두개골 골이식을 이용한 전두골 골종의 치험례

신진용,노시균,이내호,양경무,Shin, Jin-Yong,Roh, Si-Gyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: An osteoma is one of the common benign tumors that penetrate the nasal portion, paranasal and frontal sinus. This tumor is mostly found by radiation test accidentally, however in rare cases; it can be found to be touched or with its symptoms as the tumor grows. We report this case since we found and healed the benign tumor which was affecting orbit and the both sides of fronal sinus. Methods: A 19 year old female patient visited to our hospital due to the mass on her forehead. The symptoms began 3 years ago but no special symptom was found except for touchable mass. She was diagnosed as the osteoma of superior orbital parts and both sides of frontal sinus using X-ray and CT scanning. The size of osteoma was $5{\times}2.5{\times}3.5\;cm$ and indicated the patterns penetrated to the right side of orbital region. The osteoma excision was conducted with coronal incision and wide area of defect part in frontal sinus and superior orbital part were reconstructed by cranial bone graft and resorbable fixation plates. Results: The patient recovered without any postoperative infections or complications and symptoms. Dysaesthesia was found on her frontal area but improved in 1 month after the surgery. Conclusion: The occurrences of osteoma in frontal sinus are rare and can be treated with conservative methods if there are no infections and symptoms. We report this case since we found the benign tumor, which was affecting orbit and the both sides of fronal sinus and healed it with coronal resectomy without any complications.

수부의 고압 분사 손상

김성기,노시균,이내호,양경무,Kim, Seong-Ki,Roh, Si-Gyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: High-pressure injection injury is caused by accidental injection of the high-pressure injection devices in industry. The initial benign appearance of the wound fools patients into delays in an adequate treatment. And it can result in disastrous outcomes such as necrosis and amputation. To avoid the poor prognosis, the injuries require a prompt surgical intervention. The purpose of this article is to recognize the poor outcome of the highpressure injection injury and to introduce an adequate treatment in need. Methods: We have 4 cases of the high-pressure injection injuries in the hand from April, 2005 to March, 2009. Average age is 39 years (30 - 49 years old), 2 cases are the palm of dominant hand, 1 case is the thumb of dominant hand, and 1 case is the palm of non-dominant hand, respectively. We followed up these patients for 20 months on average. In 3 cases, the immediate, aggressive surgical intervention was carried out, but the other one was delayed in early adequate treatment. The wounds were covered by local advancement flap, anterolateral thigh free flap, conservative treatment with antibiotics and dressing. Results: No pathogens after culture were found nor any findings of fracture in imaging study. Conservative treatment, local advancement flap and anterolateral thigh free flap for the open wound resulted in a desirable aesthetic outcome. In a long-term follow up, functional capability of the patient was also satisfactory. Conclusion: Upon initial evaluation, most high-pressure injection injuries present as innocuous wounds with very few symptoms and result in delaying the proper management. And the majority of high-pressure injection injuries will produce significant morbidity to the hand, amputation. And the initial aggressive surgical debridement was needed to prevent the poor outcome. The key to success in treating high-pressure injection injuries of the hand is the prompt aggressive surgical intervention.

광배근 유리 피판술을 이용한 두피 및 두개골 결손의 재건

김성기,노시균,이내호,양경무,Kim, Seong-Ki,Roh, Si-Gyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 2013 Archives of reconstructive microsurgery Vol.22 No.1

Purpose: Reconstruction of scalp and calvarial defects should provide both aesthetic and functional aspects. The inelastic nature of the scalp and previous surgery or radiation preclude the use of primary closure or a local flap. With development of microsurgical technique, a free tissue transfer is a good option. We use the latissimus dorsi myocutaneous free flap for reconstruction. Materials and Methods: A review of all latissimus dorsi free flap reconstructions performed in nine patients from 2009 to 2012 was conducted. There were six males and three females, ranging in age from seven to 69 years, and nine different regions, including five temporal regions, two occipital regions, and two frontoparietal regions. The flaps ranged in size from $9.0{\times}10.0cm$ to $14.0{\times}15.0cm$. Recipient vessels available for microanastomosis were most often the superficial temporal vessels and two patients had anastomoses to the external carotid artery and internal jugular vein. Results: All flaps survived postoperatively. With a median follow-up period of 14 months, no major complications were noted. However, two patients developed minor wound dehiscence, and a hematoma was observed in one patient. Conclusion: We performed the latissimus dorsi myocutaneous free flap reconstruction, which is one of the most popular reconstructive methods. The latissimus dorsi myocutaneous free flap reconstruction has been proven successful in our patients with satisfactory results. During the long term follow-up period, even though depressions were observed on the defect area in some patients, they were treated successfully with cranioplasty. Therefore, we recommend the latissimus dorsi myocutaneous free flap for reconstruction of scalp and calvarial defects.

대상포진 후 발생한 비부의 괴사성 근막염 치험례

배우식,배충상,노시균,이내호,양경무,Pae, Woo-Sik,Bae, Chung-Sang,Roh, Si-Gyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한두개안면성형외과학회 2012 Archives of Craniofacial Surgery Vol.13 No.2

Purpose: Varicella-zoster virus (VZV) infection is a common childhood disease. However, old and immune compromised patients are also at risk. Necrotizing fasciitis is a life threatening infection of the subcutaneous tissues, rapidly extending along the fascial planes. It is associated with a significant mortality rate, reported between 20% and 50%, and is therefore regarded as a surgical emergency. The authors treated a patient, who developed skin necrosis of her nose and left hemifacial area, following VZV infection. There are few literatures concerning this case; therefore, we present a rare case with review of literature. Methods: A 39-year-old woman had shown a localized, painful, multiple bullae and eschar formation in her nose and left hemifacial area for several days. Her skin lesion had rapidly worsened in size and morphology. Results: We diagnosed her as a necrotizing fasciitis, following herpes zoster, and then we performed a debridement of necrotic tissue and took a full thickness skin graft on her nose and left hemifacial area. Now, she was followed up with acceptable aesthetic result after 6 months. Conclusion: Secondary bacterial skin infection following VZV, can cause a result in a higher risk of complications. Among the complication, a necrotizing fasciitis of the head and neck is uncommon, and involvement of the nose is even more rare. Through this uncommon case report, we intend to emphasize the fact that early diagnosis of necrotizing fasciitis is very important, since it frequently necessitates surgical treatment which improves morbidity and leads to good recovery.

비흑색종 피부암 186예의 완전 절제술 후 재건술의 고찰

남경화 ( Kyung Hwa Nam ),노시균 ( Si Gyun Roh ),윤석권 ( Seok Kweon Yun ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.1

Background: Skin cancer is divided into two categories, melanoma and nonmelanoma skin cancer, by its malignant potential. The former is prone to be metastatic and it often requires regional lymph node dissection and chemotherapy, while the latter is rarely metastatic with no need for such further treatment. We report here on the reconstruction methods after surgical removal of skin cancers, with excluding melanoma. Objective: Our purpose was to analyze the reconstruction methods according to the location and size of the lesions after surgical removal of nonmelanoma skin cancers and we report on the clinical findings. Methods: We analyzed 186 cases of nonmelanoma skin cancers that were treated Between January, 2000 and December, 2006 at the Department of Dermatology, Chonbuk University Hospital. The cases were analyzed according to the reconstruction methods for the defects after surgery, the gender ratio, the age range, the lesion site and the lesion size. Results: The mean age of onset was 67.7 years old. The ratio of men to women was 1:1.02. The most common nonmelanoma skin cancer was basal cell carcinoma (66.7%), followed by squamous cell carcinoma (22.1%), and Bowen`s disease (4.3%). The most common site of all the nonmelanoma skin cancers was the face (68.8%), followed by the trunk (7.5%) and scalp (6.5%). The most common reconstruction method was local flap (40.3%), followed by primary closure (38.7%), skin graft (18.8%) and secondary intention (2.2%). In terms of location, the most commonly used method was local flap for the face (50.0%) and primary closure for the trunk (53.3%), scalp (83.3%) and the upper (44.4%) and lower extremities (63.6%). According to the lesions` size, the most common method was flap for tumor between 10 mm and 30 mm in diameter (95.1%), primary closure for tumor less than 10 mm in diameter (66.7%) and graft for tumor greater than 30 mm in diameter (66.7%). Conclusion: We offer this data for the reconstruction methods of nonmelanoma skin cancers and their clinical findings in Korea. (Korean J Dermatol 2009;47(1):18~23)

유두유륜에서 발생한 색소성 얕은 기저세포암

우수한 ( Soo-han Woo ),박수경 ( Su-kyung Park ),김대우 ( Dae-woo Kim ),노시균 ( Si-gyun Roh ),박진 ( Jin Park ),윤석권 ( Seok-kweon Yun ),김한욱 ( Han-uk Kim ) 대한피부과학회 2016 대한피부과학회지 Vol.54 No.9

Basal cell carcinoma, which characteristically develops on sun-exposed areas such as the head and neck, is the most common cutaneous malignancy. The most important risk factor associated with its development is chronic ultraviolet light exposure, and basal cell carcinomas in non-sun-exposed areas are, therefore, rare. In particular, the nipple-areola complex is an extremely rare site for basal cell carcinomas, and only three cases involving this area have been reported in Korea to date. Here, we report the case of a 66-year-old woman with pigmented superficial basal cell carcinoma in the nipple-areola complex. Typical dermoscopic findings were obtained in this case. (Korean J Dermatol 2016;54(9):735∼738)

융기성 피부섬유육종의 치료를 위한 광범위절제술과 모즈 미세도식 수술의 비교 연구: 단일 기관의 경험

송기훈 ( Ki Hun Song ),박진 ( Jin Park ),윤석권 ( Seok Kweon Yun ),김한욱 ( Han Uk Kim ),노시균 ( Si Gyun Roh ),이내호 ( Nae Ho Lee ) 대한피부과학회 2013 대한피부과학회지 Vol.51 No.1

Background: Dermatofibrosarcoma protuberans is a mesenchymal tumor of the skin of intermediate-grade which is a rare condition. The slow growing and aggressive invasion on local tissues are characteristic features of dermatofibrosarcoma protuberans. The treatment for dermatofibrosarcoma protuberans is mainly a surgical excision such as a wide excision and Mohs micrographic surgery. Objective: The aim of this study was to compare the result of wide excision and Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans at a single institution in Korea. Methods: A retrospective review was done for 24 patients diagnosed with dermatofibrosarcoma protuberans and treated surgically from 1999 to 2010 at Chonbuk National University Hospital. Patient demographics, tumor features, surgical features, and recurrence during the follow-up period were evaluated. Results: 13 patients were treated with wide excision, and 11 with Mohs micrographic surgery. There was no metastasis for all the cases. Mean operation time for the wide excision group was 83 minutes whereas 182 minutes for the Mohs micrographic surgery group, and it was a statistically significant difference. However, no significant difference was observed in post-operative defect size, advanced surgical repair and local recurrence in our study. Conclusion: We suggest that wide excision and Mohs micrographic surgery are both successful modalities for the surgical treatment of dermatofibrosarcoma protuberans. Hence, individualized patient and tumor characteristics should be concerned when determining the surgical options for dermatofibrosarcoma protuberans. (Korean J Dermatol 2013;51(1):13∼20)

연골모양 땀관종의 임상, 병리조직 및 면역조직화학적 연구

황수란 ( Su Ran Hwang ),박진 ( Jin Park ),윤석권 ( Seok Kweon Yun ),김한욱 ( Han Uk Kim ),노시균 ( Si Gyun Roh ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.5

Background: Chondroid syringoma is a rare benign tumor composed of epithelial and stromal elements. Studies of chondroid syringoma are lacking in Korea and controversy still exists regarding the stromal cell origins. Objective: To investigate the clinicopathological and immunohistochemical characteristics of chondroid syringoma in Korea. Methods: We included 23 patients who were diagnosed with chondroid syringoma. Results: There was a predilection for males (M : F=2.3 : 1), and the mean patient age was 50.4±15.4 years (range 22∼78 years), peaking in the forties. Of the 23 cases, 22 (95.7%) had it on the head and neck. There were 21 apocrine type cases and 2 eccrine type cases. Apocrine type cases showed decapitation secretion as well as follicular and sebaceous differentiations. Myxohyaline matrix was present in all cases, and in some cases, chondroid, lipomatous, and osseous metaplasias were also observed. In apocrine type cases, inner cell layers displaying tubuloglandular structures expressed cytokeratin, carcino-embryonic antigen, and epithelial membrane antigen, while outer cell layers expressed vimentin, S-100 protein, neuron-specific enolase, and smooth muscle actin. Stromal cell immunophenotypes were similar to those of the outer layer. Conclusion: Chondroid syringoma was most commonly observed on the head and neck in middle-aged males. The apocrine type was far more common than the eccrine type and showed various differentiating characteristics. The matrix may contain myxohyaline stroma with alterations, including chondroid, lipomatous, and osseous metaplasias. Our immunohistochemical study suggests that myoepithelial cells play an important role in the histogenesis of chondroid syringoma and matrix production. (Korean J Dermatol 2014;52(5):302∼313)

피부섬유종의 더모스코피 소견과 조직학적 아형의 상관관계에 관한 연구

황수란 ( Su Ran Hwang ),우수한 ( Soo Han Woo ),이진호 ( Chin Ho Rhee ),박진 ( Jin Park ),윤석권 ( Seok Kweon Yun ),김한욱 ( Han Uk Kim ),노시균 ( Si Gyun Roh ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.10

Background: Dermoscopic features may be useful in verifying the clinical diagnosis and increasing the diagnostic accuracy of dermatofibroma. There have been no systematic analyses of the dermoscopic features of dermatofibroma in Koreans or studies regarding the correlation between dermoscopic features and histologic subtypes. Objective: To investigate the dermoscopic features of dermatofibroma in Koreans and to explore the relationship between the dermoscopic features and histologic subtypes of dermatofibroma. Methods: The study included 83 lesions from 61 patients with dermatofibroma. Dermoscopic examination was performed via hand-held polarized dermoscopy at 10× magnification. Images were documented using a digital camera with a 3-fold optical zoom. Results: The main dermoscopic structures were pigment network (63.9%), white scar-like patch (53.0%), and homogeneous area (50.6%). The frequency of homogeneous area (50.6%), scale (50.6%), ring-like structure (36.1%), exophytic papillary structure (7.2%), and telangiectasia (6.0%) was significantly higher, and globule-like structure (20.5%) and erythema (8.4%) was significantly lower in Koreans than in Caucasians (p<0.05). Eleven dermoscopic patterns including a peripheral delicate pigment network and central white scar-like patch (28.9%) and total delicate pigment network (15.7%) were observed and there was no significant difference compared to Caucasians. Seven histologic types were observed; however, the correlation between dermoscopic features and histologic subtypes was not significant. Conclusion: The most common pattern of dermatofibroma was pigment network and central white scar-like patch in both Koreans and Caucasians. A correlation between dermoscopic features and histologic subtypes in dermatofibroma was not found. These results may be helpful in clinically diagnosing dermatofibroma, especially in Koreans. (Korean J Dermatol 2014;52(10):681∼691)

부분층 피부이식으로 치료한 Nicolau 증후군

조용선 ( Yong Sun Cho ),황수란 ( Su Ran Hwang ),송기훈 ( Ki Hun Song ),남경화 ( Kyung Hwa Nam ),박진 ( Jin Park ),윤석권 ( Seok Kweon Yun ),김한욱 ( Han Uk Kim ),노시균 ( Si Gyun Roh ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.9

Nicolau syndrome is a rare adverse reaction and characterized by the acute onset of necrosis of the skin and soft tissue following intramuscular drug injection. Conservative treatments with dressings, debridement, and pain control are the mainstay of therapy. Surgical intervention such as skin graft is rarely required. We report a case of 21-year-old man with this syndrome on the right buttock after an intramuscular injection of diclofenac in which skin graft was necessary. The lesion eventually required debridements and split-thickness skin graft for reconstruction because it was very extensive and not successfully treated by the conservative method for four months. (Korean J Dermatol 2011;49(9):843~846)