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        두개 악안면 수술시 새로운 골대체물로 이용될 수 있는 계란껍질에 대한 연구

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

        The first successful bone transplantation carried out in 1688 by Van Meek'ren, a Dutch surgeon. The ideal bone substitute should be biocompatible, osteoinductive or at least osteoconductive, available in unlimited quantity, low cost and have satisfactory mechanical properties. To accomplish these goals, autografts are still preferred material. However, bone harvesting procedures have been focused to solve the following problems; necessity of a second surgical site, morbidity and potential deformity of the donor site, an increased operative time, donor availability limitations, and resorption of autogenic bone grafts. Ten adult white New Zealand rabbits, three, 10 mm in diameter, full layer skull defects were made in the frontoparietal bone. Two bone defects were filled with hydroxyapatite and powdered eggshell, the other defect was not filled(control). All animals were sacrified at 10 weeks, the specimens were examined macroscopically to test for graft mobility. The graft with surrounding bone was then harvested and studied by histology. The results were as follows: 1. Control: Bone regeneration occurred nearly complete. 2. Hydroxyapatite: Macroscopically - No encapsulation. Despite a gross delineation between implant and bone, imlant was firmly united to bone. Histology - Bony trabeculae surrounded by proliferated connective tissue are observed in the defect site and implant. Osteoblastic rimming is noted along the bone fragments 3. Powdered eggshell: Macroscopically - Grafted site was encapsulated by proliferated connective tissue and palpable softer than the surrounding bone. Histology - The presence of eggshell particles encapsulated by fibrous connective tissue. Partial bone regeneration from the defect margin was noticed, but the bone healing was never complete. In conclusion, the use of safe and inexpensive material is recommended for filling limited bone defects in non-weight bearing areas. The use of powdered eggshell for bone substitute may also be considered, after further studies, to access its long term stability, porosity and biocompatibility.

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        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.

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