개량된 McIndoe 술식을 이용한 무질증 환자의 질 재건

탁관철,최봉균,최종우,Tark, Kwan Chul,Choi, Bong Kyoon,Choi, Jong Woo 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.1

The reconstructive modalities for vaginal reconstruction include simple dilatation, skin graft, use of intestinal segments and various methods using flaps. However, skin grafting procedure is the most commonly used technique and the McIndoe procedure is a representative technique among skin grafting procedures. McIndoe procedure is easier, faster and has a lower morbidity compared to other techniques. However the conventional McIndoe procedure has several problems such as incomplete vestibule formation, excessive bleeding during dissection, possibility of recto-vaginal or urethro-vaginal fistula formation, late vaginal contracture and discomfort in wearing hard plastic mold for a long time after operation. To solve these problems, the authors modified the conventional McIndoe procedure in several perspectives. The undeveloped vestibule was incised with X-shaped mucosal incision between the urethral opening and posterior margin of the vestibule and deepened by blunt finger dissection to provide a sufficient diameter & length of the neovagina and to minimize bleeding. A sizable medium thickness split skin graft was harvested and wrapped over a roll gauze-filled condom mold. Applying multiple stab incision on the skin grafted condom mold, it was inserted into the prepared neovaginal canal. Distal margin of the skin graft was secured with tips of the mucosal flaps created by X-shaped vestibular incision to prevent accidental extrusion of the skin grafted mold. During last 15 years, we applied this modification to 20 vaginal agenesis patients and investigated results of the 12 patients who could be followed up serially including hematoma formation and skin graft survival rate, size, depth, presence of late contracture, appearance, comfortness, and hygiene of the neovagina. And they were compared with 8 patients of 20 patients who underwent conventional McIndoe procedures. The modified McIndoe procedure revealed lower complication rate, higher patient satisfaction and better functional results.

거대지증 치험 2례

곽동열,이영호,탁관철 大韓成形外科學會 1988 Archives of Plastic Surgery Vol.15 No.4

Macrodactyly is a rare congenital anomaly characterized by an increase in the size of all the elements of structurers o one or more fingers of toes. The condition usually occurs unilaterally and asymmetrically. The authors have recently experienced two cases of pedal macrodacty, which were treated with modified Tsuge technique and we obtained satisfactory results. Thus we represent our methods and cases with a riview of literatures on macrodactyly.

Adriamycin 주입후 생긴 조직손상에 대한 Hydrocortisone의 억제효과

설철환,이혜경,탁관철 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

The objective of this study was to clarify the different inhibitory effects against necrosis according to the injection time of hydrocortisone on adriamycin extravasated wounds. The extravasation of chemotherapeutic agents yields severe inflammatory responses, crust formation, skin necrosis, and ulceration. Thus, many studies on the prevention and alleviation of this tissue injury have been made. However, a comparative study on the inhibitory effect of antidots according to the injection time after extravasation of chemotherapeutic agents has not yet been made. We compared the effect of hydrocortisone succinate on adriamycin-induced tissue necrosis according to its injection time. Sixty mature male Sprague-Dawley rats were divided into 6 groups and each group contained 10 rats. Administration of adriamycin(1.0㎎/ml) 0.5ml by subcutaneous injection on the dorsal side of the rats was followed by injection of hydrocortisone succinate(20㎎/ml) 0.5ml on the same site according to a time protocol. Group 1(the co-ntrol group): adriamycin injection only; gorup 2(the normal saline group): injection of normal saline 30 minutes after adriamycin injection; group 3: injection of hydrocortisone 30 minutes after adriamycin injection; group 4: injection of hydrocortisone 6 hours after adriamycin injection; group 5: injection of hydrocortisone one day after adriamycin injection; group 6: injection of hydrocortisone 3 days after adriamycin injection. Mean areas of ulcer, measured in ㎟, which developed 4 week after adriamycin injection were as follows; group 1 (the control group): 67.3; group 2(the normal saline group):44.8; group 3: 12.9; group 4: 18.9; group 5: 46.7; group 6:72.0. Significant differences among the groups were noted. The groups which received hydrocortisone injection showed smaller ulcers compared to the control group or the normal saline group. As well, earlier injection time correlated with smaller ulcer formation. These findings showed the inhibitory effect of hydrocortisone succinate on tissue damage caused by adriamycin, as well as the increased effectiveness of the inhibitory effect when earlier injections were made. An analysis of this study can be applied in clinical situations for extravasation of adriamycin by administering proper agents such as hydrocortisone succinate. The administration of these agents will also help to minimize tissue necrosis.

Extensor Indicis Proprius Tendon을 이용한 Opponensplasty

한병기,이명선,이영호,탁관철 大韓成形外科學會 1986 Archives of Plastic Surgery Vol.13 No.4

Two patients who lost the ability of opposition of thumb due to electric burn were treated with extensor indicis proprius opponensplasty simultaneous with median nerve repair and excellent functional recovery of the hands was obtained. Extensor indicis proprius opponensplasty has many advantages such as this motor unit is available in volar wrist injuries and combined median & ulnar nerve palsies, either high or low, and require only a single muscle tendon unit without a tendon graft. In this article, we present and discuss the extensor indicis proprius opponensplasty and review the advantages of the method comparing with other methods.

수부의 신경초종: 감별진단과 미세수술의 중요성

탁관철,구현국,Tark, Kwan-Chul,Koo, Hyun-Kook 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: The schwannoma is a benign peripheral nerve tumor arising from the Schwann cell of the nerve sheath. Only 2-8% of schwannomas arise in the hand and wrist. Misdiagnosis is frequent such as ganglion and neurofibroma. This article documents and clarifies the clinical features of schwannomas arising in the hand and wrist, and emphasizes importance of differential diagnosis and meticulous surgical extirpation under magnification. Methods: The author reviewed clinical features of 15 patients with pathologic final diagnosis of schwannoma developed in hand and wrist during the last 12 years from 1998 through 2009. The review included the sex, age of onset, duration, preoperative diagnosis, location, involved nerve, preoperative symptoms and. Postoperative sequelae after surgical extirpation of the lesion with magnification, or without magnification of the surgical fields. Results: The chief complaints were slow growing firm mass in all patients, and followed by pain in 40%, and paresthesia in 40% respectively. The lesions were developed solitarily in 14 patients (93%). The postoperative pathologic diagnosis and preoperative diagnosis were coincided with only in 6 patients (40%). Other preoperative diagnosis were soft tissue tumor in 4 patient (26.6%), and ganglion in 3 patients (20%), and neurofibroma in 2 patients (13%). In all patients who were undergone surgical excision under the fields of magnification, all symptoms were subsided without any sequelae. Meanwhile muscle weakness, paresthesia, hypoesthesia and /or accidental nerve resection developed after surgical excision with naked eye. Conclusion: Schwannoma in hand most commonly appears as a slow growing solitary mass with pain or paresthesia. The chance of preoperative misdiagnosis was 60% in this series. To provide good prognosis and less sequelae, careful and elaborate diagnostic efforts and meticulous surgical excision under the magnification are necessary in management of schwannoma.

강원 지역의 화상발생과 가옥구조와의 상관관계 연구

卓寬哲,柳在德 연세대학교 대학원 1985 延世論叢 Vol.21 No.5

Abstract Many peoples, especially children living in a grouped, crowded housing in a mine field of this country are suffering from terrible burn injury which bring about a disabled and disfigured living through a whole life. Although many excellent surgeons offer their endless efforts to treat burn injury, the results wouldn't be hotter than that of preventing burn injury. The authors reviewer and analysed 703 cases of thermal burn patients who have been admitted and treated at Wonju Christian Hospital, Yonsei University College of Medicine from January 1974 to April 1984, and also made a field survey to prove correlation between house structure and epidemiology of burn injury, so as to find out important factors and ultimately to prevent burn injury. Following results were obtained after analysis and field survey of these patients. 1. The number of patients were increases year after year, and the admitted patients of the year of 1980 were twice of 1974. 2. Males (64.9%) were affected more often than females(35.1%). The moat frequently affected age group was under the age of 10yrs as 54.0%, next was 4th decade, and the older the lower incidence. 3. In regional distribution, Wonju city area was most frequent as 42.8%, and next rest of Kangwon area as 15.0%, Choongbuk area, Sabook area, Sangdong area, Dogye area, Taebak city area came in order. 4. In seasonal occurrence, more frequent in winter and sprint than in summer and autumn, and more frequent in March and April than other mouths of a year. 5. Among the burn occured places, kitchen baa roost frequent as 49.5%, and next room as 23.5%, working places as 15.4%, outdoors as 14.3% came in order. 6. Among the causes of burn injury, scald was moat frequent as 48.5%, and flame as 28.4%, electricity as 7.0%, contact as 4.6% came in order. 7. Among the affected sites of burn injury, multiple Bites were roost frequent as 46.8%, and lower extremity, face, upper extremity, trunk and lower extremity, upper and lower extremity, face and trunk, trunk came in order. 8. In the depth of burn injury, second degree burn was Most frequent as 49.8%, and third degree burn as 48.4%, fourth degree as 1.3%, thirst degree as 0.6% came in order. 9. In treatment and prognosis, conservative treatment was moat popular as 53.5%, and debridement and skin graft as 27.9%, diagnosis only as 16.6%, expire as 8.0% came in order. 10. The average hospital days were 19.5 fays and average dabs from burn injury to death were 11. 9 days. 11. Among the patients who were amputated their digits during the treatment, the most frequent burned placers were working place as 4 cases and next kitchen as 3 cases. 12. Among the expired patients, the moat frequent burned place was kitchen as 30 cases, and next working placers as 11 cabob, room as 10 cases, outdoors as 4 cases came in order. 13. Among the patients who burned at kitchen, the most frequent cause was scald as 76.5%, and next contact as 18.0%, oil stove as 3.7%, boiling oil as 1.9% came in order. 14. The percentages of patients under the age of 10 gears was highest in kitchen burn as 81.4%, and room burn as 50.0%, bathroom burn as 25%, outdoors burn as 17.4% came in order. 15. The percentages of patients under the age of 10 years was highest in Sabook area as 65.6%, and Dogye area as 58.3%, Tieback city area as 56.0% came in order, and was lowerest in Sangdong area as 32.6%. 16. In most of mine fields, the houses have only one room and one door through the kitchen, however in fess burn injuries are Occurring area such as Sangdong area, they have one room with 2 doors, one on the front of the room and the other or the opposite side through the kitchen. 17. We have obtained the conclusion that there is statistically significant correlation between house structure and children's burn incidence.

배양된 인체 혈관내피세포에서 유해산소군에 대한 Polyphenol의 보호 효과

탁관철,설철환,김주봉,나동균 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.6

Snow-Littler Procedure를 이용한 열수의 치료

탁관철,김영석,MuradJafarov 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.4

The variation of cleft hand deformity is so wide that there are many synonyms and classifications for it. Among them the classification of Manske based on the condition of first web space is mostly important in functional perspectives. In type IIb or III of the Manske's classification, in which the thumb web space is narrowed or syndactylized, release and re-creation of the thumb web space is extremely important for functional and aesthetic reconstruction. A representative procedure for correction of the type IIb or III cleft hand is Snow-Littler procedure in which the cleft is released as a palmar-based flap and then transferred to the released first web space for creation of the commissure. During the last 10 years, the authors experienced 38 cases of cleft hand deformity in 30 patients. Among them type IIb or III cleft hand was 5 cases in 4 patients. In all patients, 3rd digit was missing except 1 case and the first web spaces were completely syndactylized. We applied the Snow-Littler procedure for correction of these 5 cases. The functional outcomes and patients' satisfaction were followed up postoperatively. Thumb abduction was possible in range of 59.6±12.3. Intermetacarpal stabilities were well maintained and average pinch power was 2.3± 0.8Kg. In one case partial necrosis of the palmar-based flap tip was occurred. Careful design and preservation of the intrinsic blood supply of the palmar-based flap is extremely important for viability of the flap and successful results.

Z-자 내안각 췌피성형술을 동반한 쌍꺼풀 수술: 그 적응증, 결과 및 주의점

탁관철,김지명 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.6

The formation of pretarsal fold without modification of the medial canthal folds may produce eyes with rounder and narrower palpebral fissures. In the last 6 years, the authors performed double eyelidplasty in 16 patients with Oriental eyelids and type III medial epicanthal fold. In 9 patients, simple double eyelidplasty was performed and in 7 patients double eyelidplasty combined with Z-epicanthoplasty were performed. The aesthetic and functional outcomes, and overall patient satisfaction were followed up in 15 patients up to 5 years.In group of double eyelidplasty only, results were equivalent to Good selectively in only 4 patients who had relatively long preoperative palpebral fissure. The epifolds were sustaining in all patients. Remaining patients showed Fair or Poor results.In group of double eyelidplasty combined with Z-epicanthoplasty, all patients showed Good or Excellent results except one who had defective scar maturation.To achieve apparent aesthetic enhancement and beautiful looking eyes with lengthy palpebral fissure in patients with Type III or IV medial canthal epifold, epicanthoplasty should be combined with double eyelidplasty. It achieves apparent aesthetic enhancement by eliminating the medial epicanthal fold and opening the lacrimal lake widely leaving minimal scar and natural supratarsal skin fold line in a single stage operation.

유리피판을 이용한 경부구축의 교정

탁관철,이충재,유재덕 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.4