유리피판술을 이용한 구축성 화상반흔의 교정

임 풍,허 진,조성필,장익수,한기택 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3

Burn scar contractures of the various joint areas including anterior cervical region, popliteal region, ankle, antecubital region and wrist accompanied with severe functional limitations and esthetic problems. Many authors recommended full-thickness, split-thickness skin graft, local skin flap, or distant skin flap. But the recurrence of the contracture and many following procedures have been troublesome after these surgeries. Recent progress in the field of microvascular surgery has opened the way for various types of free transfer. The microvascular surgery enabled the various joint regions to be resurfaced with free flap and so the recurrence of contracture was prevented. Authors treated 20 patients with severe and recurrent burn scar contracture of the various joint regions using various microvascular free flap transfer. We obtained satisfactory functional results without late recurrence of the contracture of the transferred flaps.

안면부 손상환자에서 삼차신경 제성감각 유발전위 (Trigeminal Somatosensory Evoked Potential)를 이용한 삼차신경손상의 진단

임 풍,고영석,이석기,한기택 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6

Trigeminal somatosensory evoked potential is an electrophysiologic diagnostic method for the lesions of trigeminal nerve. In facial traumas such as lacerations, contusions, or fractures etc, the injury of the branches of trigeminal nerve is common. For the evaluation of this injury, however, most surgeons have so far depended on the patient's history and physical examinations, only such as pin-prick test and two-point discrimination test. We performed trigeminal somatosensory evoked potential for the evaluation of the trigeminal nerve in 20 patients whose branches of trigeminal nerves were suspected to be injured by facial trauma. The results were as follows; The trigeminal SSEP showed abnormal findings in 16 out 20 patients. After 2 months, 15 out of 16 patients whose the findings of trigeminal SSEP had been abnormal showed no sensory improvement, but 3 cases of 4 patients with normal SSEP findings improved their symptoms. These results suggest that the trigeminal SSEP is a reliable electrophysiologic method not only for diagnosis but also for predicting prognosis of the injuries of trigeminal nerves.

골파괴를 동반한 부비동 점액낭종의 근치수술후 동시재건술 치험례

임 풍,이종원,조성필,강윤섭 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.5

Mucocele is a chronic, expansile & cystic lesion of the paranasal sinuses, which contains sterile, mucoid secretions. Although the etiology and pathogenesis of a sinus mucocele are uncertain, the accepted theory points to an obstruction near or at a sinus outlet that causes retention of mucous secretion within the sinus cavity. Osseous trauma, tumors or a mucosal thickening (chronic inflammatory disease) in the areas of outlet are the major associated factors. The mucoceles are most frequently found in the frontal sinus. Progressive enlargement of mucocele may cause local bone destruction, variable functional impairments, and facial deformities. In this case, simple surgical removal of mucocele may produce severe facial deformyty and functional impairment postoperatively. To minimize postoperative facial deformities, we have applied primary reconstuctive procedures, utilizing cranial bone grafting for postoperative defect in 2 patients. Judging from postoperative cosmetic and functional viewpoints, the results were fairly satisfactory.

목재 이물에 의한 안와내 관통상과 합병증의 치험례

임 풍,변준희,이종원,김수환 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3

2 cases of retention of wooden foreign body by penetrating intraorbital injury are presented. Initial failure to recognize the nature of the injury led to late intraorbital and intracranial complications, respectively. These wounds may appear deceptively minor and superficial, are often not accompanied by immediate ophthalmological and neurological changes, so they are considered trivial and over-looked. In addition, the wooden foreign bodies are not easily detected by routine rentgengraphic studies, which makes the diagnosis more difficult. Recently computerized tomography and magnetic resonace imaging are used helpfully in detection and localization of wooden foreign body. The clinical usefulness and practical limitation of the diagnostic modalities and management of this type of injury are discussed.

자가 주상와연골 (Autogenous scapha cartilage) 이식을 이용한 하안검 내반증의 교정

임 풍,염원석,이석기,한기택 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

The lower eyelid entropion is characterized by a turning inward of the eyelid margin. Ocular inflammation and tearing may result from lashes or keratinized epithelium. Moreover inversed lower eyelids are considered one of the cosmetic defects. To correct an entropion surgically, the procedure should be chosen individually. Simple excision, suture repair, marginal rotation and tarsal strip procedure may be considered, but in cases of cicatrical entropion or lower lid defect, the main surgical principle involves release of scarred tissue and replacement of the deficient tissue with appropriate graft. We used scapha cartilage only as a spacer, in patients with cicatrical entropion or involutional entropion. The result was satisfactory and the raw surface of the graft facing to the eyeball was epithelialized from the surrounding mucosa within a couple of weeks. We report our concept of scapha cartilage graft and simple technique for the treatment of cicatrical entropion or entropion caused by lower lid defect .

재발된 Keloid 환자에서 수술적 방법과 병용한 방사선 요법

위성신,임 풍,조문제,김영진,김재덕 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.6

11 keloid sites on 10 patients were treated with a surgical excision followed by postoperative X-ray radiation, begun within 72 hours after the surgery. Only patients with recurred keloids after the steroid therapy were included in this study. The lesions were greater than 2cm in size. The most frequent dose schedule was 1200 cGy in three fraction over 3 days. The follow-up time was 8months to 51 months. Exellent or improved results were obtained in 81.8%. More favorable results were obtained in the treatment of smal keloids. It was concluded that the excision and postoperative irradiation constitute effective an keloids treatment.

면역 조절제가 화상 흰쥐의 면역반응에 미치는 영향

오영환,임 풍,한기택,이석기,이재웅 大韓成形外科 學會 1991 Archives of Plastic Surgery Vol.18 No.5

Sepsis still remains the major cause of late morbidity and mortality after severe thermal injury. Numerous studies have shown that severe thermal injury results in major alterations of many aspects of immunity. It has been noted by many studies that cell mediated immunity is most consistently and profoundly suppressed among these immune impairments. Attention has recently been focused on restoring to the normal immune response by use of immunomodualating agents in burned patients. The aim of this experiment is to investigate the changes of immune response by immunomodulating agents;r-interferon and polyinosinic-polycytidylic acid(poly I:C)in severe thermal injury. Lymphocytes were isolated from peripheral blood of burned rats with or without administrations of r-interferon and poly I:C on the 1st, 3rd, 5th, 7th and 14th postburn days and changes of their subsets were observed and stimulation index were measured after stimulation with mitogens(PHA,Con-A and PWM). Also the lymphocytes from the burned rats were mixed with r-interferon or poly I:C and stimulated with the mitogens in vitro. Status of immune response were evaluated by lymphocyte counts, T cell subset and mitogen stimulation index. The results were as follows; 1. The lymphocyte counts decreased markedly in both the burn control group and all the drug injected groups and there was no statistically significant difference between the both groups. 2. The total T cell decreased in number in both the burn control and drug injected groups. A significant decrease of total T cell appeared at 5th day in the r-interferon injected group, and at 5th and 7th day in the poly I:C injected group. Th to Ts ratio decreased in the burn control group, but there was no significant difference between the burn control and the drug injected groups. 3. PHA, Con-A and PWM stimulation index increased in the burn control groups in comparison with the normal control group. In conclusion, after extensive thermal injury the immune modulating agents had no effect in changes of total lymphocyte count, but the immune response for mitogen stimulation with these agents was changed variable.

전두사골 부위에 발생한 수막뇌류 치험례

엄익태,임 풍,김진철 大韓成形外科學會 1988 Archives of Plastic Surgery Vol.15 No.2

Meningoencephalocele is an extracranial protrusion of the menings, cerebrospinal fluid and some portion of the brain, and is usually classified into;anterior, occipital, temporal and basal types according to the location. In most large series of cases of this disease reported in the literature, the frontoethmoidal meningoencephalocele which is called anterior type constitute only a small percentage. In contrast to other type of meningoencephalocele, the incidence of associated congenital abnormalities is relatively low in this disease. Therefore, the longoterm prognosis following surgery is excellent. Recently, we experienced 2 cases of frontoethmoidal meningoencephaloceles which were treated by intraand extracranial approach, and obtained satisfactory results and report these with review of articles.

가토에서 두개골이식 공여부의 골재생에 Gelfoam,Bone Wax 및 Hydroxyapatite가 미치는 영향

김명철,임 풍,김진철 大韓成形外科學會 1988 Archives of Plastic Surgery Vol.15 No.2

The use of calvarial bone graft is a recent advance in craniofacial surgery. Calvarium has multiple potential advantages as a donor source due to least degree of disability and morbidity including pain. In addition, calvarium is a membranous bone which undergoes less resorption and maintains its volume to a significantly greater amount than endochondral bone when autografted in the craniofacial region. However, the knowledge of bone graft healing has been well understood and investigated, but donor site healing with the effect of various hemostatics and alloplastic material coralline hydroxyapatite on the subsequent osteoneogenesis have not been reported. The present study was designed to investigate the effect of gelfoam, bone wax and hydroxyapatite on the early stage of osteoneogenesis at the calvarial bone graft donor site and to compare with the normal progression of bone healing in control group. In 35 rabbits, four split thickness bony defects were created on the outer table of parietal bone, which were measured 5x5x2mm and treated in the following four different manners. 1) control 2) gelfoam 3) bone wax 4) hydroxyapatite. Each 7 rabbits were sacrificed at 1, 2, 4, 6, 8 weeks after taking a plain skull x-ray film. Both macroscopic and microscopic examinations were done. The results were as follows: 1. At 2 weeks in the control group, there was marked pproliferation of osteoblast and formation of osteoid. At 4 weeks, the healing with new bone formation was found to be complete. At 6 weeks, remodeling was finished and by 8 weeks, the endosteal coverage for defect area was started. 2. The group treated with gelfoam showed diminished proliferation of osteoblast and osteoid formation with marked foreign body reaction by 2 weeks. At 4 weeks, foreign body reaction was disappeared and progression of new bone formation and remodeling was similar to the control group. 3. The group treated with bone wax showed moderate foreign body reaction from 2 weeks and continued throughout the experimental period, but only mild inhibition of osteoneogenesis in the progression of remodeling was found. 4. The group treated with hydroxyapatite also showed minimal forign body reaction from 4 weeks, but similar or rather rapid pprogression of remodeling was noted.

사두의 치험 2예

강준기,임 풍,김진철,이종건,김명철,박철주 大韓成形外科學會 1988 Archives of Plastic Surgery Vol.15 No.1

Patients with abnormal head shapes resulting from premature fusion of one or more cranial sutures have been grouped under the term craniosynostosis. Plagiocephaly is a premature unilateral coronal synostosis consisting of flattening of the frontal region and asymmetrical orbits with resultant facial asymmetry. Early surgical treatment has been advised for the prevention of exophthalmos, visual loss, cosmetic deformities and brain damage. But the treatment differs according to the age the malformation is first recognized. A linear craniectomy along the involved sutures has been used for many years. Recently, several new or modified approaches to the treatment of coronal synostosis have developed. From september 1986 to february 1987, two patients with plagiocephaly were treated by extended craniectomy along the fused sutures with frontal bone replacement and Tessier's bilateral frontal bone advancement at 3 and 11 months. Postoperative follow up has continued, ranging from 5 to 10 months with good craniofacial symmetry.