• Archives of Plastic Surgery
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• 제36권6호
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• pp.714-719
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• 2009

Purpose: Recurrent ischial pressure sore is troublesome for adequate soft tissue coverage, because usually its pocket has a very large deep space and adjacent donor tissue have been scarred in the previous surgery. However, the conventional reconstructive methods are very difficult to overcome them. Modified gluteus maximus myocutaneous V - Y advancement flap from buttock can be successfully used in these circumstances. Methods: From February 2007 to October 2008, modified gluteus maximus myocutaneous V - Y advancement flaps were perfomed in 10 paraplegic patients with recurrent ischial pressure sore. The myocutaneous flap based on the inferior gluteal artery was designed in V - shaped pattern toward the superolateral aspect of buttock and was elevated from adjacent tissue. Furthermore, when additional muscular bulk was required to obliterate dead space, the flap dissection was extended to the inferolateral aspect which can included the adequate amount of the gluteal muscle. After the advanced flap was located in sore pocket, donor defect was repaired primarily. Results: The patients' mean age was 46.9 and the average follow - up period was 12.4 months. The immediate postoperative course was uneventful. But, two patients were treated through readvancement of previous flap due to wound dehiscence or recurrence after 6 months. The long - term results were satisfied in proper soft tissue bulk and low recurrence rate. Conclusions: The modified gluteus maximus myocutaneous V - Y advancement flap may be a reliable method in reconstruction of recurrent ischial pressure sore, which were surrounded by scarred tissue because of its repetitive surgeries and were required to provide sufficient volume of soft tissue to fill the large pocket.

• 대한구순구개열학회지
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• 제12권1호
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• pp.21-32
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• 2009

Generally, an adult cleft lip or/and palate patient shows some amount of maxillary deficiency due to limitation of bony growth caused by heavy scars resulted from previous operations such as a cheiloplasty and/or a palatoplasty at an early child age. To solve the problem, advancement of the maxilla is usually required during orthognathic surgery. However, severe tensional force resulted from heavy scars on the palate and/or the lip, as well as the bony defect at the cleft area limited sufficient advancement of the maxillary segment and finally caused relapse of the reposed maxilla. Therefore, distraction osteogenesis of the maxilla was introduced for the successful maxillary advancement inthose kinds of patients. As both hard and soft tissues can be simultaneously and gradually extended with this technique, tensional force caused by heavy scars opposed to forward movement of the maxilla can be reduced to an extent not to develop severe relapse of the advanced maxilla. Since distraction osteogenesis of the maxilla was applied as one of standard protocols for the treatment of the patients with severe maxillary hypoplasia dueto cleft lip and/or palate, the devices for the distraction was improved to control the vectors of distraction with better and more stable. We have treated a 23-year-old male cleft patient with a severe maxillary hypoplasia using a newly developed a maxillary distraction device and a RP model for a pre-operative simulation surgery. As a result, we could successfully move the maxilla as we designed pre-operatively and also reduce much of operation time. Therefore, we report of the case to share our experience with colleagues.

• 한국진공학회:학술대회논문집
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• 한국진공학회 1999년도 제17회 학술발표회 논문개요집
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• pp.184-184
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• 1999

반도체소자의 고집적, 미세화에 따라 MOSFET 소자에서의 고농도, 미세접합이 요구되고 있다. 이러한 고농도, 미세접합을 형성하기 위하여 기존의 저에너지 이온주입법을 대체 또는 병행할 목적으로 플라즈마 이온주입방법이 활발히 연구되고 있다. 본 연구에서는 플라즈마 이온주입방법을 이용하여 (100) 실리콘 기판에 보론을 주입후 열처리하여 형성된 p+층의 도펀트의 활성화와 이온주입으로 인한 실리콘 기판의 손상을 고찰하였다. 본 실험에서 (100)실리콘 기판에 도핑할 소스 가스로 BF3을 주입하고, D.C. pulse 플라즈마 도핑시스템을 사용하여 플라즈마 내의 보론이온을 웨이퍼 홀더에 -1~-5kV의 인가된 음전압에 의해 가속시키어 실리콘 웨이퍼에 주입하였다. 주입에너지 -1kV, -3kV, -5kV와 1$\times$1015, 3$\times$1515의 dose로 주입된 실리콘 기판을 급속가열방식(RTP)을 사용하여 $600^{\circ}C$~110$0^{\circ}C$의 온도구간에서 10초와 30초로 열처리하여 도펀트의 활성화와 미세접합을 형성한 후 SIMS, four-point probe, Hall 측정, 그리고 FT-IR을 이용하여 플라즈마 이온주입된 도펀트의 거동과 활성화율을 관찰하였고 FT-IR과 TEM의 분석을 통하여 이온주입으로 인한 실리콘 기판의 손상을 고찰하였다. SIMS, four-point probe, Hall 측정, 그리고 FT-IR의 분석으로 열처리 온도의 증가에 따라 도펀트의 활성화율이 증가하였고, 이온주입 에너지와 dose 그리고 열처리 시간의 증가에 따라서 주입된 도펀트의 활성화는 증가하였다. 그리고 주입에너지와 dose 그리고 열처리 시간의 증가에 따라서 주입된 도펀트의 활성화는 증가하였다. 그리고 주입에너지와 dose를 증가시키면 접합깊이가 증가함을 관찰하였다. 이온주입으로 인한 기판손상의 분석을 광학적 방법인 FT-IR과 미세구조를 분석할 수 있는 TEM을 이용하여 분석하였다. 이온주입으로 인한 dislocation이나 EOR(End Of Range)과 같은 extended defect가 없었고, 이온주입으로 인한 비정질층도 없는 p+층을 얻을수 있었다.

• Journal of Chest Surgery
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• 제28권7호
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• pp.658-665
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• 1995

Between March 1989 and December 1994, one-stage repair was performed for correction of the intracardiac malformations associated with aortic coarctation in 34 patients or interrupted aortic arch in 8 patients via median sternotomy. There were 26 male and 16 female patients, and their body weight ranged from 1.8 to 8kg[mean weight, 4.0$\pm$l.4kg . The age at the operation ranged from 7 days to 18 months [mean age, 3.1$\pm$3.8 months . The repair of aortic coarctation or interrupted aortic arch was performed using extended end-to-end anastomosis in most of the patients[86%, 36/42 , and six patients underwent ductal tissue excision and patch aortoplasty. Intracardiac defects were corrected concomitantly through the right atrium unless the anatomy dictated otherwise. Obstructive outlet septurn was resected whenever necessary. There were seven early deaths[16.8% , and three late deaths with a mean follow-up period of 25 months [range from 1 to 65 months . Three patients were reoperated upon residual subaortic stenosis,stenosis at the RPA origin, and subacute bacterial endocarditis respectively. None showed any significant residual or anastomotic stenosis postoperatively. One stage repair of the aortic coarctation and interrupted aortic arch associated with intracardiac defect leaves no native coarctation shelf tissue or residual hypoplasia in the repaired segment, has low incidence of recurrent or residual stenosis, minimizes reoperation and incisions, and manages arch hypoplasia easily.We conclude that surgical results of one-stage repair for the intracardiac malformation associated with aortic coarctation or interrupted aortic arch are resonable.

• Archives of Reconstructive Microsurgery
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• 제14권2호
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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.

• Archives of Reconstructive Microsurgery
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• 제19권2호
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• pp.108-111
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• 2010

Purpose: In reconstructing a defect on the dorsum of the hand, there are many cases of extensor tendons exposed or even missing. The repaired or reconstructed tendons need relevant gliding environment for good functional recovery. The anterolateral thigh flap offers a vascular fascial component with large amounts that can be used for covering exposed tendons and we report a unique case of single-stage hand dorsum and gliding surface reconstruction. Methods: A 35-year-old man had severe post-traumatic scarring in his left dorsal hand and coverage of the flap with split-thickness skin graft has been done before. After scarred skin excision and extensor tendon graft for missed part, a free anterolateral thigh adipofascial flap was used to resurface the hand dorsum and to reconstruct a two-layer gliding surface of the extensor tendons. The extensor tendons were wrapped in the fascial component with the fat layer inside. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. Good overall functional recovery and tendon excursion were observed. He was also satisfied with postoperative appearance. Conclusion: A free anterolateral thigh adipofascial flap was used successfully for reconstruction of a two-layer tendon gliding surface to treat a patient with severe scarring in the dorsal hand.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.184-194
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• 2022

The face and the external nose define an individual's physical appearance. Nasal deformities can cause facial disfigurement along with unwanted psychological repercussions. Nasal deformities range in severity, with the most severe cases being indications for a rhinectomy, due to the complexity of the nasal defect. According to published literature, there is no consensus among otolaryngologists and plastic surgeons on which technique or flap use is preferred in terms of complications, aesthetic outcome, or patient satisfaction. The goal of this study is to provide a comprehensive analysis of published studies on nasal reconstruction following rhinectomy. Using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines for writing systematic reviews, a systematic review was conducted. Four databases were searched using a search strategy. These articles were then imported into the COVIDENCE software and went screening and thorough article review. After screening 2,237 articles, 23 studies were then extracted for data collection analysis. We collected data from 12 case series, 4 case studies, 1 prospective case series, and 4 retrospective chart review studies. The most commonly reported flaps were forehead flaps, superior extended nasal myocutaneous island, forearm free flaps, anterolateral thigh (ALT) free flap, medial femoral condyle free flap (n = 8), and zygomaticus implants (n = 6), and retained nasal prosthesis. Although not specifically indicated by a certain number, the most common indication for the rhinectomy was malignancy, followed by traumas, postsurgical complications, radionecrosis, and congenital nasal malformations.

• Journal of Chest Surgery
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• 제30권4호
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• pp.363-372
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• 1997

본 연구는 1986년 6월 3일부터 1995년 12월 31일까지 서울대학교 어린이 병원 흉부외과에서 경험한 144례의 대동맥 교약증 환아를 대상으로, 술후 결과에 영향을 미치는 여러 가지 요소들을 분석하였다. 환아의 평균 연령은 15.73+32.43(범 위 0.1-191.0, 중앙값=3.3)개월이 었고, 이중 11)례(78.5%)의 환아는 영아, 25례(17.4%)는 신생아였다. 환아를 대동맥궁 협 착 부위와 동반 심기형에 따라(제 1형:국소 협착, 제2형:대동맥 헙부 협착, 제3형 :대동맥 협부 및 횡대동맥궁 협착, h:심실중격결손증 동반, B:기타 복 잡 심기 형 동반) 9가지로 분류한 결과, 1, IA, IB, I, IIA, IIB, III, IIIA, IIIB형이 각각 25, 9, 6, 24, 35, 15, 4, 19, 7례 였다. 수술방법은 쇄골하동맥편 교약성형술(subclavian-flap coarctoplasty, SFC: 60례), 절단 및 문합술(resection and anastomo sis, R&A: 44례), 확장된 대동맥성형술(extended aortoplasty, Ex-Ao: 26 례), 덮개포편술(onlay patch, Onlay: 14례)이 사용되었다. 총수술 사망률은 16.0%(23/144)였고, 수술 사망률을 높이는 인자로 협착부위(I, II, III형) 동반 심기형(0, A, B), 환아의 연령, 수술방법, 단계수술 \ulcorner부 등이 분석되었는데 이중 횡대동맥궁협착을 동반하는 III형(I형 사망률=2.5%(1/40), II형=17.6% (13/74), III형=30%(9/30); p(0.01), B형(0형 사망률=3.8%(2/53), A형 =15.9%(10/63), B형 =39.3%(11/28); p(0.01) 등이 의미있는 위험 인자였다. 생존환아 121례는 술후 평균 29.1+28.8(범위 0-129.2)개월 외래 추 적되 었으며 이중 술후 협착을 보였던 경우는 18례로 14.9%의 헙착률은 보였다. 생존환자중 77례의 환자 (I형 20명. ll형 42명, 111형 15명)에서 술전, 술후 3개월 이내, 술후 6개월이후의 심에코도상의 대동맥 각 부위 크기에 관한 자료의 입수가 가능하였으며 이를토대로무명동맥 직근위부의 상행대동맥 직경에 대 한 대동맥협부 직경의 비율(대동맥협부지수)및 경동맥부위의 횡대동맥 직경비율(횡대동맥지수)을구하 여 형태 별로 술전, 수술 직후 6개월이상 경과후의 대동맥 크기 변화의 양상을 관찰하였다. 제 I, II, III형 모두에서 술전에 비하여 술후 평균 대동맥협부지수의 의미있는 증가가 관찰되었으며(p<0.01),제 III형에서는 횡대동맥지수의 의미있는 증가도 관찰되었다(p<0.01). 재헙착으로 진단된 I, II형의 수술직후 대 동맥협부지수와 111형의 횡대동맥 지수는 비협착군에 비하여 의미있게 작았는데 이는 아마도수술 당시 협 착 부위의 완전제거가 이루어지지 않은 것이 원인이라고 사료되었다. 본 분석에서는 어린 연령(3개월 이하), 3개월이하에 시행한 쇄골하동맥편 교약성형술이 의미있는 재협착의 위험요소로 밝혀졌다. 결론 적으로 저자등은 본연구를 통하여 대동맥협부지수, 횡대동맥 지수 등이 개개 대동맥교약 환아의 해부학 적, 임상적 특징을 파악하는데 도움이 되는 도구라는 사실을 발견하였고 아울러 교약의 해부학적 특성, 동반 심기 형, 연령, 수술방법 등이 수술사망 및 재협착에 영향한다는 사실을 입증하였다.

• Journal of Chest Surgery
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• 제38권8호
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• pp.583-588
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• 2005

선천성 기관 협착증은 드문 질환이며, 장분절성 기관 협착은 아주 치명적이다. 신생아나 영아에서 심한 호흡 부전이 발생하고 복합 심기형이 동반되면 수술 교정이 쉽지 않다. 선천성 심기형을 동반한 장분절성 기관 협착으로 인공 호흡기 이탈이 불가능한 2.6 kg 체중의 어린 영아 1예와 신생아 1예에 서 기관성형술을 시행하였다. 심실중격결손증 수술 후 미만성 기관 협착이 발견된 어린 영아는 기관 절제술 및 좌측 주 기관지로의 확장 문합술을 시행받았으며, 미만성 근위부 기관 협착과 팔로사징을 동반한 신생아는 활주 기관성형술과 팔로사징 완전 교정술을 동시에 시행받았다. 두 환아 모두 술후 컴퓨터 단층 촬영에서 양호한 결과를 보였으며, 현재 증상 없이 건강한 상태이다.

• 한국항해항만학회지
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• 제31권5호
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• pp.421-426
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• 2007

최근 건설구조물의 하자보수기간은 5년에서 10년으로 연장되었고 건설품질 및 유지관리에 대한 인식의 변화에 따라 교량, 댐, 항만 구조물의 수중부 은폐된 부분에 대한 유지관리를 위해 반영구적인 공법의 개발이 요구되고 있다. 본 연구에서는 지금까지 대형 강관 및 교각의 수중시공에서는 잠수부들의 기술능력부족과 수중에서의 작업조건의 까다로움 등으로 임시적인 작업이 되었던 현 실정을 고려하여 수중구조물 유지관리에 실용화 될 수 있는 공법으로 부체식 섹터케이슨을 제안하였다. 특히, 상부구조물이 수면에 가까운 경우 및 구조물간 간격이 좁은 경우 보수구간의 접근성과 교각과 같은 대형 수중구조물 유지 보수 시 드는 고비용의 문제 등으로 전체 구조체를 설치하는 대신 섹터케이슨을 개발하여 도입함으로써 비상시 이동과 장래 신속한 작업수행 및 작업수준 향상에 획기적인 역할이 기대 된다.