안면부에 발생한 기저세포암 137례의 임상적 고찰

이봉무,심정수,김태섭,한동길,박대환,Lee, Bong Moo,Shim, Jeong Su,Kim, Tae Seob,Han, Dong Gil,Park, Dae Hwan 대한두개안면성형외과학회 2013 Archives of Craniofacial Surgery Vol.14 No.2

Background: Basal cell carcinoma (BCC) is the most common skin cancer. About 74% cases of basal cell cancer occur on the head and neck. Basal cell carcinoma on the face may have a higher degree of subclinical spread than tumors arising elsewhere. And incompletely excised BCCs become more aggressive when they recur. So the surgical removal and reconstruction of BCC located on the face are important to make perfect curing and cosmetic results. Methods: A retrospective study was done with 128 patients (137 cancers) who were treated with BCC on the face since 1987 to 2011. General data of these cases such as the primary site of cancer, age and sex of the patients, operative methods, and recurrence rate were reviewed. Results: The ratio of men to women was 1:1.4. And 86.9% of the patients with BCC were older than the age of 50 years with the mean age of 65.8 years. The distribution of facial basal cell carcinoma was on the nose, eyelids, cheek, and nasolabial fold. Surgical methods for treatment were local flap, full thickness skin graft, primary closure, and split thickness skin graft. Specifically, local flap consists of V-Y advancement flap, cheek advancement flap, limberg flap, forehead flap, nasolabial flap, rotation flap, transposition flap, bilobed flap, and island flap. Six cases recurred and all of them were treated with reoperation. Conclusion: The authors reviewed facial basal cell carcinoma cases in our hospital. This study might be helpful to choose appropriate operation method to manage BCC on face in Korea.

역혈류성 전외측대퇴 혈관경피판을 이용한 무릎 주위 결손의 재건

박상순,심정수,Park, Sang-Soon,Shim, Jeong-Su 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: As the soft tissue defect around the knee is difficult to reconstruct, local flap or free flap is used. Distally based anterolateral thigh pedicled flap introduced by Zhang uses sufficient reverse flow supplied from the vascular network around the knee. We report successful reconstruction of defect around knee by this method. Methods: Four patients with skin & soft tissue defect around knee have been treated for reconstruction using the distally based anterolateral thigh pedicled flap. First, the doppler was used to check the perforator flap of the descending branch of the lateral circumflex femoral artery and to draw and dissect the perforator flap as much as needed. After the dissection, the proximal of the descending branch was clamped and checked for sufficient supply of blood flow from the reverse flow and then ligated. It was dissected along the descending branch and in order to prevent damage to the joined parts of the descending branch and the lateral superior geniculate artery, a more careful ligation was done starting from 10 cm superior to the knee. The defect was reconstructed after securing enough vascular pedicle to cover all the damaged parts. Results: Not all patients suffered from flap necrosis. In case of the patient with chronic osteomyelitis, slight venous congestion was observed right after the surgery but it disappeared the following day. All three patients had no occurences of additional complications. Conclusion: Distally based anterolateral thigh pedicled flap was enough to provide large flap for knee reconstruction. It had sufficient blood flow and vascular pedicle. It also had taken short operation time compared to the free flap operation. The distally based anterolateral thigh pedicled flap used by the authors is a very useful way of reconstructing the area around knee.

헤링씨 법칙 비의존성 단안성 윗눈꺼풀처짐증 환자에서 수술 후 생긴 건측의 눈꺼풀처짐증

하원호,이용직,박대환,한동길,심정수,Ha, Won Ho,Lee, Yong Jig,Park, David Dae Hwan,Han, Dong Gil,Shim, Jeong Su 대한두개안면성형외과학회 2013 Archives of Craniofacial Surgery Vol.14 No.1

Background: Correction of unilateral blepharoptosis is unexpectedly difficult because healthy eye is often affected by Hering's law. Methods: We measured changes of marginal reflex distance (MRD1) on the unaffected eyelids between preoperative and 3-month postoperative photographs after ptosis correction. This study analyzed 134 unilateral blepharoptosis patients with ptosis correction from February 2002 to February 2011. Fifty patients among them were negative in Hering's law dependence test. From the preoperative and postoperative photographs the MRD1 of unaffected upper eyelids were measured and adjusted with the average pupil diameter of Koreans. Mean age was 34.4 and male was 30 and female was 20. Average follow-up periods were 14 months. Results: Thirteenth unaffected eyes (26%) showed decreased MRD1, and 3 patients (6%) showed decreased MRD1 value over 1.0 mm. Then 3 patients needed additional operations for correction of preoperatively unaffected but ptotic eyelids. Conclusion: There were no meaningful data statistically in the value of MRD1 in every unaffected eye of the patients and in the difference between preoperative and postoperative MRD1 of groups divided according to severity, causes, and types of operation.

실라스틱(Silastic$^{(R)}$) 배액관을 이용한 간편한 봉합고정 드레싱

김찬우,박상순,이용직,심정수,박대환,Kim, Peter Chan Woo,Park, Sang-Soon,Lee, Yong-Jig,Shim, Jeong-Su,Park, Dae-Hwan 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Tie-over dressing is widely used to secure skin grafting on face, body, or extremities. It can be a rather complicated task and is not easy to make compressive dressing again if performed in a conventional method. So, we hereby introduce an easy reproducible tie over dressing method. Methods: After completing the skin graft, Cut the silastic drainage longitudinally in half and spread to the grafted skin margin. Drainage is fixed by using the stapes or sutures. A fluffy gauze bolus dressing is placed over a furacin impregnated gauze and wrapped around. After suturing the distal margin of silastics with opposite side using the silk thread either 5 - 0 or 3 - 0, knot of suturing, which is pressed down against the dressing while the threads are tightened, is made into center of each sides. Results: It can make dressing again after observing the grafted skin, and it can also make pressure on the grafted area evenly until the grafted skin is taken. Conclusion: This dressing method makes the surgeons and patients comfortable. To surgeons, it provides more rapid and easier way to do dressing, and to patients, it eliminates pain caused by redressing.

비골 골절 형태의 입체적 분석에 있어 3D 영상과 비교한 단순방사선영상 및 2D CT 영상의 정확도

한동길,김태섭,박대환,심정수,이용직,Han, Dong Gil,Kim, Tae Seob,Park, David Dae Hwan,Shim, Jeong Su,Lee, Yong Jig 대한두개안면성형외과학회 2012 Archives of Craniofacial Surgery Vol.13 No.2

Purpose: The nasal bone fracture is known as the most common facial fracture, with the postoperative results and the patient's satisfaction known to be lower than other facial fractures. The patient's satisfaction is firstly related to the accurate comprehension of the spatial relationship in the fractured nasal bone and secondly to the accurate reduction based on accurate comprehension. The aim of this study is to evaluate the objective usefulness of the three-dimensional (3D) imaging. Methods: The survey was conducted on 10 randomly selected cases of nasal bone fractures among the 46 cases with 3D computed tomography (CT) during the past one year. It was requested upon 4 plastic residents and 4 plastic surgeons to draw 3D aspect of fractured nasal bone directly on the printed photos of cadaver nasal bone, based on simple X-ray and two-dimensional (2D) CT. They were compared with the real fractured nasal bone aspects based on the 3D image and marked the difference in the 10-point scale of 0 to 10. Results: The average score of the 4 residents was 1.62 and that of the 4 surgeons was 4.47 out of 10 by simple X-ray. The average score of the 4 residents was 5.67 and that of the 4 surgeons was 7.25 out of 10 by 2D CT. Conclusion: It was surmised that the precise analysis and accurate comprehension of the spatial relationship of the fractured nasal bone using the 3D image, as based on the 2D CT images, can produce more favorable satisfaction levels in the patients.

증 례 : 중형의 선천성 멜라닌 세포성 모반에서 발생한악성 흑색종의 대상포진 양 피부 전이 1예

김영일 ( Youngil Kim ),김인용 ( Inyong Kim ),채인수 ( In Soo Chae ),봉진구 ( Jin Gu Bong ),정영주 ( Young Ju Jeong ),배성화 ( Sung Hwa Bae ),심정수 ( Jeong Su Shim ),오훈규 ( Hoon Kyu Oh ),박재복 ( Jae Bok Park ),이호준 ( Ho Jun L 대한피부과학회 2015 大韓皮膚科學會誌 Vol.53 No.9

Zosteriform metastasis from malignant melanoma is a rare type of skin metastasis that shows cutaneous lesions including patches, plaques, and nodules along with dermatomes, and thus needs to be distinguished from herpes zoster skin infection. Although some authors have explained the mechanism of zosteriform metastasis, its pathogenesis remains unknown. Herein, we describe an 85-year-old woman with zosteriform metastasis of malignant melanoma arising in a medium-sized congenital melanocytic nevus. (Korean J Dermatol 2015;53(9):708∼712)