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Reconstruction of Large Heel Defects Using Gracilis Muscle Free Flaps (유리 대퇴박근판을 이용한 발꿈치의 재건)

  • Jeong, Jae-Ho
    • Journal of Yeungnam Medical Science
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    • v.14 no.1
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    • pp.227-236
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    • 1997
  • 발꿈치는 신체의 다른부위에 비하여 엄청난 하중을 지탱하고 있으며, 주행시에는 막대한 전단력을 받으므로 그 재건에 있어서 어려운 점이 있다. 그 동안 발꿈치의 연부조직 결손을 재건하기 위한 많은 방법들이 개발되어 왔지만, 비교적 큰 발꿈치의 연부조직 결손을 재건하는 것은 아직도 쉬운 일이 아니다. 이처럼 큰 결손의 재건에는 주로 유리 피판술을 이용한 재건술을 사용하는데, 그 중에서도 광배근, 복직근, 대퇴박근 등의 근육을 이용하는 방법이 최근에 많이 이용되고 있다. 이와 같은 유리 근 피판에 피부이식을 이용하는 발꿈치 재건술은 표재성 감각기능을 재건하지 못하는 것이 단점으로 지적되고 있으나, 보행 또는 주행시 발꿈치에 가해지는 압력과 전단력을 효과적으로 견디어 낼 뿐아니라, 외관상으로도 정상에 가까운 발꿈치를 재건할 수가 있어서 좋은 방법으로 인정되고 있다. 특히, 대퇴박근은 피판을 비교적 쉽게 채취할 수 있고, 공여부에 기능적인 장애나 심한 변형을 남기지 않아서 좋은 방법이라 생각된다. 다만 크기가 비교적 작아서, 발등이나 족관절 상부에까지 이르는 광범위한 연부조직 결손에서는 사용할 수 없는 점이 아쉽다. 저자는 비교적 가늘고 긴, 대퇴박근의 형태적 특징을 최대한 이용하여, 결손부의 다양한 형태 및 크기에 따라 대퇴박근을 말발굽형, 나선형, S-자형 등으로 적절히 형상화하여 발꿈치 결손을 효과적으로 재건하는 방법을 고안하였다. 또한, 공여부에 긴 선상 반흔이 남는 것을 피하기 위하여 두 개의 작은 절개를 통해서 대퇴박근을 채취하였다. 이 방법을 이용하여 영남대학교 의과대학 성형외과학 교실에서는 1993년 이후부터 7명의 비교적 큰 발꿈치의 연부조직 결손 환자를 대상으로 유리 대퇴박근 피판술을 이용한 재건술로 성공적인 결과를 얻을 수 있었다.

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Removable prosthetic rehabilitation in patient with maxillofacial defects caused by gunshot: A case report (총상으로 인한 악안면 결손을 가진 환자에 대한 가철성 보철물 수복증례)

  • Lee, Donggyu;Kang, Jeongkyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.55 no.2
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    • pp.198-204
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    • 2017
  • Maxillofacial defect comes from congenital defect, trauma and surgical resection. Patients with intraoral defect are commonly related to maxillary defect and they need prosthetic rehabilitation. Functional reconstruction of partially edentulous mandible has many limitations. However, if both condyles are intact, maxillofacial prosthesis using partial denture give competent results. In this case, a patient of 58 year-old male has a defect on palate and left mandibular posterior teeth from gunshot. The maxillary defect of this patient is Class IV according to Aramany classification and the mandibular one is Type V according to Cantor and Curtis classification. For retention of the obturator, remaining teeth are fully utilized and artificial teeth are arranged harmoniously to provide stable occlusion. Mandibular RPD covered limited range of deformed soft tissue derived from mandibular resection surgery. With these treatments, the patient in this case showed improvements in mastication, swallowing and speech.

치아, 구강 및 악안면외상의 1차적 처치

  • Kim, Myeong-Rae
    • The Journal of the Korean dental association
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    • v.22 no.5 s.180
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    • pp.387-392
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    • 1984
  • 외상의 처치는 일반적으로 응급처치기(emergency 혹은 initial phase), 중간처치기 (intermidiate 혹은 planning phase) 그리고 항구치료기 (definitive phase)로 구분되며 응급처치의 범주내에서는 우선 환자의 생명유지를 고려하고 다음엔 창의 생활력(vitality)을 유지하여 장차의 조직결손과 기능적 결합을 예방하는 데 목적이 있다. 그러므로 구강 및 악안면의 광범한 외상은 기도확보, 대량실혈의 방지, shock의 예방 (수액보충 등) 및 감염대책 등의 순으로 응급대처하게 된다. 그러나 일반 개원임상의들이 자주 접하는 비교적 작은 외상에서는 위의 대원칙에 더하여 창상의 효과적인 1차적 처치에 더욱 관심을 갖어 조직의 괴사나 결손 및 변형으로 인한 기능적 심미적 장애를 최솔 하는 것이 중요하다.

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Prosthetic Treatment with Palatal Obturator for the Patient who had Hemimaxillectomy: Case Report (상악골 부분 절제술을 받은 환자에서 구개 폐쇄 장치를 이용한 보철치료: 증례보고)

  • Choi, Su-Jeong;Jo, Kwang-Hun;Lee, Kyu-Bok
    • Journal of Dental Rehabilitation and Applied Science
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    • v.27 no.3
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    • pp.337-342
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    • 2011
  • Congenital or traumatic loss on the oral and maxillary area or the loss of jaws due to the surgical excision of a tumor causes functional problems, such as masticatory and swallowing disorders, phonetic problems and psychological disorders in patients. In most cases, a prosthetic restoration is needed to resolve these problems and restore the damaged tissue and function. When loss occurs on the maxilla, foods and liquids leak into the nasal cavity, and a nasal sound can be heard due to air leakage into the removed area. In these cases, the palatal obturator can be used to improve the esthetic and functional aspects because it restores the removed area of the maxilla and closes the opened route between the oral cavity and maxillary sinus or nasal cavity. In this case report, a palatal obturator was applied to patients who had a hemimaxillectomy due to the occurrence of squamous cell carcinoma on the right maxillary area. Therefore, fundamental functions, such as phonetic and swallowing functions were restored, and the esthetic aspects of the facial profile were improved.

Tissue Engineering for Dental Implants

  • Kim, Hyun-Man;Go, Jae-Seung
    • The Journal of Korean Academy of Prosthodontics
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    • v.38 no.4
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    • pp.421-426
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    • 2000
  • 조직공학은 결손된 조직의 구조 및 기능을 신속히 수복할 수 있도록 적절한 생체소재, 세포, 활성인자 세가지 구성요소를 적절히 조합하는 것이다. 이렇게 하므로써 결손된 조직을 대체할 수 있는 세포에 대한 부착, 이동, 증식, 분화조건을 최적상태로 만들어 주는 것이다. 이러한 관점에서 치아임플랜트의 조직 공학적 적용은 다음 몇가지 관점을 고려할 수 있다. 첫째, 인공치아 임플랜트도 넓은 의미에서 그 자체로서 조직공학의 범주에 들어간다고 할 수 있다. 따라서 결손된 치아의 구조 및 기능을 신속히 회복시킬 수 있도록 조직공학적인 관점에서 검토할 수 있다. 생체소재는 표면에너지의 관점에서, 세포는 골모세표와 섬유모세포관점에서, 활성인자는 세포분화 촉진인자의 관점을 고려할 수 있다. 둘째, 치아임플랜트의 기능회복 촉진을 위한 조직공학기법을 부가적으로 적용하는 것이다. 임플랜트와 생체조직사이에 기능성 조직을 신속히 형성시키므로써 임플랜트의 기능회복을 촉진하는 적절한 생체소재, 세포, 활성인자를 적절히 이용하는 정통 조직공학기법을 적용하는 것이다.

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A Study on Convergence Family Function and parameter validation fusion of youth protection factor (융합적 가족 기능과 청소년 보호요인의 매개검증에 관한 연구)

  • Jang, Chun-Ok
    • Journal of the Korea Convergence Society
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    • v.6 no.4
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    • pp.121-126
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    • 2015
  • Korea Youth Panel (2008) has 2 panels of the 5th year of Knowledge data to perform statistical analysis and regression analysis, the risk factors in the risk conditions of the family of functional deficits, protective factors, the relationship between the mediating effect of psychological adaptation and protective factors verification mechanisms and the psychological adaptation level it is an objective to analyze the protective factors that protect the high youth. To investigate the differences by frequency analysis and personal characteristics of the analyte's was performed t test using PASW (Predictive Analytics Software) 18.0. And to verify the effect of the parameters is performed rank regression analysis for verification of the effects of protection factors for adaptation. Rather than focusing on youth risk factors in social welfare practice field, focusing on processes and protective factors to reduce the risk factors, it is possible to convert the viewpoint overlooking the youth exposed to risk factors. Also, for young people experiencing difficulties that features loss of the family, it is determined that the prepared foundation which can be provided in the direction of social welfare practical intervention.

A Case Report of Congenital Eyelid Defect without Any Other Deformities (다른 기형을 동반하지 않은 선천성 상안검 결손증 1례 보고)

  • Moon, Jae Won;Yang, Jeong Yeol
    • Archives of Craniofacial Surgery
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    • v.9 no.2
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    • pp.90-92
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    • 2008
  • Purpose: Congenital upper eyelid defect is rare anomaly whether it is compared with syndromic anomaly or not. It has many clinical manifestation in the extent, location. Many operation procedures such as simple closure, semicircular rotation flap, Cutler Beard procedure, lower lid rotation flap, etc can be used to reconstruct eyelid defects. We intend to introduce a simple, congenital eyelid defect which was not compared with syndromical anomaly, ophthalmic complication. Methods: Our experience is a case of 19 years old female who had a upper eyelid coloboma without any other anomalies. we could not find any skeletal deformity in orbital CT scan. she had no ophthalmic problem. we reconstructed the defect with bilateral marginal flap after deepithelization of supramarginal area and tarsal reposition. Results: There were no visible deformity of lid lining. postoperative scar was favorable. satisfactory results were obtained in cosmetic and functional aspects. Conclusion: Upper lid coloboma without other anomalies is rare. we obtained satisfactory outcome as treated this rare case with marginal flap advancement.

Novel Connective tissue graft technique for Ridge Augmentation in case of Conventional fixed partial denture : Case reports (치조제 결손부 증대를 위한 새로운 결합조직 이식술)

  • Ahn, Myung-Hwan
    • Journal of the Korean Academy of Esthetic Dentistry
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    • v.22 no.1
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    • pp.47-55
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    • 2013
  • There have been a great number of developments in clinical techniques and dental materials in dentistry to date. Looking at these developments, while it could be seen that functional elements such as mastication were prioritized rather than aesthetic aspect in the past, aesthetic needs of patients have steadily increased over time and accordingly the aesthetic has become considered a priority in the development of dentistry. Although the first to be considered in discussing the aesthetic in clinical dentistry will be the white aesthetic that is the tooth part of prosthesis, the pink aesthetic that refers to the harmony of such prosthesis with gingiva can be an important consideration not to be ignored aesthetically. However, the harmony with the gingiva often cannot be obtained only by the beautiful prosthesis, and in particular, the pontic and implant areas have poor conditions to achieve the gingival (pink) aesthetic due to the absorption of alveolar ridge compared to natural teeth. Among the most important elements of the gingival aesthetic are the gingival level and the interproximal papilla height. It is very difficult to make the gingival aesthetic in the case of insufficient alveolar ridge, and the recovery of ridge volume and contour is necessary in order to overcome this condition. To this end, the most widely used method is the "connective tissue graft". Many techniques of the connective tissue graft have already been introduced for the ridge augmentation, and each technique has different purposes, and advantages and disadvantages. Rather, due to the excessive amount of techniques, there is confusion about selecting the right technique at a certain time. However, the goal is clear. Ways to increase the success rates must be found, and at the same time, a more favorable way to the gingival aesthetic is to be chosen. Thus, in this study, considerations for the gingival aesthetic that makes harmony and the techniques to achieve it are discussed.

Effects of Maxillary Lateral Incisor Agenesis on Skeletodental Characteristics in Mixed Dentition (상악 측절치 결손이 어린이 안면골격과 치열궁 형태에 미치는 영향)

  • Nam, Siyeon;Shin, Jonghyun;Kim, Jiyeon;Jeong, Taesung;Kim, Shin
    • Journal of the korean academy of Pediatric Dentistry
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    • v.46 no.2
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    • pp.147-157
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    • 2019
  • This study aimed to evaluate skeletodental characteristics of patient with maxillary lateral incisor agenesis (MLIA) in mixed dentition. It involved the children in early mixed dentition who visited Pusan National University dental hospital for orthodontic purposed and had intact primary canines. 38 children with MLIA and 38 controls with the same chronological age satisfying the inclusion criteria were selected. The craniofacial structures and dental arch dimensions of the MLIA were evaluated using model & cephalometric analysis and compared to controls. The rate of unilateral MLIA was high in male and the rate of bilateral MLIA was high in female. In model analysis, the width / length ratio of maxillary anterior portion of the MLIA group were higher and arch perimeter of the maxilla of the MLIA group were smaller than those of the control group (p = 0.003, 0.04). Cephalometric analysis showed that there were no significant differences in terms of skeletal, dental analysis. In soft tissue profile, nasolabial angle was larger in MLIAs than in controls (p = 0.039). Considering these skeletodental characteristics of MLIA, early diagnosis and proper management is highly recommended to minimize the possibility of functional defect.