• Archives of Plastic Surgery
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• 제32권2호
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• pp.199-204
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• 2005

The nose is the most prominent area of the face, therefore susceptible to trauma and skin cancer. When small sized defect is in nasal tip, it results in disturbance of the facial harmony even if replantation, composite graft, skin graft or median forehead flap has been used for the reconstruction. So it is needed that the best method reconstruction is performed according to the degree of defect or deformity. And at the same time the physiology and anatomy of nose were clarified and its aesthetic subunits were employed. How can we cover the about 3 cm sized nasal defect in nasal tip with cartilage exposure? At first, we can think forehead island flap is most appropriate. We performed 7 cases of the forehead island flap for reconstruction of the defect in nasal tip(4 cases: cancer, 3 cases: trauma) from March, 2001 to August, 2004. This result was satisfactory in the point of texture, color, donor scar, and there were no complication such as wound disruption, infection, flap atrophy, and hematoma. The advantages of forehead island flap are: 1) No injury of deep vessel and nerve, 2) control of shape and volume, 3) Short operation time, 4) primary closure of donor site, 5) one stage operation. Also, forehead island flap can cover the defect in nose where skin graft and local flap can not cover. But, operator always must take care for flap congestion and donor site scar. We thought forehead island flap is one of the best option of reconstruction of nasal tip defect.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.397-418
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• 1994

Microvascular surgery has been widely used in the clinical field of replantation and reconstructive surgery. Since the last 20 years, microsurgical techniques and instruments have been rapidly developed and the success rate is remarkably increased. But thrombotic occlusion of vessels remains the major reason for clinical failure. The change of vessel wall is the most important factor in thrombus formation. If we can reduce the traumatic changes in the vessel walls during surgery, the success rate can be markedly increased. For this study, femoral arteries and veins of 36 Sprague-Dawley rats with average weights of 300gm were used. The author observed the histological changes and healing process in the anastomostic site after 1 hour, 24 hours, 1, 2, 3 and 4 weeks under light microscopy and scanning electron microscopy. The results were as follows : 1. The patency rate was 100% in femoral arteries and 85% in femoral vein. 2. At the early stages after microvascular anastomosis, the loss of endothelial cell in the vessel walls was observed in the wide area including anastomotic site. In scanning electron microscopic finding the anastomotic site was covered with much fibrin, many red blood cells and some platelets. 3. At 1st week, new endothelial cells were formed toward anastomotic site and at 3rd week, the anastomotic site was completely covered by new endothelial cells. At 4th week, the complete endothelialization over the threads was observed. 4. The media extended from the anastomotic site toward the end of the specimen. At later stages, the extent of media necrosis was markedly decreased. But the media necrosis of anastomotic site was not regenerated till 4th week. 5. Intimal hyperplasia appeared at 1st week and increased till 4th week. The layer consisted of endothelialization the most luminal layers and smooth muscle in the deeper layers. But in veins, the response was less pronounced than in arteries. 6. Foreign body granuloma remained during 4 weeks and aneurysm was observed at 3rd week in artery. In aneurismal wall, media necrosis, loss of elastic lamina and intimal hyperplasia were seen.

• 대한소아치과학회지
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• 제45권2호
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• pp.250-256
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• 2018

치아의 완전 탈구는 치조골에서 치아가 완전히 이탈된 것으로 정의되며, 결과적으로 신경혈관 공급의 중단을 야기하는 가장 심각한 치과적 손상 중 하나로 알려져 있다. 완전 탈구는 조직 허혈(tissue ischemia)을 야기하며, 이는 치수 괴사를 초래할 수 있다. 치근단형성술(apexification)은 치수 괴사로 진단된 미성숙 영구치에서 치근단 장벽을 유도하는 전통적인 치료 방법이다. 하지만 치근단형성술로는 치근 길이 및 두께의 증가를 포함하는 치근 발육을 얻을 수 없다. 본 증례는 완전 탈구되어 재식된 이후 치수 괴사로 진단된 치아를 가진 5세 환자에서 ciprofloxacin, metronidazole, cefaclor 및 CollaTape과 Biodentine을 이용하여 시행된 치수재생치료(regenerative endodontic treatment)의 임상적 및 방사선학적 결과를 다루고 있다.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.46-49
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• 2010

Purpose: It has been reported that the ear perfusion can maintain by a very small pedicle because the ear has good vascularized system. Replantation of an amputated ear with vascular anastmosis, has been reported before and offers the succeessful reconstructive results. But, in this paper we report a case of complete nonmicrosurgical salvage of a nearly amputated ear based on 7 mm-wide small skin pedicle with adjunctive therapies. Methods: A 49-year-old man was referred with a nearly complete detachment of left ear. The blood supply to the ear was maintained exclusively on 7 mm-wide small skin pedicle in the lobule. After we identified the fresh bleeding at the distal margin of the detached ear, we performed the primary repair. At the end of the procedure, the areas of the concha bowl and helical root appeared to be congested. So the immediate postoperative treatment for improving the tissue survival was done with Lipo-Prostaglandin E1 (Eglandin$^{(R)}$) injection, leech apply and antibiotics medications. Results: Assessment of the replanted ear on postoperative day 14 revealed a nearly viable auricle including the helical root. The ear appeared to be entirely healed, with excellent projection and fully restored normal elasticity. Conclusion: We found the complete salvage of a nearly amputated ear based on 7 mm-wide small skin pedicle with adjunctive therapies including Lipo-Prostaglandin E1 (Eglandin$^{(R)}$) injection, leech apply and antibiotics without microsurgery.

• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.81-89
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• 1994

Firstly the wrap-around free flap from the great toe was transferred successfully by Morrison and O'Brien in 1980 for reconstruction in chronic case of amputated thumb distal to the MP joint. Since then, significant bone peg resorption and grafted bone fracture have been reported in most of cases after operation. We have performed thumb reconstructions within 2 weeks after injury in 11 cases which included acute crushing injuries or failed replantation of thumb at Guro Hospital from September, 1983 to October, 1993. The results obtained from this study are as follows: 1. There were 8 males and 3 females and the mean age was 28.8 years old ranged from 3 years old to 50 years old. 2. The most common injury mechanism was machinary injury in 10 of 11 cases. 3. We have performed thumb reconstructions by using wrap-around free flap from the great toe without bone graft in 6 cases and with bone graft in 5 cases within 2 weeks after injury. 4. During 6 years and 1 month mean follow-up period, there were bone resorptions in 3, grafted bone fracture in 1, infections in 2 and soft tissue necrosis in 3 cases. 5. We obtained satisfactable results in respect of function and cosmesis and urged to use this flap for reconstruction in acute thumb injury.

• 대한소아치과학회지
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• 제38권4호
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• pp.435-440
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• 2011

상악 견치의 매복은 소아치과 의사가 흔히 접할 수 있는 맹출장애이며, 이를 방치하였을 경우 인접치의 치근 흡수, 낭종 형성 등의 임상적인 문제점을 유발할 수 있다. 이에 대한 치료는 간단한 유치 발치에서부터 매복치아의 교정적 견인, 외과적 자가이식 등 다양한 방법을 고려할 수 있다. 이 중 자가 이식은 매복치아가 교정적 견인술을 시행하기 어려운 위치에 존재하거나 재위치 시키는데 실패했을 경우에 매복치아의 발거에 앞서 고려할 수 있으며, 그 예후는 치근의 완성도, 환자연령, 외과적 술식, 근관치료 시기, 치아고정 기간 등에 의해 결정된다. 본 두 증례들은 혼합치열기 말기에 상악 견치가 매복된 환자에서 그 매복 위치가 자발적인 맹출 유도나 교정적 견인 및 배열이 어렵다고 판단된 경우이며, 자가 이식 후 근관치료와 교정 치료를 시행하고 현재까지 성공적으로 유지되고 있어 보고하는 바이다.

• Restorative Dentistry and Endodontics
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• 제41권4호
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• pp.296-303
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• 2016

Objectives: The purpose of the present study was to evaluate the effects of proanthocyanidin (PAC), a crosslinking agent, on the physical properties of a collagen hydrogel and the behavior of human periodontal ligament cells (hPDLCs) cultured in the scaffold. Materials and Methods: Viability of hPDLCs treated with PAC was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The physical properties of PAC treated collagen hydrogel scaffold were evaluated by the measurement of setting time, surface roughness, and differential scanning calorimetry (DSC). The behavior of the hPDLCs in the collagen scaffold was evaluated by cell morphology observation and cell numbers counting. Results: The setting time of the collagen scaffold was shortened in the presence of PAC (p < 0.05). The surface roughness of the PAC-treated collagen was higher compared to the untreated control group (p < 0.05). The thermogram of the crosslinked collagen exhibited a higher endothermic peak compared to the uncrosslinked one. Cells in the PAC-treated collagen were observed to attach in closer proximity to one another with more cytoplasmic extensions compared to cells in the untreated control group. The number of cells cultured in the PAC-treated collagen scaffolds was significantly increased compared to the untreated control (p < 0.05). Conclusions: Our results showed that PAC enhanced the physical properties of the collagen scaffold. Furthermore, the proliferation of hPDLCs cultured in the collagen scaffold crosslinked with PAC was facilitated. Conclusively, the application of PAC to the collagen scaffold may be beneficial for engineering-based periodontal ligament regeneration in delayed replantation.

• 대한소아치과학회지
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• 제30권4호
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• pp.605-610
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• 2003

계승 영구치의 맹출시 상방에 위치한 유치의 치에서는 영구치와 근접한 치근첨에서부터 치근의 흡수가 일어나며 이를 생리적 치근 흡수라고 한다. 정상적인 영구치의 맹출과 관계없이 외상, 재식술, 교정치료, 치아의 지연 맹출, 불규칙적 맹출, 또는 종양이나 낭종의 성장 등과 관련되어 나타나는 치근의 흡수를 병적 치근 흡수라고 하며 생리적 치근 흡수와는 그 양상이 상이하고 다양하게 나타난다. 본 증례에서는 외상을 주소로 내원한 어린이를 대상으로 치근단 방사선 사진상에 나타나는 다양한 상악 유중절치의 병적 치근 흡수 양상을 관찰하여 다음과 같은 결과를 얻었다. 1. 외상성 손상을 받은 10개의 상악 유중절치에서 여러 가지 병적 치근 흡수 양상을 관찰하였다. 2. 병적 치근 흡수된 치아에서 치수절제술을 시행한 후에도 흡수는 지속적으로 진행되었다.

• 대한소아치과학회지
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• 제28권4호
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• pp.575-582
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• 2001

영구 전치부에 발생한 외상성 치은연하 파절과 자연 맹출을 기대하기 어려운 함입탈구가 발생한 경우에 여러 가지 치료방법이 알려져 있으나, 교정적 치아 정출술이 골수술을 동반한 치관길이 연장술이나 의도적 재식술에 비해 양호한 치료 성과를 나타내는 것으로 보고되고 있다. 본 증례는 외상으로 인해 치은연하로 치관파절을 보이는 환아들에서 근관치료와 함께 고정성 장치를 이용하여 치주수술을 동반한 교정적 치아 정출술을 시행한 후 복합레진 수복술로 치료하였다. 또한 치아함입이 있는 환아에서는 6개월 동안 자연 맹출을 기다린 후 맹출되지 않아 가철성 장치를 이용한 치아 정출술을 시행하여 치아를 원래의 위치로 회복시킬 수 있었는데, 이 환아의 경우 치료도중 실활의 증상을 보여 근첨성형술을 시행하였고 근첨이 형성된 후에는 근관충전을 통하여 비교적 양호한 임상적 결과를 얻을 수 있었다.

• Restorative Dentistry and Endodontics
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• 제43권2호
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• pp.16.1-16.9
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• 2018

Objectives: Understanding the reason for an unsuccessful non-surgical endodontic treatment outcome, as well as the complex anatomy of the root canal system, is very important. This study examined the cross-sectional root canal structure of mandibular first molars confirmed to have failed non-surgical root canal treatment using digital images obtained during intentional replantation surgery, as well as the causative factors of the failed conventional endodontic treatments. Materials and Methods: This study evaluated 115 mandibular first molars. Digital photographic images of the resected surface were taken at the apical 3 mm level and examined. The discolored dentin area around the root canal was investigated by measuring the total surface area, the treated areas as determined by the endodontic filling material, and the discolored dentin area. Results: Forty 2-rooted teeth showed discolored root dentin in both the mesial and distal roots. Compared to the original filled area, significant expansion of root dentin discoloration was observed. Moreover, the mesial roots were significantly more discolored than the distal roots. Of the 115 molars, 92 had 2 roots. Among the mesial roots of the 2-rooted teeth, 95.7% of the roots had 2 canals and 79.4% had partial/complete isthmuses and/or accessory canals. Conclusions: Dentin discoloration that was not visible on periapical radiographs and cone-beam computed tomography was frequently found in mandibular first molars that failed endodontic treatment. The complex anatomy of the mesial roots of the mandibular first molars is another reason for the failure of conventional endodontic treatment.