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변준희,임영민,유결 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.2
Reconstruction of calvarial bone defects from congenital anomaly or from bone loss due to traumatic or neoplastic processes remains a significant problem in craniofacial surgery and neurosurgery. To facilitate bone regeneration, there have been many trials such as autologous bone graft or allograft, and the addition of demineralized bone matrix and matrix-derived growth factor. Guided bone regeneration is one of the methods to accelerate bone healing for calvarial bone defects especially in children. Pericranium is one of the most usable structure in bone regeneration. It protects the dura and sinus, and provides mechanical connection between bone fragments. It supplies blood to bone cortex and osteoprogenitor cells and enhances bone regeneration. For maximal effect of pericranium in bone regeneration, authors used pericranium as a flap for covering calvarial defects in surgeries of 11 craniosynostosis patients and achieved satisfactory results: The bone regeneration of original cranial defect in one year after operation was 74.6%(±8.5%). This pericranial flap would be made more effectively by individual dissection after subgaleal dissection rather than subperiosteal dissection. In this article, we reviewed the role of pericranium and reported its usefulness as a flap in surgery of craniosynostosis to maximize bone regeneration.
Medpor를 이용한 안와 파열 골절 치료의 임상적 고찰(100명 분석)
변준희 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.3
The treatment and the operation timing for blowout fracture have been controversial, but recently most surgeons advocate early operative treatment for better postoperative results and decreased incidences of diplopia and enophthalmos. This is a retrospective study on early surgical reconstruction of the blowout fracture with ?? (porous polyethlene) implant. From Dec. 1993 to Aug. 1998, 100 patients (83 males and 17 frmales) with blowout fracture were operated using Medpor. The indications for operation were positive symptoms and signs (diplopia, enophthalmos, limitation in forced duction test, and Hess test)or, although without these, fractures larger than 1 cm in diameter proven with orbital CT. The open reduction was done by subciliary or transconjunctival approach and the bony defect was covered with Medpor (thickness 0.85 mm, pore size-over 100 m). The results were evaluated from the 100 patients who have been followed up over 3 months. The average follow-up time was 22 months, with a range of 3 to 47 months. Diplopia, restricted ocular motility and enophthalmos were preoperatively documented in 67, 34 and 14 percent of patients, respectively. Among these 67 patients of diplopia, 63 patients recovered completely and 4 patients, who were operated after 3 weeks after injury, complained minimal diplopia even in postoperative 6 months. Six of 34 patients who were noted of preoperative extraocular muscle limitation showed some residual limitation of inferior rectus or inferior oblique muscle over postoperative 6 months. Two of 14 patients who were noted of enophthalmos were kept mild enophthalmos over postoperative 6 months. With the use of ?? implant, the operation time was shortened compared with the use of the autogenous bone graft and there were no early and late complications due to the Medpor as a synthetic material. Untreated blowout fracture frequently results in delayed diplopia, enophthalmos, or strabismus although preoperative symptoms and signs are absent or minimal. Therefore the operation should be done as soon as possible. Medpor, porous polyethlene implant, is one of the most suitble material for reconstruction of the fractured orbital wall because of its long-term stability, high tensile strength, easy contouring, a virtual lack of surrounding soft-tissue reaction, and low infection rate, and that porous structure is permitted ingrowth of vascular and osseous tissue.
변준희,최문섭 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.2
Epithelioid hemangioma was firstly described by Enzinger and Weiss. It belongs to a group of unusual vascular proliferation accompanying prominent eosinophilic infiltration and synonymous with angiolymphoid hyperplasia with eosinophilia(ALHE). Histopathologically, the lesion is characterized by localized, marginated and relatively symmetrical proliferation of capillaries around a medium-sized vessel with an epithelioid hyperplasia of endothelial cell and marked infiltration of inflammatory cells, eosinophils and lymphocytes. The lesion occurs usually in the dermal and subcutaneous tissue of the head and neck area. We report a case of epithelioid hemangioma occuring on the nasal tip in a 72-years-old man. Microscopically, the lesion consisted of a proliferating vessels surrounded by inflammatory infilatration predominantly composed of eosinophils and lymphocytes. But vessels were lined by conventional-appearing endothelial cells.