외이 성형술

오갑성 인제대학교 1999 仁濟醫學 Vol.20 No.1S

성형외과 영역에서 정교한 모양의 외이를 제건한다는 것은 힘든 일이지만, 여러 술자들의 경험과 기술들을 바탕으로 많이 발전되어 왔다. 원래 외이 성형술은 외상으로 인한 외이 변형을 재건하려는 노력으로부터 시작하여 그 후선천성 기형, 이중에서도 돌출이를 교정하면서, 현재는 무이증, 소이증 등을 재건하기에 이르렀고, 많은 경우 만족 할만하게 되었지만 다른 모든 수술과 마찬가지로 술전 정확한 검사 및 환자 상태를 파악하고, 각 귀 기형 정도에 제일 적합한 수술 기법을 시행해야 술 후 합병증을 줄이고 훌륭한 결과를 가져올 수 있다. 여기서는 저자의 경험을 바탕으로 여러 귀 기형과 이를 재건하기 위한 수술법들을 소개하고자 한다. Reconstruction the auricle has been one of the plastic surgeon's most baffling problems. Early surgical attention focused mainly on traumatic deformities. However by the end of the nineteenth century, surgeons began to address congenital defects, in particular prominent ears. Durign the years, ear reconstruction has stimulated the imagination of many surgeons who have provided innumerable contributions. Otoplasty gives rewarding results to both patient and surgeon in the majority cases. Careful preperative assessment to determine the cause of the ear deformities in essential. As with all surigcal procedure, comlications and unsatisfactory results can arise. However, with a systemic approach and a good understanding of the technique available, the otoplasty surgeon will fired that to be a rewarding procedure. The purpose of this article is to present various techniques that are affective in managing auricular deformities.

외이 성형술

오갑성 인제대학교 1999 仁濟醫學 Vol.20 No.1

비첨 하수의 교정: 7례

윤창신,오갑성 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.8

The primary factors determining nasal tip outline are shape and position of the alar cartilages. The relation of the alar cartilages to the upper lateral cartilages, septum, and soft tissue envelope defines the conformation of the tip-lobule complex. Plunging tip is a condition as long nose, tip drooping and becomes more accentuated with aging. Hanging columella is a prominent downward bowing of the columella. Plunging tip and hanging columella are common causes of acute nasolabial angle. Correction of the plunging tip in the long nose is usually achieved satisfactorily through shortening of the lateral walls by excising an adequate amount of cartilage from the septal, lateral, and alar cartilage. Tip rotation in a cephalic direction can be achieved commonly by resection of the cephalic portion of the lateral crura, excision of a triangular segment of the caudal margin of the septum and a cartilaginous septal transfixion incision involving excision of a superiorly based triangle of septum with cephalic rotation of the entire nasal lobule. Modification of the caudal margin of the septum is done to achieve three goals: (1) cephalic rotation of the tip, (2) shortening of nasal length, and (3) alterations in the nasolabial angle. We have elevated and rotated in a cephalic direction nasal tip by means of resection of cephalic portion of lateral crura, resection of the caudal margin of the septum and mucous membrane, and /or invagination technique for correction of the plunging tip and hanging columella. From March 1996 to February 1998, we have performed the tip-plasty in 7 patients of the plunging tip and hanging columella. We have found good cosmetic results with improved nasolabial angle.

두개악안면골 성형술에 관한 임상적 고찰(652명, 1061례) : 3년간의 경험

김수신,선 욱,백롱민,오재욱,백세민,한흥수,오갑성 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.4

Congenital or acquired facial deformity of an individual cause a significant disability with social life and can bring about many psychological problems with inferiority complex. During recent years many centers and hospitals for craniofacial surgery have developed since Paul Tessier's introducton of craniofacial surgery in the late 1960s. But few attempts had been made to provide comprehensive analysis of this division. We present the study on 1,061 craniomaxillofacial procedures such as reconstructive surgery for hypertelorism, craniooplasty, orbital reconstructive surgery for hypertelorism, cranioplasty, orbital reconstruction, LeFort osteotomy, various kinds of mandibular osteotomy, TMJ reconstruction, segmental osteotomy of maxilla & mandible, genioplasty, mala-plasty and angle-plasty of mandible etc. The procedures were classified into 3 major categories as the following: Orbito-craniofacial(102), orthognathic(379), facial contouring(580). Overall mortality was zero percent and major compilcations were noticed in 2.61 percent(17 cases) of the patients, but not all had permanent sequelae. The complications were CSF leskage, dural tear, major infection, airway problems, loss of teeth, vocal cord granuloma etc. Finally, our procedures have undergone many changes and advances.

지속적인 직류 자장이 백서의 임의형 피판생존에 미치는 영향에 關한 硏究

백세민,유영준,한흥수,오갑성 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.3

The present study was undertaken to determine if direct current(DC) electirical fields could improve survival rate of random pattern skin flap in the rat. 20 Sparque- Dawley rats were divided into two groups and caudally based 2cm width and 8cm length random pattern flaps were elevated in all rats. Electrical fields of 9mA were introduced by 1.5V disk button battery. Electrical field was applied for 5days to the stimulation group(B). DC electrical fields shows the enhancement of flap survival by increasing the rate to 33.5%(p<0.01). The enhancement of skin flap survival by application of direct current electrical field has possibility for cover the large skin defect.

악관절 강직의 재건술

박재석,김동일,임재호,백롱민,백세민,백승준,오갑성 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.5

Temporomandibular Joint ankylosis is a serious disabling condition manifested by impairment of speech, difficulty in mastication, poor oral hygiene, facial asymmetry and mandibular micrognathia, it invariably results in psychological as well as physical disability. Sixty-five cases of TMJ ankylosis were surgically treated during a past 10 years interval by radical resection and release of the involved structure, and if necessary. ipsilateral and contralateral condylectomy and coronoidectomy, reconstruction of the ramus with costochondral grafts(58 patients) or silastic implants(7 patients), and then early aggressive continuous physiotherapy. There was no predilection for sex. In 32 patients (49% ), trauma was the most common cause of TMJ ankylosis, followed by infection in 18 patients(28%). The average preoperative maximal interincisor opening (MIO) was 11.7mm, which increased to 35mm after 1 year. Forty-five patients (69%) had MIO greater than 30mm, and resumed satisfactory life style without any discomfort. In 37 patients, simultaneous total correction of TMJ ankylosis in combination with maxillary and mandibular osteotomies was performed to correct the facial distortion and asymmetry. Relapse (MIO less than 20mm) occurred in 5 patients (7.7%). Of these, 3 patients were surgically treated again, and improvement in mouth opening was achieved by re-releasing the restraining structures and arthroplasty with silicone implant or costochondral grafts. Other complications were infection in 3 patients, undercorrected facial asymmetry in 2 patients and transient lower paresthesia in 1 patient.

두피를 공여부로 한 부분층 식피술의 임상적 고찰

김진환,최 준,백롱민,백세민,오갑성 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.6

Plastic surgeons regard the management of tissue defects as a major issue and use the split thickness skin graft as one of the popular treatment modalities. Since Crawford has introduced the scalp as a donor site for split thickness skin graft, this method has been used with its many advantages. From Jan. 1989 to Jan. 1992, we perfomed the split thickness skin graft using the scalp as a donor site in 23 patients. The grafted scalp has many advantages such as improved color match in facial area, improved texture in other areas and invisible donor scar due to hair regrowth. We could conceive that good color match between the scalp and the face may be due to their histologic similarities.

광범위 이중층 안면 거상술(extended Radical Double layer face Lift)의 임상적 고찰

백세민,선욱,최준,김순걸,박성규,오갑성 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.6

Rhytidectomy has been researched as the one of the methods to overcome aging process. In spite of the various trials of rhytidectomy beyond time, the basic principle is dissection and lift. The major different point among them is the dissection palne, which can be classified as subcutaneous, sub-SMAS and its continuous layer, and subperiosteal plane. We have experienced 283 cases of rhytidectomy through various dissection plane from March 1988 to Feburary 1993. Among them, 93 cases were performed through double-layer lift technique, the most characteristic feature of which is double layer dissection in temporal and midface area. Double layer dissection was performed under and above superficial temporal fascia in temporal area, under and above SMAS in masseteric area, and subperiosteal and subcutaneous in the other midface area. According to our experience of double layer lift, we could obtain the advantages of subperiosteal lift such as long lasting effect, natural appearance and accessibility to contour facial bone by lift of periosteum and other structure to support skin. Also, we achieved the divect rhytidectomy effect by subcutaneous lift and we could control the direction of lift with combination of subperiosteal lift.

소이증의 단단계 재건술 : 이개거상술의 불필요성에 대한 고찰

백롱민,김진오,백세민,오갑성 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.6

Various materials and new methods have been developed steadily in reconstruction of the auricle, since Tanzer developed this procedure using autogenous costal cartilage in 1959. Composed of a delicately convoluted cartilage frame covered by a fine skin envelope, the external ear is a difficult structure to draw or sculpt, let alone surgically reproduce. However, advancements in technique and alternative approaches have resulted in the achievement of favorable outcomes that are gratifying to both patient and physician. We augmented the convolutions by using a three-layered costal cartilage and two suction drain catheters to form an acceptable facsimile of an ear. Before skin closure, the position and convolution of the cartilage frame can be reconfirmed using the two effective continuous suction drains. After cartilage framework positioning, we elevate the soft tissue in the conchal area, above the level of the periosteum as a posteriorly based turn-over flap to construct a deep conchal cavity and to gain sufficient soft tissue to cover the auricular framework for skin grafting. With our method, an entire ear could be reconstructed in one stage by eliminating the stage of elevation. From August 1988 to July 1995 we performed external ear reconstruction of 137 microtia using our modifications and the results of these procedures have been favorable.

C-arm Fluoroscopy를 이용한 하악각 축소 성형술

오갑성,김진오,권장덕,백롱민 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

The prominent mandibular angle is one of the disfiguring features in the Oriental, commonly seen and considered to be unattractive. Because it gives a square and muscular facial appearance, its surgical correction is dine frequently as a modality of facial contouring surgery in the Oriental. The reduction mandibular angleplasty is not a simple surgical technique for the unexperienced surgeon. We adopted C-arm fluoroscopy as a method of identifying the osteotomy line for the beginners. The reduction mandibular angleplasties assisted by C-arm fluoroscopy were performed in 9 patients, providing symmetric and satisfactory results. Now we are sure that the reduction mandibular angleplasty assisted by C-arm fluoroscopy can be an accurate and safe method for the unexperienced surgeon, especially the patient with deep-seated prominent mandibular angle.