• 대한두개안면성형외과학회지
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• 제23권6호
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• pp.269-273
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• 2022

Naso-orbito-ethmoidal (NOE) fractures are complicated fractures of the mid-face. The treatment of NOE fractures is challenging and a comprehensive treatment strategy is required. We introduce a case of NOE fracture treated with open reduction and suspension sutures. A 28-year-old woman presented with a unilateral NOE fracture. To reduce the frontal process of the maxilla, a suspension suture was made by pulling the fragment using a double arm suture via a transcaruncular incision. The suture thread was placed in the horizontal plane. Another suspension suture on the inferior orbital rim assisted reduction procedure, and they passed through the overlying skin. The reduction alignment could be finely adjusted by tightening the transcutaneous suture threads while checking the degree of bone alignment through the subciliary incision. The two suture threads were suspended using a thermoplastic nasal splint. An additional skin incision on the medial canthal area, which would have resulted in a scar, could be avoided. Four months postoperatively, computed tomography showed an accurate and stable reduction. The patient was satisfied with her aesthetic appearance, and functional deficits were not present.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.745-749
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• 2022

Background Soft tissue defects of the multiple finger present challenges to reconstruction surgeons. Here, we introduce the use of a lateral arm free flap and syndactylization for the coverage of multiple finger soft tissue defects. Methods This retrospective study was conducted based on reviews of the medical records of 13 patients with multiple soft tissue defects of fingers (n = 33) that underwent temporary syndactylization with a microvascular lateral arm flap for temporary syndactylization from January 2010 to December 2020. Surgical and functional outcomes, times of flap division, complications, and demographic data were analyzed. Results Middle fingers were most frequently affected, followed by ring and index fingers. Mean patient age was 43.58 years. The 13 patients had suffered 10 traumas, 2 thermal burns, and 1 scar contracture. Release of temporary syndactyly was performed 3 to 9 weeks after syndactylization. All flaps survived, but partial necrosis occurred in one patient, who required a local transposition flap after syndactylization release. The mean follow-up was 15.8 months. Conclusion Coverage of multiple finger defects by temporary syndactylization using a free lateral arm flap with subsequent division offers an alternative treatment option.

• Journal of Chest Surgery
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• 제36권6호
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• pp.391-396
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• 2003

배경: 하지정맥류에 대한 수술치료법으로 광투시 전동형 정맥적출술이 최근에 소개되어 널리 이용되고 있다. 광투시 전동형 정맥적출술의 장점은 절개를 최소화하여 미용적으로 우수하다. 그러나 단점으로는 Trivex라는 고가의 장비를 반드시 사용하여야 하며 환자부담이 증가되는 단점이 있다. 이에 저자는 Trivex 대신에 기존 관절경장비를 이용하여 광투시 전동형 정맥적출술을 실시하여 치료효과와 유용성을 관찰하였다. 대상 및 방법: 2000년 3월부터 2002년 2월까지 하지정맥류 환자 78명을 대상으로 기존 관절경장비를 이용하여 113예의 광투시 전동형 정맥적출술을 실시하였다. 환자들의 병력, 절개창 숫자, 수술의 효과와 합병증 등을 관찰하였다. 결과: 환자들의 평균연령은 41.8세였으며 남자가 34명 여자가 44명이었다. 평균수술시간은 편측 하지당 48.7분이었고 절개창은 스트리핑을 위한 서헤부와 발목부의 창상을 포함하여 평균 4.9개였다. 수술 후 합병증으로는 전례에서 반상출혈이 있었으나 저절로 흡수되어 사라졌으며, 3주 이상의 부종이 6예, 수술 시 발견치 못하고 남은 정맥류가 4예 수술 중 shaver의한 피부천공이 2예 있었다. 또한 압박스타킹 착용에 따른 접촉성 피부염이 나타난 경우가 4예 있었다. 시각적 상사척도에 의한 환자들의 수술에 대한 주관적인 만족도는 평균 92.6%였다. 결론: 관절경장비를 이용하여도 광투시 전동형 정맥적출술이 가능하며 심한 합병증 없이 미용적으로 우수하다고 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권5호
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• pp.415-421
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• 2001

본 연구는 편측성 완전구순열에서 Cronin의 삼각피판법과 Millard의 회전신전법에 의한 수복시 술후 결과를 비교 하고자 시행되었다. 13명의 편측성 완전구순열 환자를 대상으로 삼각피판법과 회전신전법에 의해 구순성형술을 시행하고, 술전${\cdot}$술후 사진을 토대로 구순부에서는 수직 길이, 반흔, 적순, 입술의 볼록함(lip pout), 큐피드궁의 다섯항목에 대하여, 비부에서는 비익, 비주, 비공저, 비첨, 비중격의 다섯 항보겡 대하여 각 항복 당 $0{\sim}10$점씩 총 100점으로 평가하고 술후 결과를 분석하여 다음과 같은 결과를 얻었다. 총폄점은 Cronin의 삼각피판법을 시행한 경우에 $74.77{\pm}0.86$점으로 Millard의 회전신전법을 시행한 경우의 $66.50{\pm}1.14$점에 비해 유의하게 높았다. 반흔비대는 Millard의 회전신전법을 시행한 경우에 28.6%의 발생율을 나타냈으나 Cronin의 삼각피판법을 시행한 경우에는 발생되지 않았다. 구순 기엥 대한 객관적 평가 결과 평균 길이 비는 Millard의 회전신전법을 시행한 경우에 $0.73{\pm}0.10$으로 Cronin의 삼각피판법을 시행한 경우 $0.80{\pm}0.96$보다 짧았으나 통계학적으로 유의한 차이는 없었다. 이상의 결과는 편측성 오나전구순열에서 Cronin의 삼각피판법이 Millard의 회전신전법보다 더 좋은 결과를 나타냄을 시사한다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권5호
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• pp.380-385
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• 2010

Introduction: The iliac crest has been the accepted place to obtain bone for reconstruction in oral and maxillofacial surgery. The iliac crest has many advantages because of its accessibility, large amount of cancellous bone, relative ease of bone harvest, possibility of two team approach and ability to close the wound primarily. This study evaluated retrospectively the morbidity of bone harvesting from the anterior iliac crest to provide a logical guide for recognizing the complications and morbidities of an iliac crest bone graft. Materials and Methods: Fifty healthy patients (mean age of 35.5 years; range 7 to 59) underwent iliac crest bone harvesting for a maxillofacial reconstruction from January 2007 to September 2009 at the Department of Oral and Maxillofacial Surgery in Kyungpook National University Hospital. Age, sex, size and kind of grafted bone, duration of pain on donor site, duration of gait disturbance, sensory deficit, scar, contour defect were measured in each patients by retrospective research. Results: The mean duration of pain is 6.7 days, and mean duration of gait disturbance is 7.2 days. Most patients were free from gait disturbances and pain within 2 weeks and there was no correlation between the size of the harvesting block bone and the duration of gait disturbance or pain. However, this study showed that the duration of pain is associated with gait disturbance. In addition, most patients had no complaints regarding their surgical scar and contour defect, and only one patient had permanent impairment of the sensory function. Moreover, an iliac bone graft did not extend the length of hospitalization. Conclusion: This study suggests that split thickness bone harvesting from the inner table of the anterior iliac crest is a well accepted procedure with relatively low morbidity.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권5호
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• pp.323-329
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• 2003

본 연구는 편측성 완전 구순열에서 Millard 회전신전법 만으로 수복한 경우와 구순접합술 후에 Millard 회전신전법으로 수복한 경우의 술후 결과를 비교하고자 시행되었다. 20명의 편측성 완전 구순열 환자를 대상으로 7명에서는 Millard 회전신전법만으로 수복하였고, 13명에서는 구순접합술 후에 Millard 회전신전법으로 수복하였다. 술전 술후 사진을 토대로 구순부에서는 수직 길이, 반흔, 적순, 입술의 볼록함(lip pout), 큐피드궁의 다섯 항목에 대하여, 비부에서는 비익, 비주, 비공저, 비첨, 비중격의 다섯항목에 대하여 각 항목 당 $0{\sim}10$점씩 총 100점으로 평가하고 술후 결과를 분석하였다. 총평점은 구순접합술 후에 Millard 회전신전법으로 수복한 경우 $74.74{\pm}1.09$점으로 Millard의 회전신전법 만으로 수복한 경우 $66.50{\pm}1.14$점에 비해 유의하게 높았다. 반흔 비대는 Millard 회전 신전법 만으로 수복한 경우에 28.6%, 구순접합술 후에 Millard 회전신전법으로 수복한 경우에 23.1%의 발생율을 나타냈다. 구순길이의 객관적인 평가 결과, 구순접합술 후에 Millard 회전신전법으로 수복한 경우 평균 길이비는 $0.84{\pm}0.08$로 Millard 회전신전법만으로 수복한 경우의 $0.73{\pm}0.10$에 비해 길었으나 통계학적으로 유의한 차이는 없었다. 이상의 결과는 편측성 완전 구순열 수복 시 Millard 회전신전법에 의한 구순성형술에 앞서 구순접합술을 시행함으로써 더 좋은 결과를 얻을 수 있음을 시사한다.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.415-420
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• 2010

Purpose: Heterotopic calcification is a pathological event in which deposits of calcium salts build up, usually in the joint area or soft tissues. It can occur under many conditions and in some rare cases may develop in burn scars. In particular, ulcerations in burn scars accompanied by heterotopic calcification are difficult to treat through conservative treatment. This study reports methods for accurate diagnosis and adequate treatment of ulceration in burn scars accompanied by heterotopic calcification. Methods: Fourteen patients who visited our hospital from March 2008 to January 2010 were subjected to this study. Their sex, age, modes of burn, degree, TBSA (%), ulcerated area, the time of occurrence of the ulcerations in the burn scars were investigated. In addition, radiological examination and biopsy was performed to diagnose heterotopic calcification. Results: Among the 14 cases, 6 were male and 8 were female. The average age of the patients was 48.2 (27 - 69 yrs). As for the mode of burn, 11 were flame burns and 3 were scalding burns. The average time of occurrence of the ulcerations in the burn scars was 4.5 months. The ulcerated areas were situated in the legs in 12 cases, arms in 1 case, and torso in 1 case. The diagnosis was confirmed through X-ray and biopsy, and skin graft was performed after wide excision. Conclusion: Diagnosis of the ulceration in burn scars accompanied by heterotopic calcification is possible through radiological and pathologic studies. Surgical treatment is the most reliable method of treatment, and we chose to perform skin graft after wide excision. Also, we learned that the complete removal of the calcified tissue and the inflammatory fibrotic tissues is crucial in preventing recurrence. Also, in contrast to Marjolin's ulcer, heterotopic calcification had a small size, little or no granulation tissue, and lacked fungating type ulceration. Therefore, favorable prognosis could be achieved through adequate treatment.

• Radiation Oncology Journal
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• 제15권3호
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• pp.269-276
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• 1997

목적 : 켈로이드와 비후성 반후에서 재발을 방지하기 위해 외과적 절제술후 방사선치료를 받은 환자를 대상으로 그에 대한 효과를 알아보고자 하였다. 방법 : 1987년 10월부터 1995년 4월까지 켈로이드로 수술후 방사선치료를 받은 106명의 환자 에서 167예를 대상으로 후향적 분석을 하였다. 켈로이드의 주된 발생원인으로는 수술이 83예$(49.2\%)$, 외상이 42예$(25.0\%)$ ear-piercing이 9예$(5.4\%)$, 화상이 9예$(5.4\%)$였다. 켈로이드의 위치별 분포로는 이개에 25예$(15.0\%)$, 그외 머리와 목이 81예$(48.5\%)$, 체간이 36예$(21.5\%)$, 사지가 25예$(15.0\%)$였다. 남자는 19명, 여자는 87명이였고 연령은 3세에서 70세였다(중앙값:32세). 방사선치료는 수술후 24시간 이태에 시행하였으며 6-8MeV의 전자선을 이용하여 총 조사선량은 400cGy에서 1900cGy까지 조사하였다(평균값: 1059cGy). 추적관찰 기간은 24개월에서 114개월 이었으며 중앙값은 49개월이었다. 결과 : 대상환자 106명의 환자에서 167예를 치료한 결과, 재발은 21예로 $12.6\%$의 재발율을 보였고, 1년 재발율은 $10.2\%$, 2년 재발율은 $11.4\%$였다. 재발된 병변에 있어서 수술후 12개월이 내에 재발된 경우는 전체의 $81\%$였다(17/21). 재발된 25예의 재발기간은 수술후 1개월에서 47개월까지였으며 평균재발기간은 9.6개월이였다. 재발된 부위를 살펴보면 이개에 2예$(1.2\%)$, 그외 머리와 목이 14예$(8.4\%)$, 체간이 4예$(2.4\%)$, 사지간 1예$(0.6\%)$로 나타났다. 재발에 영향을 미치는 예후인자에 연령. 성별, 분할조사 크기, 1회 조사량, 원인, 위치, 발생전 치료유무에 따라 분석한 결과 : 과거의 치료유무에서 치료경험이 없었던 군이 치료경험이 있었던 군보다 재발율이 낮았으며$(11.0\%\;vs.\;22.6\%)$ 과거와 치료유무만이 통계적인 유의성이 있었다(P=0.04). 치료에 따른 합병증으로 특이한 사항은 없었다. 결론 : 켈로이드와 비후성 반흔 환자에서 재발 발지를 위한 수술후 방사선치료는 비교적 안전하고 효과적이였다. 그러나 추후 수술후 방사선치료의 역할을 보다 더 정확히 평가하기 위해서는 비교 연구와 전향적인 연구가 필요할 것으로 사료된다.

• Archives of Plastic Surgery
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• 제42권4호
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• pp.438-445
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• 2015

Background Breast auto-augmentation (BAA) using an inferior pedicle dermoglandular flap aims to redistribute the breast tissue in order to increase the fullness in the upper pole and enhance the central projection of the breast at the time of mastopexy in women who want to avoid implants. The procedure achieves mastopexy and an increase in breast volume. Methods Between 2003 and 2014, 107 BAA procedures were performed in 53 patients (51 bilateral, 2 unilateral and 3 reoperations) with primary or secondary ptosis of the breast associated with loss of fullness in the upper pole (n=45) or undergoing explantation combined with capsulectomy (n=8). Six patients (11.3%) had prior mastopexy and 2 (3.7%) patients had prior reduction mammoplasty. The mean patients' age was 41 years (range, 19-66 years). All patients had preoperative and postoperative photographs and careful preoperative markings. Follow-up ranged from 6 months to 9 years (mean, 6.6 months). Results The range of elevation of the nipple was from 6 to 12 cm (mean, 8 cm). The wounds healed completely with no complications in 50 (94.3%) patients. Three patients had complications including 2 (3.7%) hematomas and 1 (1.9%) partial necrosis of the nipple-areola complex. Three (5.7%) patients were dissatisfied with the level of mastopexy achieved underwent a further procedure. No patient complained of scar hypertrophy. Conclusions BAA is a versatile technique for women with small breasts associated with primary or secondary ptosis. It is also an effective technique for the salvage of breasts after capsulectomy and explantation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.548-552
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• 2010

The submandibular gland is the second largest major salivary gland, which secretes 40% of the total daily saliva. Owing to its anatomic characteristics as well as the high viscosity and basicity of the saliva, sialolithiasis is found most commonly in the submandibular gland. Sialolithiasis that cannot be treated by conservative treatment is conventionally removed by an excision of the submandibular gland. Generally, an excision of the submandibular gland is performed via an extra-oral approach but the disadvantages of this treatment include a risk of injuring the facial nerve and scar formation. Case reports have revealed an even less invasive intraoral surgical technique for the removal of sialolith that does not affect the submandibular gland function. The functional recovery of the gland, complications and recurrence rates after surgery with this conservative intraoral procedure were all successful. We report 5 patients from the department of Oral and Maxillofacial Surgery at Dental Hospital, Yonsei University, who had undergone a resection of the sialolith though the intraoral approach with successful results.