experimental groups treated with hyperbaric oxygen(2.5 atm absolute, 100% oxygen, once a day for 7days) after irradiation and with hyperbaric oxygen combined with allopurinol(100㎎/㎏, once a day for 7 days), in comparison with a radiation-only group. On reviewing the flap survival length 10 days postoperati-vely, the average flap survival length in the radiation-only group was 2.2±0.5㎝, while in the non-radiation group it was 5.5±0.3㎝. The reduction ratio of flap survival by irradiation was 60%. There was a significant increase in the mean flap survival length in the groups treated with hyperbaric oxygen(4.0±1.6㎝) and hyperbaric oxygen combined with allopurinol(5.5±1.8㎝). The increased ratio of flap survival in each group was 85% and 150% when compared to the radiation-only group. The author found that rat skin flap survival decreased, even at an early stage, as a result of high dose local irradiation and that decreased flap survival by irradiation could be restored by hyperbaric oxygen and allopurinol. The group treated with hyperbaric oxygen combined with allopurinol showed increased flap survival over the group treated with hyperbaric oxygen only. The results showed a method which could possibly increase flap survival in cancer patients who require early radiation after flap surgery.

임의형 피부피판에 미치는 Chlorpromazine과 Nicotine의 영향에 대한 연구

김정철,이경호,홍정수,설정현,서동보 대한성형외과학회 1992 Archives of Plastic Surgery Vol.19 No.3

The concepts of random-pattern skin flaps and the reliability of its survival are important for those who use skin flap technique in plastic and reconstructive surgical fields. The effects and interrelationships of chlorpromazine and nicotine on random-pattern skin flaps were investigated in 60 Sprague-Dawley rats. This study was composed with 5 groups of chlorpromazine and nicotine administration. Chlorpromazine was adminstered after flap elevation during 14days as 0.6㎎ per 100gm of body weight and nicotine was administered 14 days before flap elevation and 14days after operation as low-dose method. The results were as follows. The experimental group studied with chlorpromazine revealed an increased rate of random-pattern skin flap survival compared with the control group which was treated with normal saline. The group studied with nicotine administration showed significant decrease of skin flap survival than that of the control group studied with normal saline. And the results were confirmed on the basis of light microscopic findings. There was no specific advantage in cessation of nicotine after long use compared with that of continuous use of it by statistical analysis. And the effect of nicotine was continued for 2weeks after cessation of it. Administration of chlorpromazine after elevation of skin flap in long-use nicotine group revealed an increased rate of skin flap survival. The results, suggested that administration of chlorpromazine can increase the survival of random-pattern skin flaps. And the use of nicotine can decrease the survival of random-pattern skin flaps which can be reversed by treatment with chlorpromazine. All these results were supported by light microscopic findings.

A Comparison of the Local Flap and Skin Graft by Location of Face in Reconstruction after Resection of Facial Skin Cancer

이경석,김준오,김남균,이윤정,박영지,김준식 대한두개안면성형외과학회 2017 Archives of Craniofacial Surgery Vol.18 No.4

Background: Surgery for reconstruction of defects after surgery should be performed selectively and the many points must be considered. The authors conducted this study to compare the local flap and skin graft by facial location in the reconstruction after resection of facial skin cancer. Methods: The authors performed the study in patients that had received treatment in Department of Plastic Surgery, Gyeongsang National University. The cases were analyzed according to the reconstruction methods for the defects after surgery, sex, age, tumor site, and tumor size. Additionally, the authors compared differences of aesthetic satisfaction (out of 5 points) of patients in the local flap and skin graft by facial location after resection of facial skin cancer by dividing the face into eight areas. Results: A total of 153 cases were confirmed. The most common facial skin cancer was basal cell carcinoma (56.8%, 87 cases), followed by squamous cell carcinoma (37.2%, 57 cases) and bowen’s disease (5.8%, 9 cases). The most common reconstruction method was local flap 119 cases (77.7%), followed by skin graft 34 cases (22.3%). 86 patients answered the questionnaire and mean satisfaction of the local flap and skin graft were 4.3 and 3.5 (p=0.04), respectively, indicating that satisfaction of local flap was significantly high. Conclusion: When comparing satisfaction of patients according to results, local flap shows excellent effects in functional and cosmetic aspects would be able to provide excellent results rather than using a skin graft with poor touch and tone compared to the surrounding normal skin.

The Reappraisal of the Slide-Swing Skin Flap: A Versatile Technique for Surgical Defects

( Min-soo Kim ),( Seul-ki Lee ),( Mihn-sook Jue ),( Hyang-joon Park ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.5

Background: The slide-swing skin flap is a combination of transposition and adjacent skin sliding and can be used to close large, round defects with a flap that is smaller than the primary defect to produce aesthetically good results. Objective: To evaluate the efficacy and safety of the slideswing skin flap for various surgical defects caused by skin tumor excisions. Methods: This retrospective case series, which includes 33 Asian patients between the ages of 25 and 86 years, describes the slide-swing skin flap after primary excision for malignant or premalignant skin conditions. The outcomes were assessed 12 weeks after surgery using the patient and observer scar assessment scale (POSAS). Results: Patients were 25 male and 8 female, and the causes of surgery were various malignant skin tumors including malignant melanoma, dermatofibrosarcoma protuberans, and malignant nodular hidradenoma. Tumors were on the lower limb in eleven patients, back in nine patients, chest in five patients, face in three patients, buttock in three patients and two patients had tumors in other locations. The mean defect size was 3.5×3.1±1.9×2.2 cm (range, 1.4×0.9∼9.0×12.0 cm). The mean patient POSAS total score was 9.7±3.0 and mean patient overall opinion score was 1.8±0.7. The mean observer POSAS total score was 11.0±2.7 and mean observer overall opinion score was 1.9±0.5. All flaps survived and postoperative recoveries were uneventful. Conclusion: The slide-swing skin flap is highly versatile and can be used to cover various surgical defects, irrespective of size and location, with excellent functional and cosmetic results. (Ann Dermatol 31(5) 525∼529, 2019)

안면부 피부암 절제 후 발생한 결손 부위에 V-Y-S 피판을 이용한 재건술

김규보,천지선,이승찬,조안영,양정열 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.5

Purpose: There are many methods for the reconstruction of the facial defect after an excision of a skin cancer; such as skin graft, local flap, free flap, etc... Skin graft has its' limitations; it could remain in different color with in regards of the recipient to donor, with an unfavorable scar. Free flap can lead to big donor site morbidity with long operation time and uncontrolled scar as a disadvantage factor. Compared to the prior, local flap offers several merits; sufficient blood supply, good tissue quality and short operation time. We revised 'V-Y-S flap' for the facial defect, which proved to have favorable outcomes.Methods: Total 7 V-Y-S flaps were performed to patients with skin cancers(six squamous cell carcinoma and one basal cell carcinoma). Two of these flaps were combined with composite grafts, one with full thickness skin graft. Six patients were female and one male. The average diameter of defects after excision was 2.3cm. The follow-up period was 18 months maximally. Results: We treated seven facial skin cancers with 'V-Y-S flap'. There were no flap necrosis, cancer recurrence and scar contracture as a result. Furthermore, this method also offers a favorable central scar line that is parallel to the nasolabial fold and the nasojugal groove, especially in the nasolabial area and superomedial side of the cheek. With this method, we could cover a maximum diameter of 4cm facial defect. Conclusion: In conclusion, it is suggested that V-Y- S flap is a useful mehtod to cover facial defects after the excision of a skin cancer.

능형피판을 이용한 피부결손의 재건술

길민석,민경원 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.1

Rhombic flap has been popularized as a reconstructive method for the small and medium sized-skin defect of head, neck and trunk in recent years. When Rhombic flap is decided on, the excisional outline is made in Rhomboid shape, which may be regarded as a fusiform shape with straight side, equilateral parallelogram. It is simple, However Rhombic flap is more complex than it appears, and certain factors-physical property and geometry of skin, proper flap design should be thoroughly understood to assure its successful use. Our results will supply the plastic surgeons and others with the easy, simple, safe surgical method in the reconstruction of the small and medium sized skin defect. The authors used the 26 consecutive flexible Rhombic flaps as a reconstructive method of a small and medium sized skin defect in head, neck and trunk. We concluded that flexible Rhombic flap had the following advantages; 1)Rhombic flap is easily elevated and had a simple surgical technique. 2)Rhombic flap has a excellent viability. 3)Rhombic flap is used in a whole body area. 4)Rhombic flap is safe within 10cm of one side limb of the designed flap in our experience. 5)The final results is more aesthetic than that of straight line closure or that of skin graft or other type of local flaps.

The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy

Yun, Min Ho,Yoon, Eul Sik,Lee, Byung-Il,Park, Seung-Ha Korean Society of Plastic and Reconstructive Surge 2017 Archives of Plastic Surgery Vol.44 No.6

Background Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy. Methods A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups. Results Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02). Conclusions Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.

수지 배측 피부를 이용한 신경혈관 도서형 피판술

김풍택,김익동,김재형,Kim, Poong-Taek,Kim, Ik-Dong,Kim, Jae-Hyung 대한미세수술학회 1998 Archives of reconstructive microsurgery Vol.7 No.1

When covering a skin defect of the finger with a local flap is difficult, a vascular island flap is often used. For a palmar skin defect, it is desirable to add a sensory supply to the flap. This report describes a neurovascular island flap that was used to repair a palmar skin defect, the donor skin coming from the dorsal region of the middle phalanx. This flap is elevated with a vascular pedicle of the palmar digital artery and its dorsal skin branch, including the dorsal digital veins, palmar digital nerve and its cutaneous branches. The advantage of this flap are that it can be transferred with ease and without any tension. No special manipulation is required under a microscope and operation can be performed under a simple nerve-block. There if little possibility that the flap itself undergoes ischemic change or congestion. The disadvantage of this flap are that a skin graft is required at the donor skin site and one palmar digital aretery is lost. We think that this neurovascular island flap is one of the useful methods for skin defects that are difficult to cover with a local flap.