• Archives of Plastic Surgery
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• v.34 no.4
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• pp.448-454
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• 2007

Purpose: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. Methods: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. Results: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. Conclusion: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.329-334
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• 2010

Purpose: Adhesion after flexor tendon injury is a result of fibrosis between tendon and tendon sheath. This, finally interfere with gliding mechanism of tendon and results in functional problem of hands. Therefore, there have been many trials to reduce adhesion around the tendon. However, there is no standard procedure clinically practiced in hospitals. Mitomycin-C is an antineoplastic alkylating agent that decrease fibroblast proliferation and scar formation. It is commonly used in many surgery to reduce postoperative adhesion. This study was designed to observe the effect of Mitomycin-C on preventing adhesion in injured flexor tendon. Methods: The deep flexor tendon of digit 2 and 4 in the left forepaw of 15 New Zealand White rabbits were subjected to partial tenotomy. In study group, injury site was exposed to a single 5-minute application of Mitomycin-C, and in control group was left untreated. Digit 2 and 4 in the right forepaw of each rabbit were considered as nonadhesion control group. After 2 weeks, the animals were sacrificed and digits were amputated for biomechanical test and histological study. Results: In biomechanical study to measure yield point, mean yield point of non-adhesion control was $17.43{\pm}2.33$ and $25.07{\pm}4.03$ for adhesion control, which proves increase of adhesion in adhesion control group (p<0.05) in 95% confidence. In Mitomycin-C group, mean yield point was $12.71{\pm}4.97$. Compared with adhesion control, there was decrease in adhesiveness in Mitomycin-C group (p<0.05) in 95% confidence. In histological study, the result of adhesion control revealed massive adhesions of bony structure, fibrotic tissue and tendon structure with ablation of the border. However in Mitomycin-C group, we could find increased fibrotic tissue, but adhesion is much lesser than adhesion group and borders between structures remain intact. Conclusion: This study suggests that Mitomycin-C can significantly reduce adhesion of injured flexor tendon in rabbit model.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.20-25
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• 2020

Background Ultrasonic dissection devices cause less thermal damage to the surrounding tissue than monopolar electrosurgical devices. We compared the effects of using an ultrasonic dissection device or an electrocautery device during prosthetic breast reconstruction on seroma development and short-term postoperative complications. Methods We retrospectively reviewed the medical records of patients who underwent implant-based reconstruction following mastectomy between March 2017 and September 2018. Mastectomy was performed by general surgeons and reconstruction by plastic surgeons. From March 2017 to January 2018, a monopolar electrosurgical device was used, and an ultrasonic dissection device was used thereafter. The other surgical methods were the same in both groups. Results The incidence of seroma was lower in the ultrasonic dissection device group than in the electrocautery group (11 [17.2%] vs. 18 [31.0%]; P=0.090). The duration of surgery, total drainage volume, duration of drainage, overall complication rate, surgical site infection rate, and flap necrosis rate were comparable between the groups. Multivariate analysis revealed that the risk of seroma development was significantly lower in the ultrasonic dissection device group than in the electrocautery group (odds ratio for electrocautery, 3.252; 95% confidence interval, 1.242-8.516; P=0.016). Conclusions The findings of this study suggest that the incidence of seroma can be reduced slightly by using an ultrasonic dissection device for prosthesis-based breast reconstruction. However, further randomized controlled studies are required to verify our results and to assess the cost-effectiveness of this technique.

• Proceedings of the Korean Vacuum Society Conference
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• 2010.02a
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• pp.179-179
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• 2010

1차원 나노구조를 갖는 ZnO를 성장하기 위해 Laser ablation, Chemical vapor deposition (CVD), Chemical transport method, Molecular beam epitaxy, Sputtering 등의 다양한 형성법들이 이용되어지고 있다. 특히 대량생산과 경제성 측면에서 많은 장점을 가지고 있는 CVD를 이용한 ZnO 성장 및 응용 연구가 활발하게 수행되고 있다. 본 연구에서는 Thermal CVD를 이용하여 반응물질과 기판 사이의 거리, 기판온도, $O_2$/Zn 비율 등의 성장변수를 변화시켜 ZnO 나노구조를 성장하고 구조 및 광학적 특성을 연구하였다. Scanning electron microscope를 통한 구조 특성평가 결과 반응물질과 기판 사이의 거리가 13 cm 이하의 조건에서 ZnO 나노구조들은 나노판(Nanosheet)과 나노선(Nanowire)이 혼재하여 성장된 것을 보였다. 그리고 반응물질과 기판사이의 거리가 15 cm 이상부터 나노판이 없어지고 수직한 ZnO 나노막대(Nanorod)가 형성되었다. 상온 Photoluminescence 스펙트럼에서 반응물질과 기판사이의 거리가 5에서 15 cm로 증가할수록 결함 (Defect)에 의해 발생된 515 nm 파장의 최대세기 (Maximum intensity)가 10배 이상 감소한 반면, ZnO 나노구조에 의한 378 nm 파장의 NBE발광 (Near band edge emission)은 8배 이상 증가하였다. 이러한 구조 및 광학적 결과로부터, 질서 없이 성장된 것보다 수직 성장된 ZnO 나노구조의 결정질(Crystal quality)이 좋은 것을 확인하였다. 이를 바탕으로 성장변수에 따른 ZnO 나노구조의 형성 메커니즘을 Zn와 O 원자의 성장거동을 기반으로 한 모델을 이용하여 해석하였다.

• Proceedings of the Korean Vacuum Society Conference
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• 2010.02a
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• pp.117-117
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• 2010

나노입자 제조 기술이 점차 발전하면서 금속산화물, 반도체용 및 태양전지용, 신소재 등 다양한 응용분야에 사용하고 있다. 따라서 이와 같은 나노입자 제조방법으로는 펄스 레이저 용사법(pulsed laser ablation), 플라즈마 아크 합성법(plasma arc synthesis), 열분해법(pyrolysis), plasma-enhanced chemical vapor deposition (PECVD)법 등과 같은 기상공정이 많이 사용되고 있다. 기상공정은 기존의 공정에 비해 고순도 입자의 대량 생산, 다성분 입자의 화학적 균질성 유지, 비교적 간단하고 깨끗한 공정 등의 장점을 가지고 있다. 기상공정에서 일반적인 입자 형성 메커니즘은 기체 상태의 화학 물질이 물리적 공정 혹은 화학 반응에 의해 과포화상태에 도달하게 되며, 이 때 동질 핵생성(homogeneous nucleation)이 일어나고 생성된 핵(nuclei)에 기체가 응축되고 충돌, 응집하면서 입자는 성장하게 된다. 열분해법은 실리콘 나노입자를 생산하는 기상공정 중 하나이다. 일반적으로 열분해 공정은 지속적으로 열이 가해지는 반응기 내에 반응기체인 $SiH_4$을 주입하고, 운반기체는 He, $H_2$, Ar, $N_2$ 등을 사용하였을 때, 높은 열로 인해 $SiH_4$가 분해되며, 이 때 가스-입자 전환 현상(gas to particle conversion)이 일어나 실리콘 입자가 형성된다. 그러나 입자 형성과정은 $SiH_4$ 농도, 유량, 작동 압력, 온도 등 매우 다양한 요소에 영향을 받는다. 고, 복잡한 화학반응 메커니즘에 의해 명확히 규명되지는 못하고 있다. 이에 본 연구에서는 복잡한 화학반응을 해석하는 상용코드 CHEMKIN 4.1.1을 이용하여 열분해 반응기 내에서의 실리콘 입자 형성, 성장, 응집, 전송 모델을 만들고 이를 수치해석하였다. 표면 반응, 응집, 전송에 의한 입자 성장 메커니즘을 포함하고 있는 aerosol dynamics model을 method of moment법으로 해를 구하였으며, 이를 실험 결과와 비교하여 모델링을 검증하였다. 또한 반응기의 온도, 압력, 가스 농도, 유량 등의 요소를 고려하여 실리콘 나노입자를 형성하는 최적의 조건을 연구하였다.

• Proceedings of the Korean Vacuum Society Conference
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• 2013.08a
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• pp.229.2-229.2
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• 2013

Yttrium oxide (Y2O3)는 band gap이 5.5 eV 정도로 상대적으로 넓고, 굴절상수가 1.8, 유전율이 10~15, Silicon 과의 격자 불일치가 작은 특성을 가지고 있다. 또한 녹는점이 높아 열적으로 안정하기 때문에 전자소자 및 광학소자에 다양하게 응용되는 물질이다. Y2O3 박막은 다양한 방법으로 증착할 수 있는데, 그 방법에는 e-beam evaporation, laser ablation, sputtering, thermal oxidation, metal-organic chemical vapor deposition, and atomic layer deposition (ALD) 등이 있다. ALD는 기판 표면에 흡착된 원자들의 자기 제한적 반응에 의하여 박막이 증착되기 때문에 박막 두께조절이 용이하고 step coverage와 uniformity 측면에서 큰 장점이 있다. 이전에는 Y(thd)3 and Y(CH3Cp)3 와 같은 금속 전구체를 이용하여 ALD를 진행하여, 증착 속도가 낮고 defect이 많아 non-stoichiometric한 조성의 박막이 증착되는 문제점이 있었다. 이번 연구에서는, (iPrCp)2Y(iPr-amd)와 탈이온수를 사용하여 Y2O3 박막을 증착하였다. Y2O3 박막 증착에 사용한 Y 전구체는 상온에서 액체이고 $192^{\circ}C$ 에서 1 Torr의 높은 증기압을 갖는다. Y2O3 박막 증착을 위하여 Y 전구체는 $150^{\circ}C$ 로 가열하여 N2 gas를 이용하여 bubbling 방식으로 공정 챔버 내로 공급하였다. Y2O3 박막의 ALD window는 $250{\sim}350^{\circ}C$ 였으며, Y 전구체의 공급시간이 5초에 다다르자 더 이상 증착 두께가 증가하지 않는 자기 제한적 반응을 확인할 수 있었다. 그리고 증착된 Y2O3 박막의 특성 분석을 위해 Atomic force microscopy (AFM)과 X-ray photoelectron spectroscopy (XPS), Auger electron spectroscopy (AES) 를 진행하였다. 박막의 Surface morphology 는 매끄럽고 uniform 하였으며, 특히 고체 금속 전구체를 사용했을 때와 비교하여 수산화물이 거의 없는 박막을 얻을 수 있었다. 그리고 조성 분석을 통해 증착된 Y2O3 박막이 stoichiometric하다는 것을 알수 있었다. 또한 metal-insulator-metal (MIM) 구조 (Ru/Y2O3/Ru) 의 resistor 소자를 형성하여 저항 스위칭 특성을 확인하였다.

• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.105-111
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• 2005

Perforator flaps have become increasingly popular in microsurgery nowadays and are being used widely for many cases of reconstruction after trauma and cancer ablation. And thoracodorsal perforator based free flap is one of them having the merits of carrying a large skin paddle with leaving intact innervation and function of the remaining latissimus dorsi muscle. We made a homogeneous thin flap excluding the main muscle with a long vascular pedicle and tried to decrease the donor site morbidity. But, it needs a long learning-curve and we have met marginal flap necrosis frequently. Besides, prolonged operation time for complete perforator dissection may be a tedious job to the microsurgeon. To overcome these disadvantages, we usually included very small portion of the latissimus dorsi muscle during this flap elevation around the pedicled 2-3 thoracodorsal perforators during this flap elevation. We performed 3 cases of thoracodorsal perforator based free flap at Hallym university sacred heart hospital between May and August 2005 for the soft tissue defect of the scalp and feet. The average flap size was $8{\times}14\;cm$. Although it is not a true perforator flap, we can get the reliability for the flap survival with much better blood circulation and save the time of one or two hours to dissect the perforators completely. All cutaneous flaps survived completely without any complication except one fatty female who had the very small superficial fat necrosis due to flap bulkiness. We believe the thoracodorsal perforator based free flap can be extended its versatility and reliability by including the very small portion of the muscle around the perforators.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.24 no.1
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• pp.33-40
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• 2013

Background and Objectives:This study is to objectively compare and analyze the acoustic changes in the patients with total thyroidectomy before and after RI therapy. Subjects and Methods:For this study, a total of 50 patients with total thyroidectomy were participated as subjects. Voice samples were obtained at the time of post-operation (Post-OP), before high-dose radioactive iodine therapy (Pre-RIT), and after high-dose radioactive iodine therapy (Post-RIT). Acoustic analysis, the maximum phonation time and K-VHI (Korea-Voice handicap index) were used for subjective evaluation. Results:According to the comparison analysis of the three periods, mFo (Hz) was significantly reduced in all of the vowels /a/ and /i/ as the hormone was discontinued. This can be related to the reduction in vocal range. As thyroid hormone was discontinued, Shim (%) and APQ (%) values, which are the parameters related to the degree of aggressiveness, showed a significant increase in the middle vowel /a/. As thyroid hormone was discontinued, emotional index was significantly decreased in VHI (voice handicap index). Conclusion:These results can be assumed that thyroid hormone suspension is related to the increased changes in the vocal intensity, the increase in noise and the reduction in vocal range. Emotionally, these data can be assumed that the responsive factors of one's own voice disorders were significantly decreased in the patients with vocal handicap.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.103-108
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• 2014

Thyroglossal duct cyst (TGDC) carcinoma generally shows a favorable prognosis. If metastasis is present latently, it may not threaten the patient's life immediately. It has been shown, however, that larger than 1 cm papillary carcinoma (PC), level VI metastasis to the lymph node (LN), which is the nearest to the thyroid, independently predicts a worse prognosis. In the case presented herein, a 61-year-old female patient was diagnosed with an about 3 cm PC in the TGDC, particularly the columnar variant subtype, one of the aggressive variants. She had occult papillary thyroid microcarcinoma, but no LN metastasis. Even though she underwent the Sistrunk procedure and total thyroidectomy with central compartment neck dissection followed by high-dose radioactive iodine remnant ablation, however, the cancer cells spread to level IV neck LN, and finally to the lung. Therefore, when a patient is diagnosed with an aggressive histologic variant of PC in the TGDC, even without LN metastasis, the invasive surgical approach and close postoperative surveillance are necessary, with consideration of the risk of disease progression. Therefore, if it is possible to stratify the risk for patients, higher-risk patients can be offered a more invasive therapeutic approach.

• Journal of the Optical Society of Korea
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• v.12 no.4
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• pp.309-313
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• 2008

We studied the sapphire and germanium fibers to determine which optical fiber best transmits Erbium:YAG laser for intracorporeal lithotripsy. Human calculi were ablated with an Erbium:YAG laser in contact mode using two fibers. Optical outputs at the distal end of fibers were measured before and after laser lithotripsy. Upon the irradiation on the calculus with the 50 mJ and 100 mJ pulse energy, the output energy at the distal end of germanium fiber declined to approximately 50% of the input energy. For the sapphire fiber, the output energy at the distal end remained unchanged with 100 mJ input energy; however the output energy had dropped to 50% for 200 mJ input energy. In order to examine how the types of target tissue affect the fiber damage, the sapphire fiber was tested for the irradiation on soft tissue and water as well. No energy decline was observed during soft tissue and water irradiation. We also characterized ablation craters with both optical fibers. Both fibers produced similar craters on calculi in terms of depth and diameter. Sapphire fibers are better suited than germanium fibers for Erbium:YAG lithotripsy in terms of the fiber damage.