대퇴근막을 이용한 저위 이개 변형의 치험례

예병환,김영진,이백권,안상태,장도명 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.7

"Low-set" ear is the deformity which is related with the gentic diseases such as hemifacial microsomia, Turner's syndrome, neurofibromatosis and with the old hemangioma. Much attention is paid to correction of congenital or posttraumatic external ear deformity, but there is little description about the techniques for repositioning of the malpositioned ear. We successfully corrected 2 cases of the "low-set" ear deformity associated with neurofibromatosis using a strip of fascia lata; 1. As a suspension from concha cartilage to pericranium and deep temporal fascia. 2. As a sling form around the auricular cartilage fixating to pericranium and deep temporal fascia. With the above techniques, we can get good results of relatively permanent repositioning of the malpositioned ear even after 6 months or more postoperatively.

구순열 및 구개열 환자 673례에 대한 임상적 분석

장도명,위성신,강윤제,임풍,이종건 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.4

Cleft lip, with or without cleft palate, is one of the most common congenital malformations in Korea. Improper management of the patients with cleft lip and/or palate may result in facial maldevelopment, speech disturbance, social maladjustment and psychological stress together with their parents. For the past 16 years, from 1978 through 1994, we have treated 1502 patients with cleft lip and/or palate in Catholic Medical Center. The medical records and laboratory data were reviewed in order to secure the information for the retrospective study but valuable data were available in 673 cases. The present paper deals with an analysis of them to report the statistical and basic clinical data of cleft lip and/or palate. The results were as follows; 1. The rate of the associated anomalies was 4.1% and congenital heart disease was the most frequent one. 2. The ratio of cleft lip, cleft lip with palate and cleft palate alone was 1.5 : 1.3 : 1.0. 3. The ratio of left, right and bilateral cleft lip was 2.3 : 1.4: 1.0 and that of cleft lip with palate was 1.5 : 1.0 : 1.01. 4. The incomplete cleft lip occurred 2.01 times more than complete cleft lip and complete cleft lip with palate occurred 2.95 times more than incomplete cleft lip with palate, and the ratio of complete, incomplete and submucose cleft palate was 2.5 : 8.0 : 1.0. 5. Male was affected 1.4 times more than female in cleft lip and 2.3 times in cleft lip with palate and female was affected 2.3 times more than male in cleft palate. 6. Most of the patients was operated between the age of 3 months to 1 year in cleft lip(62%) and between 1 to 2 years in cleft palate(50%), 7. Before 1990, the Tennison-Randall method was widely used but after that, the Millard methods( ⅠⅡ) were undergone predominantly in cleft lip repair and most of the patients with cleft palate (91%) was treated by push-back palatoplasty, except submucose type which was corrected by double reversing Z-palatoplasty. 8. Almost all the patients with cleft palate(95%) were treated by myringotomy due to the middle ear disease (serous otitis media)at the same time.

전산화 단층촬영을 이용한 정상 한국인의 연령별 안와 거리의 분석

장도명,이석기,한기택,임풍,양성렬 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.1

The distance between the orbits and their individual dimensions are important in the diagnosis and in determining the standard operative values of craniofacial anomalies. The orbital dimensions can be measured by pain rheontgenography or computed tomography. Plain rheontgenography of the orbit may be difficult for the non-radiologist in identifying the measurement landmarks and to interpret them, whereas computed tomography allows more precise analysis by imaging soft tissue relationships to surrounding orbital bones. This article describes the normal range of the bony interorbital distance, lateral orbital distance and transverse diameter of the orbit from a series of CT scans of the orbits in 162 patients with normal orbits between the age of three months and adulthood. Being measured in the plane of the optic nerve, the interorbital distance was from 1.73cm to 2.76cm(adult averge, 2.72cm) in men and from 1.65cm to 2.59cm(adult average, 2.56cm) in women. The lateral orbital distance was from 7.55cm to 10.38cm(adult average, 10.35cm) in men and from 7.42cm to 10.09cm(adult average, 10.08cm) in men and from 2.77cm to 3.73cm(adult average, 3.66cm) in women. It could be seen that 50 percents of the interorbital growth occurs prior to three years of age and the growth persists beyond twelve years of age, but at a slow rate.

V.A.C.(Vacuum-assisted closure)를 이용한 창상 치료 치험례

장도명,이백권,김영진,홍정근 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Healing is an intricate, interdependent process that involves complex interactions between cells, the microcellular environment, biochemical mediators and extracellular matrix molecules. The goals of wound healing are to minimize bloods loss, to replace any defect with new tissue, and to restore an intact epithelial barrier as rapidly as possible. The rate of wound healing is limited by the available vascular supply and the rate of formation of new capillaries and matrix molecules, which are heavily influenced by locally-acting growth factors that affect proliferation, angiogenesis, chemotaxis, gene expression, proteinases, and protein production. We present a new method for wound control and treatment, the V.A.C (vacuum-assisted closure) technique. It places open-cell foam dressing into the wound cavity and applies subatmospheric pressure. The application of subatmospheric pressure accelerates the rate of wound healing by the foollowing two mechanisms: 1. Removal of excessive interstitial fluids, which decrease localized edema, reduce concentration of inhibitory factors, and increase local blood flow. 2. Transmission of mechanical forces to surrounding tissues with resultant deformation of the extracellular matrix and cells, which then increase protein and matrix synthesis as well as cell proliferation. We applied it to 17 patients: 1 Livedo vasculitis, 1 burned by flame 3 pressure sores, 1 extravasation injury, 1 wound infection, 2 wound disruption, and 8 diabetes mellitus feet. In the end, most of the remaining wounds were treated with a simple split-thickness skin graft and the results were encouraging. We concluded that the V.A.C technique may be an effective substitute to help promote wound healing. It could be especially helpful in chronic complicated wounds in aging or debilitated patients who can not tolerate aggressive surgical procedures.

Tumor Necrosis Factor-α가 비후성 반흔 및 Keloid 섬유아세포의 Type I Procollagen과 Collagenase의 유전자 발현에 미치는 영향

신승엽,장도명,김영진,이백권,위성신,안상태 大韓成形外科學會 2001 Archives of Plastic Surgery Vol.28 No.2

청피반성 혈관염(livedo vasculitis)의 수술적 치험례

이종건,장도명,김영진,손경동,이백권,임풍 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

Livedo vasculitis is thought to be a thrombogenic disorder that is related to the autoimmune disease. It clinically shows purplish mottling and recurrent painful ulcers in the lower extremities, leaving atrophie blanche after healing of the ulcers. Histopathologic finding are thrombotic occlusion in the mid-dermal vessels without necrotizing vasculitis. The therapeutic approach has largely been made by the use of drugs that stimulate endogenous fibrinolytic activitiy, that inhibit thrombus formation, or that cause vasodilation, but surgical intervention by excision and skin graftion has rarely been reported as a primary treatment. In our experience, two patients with livedo vasculitis, who had been unresponsive to various medications, were treated with wide excision and several times of skin grafting. And they experienced complete healing without recurrence.

prostaglandin E₁이 비후성 반흔 및 켈로이드 섬유아세포의 제 1형 교원질 분해 효소 mRNA 발현에 미치는 영향

정상훈,김영진,장도명,이백권,조길환 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.6

To investigate the effects of prostaglandin E₁(PGX₁) in prevention of proliferative scar formation, we cultured fibroblasts of normal skin(NS), hypertrophic scar(HS) and keloid(KL) tissues obtained from patients. We have compared type I collagenase production of cultured fibroblasts from normal skin, hypertrophic scar, and keloid tissues under various concentrations of PGE₁. Our results demonstrate that type I collagenase production was significantly increased after addition of PGE₁in HS and KL, but not NS. Type I collagenase production of HS and KL fibroblasts were increased similarly in 10 ??M and 10?? M of PGE₁and maximally increased in the concentration of 10??M. This promotive effects of PGE₁on the production of type I collagenase was larger in KL than in HS. These results also suggest that PGE₁may play the promotive effects on type I collagenase production in dose-dependent manner. PGE₁may have a role in the prevention of hypertrophic scar and keloid by enhancing the production of type I collagenase of HS and KL fibroblasts. The promotive effects of PGE₁on type I collagenase production was variable depending on its concentration, and its effects was maximum in certain optimal condition. The maximally effective concentration of PGE₁in the prevention of proliferative scar formation should be searched in further investigations for clinical use.

무갑상선 쥐에서 중식성 반흔의 새로운 실험모델

김영진,이백권,장도명,조길환,임풍 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

Proliferative scarring in the form of keloids and hypertrophic scars continues to be a clinical problem for some patients. The lack of an animal model for such scarring has been an obstacle to studying the biology and effective therapy of these entities. Consequently we created an accurate reproductive animal model to systematically study them. Human proliferative scars were explanted into flaps based on isolated vascular pedicles in congenitally rats. We compared the procollagen type Ⅲ peptide levels of proliferative scar tissue before and after explanting. The procollagen type Ⅲ peptide levels of explanted proliferative scar tissue remained increased as before explanting. Histological analysis of the explanted proliferative scar tissue revealed that all explants retained their original histotypic character even after 1 year. We could also retain the volume of implanted proliferative scar for 1 year and studied in vitro cellular proliferation. Fibroblast cultures from explanted scars demonstrated less aggressive growth characteristic than those from original surgical specimens. The advantages of this animal model are as follows: 1. The explants retain their histotypical character for a long period. 2. Placement of the explants outside the dorsum of a nude rat makes serial observation and measurement easier. 3. Agents under test can be injected into the explants through a catheter inserted into a single pedicle of island flap without the possibility of spreading systematically.

성인의 천미추부 종괴

조길환,이백권,장도명,김영진,안상태 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

We developed an animal model to recreate the condition of an open fracture in communication with the maxillary sinus. We then studied wound healing of the sinus wall structures following fracture in the presence of autogenous bone and alloplastic implant. This model is designed to simulate the repair of an orbital floor fracture in humans. The New Zealand White rabbit was used as the animal model. Standardized 8mm defects were made bilaterally in the maxillary sinuses to include bone and mucosa in 36 rabbits. Two different implants and autogenous calvarial bone graft were placed in the soft-tissue pockets to obturate the defects, exposing one surface of the implant to the open sinus. Medpor porous polyethylene, silicone and calvarial bone implant were compared. Animals were killed at 1, 2 and 8 weeks after implantation. Gross examination of the specimens for the amount of mucosal closure and implant tissue fixation was performed. Histological sections were evaluated for bone and soft-tissue morphology juxtaposed to the implant. Complete closure of the mucosal defect was demonstrated with each type of implant. Medpor implants showed both vascular and soft-tissue ingrowth into pores by week 1. Bone ingrowth was seen by week 2. Closure of the Medpor obturated defects occurred more rapidly than in the silicone group. The Medpor implants and calvarial bone demonstrated bone and soft-tissue fixation, callus formation and maturation, while mature overlying mucosa was reconstituted over the defects. Silicone implants demonstrated a fibrous tissue reaction within 1 week of implantation and they never became fixed to bone or soft tissue. Maxillary sinus wall regeneration occurred in all defects. This study supports clinical observations of maxillary sinus wall regeneration in humans. Although sacrococcygeal mass is rare and usually found in infants or children, adolescent or adult patients with protruding mass in sacrococcygeal region occasionally come to us simply for a cosmetic problem. In this situation, even though there is no definite neurological deficit, it should be evaluated whether or not the underlying bony pathology or dural defect exists. Few cases about the sacrococcygeal mass have been reported in adults. We reviewed our cases including preoperative evaluation methods and postoperative diagnosis. From March, 1993 to February, 1997, we experienced 6 adult patients with sacrococcygeal mass and no neurological abnormality. Preoperative evaluation were made by plain X-ray, myelogram, computed tomography(CT), and magnetic resonance imaging (MRI), as needed. Postoperative diagnoses were 2 meningoceles, 2 lipomyelomeningoceles, 1 desmoid tumor, and 1 teratoma. From our experiences, CT or MRI is essential to evaluate the sacrococcygeal mass preoperatively. These methods can visualize the precise anatomic location and extent of the mass, its relation to the spinal cord, and associated bony abnormalities. MRI is superior to CT, especially in defining the nature of the mass and involvement of the spinal cord. Conclusively, even a simple mass in the sacrococcygeal region in adults needs MRI or CT evaluation, and MRI is the most valuable method of evaluating the mass preoperatively and provides important information to establish a treatment plan.