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은석찬,허찬영,백롱민,민경원,정철훈,오석준 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.5
Purpose: Blowout fractures of the orbit are common sequelae to blunt facial trauma and now increasing in number due to automobile accidents, violence and industrial disasters. There are some reports of diagnosis and treatment of this fracture, but detailed data provided in overall aspects are very few. We analysed extensive data to provide guide line of blowout fracture patients care.Methods: We retrospectively studied 387 orbital blowout fracture patients who had been followed up at least 3-6 months. Their hospital records were reviewed according to causes, fracture site, operation methods, and follow up results, etc. Results: The ratio of males to females was 7 : 3 and fractures were most often seen in the 20-29 age group. 180(47%) patients had medial orbital wall fractures, 155(40%) patients had floor fractures and 52(13%) patients had a combination of orbital floor and medial wall fractures. The highest associated bone fracture was the nasal bone(37%). The open reduction was done in the 324 patients(83.7%) and insertion materials were used in the 249 patients(77%). Total 45 patients(14%) complained of residual diplopia and 26 patients(8%) kept mild enophthalmos. 24 patients(7%) showed some restriction of extraocular muscle movements. Conclusion: We broadly surveyed the information of blow out fracture patients and believe that this study provides important prognostic information that can be of benefit to both patient and surgeon during preoperative counseling and postoperative analysis of orbital blowout fractures.
안와골절에서 인공삽입물의 변위교정을 위한 이차수술: 증례보고
은석찬,오석준,정철훈,최동일,조우성 대한두개안면성형외과학회 2006 Archives of Craniofacial Surgery Vol.7 No.2
The operative treatment of orbital blowout fracture involves restoration of intra-orbital soft tissue and bony structural integrity. In extensive blowout fracture cases, inadequate dissection inappropriate implant insertion, postoperative edema and subsequent increase of intraorbital pressure may sometimes lead to displace the implant. This case study was performed on 6 patients who underwent secondary blowout fracture operation. After primary blowout fracture reduction operation, we found severely displaced implant in the postoperative computed tomogram study. The most prevalent sites were the posterior portion of the inferior and medial wall. We performed further dissection of the fracture sites and inserted more larger sized implant than before. Then we fixated the implant to prevent postoperative displacement. Among these patients, 3 patients who operated more than 3 months after the first operation, complained residual diplopia and eyeball movement disorder. These clinical cases have troublesome and unique features, so we report our experiences with review of the literatures.
은석찬,정철훈,서동국,조우성 대한미용성형외과학회 2005 Archives of Aesthetic Plastic Surgery Vol.11 No.2
Augmenatation rhinoplasty may be effectively accomplished with alloplastic materials. However, certain circumstances mandate the use of autologous grafts(e.g., dorsal augmentation that exceeds 8 mm and patient intolerance of alloplastic implants). Rib or costal cartilage graft have gained wide-spread use in rhinoplasty. Rib cartilages are pliable and soft but they easily undergo warpage, whereas solid bone graft frequently lead to an unnatural hardness of the nasal tip and dorsal resorption. The rib/costal cartilage combination graft(=autogenous chondro-osseous rib grafting) are excellent alternatives. In this study 12 patients received 14 rib grafts harvested in the 7th or 8th rib. Materials were used as cantilevered dorsal onlay grafts, columellar struts, and tip grafts. During 8 months of follow up periods, most patients have firm and stabilized nasal dorsum with soft and mobilized tip without prominent complications such as infection, protrusion, mobilization, etc. In conclusion, this autogenous chondro-osseous rib grafting technique can be an effective and safe method in the primary or secondary rhinoplasty.
흰쥐 모델에서 공여항원에 감작된 수지상세포가 피부동종이식의 생착에 미치는 영향
은석찬,김병준,김진희,허찬영,백롱민,장학,민경원 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.4
Purpose: Prevention of acute rejection in skin allografts without continuous immunosuppression lacks reports in worldwide literature. Needs for chronic immunosuppression preclude the use of tissue allograft as a routine surgical reconstructive option. Recently dendritic cells(DC) gained considerable attention as antigen presenting cells that are also capable of immunologic tolerance induction. This study assesses the effects of alloantigen-pulsed dendritic cells in induction of survival increase in a rat skin allograft model. Methods: Recipient-derived dendritic cells were harvested from rat whole blood and cultured with GM- CSF(200ng/mL) and IL-4(8ng/mL) for 2 weeks. Then donor-specific alloantigen pulsed dendritic cells were reinjected into tail vein before skin graft. The rat dorsal skin allografts were transplanted in 5 subgroups. Groups: I) untreated, II) anti-lymphocyte serum(ALS, 0.5 mL), III) FK-506(2mg/kg), IV) DCp, VI) DCp and FK- 506. Graft appearance challenges were assessed postoperatively. Results: The group V(DC and FK-506 treated) showed longest graft survival rate(23.5 days) than other groups; untreated(5.8 days), ALS(7.2 days), FK-506 (17.5 days), DCp(12.2 days). Conclusion: Donor antigen pulsed host dendritic cell combined with short-term immunosuppression prolong skin allograft survival and has potential therapeutic application for induction of donor antigen specific tolerance.
Facial Transplantation Surgery Introduction
은석찬 대한의학회 2015 Journal of Korean medical science Vol.30 No.6
Severely disfiguring facial injuries can have a devastating impact on the patient’s quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie “Face/Off” have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.