• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.98-104
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• 2000

Expansion in the scope and technique of head and neck tumor resection during the past two decades has paralleled precise tumor localization with advanced radiographic imaging and the availability of microvascular free tissue transfer. Especially, the defect reconstruction utilizing free flap results in improvement of patient survival due to decrease of local recurrence by wide resection of cancer. The rectus abdominis free flap has been used widely in reconstruction of the breast and extremities. However, the report of cases on its applications in the head and neck, based on the deep inferior epigastric artery and vein, is rare. This flap is one of the most versatile soft-tissue flaps. The deep inferior epigastric artery and vein are long and large-diameter vessels that are ideal for microvascular anastomosis. The skin area that can be transferred is probably the largest of all flaps presently in use. The versatility of the donor site is due to the ability to transfer large areas of skin with various thickness and amounts of underlying muscle. This article is to report reconstruction of midface defects utilizing the rectus abdominis free flap in 2 patients with maxillary squamous cell carcinoma and discuss briefly considerations in flap design and orbital exenteration, and healing of irradiated recipient site by hyperbaric oxygen therapy with literature review.

• Proceedings of the Korean Society of Disaster Information Conference
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• 2022.10a
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• pp.381-382
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• 2022

국내에서 1980년대까지 연탄을 에너지로 많이 사용하면서 일산화탄소 중독이 빈번하여 고압산소치료가 활용되다가 이후 연탄 사용의 감소로 고압산소치료기가 대부분 활용되지 못하고 폐기되는 경우도 많았다. 이후 세월호 사고에서의 잠수사들에 대한 고압산소치료 적용, 가스누출이나 번개탄을 활용한 자살시도가 빈번해지며 고압산소치료기를 보유하고 있는 기관이 부족해 적절한 치료를 제 때 받지 못하여 고압산소치료기의 필요성이 되두되었다. 국내에서는 2021년 기준으로 한해 36,266 건의 화재가 발생하고 2020년에 365명이 화재로 사망하며, 화재로 인한 손상은 1,917건이었는데. 화재 시 여러 유독가스를 흡입하게 되고, 이에 따라 고압산소치료가 필수적으로 진행되어야 한다. 유해화학물질 사고, 대규모 오염, 다양한 교통수단에서의 대형 사고, 건축물 붕괴 사고 및 대규모 지진, 화산폭발 같은 자연재해 시에도 가스 중독이 발생하며, 이는 고압산소치료가 필요하게 된다. 따라서 다양한 종류의 재난에서 발생하는 유독가스 피해자에게 고압산소치료는 필수적이나 본 연구에 의하면 국내에는 고압산소치료챔버의 숫자와 동시에 고압산소치료로 수용할 수 있는 환자수에도 한계가 있고 그 분포의 불균형도 존재하고 있어 재난 시 인명 피해 감소의 기반 장비, 시설로서 고압산소챔버의 균형있는 확산, 적용이 시급한 실정이다. 다행히 최근 전국적으로 고압산소챔버가 증가하는 추세에 있어 그 현황과 배치 상황을 조사하여 이를 통하여 고압산소챔버가 필요한 유독가스 발행 재난에 대비할 수 있는 역량이 증가하고 있다.

• Journal of The Korean Society of Clinical Toxicology
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• v.11 no.1
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• pp.41-45
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• 2013

Following are brief statements about the delayed encephalopathy of a patient who recovered without disturbance of consciousness after acute carbon monoxide poisoning. A 72-year-old male was found without consciousness at home and then visited the ER center. Later we learned that the patient was using briquettes as a household heating source. Blood carbon monoxide hemoglobin level was 17.5%. As carbon monoxide poisoning was uncertain after the first interview with the patient, hyperbaric oxygen therapy was not administered at the early stage. After supplying 100% oxygen, the patient recovered consciousness, however, the strength of the lower limb muscle had decreased to class II. The patient showed continued weakening of the lower limb muscle and an increase of CPK; therefore, he was diagnosed as carbon monoxide intoxication and rhabdomyolysis and then admitted to the intensive care unit (ICU) for conservative treatment. During the hospitalization period, continued weakening of the lower limb muscle was observed and he was diagnosed as myopathy after EMG/MCV. However, he suddenly showed altered mentality on the 20th day of hospitalization, and underwent brain MRI. T2 weighted MRI showed typically high signal intensity of both globus pallidus and periventricular white matter; therefore, he was diagnosed as delayed carbon monoxide encephalopathy. This case showed delayed encephalopathy accompanied by rhabdomyolysis and myopathy of a patient who recovered without disturbance of consciousness.

• Journal of Preventive Medicine and Public Health
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• v.15 no.1
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• pp.145-151
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• 1982

Breslau's report on the two stillbirths induced by illuminating gas poisoning made many investigators explore the hazards. of carbon monoxide(CO) poisoning to pregnancy. The pregnant woman, her fetus, and the newborn infant have been identified to be particularly vulnerable to CO even in low concentration. Several factors, such as placental barrier, membrane resistance of maternal and fetal red blood cells etc., were considered to be related to the delayed elimination of CO from fetus. Slower elimination of CO from fetus than from mother was confirmed in several in vivo studies. But there are few studies which have confirmed the difference of carboxyhemoglobin (HbCO) dissociation in adult and fetal bloods. Author investigated the effects of hemoglobin itself on the elimination of CO from mother and fetus. By observing the difference of CO dissociation from adult and fetal hemoglobin at the various partial pressures of oxygen, the author tries to suggest the base of the proper treatment measure for the CO poisoning of pregnant woman and newborn infant. The results were as follows: 1. The total hemoglobin amounts of adults and fetal bloods were $16.1{\pm}0.50gm%\;and\;15.7{\pm}0.32gm%$, respectively. The fetal hemoglobin proportions in adult and fetal bloods were $1.2{\pm}0.15%\;and\;72.7{\pm}3.01%$, respectively. 2. Adult and fetal bloods saturated by CO to 100% HbCO were exposed to ambient air$(21%\;O_2),\;100%\;O_2\;and\;3\;ATAO_2$. After 30 minutes exposure, the HbCO saturations of adult blood were 96.7%, 70.9%, and 52.8%, respectively, and those of fetal blood were 98.5%, 76.1%, and 62.2%, respectively. HbCO dissociation was proportional to the partial pressure of oxygen and the most marked dissociation was shown under 3 ATA $O_2$, HbCO dissociation of fetal blood was slower than that of adult blood in all conditions. According to the above results, it is possible that CO poisoning make more serious damage to the fetus and newborn infant than to the adult due to the delayed dissociation of HbCO. Thus in the treatment of CO poisoning of pregnant woman and newborn infant, hyperbaric oxygen therapy seems to be the most eflective treatment measure, but the duration of hyperbaric oxygenation should be lengthened accordingly.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.3
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• pp.265-269
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• 2010

Radiation therapy for malignancy of head and neck leads to secondary effects, such as mucositis, xerostomia, dental caries and osteoradionecrosis. Osteoradionecrosis is a delayed complication which causes chronic pain, infection and constant deformity after necrosis. It occurs spontaneously or after primary oncologic surgery, dental extraction or by trauma of prosthesis. To reduce the incidence of osteoradionecrosis, appropriate antibiotic usage, atraumic procedure, tension-free primary suture and hyperbaric oxygen therapy are essential. This case is about a 74 years old woman who was treated for osteoradionecrosis after extraction of right lower molar at year 2006. She had received radiation therapy for angiosarcoma on tongue at year 2004. At year 2008 the patient came to our hospital for extraction of the opposite premolar but despite careful treatment, osteoradionecrosis occurred again. She was successfully treated by surgical procedure so we report this case.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.110-116
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• 1991

Fracture site osteomyelitis begins rarely with an acute event but rather has a subacute onset. It develops almost exclusively in the mandibular region. The treatment principles of mandibular fracture site osteomyelitis are complete removal of inflammatory tissue and drainage, rigid fixation with or without autogenous bone bone graft and specific antibiotic therapy. But hyperbaric oxygen used as a modality in the treatment of intractable osteomyelitis. In this paper, we reported that the three patients who have osteomyelitis accompying secondary in fection after mandibular fracture.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.2
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• pp.179-185
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• 1994

The Ameloblastoma is a true neoplasm of enamel organ-type tissue histopathologically. Ameloblastoma is recognized as a benign tumor, but its clinical behavior is locally invasive. Therefore treatment of choice is surgical resection rather than conservative enucleation. This is a case report about En-bloc excision of granular ameloblastoma arising from dentigerous cyst in the right mandibular angle area of 50-year male patient. He visited local clinic with chief complaint of facial swelling on the right mandibular angle area. Surgical removal was performed by cyst enucleation and En-bloc excision with preservation of inferior border of mandible. After 1 year, iliac bone graft was done and hyperbaric oxygen therapy was applied. We obtained a good result of bony regeneration without any sign of recurrence.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.642-648
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• 2011

Purpose: The recent advances in microsurgical techniques and their refinement over the past decade have greatly expanded the indications for digital replantations and have enabled us to salvage severed fingers more often. Many studies have reported greater than 80% viability rates in replantation surgery with functional results. However, replantation of multi-level amputations still remain a challenging problem and the decision of whether or not to replant an amputated part is difficult even for an experienced reconstructive surgeon because the ultimate functional result is unpredictable. Methods: Between January of 2002 and May of 2008, we treated 10 multi-level amputated digits of 7 patients. After brachial plexus block, meticulous replantation procedure was performed under microscopic magnification. Postoperatively, hand elevation, heat lamp, drug therapy and hyperbaric oxygen therapy were applied with careful observation of digital circulation. Early rehabilitation protocol was performed for functional improvement. Results: Among the 19 amputated segments of 10 digits, 16 segments survived completely without any complications. Overall survival rate was 84%. Complete necrosis of one finger tip segment and partial necrosis of two distal amputated segments developed and subsequent surgical interventions such as groin flap, local advancement flap and skin graft were performed. The overall result was functionally and aesthetically satisfactory. Conclusion: We experienced successful replantations of multi-level amputated digits. When we encounter a multi-level amputation, the key question is whether or not it is a contraindication to replantation. Despite the demand for skillful microsurgical technique and longer operative time, the authors' results prove it is worth attempting replantations in multi-level amputation because of the superiority in aesthetic and functional results.

• Journal of The Korean Society of Clinical Toxicology
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• v.17 no.2
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• pp.86-93
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• 2019

Purpose: The objective was to determine the association between PaCO₂ and adverse cardiovascular events (ACVEs) in carbon monoxide (CO)-poisoned patients. Methods: This retrospective study included 194 self-breathing patients after CO poisoning with an indication for hyperbaric oxygen therapy and available arterial blood gas analysis at presentation and 6 hours later. The baseline characteristics and clinical course during hospitalization were collected and compared. The mean PaCO₂ during the first 6 hours after presentation was calculated. Results: The incidence rates of moderate (30 mmHg< PaCO₂ <35 mmHg) or severe (PaCO₂ ≤30 mmHg) hypocapnia at presentation after acute CO poisoning were 40.7% and 26.8%, respectively. The mean PaCO₂ during the first 6 hours was 33 (31-36.7) mmHg. The incidence of ACVEs during hospitalization was 50.5%. A significant linear trend in the incidence of ACVEs was observed across the total ranges of PaCO₂ variables. In multivariate regression analysis, mean PaCO₂ was independently associated with ACVEs (OR 0.798 (95% CI 0.641-0.997)). Conclusion: Mean PaCO₂ during the first 6 hours was associated with increased ACVEs. Given the high incidence of ACVEs and PaCO₂ derangement and the observed association between PaCO₂ and ACVEs, this study suggests that 1) PaCO₂ should be monitored at the acute stage to predict and/or prevent ACVEs; and 2) further study is needed to validate this result and investigate early manipulation of PaCO₂ as treatment.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.6
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• pp.585-594
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• 2018

Objective: This study was designed to report on the progress of the fire at Jecheon sports complex and to assess the adequacy of Disaster Medical Assistant Team (DMAT)'s activities in response to the fire disaster. Methods: We conducted a retrospective review based on camera recordings and medical records that were recorded at the disaster site for assessment of activities. We cooperated with firefighters, police officers, local hospital medical staffs and public health personnel in Jecheon in order to classify patients in the disaster field and to understand the patients' progress. Results: At 15:53, the first request for emergency rescue came to the 119 general emergency call center, and a request for DMAT activation came at 16:28. DMAT arrived at the site at 17:04 and remained active until the following day at 00:43. The total number of casualties was 60, including 27 minimal (Green) patients, 29 expectant (Black) patients, three delayed (Yellow) patients, and one immediate (Red) patient. There were 32 patients who received on-site care by DMAT. Two patients were transferred from a local hospital to Wonju Severance Christian Hospital for hyperbaric oxygen therapy. Conclusion: Twenty-nine victims were found in the sports complex building, and there were 31 mildly to moderately injured patients in this fire disaster. The main cause of death was thought to be smoke suffocation. Although DMAT was activated relatively quickly, it was not able to provide effective activity due to the late rescue and difficulty with fire suppression.