• 한국임상수의학회지
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• 제31권1호
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• pp.46-50
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• 2014

두개골에 종괴를 가진 7세 암컷 웰키코기가 내원하였다. 종괴는 다엽성 골종양으로 진단되었으며, 외과적으로 제거하었다. 종양 제거후 발생한 대형 골결손부를 치료하기 위해 3D 잉크젯 프린터로 제작한 커스텀 메이드 인공뼈를 결손부에 이식하였다. 이식후 4.3년동안 CT촬영을 통해 변화를 관찰하였다. 인공뼈는 관찰기간동안 주변 두개골과 성공적으로 유합되어 결손부를 수복하고 있었으며, 이식후 6개월부터 점차적인 인공뼈의 흡수상이 확인되었다. 커스텀 메이드 인공뼈가 대형 골결손부의 또 다른 치료방법으로서 사용될 수 있을 것이라 기대된다.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.469-472
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• 2010

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

• 한국임상수의학회지
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• 제26권1호
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• pp.109-112
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• 2009

약 3주령된 80 g의 암컷 치와와견이 두부 촉진 시 두개골이 확인되지 않으며, 어미젖을 먹을 시 이상을 보이고 성장 저하의 증상을 지닌 채 내원하였다. 신체 검사에서 입과 두부의 좌측 기울어짐과 좌측 안구 각막의 손상을 확인하였다. 방사선 검사에서 전두골과 두정골의 골음영이 관찰되지 않았으며, 초음파 검사에서 측뇌실의 확장을 관찰하였다. 컴퓨터단층촬영 검사를 통해 전두골과 두정골의 결손, 뇌실의 확장, 지주막 낭종을 확인하였다. 환자는 내원 익일에 폐사하였다. 부검에 의해 원발성 acalvaria로 확정 진단하였다.

• Journal of Korean Neurosurgical Society
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• 제52권6호
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• pp.541-546
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• 2012

Objective : The prefabrication of customized cranioplastic implants has been introduced to overcome the difficulties of intra-operative implant molding. The authors present a new technique, which consists of the prefabrication of implant molds using three-dimensional (3D) printers and polymethyl-methacrylate (PMMA) casting. Methods : A total of 16 patients with large skull defects (>100 $cm^2$) underwent cranioplasty between November 2009 and April 2011. For unilateral cranial defects, 3D images of the skull were obtained from preoperative axial 1-mm spiral computed tomography (CT) scans. The image of the implant was generated by a digital subtraction mirror-imaging process using the normal side of the cranium as a model. For bilateral cranial defects, precraniectomy routine spiral CT scan data were merged with postcraniectomy 3D CT images following a smoothing process. Prefabrication of the mold was performed by the 3D printer. Intraoperatively, the PMMA implant was created with the prefabricated mold, and fit into the cranial defect. Results : The median operation time was $184.36{\pm}26.07$ minutes. Postoperative CT scans showed excellent restoration of the symmetrical contours and curvature of the cranium in all cases. The median follow-up period was 23 months (range, 14-28 months). Postoperative infection was developed in one case (6.2%) who had an open wound defect previously. Conclusion : Customized cranioplasty PMMA implants using 3D printer may be a useful technique for the reconstruction of various cranial defects.

• Archives of Plastic Surgery
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• 제35권2호
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• pp.219-222
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• 2008

Purpose: The purpose of this study is to develop hydroxyapatite cement simplified procedures for reconstruction of craniofacial deformities. Due to its expense and characteristics of quick hardening time, it may be inappropriate for forehead reconstruction or augmentation. Therefore we hear by introduce a more precise, easy and cheap method. The authors report forehead reconstruction with hydroxyapatite cement for a patient who suffered from craniofacial deformity. Methods: Case report and literature review. Results: A 35 year old man came to us with forehead and temporal area depression. He had a history of brain operations due to traumatic epidural hematoma. A physical exam showed an evidence of right side forehead weakness sign. Authors made RP model of his skull and applied check framework with Kirschner's wires for measuring accurate volume and contour on the depressed right side forehead area on the RP model. After complete exposure of defect area by bicoronary insicion, absorbable plate which applied on skull area was removed. Using three Kirschner's wires, authors made check framework on the right forehead lively and fixed with 2-hole miniplates on the boundary of the defect. After checking asymmetry, hydroxyapatite was applied on check shape framework just above Kirschner's wire. After removing Kirschner's wire, we corrected minimal unbalance and contour with bur. Conclusion: Check framework with Kirschner's wire was very convenient and cost saving methods for forehead reconstruction with hydroxyapatite cement.

• 한국수정란이식학회지
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• 제32권1호
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• pp.33-38
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• 2017

A 10-day-old, Holstein calf with facial mass of 10 cm in diameter at the forehead region referred to Veterinary Medical Teaching Hospital in Chungnam National University. The mass was soft and fluctuating swelling. It had normal skin and hair hanging forward from frontal region and was thought to contain cerebrospinal fluid. On the skull radiography, cauliflower like-irregular marginated, soft tissue opacity mass was identified craniodorsal to the frontal bone. The mass appeared as a cyst filled with anechoic fluid on ultrasonography. Soft tissue structures considered brain tissues were observed in the deep area of the mass. On the computed tomography, a large skull defect of left side frontal bone was found, and heterogeneous materials were exposed through the defect but exposure of cerebral meninges and brain tissue were not confirmative. On magnetic resonance imaging, herniated left brain parenchyma showed heterogenous T2 and T1 hyperinsensity. In the intracranium, T2 hyperinstense and T1 hypointense fluid was identified on the left side, instead of left cerebral parenchyma. Also leftward shift of right hemisphere and midline structure, including thalamus and midbrain, were observed. The definitive diagnosis was confirmed as a meningoencephalocele based on computed tomography and magnetic resonance imaging. The calf was euthanized and necropsy was performed. On necropsy, both hemisphere were developed unequally with different size. One side hemisphere was grown in the outside through 10 cm hole on the median plane.

• 한국멀티미디어학회논문지
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• 제18권9호
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• pp.997-1007
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• 2015

In this paper, we propose a method for automatically analyzing the bone formation in a mouse model of frontal bone defect. We perforate two holes of 0.8mm diameter in the frontal bone and observe the bone formation process using a micro CT. Because the conventional analysis software of the micro CT does not support automatic analysis of the bone formation status, we have to use a manual analysis method. However the manual analysis is very cumbersome and requires a lot of time, we propose an automatic analysis method. It rotates the image around three axes directions so that the mouse's skull come into regular position. It calculates the cumulative image of the voxel values for the perforated bone surface. It estimates the hole location by finding the darkest point in the cumulative image. The proposed method was applied to 24 CT images of saline administration group and PTH administration group and hole location was estimated. BV/TV index was calculated for the estimated hole to evaluate the bone formation status. Experimental results showed that bone formation process is more active in PTH administration group. The method proposed in this paper could replace successfully the cumbersome and time consuming manual job.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.48-52
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• 2020

Composite skull defects in patients with severe head injuries are very challenging to manage. The dilemma when deciding whether to perform a definitive reconstruction is how long to wait for physiological recovery before an intervention complicates the situation. The inability of such patients to tolerate prolonged anesthetic exposure is a driving factor for performing the minimal intervention necessary to facilitate recovery. Herein, we present a case involving the successful immediate reconstructive treatment of a severely head-injured adolescent with a composite scalp defect secondary to trauma. A 14-year-old boy sustained a severe head injury from a motor vehicle accident with a composite scalp defect in the right fronto-parietal region. The frontal lobe was exposed, and the right eye was crushed and devitalized. The patient was deeply unconscious for 3 days, without any significant improvements before reconstructive surgery was proposed due to fear of possible meningitis resulting from the exposure of brain structures. We successfully managed the patient with a fronto-parieto-occipital flap, after which the patient promptly recovered consciousness.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권4호
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• pp.256-263
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• 2002

Using the rat's skull, the study on the biodegradability and guided bone regeneration of the chitosan membrane was performed. The results are as follows: 1. The biodegradability of the chitosan membrane could not be confirmed, but after 12 weeks, this membrane did not yet break into small pieces and there was no specific local tissue reaction. 2. It was not certain whether the pore size of this membrane was affected on osteoblastic activity. 3. After 6 weeks, the bony defect area of rat's skull was not completely filled, but on high magnification it showed that the osteoclasts and the osteoblasts were observed in the regenerating area. In conclusion, the chitosan membrane developed in this study was fit for guided bone regeneration.

• 한국주조공학회지
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• 제24권6호
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• pp.314-322
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• 2004

The CaO crucible is expected to serve as a useful tool for melting Ti and its alloys due to its thermodynamic stability. However, tjere still remain problems that need to be resolved in the melting of Ti and its alloys to enable commerical use. The cause of the defects of Ti-6AI-4V alloy castings melted in the CaO crucible were examined and compared with induction skull melting. The key factors of the melting technique using the CaO crucible, affecting the quality of Ti-6AI-4V alloy castings, were investigated. Defects of the Ti-6AI-4V alloy castings are caused by the chemical reduction of CaO by Ti. Pressurizing with argon gas in a vacuum induction chamber is effective for reducing the defects. Preheating of the charged material in the crucible and quick pouring into a mold of lower temperature, just after melting down, are important for produsing sound Ti-6AI-4V castings.