자가연골이식을 통한 해부학적 비첨성형술

고법민,강상윤,유영천,양원용 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.1

Augmentaion rhinoplasty is one of the most common aesthetic surgery in Korea. Plastic surgeons have been more interested in not only simple augmentation of nasal dorsum, but making more beautiful and natural nasal tip. In the people who has depressed nasal bridge with round and blunted tip, simple augmentation of the nasal dorsum with silicone or Gore-Tex implants could aggravate the tip's disfigurement, so the need for tip plasty has been more emphasized in those persons.There have been used two traditional techniques in endonasal autogenous cartilage tip graft for increasing tip projection, Sheen's shield graft and Peck's onlay graft. But these techniques have several disadvantages such as displacement, visibility of graft margin and flattening of infralobule. The most criticizable problem is that these grafts have limitation in producing the natural and anatomical tip contour.We have done 45 consecutive nasal tip plasties using anatomically-shaped cartilage grafts which was developed from the idea of combination of Sheen's shield and Peck's onlay graft. We followed up the patients from 2 to 14 months. Most patients have been very satisfied with the results and no serious complications were noted.Author's graft was designed to minimize displacement by stable placement on both alar domal and lobular segments, minimize graft visibility by increasing graft contact to nasal tip skin, manipulate the cephalo-caudal length by modification of onlay thickness, and most of all, reproduce the anatomical tip projection and contour.

ANATOMICAL EXPANDER와 IMPLANT를 이용한 유방 재건의 경험

고법민,박원진,김재중,하범준,이재승,신명수 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

The use of a tissue expander and implant is the simplest option for breast reconstruction after mastectomy. Use of a round dome-shaped prosthesis and the commonly used one-stage technique with a Becker type prosthesis, however, often produces an undesirable upper pole fullness. To overcome this and to achieve improved aesthetic results, we started using an anatomically-shaped expander and implant, as described by Maxwell, as a two-stage breast reconstruction. We reviewed the results of our 21 reconstructed breasts in 22 patients who were deemed suitable for reconstruction using this technique since January 1995. The most commonly used expander was 350cc (range 350-550cc) and an average of 4.2 inflations were required before replacing the expander with a permanent implant. All the expanders were placed in submuscular pockets and implant volume. The longest follow-up was 36 months. Few complications developed and most patients were satisfied with the results. We found that the anatomically-shaped expander and implant produced better aesthetic results compared to a done-shaped prosthesis.

구개열 환자에게 발병되는 중이염에 관한 임상경험

신명수,고법민,박원진,하범준,이재승 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.1

It has been well documented that dysfunction of the Eustachian tube if the main cause of middle ear disease in most cleft palate patients. The middle ear disease is refractory to medical treatment and has frequent recurrences; the final results may end up with chronic otitis media and/or hearing loss. Currently, myringotomy with placement of ventilation tube in early infant stage have been widely accepted for treatment of otitis media in cleft palate patients. We calculated the frequency of the occurrence of otitis media in cleft palate patients who have received palatoplasty in our clinic. Preoperative otoscopic examination and tympanometric test were taken in all patients. We performed tympanostomy and ventilation tube insertion at the time of palatal repair on every patients who had evidence of otitis media in the preoperative otologic examinations. Since November 1996, 79 patients received palatoplasty and among these 63 patients(79.7%) received bilateral ventilation tube insertion simultaneously. We confirmed the previously documented high prevalence of otitis media in cleft palate patients and understood the importance of preoperative otologic examinations in the managements of cleft palate.

광범위 안면부 반흔 성형술에 피부 신장기를 이용한 연속 절제술

김도형,양원용,유영천,고법민 대한미용성형외과학회 2002 Archives of Aesthetic Plastic Surgery Vol.8 No.1

Expanded Polytetrafluoroethylene(Gore-tex?)을 이용한 안면부 미용수술의 경험

유영천,정승일,양원용,고법민 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.1

To date, for facial soft tissue augmentation, numerous implant materials have been used, including autogenous, homogenous, and alloplastic grafts. Among these, the porous material, Gore-tex has a pore (0.5-30 microns, average 22 microns) which allows sufficient but limited soft tissue ingrowth to anchor implants, but not so much to make removal difficult or destructive to adjacent structures. In addition, this material has some advantage: non-carcinogenic, non-allergic, less capsule formation and reduced chance of infection due to high vascularity. In the past years Gore-tex has found multiple applications in facial plastic and reconstructive surgery. However this alloplastic material can be associated with potentially severe complications and side effects such as soft tissue reaction, infection, extrusion, exposure, etc. There have been also adverse criticism of Gore-tex: relative difficulties in postoperative removal, in carving implant, higher infection and extrusion rates in scarred tissue and thicker implant as well as postoperative volume reduction. In order to analyze results depending on the implantation site, the presence of scar on recipient site, thickness and type of implant, a retrospective chart review of 56 patients(69 cases) was undertaken of all patients who underwent facial soft tissue augmentation with Gore-tex graft from November 1998 to November 2001 in a wide variety of situations. All cases were categorized as either primary(normal recipient site) or secondary(scarred recipient site) cases and the thickness of each graft used in millimeters was recorded. Postoperative follow up revealed a stable implant material with no major complications relating to the graft material and no differences in developing complications according to the implantation site, the presence of scar, thickness and type of implant. All patients were highly satisfied with their results.

초기 창상치유 과정에 미치는 키토산 올리고머의 영향

유용 ( Yong Yu ),박원호 ( Won Ho Park ),이상철 ( Sang Cheol Lee ),고법민 ( Bub Min Ko ) 한국키틴키토산학회 2003 한국키틴키토산학회지 Vol.8 No.1

키토산의 해중합 반응은 아질산염을 사용한 탈아민 분해반응에 의해 수행되었다. 키토산 올리고머의 평균 종합도는 키토산의 아미노기에 대한 아질산염의 몰비를 변화시킴으로써 조절이 가능하였다. 키토산 올리고머를 함유하는 연고의 창상치유 효과는 토끼의 귀를 대상으로 한 개방창 실험을 통해 현미경 분석 및 조직학적 검사로 조사해 보았다. 그 결과, 키토산 올리고머를 함유하는 연고시료로 처리된 창상은 7일 후에 거의 상피화가 진행되었고 상처주위의 과립상 조직은 상당부분 섬유조직으로 치환되었다. 따라서, 키토산 올리고머를 함유하는 연고는 제조의 용이성 및 높은 치유효과를 가지는 창상치유제로 유망하다는 사실을 확인할 수 있었다. Depolymerization of chitosan was carried out by deaminative cleavage using sodium nitrite. The average degree of polymerization of chitooligosaccharide (COS) could be controlled by varying the molar ratio of sodium nitrite and the amino group of chitosan. The accelerating effect of the ointment containing COS on open wound healing in rabbits was investigated by macroscopic and histological examination. The COS was found to be very effective as a wound-healing accelerator. The wound treated with COS ointment was almost reepithelialized, granulation tissues in the wound were considerably replaced by fibrosis at 7 days after initial wounding. The COS oinment is considered to be a suitable wound healing agent due to its easy preparation and high effectiveness.