변형된 도서형 후이개 근막피판을 이용한 상안검, 검판, 눈썹의 동시재건에 대한 치험례

장효죽,홍인표,김종환,이세일 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.4

구순열 및 구개열 환자에 대한 Toxoplasma항체의 혈청학적 연구

심영기,이세일,홍인표,정평림,장효죽 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.1

The etiology of the cleft lip and palate can be explained with a multifarious theory. According to articles, there are some relationships between congenital toxoplasmosis and the cleft lip&palate, but the direct relationships is not obvious. Therefore, this research aims to find the difference of the serum toxoplasma antibody titer between 172 cleft patients who have been treated at National Medical Center and their mother group of 81 cases, healthy control group of 150 cases. The antibody titer was identified by the indirect fluorescent antibody test(>16)and the enzyme-linked immunosorbent assay(>0.3). The results are as follow : 1. By ELISA, the positive rate of the cleft patients(8.1%, 14cases)and that of the mother group(9.9%, 8cases)is higher than the healthy control group(2.7%, 4cases)(p<0.05). 2. By IFAT, the positive rate of the cleft patients(10.5%, 18cases)is higher than the healthy control group(5.3%, 8cases), but the difference is not significant(p>0.05). And the positive rate of the mother group(13.6%, 11cases)is higher than the healthy control group(5.3%, 8cases)(p<0.05). 3. By ELISA and IFAT, the positive rate of the mother group is higher than the cleft patient but the difference is not significant. 4. By ELISA and IFAT, the positive rate of the cleft patients according to the clincal group is not significant. 5. By ELISA and IFAT, the positive rate of the chronic disease group(17.3% & 27.7%)is higher than the healthy control group(2.7% & 5.3%)(p<0.05).

최근 10년간 구순열, 구개열 및 구순구개열의 발생 빈도

이세일,김종환,민도원,홍인표,장효죽 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

Cleft lip, cleft palate and cleft lip & palate are congenital. Many authors have reported their incidence, type and position domestically, but most studies have been made in a single area or hospital. We do not think that the incidence, type and position which have already bee reported reflect the whole of korea, and therefore, did research on incidence, type, position and blood type of patient, sex, birth order, parents' age, blood type, duration of pregnancy, Apgar score and associated anomalies in 323,652 delivery cases in 16 training hospitals from 1 to 11 years (on the average 7.5 years) during one month of february, 1995. One total cleft lip, cleft palate and cleft lip & palate among the 966.1 newborn cases, one cleft lip cases among 3636.5 newborn, one cleft palate cases among 5137.3 newborn, and one cleft lip & palate cases among 1712.4 newborn are showed. 12.5% of cleft lip cleft palate and cleft lip & palate patients developed associated anomalies, particularly 28.6% hand anomalies and 24.5% central nerve system anomalies. Therefore cleft lip, cleft palate and cleft lip & palate patients should be checked a hand anomaly and evaluated central nerve system.

가토 이개에서 자가 연골막 이식시 압좌손상에 따른 연골 생성 차이에 대한 실험적 연구

채종훈,홍인표,김종환,장효죽 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.5

The perichondrium has neochondrogenic potential. Many authors have published their study for the cartilage regeneration from perichondrium and the clinical uses of perichondrial graft. How is the difference of thickness of the regenerated cartilage after crushing the free perichondrial graft, compare with uncrushed graft? In this study, the perichondrium was obtained from rabbit, ears, and sectioned 10x10 mm slices. The uncrushed and crushed perichondriums were grafted into subcutaneous layer of back. After the 2,4 and 8 weeks, authors obtained regenerated cartilage from both crushed and uncrushed free perichondrial graft from rabbit back, examined the survival rate and thickness by histologic study. The results are as follows: 1. The survival rate was no difference between the uncrushed perichondrium & crushed perichondrium (p>0.05). 2. The cartilage from the uncrushed perichondrium was thicker than the crushed perichondrium, at only 8 weeks(p<0.01). 3. The thickness of regenerated cartilage was similar to the cartilage of the donor site of free perichondrial graft at 4 weeks(p>0.05).

가토의 이개에서 복합조직 이식의 크기에 따른 생착율 변화와 조직학적 관찰

이세일,김종환,박종범,홍인표,장효죽 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

Composite tissue grafts have been used as a convenient, aesthetic means of head and neck reconstruction for more than a century. However, their use has been limited by their often unpredictable survival, particularly large sized composite graft. To observe the survival rate of composite graft according to size change, we used a rabbit model. Triangular-shape composite graft was incised on the medial and lateral side of auricle(skin-cartilage-skin), was reapproximated. The following 8 groups of composite graft (total 64) were prepared (size:5,7,9,11,13,15,17,19mm). The microscopic examination was obtained at postoperative 5th day and 10th day. At 21 days, all grafts were assessed for survival area. Our results demonstrated that 1) From 5mm to 15mm, the percent survival area was not decreased according to increased graft size. But the percent survival area was decreased at the size of 17,19mm 2) The percent survival area was greater in composite grafts on thick cartilage area (medial) than on thin cartilage area (lateral). 3) Microscopic finding; 5th days-there was blood clot and inflammation reaction between donor and recipient 10th days-the epitheilal connection was found. The thickness of donor catilage was not changed but wraped, the perichondrium and connective tissue inigrety was partially destructed

최근 12년간 욕창의 외과적 치료성적에 대한 고찰

장효죽,홍인표,최정준,김종환,이세일 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.3

Pressure sore is common problem in bedriden patients or spinal cord injured persons. It needs excellent nursing care for prevention and treatment. The advent of muscle flaps and water flotation beds have contributed significantly to the success of operative closure of pressure sores. However, the long term results of surguical procedures are not well described. We reviewed the data from 52 consecutive patients with 69 pressure sores operated in National Medical Center between 1983 and 1994 in an effort to look at initial operative success and late recurrence. The results were as follows : 1. The incidence according to age was highest in 4th decade. 2. Trauma was most frequent cause of pressure sore, traffic accident was cause of 16 cases and falling down injury was cause of 15 cases. 3. The total number of pressure sores was 69 cases in 52 patients 4. The most frequent site of pressure sore was sacral area(32 cases), others was as follows : ischial area(18 cases), greater trochanteric area(10 cases), heel(7 cases), back(2 cases) 5. Pressure sores were treated by myocutaneous flap, fasciocutaneous flap in 49 cases and 20 cases were treated by random local flap, STSG. The myocutaneous flap and fasciocutaneous flap were as following : gluteus maximus rotation flap(19 cases), gluteus maximus V-Y advancement flap(9 cases), tensor fascia lata(8 cases), gluteus maximus sliding flap(5 cases), posteriorgluteal thigh flap(2 cases), thigh trasposition flap(3 cases), total thigh flap(2 cases), hamstring myocutaneous flap(1) 6. The postoperative complications were suture-line dehiscence(9 cases), hematoma collection(4 cases), wound infection(4 cases), pneumonia(1 case), total loss of STSG(2 cases). The complication rate was 33.3%. 7. The recurrence of pressure sore occurred in 36 cases including second and third recurrence(7 cases). The rate of recurrence was higher on random local flap and STSG than myocutaneous, fasciocutaneous flap. 8. The most common site of recurrence was the ischial area(in 13 cases)which was increased than before in Korea. 9. The analysis of duration until pressure sore was recurred revealed that 10 pressure sores were recurred on 7-9 months after initial surgery because the postoperative management was improper.

내시경을 이용한 전두부 거상술

민도원,장효죽,홍인표,김종환,이세일 대한미용성형외과학회 1995 Archives of Aesthetic Plastic Surgery Vol.1 No.2

외상성 신경종의 예방에 관한 연구

팽성숙,장효죽,홍인표,김남호,서정일,김종환 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6

A painful neuroma in the hand can be psychologically and physically disabling. The difficulty in alleviating the problems is attested by the numerous methods of treatment espoused in the literature. Traumatic neuroma was first described by Odier in 1881. He described the enlargement or swelling which develops at the distal ends of the proximal segments of peripheral nerves after partial or complete division and spoke of these as nerve tumors. In 1920 Huber and Lewis published reports of their experimental work in the prevention and causes of traumatic neuromas. Little of practical significance has been done since the work of Huber & Lewis, and most surgical techniques of today are still based on their experiments. There is no procedure that is completely and consistently successful in preventing neuroma formation. Altyough some different technique have been described, successful method of treatment hasn't been found as ever. These treatments include crushing the neuroma, ligating it, burying it in soft tissue or bone, injecting it with alchohol, or gentian violet, capping it with a silicone cuff, or pulling a perineurial sleeve over the axial ends. In spite of its advocates, these methods was insufficient as well. So the authors carried out animal study to find out the better operative procedure to prevent the traumatic neuroma. In the result of study, epineural closure combined with the use of chemical coagulent (5-flurouracil) in the severed end was satisfactory method compared with the others.

Influence of Intraventricular Muscimol on Blood Pressure of the Rabbits

Lim, Dong-Yoon,Jang, Hyo-Jook,Kim, Sang-Hoon 朝鮮大學校 附設 醫學硏究所 1991 The Medical Journal of Chosun University Vol.16 No.2

GABA 수용체의 agonist로 알려진 muscimol을 가토의 측뇌실내에 투여하여 혈압 및 심박에 대한 영향을 검토하고 GABA와 비교코자 본 연구를 시행하여 다음과 같은 결과를 얻었다. Muscimol (0.1-1.0 ug) 을 가토의 측뇌실내로 주입시 현저하고 지속적인 용량 의존적 혈안강하 및 심박감소 자용을 나타내었다. 이러한 Muscimol(0.3 ug)의 측뇌실내 투여로 인한 혈압하강 반응은 atropine,clonidine, bicuculline 및 picrotoxin 의 전처리로 유의하게 감약되었으나 양측미주신경절단, propranolol, ketansehne 및 strychnine에 의해서 아무런 영향을 받지 않았다. Muscimol 의 심박 감소작용은 atropine, clonidine, bicuculline, 및 picrotoxin 등의 전처리로 현저히 억제되었으나 양측 미주신경절단, propranolol, ketanserine 및 strychnine 에 의해서 전혀 영향을 받지 않았다. 이상의 연구결과로 보아, muscimol 은 가토의 측뇌실내로 투여시 혈압강하 및 심박감소 작용을 나타내며 이는 뇌내의 GABA-A 수용체를 통해서 나타내면 또한 중추의 cholinergic muscarine 수용체와 관련성이 있는 것으로 사료된다. The present study was an attempt to demonstrate the effect of intra-cerebroventricular muscimol, which is known to be a GABAergic receptor agonist, on the arterial blood pressure and heart rate in the rabbits anesthetized with urethane and to compare with gamma-aminobutyric acid effect. Muscimol at the cumulative doses (0.1-1.0μg) given into the lateral ventricle of the brain caused a marked, prolonged and dose-related fall in arterial blood pressure as well as in heart rate. Muscimol (0.3μg,i.v.t.)-induced depressor responses were significantly attenuated by the prior administration of atropine, clonidine, bicueulline and picrotoxin, respectively while was not affected by the pretreatment with bilateral vagotomy, propranolol, ketanserine and strychnine, respectively. Muscimol (0.3/μg,i.v.t.)evoked bradycardic response was markedly inhibited by the pretreatment with atropine, clonidine, bicuculline and picrotoxin, respectively but was not influenced by bilateral vagotomy, propranolol, ketanserine and strychnine. From the above experimental results, it is thought that muscimol administered intracerebroventricularly causes hypotensive and bradycardic responses in the urethane-anesthetized rabbits, and the cardiovascular effect may be mediated through GABAergic A-receptor stimulation in brain which is associated with central cholinergic muscarinic receptors.

하지에서 골노출을 동반한 연부조직 결손의 재건

홍인표,김종한,장효죽,이세일,윤경준 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.3

Reconstruction of soft tissue defect with bony exposure in lower extremity is best achieved by applying the most proper method after considering the condition of the defect and the mechanism of the injury. The method also focuses on covering the exposed bone, preventing the recurrent osteomyelitis, and reducing the complication such as malunion. During the recent 5years, we have used 5cases of local flaps, 5cases of free flaps, 3cases of muscle flaps, one case of fasciocutaneous flap, one case of island flap & one case of distant flap to cover the defects of these patients. Local flap & STSG were used for small sized defects, muscle flaps were used for large defects of upper 2/3 of lower leg, and free flap reconstructions were performed for lower 1/3 defects and in cases of bony exposure or osteomyelitis. There were no recurrences of osteomyelitis & donor site morbidity was minimal. Partial loss of STSG was th most common complication but we have obtained satisfactory results in most cases, so we present these cases with a brief review of concerned literature.