• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.40.1-40.4
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• 2016

Background: This report describes the authors' experience of "melting" septal cartilage after placement of a septal extension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, and provides a review of the literature. Methods: Electronic medical records were used to obtain details of the patient's clinical history. Results: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited our department to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip (first operation). Five days after surgery, it was found that the septal extension graft was melting without any signs of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without any sign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Five months after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, and thus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tip augmentation (third operation). Conclusions: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Further studies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.

• Journal of Chest Surgery
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• 제9권2호
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• pp.143-147
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• 1976

A case of congenital funnel chest which was observed in 6 year old male was reported. The patient represented clinical status of depression of lower sternum, recurrent upper respiratory tract infection, and slight exertional dyspnea. The treatment was carried out by "turnover" method, and it was easy to do viable on sternum, costal cartilage, and intercostal muscles. And it is fit to reimplantation by free autograft when repair was indicated. The plane of the manubrium, an acute hump on the sternum, and asymmetry constitute limiting factors in the cosmetic results.

• Journal of Chest Surgery
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• 제25권3호
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• pp.321-324
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• 1992

Poland`s syndrome is very rare anomaly and typified by absence of the pectoralis major, absence or hypoplasia of the pectoralisminor, absence of costal cartilage, hypoplasia of breast and subcutaneous tissue, and brachysyndactyly. The clinical features are variable but all patients have absence of at least the sternal head of the pectoralis major muscle. The syndrome is not hereditary and is of unknown origin. Early recognition of Poland`s syndrome may give the provision of psychologic and genetic counselling for anxious parents. We have encountered a patient with this entity, and underwent successful correction.

• Journal of Chest Surgery
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• 제24권7호
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• pp.712-718
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• 1991

The pectus excavatum or funnel shaped thorax is a relatively frequent malformation of the chest wall which composed of depressed sternum and costal cartilage. The so-called sternal turnover operation for pectus excavatum has been disappointing due to postoperative complication such as fistula formation with necrosis of bone and muscle. Thus, the need of preserved vascular pedicle to sternum was stressed in this type of operation, keeping the bilateral internal mammary vessels preserved. We have experienced two cases of modified sternal turnover in children and obtained satisfactory postoperative results.

• Archives of Plastic Surgery
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• 제33권1호
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• pp.53-60
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• 2006

The current authors performed two-stage ear reconstruction of microtia using autogenous costal cartilage combined with canaloplasty of the acoustic meatus in a team approach. In the first stage, lobule transposition, fabrication of the cartilage framework, and implantation of the framework were peformed. In the second stage, elevation of the auricle, cartilage graft for posterior auricular sulcus, coverage with the mastoid fascia flap and skin graft, and concha excavation were performed. The canaloplasty was combined simultaneously in patients with radiologic and audiometric evidence of cochlear function in the second stage. A total of 36 consecutive patients with congenital microtia were treated from 1998 to 2003. Among them, 27 patients(male: 18, female: 9) ranging from 7 to 43 years old were combined with canaloplasty. The follow-up period was one year to 5 years. Thirteen patients exhibited improved hearing over 30 dB PTA(pure tone average), 9 patients below 30 dB, and 5 patients with no improvement. Complications related to the canaloplasty were chronic drainages of the auditory meatus and meatal stenosis. Lobule type deformity combined with the canaloplasty showed higher complications than concha type. Therefore, in the lobule type, meticulous manipulation is necessary to reduce complications after the canaloplasty.

• Archives of Plastic Surgery
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• 제39권2호
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• pp.162-165
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• 2012

The synchondrosis between the sixth and seventh costal cartilage is usually used for the base frame in autogenous ear reconstruction. If the synchondrosis is loose, a variety of modifications can be devised. This report introduces new methods for these problems. In cases of incomplete synchondrosis, only the surface of the base block margin was smoothly tapered without carving for the removal of the conchal deepening. The secure fixation of the two segments (helix and antihelix) to the base block using fine wire sutures gave stability to the unstable basal frame. After confirming that all the segments were assembled in one stable piece, the remaining conchal deepening of the basal framework was removed, and the outer lower portion of the basal cartilage was trimmed along its whole length. A total of 10 consecutive patients with microtia, ranging from 8 to 13 years old, were treated from 2008 to 2009. The follow-up period was 6 months to 2 years. Despite incomplete synchondrosis, the stable frameworks were constructed using the authors' method and aesthetically acceptable results were achieved. The proposed method can provide an easy way to make a stable cartilage framework regardless of the variable conditions of synchondrosis.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
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• pp.14.3-14
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• 1983

최근 급속히 증가 추세에 있는 각종 산업재해와 교통사고로 인한 심한 신체적 손상, 심혈관계수술 및 호흡계수술등을 받은 환자에서 기도유지를 위해 사용되는 기관내삽관과 기관절개위의 후유증 또는 두부외상으로 발생하는 외상성 기관협착의 빈도가 점차 높아짐에 따라서 이에 대한 치료로 기관성형술이 주목할만한 관심을 보여주고 있다. 기관성형술의 방법으로는 손상된 기관의 위치나 크기에 따라 여러 가지가 있으나 부분절제 및 단단문합술, 경부피변과 자가이식물질등을 이용한 재건술을 들 수 있다. 1965년 Grillo가 개에서 환상절제후 기관성형술을 시행한 이래 환상기관협착의 경우에는 부분절제및 단단문합술이 많이 이용되고 있다. 또한 자가이식물질로는 비중격, 늑골, 이개의 연골이 많이 사용되고 있으며, Consiglio와 Caputo가 이개연골을 이용하여 기관성형술을 시행한 이래 Morgenstein은 기관결손이 있는 환자에서 이개연골을 사용하여 혼합이식을 시행하여 성공적인 재건을 보고하였다. 이개연골이식은 이비인후과의사에게는 쉽게 채취하여 활용할 수 있고 친근감이 있는 장점이 있다. 최근 본교실에서는 5예의 기관협착증 환자에서 이개연골이식(2예), 부분절제후 단단문합술(3예)에 의한 기관성형술을 시행하여 좋은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제41권6호
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• pp.742-746
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• 2008

배경: 새가슴의 수술적 치료는 완전한 늑연골의 절제와 흉골의 쐐기 골절술을 하는 변형된 라비치 술식을 주로 사용한다. 저자들은 수술을 간편하고 쉽게 하고자 변형된 튀어나온 늑연골만을 절제하고 흉골의 골절술없이 스테인레스 금속막대로 튀어나온 흉골을 앞에서 눌러 압박하는 방식으로 수술을 하였다. 이러한 방식으로 수술한 환자들을 대상으로 수술의 유용성과 효과 등을 평가하고자 본 연구를 시행하였다. 대상 및 방법: 2006년 7월부터 2008년 6월까지 새가슴으로 본원에서 부분 늑연골 절제와 스테인레스 금속막대를 이용한 흉골 압박 수술을 시행 받은 환자들 10명을 대상으로 진행을 하였다. 수술의 효과와 합병증 등을 관찰하였다. 결과: 새가슴만 단독으로 수술 받은 환자가 5명, 새가슴과 오목가슴이 같이 복합으로 존재하여 새가슴 수술과 오목가슴의 너스 수술을 같이 시행 받은 환자가 5명이었다. 환자들의 평균 연령은 13.4+3.3세였다. 평균 수술기간은 새가슴 단독 수술만 시행된 경우가 137.6+22.9분이었고 새가슴과 오목가슴이 공존하여 같이 수술을 받은 경우는 234.0+36.5분이었다. 평균 입원기간은 11.8+1.0일이었다. 새가슴의 술전 Halter's pectus index는 $2.10{\pm}0.21$에서 수술 후에는 $2.53{\pm}0.07$로 증가하였다. 합병증으로는 단순한 부분적인 창상균열이 1예 있었다. 결론: 저자들은 10명의 새가슴 환자들에게 변형된 튀어나온 늑연골만을 절제하고 흉골의 골절술 없이 스테인리스 금속막대로 튀어나온 흉골을 앞에서 눌러 압박하는 수술을 시행하여 좋은 결과를 얻었다. 이러한 저자들의 치료법은 기존의 라비치 수술법에 비하여 쉽고 간편한 수술법이다. 그러나 아직 금속막대의 제거가 모든 환자에서 완전히 이루어진 상태가 아니므로 정확한 치료효과에 관하여서는 좀 더 많은 수술례를 대상으로 장기적인 추적 관찰이 필요하다.

• Journal of Chest Surgery
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• 제32권5호
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• pp.489-493
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• 1999

새가슴은 흉골이 전방으로 돌출 되는 흉벽 기형의 하나로 전방 흉벽이 함몰되는 누두흉보다 그 빈도가 훨씬 적다. 남자에게서 흔하며, 척추 측만증(scoliosis)을 가장 많이 동반한다. 새가슴의 수술적 교정 \ulcorner1952년 Ravitch가 연골흉골병형(chondromanubrial type)에서 다발 기형 늑골 절제와 이중 골 절단술을 처음으로 시행하였다. 저자들은 출생 시부터 관찰되어 성장에 따라 심해진 비대칭성 새가슴 환자 1례에서 양측 기형 늑연골의 연골막하 부분 절제술과 흉골의 단일 골 절단술을 시행하였다. 술후 합병증은 없었으며, 만족할만한 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다.

• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.109-113
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• 2009

Purpose: Materials for ear reconstruction are autogeneous cartilage and artificial implants. Despite their potential for donor site complications, autogeneous cartilage frameworks remain the accepted standard for external ear reconstruction. The purposes of this study were to investigate our ear reconstruction cases for 12 years. Methods: During twelve years from January 1996 to December 2008, 70 patients visited our hospital for ear reconstruction of microtia. Among them, 65 cases used autogenous cartilage frameworks, 3 cases used tissue expander and 2 cases used artificial implants. We investigated sex & age, common site, combined malformation, operation methods & their complications, donor site & their complications, anterior chest wall deformity and aesthetic evaluation. Results: Males were affected more often than females. Male to female ratio was 1.8 : 1. The common site of microtia was right ear (72%). And hemifacial microsomia was the most common associated congenital malformation. Surgical techniques included Tanzer-Ruecker method, Tissue-expander and Artificial framework ($Medpore^{(R)}$). Incidence of complication was higher with Tissue-expander & artificial framework than with Tanzer-Ruecker method. But There are few reports of using Tissue-expander & artificial framework and there was no acceptable statistical difference. And costal cartilage was harvested in ipsilateral side and anterior chest wall deformity reported only 2 cases under 10 year-old patients. Other minor complications reported such as, wound disruption and chest wall scar, but without any serious complications. Aesthetic result was evaluated by surgeons and patients for postoperative satisfaction and clinical evaluation. Conclusion: In ear reconstruction of microtia patient, delicate surgical strategy is important for natural shape and maintenance of postoperative contour. However, many methods were introduced for reconstrucion of microtia, the authors reconstructed an auricle in Tanzer-Ruecker method, Tissue-expander and Artificial famework ($Medpore^{(R)}$) for 70 patients. In our study, we generally chose Tanzer-Ruecker method and this treatment modality was satisfactory for patients and the postoperative result was acceptable for surgeons.