최근 10여년간의 하악골 골절 250예에 대한 임상적 고찰

손문방,박일홍,박병윤 대한외상학회 1994 大韓外傷學會誌 Vol.7 No.1

The frequency rate of accidents has been rapidly rising up along with the intricate transportation device and machinerry industry in move complexed social structure caused by rapid development of civilization, and therefore, results in a rapid increase of facial injury. The frequency rate of mandibular fracture comes in next to the most commonly occuring nasal bone fracture. The mandible differs from other facial bones in its unique anatomical structure of a mobile skeleton, so that, non union of mandibular fracture may incur a restriction of speech or facial deformity which impedes sociopsychological life of the patient. An accurate diagnosis and proper treatment of mandibular fracture is therefore, important to achieve the ultimate postoperative status and thus prevent complications. Of the numerus reports on facial bone fractures, none has been made on the mandibular fracture in the aspect of plastic surgery, that hereby, report on the 250 patients of mandible fracture, treated at the department of plastic and reconstructive surgery, Shinchon and Youngdong severance hospital, Y.U.M.C. in recent 14years.

피하조직내 매몰법을 이용한 수지첨부 절단부의 재접합술

손문방,이훈범,정일화,탁관철,이영호 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.2

The microsugical technique in the reconstruction and replantation at various amputated parts of the body has recently been advanced and rooted as inevitable and necessary basic operative procedure in the field of plastic and reconstructive surgery. Although the success rate in the replantation of amputated digits at the proximal and middle phalanx is high, the result of microreplantation of finger amputation at the level of distal phalanx has been unsatisfactory. especially in cases involving amputations through the region between the DIP joint and lunula. The authors have obtained good results by using the method of subcutaneous pocketing, and report clinical cases along with al review of the references. From August, 1991 to August, 1993 there were 8 cases of finger amputations at the level between the DIP joint and lunula, and instead of implementing microvascular replantation, the authors performed subcutaneous pocketing of amputated distal phalangeal parts after deepithelization, nall extraction and fixation.

박피술에 의한 신생아의 선천성 거대 모반증의 치험례

손문방,신극선 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.5

The congenital giant nevus in neonates not only gives na unsightly appearance, but also has a malignant transformation potential. The incidence of malignant transformation varies from 2 to 32%. Recently, Quaba and Wallace (1986) reported that the giant nevus which covered more than 2% of the total body surface area could become malignant within the first 15years of life with an incidence rate of 8.52%. We treated a neonate with a giant nevus which involved extensively the abdomen, back, buttocks and thighs; the lesion was dermabraded by two times within 5 months age. After 14 months of the follow-up, no signs of recurrence were noted; the result was acceptable in the aesthetic standpoint and for a preventive measure of malignant transformation.

일측성 구순열-비변형의 환측과 정상측의 비익 외각연골의 비교연구

박병윤,손문방,이영호 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.5

The etiology of unilateral cleft lip nose deformity is a subject of considerable debate. One theory holds an idea that the deformity is caused by intrinsic factors whereas another theory attribute the cause of deformity to external factors such as differnce in the tension of soft tissue and muscle translocation. The exact cause of the cleft nasal deformity is not known, but some investigators think that the deformity is caused by the hypoplasia of lateral crus of alar cartilage. To find out whether the deformed alar cartilage is hypoplastic, we measured the lateral crus of alar cartilage of both sides in 18 patients for the past 10 years. The lateral crus of alar cartilage was brought out of the soft tissue of the nose by dissection them from the skin and mucosa through the inverted W-incision or open rhinoplasty incision. Thickness of both lateral crus of sleft and non-cleft sides was measured with a caliper. To apprais with a caliper. Also, width and length were measured with a caliper. To appraise the histopathology, randomly seleted 8 cases of specimens were obtained from the proximal part of both lateral crus of cleft and non-cleft sides by using a punch of two millimeters in diameter. The specimens were fixed with H-E, PAS, Trichrome and PCNA stains. By comparing the measurements of lateral crus of alar cartilages of cleft and non-cleft sides, the size of the lateral crus of the sleft side was more or less the same as that of non-cleft side. Histologically no difference was ascertained. In conclusion, we think the lateral crus of the alar cartilage of the cleft side is never hypoplastic; therefore, external factors such as soft tissue defect or dearrangement are more attributable than the intrinsic factors in the development of secondary cleft lip nose deformity.

반전 도서형 피판(Reverse island flap)을 이용한 상지 및 하지의 연부조직 결손의 재건

김석원,손문방,정윤규 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.1

Many procedures have been described to resurface upper and lower extremity defects. The procedures included skin grafts, local flaps, distally and proximally based island flaps, and free skin muscle flaps. Since the 1970s, several skin-flap concepts, such as random-and axial-pattern flaps, free flaps, musculocutaneous flaps, and fasciocutaneous flaps have been poposed. In 1976, Bostwick et al. introduced the reverse flow temporal artery island flap. Thereafter, distally based soleus flap, reverse forearm flap, and distally based peroneal island flap have been proposed. In 1976, Bostwick et al. introduced the reverse flow temporal artery island flap. Thereafter, distally based soleus flap, reverse forearm flap, and distally based peroneal island flap have been introduced. Such flaps are called reverse-flow island flaps. These flaps have to rely on a retrograde arterial flow through the artery of the pedicle and require reverse flow through the vein to ensure venous drainage. Twelve reverse island flaps were transferred to cover the hand and heel defects. These included forearm, peroneal, and lateral supramalleoar flaps. These were accomplished by isolating and mobilizing the vascular supply of the unit and elevating them as island pedicle flaps. Nine patients were male and three were female, with an average age of 35 years(range from 8 to 71 years). Etiology of the extemity defect was variable and included crushing(5 patients), electrial burn(2 patients), unstable scars(2 patients), postburn scar contractrue(1 patient), pressure sore(2 patients). All flaps were survived except distal marginal necrosis in 2 cases. The reverse island flap has proven itself to be very effective when the flap is transferred from a proximal to a distal location for the reconstruction of an extremity without violation of the opposite extremity or previously uninjured distant sites. Based on our clinical cases repaired with flaps, we consider these flaps to be useful as alternatives for the repair and reconstruction of soft tissue defects in the upper and lower extremity, whether caused by accidental injury or sore. The results of our flaps have proved to be both reliable and durable in all instances.

Peroneal Tissue

박일홍,박희전,손문방,황성관,정운규 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.6

Various methods, such as bone grafts, pedicled flaps and free flaps have been utilized in the treatment of wide soft tissue and/or bony defects of the lower extremities. Recent advances in elucidating the anatomical structure of the peroneal vasculature have led to frequent use of peroneal tissue in reconstruction of soft tissue defects of the lower extremities. From 1990 on ward, we were able to achieve satisfactory results, using the peroneal tissue in restoring bony defects of the lower extremities accompained by various degree of soft tissue loss. It included 10 cases among 9 patients during a 2 year period, the average age was 35.6 years & average follow-up period was 11.6 months. Free flaps were chosen in 3 cases and island flaps in 7 cases, 3 of which were proximally-based & 4 distally-based. Soft or bony tissue alone was used as donor material in 2 & 3 cases, repectively, and 2 osteocutaneous and 3 osteomuscular types of flaps were also employed. The patients exhibited a wide range of external wounds due to trauma and pressure sores. They included acute fractures in 7 cases, non-union in 1 cases and soft tissue defect at the heel and ankle in 1 cases each. The bony defects ranged from 6.5cm to 11.0cm in length and soft tissue defects measured from 4x2.5cm to 6x6.5cm in size. A case in which necrosis developed after a fibula free flap, was treated with an island flap. Another case of fibula island flap, complicated by non-union at the proximal site of transfered fibula 6 months postoperatively was relieved by autogenous bone graft. A case of fibula island flap was complicated by fracture of fibula shaft. The flaps using peroneal tissues have several advantages such as reliable vasculature, thin subcutaneous tissue and possibility of composite tissue.

Soft tissue defect of tibia

정윤규,최해천,손문방,윤여승,나중호 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.5

Use of the muscle flap is now well accepted as a method of covering soft tissue defect of the tibia associated with fracture, bone gap or osteomyelitis. Two local sources of muscle flaps gastrocnemius and soleus muscles are available for reconstruction of the lower extremity. Gastrocnemius muscle flap is the flap of choice for coverage of the knee and upper third of leg. The soleus muscle flap is the local source of choice for reconstruction of most defects involving the middle third of the leg and it can be used to reach defects in the proximal 30% of the lower third. During the past three years, we experienced 35 cases of soft tissue defect in the lower extremity, of which 30 cases (91%) were accompained with fractures. Gastrocnemius and soleus muscle were used alone in 14 an 16 cases, respectively, and both muscles were employed simultaneously in five cases. The size of the defect averaged about 5.8×4cm and 5×5.2cm respectively for gastrocnemius and soleus and 10.8×6cm in cases where both muscles were used. The postoperative follow-up period ranged from one month to 40 months, with an average of 23 months. Most of the flaps (34/35) survived. Th complication rate was 25.7% for early complications less than 6mnths postoperatively whereas nine out of 23 patients (39.1%) experienced late complications greater than 6months postoperatively. The advantages of local muscle flaps in lower extremity reconstruction and the maximum size of the defect possible compared to reconstruct safely are as follows : 1. The increased blood supply antibiotic carrying capacity by the muscle flap when compared with random flap represent advantage of the muscle flap in management of fracture and osteomyelitis. 2. Relatively simple and easy technique compared to free flap surgery. 3. Minimal donor site mobidity. 4. Acceptable aesthetic result of S.T.S.G. on the muscle flap 5. The maximum size of defect possible to reconstruct safely were up to 10×7cm in gastrocnmius muscle and 10×8cm in soleus muscle.

도서형 피판을 이용한 개방된 주관절의 피복

정윤규 ( Youn Kyu Chung ),손문방 ( Moon Bang Sohn ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.2

The management of soft tissue defects of the elbow is a difficult problem. Open elbow joint can inevitably result in leakage of synovial fluid and subsequent joint infection. Soft tissue defect in this area can cause a severe functional disability due to continuous erosion of supporting structures of the joint, and it can further cause the reduction of dislocation or fracture difficult. There fore, an adequate coverage of the lesion and early excercise are important to salvage the elbow joint with good function. Recently I have experienced two parients with exposed elbow joint due to traumatic injury. One has open wound in the posterior aspect of elbow joint and the other in the lateral aspect. I successfully treated the patients using the proximally-based radial forearm island flap and latissimus dorsi muscular island flap with split thickness skin graft. And I also found that two procedures are very useful.

Threaded K-wire를 이용한 관골 골절의 비관혈적 정복술

박병윤,김동현,이훈범,이영호,손문방,정윤규 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.3

The zygomatic projections articulate with sphenoid, frontal bone, maxilla and maxillary alveolus. The prominent position of zygoma make it susceptible to traumatic injury. The fracture dis-placement is classified into several types. According to the degree of displacement and fracture segments, the method of its treatment is decided. In the cases of closed reduction, Gillies'or Dingman's maneuver have been applied for the lifting and pulling of displaced zygoma, even though the open reduction was indicated. In my personal opinion, there are some difficulties and disadvantages because this method is indirect reduction of the fractured zygoma. The author designed a new direct transcutaneous reductionmethod with threaded K-wire and applied this method to some cases. The author conclude the advantages of this method are as followings. 1) There is no destruction of fine submuscular structure around lower eyelid and zygoma. 2) There are no incision on the face and scalp. 3) The relapse of the displacement was not occurred. 4) The surgical method is very simple. 5) It takes very short(10-15 minutes)