• Archives of Plastic Surgery
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• 제44권5호
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• pp.420-427
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• 2017

Background It can be difficult to select an appropriate flap for various defects on the hand. Although defects of the hand usually must be covered with a skin flap, some defects require a flap with rich blood supply and adequate additive soft tissue volume. The authors present their experience with the anconeus muscle free flap in the reconstruction of various defects and the release of scar contractures of the hand. Methods Ten patients underwent reconstruction of the finger or release of the first web space using the anconeus muscle free flap from May 1998 to October 2013. Adequate bed preparations with thorough debridement or contracture release were performed. The entire anconeus muscle, located at the elbow superficially, was harvested, with the posterior recurrent interosseous artery as a pedicle. The defects were covered with a uniformly trimmed anconeus muscle free flap. Additional debulking of the flap and skin coverage using a split-thickness skin graft were performed 3 weeks after the first operation. Results The average flap size was $18.7cm^2$ (range, $13.5-30cm^2$). All flaps survived without significant complications. Vein grafts for overcoming a short pedicle were necessary in 4 cases. Conclusions The anconeus muscle free flap can be considered a reliable reconstructive option for small defects on the hand or contracture release of the web space, because it has relatively consistent anatomy, provides robust blood supply within the same operative field, and leads to no functional loss at the donor site.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.66-74
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• 2009

Purpose: The importance of the deformities in alar - columellar complex has been underestimated in Asian ethnic groups for the last decades. Fortunately, with increasing familiarity of the open rhinoplasty techniques, the anatomic details of the nasal tip have been pointed up. Definitely, having an interest and demand for improving the sub - normal relationship between the alar rim and columella are indebted for such growing of knowledge about nasal tip anatomy. However, it is true that any single procedure is not settled as versatile and fully confident modality to correct the retracted notching of the alar rim. With this article, I should like to propose another useful option for treating retracted ala. Methods: The author has tried to correct alar rim retraction by means of: (1) Triangular onlay septal cartilage graft on the lower lateral cartilage with the medial end fixed to the anterior surface of the lateral crus(Alar extension graft), (2) Inserting lateral end of the alar extension graft to the vestibular skin pocket in the form of a finger - in - groove, (3) using the vestibular skin in the form of an advancement flap, and (4) using the soft shield graft to prevent possible visible step - off of the alar margin. Results: The author applied an alar extension graft to 16 patients in order to correct a retracted ala for the last 27 months (August, 2003 - October, 2005). The distances from alar rim to long axis of nostril were improved to be within 2 mm in all of the cases, and also the shape of the alar rim changed to a round form. Nostril asymmetry (6%) in one case, temporary palpable step - off (18%) in three cases, temporary visible step - off (6%) in one case, and temporary paresthesia of the tip (25%) in four cases were observed. Conclusion: The alar extension graft is simple and efficacious. It does not need donor sites other than the operative field, and its results are predictable. In particular, since it may give structural intensity to a weak lower lateral cartilage, it may be preferentially used for the correction of a retracted ala that arises from hypoplastic lower lateral cartilage. Moreover intensified lower lateral cartilage also improves the esthetic shape of lobule.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.238-243
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• 2013

Background Primary malignant tumors of the hand, although unusual, may present varied and often complex clinical problems. The main treatment modality of skin cancer of the hand has changed. Methods We retrospectively reviewed the medical records of 43 patients who underwent surgery for malignant skin tumors of the hand during an 18-year period, from September 1994 to February 2012. The characteristics of the tumor, methods of reconstruction, and long-term results were reviewed. Results We had 43 patients with 27 melanomas, 14 squamous cell carcinomas, and 2 sarcomas. Their ages ranged from 19 to 74 years (mean, $53.4{\pm}14.5$ years), from 46 to 79 years (mean, $59.7{\pm}9.6$ years), and from 15 to 43 years (mean, $29{\pm}19.8$ years), respectively. Thirty-four cases occurred on the fingertip (16 of those cases on the thumb), 5 cases occurred on the palm, and 4 cases on the dorsum of the hand. Amputation was most frequently used in early cases, but recently, tissue-sparing excision has been performed frequently. The incidence of local recurrence was 3 cases and distant metastasis was 1 case, and the 5-year survival rate was 100%, except in 4 cases due to follow-up loss. Conclusions The principles of treatment-to be curative and to preserve function and appearance-are important points. "Preservative surgery" preserves function and cosmesis of the involved finger or hand dorsum or palm. Preservative surgery not only emphasizes less resection and surgery of a smaller scale, but also optimal reconstruction of the soft tissue defect of the digit.

• Archives of Plastic Surgery
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• 제45권1호
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• pp.62-68
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• 2018

Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated $90^{\circ}$ cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes.

• 대한골관절종양학회지
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• 제9권1호
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• pp.52-60
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• 2003

목적: 건초에서 발생하는 거대 세포종(황색종)은 수부에서 발생하는 양성 연부조직 종양중 낭종 다음으로 흔하며, 수술 절제후, 간혹 재발 되기도 한다. 대부분 단발성으로 발생하나 가족성 고콜레스테롤혈증 환자에서는 다발성이며 대칭적 발생을 보인다. 저자들은 수부 건초에서 발생한 거대세포종의 임상적 특성과 수술 절제후 장기 추적 결과를 분석하였고, 특히 단발성 및 다발성 거대세포종 환자의 특성을 비교하였다. 대상 및 방법: 1995년부터 2002년까지 만 8년간 본 병원에서 수술 가료후 건초의 거대세포 종으로 확진된 총 21예(다발성 3예 포함)를 대상으로 임상 및 X-선상 분석을 하였으며, 수술 절제후 평균 16개월(3~46개월) 추적하여 재발여부 및 단발성과 다발성 거대세포종의 임상 과정을 비교 하였다. 결과: 총 21예중 14예(66.7%)가 여자였으며 40대에서 16예(76.2%)로 빈발하였고 평균 연령은 47세(19~68세)였다. 단발성 거대세포종 18예중 수지별 발생은 인지와 환지가 각4예씩, 소지(3예), 중지(2예) 및 모지(1예)의 순이었고, 수장부의 발생이 4예였다. 원위 및 중위 지골 부위가 9예(50%), 근위 지골 부위가 4예, 중수지골 및 중수지절 부위가 2예였다. 신전건(7예)보다 굴곡건(11예) 건초 이환이 더 많았고(양측 건이환 3예), 증상 발현에서 수술까지의 지연은 평균 14개월(3~48개월)이였다. 다발성 거대세포종 3예중 1예는 인지와 중지의 중위지골 부위에 발생하였고, 2예는 고콜레스테롤혈증을 동반한 20대 남자들에서 대칭적 거대세포종이 수부를 포함하여 22곳 및 12곳등 다발적 이환을 보였고, 외형상의 돌출로 보기 흉하거나 기능 제한을 초래하는 부위만 선택적으로 아전절제하였다. X-선상 연부조직 음영 증가외 4예에서 종괴의 압박에 따른 피질골 미란과 파열소견을 보였다. 수술시 3예에서 수지 신전건과 굴곡건의 양측 건초를 모두 침범하는 넓고 큰 다엽상 소견을 보였으며, 평균 16개월 추적중, 총 18예중 3예에서 재발(16.7%)하였다. 이들 재발예는 단발성 거대세포종중 굴곡건과 신전건 건초를 광범위하게 다엽상 이환을 하였거나 술전 X-선상 골피질의 파열이나 골미란등이 있어 불완전 절제를 시행한 경우들이었으며, 재 광범위 절제 하였고 추적 관찰 중이다. 단발성 및 다발성 거대세포종은 종괴의 병리 조직학상 유사함을 제외하면, 발생 기전이나 침범 부위와 정도, 동반 질환은 물론 치료와 예후에도 차이가 많아 서로 다른 질환으로 판단된다. 결론: 수부의 건초에서 발생하는 거대세포종(황색종)은 드물지 않은 종양으로 완전 절제가 필수적이며, 특히 가족성 고콜레스테롤혈증 환자에서는 다발성 건 황색종을 동반 할수 있어 치료에 유의해야 한다.

• 분석과학
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• 제23권1호
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• pp.89-96
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• 2010

사건현장 증거물에 존재하는 지문으로는 혈액, 페인트, 잉크와 같이 색을 보유한 물질에 접촉한 후 증거물에 유류되어 육안확인이 가능한 현재지문(visible fingerprint)과 비누, 왁스와 같은 부드러운 증거물에 압착 유류되어지는 압착지문(plastic fingerprint), 땀성분이나 생활속에서 유지류(oil)등에 오염되어 육안확인이 어려운 잠재지문(latent fingerprint)형태로 존재한다. 그 중 유지문(oil-contaminated fingerprint)은 식용유(soybean oil), 자동차 엔진오일(engine oil)을 비롯한 공업용 윤활유인 합성윤활유 및 산업현장 기계류에 사용되는 그리스와 같은 유지류에 의해 오염된 지문이 증거물에 유류되어 육안으로 식별하기 어려운 지문이며 이의 현출법에 대한 표준화 현출법은 미비하다. 이에 본 연구는 사건현장에서의 다빈도 채택증거물인 유리, 플라스틱, 알루미늄 대상물질에 식용유, 총기윤활유(LSA), 엔진오일로 오염된 유지문을 ultraviolet 광원을 이용한 광학적인 방법과 분말법 및 화학적 현출법으로 현출하기전 동결전처리법을 시도하고 분말법, cyanoacrylate (CA) fuming법, 형광발색법을 이용한 연속적 재처리법을 이용하여 최적 현출법을 제시하고자 하였다.

• 대한소아치과학회지
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• 제32권2호
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• pp.306-311
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• 2005

Lesch-Nyhan 증후군은 purine의 대사장애를 보이는 질환이다. 신생아에서 대략 1:100,000 정도의 이환율을 보이는 X염색체 열성 유전 질환으로 남자에서 흔하며, purine의 대사에 관여하는 효소인 hypoxanthine guanine phosphoribosyl transferase(HGPRT)의 결손 또는 활성 감소 결과, 과도한 요산 형성 및 과요산혈증(hyperuricemia)이 일어난다. 이 질환은 임상적으로 정신지체, 무도증(choreoathetosis), 경련성 뇌성 마비, 심각한 자해 행위가 특징이다. 이 중 자해행위는 입술과 혀, 손가락을 깨무는 경우가 흔하고, 혀와 손가락이 완전히 절단될 수도 있다. 이 경우 자해로 인한 통증 뿐 아니라, 상처 부위로의 2차 감염 및 연조직 결손으로 인한 심미성이 문제가 된다. 본 증례는, 상하악 유전치의 입술 깨물기 습관에 의해 하순이 심하게 손상된 Lesch-Nyhan 증후군 환아로서, mouth guard를 이용한 보존적인 방법과 소아정신과와의 협진을 통한 신경학적 약물치료로 자해에 의한 손상을 방지하여, 단기간에 비교적 만족할 만한 결과를 얻었기에 이를 보고하는 바이다.

• 한국근적외분광분석학회:학술대회논문집
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• 한국근적외분광분석학회 2001년도 NIR-2001
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• pp.1246-1246
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• 2001

The quality of meat is highly variable in many properties. This variability originates from both animal production and meat processing. At the pre-slaughter stage, animal factors such as breed, sex, age contribute to this variability. Environmental factors include feeding, rearing, transport and conditions just before slaughter (Hildrum et al., 1995). Meat can be presented in a variety of forms, each offering different opportunities for adulteration and contamination. This has imposed great pressure on the food manufacturing industry to guarantee the safety of meat. Tissue and muscle speciation of flesh foods, as well as speciation of animal derived by-products fed to all classes of domestic animals, are now perhaps the most important uncertainty which the food industry must resolve to allay consumer concern. Recently, there is a demand for rapid and low cost methods of direct quality measurements in both food and food ingredients (including high performance liquid chromatography (HPLC), thin layer chromatography (TLC), enzymatic and inmunological tests (e.g. ELISA test) and physical tests) to establish their authenticity and hence guarantee the quality of products manufactured for consumers (Holland et al., 1998). The use of Near Infrared Reflectance Spectroscopy (NIRS) for the rapid, precise and non-destructive analysis of a wide range of organic materials has been comprehensively documented (Osborne et at., 1993). Most of the established methods have involved the development of NIRS calibrations for the quantitative prediction of composition in meat (Ben-Gera and Norris, 1968; Lanza, 1983; Clark and Short, 1994). This was a rational strategy to pursue during the initial stages of its application, given the type of equipment available, the state of development of the emerging discipline of chemometrics and the overwhelming commercial interest in solving such problems (Downey, 1994). One of the advantages of NIRS technology is not only to assess chemical structures through the analysis of the molecular bonds in the near infrared spectrum, but also to build an optical model characteristic of the sample which behaves like the “finger print” of the sample. This opens the possibility of using spectra to determine complex attributes of organic structures, which are related to molecular chromophores, organoleptic scores and sensory characteristics (Hildrum et al., 1994, 1995; Park et al., 1998). In addition, the application of statistical packages like principal component or discriminant analysis provides the possibility to understand the optical properties of the sample and make a classification without the chemical information. The objectives of this present work were: (1) to examine two methods of sample presentation to the instrument (intact and minced) and (2) to explore the use of principal component analysis (PCA) and Soft Independent Modelling of class Analogy (SIMCA) to classify muscles by quality attributes. Seventy-eight (n: 78) beef muscles (m. longissimus dorsi) from Hereford breed of cattle were used. The samples were scanned in a NIRS monochromator instrument (NIR Systems 6500, Silver Spring, MD, USA) in reflectance mode (log 1/R). Both intact and minced presentation to the instrument were explored. Qualitative analysis of optical information through PCA and SIMCA analysis showed differences in muscles resulting from two different feeding systems.

• 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.

• 미술자료
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• 제97권
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• pp.87-104
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• 2020

산률(山律) 선우영(鮮于英)(1946~2009) 필(筆) <금강산 묘길상도>(2000)는 국립중앙박물관이 소장하게 된 최초의 북한 화가 작품이다. 지금까지 알려진 <묘길상도> 가운데 가장 큰 종축(縱軸) 형식으로 크기가 세로 130.2cm, 가로 56.2cm에 이르는 지본수묵진채(紙本水墨眞彩) 그림이다. 선우영에 관하여는 최근 우리나라에도 수차례 개최된 전시회에서 비교적 잘 알려졌다. 그는 1989년 공훈예술가, 1992년 인민예술가 칭호를 받는 등 이른바 '진채세화(眞彩細畫)'의 대가로서 북한을 대표하는 화가가 되었고, 60여 점의 작품이 북한 국보로 지정되었다. 이 그림의 주제인 <묘길상> 마애불은 금강산 내금강 지역에 있는 만폭동 골짜기의 높이 40m 벼랑 아래에 15m 정도 크기로 새겨진 고려시대의 마애불이다. 이 마애불의 명칭은 마사연(摩詞衍) 동쪽에 있었던 묘길상암(妙吉祥庵)에서 유래한다. 마애불의 오른쪽 옆 바위에는 직암(直庵) 윤사국(尹師國)(1728~1709)이 쓴 '묘길상(妙吉祥)'이라는 큼직한 음각의 글씨가 새겨져 있다. 필자는 불상의 수인(手印)을 오른손과 왼손이 모두 엄지와 약지(藥指)가 만나는 하품하생인(下品下生印)과 비슷하지만 왼손이 아래를 향하고 있지 않고 오른손과 거의 직각을 이루며 복부에 놓여있으므로 설법인(說法印)으로 보았다. 즉 이 불상은 설법인을 결하고 있는 석가상(釋迦像)이라고 결론지었다. 선우영의 <금강산 묘길상도>는 조선시대 같은 주제의 그림들과 비교하면 불상의 자연 환경, 즉 벼랑 아래 감실에 새겨진 불상이라는 점과 불상이 인간의 모습이 아닌 암각상임을 수묵진채로 표현한 유일한 그림이다. 구도와 색감이 자아내는 초현실주의적 분위기 또한 이 <금강산 묘길상도>의 특징이라 하겠다. 이 그림을 포함한 선우영의 대부분 작품이 진채로 바위 질감을 사실적으로 표현한 그림이지만 그의 만년작 <파도>(2008)와 같이 전통적의 수묵화에 가까운 그림도 그렸던 폭넓은 작품 세계를 보여주는 화가이다.