조직확장술을 이용한 연조직 재건

Abstract

Over the 7 years, we have used tissue expansion technique to achieve soft tissue reconstruction in 61 patients with various kinds of congenital or acquire defects of the scalp, face, trunk, and extremities. Of these patients, 25 were male and 36 were female, ranged in age from 5 to 36 years(mean 21). Burn scar(44%) was the most common indication and the rest of them were traumatic scar, microtia, tumor, nevus, vascular malformation, paraffinoma, and cleft lip scar. Twenty five expansions were performed in the face, 12 in the scalp, 9 in the upper extremity, 7 in the ear, 5 in the neck, 4 in the lower extremity, and 1 in the trunk. Rectangular shaped prosthesis with remote internal reservoirs were most commonly used types, and the expander volume ranged from 1.5 to 1,100 mL. Every expander was prefilled to 21 percent of its volume in average and inflation was begun about 2 weeks after implantation. The process was repeated at weekly intervals until adequate tissue expansion was obtained. Expansion period ranged from 2 to 31 weeks(mean 13). Hyperexpansion(mean 130%) was a rule in this series, allowing a skin surplus for reconstruction. Clinical assessment was done with an excellent result of 37%, especially in the scalp. Twenty two percent of the patients had complications requiring specific treatment with consequent alteration of the treatment plan. The most common complication was prosthesis exposure.

저자들은 지난 7년 동안 조직확장술을 이용하여 재건했던 증례들 중 최소한 6개월 이상 추적조사가 가능했던 5-36세 사이의 남녀 환자 61례를 대상으로 진단, 시술 부위, 확장기의 제원, 술기, 합병증 및 수술 결과를 분석하여 다음과 같은 결과를 얻었다. 1. 원인질환은 화상성 반흔이 가장 많았고 시술 부위는 안면부가 가장 많았다. 2. 조직확장기는 장방형을 가장 많이 사용하였고 크기는 용적보다는 기저부의 크기를 기준으로 결손부 재건에 필요한 공여부 피판의 크기와 위치를 고려하여 선택하였다. 3. 술 후 약 2주벝 7일 간격으로 평군 13주(2-31주) 동안 확장시켰으며, 조직확장기를 삽입할 때 확장기 용량의 약 21%에 해당되는 생리식염수를 미리 주입하였고, 최고 400%까지(평균 130%) 과팽창(hyperexpansion)시켰다. 4. 합병증은 21%(13/61례)에서 발생하였고 확장기 노출에 의한 경우가 가장 많았다. 5. 술 후 미용적 성취도에 대한 분석(ordinary scale method)에서 대부분(29/30례) 양호(good) 이상의 결과를 얻었고 부위별로는 두피에서 가장 우수한 결과를, 하지에서 가장 불량한 결과를 얻었다.