Cornelia de Lange 증후군에 동반된 족부합지증

노시균,이내호,양경무 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.4

Cornelia de Lange syndrome was first described by Brachmann in 1916 and later reported by Cornelia de Lange in 1933. It is a rare malformation and retardation syndrome of unknown causes, with characteristic abnormalities including microcephaly, short stature, heavy eyebrows, long eyelashs, strabismus, small nose with anteverted nares, long philtrum, micrognathia, hypoplastic nipples and umbilicus, flexion contracture of elbows, micromelia and hirsutism. Rare cases of possible autosomal-recessive and autosomal-dominant inheritance have been reported. Severe growth and mental retardation are common. Aspiration, apnea, bowel obstruction, and cardiac defects constitute significant dangers during infancy. Failure to thrive is the rule. Also they have common anomaly of upper & lower extremity, example of proximally placed thumbs, clinodactyly of the fifth finger and syndactyly of the second and third toes. We present a case of Cornelia de Lange syndrome, associated with syndactyly of the great toes and the second toes.

Clinical Characteristic and Psychiatric Features of Self-Inflicted Wrist Laceration: A Single Institute Retrospective Study

노시균,조희은,이내호,양경무 대한수부외과학회 2015 대한수부외과학회지 Vol.20 No.1

Purpose: Self-inflicted wrist laceration is a common injury in the department of hand surgery. The aim of this study was to investigate the clinical characteristics and psychiatric features of self-inflicted wrist laceration using categorization according to wound severity. Methods: We reviewed 71 patients from 2002 through 2012. All of the patients were grouped into four groups. Data regarding the following characteristics were collected: age, gender, size, structure involved, instruments used, history of previous self-inflicted injury, comorbidities in psychiatric and presentation of follow-up outpatient appointment to the department of plastic surgery and psychiatry. Results: In these patients, approximately 64% of patients were female. About 80% of patients cut their wrist using a knife. And in grade 3-4 injury, percentage of glass injury was relatively high (22%), compared with other grades (3%). Unlike previous studise, patients in grade 3-4 tended to cut their wrist repeatedly. Focusing on psychiatric problems, approximately one quarter of patients had a previous history of self-infliction. In all patient groups, mood disorder was the most common disorder in patients who had a previous psychiatric disorder. But after operation, more than two thirds of patients had not visited department of psychiatry again. Conclusion: We identified some other differences among their characteristics. All patients in group also should be evaluated and surgically treated properly. A multidisciplinary approach is required for patients with wrist laceration due to self-injury in comparison to those with laceration due to other causes. Because many of them have previous self-injury experiences and psychiatric disease.

소아에서의 미세수지접합술의 경험

신진용,노시균,이내호,양경무 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.3

Purpose: Owing to the improvement of microscope, microsurgery implements, and microsuture, finger replantation has made a considerable development. With high success rate of microsurgery in children, positive results have been reported from distal amputation. We report the patients demographics, methods, and results of the microsurgery performed in children in our hospital for the last 8 years. Methods: From the medical records of 21 patients who had given the treatment in our hospital from January 2000 to December 2007, we analyzed patients’ sex, age, operative method, and complication retrospectively. Results: The number of male patients was twice as many as female, where most patients belong to the ages of five to ten years. Operative methods performed in this study included end-to-end anastomosis of artery and vein, vein graft, and epineurial suture. As a result, 19 out of 21 cases were successfully accomplished, and four of them went through the debridement of necrotic tissue due to the partial necrosis of the lesion. A one-year follow-up observation was made after surgery and most of them were almost fully recovered as in their previous state. Conclusion: The success rate of finger replantaion in children is continuously improving despite the difficulty of vessel anastomotic procedure, rehabilitation treatment and management after surgery. We report the satisfactory results of pediatric finger replantation technically and aesthetically.

협부에 발생한 점액양 지방육종의 치험례

유준호,노시균,이내호,양경무,차은정 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.4

Purpose: Liposarcoma is the most common soft tissue sarcoma, and usually occurs on the thigh or in the retroperitoneal space, but rarely in the oral region. This report presents a case of liposarcoma of the cheek and includes a review of the literatures. Methods: A 21-year-old woman was admitted with a palpable mass in her cheek of about two years duration, which increased in size gradually initially, but had increased rapidly over the three months. There was no particular pain or tenderness. MRI showed a well-enhanced, well-defined mass, which suspected to be hemangioma. Results: The spherical, well-encapsulated mass was surgically excised. Biopsy results revealed myxoid liposarcoma. FDG PET-CT on the seventh postoperative day, revealed a minimal to mild FDG-uptake soft tissue lesion around the mass defect area without evidence of distant metastasis. The patient is being observed and undergoing radiation therapy. Conclusion: Liposarcoma in the head and neck region is a rare disease, and can be overlooked as a benign tumor without a pathologic diagnosis. Therefore, proper treatment and follow-up are required based on an understanding of this disease.

패혈성 쇼크 환자에서 Norepinephrine의 사용 후 발생한 상, 하지의 허혈성 괴사

김성훈,노시균,김성기,이내호,양경무 대한수부외과학회 2012 대한수부외과학회지 Vol.17 No.3

Purpose: Norepinephrine is initially used to increase blood pressure in patients with septic shock. It increases blood flow to vital organs but decrease the flow to end-organs resulting in ischemic changes in end-organs. We report five patients with ischemic necrosis of upper and lower extremities after using norepinephrine in septic shock. Materials and Methods: We retrospectively reviewed medical record of five patients with ischemic necrosis of upper and lower extremities after treating septic shock from March 2010 to March 2011. Results: Five patients developed ischemic necrosis of upper and lower extremities during intensive care. All patients experienced septic shock due to medical problems, which required norepinephrine to increase blood pressure. After conservative treatment, stump revision or below knee amputation were done. Conclusion: We believe that more active treatment and protection of the end-organs will be needed to prevent poor prognosis during the recovery of septic shock. 목적: 패혈성 쇼크 환자에서 혈압 상승을 위해 norepinephrine이 사용된다. 병태생리학적으로 말초 기관으로 혈류를 감소시킴으로써 생명 유지 기관으로의 혈류를증가시켜 말초 기관의 허혈성 변화를 일으킨다. 저자는 패혈성 쇼크 환자에서norepinephrine의 사용 후 발생한 상지 및 하지의 허혈성 괴사에 대해 고찰해보았다. 대상 및 방법: 2010년 3월부터 1년간 총 5명의 환자에서 강심제의 사용 후 발생한 상지 및 하지의 괴사에 대해 본 병원의 의무 기록을 조사하였다. 결과: 패혈성 쇼크로 norepinephrine를 사용한 5명의 환자에 대해 괴사 조직 제거술시행 후, 각 환자에 대해 보존적 치료, 상지 및 하지의 부분적 절단술 및 무릎하 절단술을 시행하였다. 결론: 저자는 총 5명의 환자에서 허혈성 괴사 후 상지 및 하지의 절단술을 시행하였고, 기능적 및 미용적으로 좋지 않은 예후를 보였다. 따라서 패혈성 쇼크로 인한 강심제의 사용 후 생명 활력 징후가 회복된 후에는 말초 기관에 대한 관심 및 적극적 치료가 필요하리라 생각된다.

수질부 축소술과 전층 피부이식술을 이용한 교차수지 피판술

조용현,노시균,이내호,양경무 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.5

Purpose: Typical cross finger flap is still a good method for reconstruction of fingertip injuries. However, it is necessarily followed by great loss and aesthetically unpreferable result of donor finger. Hereby, we introduce a modification of cross finger flap with reduction pulp plasty and full thickness skin graft, with which we could reduce the defect size of injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Method: This method was performed in the patients with fingertip injuries of complete amputation or in case of loss of fingertip due to necrosis after replantation. Firstly, reduction pulp plasty was performed on the injured finger to reduce the size of defect of fingertip. Additional skin flap was obtained from the pulp plasty. Secondly, cross finger flap was elevated from the adjacent finger to cover the defect on the injured finger. At the same time, defect on the donor finger produced by the flap elevation was covered by full thickness skin graft with the skin obtained from the pulp plasty of injured finger. Results: Flap and graft survived without any necrosis after surgical delay and flap detachment. All of them were healed well and did not present any severe adversary symptoms. Conclusion: Cross finger flap with reduction pulp plasty and full thickness skin graft is an effective method that we can easily apply in reconstruction of fingertip injury. We think that it is more helpful than the usual manner, especially in cases of children with less soft tissue on their fingers for preservation and reduction of the morbidity of donor finger.

Alar Extension Graft를 이용한 콧방울뒤당김의 교정

김현수,노시균 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.1

Purpose: The importance of the deformities in alar - columellar complex has been underestimated in Asian ethnic groups for the last few decades. Fortunately, with increasing familiarity of the open rhinoplasty techniques, the anatomic details of the nasal tip have been pointed up. Definitely, having an interest and demand for improving the sub-normal relationship between the alar rim and columella are indebted for such growing of knowledge about nasal tip anatomy. However, it is true that any single procedure is not settled as versatile and fully confident modality to correct the retracted notching of the alar rim. With this article, I would like to propose another useful option for treating retracted ala. Methods: The authors have tried to correct alar rim retraction by means of: (1) Triangular onlay septal cartilage graft on the lower lateral cartilage with the medial end fixed to the anterior surface of the lateral crus(Alar extension graft), (2) Inserting lateral end of the alar extension graft to the vestibular skin pocket in the form of a finger-in-groove, (3) using the vestibular skin in the form of an advancement flap, and (4) using the soft shield graft to prevent possible visible step-off of the alar margin. Results: The authors applied an alar extension graft to 16 patients in order to correct a retracted ala for the last 27 months (August 2003-October 2005). The distance from alar rim to long axis of nostril was improved to be within 2mm in all cases, and also the shape of the alar rim changed to a round form. Nostril asymmetry (6%) was observed in one case, temporary palpable step-off (18%) in three cases, temporary visible step-off (6%) in one case, and temporary paresthesia of the tip (25%) in four cases, respectively. Conclusion: The alar extension graft is simple and efficacious. It does not need donor sites other than the operative field, and its results are predictable. In particular, since it may give structural intensity to a weak lower lateral cartilage, it may be preferentially used for the correction of a retracted ala that arises from hypoplastic lower lateral cartilage. Moreover intensified lower lateral cartilage also improves the esthetic shape of lobule.

귀밑샘의 상피세포-근상피세포 암종 치험례

배우식,노시균,이내호,양경무,강명재 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.4

Purpose: Epithelial-myoepithelial carcinoma (EMC) represents about the 1% of the malignant neoplasms in the salivary glands and clinically most commonly found localized, well defined and sometimes presents orofacial pain. Treatment of choice is surgical excision. Postoperative radiotherapy can be used when surgical margins are doubtful. We report our experience of EMC of the parotid gland. Methods: A 78-year-old man presented with a threeyear history of a localized, painless, 7 × 6 cm sized recurred tumor in his right preauricular area. He was diagnosed as EMC of the right parotid gland. So a total parotidectomy was performed. In his old medical history, he had a mass in the same area 5 years ago. The diagnosis of pleomorphic adenoma was made and the mass excision was performed at the local clinic without further evaluation. Results: It was unable to visually discriminate between the tumor and the normal tissue. So a total parotidectomy was performed. The patient was got post-operative radiotherapy and was followed up for 9 months. There was no specific evidence of recurrence. Conclusion: We present a case of EMC of the parotid gland in right preauricular area, which is uncommon. So we report a uncommon case of EMC to discuss about our experience with relevant journal discussion.

Clinical Experience of Morel- Lavallee Syndrome

김선우,노시균,이내호,양경무 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.1

Versatility of the Distally-Based Sural Artery Fasciocutaneous Flap on the Lower Leg and Foot in Patients with Chronic Disease

JinSuPark,노시균,이내호,양경무 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.3

Background A recent advancement in microsurgery, the free flap is widely used in the reconstruction of the lower leg and foot. The simple and effective methods of local flaps, including transposition and advancement flaps, have been considered for patients with chronic debilitation who are unable to endure long surgical procedures or general anesthesia. However,the location and size of the wound may restrict the clinical application of a local flap. Under these circumstances, a sural flap can be an excellent alternative, rendering satisfying clinical outcomes in chronically debilitated patients. Methods Between 2008 and 2012, 39 patients underwent soft tissue defect treatment by sural artery flap as a final method. All of the patients had at least one chronic disease or more (diabetes, hypertension, vascular disease, etc.). Also, all of the patients had a history of chronic lower extremity ulceration, which revealed no response to several months of conservative treatment. Results The results of the 39 cases had a success rate of 100% with 39 complete recoveries. Nine cases suffered complications: partial necrosis (n=4), wound dehiscence without necrosis (n=3), hematoma (n=1), and infection (n=1). Conclusions The sural artery flap is not only useful for the lower leg but also for the heel, and other various parts. Furthermore, it is a relatively simple surgical technique for reconstructing the defect area for patients with various chronic conditions with a high surgical risk or contraindications to surgery.