가토 이개연골의 신장에 의한 연골생성

Abstract

A common goal of plastic surgeons facing structural defects is providing proper tissue replacement with functional and aesthetic restorations. Gradual traction on living tissue creates stresses that can stimulate and maintain the regeneration and active growth of certain tissue structure. The application of this principle, the “Law of Tension-Stress” has allowed control of both osseous healing and the shaping processes of bone and soft tissues in many situations. The purpose of this study was to investigate the possible use of distraction chondrogenesis as a new surgical procedure for reconstructive or cosmetic surgery. The process of cartilage formation in ear lengthening by distraction was studied in 12 rabbits (24 ears). Four rabbits were randomly assigned to each of three separate groups: groupⅠ: control group: groupⅡ: subperichondrial cartilage incision without distraction: group Ⅲ: subperichondrial cartilage incision with distraction. Distraction began on postoperative day six and continued at a rate of 0.2mm every 24 hours for 28days using a distraction device (modified from Sure Closure). After 1, 2, 4 and 8 weeks, the animals were sacrificed and the cartilage histologically proved. Group Ⅰ and Ⅱ showed similar appearance and width. As contrast with group Ⅰ and Ⅱ, group Ⅲ showed 5.1mm in lengthening of ear width by 8weeks. Under microscopic examinations. Group Ⅲ showed immature chondrocytes in the gap between cartilage endings by 2 weeks. Those immature chondrocytes underwent remodeling and resulted in matured cartilage by 4 weeks after completion of distraction (1.2±0.2mm).

가토의 이개연골을 연골막을 보존한 상태에서 절단하고 점진적이고 지속적으로 신장시켰을 때 다음과 같은 결과를 얻을 수 있었다. 이개연골의 폭을 대조군과 비교하였을 때 시간이 지남에 따라 이개의 폭이 신장되었고 제 8주에는 5.1mm 정도 신장되었다. 술후 제2주에는 연골단 사이에 미성숙 연골세포의 침윤이 나타나서, 술후 제4주에는 미성숙 연골이 생성되었으며, 술후 제 8주에는 성숙한 연골세포로 구성된 연골이 생성되었으며, 평균 1.2±0.2mm의 연골 신장을 나타내었다. 연골을 절개한 뒤 신장시키지 않은 제 2군과 비교했을 때 연골세포가 더 조기에 나타나며, 결합조직에 의한 수복이 아니라 신생연골로 수복됨을 알 수 있었다. 연골을 신장시키면 연골이 신생되므로 연골신연술은 연골 기형 및 변형을 교정하는 새로운 술기로 기대된다.