후두부에 발생한 유피낭종의 특징

최환준,탁민성,최창용,강상규,이영만,Choi, Hwan-Jun,Tark, Min-Seong,Choi, Chang-Yong,Kang, Sang-Gue,Lee, Young-Man 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Congenital dermoid cysts develop during the fusion of the embryo when the ectodermal tissue gets trapped in the line of fusion. Dermoid cysts of the head are rare lesions comprised of epidermal and mesodermal elements. Furthermore, dermoid cysts in the occipital area are extremely rare. Only a few cases of dermoid cysts in the posterior scalp have been reported. Especially, A bilateral, synchronous presentation in this location has not been reported previously in the literature. Methods: All 5 cases had a gradually enlarging mass of the posterior aspect of the scalp. The cysts were mobile, noncompressible, and non-tender, without evidence of an associated sinus tract, skin dimpling, discoloration, or communication with adjacent structures. The CT scan displayed a hypodense cystic lesions about -87 to +24 HU (Housefield units, average +3.2 HU) with hypodense capsule and no postcontrast enhancement. All tumors were found just under the skin, and were well encapsulated, so they were completely removed the mass with adjacent periosteum. Results: On gross findings, all tumors were oval-or round-shaped, and when the cystic tumor was cut open it presented a greasy and caseous substance. Histologically, all specimens contain desquamated squamous epithelium and keratin in the lumen and are encapsulated and lined by keratinized stratified squamous epithelium. And, all cases of posterior mass are the presence of adnexal structures. Conclusion: Appropriate diagnosis requires not only an index of suspicion for this rare tumor a very careful history and search for skin changes. Especially, CT can reveal the exact location of the cyst, its relationship with the adjacent structures. We think that occipital dermoids divide into superficial and deep type. In our cases, because they did not have intra-cranial involvement or fistula formation, they are superficial type. This report describes the clinical and operative aspects of the superficial dermoid cysts and provides a review of the literatures.

안저골절 정복술 후 풍선 달린 카테터와 방사선조영제의 이용

최환준,이한정,양형은,이영만,Choi, Hwan-Jun,Lee, Han-Jung,Yang, Hyung-Eun,Lee, Young-Man 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. Methods: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. Results: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. Conclusion: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

저형성 골수이형성증후군의 항임파구혈청 치료 1예

최환준,박선자,김민철,박재후,이시래,박숙자 大韓血液學會 1991 大韓血液學會誌 Vol.26 No.2

뱀 교상 환자에서 국소 산소치료에 대한 증례보고

최환준,이다운,류형래,김준혁,이준호 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.4

Snakebites, though uncommon, are a potentially serious cause of disability or death. Local symptoms may include pain, edema, or ecchymosis that may progress to skin necrosis or compartment syndrome. This study explores the case of a 4-year-old male patient bitten by a snake on the distal volar aspect of his left ring finger. On physical examination, there were moderate swelling, hemobullae formation, and the skin necrosis was progressing on middle phalanx of ring finger. Fasciotomy and topical oxygen therapy was performed. The topical oxygen therapy (TOT) was started once a day for 90 minutes with 4 L/minute of oxygen flow. TOT is a method of delivering humidified oxygen directly to the wound bed to support the healing of chronic and hypoxic wounds. There is no report on TOT for snakebite injury. In this report, we would like to report on the clinical experience of early surgery and adjuvant TOT with literary consideration. 뱀 교상은 흔하지 않지만 국소 통증, 종창, 홍반, 구획증후군, 조직괴사 등의 국소 부위 증상을 보이며, 전신적인 증상으로 출혈, 쇼크, 혼수, 심한 경우 사망에 이를 수도 있다. 이번 연구는 4살 남아에서 좌측 수부 제4수지 중위지부 뱀 교상 후 중등도의 부종과 수포, 피부 괴사가 진행된 사례를 소개한다. 입원 3일째 근막절개술 및 국소 산소요법을 시행하였다. 국소 산소요법은 하루 한 번, 분당 4 L 속도의 100% 산소농도로 90분간 진행하였다. 환자는 수술 후 추가적인 조직괴사 없이 상피화되어 퇴원하였다. 국소 산소요법은 창상에 습윤한 고압의 산소환경을 제공하여 만성 창상 또는 저산소성 창상의 치유에 도움을 줄 수 있다. 현재 국내 대표적인 독성동물인 뱀 교상에 대해 보조적으로 국소 산소요법을 실시한 보고는 없다. 이에 이번 증례보고에서는 조기에 수술과 보조적 국소 산소요법을 병행하여 치료한 임상적 경험을 문헌적 고찰과 함께 보고한다.

손가락동맥과 동반정맥 구조에 대한 해부학적 연구

최환준,심병관,김철한,탁민성,김준혁,정성균,이영만,Choi, Hwan-Jun,Shim, Byung-Kwan,Kim, Cheol-Han,Tark, Min-Seong,Kim, Jun-Hyuk,Jung, Sung-Gyun,Lee, Young-Man 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.2

Purpose: Many descriptions of the digital arterial anatomy including skin territory of the finger have been published. Relatively few studies on venous architecture of the finger have been performed in this area, in part, attributable to the technical difficulties encountered in dissecting small vessels. The purpose of this study is to present the precise microsurgical anatomy of the vein related to the digital artery and venae comitantes of the components. Methods: Arterial and venous anatomy of their relation to the fingers were examined in 38 specimens of two fresh cadavers and 36 clinical cases. All specimens were evaluated grossly, surgical microscopically, or / and light microscopically to observe the three & two-dimensional structure of the artery and joining vein, evidence of the venae comitantes, and venous valve. Results: No longitudinal venae comitantes along the digital artery were found in any specimens. The size of the venae comitantes of each digital artery was much smaller than other vein, but always existed any level of digital artery. One or two venae comitantes in the digital artery ran spiral, oblique, helical, fibrillar, or irregular branched shape. The authors also found the vein of the finger, that had bicuspid valves, but not in venae comitantes. Conclusion: Recently, venous outflow problem rather than arterial circulation is the most common cause tissue failure after microvascular surgery in the hand. Sometimes, if it is not recognized early, there is an increased risk of tissue damage and loss. The authors concluded that this study presents a useful knowledge for the characterization of the venous structure and evidence for venae comitantes like a venule in the digital artery at varying levels of the finger.

코뼈골절 비관혈적 정복술 후 점막유착에 대한 연구

최환준,탁민성,이용석,최창용 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.2

Purpose: Several authors reported about the post- traumatic nasal aesthetic complications. However, the studies for functional or intra-nasal complications have been rarely reported. The aim of this study is to observe the incidence of intranasal synechia. Methods: We reviewed the data from 401 consecutive patients with nasal bone fracture from september 2006 to December 2007. We enforced evaluation with preoperative CT in all patients but postoperative CT within complicated patients. We classified the nasal bone fracture according to the anatomy and severity of fracture. Type I is nasal tip fracture(15%, n=59), Type II is simple lateral without septal injury(38%, n=152), Type III is simple lateral with septal injury(23%, n=92), Type IV is closed comminuted(20%, n=82), Type V is open comminuted or complicated(4%, n=16). We studied 98 patients with nasal bone fracture who had postoperative symptoms or underwent postoperative endoscopic evaluation. And then we evaluated the postoperative endoscopic finding and nasal synechal formation after operation. Results: The incidence of intranasal synechiae was 15%(n=62). According to the endoscopic findings, the incidence of intranasal synechiae was 10%(n=6) in Type I, 8%(n=12) in Type II, 16%(n=15) in Type III, 24%(n= 20) in Type IV, and 56%(n=9) in Type V, respectively. Additionally, the incidence of subjective nasal obstruction and olfactory dysfunction is 18%(n=72) and 13%(n= 51), while the incidence of symptomatic synechiae of nasal obstruction and olfactory dysfunction is 92%(57/ 62) and 55%(34/62). Conclusion: We identified relatively high prevalence of nasal obstruction and olfactory dysfunction in nasal synechiae. Based on the results of this study, intranasal synechiae really caused airway obstruction(92%). Our data showed significant relationship between intranasal synechiae and severity of the fracture, because of increasing mucosal handling and destructive closed reductional procedures. First of all, education of delicate procedure regarding this subject should be empathized accordingly.

부악하선에서 유발된 양측성 몰입성 하마종

최환준,김선주,이영만,Choi, Hwan-Jun,Kim, Sun-Joo,Lee, Young-Man 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: Whereas oral ranula is relatively common and presents as a cyst in the mouth, the plunging ranula is rare and manifests itself as a mass in the neck with or without an associated oral lesion. The purpose of this study is to examine the clinical characteristics of rare bilateral plunging ranula arising from accessory submandibular gland in order to provide our experience for its correct diagnosis and treatment. Methods: A 13-year-old girl manifests as a slow growing painless, non-mobile swelling in the anterior neck. She underwent surgery via a cervical approach. A pseudocyst was extirpated and adjacent accessory gland tissue and related lymph node were removed. Results: The histologic appearance is characteristically of a cyst, devoiding of epithelium or endothelium, with a vascular fibro-connective tissue wall containing some chronic inflammatory cells and macrophage stuffed with mucin. Pathologic findings represented a form of myxomatous degeneration and lined by condensed connective tissue and granulation tissue. The nature of the accessory gland tissue was same as subligual gland. Although total submandibular or sublingual gland excision was not performed, no recurrence was observed during 6 months follow-up periods. Conclusion: Usually, unilateral plunging ranula develops commonly because of rupture of sublingual gland duct by trauma and extravasation of salivary secretion to the adjacent tissue. But our case developed because of bilateral congenital accessory submandibular gland. This is thought to be a result from a congenital failure of canalization of the terminal end of the duct. Finally, the correct diagnosis is essential for the most effective treatment, which is excision of the ranula and related accessory salivary gland. We performed excision of accessory submandibular gland and plunging ranula and had a good result without recurrence.

연부 조직에 잔류된 금속성 및 비금속성 이물질 Computed Tomography 계수의 임상적 의의

최환준,이한정,강상규 순천향대학교 순천향의학연구소 2010 Journal of Soonchunhyang Medical Science Vol.16 No.2

Computed tomography (CT) theoretically improved detection of foreign bodies and provided more information of adjacent soft tissues. The CT scanner and picture archiving and communications system (PACS) program proved to be an excellent instrument for detection and localization of most soft tissue foreign bodies above certain minimum levels of detectability. The characters of metal and non-metal material in penetrating trauma to the soft tissue, it is often underestimated by physical examination. So, diagnosis of a retained foreign object is always critical and difficult. From March 2007 to February 2009 a study was done with 100 patients who had soft tissue trauma. Axial and coronal CT images were obtained with a CT scanner (HiSpeed Advantage CT/i). And then, we measured CT Hounsfield units (HU) of foreign body to remain in the soft tissue. The metallic foreign bodies consisted of stainless steel (2,222±737 HU), titanium (2,921±218 HU), gold (2,908±325 HU), lead (2,758±539 HU), copper (2,909±228 HU), silver (3,069 HU) and mean value is 2,633±603 HU. Non-metallic foreign bodies consisted of silicone (278±120 HU), glass (947±523HU), polyethylene (32±5 HU), polylactide plate (144±16 HU), stone (1,320±280 HU), plastic (-47 HU), wood (-464 HU) and mean value is 557±526 HU. The PACS program allows one to distinguish metallic from nonmetallic foreign bodies and to individually identify the specific composition of many nonmetallic foreign bodies. This program does not, however, allow identification of the specific composition of a metallic foreign body.

짓니긴 및 벗겨진 손상에서 가로손가락손바닥활을 이용한 손가락 재건

최환준,이인수,최창용,김미선,김준혁,Choi, Hwan-Jun,Lee, In-Soo,Choi, Chang-Yong,Kim, Mi-Sun,Kim, Jun-Hyuk 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: In the finger, there are three major palmar arches in the arterial system. The location of this arches are constant. The middle and distal transverse arches are consistently large (almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. This paper describes our experiences in reconstruction and replantation of the finger using rerouting the transverse digital palmar arch. Methods: 31 patients with injuries according to our classification were treated from March of 2005 to October of 2008. In this study the authors subdivided injuries into those with amputation distal to the insertion of the flexor digitorum profundus (Class I, 31 fingers); those with amputation distal to the insertion of the flexor digitorum superficialis (Class II, 4 fingers). Replantation was performed using the artery-only technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration or converting the arch. Venous drainage was provided by an external bleeding method with partial nail excision, medical leech, and repaired margin. Results: The success rate was 87% (n=27) in class I and 75% (n=4) in class II. The authors conclude that crushing and complete avulsion injuries & amputations are salvageable, with acceptable functional results in select patients, especially those with amputation distal to the insertion of the flexor digitorum superficialis. Conclusion: We performed replantation and reconstruction with only-arterial transposing anastomosis successfully, resulting in good recovery of aesthetic and functional outcome. Three major digital palmar arches, especially distal two branches, give us additional treatment options. In the finger replantation and reconstructive techniques using rerouting healthy the transverse digital palmar arch increase the survival rate of the finger.

신장 이식 환자에서 발생한 안면부 임파종의 경험례

최환준,강상규,이장현,김미선 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.6

Survival rate after renal transplantation has increased by using intense immunosuppressive agents and sophisticated operative techniques were introduced but incidences of malignancy is increasing after transplantation. Renal transplanted patients undergo variable malignancy but the acute T-cell lymphoma originating in the face is relative rare. Cyclosporin A is an immunosuppressive agent with selective inhibitory effects on T lymphocytes. It is currently available to use in organ and bone marrow transplantation recipients. We report a case of acute arising T-cell lymphoma on forehead of a 56-years-old male patient. This patient received renal allograft about 15 years ago. And then for recent 3 years, he takes Cyclosporin A 15mg/day due to allograft rejection. Its pathologic finding was diffuse large T-cell type and exhibited homogenecity of the tumor. He has been followed 3 months and no relapse occurred. We report this case with a brief review of literatures.