• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권1호
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• pp.25-30
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• 2013

Purpose: Many surgical procedures in oral and maxillofacial area can induce trauma to the peripheral nerve. The aim of the study is to evaluate the effects of short-term steroid therapy on nerve recovery after crush injury. Methods: Sixteen rats were randomly divided into two groups. The right sciatic nerves were exposed, crushed, and sutured. The control group was not given steroids. The test group was injected with dexamethasone disodium phosphate (2 mg/kg body weight/day) for 7 days. In all animals, compound muscle action potential (CMAP) was recorded before and at 1, 7, 14, 21, and 28 days after injury. Results: The amplitude of the CMAP before and at 1, 7, 14, 21, and 28 days after injury were $53.20{\pm}4.80$ mV, $20.12{\pm}5.38$ mV, $30.01{\pm}14.15$ mV, $31.14{\pm}13.56$ mV, $31.73{\pm}16.33$ mV, and $37.23{\pm}16.98$ mV in the control group, and $55.25{\pm}6.72$ mV, $18.62{\pm}6.26$ mV, $29.50{\pm}13.06$ mV, $32.90{\pm}13.226$ mV, $30.17{\pm}11.80$ mV, and $38.41{\pm}12.27$ mV in the test group, respectively. The nerve conduction velocity was $18.82{\pm}3.94$ m/s, $16.73{\pm}3.48$ m/s, $19.60{\pm}2.45$ m/s, $18.68{\pm}3.94$ m/s, $18.02{\pm}3.51$ m/s, and $19.25{\pm}3.88$ m/s in the control group, and $18.94{\pm}3.48$ m/s, $17.28{\pm}2.53$ m/s, $7.57{\pm}2.54$ m/s, $18.77{\pm}2.12$ m/s, $19.48{\pm}1.55$ m/s, and $19.22{\pm}2.97$ m/s in the test group, respectively. There was no significant difference between both groups (P>0.05). Conclusion: This study did not show any therapeutic effect of short-term administration of steroids on injured rat sciatic nerve. Further studies are needed.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권6호
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• pp.567-571
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• 2008

Purpose: The purpose was to assess the usefulness of midazolam in patients undergoing minor oral surgery under conscious sedation. Materials and methods: Bispectral index was examined in 20 patients receiving oral minor surgery with conscious sedation supplemented with local anesthesia. All patients included were ASA I and had no contraindications to the study medications. The patients were escorted to the day surgery operation room where, before the commencement of the sedation and surgical procedures, routine monitoring was applied, including the noninvasive monitoring of arterial blood pressure, arterial oxygen saturation, and 3-lead electrocardiogram (Electrocardiogram). Bispectral index electrodes were applied on the frontotemporal region after cleansing the skin with alcohol. Bispectral index was calculated with the Electrocardiogram monitor (A-2000; Aspect Co.). Midazolam was then titrated (initially 3mg wait 2min and 2mg). Vital sign and Bispectral index checked every 5 minute until the end of the procedure. The results were then compared. Results: The Bispectral index index values throughout the sedation study period alter many level. The index was dropped at 5 minutes after administration, but raised at injection and odontomy procedure. During the operation, mean Bispectral index index was higher than conscious sedation index range($60{\sim}80$). The amnesic effect was shown 17 cases out of 20 cases(85%). Conclusion: Conscious sedation technique using midazolma is a safe and effective method of controlling behavior in oral and maxillofacial surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.18.1-18.6
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• 2018

Background: Clefts in newborns are associated with severe morphological and functional impairment. Especially the lip is of importance as if the treatment result is unsatisfactory, it can lead to psychological changes in the patient. Different operative procedures have been developed over the last decades. The aim of the presented study was the comparison of the surgical techniques according to Millard and Pfeifer regarding the temporal development of the postoperative symmetry of the lip height and mouth width. Methods: Digitized photographs of patients from the department of oral and maxillofacial surgery at the University of Göttingen were evaluated from 1979 to 1996. With a video analysis program, the lip height and mouth width were analyzed regarding the symmetry. We demonstrated the symmetry values over a period of 8 years in order to show the influence of growth on postoperative results. Results: The development of the vertical symmetry of the Philtrum and the lip vermillion on the cleft side in comparison to the healthy side behaves differently depending on Pfeifer and Millard. The lip height of the cleft lip was shorter in both techniques than on the healthy side, but Pfeifer's difference was significantly more pronounced. The lip vermillion height on the cleft side was slightly shorter in the Millard group and markedly larger in the Pfeifer group. Both techniques can achieve good symmetry results for the vertical dimension of the lip. According to Pfeifer, the development of the horizontal dimension on the cleft side is bigger within the first 4 years than on the healthy side; according to the Millard technique, the horizontal development is smaller. These differences are greater within the first 6 years and approach between the 6th and 8th year. Conclusions: The Millard technique demonstrates better results concerning the philtrum and vermillion symmetry during growth within the first 6 years. Over the whole study period, growth corrects the philtrum and vermillion symmetry within the Pfeifer group.

• Archives of Plastic Surgery
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• 제32권1호
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• pp.12-18
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• 2005

The Transverse rectus abdominis musculocutaneous (TRAM) flap has been commonly used for autologous breast reconstruction. Despite these clinical usefulness, the TRAM flap is prone to partial flap or fat necrosis in especially pedicled flap. To improve flap survival, the surgical delay procedures and pharmacological treatments have been developed. In many studies for the pharmacological treatment, Lipo-$PGE_1$ has demonstrated a marked ability to improve flap survival and it's effect has been proved similar to surgical delay procedure. The purpose of this study is to determine the most effective route of Lipo-$PGE_1$ administration as a pharmacological treatment in TRAM flap of the rat. Fifty male Sprague-Dawley rats weighing 300-350 gm were divided into five groups, One week before flap elevation, Lipo-$PGE_1$($2{\mu}g/kg$) was injected three times in a week and than the left inferior epigastric vessel based TRAM flap ($5.0{\times}3.0cm$) elevated; group I: no procedure before flap elevation; group II: intraperitoneal injection; group III: intravenous injection; group IV: subcutaneous injection; group V: topical application. A flap was assessed at postoperative 7 days by comparison of flap survival rate, vessel counts(H-E stain), and vascular endothelial growth factor(VEGF) protein expressed by Western blot. The results demonstrated that the mean percentages of the flap survival area in group III were significantly higher than that of any other group(p<0.05). The vessel counts of all experimental groups were statistically higher than that of control group(p<0.05). Only in group III, the VEGF protein expression was increased significantly than control group and there are no difference in other experimental groups. In conclusion, the intravenous administration of the Lipo-$PGE_1$ is the most effective on flap survival, and the VEGF induced by Lipo-$PGE_1$ has some positive effects on new vessel formation and flap survival.

• 대한치과보철학회지
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• 제36권2호
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• pp.203-244
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• 1998

The human mandible is always under the condition of loading by the various forces extorted by the attached muscles. The loading is an important condition of the stomatognathic system. This condition is composed of the direction and amount of forces of the masticatory muscles, which are controlled by the neuromuscular system, and always influenced by the movement of both opening and closing. Mandible is a strong foundation for the teeth or various prostheses, nevetheless it is a elastic body which accompanies deformation by the external forces on it. The elastic properties of the mandible is influenced by the various procedures such as conventional restorative treatments, osseointegrated implant treatments, reconstructive surgical procedures and so forth. Among the treatments the osseointegrated implant has no periodontal ligaments, which exist around the natural teeth to allow physiologic mobility in the alveolar socket. And so around the osseointegrated implant, there is almost no damping effect during the transmission of occlusal stress and displacements. If the osseointegrated implants are connected by the superstructure for the stabilization and effective distribution of occlusal stresses, the elastic properties of mandible is restricted according to the extent of 'splinting' by the superstructure and implants. To investigate the change of elastic behaviour of the mandible which has osseointegrated implant prosthesis of various numbers of implant installment and span of superstructre, a three dimensional finite element model was developed and analyzed with conditions mentioned above. The conclusions are as follows : 1. The displacements are primarily developed at the area of muscle attachment and distributed all around the mandible according to the various properties of bone. 2. The segmentation in the superstructure has few influence on the distribution of stress and displacement. 3. In the load case of ICP, the concentration of tensional stress was observed at the anterior portion of the ramus($9.22E+6N/m^2$) and at the lingual portion of the symphysis menti($8.36E+6N/m^2$). 4. In the load case of INC, the concentration of tensional stress was observed at the anterior portion of the ramus($9.90E+6N/m^2$) and the concentration of tensional stress was observed at the lingual portion of the symphysis menti($2.38E+6N/m^2$)). 5. In the load case of UTCP, the relatively high concentration of tensional stress($3.66E+7N/m^2$) was observed at the internal surface of the condylar neck.

• 대한정형외과학회지
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• 제52권1호
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• pp.40-48
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• 2017

목적: 족부 및 족관절부의 연부조직 결손은 해부학적 한계와 기능적 특성상 선택할 수 있는 재건술의 폭이 비교적 적은 편으로 미용 및 기능적 필요로 인하여 동일 하퇴부의 추가 반흔을 피하고자 하는 경우 그 선택의 폭은 더 줄어들게 된다. 저자들은 이런 경우 전외 측 대퇴 천공지 피판술을 시행하였고 그 임상적 결과를 보고하고자 한다. 대상 및 방법: 총 16예가 대상에 포함되었고 남자 12명, 여자 4명, 평균 나이는 34세였다. 연부조직 결손의 가장 흔한 원인은 외상으로 9예였다. 추시기간은 평균 33개월이었고 피판의 평균 크기는 146 cm²로 피판의 생존 및 합병증, 보행 여부 등을 평가하였다. 결과: 총 16예의 피판 중 15예는 성공적으로 생존하였으며 1예에서는 환자의 조기 보행으로 인한 천층 일부 괴사로 피부이식술을 추가하여 호전되었다. 모든 환자들에게서 보조 기구 없이 독립 보행이 가능하여 피판이 보행에 지장을 준 경우는 없었고 최종 추시까지 잔존하는 특별한 합병증은 없었다. 결론: 족부 및 족관절 연부조직 결손의 재건에 있어 이차 치유나 단순 봉합, 또는 유경 피판술 등의 방법으로 피복이 어려운 경우 전외측 대퇴 천공지 피판술은 안전하면서도 얇게 결손 부위를 피복할 수 있어 유용한 유리 피판술로 생각된다.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.681-686
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• 2010

Purpose: Obese proportion is increasing universally, estimating more than a billion. So reducing the weight became one of the topic in medical market. Not only diet, exercise, medication, but also many surgical procedures are being developed, such as sleeve gastrectomy, gastric bypass surgery. After massive weight loss, skin excess and laxity occurs, leading to unsatisfying body contour. Body contouring surgery including abdominoplasty, breast reduction is performed when skin excess is present in abdomen and breast. When skin excess is present circumferentially, belt dermolipectomy is the treatment of choice. Methods: A 23-year-old man had weight gain since he was 12 of age. A year before visiting to our department, his height was 168 cm, weight was 150 kg and body mass index (BMI) was 53.15 kg/$m^2$. The patient lost 55 kg of his weight through exercise and diet control. When he visited again, his weight was 95 kg and BMI was 33.66 kg/$m^2$. In physical examination, skin excess and laxity was seen in both breast and abdomen circumferentially and lateral folds were seen in the back. Abdominal contour deformity (Pitman classification type 6) and pseudogynecomastia (grade 3) were present in both breast. Belt dermolipectomy of abdomen, both breast and lateral folds was performed, resecting 6,400 g of tissue and additive 1,200 g through revisional operation. Results: The patient lost 6,500g of his weight and BMI reduced by 2.3 kg/$m^2$. The patient's hospital course was uneventful during 5 weeks of hospitalization and he was satisfied with his final body contour. Conclusion: Body contouring with belt dermolipectomy in patient who has circumferential skin excess and laxity after massive weight loss can be a treatment of choice.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.62-67
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• 1998

전북대학교병원 정형외과에서 1994년 6월부터 1998년 3월까지 하퇴부 원위 1/3 및 족부에 시행하였던 박근 유리조직 이식술 12례에 대하여 최소 6개월부터 최고 4년 9개월까지 추시하여 다음과 같은 결과를 얻었다. 1. 하퇴부 원위 1/3의 손상원인은 개방성 골절에 의한 뼈 및 연부조직노출이 4례(33.3%)였으며, 골절수술후 연부조직 괴사로 인한 2차 뼈 및 내고정물노출이 2례(16.7%)였고, 족부의 손상원인은 압궤손상 5례(41.7%), 골절치료시 발뒤꿈치의 압박괴사 1례(8.3%)였다. 2. 수여혈관은 하퇴부 원위 1/3에서는 전경골 동맥이 4례, 비골동맥과 족배동맥이 각각 1례였으며, 족부의 수여혈관은 족배동맥이 4례, 후 경골동맥이 2례였다. 수여정맥은 2개를 봉합함을 원칙으로 하였으나 하퇴부 원위 1/3에서 총 6례중 3례, 족부에서도 총 6례중 3례에서만 2개의 수여정맥 봉합술이 가능하였다. 3. 총 12례중 11례(91.7%)에서 술후 3주까지 관류(perfusion)가 가능하여 성공하였으며, 피부 이식술은 술 후 평균 22일만에 시행하였고, 재활운동은 술후 평균 32일만에 가능하였다.

• The Korean Journal of Pain
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• 제34권1호
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• pp.106-113
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• 2021

Background: We aimed to investigate the analgesic efficacy of an erector spinae plane block (ESPB) in immediate breast reconstruction (IBR) with a tissue expander. Methods: Adult women undergoing IBR with a tissue expander after mastectomy were randomly assigned to either intravenous patient-controlled analgesia (IV-PCA) alone (group P) or IV-PCA plus ESPB (group E). The primary outcome was the total amount of opioid consumption during 24 hours postoperatively between the two groups. Secondary outcomes were patient satisfaction, pain score at rest and on shoulder movement using numerical rating scale, incidences of postoperative nausea and vomiting (PONV), and a short form of the brief pain inventory (BPI-SF) at 3 and 6 months after surgery between the groups. Results: Fifty eight patients completed the study. At 24 hours postoperatively, total opioid consumption was significantly less in group E than in group P (285.0 ± 92.0, 95% confidence interval [CI]: 250.1 to 320.0 vs. 223.2 ± 83.4, 95% CI: 191.5 to 254.9, P = 0.005). Intraoperative and cumulative PCA fentanyl consumption at 3, 6, 9, and 24 hours were also less in group E than in group P (P = 0.004, P = 0.048, P = 0.020, P = 0.036, and P < 0.001, respectively). Patient satisfaction was higher in group E (6.9 ± 1.8 vs. 7.8 ± 1.4, P = 0.042). The incidences of PONV was similar. Conclusions: The ESPB decreased postoperative opioid consumption and increased patient satisfaction without significant complications after IBR with a tissue expander after mastectomy.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.