• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.21.1-21.6
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• 2020

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

• 대한치과교정학회지
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• 제27권5호
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• pp.683-696
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• 1997

성체의 상처 치유과정중 반흔조직 형성에 수종의 성장인자가 관련이 있는 것으로 보고되고 있으나, 태자의 피부상처가 반흔형성없이 치유되는 기전에 관한 성장인자의 역할은 아직 알려져 있지 않다. 따라서 본 연구의 목적은 토끼태자의 상처 치유과정에서 반흔조직의 형성과 관련이 있는 수종 성장인자의 분포를 조사하기 위한 것이다. 뉴질랜드산 흰 토끼를 임신 3기의 중반인 24일째에 자궁절개술을 시행하고 태자에 인위적으로 구순열상을 만든 후, 봉합한 군(봉합군)과 봉합하지 않은 군(비봉합군), 정상대조군(sham operated control group)으로 나누고 이들을 각각 수술후 1, 2, 3, 5, 7일째에 희생시켜 상처치유에 대한 육안관찰 소견과 H & E 염색 소견 및 $TGF-{\beta}1,\;TGF-{\beta}2$, PDGF, bFGF의 면역조직화학적 염색 소견을 관찰하여 다음과 같은 결론을 얻었다. 1. 봉합군과 비봉합군에서 전기간동안 염증반응과 반흔조직의 형성 그리고 신생 혈관의 형성 증가는 없었다. 2. 비봉합군의 재상피화가 봉합군에 비해 다소 느렸다. 3. bFGF는 정상대조군, 봉합군과 비봉합군에서 차이가 없었다. 4. PDGF는 봉합군과 비봉합군에서 1, 2일군에서 증가하였다가 그후 감소하여 정상대조군과 차이가 없었다. 5. $TGF-{\beta}$는 봉합군과 비봉합군에서 1, 2일군에서 약간 증가하였다가 그후 감소하여 정상대조군과 차이가 없었다. $TGF-{\beta}1$에 비하여 $TGF-{\beta}2$의 검출양이 많았다.

• 대한관절경학회지
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• 제5권1호
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• pp.13-16
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• 2001

목적 : 전방십자인대 재건술후 시행한2차 관절경 소견을 통하여 이식건 주위의 반흔 조직의 형태와 그 의미를 알아보고자 하였다. 대상 및 방법 : 1997년 11월부터 1999년 6월 사이에 본원에서 전방십자인대 재건술을 받고 2차 관절경 검사를 시행한 환자중 임상적 증상이 없는 14명 15예를 대상으로 하였다. 이학적 검사 및 단순 측면 방사선 검사 상 터널의 위치를 측정하였는데 경골 터널은 경골 고평부 전-후방 길이에서 터널 위치를 백분율로 표시하였고 대퇴골 터널은 Blumensaal선 전-후방 길이에서 터널 위치를 백분율로 표시하였다. 2차 관절경 검사에서 이식건 주위의 변화를 관찰하였다. 결과 : 단순 방사선 측면 사진 상 경골 터널의 위치는 $27\%$에서 $58\%$로 평균 $41\%$였으며 대퇴 골 터널의 위치는 $58\%$에서 $83\%$로 평균 $76\%$로 모든 예에서 이상적으로 위치하였으며 관절경 소견상 모든 예에서 이식건 감입 현상은 없었으며 3예를 제외한 대부분의 예에서 대퇴과간 절흔과 이식건 사이 혹은 이식건 주위에 섬유성 반흔 조직 형성을 하였는데 그 형태로는 세동성 섬유(fibrillated fiber)가 6예, 섬유성 결절(fibrous nodule)이 5예, 섬유성 띠 (fibrous band)가 1예 있었다. 결론 : 전방십자인대 재건술후 이식건의 감입 현상 없어도 이식건 주위에 섬유조직의 형성이 다양하게 나타날 수 있다.

• 한국진공학회지
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• 제7권1호
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• pp.59-65
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• 1998

13.56MHz를 사용하는 r.f.PACVD(Plasma assisted chemical vapor deposition)방법 으로 다층 다이아몬드상 카본(DLC)필름을 Si wafer기판 위에 합성하였다. 다층 DLC필름은 2.5$\mu$m두께의 순수한 DLC필름과 0.2$\mu$m두께의 Si이 함유된 Si-DLC필름으로 구성되었으 며, ball on disk type의 tribometer를 이용하여 대기 중에서 다층 DLC필름의 마모거동을 고 찰하였다. 표면층으로 합성된 Si-DLC필름내의 Si함량이 증가함에 따라 다층 DLC필름과 AISI52100 steel ball 사이에 0.1 이하의 낮은 마찰계수를 유지하는 기간이 증가하였다. 44,000cycle과 158,400cycle의 마모실험 후 측정된 다층 DLC필름의 마모율은 각각 $2.5\times10^{-8}\sim1.8\times10^{-7}\textrm{mm}^3$/rev.과 $7.1\times10^{-9}\sim1.8\times10^{-8}\textrm{mm}^3$/rev.로 나타났다. 158,400cycle의 마모실험 후 측정된 마모율은 내마모 특성이 우수한 DLC필름보다도 2배 정도 우수한 것으로 나타났 다. 마모시험에 의해 형성된 debris의 조성을 분석한 결과, 이런 낮은 마찰계수와 우수한 내 마모 특성은 steel ball의 wear 표면을 덮고 있는 Si oxide debris층의 형성에 따른 결과로 판단되었다. 또한, 이러한 steel ball의 wear scar표면에 형성된 debris층을 제거하여도, 새로 운 Si oxide debris층이 wear scar표면에 다시 생성되어 낮은 마찰계수를 유지하고 있었다.

• 대한치과교정학회지
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• 제28권1호
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• pp.1-15
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• 1998

태아와 성체의 상처치유과정에서 다른 점으로는 태아 상처가 염증반응과 반흔조직의 생성이 없이 신속히 치유됨을 들 수 있다. 태자상처의 비반흔성 치유와 세포외기질의 역할을 연관지어 해석하려는 노력이 진행중에 있으나, 각 실험 동물종간의 차이 및 세포외기질 구성요소의 다양성등 많은 변수가 아직 미결의 과제로 남아 있다. 본 연구의 목적은 토끼 태자의 상처 치유과정에서 반흔조직의 형성과 관련이 있는 세포외기질의 주요성분인 교원질 I, III, IV, V형, fibronectin, laminin의 시기적 출현 및 분포양상을 조사하기 위한 것이다. 뉴질랜드산 횐 토끼를 임신 3기의 중반인 24일째에 자궁절개술을 시행하고 태자에 인위적으로 구순열상을 만든 후, 봉합한 군(봉합군)과 봉합하지 않은 군(비봉합군), 정상대조군(sham operation group)으로 나누고 이들을 각각 수술후 1, 2, 3, 5, 7일째에 희생시켜 상처치유에 대한 육안관찰 소견과 H & E 염색 소견 및 교원질 I, III, IV, V형, fibronectin, laminin의 면역조직화학적 염색 소견을 관찰하여 다음과 같은 결론을 얻었다. 1. 봉합군과 비봉합군에서 전기간동안 염증반응은 없었다. 2. 비봉합군의 재상피화가 봉합군에 비해 다소 느렸다. 3. 교원질 I, III, V형은 봉합군과 비봉합군에서 2일군까지는 발견되지 않았고 3일군이후 존재하였으나 염색정도가 인접정상조직이나 정상대조군에 비하여 증가하지 않았다. 4. 상피 기저막에서 교원질 IV형의 염색소견은 봉합군과 비봉합군에서 3일군이 다소 증가하였으나 그후 감소하여 인접정상조직이나 정상대조군과 차이가 없었고, laminin의 염색 소견은 봉합군과 비봉합군에서 5일군이후 발견되었고 염색정도의 증감없이 7일군까지 유지되었고 인접정상조직이나 정상대조군과 차이가 없었다. 5. 혈관내피세포 기저막에서 laminin과 교원질 IV형의 염색소견은 인접정상조직이나 정상대조군에 비해서 증가하지 않았다. 6. Fibronectin은 봉합군과 비봉합군에서 fibrin clot과 창상 기저부 및 창상연을 따라 3일군까지 염색소견이 증가하였다가 그후 감소하여 인접정상조직이나 정상대조군과 차이가 없었다.

• 대한후두음성언어의학회지
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• 제20권1호
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• pp.36-41
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• 2009

Background and Objectives: Topical administration of mitomycin-C (MMC) has been reported to reduce or delay scar formation in airway surgery. However, it is not infrequent to experience recurrent stenosis or adhesion of operative wound even after a meticulous MMC application during the laryngeal surgery. Therefore we aimed to evaluate the effectiveness of repeated postoperative MMC applications and the technical feasibility of MMC applications to the laryngeal wound at an outpatient clinic. Methods: We reviewed medical records of 13 consecutive patients who received office-based MMC applications after laryngeal airway surgery at Samsung Medical Center, Seoul, Korea. The patients were grouped into 3 categories according to the site of surgical wound and the purpose of MMC application; group I : supraglottic stenosis (n=5), group II : cordectomy and arytenoidectomy site granulation prevention (n=3), Group III : laryngeal web prevention (n=5). Outcomes in each group and adverse effects of repeated MMC applications were evaluated. Results: Office-based MMC application was successfully performed one to four times with a week interval for each patient. No significant complications were observed except slightly decreased mucosal wave in one female patient who received 4 times of MMC application at the anterior commissure of vocal fold. Repeated MMC applications at the outpatient clinic resulted in wide or acceptable supraglottic airway in group I, clean wound healing without granulation formation in group II, and negligible or no web formation at the anterior commissure in group III. Conclusion : Office-based topical administration of MMC to the larynx was technically feasible. Postoperative repeated MMC applications were effective to reduce recurrent stenosis or adhesion of supraglottic structures, to prevent granuloma formation after laser arytenoidectomy and glottic web formation after anterior commissure resection.

• 대한본초학회지
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• 제36권5호
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• pp.29-36
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• 2021

Objectives : The purpose of this study was to fix the synonyms, origin, formation mechanism, description, and efficacy of Hwangnapchim in Elucidation of Materia Medica. Methods : Through searching histories and herbal classics, We categorized the contents, and compared with Aquilariae Lignum Resinatum. Results : The synonyms of Hwangnapchim were classified by 3 categories : Napchimhyang-type, Ganamhyang-type and Ginamhyang-type. In early period, it was called by Napchimhyang-type, named after its description that was similar to beeswax. Afterward it was called by Ganamhyang-type or Ginamhyang-type, because of the name "Kynam" that was called by in its producing region. And there were records of producing region of Vietnam, Cambodia, and being from abroad, while those of Vietnam were most frequent. According to custom duties of Ming Dynasty, Hwangnapchim was 17.5 times as expensive as Agarwood. Hwangnapchim shared main producing region, original plant, and process of formation with Agarwood. Therefore, its original plant was Aquilaria crassna, but added honey during formation process. Hwangnapchim was classified 5 types according to its description, the highest quality was Yu-gyeol, resembled beeswax, and easily recovered if get a scar. Hwangnapchim had a fragrance at room temperature, a spicy flavor, and the efficacy of blocking urine and feces. Conclusions : These results showed that Vietnam was major producing area of Hwangnapchim, and that it shared same origin with Agarwood, but it had different description, efficacy, and higher prices because of being added honey during formation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제25권4호
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• pp.350-355
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• 1999

Purpose : The purpose of this study was 1) to find nerve damage after inferior alveolar nerve transposition and 2) to examine whether the soft tissue or bone changes around the nerve produce the compression to the nerve in the healing period. Materials and Method : Inferior alveolar nerve was exposed through the bony window and the scratch was made in the bone to be thought as the inferior alveolar canal. Suture was made after the nerve was repositioned. The nerve and surrounding tissues were examined with the light microscope and the fluorescent microscope before surgery and at 1 month, 3 months, and 5 months after surgery. Results : After surgery, the epineurium was damaged and the nerve was divided to several fascicles covered with the perineurium The newly formed fibrous connective tissue and vessels were seen around fascicles. There was new bone formation. However the nerve was not compressed by the connective tissue or the new bone. Conclusion : The results of this study suggest that neurosensory disturbances after inferior alveolar nerve transposition are resulted by the direct trauma in surgery rather than the compression to the nerve by the scar or new bone formation in the healing period.

• 대한두개안면성형외과학회지
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• 제11권1호
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• pp.19-22
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• 2010

The author presents a new method for the formation of Cupid's bow and the vermilion tubercle by using the inferior-based lip skin flap in a secondary bilateral cleft lip deformity. The length of the flap includes the entire length of the previous upper lip scar. Both skin flaps are elevated and turned down toward the central part of the vermilion. The distant portion of the turned-down skin flaps are deepithelialized and trimmed according to the new shape of Cupid's bow. The deepithelialized portions of both flaps are buried under the central vermilion mucosa in order to create the vermilion tubercle. The advantages of the proposed procedure are; provision of a more natural shape of Cupid's bow, the lip length is increased, and the vermilion tubercle can be reconstructed at the same time. Therefore, this technique is best suited for a case of a bilateral absence of Cupid's bow combined with a short lip in a sufficient upper lip of a bilateral cleft lip deformity. The proposed procedure, however, should be avoided in the tight upper lip because of a great deal of tension on the donor.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.569-573
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• 2007

Purpose: The selection of the recipient vessels in breast reconstruction has a great influence on the surgical result and the shape of the reconstructed breast. We would like to introduce the criteria for the selection of recipient vessels in delayed reconstruction of the breast. Methods: We studied 56 patients with delayed breast reconstruction using free TRAM flaps from April 1994 to December 2006. The thoracodorsal and the ipsilateral internal mammary vessels were used as recipients in 25 patients each, the opposite internal mammary vessels in 3 patients, the thoracoacromial vessels in 2 patients, and the transverse cervical artery with the cephalic vein in 1 patient. The survival rate of the flaps, the vessel diameter, the length of the pedicles, and the convenience of vessel dissection were studied. Results: The diameter of the recipient vessel did not influence the anastomosis. The operation time, the survival rate of flap, the postoperative complications showed no significant difference according to the recipient vessel. Dissection of the thoracodorsal vessels was tedious due to scar formation from the prior operation. Dissection of the internal mammary vessels proved to be relatively easy, and the required length of the pedicle was shorter than any other site, but the need for removal of rib cartilage makes this procedure inconvenient. Conclusion: The first choice of the recipient vessel in immediate breast reconstruction is the thoracodorsal vessels, but in cases of delayed reconstruction the internal mammary vessels are favored as the first choice, because the thoracodorsal vessels have a high unusability rate. If the ipsilateral internal mammary vessels prove to be useless, the contralateral vessels can be used. The thoracoacromial vessels are useful, when the mastectomy scar is located in the upper portion. The transverse cervical artery and the cephalic vein can serve as the last resort, if all other vessels are unreliable.