기업의 환경문제 대응전략에 관한 소고

김신락 부산수산대학교 1993 (最高經營管理者課程)論文集 Vol.1993 No.10

Craniometaphyseal Dysplasia

김신락,한예식 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.2

관상절개술을 통한 관골 복합골절 치료에 대한 환자의 만족도 조사

김신락,박진형,한예식,예병진 대한두개안면성형외과학회 2011 Archives of Craniofacial Surgery Vol.12 No.1

Purpose: It is difficult to objectively evaluate the outcomes of plastic surgical procedures. The combination of aesthetic and medical factors makes outcome quantification difficult. In this study, fracture reduction accuracy was objectively evaluated in patients with zygomatic complex fractures. Patients satisfaction with the accuracy was also examined. In addition, the patients’ overall satisfaction and discomfort due to complications were analyzed. Methods: Eighty-five patients who had surgeries via bicoronal incision for zygomatic complex fracture from March 2006 to December 2009 were included in this study. Two plastic surgeons evaluated the accuracy of the fracture reduction with postoperative computed tomography. A survey questionnaire was administered to evaluate the patients’ overall satisfaction and the impact of symptoms associated with the procedure on the patients’ daily lives. Results: The overall patient satisfaction rate was 82.1 ± 10.9% (range, 45~100%). The level of deformation was 6.7 ± 10.9%, the levels of discomfort in daily life due to pain, paresthesia, scar, and facial palsy were 8.5 ± 13.2%, 5.8 ± 8.9%, 4.4 ± 9.9%, and 1.9 ± 9.2%, respectively. According to the visual analogue scale, paresthesia was found to be the most frequent symptom (43.5%), and pain was the most troublesome symptom. Conclusion: The use of bicoronal incision for treating zygomatic complex fractures can cause various complications due to wide incision and dissection. However, this technique can provide optimized reduction and rigid fixation. Most of these postoperative complications can cause significant discomfort in the patient. It is thought that the use of correct surgical technique and the accurate knowledge of craniofacial anatomy will result in a reduction of complications and significantly increase patient satisfaction. (J Korean Cleft Palate Craniofac Assoc 12: 17, 2011)

설하신경마비를 동반한 설골골절 : 증례보고

김신락,박진형,한예식 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.2

Purpose: Hyoid bone is a U - shaped bone in the anterior of the neck. Hyoid bone fractures are exceedingly rare and represent only 0.002 % of all fractures because of its protective position relative to the mandible and its suspension by elastic musculature. We report a patient who presented hyoid bone fracture associated with hypoglossal nerve palsy. We also discuss the possible complication and treatment. Methods: A 69 - year - old man was transferred from another institution because of persistent purulent discharge from the left chin. He had a history of trauma in which a knuckle crane grabbed his face and neck in the construction site. A CT scan at the time of the accident demonstrated a comminuted fracture of the right side of the mandible and hyoid bone fracture at the junction between body and right greater cornua. The displaced fracture of hyoid bone and fullness in the pre - epiglottic space were noted, probably indicating some edema. The patient was transferred into ICU after treatment of emergency tracheostomy because the patient showed respiratory distress rapidly. When the patient was hospitalized in our emergency room, he complained of dysphagia and pain when swallowing. On examination of oral cavity, the presence of muscle wasting with fasciculation of the tongue was noted and the tongue deviates to the left side on protruding from the mouth. Pharyngolarygoscopy was performed to make sure that there was no evidence of progressive swelling and pharyngeal laceration. Results: The patient underwent surgical removal of dead and infected tissue from a wound and reconstruction of mandibular bony defect by iliac bone grafting. Hyoid bone fracture was managed conservatively with oral analgesics, soft diet and restricted movement. Hypoglossal nerve palsy was resolved within 7 weeks after trauma without complications. Conclusion: Closed hyoid bone fracture is usually uncomplicated and thus it can be treated conservatively. Surgical intervention for hyoid bone fracture is recommended for patient with airway compromise, pharyngeal perforation and painful symptoms which show no response to conservative care. Furthermore, since respiratory distress syndrome may develop quickly, it is required for close observation. Besides, hypoglossal nerve palsy is a rarely recognized complication of hyoid bone fracture.

Transfacial Surgical Approaches to Secure Wide Exposure of the Skull Base

김신락,이정우,한예식,김한규 대한두개안면성형외과학회 2015 Archives of Craniofacial Surgery Vol.16 No.1

Background: Treatment of skull base tumors is challenging due to limited access andpresence of important neurovascular structures nearby. The success of a complete tumorresection depends on the extent of tumor exposure and secure field of view. Whilethese tumors are often removed by transcranial endoscopic access, transfacial approachis sometimes required depending on the location and size of the tumor. This study describesvarious transfacial approaches in patients undergoing skull base tumor resection. Methods: From March to November 2013, 15 patients underwent skull base tumor resectionvia transfacial accesses at a tertiary institution. Data were reviewed for patientdemographics, type of access used, completeness of tumor resection, surgical outcome,and postoperative complications. Results: Two clivus tumor patients underwent transmaxillary approach; three tuberculum-sellae and suprasellar-hypothalamus tumor patients underwent transbasal approach;three clinoid and retrobulbar intraconal orbital tumor patients underwent orbitozygomaticapproach; and seven petroclival-area, pons, cavernous sinus, and lateral-sphenoid-wingtumor patients underwent zygomatic approach. In all cases, the upper and lower marginsof the tumor were visible. Complete tumor removal consisted of 10 cases, and partial tumorremoval in 5. There were no immediate major complications observed for the transfacialportion of the operations. The overall cosmetic results were satisfactory. Conclusion: Plastic surgeons can use various transfacial approaches according to the locationand size of skull base tumors to secure a sufficient field of view for neurosurgeons.

임상적 기준점을 이용한 얼굴신경 목가지의 해부학적 연구

박진형,김신락,한예식,양희준 대한체질인류학회 2011 대한체질인류학회 학술대회 연제 초록 Vol.54 No.-

The Effect of Platelet-Rich Plasma on Survival of the Composite Graft and the Proper Time of Injection in a Rabbit Ear Composite Graft Model

최현남,한예식,김신락,김한결,김현,박진형 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.6

Background: Administration of growth factors has been associated with increased viabilityof composite grafts greater than 1-cm in diameter. Platelet-rich plasma (PRP) contains manyof the growth factors studied. In this study, we evaluate the effect of PRP injection oncomposite graft viability and the proper time for injection. Methods: A total of 24 New Zealand White rabbits were divided into four groups. AutologousPRP was injected into the recipient sites three days before grafting in group 1, on the day ofgrafting in group 2, and three days after grafting in group 3. Group 4 served as control withoutPRP administration. Auricular composite grafts of 3-cm diameter were harvested and graftedback into place after being rotated 180 degrees. Median graft viability and microvessel densitywere evaluated at day 21 of graft via macroscopic photographs and immunofluorescent staining,respectively. Results: The median graft survival rate was 97.8% in group 1, 69.2% in group 2, 55.7% ingroup 3, and 40.8% in the control group. The median vessel counts were 34 (per ×200 HPF)in group 1, 24.5 in group 2, 19.5 in group 3, and 10.5 in the control group. Conclusions: This study demonstrates that PRP administration is associated with increasedcomposite graft viability. All experimental groups showed a significantly higher survival rateand microvessel density, compared with the control group. Pre-administration of PRP wasfollowed by the highest graft survival rate and revascularization. PRP treatments are minimallyinvasive, fast, easily applicable, and inexpensive, and offer a potential clinical pathway tolarger composite grafts.

A Rabbit Model of Fat Graft Recipient Site Preconditioning Using External Negative Pressure

이정우,한이석,김신락,김한열,김현,박진형 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.2

Background Fat is widely used in soft tissue augmentation. Nevertheless, it has an unpredictably high resorption rate. Clinically, external expansion with negative pressure is used to increase fat graft survival. In this study, fat graft recipient sites were preconditioned by external application of negative pressure in order to test for improvements in vascularity and fat graft survival. Methods Negative pressure was applied randomly to either the left or right dorsal ear of 20 New Zealand male white rabbits at a pressure of –125 mm Hg. The negative pressure was removed one week after the skin perfusion was measured. The skin flap at each ear was elevated, and 1 g of fat was grafted above the dorsal perichondrium. After one week, the fat weight, microvessel density, mature vessel density of the skin and fat, and amount of glycerol released were measured. Three months after the grafting, the same measurements were performed, with the exception of glycerol release. Results The fat survival rate of the experimental group (75.4%±3.9%) was higher than that of the control group (53.1%±4.3%) (P<0.001). Skin perfusion was higher in the experimental group. The glycerol release in the experimental group was significantly higher than in the control. The microvessel density of the skin and fat was significantly higher in the experimental group. Three months after the grafting, the skin and fat mature vessel density was significantly higher in the experimental groups. Conclusions Negative pressure prior to fat grafting increased the vascularity of the recipient site, and, accordingly, enhanced fat graft survival.

Preoperative Identification of a Perforator Using Computed Tomography Angiography and Metal Clip Marking in Perforator Flap Reconstruction

이종우,김한열,김신락,한예식,박진형 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.1

In perforator flap reconstruction, vascular mapping using preoperative computed tomography(CT) angiography is widely used to confirm the existence and location of an appropriateperforator. This study proposes a rapid, accurate, and convenient method for marking theperforator location on the skin surface. For 12 patients who underwent perforator flapreconstruction between November 2011 and November 2013, metal clips were fixed on theskin surface at the anticipated perforator locations, which were decided using a handheldDoppler. CT angiography was used to compare the location between the metal clip and theactual perforator. The metal clip was moved and repositioned, if needed, on the basis of the CTimages. The locations of the appropriate perforator and the metal clip, which were observedduring the surgery, were then compared. In CT angiography, the mean distance between themetal clip and the perforator was 3±3.9 mm, and the mean distance that was measuredduring surgery was 0.8±0.8 mm. In conclusion, we report a simple, rapid, and precisetechnique to indicate the accurate location of the appropriate perforator on the skin surface.

가토의 하복부 축성 피판의 생존 예후 평가를 위한 컴퓨터 적외선 체열 감지기의 유용성

최현남,박진형,한예식,김신락,김한결 고신대학교(의대) 고신대학교 의과대학 학술지 2013 고신대학교 의과대학 학술지 Vol.28 No.2

Objectives: Monitoring viability of flap is important. The flap survival depends on the vascularity of the flap, on which the skin temperature depends. The authors applied digital infrared thermographic imaging (DITI) for monitoring the vascular supply of the flap and for the prediction of the prognosis of the flap survival. Methods: Eight male New Zealand white rabbits with average weight of 3kg were used. A 10 x 10 cm unipedicled fasciocutaneous island flap was elevated based on the left superficial inferior epigastric vessel. The surface temperatures on designed flap were checked with DITI for 24 hours after the operation. On 14th day after the operation, the surviving area was measured and compared with DITI image which was taken on 24 hours after the operation using digital analysis software ImageJ. Statistical analysis was evaluated by paired T-test Results: On DITI image 24 hours after the flap elevation, distal portion of the flap showed remarkable color change. The average percentage and the standard deviation of the survival area of the flap which is predicted by DITI and the average percentage and the standard deviation of the survival area of the flap which was actually measured 2 weeks after flap elevation were 55.3 (16.6), 56.2 (18.0), respectively. This shows no significant difference between the two. Conclusions: This study shows that DITI system could be used in evaluation of flap vascularity with ease, quickness and safety for patient and flap. Thus, it could be used clinically for the prediction of flap survival.