• Archives of Plastic Surgery
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• 제39권3호
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• pp.216-221
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• 2012

Background : Nipple-sparing mastectomy (NSM) is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel. Methods : Between June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared. Results : Thoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group. Conclusions : The thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.

• 대한치과기공학회지
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• 제39권1호
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• pp.17-24
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• 2017

Purpose: The purpose of this study was to evaluate the internal fitness of the resin coping that was fabricated by the traditional and Digital manufacturing methods through 3-dimensional analysis. Methods: maxillary right second molar was chosen implant master model. Custom-built impression trays were manufactured. After screwing the pick-up impression coping onto the master cast, impressions were made with silicone impression. The Working model was then made with type IV stone. The coping was fabricated: SLAC group (n=8), APPC group (n=8), LAPC group (n=8) Resin coping data was measured by using a three-dimensional evaluation program. Internal fitness was calculated by RMS (Root Mean Square).It measures mean and Standard Deviation (SD). Results: Three groups are measured $47.11{\pm}(3.08){\mu}m$ total RMS of SLAC group, $48.35({\pm}1.55{\mu}m)$ for total RMS of LAPC group, $43.45{\pm}2.09{\mu}m$ for total RMS of APPC group. Measured value is gradually increased. Followed by autopolymerized pattern resin; Stereolithography resin, Light-activated pattern resin But there were no differences stastically(P>0.321). Conclusion: Evaluation of internal fitness on Resin copings was fabricated by three-ways methods showed that no differences statistically significant and clinically acceptable results.

• 대한두개안면성형외과학회지
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• 제14권1호
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• pp.30-35
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• 2013

Background: For reconstruction of the mild to moderate medial orbital wall fractures, various surgical approaches have been used. Prior existing W-shaped incision was a direct local approach through a 3 cm incision on the superior medial orbital area with a titanium mesh implant. In this study, the authors modified W-shaped incision and reconstructed the defect with silastic sheet to improve the result and the postoperative scar. Methods: This study included 20 patients who had mild to moderate size of medial wall defect and therefore relatively suitable for reconstruction with silastic sheets from July, 2009 to December, 2011. A modified W-shaped skin incision approximately 1.2 to 1.5 cm in length was made along the superior medial orbital rim from approximately 1 cm medial to the medial canthus to the lower border of the medial eyebrow. The angles of the limbs of the W ranged from 150 to 160 degrees. Results: By using soft flexible silastic sheet, the authors reduced the incision from 3 to 1.5 cm, and by widening the angle of the W limbs, scars were more effectively hided in the relaxed skin tension line. Scar assessment was done with modified patient and observer scar assessment scale and mean score from patients was 2.08 and mean score from observers was 2.12. Conclusion: Although this method will not be suitable for every case, it can be a consistent method to obtain the surgical goal in treatment of mild to moderate blowout fractures of the medial orbital wall.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1992년도 춘계학술대회
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• pp.27-47
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• 1992

Engineers have developed new instruments that aid in diagnosis and therapy Ultrasonic imaging has provided a nondamaging method of imaging internal organs. A complex transducer emits ultrasonic waves at many angles and reconstructs a map of internal anatomy and also velocities of blood in vessels. Fast computed tomography permits reconstruction of the 3-dimensional anatomy and perfusion of the heart at 20-Hz rates. Positron emission tomography uses certain isotopes that produce positrons that react with electrons to simultaneously emit two gamma rays in opposite directions. It locates the region of origin by using a ring of discrete scintillation detectors, each in electronic coincidence with an opposing detector. In magnetic resonance imaging, the patient is placed in a very strong magnetic field. The precessing of the hydrogen atoms is perturbed by an interrogating field to yield two-dimensional images of soft tissue having exceptional clarity. As an alternative to radiology image processing, film archiving, and retrieval, picture archiving and communication systems (PACS) are being implemented. Images from computed radiography, magnetic resonance imaging (MRI), nuclear medicine, and ultrasound are digitized, transmitted, and stored in computers for retrieval at distributed work stations. In electrical impedance tomography, electrodes are placed around the thorax. 50-kHz current is injected between two electrodes and voltages are measured on all other electrodes. A computer processes the data to yield an image of the resistivity of a 2-dimensional slice of the thorax. During fetal monitoring, a corkscrew electrode is screwed into the fetal scalp to measure the fetal electrocardiogram. Correlations with uterine contractions yield information on the status of the fetus during delivery To measure cardiac output by thermodilution, cold saline is injected into the right atrium. A thermistor in the right pulmonary artery yields temperature measurements, from which we can calculate cardiac output. In impedance cardiography, we measure the changes in electrical impedance as the heart ejects blood into the arteries. Motion artifacts are large, so signal averaging is useful during monitoring. An intraarterial blood gas monitoring system permits monitoring in real time. Light is sent down optical fibers inserted into the radial artery, where it is absorbed by dyes, which reemit the light at a different wavelength. The emitted light travels up optical fibers where an external instrument determines O2, CO2, and pH. Therapeutic devices include the electrosurgical unit. A high-frequency electric arc is drawn between the knife and the tissue. The arc cuts and the heat coagulates, thus preventing blood loss. Hyperthermia has demonstrated antitumor effects in patients in whom all conventional modes of therapy have failed. Methods of raising tumor temperature include focused ultrasound, radio-frequency power through needles, or microwaves. When the heart stops pumping, we use the defibrillator to restore normal pumping. A brief, high-current pulse through the heart synchronizes all cardiac fibers to restore normal rhythm. When the cardiac rhythm is too slow, we implant the cardiac pacemaker. An electrode within the heart stimulates the cardiac muscle to contract at the normal rate. When the cardiac valves are narrowed or leak, we implant an artificial valve. Silicone rubber and Teflon are used for biocompatibility. Artificial hearts powered by pneumatic hoses have been implanted in humans. However, the quality of life gradually degrades, and death ensues. When kidney stones develop, lithotripsy is used. A spark creates a pressure wave, which is focused on the stone and fragments it. The pieces pass out normally. When kidneys fail, the blood is cleansed during hemodialysis. Urea passes through a porous membrane to a dialysate bath to lower its concentration in the blood. The blind are able to read by scanning the Optacon with their fingertips. A camera scans letters and converts them to an array of vibrating pins. The deaf are able to hear using a cochlear implant. A microphone detects sound and divides it into frequency bands. 22 electrodes within the cochlea stimulate the acoustic the acoustic nerve to provide sound patterns. For those who have lost muscle function in the limbs, researchers are implanting electrodes to stimulate the muscle. Sensors in the legs and arms feed back signals to a computer that coordinates the stimulators to provide limb motion. For those with high spinal cord injury, a puff and sip switch can control a computer and permit the disabled person operate the computer and communicate with the outside world.

• Journal of Periodontal and Implant Science
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• 제26권1호
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• pp.47-67
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• 1996

The purpose of this study was to observe the effect of $Biocoral^R$ graft and bioglass 45S5 graft in combination with ePTFE membrane in periodontal osseous defects for new bone formation. Nine healthy dogs were used. Under general anesthesia, 3-wall defects were created on the mesial and distal surfaces of the maxillary right canines, the mesials of the maxillary right second premolars, the distals of the mandibular right canines and the mesials of the mandibular right third premolars. To induce periodontitis, a silicone rubber, $Provil^R$ light body, was injected under pressure into the defects. Ninety days later, $Provil^R$was removed and followed by thorough root planing. The followings were then applied in the mesial and distal defects of the maxillary right canines, the mesials of the maxillary right second premolars, the distals of the mandibular right canines and the mesials of the mandibular right third premolars by random selections : 1) ePTFE membrane only application, 2) $Biocoral^R$ graft, 3) $Biocoral^R$ graft and ePTFE membrane application, 4)Bioglass 45S5 graft, 5) Bioglass 45S5 graft and ePTFE membrane application. The membranes were removed 1 month later. The dogs were sacrified at 1, 2 and 3 months following the graft, and block sections were made, demineralized, embedded, stained and examined by light microscope and transmission electron microscope. On the sections from teeth treated with ePTFE membrane only, the defect demonstrated extensive connnective tissue and alveolar bone regeneration. The $Biocoral^R$ graft group demonstrated extensive bone regeneration compared with ePTFE membrane only group. In the $Biocoral^R$ graft plus ePTFE membrane group, regeneration of new alveolus and crest occurred within the defect. As the experimental period lengthened, bone regeneration was increased and bone bridge was formed among the graft particles. The but bioglass 45S5 graft group demonstrated extensive bone regeneration but the amount of new bone was less than that of the $Biocoral^R$ graft group. For the bioglass 45S5 graft plus ePTFE membrane group, the amount of new bone was also increased. As the experimental period lengthened, bone regeneration was increased. Multinucleated giant cells, fibroblasts and macrophages were observed. As the bone formation was increased, the number of such cells was decreased. In conclusion, the $Biocoral^R$ was found better than the bioglass 45S5 for new bone formation, and the use of ePTFE membrane alone or with $Biocoral^R$/bioglass 45S5 can be supported as potential methods of promoting bone formation.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.437-444
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• 2009

Purpose: Transgender is a disorder of gender identity, who have appropriate chromosomal, hormonal and anatomical characteristics corresponding to their sexual phenotype but feel strongly with respect to their sexual identity, that they belong to the opposite sex. There is a persistence discomfort and sense of inappropriateness about one's assigned sex in a person who has reached puberty. Transgender is a psychiatric problem, but surgical method provides more satisfactory adjustment for patients. In gender reassignment surgery for female to male transgender, mastectomy, nipple reduction, hysterectomy, oophorectomy and phalloplasty are included. And as the final operation, recommended for scrotoplasty and artificial testes insertion. So we investigated the necessity and method of scrotoplasty in the final operation of female to male transgender. Method: The authors have long term follow-up of 75 cases female to male transgender during January, 1991 to February, 2008. Among them, 13 cases were evaluated in this study. During phalloplasty, the labium major skin preserved. And this labium majoral skin flap was made for the neoscrotum. At least six months later, artificial testes were inserted in neoscrotum with local anesthesia. Middle sized (3 cm diameter) artificial testes(silicon gel or carving soft silicone implant) were used because of the limitation of the neoscrotum. We evaluated the questionnaire and interview about the postoperative satisfaction in configuration of reconstructed scrotum, and the necessity of operation, the postoperative psychosocioeconomic improvement and limitation of body exposure activities such as swimming, public bathing. Results: Based on this study, satisfaction of reconstructed scrotum after scrotoplasty was improved(92%). The necessity of scrotoplasty was in 92.3% and the postoperative psychosocioeconomic well - being improvement was 77% in answers. Less limitation of activities requiring body exposure was 54% in answers. Most of the patients were satisfied with the results of surgical operation inspite of the operative procedure had some postoperative complications. Conclusion: This study was reported that the scrotoplasty in female to male transgender is not only a conversion of external genitalia but also an improvement of psychosocial state. Most patients sincerely hope to this operation, so we improve our surgical method for more good results.

• 한국재료학회지
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• 제14권12호
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• pp.893-899
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• 2004

Even though Ti-6Al-4V has gained popularity as an implant material, the possible dissolution of Al and V ions in body fluids remains a matter of concern. Though commercially pure Ti (Cp-Ti) overcomes this problem, the mechanical strength of pure titanium remains very low. Thus, in this experiment Cp-Ti was processed by Equal channel angular processing (ECAP), in order to increase the mechanical strength. The biocompatibility of ECAP-Ti, Cp-Ti and Ti-6Al-4V was examined by the apatite formation on each sample surface, after treating the surface with 5M NaOH and soaking in Simulated body fluids (SBF). Initially, the samples were mechanically polished on silicone carbide paper (#2000). The polished samples were treated with 5M NaOH solution at $60^{\circ}C$ for 24 hours. The NaOH treated samples were washed gently with distill water and dried at $40^{\circ}C$ for 1 day. The dried samples were heat treated in air at $600^{\circ}C$ for 1 hour. The surface morphology of these samples were studied using SEM and XRD. The SEM studies showed network of pores in all samples. The XRD showed oxide layer formation on Cp-Ti and Ti-6Al-4V. samples. However the oxide layer in ECAP-Ti was not substantial. These samples were immersed in SBF, kept at $36.5^{\circ}C$ for seven days period. At the end of 7 days, the apatite formation was confirmed only on Cp-Ti and was not observed in Ti-6Al-4V and ECAP-Ti. These observations of apatite formation relate to the fact that Cp-Ti showed greater oxide layer than other samples. The apatite examined was confirmed as tricalcium phosphate (TCP) using EDS and XRD.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.623-628
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• 2009

Purpose: In cases where nasal fractures involve frontal process of maxilla or perpendicular plate of ethmoid, 4 - 5 days of nasal packing may not provide sufficient support for avoiding displacement after packing removal. Therefore a single Kirschner - wire(K - wire) is used as an internal splint when nasal fractures involve the above two areas. Methods: Thirty five patients during the last 3 practical years were treated with a K -wire pinning according to the anatomic locations of nasal fractures. We performed a retrospective study using 13 nasal fractures out of total 35 patients. Among 13 cases, 10 patients involved frontal process of maxilla, and 3 patients were diagnosed as bilateral nasal side wall fractures accompanied with fractures of perpendicular plate of ethmoid. One patient of the last three cases had been augmented with dorsal silicone implant long before the trauma. We analyzed the anteroposterior displacement of key stone area and the width between both lateral walls by comparing immediate postoperative radiographs with 2 month follow - ups. To reduce the errors, the same measurements were taken by two different inspectors, and the mean of each inspector's measurements was compared. Patient satisfaction was analyzed using a questionnaire regarding the esthetic and functional outcomes. Results: Ten patients underwent a longitudinal K - wire fixation in submucoperiosteal plane underneath the frontal process of maxilla. And three patients underwent a transverse K - wire fixation from the one side of lateral wall to the perpendicular plate of ethmoid and to the other side of lateral wall. The mean postoperative anteroposterior displacement of the key stone area measured by two inspectors were 1.84% and 3.06%; mean narrowing of bony pyramid were 1.33% and 1.48%, respectively. Subjective satisfaction scores regarding the esthetic appearance and the maintenance of nasal shape compared with immediate post - operative state with the long term ones were not different (p>0.05). Conclusion: K - wire pinning after closed reduction is a reliable and useful method for the treatment of nasal fractures involving frontal process of maxilla or perpendicular plate of ethmoid. This is because it achieves longer intranasal support after reduction. This method also leaves conspicuous external scar, and minimal soft - tissue injury.