피부 석회증의 치험례

오득영,이종원,변준희,김선옥 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.2

Despite the careful regulation of serum calcium, calcification of cutaneous and subcutaneous tissues may occur. Calcification is the deposition of insoluble calcium salts; when it occurs in cutaneous tissues, it is known as calcinosis cutis. Calcinosis cutis is classified into four types: metastatic calcinosis cutis, dystrophic calcinosis cutis, idiopathic calcinosis cutis, and subepidermal calcified nodule. From January 2000 to May 2001, we have experienced 3 patients with calcinosis cutis. Two cases were dystrophic calcinosis cutis associated with radiation therapy and old burn scar with complications of delayed wound healing after punch biopsy, despite of conservative treatment for several weeks. Another was idiopathic calcinosis cutis. We performed surgical treatments in all cases: wide excision and pectoralis major muscle rotational flap coverage, wide excision and split-thickness skin graft, and excision and direct closure. No patients experienced wound healing problems. We believed surgical excision and appropriate reconstruction procedure is an effective theraphy in localized or ulcerated and chronic infected calcinosis cutis.

노출된 영구 심박조율기의 치험례

오득영,김태형,이종원,이백권,한기택,안상태,최윤석 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.6

In the cases of severe arrythmia and conduction failure, a permanent implanted pacemaker is considered an essential treatment modality with less complication rate, broad indications and low morbidity. However, some pacemakers needs to be removed or replaced due to infection, in need of a lead upgrade, elective replacement, conduction failure or insulation failure. The most common indication for pacemaker extraction is infection. Conservative treatments such as administration of intravenous antibiotics and limitation of debridement are not effective and the removal of the entire pacing system is considered to be the best approach to pacemaker pocket infection. Although a locking stylet, a laser sheath and other newer methods of transvenous lead extraction have been proven to be effective, all leads cannot be removed. Moreover, major complications such as, cardiac tamponade and respiratory arrest during leads extraction procedure should not be ignored. We experienced two cases of exposed pacemakers in the subclavicular region. After removing the pacemaker body, exposed proximal lead was pulled out and cut off. The end of remnant external insulation tube was tied to prevent infection propagation between external insulation tube and inner metalic coil. Wounds were covered by local flap coverage. No other problems were detected during the one-year follow-up. Since there are few reports on lead-preserving method of treating limited infection of exposed pacemakers, we would like to present our new method for treating exposed pacemakers.

Poland 증후군 환자의 흉벽 및 유방 재건술

오득영,이백권,서병철,이종원,안상태 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.3

Purpose: As a rare congenital anomaly, Poland's syndrome has been known to show hypoplasia in breast and nipple, absence of pectoralis major muscle, and aplasia or deformity of rib or costal cartilage which has been reported to be more common in male. However, most patients who are seeking operation are female patients having one-side deformity. In the field of plastic surgery, the major surgical indications could be asymmetric chest wall depression in man or breast hypoplasia in woman. There are many reconstruction options according to the degree of patient's deformity: a prosthetic implant, breast implant with or without tissue expander, latissimus dorsi musculocutaneous pedicled flap with or without implant and/or tissue expander, and free tissue transfer with or without tissue expander.Methods: The authors have treated 4 patients(2 male, 2 female) who had a diagnosis of Poland's syndrome. According to the degree of patient's deformity, all patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with one-staged or two-staged reconstruction.Results: All patents were satisfied with the results and there occurred no specific complications.Conclusion: The authors propose the treatment plan for patient with Poland's syndrome, according to the degree of patient's deformity. In case of male patient with mild deformity, the prosthetic implant or latissimus dorsi musculocutaneous pedicled flap will simulate the missing pectoralis and improve the contour deformity. In case of female patient with moderate to severe breast asymmetry and upward displaced nipple areolar complex (NAC), NAC can be lowered with tissue expander, breast can be enlarged with autologous free flaps or latissimus dorsi musculocutaneous pedicled flap with implant.

Braden Scale에 기초한 욕창발생 위험군 선별도구를 이용한 욕창의 예방

오득영,김지훈,이백권,안상태,이종원 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.4

시상봉합 조기유합증의 전두개관 개조술에서 직각 Z-절골술

오득영,변준희 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.4

Sagittal synostosis is the most common isolated craniosynostosis and usually recognized in early infancy. Numerous surgical techniques including strip craniectomy, the pi procedure, subtotal calvariectomy have been used, and they are usually successful if carried out in early infancy. Unfortunately, some children with sagittal synostosis are not considered for surgical correction by the age of 2 years. From March 2001 to February 2002, we have experienced two children older than 2 years of age with sagittal synostosis, and in all cases, performed total cranial vault remodeling with minimal bony defect. Reconstruction consisted of shortening of the sagittal midline strut, barrel stave osteotomy of temporal region, and right angled Z-osteotomy of parieto-occipital region. Using right angled Z-osteotomy, we can easily reshape and fix parieto-occipital bone flap with good stability and esthetic results. We report our technique for the late correction of scaphocephaly in two children with satisfactory results

척수수막류 결손 재건을 위한 양측 V-Y 전진피판술

신종원,오득영,이중호,문석호,서제원,이종원,안상태,Shin, Jong-Weon,Oh, Deuk-Young,Lee, Jung-Ho,Moon, Suk-Ho,Seo, Je-Won,Rhie, Jong-Won,Ahn, Sang-Tae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Meningomyelocele is the most common type of neural tube defect disease. Early surgical treatment is recommended to prevent central nervous system infection. Several reconstruction methods were reported previously regarding surgical wound defect closure following meningomyelocele excision. In this article, we report two successful patients using the bilateral fasciocutaneous sliding V-Y advancement flap as a covering for meningomyelocele defects. Methods: Two patients with meningomyelocele were evaluated. Both patients were male and received their operations on the 1st and 4th day of life. After neurosurgeons completed their part of the operation, the V-Y advancement flap was used to close the defect. Initially a bilateral V-shape incision design was made on the skin such that the base of the V-flap measures identical to the size of the wound defect. An incision was made down to the fascia in order to allow the V-flaps to slide into the defect. Subfascial dissection was performed up to 1/3 to 1/4 the length of the V-flap from the wound while minimizing injury to the perforating vessels. Results: Both patients were treated successfully and there was no evidence of complication in 2 months follow up. Conclusion: Several reconstruction methods such as local flaps, skin graft and myocutaneous flaps were reported regarding meningomyelocele surgical wound defect closure. Bilateral fasciocutaneous sliding V-Y advancement flap is an easy method without involving the underlying muscles or a secondary skin graft in a short operation time. Therefore we recommend this treatment option for reconstruction of the wound defect following meningomyelocele excision.

척수 신경 자극기 삽입부 감염의 치험례

김종석,오득영,서제원,이중호,이종원,안상태,Kim, Jong-Sok,Oh, Deuk-Young,Seo, Je-Won,Lee, Jung-Ho,Rhie, Jong-Won,Ahn, Sang-Tae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: Nowadays spinal cord stimulator is frequently used for the patients diagnosed as complex regional pain syndrome. The lead is placed above the spinal cord and connected to the stimulation generator, which is mostly placed in the subcutaneous layer of the abdomen. When the complication occurs in the generator inserted site, such as infection or generator exposure, replacement of the new generator to another site or pocket of the abdomen would be the classical choice. The objective of our study is to present our experience of the effective replacement of the existing stimulation generator from subcutaneous layer to another layer in same site after the wound infection at inexpensive cost and avoidance of new scar formation. Methods: A 50-year-old man who was diagnosed as complex regional pain syndrome after traffic accident received spinal cord stimulator, Synergy$^{(R)}$ (Medtronic, Minneapolis, USA) insertion 1 month ago by anesthetist. The patient was referred to our department for wound infection management. The patient was presented with erythema, swelling, thick discharge and wound disruption in the left upper quadrant of the abdomen. After surgical debridement of the capsule, the existing generator replacement beneath the anterior layer of rectus sheath was performed after sterilization by alcohol. Results: Patient's postoperative course was uneventful without any complication and had no evidence of infection for 3 months follow-up period. Conclusion: Replacement of existing spinal cord stimulation generator after sterilization between the anterior layer of rectus sheath and rectus abdominis muscle in the abdomen will be an alternative treatment in wound infection of stimulator generator.

만성창상의 치료에 쓰이는 치료제재

한현호,오득영 대한의사협회 2015 대한의사협회지 Vol.58 No.9

Chronic wounds are generally defined as non-healing wounds after four weeks of normal treatment. Individual risk factors for chronic wounds should be identified, but the delay of wound healing is often caused by the use of inappropriate dressing material. The concept of rapid wound healing with moist dressings has developed since the 1960s, and wet dressing is currently a widely popular method of wound treatment. Hundreds of dressing materials that maintain a moist environment are commercially available; however, selecting the right dressing material for a specific purpose is not easy, and unfortunately incorrect dressing procedures occur frequently. In order to promote wound healing education, we have classified dressing materials into basic categories and discuss the pros and cons and indications for each category. The purpose of this report is to reduce errors in selecting dressing materials and to enhance precise wound treatment.

변형된 Three-Square-Flap을 이용한 경도 또는 중등도 합지증의 치험례

서병철,오득영,이백권,이종원,안상태 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.5

Purpose: The main goals of correcting syndactyly of the hand are to form normal web appearance and to prevent motor dysfunction. We modified the original three-square-flap to improve interdigital web space and to reduce the wound healing problem due to tension.Methods: From July 2005 to February 2006, three cases of moderate to minor syndactyly were treated using modified three-square-flap. These flaps were made in such as way that the A flap from dorsal side, the B flap from the interdigital surface, and the C flap from the volar side. We modified the design of dorsal A flap as a hourglass shape instead of square shape to make normal hourglass shaped interdigital web and to reduce the tension of closure with other two flaps(B and C flap). The B and C flap were made as square shape. Results: During 4 to 10 months follow-up period, acceptable esthetic results were obtained without any specific complication, using our modification of the three-square-flap.Conclusion: Our method showed more satisfactory web appearance and was safe to use even in the cases of syndactyly secondary to burns and post- traumatic scars because of excellent blood circulation.

Spindle Cell Lipoma: A Rare, Misunderstood Entity

SEOBOMMIEFLORENCE,오득영 대한두개안면성형외과학회 2014 Archives of Craniofacial Surgery Vol.15 No.2

Spindle cell lipoma, a rare variant of lipoma, is a benign tumor found in the posterior neckand shoulder. A 24-year-old man with a close family history of malignant lymphoma hadpresented with a large, firm, nodular mass found in the right supraclavicular area. Excisionof the deeply located mass revealed a pale yellow, rubbery nodule which grosslyresembled an enlarged lymph node, with a variant of lymphoma as a primary suspect. However, pathological studies revealed the lesion to be a spindle cell lipoma. Althoughatypical in location, spindle cell lipoma should always be kept in differential diagnosis of anewly-noted soft tissue mass, as this entity may be easily cured by simple excision.