Management of Malignant Melanoma

문구현 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.5

내시경을 이용한 전두부 지방종 제거술

문구현 충북대학교 의학연구소 2000 忠北醫大學術誌 Vol.10 No.2

연구목적: 지방종은 성형외과 영역에서 가장 흔히 접하게되는 연부조직 양성 종양이다. 작은 표재성 지방종은 증상이 없으나 안면부에 발생시에는 눈에 쉽게 띄기에 수술적 치료를 요하게 된다. 전통적인 안면부 지방종의 치료법은 피부절개를 통한 제거술이나 이는 술후 해당부위에 반흔이 필연적으로 남게된다. 최근 성형수술 분야에서 내시경의 이용이 점차 늘고 있어 최소한의 절개만으로 원하는 결과를 얻는 수술법들이 속속 소개되고 있으나 아직 안변부 지방종에 내시경을 이용한 보고가 없어 저자는 내시경을 이용한 지방종 적출술을 시도하여 이의 유용성을 확인하고자 하였다. 대상 및 방법: 최근 18개월간 전두부에 발생한 지방종 환자 4례에서 내시경을 이용한 적출 술을 시도하였다 종괴의 크기는 직경 2.0 -2.7cm 이었고 2개가 떨어져 동시에 발생했던 1례를 제외하고는 모두 단일 병변을 지니고 있었다. 직경 4mm의 내시경을 이용하여 전부두 골막하 박리와 종괴 적출을 시행하였다. 결과: 눈에 띄는 부위에 반흔을 남기지 않고 모든 례에서 성공적으로 종양을 제거할수 있었고 혈종, 감염, 신경손상과 같은 합병증은 발생하지 않았다. 조직학적 검사상 보두 지방종으로 확인되었고 모든 환자들은 미용적으로 매우 만족해 하였다. 추적 관찰에서도 지방종의 재발이나 전두부 윤곽 변형등의 이차적인 합병증은 발생하지 않았다. 결론: 본 수술법은 원위부 절개를 통해 보이는 곳에 반흔을 남기지 않으면서도 전부두에 발생한 지방종 제거에 효과적인 방법이라고 사료되며 안면 다른 부위에서도 선택적으로 이용할 수 있으리라 판단된다. Purpose : Lipomas are probably the most common benign soft tissue tumor presenting to the cutaneous surgeon. Small superficial lipomas are symptom free but facial location rendered patients to receive surgery because of cosmetic concerns. Traditional treatment of facial lipoma has been direct excision with incision placed over the tumor which resulted in linear scar on corresponding location. In recent plastic surgery fields, endoscopy-assisted procedures are widely applied for minimal Incision technique so the author tried endoscopic extirpation of facial lipomas to evaluate it's efficacy. Materials and Methods: Four patients having forehead lipomas are included in this study. Diameter of the lesions were ranged from 2.0 to 2.7 centimeter and all had single mass except one case with double lesions. 4mm diameter endoscpoe was used for subperiosteal dissection and lipoma removal. Results: All tumors are successfully removed without noticeable scars on forehead and other morbidity like hematoma, infection and nerve problem. Histologic confirmation of lipoma was done. Cosmetically patients were very satisfied with the results and during follow -up, late comlications like recurrence and contour irregularity didn't occurred. Conclusion : The author concluded this endoscopy assisted extirpation with remote incision results in cosmetically excellent results and should be primary option in facial lipoma treatment.

Indications, Outcomes and Complications of Pedicled Propeller Perforator Flaps For Upper Body Defects

문구현 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.1

좌골부 및 전자부 욕창의 재건을 위한 후대퇴근막 피판술

문구현,방사익 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적: 욕창은 장기적으로 반복되는 압박으로 인해 피부 및 연부조직에 생긴 괴사를 말하며 이는 주로 골 돌출부 주위에 잘 발생한다. 이러한 욕창은 교통사고 및 산업재해의 증가로 척추손상 및 지체마비 환자가 늘어나고 집중 치료를 요하는 의식불명, 만성병증의 환자수가 증가하면서 그 발생 빈도도 증가 하고 있다. 그리고 욕창은 천골부, 대전자부 및 좌골부 등에서 호발한다. 추후에 보행이 가능한 환자의 경우 근피판보다는 근육을 보존할 수 있는 근막피판을 사용하는 것이 수술 후 보행에 더 도움을 줄 수가 있다. 그러므로 기존에 수술적 치료를 시행한 환자의 경우나, 욕창의 크기가 큰 경우, 추후에 보행이 가능한 환자에게 있어서 사용할 수 있는 술식의 유용성을 확인하고자 했다. 대상 및 방법 : 1999년 9월부터 2000년 8월까지 본원에 입원 중이던 6 례의 전자부 욕창과 5례의 좌골부 욕창을 가진 남자환자 7명, 여자환자 4명을 대상으로 하였으며, 원인별로 볼 때는 하반신 마비가 가장 많았다. 하둔부동맥 및 대퇴 심동맥의 제 1, 2 심부관통동맥으로부터 혈액공급을 받는 후대퇴근막피판을 작성한 후 피판을 전위하는 방법을 사용하였다. 결과: 피부 괴사등의 합병증 없이 모른 예에서 결손 부위을 막을 수가 있었으며 적당한 연부조직을 함께 전위 시켜줌으로 해서 추적관찰 기간 동안 욕창의 재발을 방지 할 수 있었으며 보행이 가능한 환자에 있어서도 보행에 문제가 없었다. 결론: 하둔부동맥 및 대퇴 심동맥의 제 1, 2 심부관통동맥으로부터 혈액 공급을 받는 후대퇴근막피판술은 수술이 쉽고, 출혈이 비교적 적으며 수술시간이 짧고, 피판 공여부의 봉합이 쉬우며, 보행 가능한 환자에서는 하지 근육의 기능을 보존할 수 있고, 만약 욕창이 재발 시 피판을 재거상 하여 전진시킴으로서 치료가 가능하며, 근육의 손상을 주지 않으므로 재발시 다른 수술 적 방법을 고려할 수 있는 여러가지 장점이 있는 술식이라 판단된다. Purpose : Pressure sore is an area of ischemic tissue loss resulting from prolonged or often repeated pressure, usually over a bony prominence of body. There has been recent reports describing superior durability of fasciocutaneous flap in sore reconstruction over musculocutaneous flap. Contrary to common musculocutaneous flap using gluteus & harmstring muscle, posterior fasciocutaneous flap does not incorporate any muscle, making it useful especially in ambulatory patients. Material and Methods : From September 1999 to October 2000 we have used posterior thigh fasciocutaneous flap for coverage of six trochanteric sores and five ischial sores. Posterior thigh fasciocutaneous flap is perfused by first & second profunda femoris perforating arteries. Results: All the patients recovered without any serious complications. Three cases developed minimal hematoma but it was corrected by simple evacuation. During the follow up period none of the patients were recurred and for those patients who were able to walk, there was no problem in walking. Conclusion : Posterior thigh fasciocutaneous flap has several advantages. It is easier to elevate, less operation time, less hematoma formation, good donor site morbidity and making possible to preserve the muscle component.

倫落女性에 對한 現況 및 性病에 關한 硏究

文九鉉 慶北大學校 1964 論文集 Vol.8 No.-

Five hundred and ten prostitutes living in Taegu, Kyung Joo, and Pou Hang areas were investigated for their present conditions and morbidities of the venereal diseases. Bacteriological studies of 28 strains of gonococci, 33 of coagulase positive and 75 of coagulase negative staphylococci isolated from the cervix were also made, and the following results were obtained. Ⅰ. Present conditions of prostitutes. 1. Ages of 66.6% of prostitutes were from 21 to 25 years. 2. Ages of menarche ranged from 16 to 19 years in most cases (80%). 3. First sexual intercourse was made under the ages of 20 years in 77.0%. 4. 89.0 per cent of prostitutes had not received an education higher than the level of primary school. 5. In 62.4% of prostitutes, it was found that they had no jobs in the past. 6. Important motives of the first sexual intercourse were love affaris (48.0%) and prostitution (22.0%). First intercourse of most of prostitutes (82.0%) was extra-marital. 7. Causes of fall into the misery were the difficulty in economic condition (57.1%0, seduction (27.6%) and abandonment (15.3%). 8. Prostitutes from urban areas showed a little higher percentage than those from rural areas. Ⅱ. Venereal diseases. 1. Lesions and/or pus discharges in the cervix were found in 51% of prostitutes and cervical erosions in 33.2%. 2. Gram negative diplococci in discharges were observed intracellularly or extracellualry in 31% of persons examined, and a high incidence of Gram negatice diplococci was noted among prostitutes for Koreans than in those for U.N. Forces. The appearance of leucocytes and Gram positive diplococci in discharges were almost the same in the both groups of prostitutes. 3. Thirtytwo strains of gonococci were isolated from specimens showing Gram negative diplococci upon staining, and three strains from those showing no Gram negative diplococci. 4. Thirtyfive strains out of 95 Gram negative diplococci showing positive oxidase reaction were identified as gonococci and the remaining as N. catarrhalis, N. sicca, N. flava or mimea group. 5. Gonococci were sensitive to penicillin, less sensitive to terramycin and erythromycin, moderately resistant to chloramphenicol, kanamycin and albamycin, and highly resistant to streptomycin and sulfadimethoxine. 6. One hundred and sixtytwo strains of staphylococci were/isolated from cervical discharges, and 33 strains of them were coagulase positive. 7. Among 33 strains of coagulase positive strains, 20 strains were identifed belonging to phage groupⅠ, one mixed group and 12 non-typable. Strains belonging to groupⅠ were identified as phage type 29 and one belonging mixed group as 29/6. 8. The sensitivity of staphylococci to various antibiotics showed no marked difference between coagulase positive and negative ones. Most of the strains were sensitive to antibiotics, and very few of them were resistant. 9. Serological test for syphilis was positive by VDRL test in 10.5% of prostitutes, while Syphilis recenta was not found. The incidence of positive VDRL test was higher among prostitutes in areas of poor sanitation and higher among those for Koreans. 10. Chancroid was found in 11 cases (1.9%) but Lymphogranuloma venereum and Granuloma inguinale were nor found.

Ⅵ. 泌尿器系統에 있어서의 Sulfa劑의 應用

文九鉉 中央醫學社 1961 中央醫學 Vol.1 No.6

Osseointegration을 이용한 절단된 수지 재건의 임상치험례

방사익,박양수,문구현 충북대학교 의과대학 충북대학교 의학연구소 1998 忠北醫大學術誌 Vol.8 No.2

연구목적 : 절단된 무지의 재건시 족지 유리전이술,무지형성술등이 시행되어왔으나 이는 숙련된 기술을 요하고 공여부의 희생이 문제되어왔다. 보다 기술적으로 용이하고 간편하며 쉽게 적용할 수 있는 수술법을 찾고자 골통합술을 무지결손환자에게 시도하였다. 재료 및 방법 : 수지절간 관절부위의 외상성 무지절단환자에서 골통합 티타늄 고정기을 이용하여 무지보형물을 무지근위지골에 접합시키려 2단계 수술을 시행하였다. 1단계로 장골 해면 질골이식과 같이 고정기를 근위지골 원위단 골수강래에 삽입시켰다. 고정기가 주변골과 통합이 되는 3개월째에 고정기를 노출시키고 그 위에 접합체를 고정시키는 수술을 실시하였다. 2주후 무지보형물을 접합체를 이용 고정기에 고정시킬수 있었다. 결과 : 술후 12개월간 추적관찰한 결과 고정기의 골통합이 유지되었고, 피부괴사 등의 합병증은 발생하지 않았으며 어느정도의 식별촉각을 보였다. 결론 : 절단된 수지의 재건에 있어서 골통합을 이용한 보형물법이 선택적 경우에 효과적인 대안이 될 수 있겠다 Purpose : Reconstruction of amputated finger is challenging field. Free toe-to-finger transfer, pollicization are well-known useful methods but require skillful techies, sacrifice of donor digit. To find and evaluate more readily appliable method, we tried to reconstruct amputated finger using osseointegration. Materials and Methods : A case with traumatic amputation of the thumb at the interphalangeal joint level underwent two stage reconstruction aimed at fixation of a thumb prosthesis to the first proximal phalangeal bone via an osseointegrated titanium fixture. The first stage included insertion of the fixture into the medullary cavity of the first proximal phalanx in combination with transplantation of cancellous bone from the iliac crest. After 3 months. when the fixture was firmly integrated into the bone, a skin-penetrating abutment was placed on top of the fixture, the surrounding skin being thinned to the thickness of a split-thickness skin graft to minimize relative mobility. A thumb prosthesis could then be firmly attached to this fixture. Results : At follow-up examination at 12 months postoperatively, good osseointegration of the implant persisted. There was no skin problems. Some extent of tactile discrimination was achieved in the prosthesis hypothetically based on transfer of tactile stimuli to endosteal nerves in the bone via the titanium fixture. Conclusion : Amputated finger can be successfully reconstructed using osseointegrated implant without sacrifice of donor toe or finger.

慢性前立腺炎 療法의 實際

文九鉉 中央醫學社 1962 中央醫學 Vol.3 No.1

Nd:YAG 레이저를 이용한 피부혈관종의 치료

현원석,문구현,방사익,오갑성 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.6

Although Nd:YAG laser(1064nm) showed good reduction effects on treatment of cutaneous hemangioma, its use was limited because of non-selective laser absorption and complications such as scar formation. So, we applied different modalities of Nd:YAG laser for more effective and safe treatment.We applied Nd:YAG laser to 9 patients with hemangioma on upper eyelid, cheek, back, arm, and parotid area from February, 1999 to February, 2002. The age at treatment ranged from 4 months to 4 years. Nd:YAG laser was irradiated both inside of the hemangioma by using a bare fiber through a 16G Tefflon cannula and outside of it by cooling the skin with a ice-cube. Nd:YAG laser was irradiated directly into the lesion through the bare fiber and safely to the skin through the ice cube.The mean number of treatment was 1.8, and the time interval between the next treatment was 4.5 months. The mean follow-up period was 13.5 months. Six patients showed almost full regression. Two patients had surgical excision after laser treatment, and one showed slow regression to be in the clinical observation.

Crouzon씨병 교정치료를 위한 개선된 Frontofacial monobloc advancement와 Cranial vault remodeling 병행수술 방법

문구현,이윤호 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6

Crouzon's disease characterized by exorbitism, retromaxillism, inframaxillism, and paradoxic retrogenia, was first described by Crouzon in 1912. Premature fusion of cranial sutures results in a variety of calvarial deformities, but oxycephaly and brachycephaly are most often observed.¹ According to the severity of deformity and patient's age, the method of surgical correction should be selected. In adults, for reasons of safety, staged operation, first, limited frontocranial remodeling if necessary and facial advancement later, is generally favored. Combined orbitofacial monobloc advancement and frontal repositioning was popularized by Oritz-Monasterio(1978) but this technique has been reserved only for child. Persistent intracranial dead space, increased risk of ascending infection via nasofrontal communication, possibility of frontal bone flap resorption, and some technical difficulties rendered monobloc advancement to be not indicated in adults. We thought that modification and improvement of original monobloc procedure combined with cranial vault remodeling could overcome above mentioned disadvantages. Authors' combined procedure can correct deformities of midface, forehead and cranial vault simultaneously in one stage. We performed our combined surgical procedures of modified frontofacial monobloc advancement and cranial vault remodeling in 22 year-old female patient and obtained successful without complication. Through our limited experience, this new methods probably can be safely applied to the adult patients of Crouzon's disease with calvarial deformities and correct not only front-orbito-facial region but also whole cranial vault deformity in one stage.