이차 유방재건술

안희창,김연환,최승석,안용수 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.6

Purpose: Secondary breast reconstruction is defined as a whole reconstructive procedure to correct complications and to improve the aesthetics when a patient is dissatisfied with her initial reconstruction. We would like to present these particular procedures on previously failed breast reconstruction with analysis of unsatisfactory results. Methods: From June 2002 to August 2008, we performed secondary breast reconstructions for 10 patients with failed breasts. Six patients with implant failure underwent secondary breast reconstructions using free TRAM flaps after the removal of implants. Two patients with partial loss of pedicled TRAM flaps underwent secondary breast reconstruction using Latissimus Dorsi flaps. Two patients with 1 total loss of free TRAM flap and 1 extensive fat necrosis underwent secondary breast reconstruction using implants. Results: The average age of the patients were 36.4 years (26 ~ 47 years). All flaps survived completely and had relatively good aesthetic results in free TRAM cases. There was breast asymmetry in one patient using cohesive gell implants in total loss of previously free TRAM patient, which was corrected by exchanging the implants and placing dermofat grafts. Conclusion: Secondary breast reconstruction differs from primary procedures in several aspects; there are changes in the anatomy and tissue environment of the breasts, and various limitations in choosing reconstruction methods. In addition, the patients may be uncomfortable with previous complication. It is important to consider various factors before deciding to undergo a secondary breast reconstruction carefully with informed consent.

두경부 종양 환자의 이차적 재건술

최은규,안희창 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.6

The purpose of secondary reconstruction for head and neck cancer patient is to manage complications and to improve functional and aesthetic defects following previous surgery. The complications following primary treament of tumor include radionecrosis in bones and soft tissue following radiotherapy, formation of orocutaneous fistula, dehiscence of wounds, secondary infection in wounds, and total or partial necrosis in transferred flaps. Following the resection of tumor some functional deficiencies appear such as dyspnea, swallowing and chewing difficulty due to strictures of reconstructed aerodigestive tract and bulkness of flap. In addition, we performed adjuvant surgery for aesthetic improvement or prosthetic appliance after head and neck reconstruction. We have experienced secondary reconstructions in 29 patients who underwent previous surgical resection for head and neck cancer from June 1988 to March 2000. Ages ranged from 36 to 77 with an average of 58.3. We have performed free flaps in 21 cases, skin grafts in 3 cases, local or regional flaps in 2 cases, and other adjuvant procedure in 4 cases. Secondary reconstructions were successful in all cases. The complicated wounds and fistulae were healed completely, the aerodigastric tract with the stricture was reconstructed with healthy tissue and respiration and swallowing functions were recovered. Aesthetic improvement and prosthetic appliance were also achieved through secondary adjuvant treatment. In conclusion, the successful secondary reconstruction for head and neck cancer needs a careful preoperative planning and therapeutic strategy. We believe that secondary reconstruction for head and neck reconstruction is very important for these cancer patients even though primary resection had been successfully performed for cancer removal, because it can provide better quality of life and sometimes save the patient's life itself.

횡복직근 유리피판 유방재건술후 2차적 보완 성형술

최은규,안희창 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.3

It is very difficult to reconstruct perfectly symmetrical breast in one stage operation. Therefore, it is not uncommon that the surgeons perform secondary touch surgery following breast reconstruction to get more satisfactory results. The purpose of this article is to recognize various morphologic problems which could be occurred following breast reconstruction and to present the secondary touch surgery which can solve this problem for more symmetrical and natural breast reconstruction.From August 1995 to August 2001, breast reconstruction with free TRAM flap had been performed in 53 patients. Among them, 26 patients underwent secondary touch surgery. The patient's age ranged between 26 and 56 years with a mean of 41.3 years. The average time of the operation after breast mound reconstruction was 8.9 months. The nipple-areolar reconstruction was performed at the same time in all cases. There were liposuction in 9 cases, fat mobilization in 7 cases, correction of inframammary fold in 5 cases, scar revision in 11 cases, augmentation mammoplasty for normal side in 3 cases, reduction mammoplasty for normal side in 1 case, and mastopexy in 6 cases. In addition, adjuvant surgeries were performed coincidentally such as abdominal liposuction, and facial resurfacing.The result was effective. The author could make a more symmetrical and natural breast after secondary touch surgery.The advantage of this surgery is to reconstruct a more symmetrical and natural breast by a relatively simple procedure with concomitant nipple-areolar reconstruction

Secondary Stress in Old English: Metrical Evidence

Chang Yong Sohn 현대문법학회 2011 현대문법연구 Vol.65 No.-

This paper attempts to review the validity of metrical evidence for secondary stress in OE (Old English). Initiated by Huguenin (1901), the tradition of reconstructing secondary stress on the basis of meter builds on the isomorphy between language and meter. Even though the prosodic reconstruction from meter has proven to be fairly useful, there are certain properties to be carefully considered in order to argue for the existence of secondary stress in OE. It is argued that verse types, not alliteration, cannot be a reliable source for the reconstruction of secondary stress. Due to the differences with regard to fundamental assumptions on OE meter, the predictions on the placement of secondary stress are not consistent. In addition, most OE metrical systems are not free of inherent circularity between verse types and secondary stress. It is also demonstrated that given the distinct nature of stress assignment, secondary stress in compounds should be distinguished from that in noncompound words. Moreover OE secondary stress cannot be claimed to exist without the precise definition between compounds and noncompound words being properly reflected in the reconstruction process.

이차성 구순열 환자에서 상구순 구륜근 피판중첩을 이용한 인중주의 재건

권석민,박준,양원용,유영천,강상윤 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.5

Purpose: Philtral deformity is a stigma of secondary cleft lip nose. It occurs from the false arrangement of orbicularis oris muscle and the scar of previous operation. Various methods have been used to correct this deformity. We successfully corrected philtral deformity using overlapping of orbicularis oris muscle flap. Received April 25, 2008 Revised May 22, 2008 Accepted August 12, 2008 Address Correspondence: Won Yong Yang, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Kyung Hee University Medical Center, 1 Hoegi-dong, Dong- daemun-gu, Seoul 130-702, Korea. Tel: 02)958-8431/Fax: 02)963-5638/E-mail: psyang@khmc.or.kr *본 논문은 2005년 제 58차 대한성형외과학회 학술대회에서 발표되었음. Methods: From November 2000 to August 2007, we performed 39 cases of correction of philtral deformity in secondary cleft lip nose with overlapping of orbicularis oris muscle flap. Their age ranged from 5 to 53 years old. Existing scar tissue of previous operation was deepithelialized and preserved as scar flap. Lateral orbicularis oris muscle flap was elevated, advanced and overlapped upon medial muscle flap after dissection of orbicularis oris muscle of both sides. Reconstruction of philtral column was made from overlapping area by fixation of end part of lateral muscle flap to the point between philtral dimple and column. The degree of muscle flap advancement was decided by correction state of lateral muscle bulging. Correction of nostril floor depression or whistle deformity was also performed with preserved scar flap, if necessary. Results: Realignments of orbicularis oris muscle were possible in the majority of the patients and final results of philtral reconstruction were satisfactory mostly. Correction of nostril floor depression and whistle deformity was also achieved. Additional correction was performed later to 4 patients in whom insufficient reconstruction was noted. No significant complication was observed. Conclusion: More natural and symmetric philtrum was acquired with overlapping of orbicularis oris muscle flap. To the authors' knowledge, it is an easy and effective method for correction of philtral deformity through anatomical rearrangement of distorted orbicularis oris muscle with relatively simple procedure.

<記憶>のポリティクス -教科書『中等国語』と教材「少年の日の思い出」-

황익구 한국일본사상사학회 2013 일본사상 Vol.0 No.24

This paper analyses textbook and teaching material of post-war Japan taking inspiration from the need to examine how education for children provided platform to reconstruct a “Memory” in post-war period. The main focus is laid on Japanese language textbook “Chuto-kokugo” (Ministry of Education, 1947) and one of its chapters “Shounen-no-hi-no-omoide” (Jugendgedenken, Hermann Hesse, translated by Kenji Takahashi). The “Chuto-kokugo” was the first government-designated textbook after the war, prepared in line with policy of GHQ and the Ministry of Education, which required revision of textbook. In other words, “Chuto-kokugo” was an apparatus developed together by GHQ and Ministry of Education, to disseminate crucial national policy of education reform. Needless to say, objective behind this preparation of textbook was linked to intention of reconstructing “National Memory”. In this sense, it can be said that “Chuto-kokugo” was expected to create a new “National Memory” for the children of postwar Japan, and “Shounen-no-hi-no-omoide” was purposefully included to meet that expectation. “Shounen-no-hi-no-omoide” is a story where protagonist thinks of his mistakes of youth as traumatic and starts telling those traumatic experiences when he became adult. It should be noted that there is a hidden deceptive mechanism, which uses experience of moral reflection for transforming long sealed and never expressed “Traumatic Memory” of “Guilt” and “Self Denial” into positive “Memory of Self-Affirmation”. As a result, this paper reveals that the textbook “Chuto-kokugo” and its chapter “Shounen-no-hi-no-omoide”carried the function making children of the time believe that “Memory” of crime particularly “Memory” of war and “Memory” of colonial rule can be altered by reciting words of “Human Culture and World Peace”. 本論は、戦後占領期における<記憶>の再構築が、子供世代を対象とする教育の場においていかに実現されていったかを検討すべく、当時の教科書と教材を分析したものである。分析対象としては、国語教科書の『中等国語』(文部省、一九四七年)とその収録教材「少年の日の思い出」(ヘルマン・ヘッセ作、高橋健二訳)を重点的に取り上げる。『中等国語』は、敗戦直後、教科書の改訂を必要とするGHQと文部省の方針によって編纂された戦後初の国定国語教科書である。つまり『中等国語』は、GHQと文部省の合作により、教育改革という重要な国家政策を発信する装置として誕生したものである。戦後占領期における教科書の編纂問題が、「国民の記憶」を再構築する問題と連動することはいうまでもない。そのような意味で『中等国語』には、戦後日本の子供たちに新しい「国民の記憶」の創出という期待が託されていたといえる。またその期待を実践する教材のひとつとして「少年の日の思い出」は選ばれたのである。「少年の日の思い出」は、少年時代の過ちをトラウマ的経験と見なす主人公が、そのトラウマ的経験を大人になってから語り出す物語である。注目したいのは、長い間、言語化されず、封印されてきた「トラウマの記憶」を、しかも加害の<記憶>を道徳的な反省を行ったという経験によって自己否定の<記憶>から自己肯定の<記憶>へとすり替えるという欺瞞的なメカニズムが隠されていることである。結局、教科書『中等国語』と教材「少年の日の思い出」は、「人類の文化や世界の平和」を建前に据えながら、加害の<記憶>、とりわけ戦争の<記憶>や植民地支配の<記憶>をも変容可能であることを当時の子供たちに教え込む機能を担っていたことが明らかになった。

Secondary intention healing after conservative surgery of nail unit melanoma in situ: An analysis of healing time and outcomes

( Gwanghyun Jo ),( Soo Ick Cho ),( Je-ho Mun ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Secondary intention healing (SIH) after conservative surgery for nail unit melanoma in situ (NUMIS) can be a useful reconstructive method. However, the healing process and recovery time has not been sufficiently reported. Objectives: To investigate course after SIH with functional surgery for NUMIS Methods: We analyzed 10 patients with NUMIS treated by conservative surgery and SIH in our institution from January 2015 to June 2018. We evaluated healing time, functional outcome, cosmetic outcome, and patient’s subjective satisfaction and complication. Results: Median age was 51 (range: 28-69) years old. Seven patients were female. Seven patients had fingernail involvement. Granulation tissue coverage over phalangeal bone completed in 3.7±2.4 weeks (mean±SD). Re-epithelialization achieved in 10±2.7 weeks. Mean Quick-Disabilities of the Arm, Shoulder and Hand (DASH) score was 9.4±6.2. Foot Function Index (FFI) score was 1.3±2.3. Mean Vancouver Burn Scar Assessment Scale (VBSAS) score was 4.5±1.4. Patient’s subjective global satisfaction was median 8 (range: 7-10). Conclusion: Our data suggest that SIH is a good reconstructive method after conservative surgery of NUMIS.

Secondary Reconstruction of Frontal Sinus Fracture

김양우,이동훈,전영우 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.3

Fractures of frontal sinus account for 5%–12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

Design of a fault-tolerant system for a multi-motor drive with multiple inverter leg faults

Song, Yujin,Zhao, Jin,Sun, Jiajiang The Korean Institute of Power Electronics 2022 JOURNAL OF POWER ELECTRONICS Vol.22 No.11

A novel fault-tolerant system for a multi-motor drive with one-leg, two-leg, and secondary faults is designed in this study. Fault tolerance is realized from pre-fault to post-fault via a topology reconstruction scheme and an integrated control law. The scheme develops a reconstructible topology and its reconstruction algorithm. The multi-motor drive can be reconstructed into appropriate tolerant topologies on the basis of the diagnosis results. The control law based on the predictive torque control method is universal under any topology by designing a unified voltage vector model and an optimal switching state decision. The proposed system can cope with more types of faults and effectively switch from a healthy state to a fault-tolerant state under any fault. The effectiveness and performance of the fault-tolerant system are verified and demonstrated by simulation and experiment results.

Consequence of Synthetic Bone Substitute Used for Alveolar Cleft Graft Reconstruction (Preliminary Clinical Study)

Al-Rawee Rawaa Y.,Tawfeeq Bashar Abdul-Ghani,Hamodat Ahmed Mothafar,Tawfek Zaid Salim 대한성형외과학회 2023 Archives of Plastic Surgery Vol.50 No.5

Background The outcome of alveolar grafting with synthetic bone substitute (Osteon III) in various bone defect volumes is highlighted.Methods A prospective study was accomplished on 55 patients (6–13 years of age) with unilateral alveolar bone cleft. Osteon III, consisting of hydroxyapatite and tricalcium phosphate, is used to reconstruct the defect. Alveolus defect diameter was calculated before surgery (V1), after 3 months (V2), and finally after 6 months (V3) postsurgery. In the t-test, a significant difference and correlation between V1, V2, and V3 are stated. A p-value of 0.01 is considered a significant difference between parameters.Results The degree of cleft is divided into three categories: small (9 cases), medium (20 patients), and large (26 cases).The bone volume of the clefted site is divided into three steps: volume 1: (mean 18.1091 mm3); step 2: after 3 months, volume 2 resembles the amount of unhealed defect (mean 0.5109 mm3); and the final bone volume assessment is made after 6 months (22.5455 mm3). Both show statistically significant differences in bone volume formation.Conclusion An alloplastic bone substitute can also be used as a graft material because of its unlimited bone retrieval. Osteon III can be used to reconstruct the alveolar cleft smoothly and effectively.