역행안각동맥 피판을 이용한 중안면부 결손의 재건

강낙헌,송승한,이승렬,오상하,서영준 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.5

Purpose: To report our experience of retro-angular flap for reconstruction of the midface defect. The midface, including nose, lower eyelid, and intercanthal area, is the very prominent area of face. Also midface is more vulnerable to trauma and skin cancer and defect of mid face of highly perceptible. Reconstruction of mid face is difficult because of complexity of anatomy and functions. Following factors should be considered in reconstructive prcedure of midface. First, multiple procedure may need for complete the reconstruction of mid face defect. Second, secondary reconstructive surgeries such as flap rotation or skin graft may need for donor site morbidity. Third, the color, texture and thickness of the skin used are not always complacency.Methods: 8 cases of the midface defects (3 cases of lower eyelid, 1 case of intercanthal area, and 4 cases of nose) from skin cancer were reconstructed with retroangular flap from March 2004 to August 2005.Results: Satisfactory result were obtained in color, texture and donor site scar. There was no major complication such as wound disruption, hematoma, and atrophy of flap. But partial necrosis of flap and bulkiness were observed one case in each. Retroangular flap is simple procedure that can be preceded in one stage under local anesthesia closing primary wound closure. It will leave less visible donor scar, acceptable color, texture and thickness of the skin.Conclusion: The retro-angular flap could be suggested as a safe and effective method for midface reconstruction.

여러 가지 가교제가 인체 무세포진피의 안정성에 미치는 영향

강낙헌,윤영묵,우종설,안재형,김진영 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.3

Purpose: Human acellular dermal matrix(ADM) is widely used in the treatment of congenital anomalies and soft tissue deficiencies. But it is rapidly degraded in the body and does not provide satisfactory results. There is a need to improve collagen fiber stability through various methods and ultimately regulate the speed of degradation.Methods: The ADMs were added with various cross- linking agents called glutaraldehyde, dimethyl 3,3'-dithiobispropionimidate to produce cross-linked acellular dermal matrices. 1,4-butanediol diglycidyl ether solution was applied with a pH of 4.5 and 9.0, respectively. The stability of cross-linked dermal matrix was observed by measuring the shrinkage temperature and the degradation rates. The cross- and non-cross linked dermis were placed in the rat abdomen and obtained after 8, 12 and 16 weeks.Results: The shrinkage temperature significantly increased and the degradation rate significantly decreased, compared to the control(p<0.05). All of cross- linked dermises were observed grossly in 16 weeks, but most of non-cross linked dermis were absorbed in 8 weeks. Histologically, the control group ADM was found to have been infiltrated with fibroblasts and most of dermal stroma were transformed into the host collagen fibers. However, infiltration of fibroblasts in the experiment was insignificant and the original collagen structure was intact.Conclusion: Collagen cross-linking increases the structural stability and decreases degradation of acellular dermis. Therefore, decrease in body absorption and increase in duration can be expected.

관골상악골 복합체 골절 환자에서의 안면 비대칭에 대한 임상경험

강낙헌,최상문,김주학,송승한,오상하 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.2

Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. Methods: 369 patients, treated for fractures of the ZMC were included in the study. After operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3 - dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re - evaluated. Gross photographs were obtained at outpatient clinic. Results: Total 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n = 2), lateral displaced comminuted fracture of arch (n = 6), comminuted arch fracture combined posterior root fracture (n = 9), and communited arch and body fracture (n = 12), severely contused soft tissue (n = 9). After the manipulations outcomes were acceptable. Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

토끼의 전층 복벽 결손 재건에서 무세포진피(SureDerm™)와 합성물(PROCEED^®)에 대한 생체적합성 비교 연구

강낙헌,송승한,강대영,안재형,최다미,김진영 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.2

Purpose: Deficiencies of the abdominal wall can be the a result of infection, surgery, trauma, or primary herniation. For abdominal wall reconstruction, synthetic materials have been shown to provide a better long - term success rate than primary fascial repair. But, synthetic materials cannot elicit angiogenesis or produce growth factor and are therefore plagued by an inability to clear infection. As a result of the inherent drawbacks of synthetic, significant effort has been spent on the identification of new bioprosthetic materials. The aim of our study was to evaluate the effectiveness of a synthetic material(PROCEED^Ⓡ) and an ADM(SureDerm™) to repair abdominal wall defects in a rabbit models. Methods: We measured the tensile strength of the SureDerm™ and PROCEED^Ⓡ by a Tension meter(Instron 4482). 16 Rabbit models were assigned to this study for abdominal wall reconstruction. Abdominal defect of 8 rabbits were reconstructed by PROCEED^Ⓡ and the rest were reconstructed by SureDerm™. We assessed gross and histologic examinations for the reconstructed abdominal wall. Results: The tensile strenth of SureDerm™ and GoreTex^Ⓡ is 14.64 ± 0.51 Mpa, 8.54 ± 0.45 Mpa. PROCEED^Ⓡ was estimated above the limits of measurement. Inflammatory reaction of PROCEED^Ⓡ persisted at 32weeks, but SureDerm™ decreased after 16weeks. Vascular ingrowth into the SureDerm™ was seen after 32 weeks. The basement membrane of SureDerm™ changed into a form of pseudoperitoneum. In PROCEED^Ⓡ, it seemed like pseudoepithelial lining was made from the fibrosis around the mesh. Conclusion: In our study, the SureDerm™ not only had less inflammatory reaction and presented more angiogenesis than the PROCEED^Ⓡ, but also had pseudoperitoneum formation. It is expected that SureDerm™ is useful for abdominal wall reconstruction. However, a long - term study of its usage consequences are thought to be needed.

Prader-Willi Syndrome 환자에서 여성형 유방의 치험례

강낙헌,송승한,오상하 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.5

Purpose: Prader-Willi Syndrome(PWS) is a congenital chromosomal disorder characterized by compulsive and early development of obesity. Obesity is identified as the main cause of morbidity in PWS individuals. Also, body change for rapid weight gain, such as gynecomastia, can cause considerable functional and psychological trauma, We corrected successfully gynecomastia in PWS patient, so we reported our experience of surgical method and literature reviews.Methods: A 16-year-old male patient presented with gynecomastia. He was diagnosed as with PWS at pediatric department. We performed reduction mammaplasty using inferior pedicle and Wise pattern. Excision amount was 1350g in right breast and 1415g in left breast. Also, we managed upper and lateral fullness of breast with liposuction.Results: There were no specific complications, such as hematoma, infection, nipple-areola complex necrosis, and so on. Also, aesthetic and functional outcome was acceptableConclusion: We experienced successful correction of gynecomastia in PWS patient, and found advantages of conventional reduction mammaplasty using inferior pedicle and Wise pattern at this specific situation.

수평 끝맞춤 봉합의 변형

강낙헌 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.1

Proper suturing technique is essential for obtaining good cosmetic results and for preventing scarring and poor healing of the wound. Characteristics of an ideal wound closure technique include: providing maximal wound eversion; maintaining tensile strength throughout the healing process; being technically simple and fast for the surgeon to perform; and allowing for precise wound edge approximation without leaving suture marks. There are a large variety of suturing methods available to the plastic surgeon and more than one of these techniques may be appropriate for any single wound closure. The simple interrupted suture is the simplest and most frequently employed type of suture. The vertical mattress suture is used principally to ensure eversion of skin edges, but is rarely indicated on the face. A common technique for wound closure is to alternate a vertical mattress suture with a simple interrupted suture along the length of the wound. This report outlines a new method for closing skin wounds which combines the horizontal and vertical mattress sutures. This horizonto- vertical mattress suture is easy and quick to perform, achieves precise wound approximation, provides good eversion of skin edges maintaining uniform tensile strength, reduces the risk of suture marks and gives good cosmetic results, and it can be widely applicable to the whole body area wound, including the face.

Current Methods for the Treatment of Alveolar Cleft

강낙헌 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.3

Alveolar cleft is a tornado-shaped bone defect in the maxillary arch. The treatment goals for alveolar cleft are stabilization and provision of bone continuity to the maxillary arch, permitting support for tooth eruption, eliminating oronasal fistulas, providing an improved esthetic result, and improving speech. Treatment protocols vary in terms of the operative time, surgical techniques, and graft materials. Early approaches including boneless bone grafting (gingivoperiosteoplasty) and primary bone graft fell into disfavor because they impaired facial growth, and they remain controversial. Secondary bone graft (SBG) is not the most perfect method, but long-term follow-up has shown that the graft is absorbed to a lesser extent, does not impede facial growth, and supports other teeth. Accordingly, SBG in the mixed dentition phase (6–11 years) has become the preferred method of treatment. The most commonly used graft material is cancellous bone from the iliac crest. Recently, many researchers have investigated the use of allogeneic bone, artificial bone, and recombinant human bone morphogenetic protein, along with growth factors because of their ability to decrease donor-site morbidity. Further investigations of bone substitutes and additives will continue to be needed to increase their effectiveness and to reduce complications.

토끼의 전층 복벽 결손 재건에서 무세포진피 ($SureDerm^{TM}$)와 합성물질(PROCEED$^{(R)}$)에 대한 생체적합성 비교 연구

강낙헌,송승한,강대영,안재형,최다미,김진영,Kang, Nak-Heon,Song, Seung-Han,Kang, Dae-Young,Ahn, Jae-Hyoung,Choi, Da-Mi,Kim, Jin-Young 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.2

Purpose: Deficiencies of the abdominal wall can be the a result of infection, surgery, trauma, or primary herniation. For abdominal wall reconstruction, synthetic materials have been shown to provide a better long-term success rate than primary fascial repair. But, synthetic materials cannot elicit angiogenesis or produce growth factor and are therefore plagued by an inability to clear infection. As a result of the inherent drawbacks of synthetic, significant effort has been spent on the identification of new bioprosthetic materials. The aim of our study is to evaluate the effectiveness of a synthetic material (PROCEED$^{(R)}$) and an ADM ($SureDerm^{TM}$) to repair abdominal wall defects in a rabbit models. Methods: We measured the tensile strength of the $SureDerm^{TM}$ and PROCEED$^{(R)}$ by a Tension meter (Instron 4482). 16 Rabbit models were assigned to this study for abdominal wall reconstruction. Abdominal defect of 8 rabbits were reconstructed by PROCEED$^{(R)}$ and the rest were reconstructed by $SureDerm^{TM}$. We assessed gross and histologic examinations for the reconstructed abdominal wall. Results: The tensile strength of $SureDerm^{TM}$ and Gore Tex$^{(R)}$ is $14.64{\pm}0.51Mpa$, $8.54{\pm}0.45Mpa$. PROCEED$^{(R)}$ was estimated above the limits of measurement. Inflammatory reaction of PROCEED$^{(R)}$ persisted for 32weeks, but $SureDerm^{TM}$ decreased after 16weeks. Vascular ingrowth into the $SureDerm^{TM}$ was seen after 32 weeks. The basement membrane of $SureDerm^{TM}$ changed into a form of pseudoperitoneum. In PROCEED$^{(R)}$, it seemed like pseudoepithelial lining was made from the fibrosis around the mesh. Conclusion: In our study, the $SureDerm^{TM}$ not only have less inflammatory reaction and presented more angiogenesis than the PROCEED$^{(R)}$, but also have pseudoperitoneum formation. It is expected that $SureDerm^{TM}$ is useful for abdominal wall reconstruction. However, a long-term study of its usage consequences are thought to be needed.

흰쥐의 도서형 피판에서 CD18 단일클론항체와 Superoxide Dismutase에 의한 허혈 재관류 손상의 억제 효과

강낙헌,한기택 가톨릭대학 (가톨릭신학대학) 대학원 1996 가톨릭大學醫學部 論文集 Vol.49 No.4

온열처치시 Amioride와 DIDS 투여가 마우스 SCK 유방암과 Fas II 섬유아육종의 젖산, GDP 및 GTP 량에 미치는 영향

강낙헌,이수영 가톨릭대학 (가톨릭신학대학) 대학원 1993 가톨릭大學醫學部 論文集 Vol.45 No.1