수부 역혈행성 도서형 피판술 : Long-term evaluations of sensory recovery in the transfered flap and circulatory disturbance in the hand 공여 수부의 혈류상태 및 이식피판의 감각상태에 대한 원격추적조사

차진한 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3

Bostwick reported the reverse flow temporal artery island flap in 1976, Lin described venous drainage of reverse flow flap in 1984, then the various reverse flaps of upper and lower extremities were reported, however there were no objective results of sensory recovery in the flaps and evaluation of circulatory disturbance in the hand. Fourty-three reverse flow island flaps for hand reconstruction were transferred. These included 29 digital island flaps, 3 dorsal metacarpal flaps, 3 radial forearm flaps, 2 ulnar flaps and 6 posterior interosseous flaps. Nineteen cases were sensated flaps ; 14 digital island flaps, 3 posterior interosseous flaps, 1 radial forearm flap and 1 ulnar forearm flap. After a follow-up ranging from 6 to 26 months, all flaps have survived completely without loss of flap tissue. The average static 2-point discrimination was 7.4mm in the sensated digital island flaps, 10.3mm in the nonsensated digital flaps and 16.3mm in the sensated flaps using the lateral or medial antebrachial cutaneous nerves for neural anastomosis. The radial forearm flaps, ulnar forearm flaps and digital island flaps have a well known disadvantage, which is the disruption of a major arterial supply to the hand or finger. Acute ischemia or late cold intolerance of the hand or finger was not developed clinically and in the evaluation with thermography. The use of sensated reverse island flap in the hand provide excellent sensory recovery in the flap. Provided that the other arteries in the hand are intact and well functioning, there is no circulatory disturbance to the operated hand.

이하선에 발생한 Kimura 병: 증례보고

차진한,이승철,박흥식,강소라,구혜수,이순남 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.1

Kimura disease(KD) is a chronic inflammatory disorder of unknown etiology and results from an abnormal proliferation of lymphoid follicles and vascular endothelium and rarely has been reported in Korea. Clinical findings of Kimura disease include solitary or multiple, firm, subcutaneous nodules, which usually are located on the head or neck but parotid region is the most common site. The clinical course of the disease is chronic, with lesions frequently persisting or recurring despite treatment. The prognosis for KD is good, with no potential for malignant transformation. Our case is a 45-years-old man who had huge mass on left cheek which had slowly grown since about 10 years before. We planned to perform superficial parotidectomy but the mass was poorly demarcated due to extensive fibrosis and adhesion and had easy bleeding tendency. After frozen biopsy, we performed tumor debulking operation followed by cyclosporin therapy by the dose of 2.5 mg/Kg/day. The lesion was almostly cleared successfully after 3 months later. We report important aspects of clinical findings, histologic features, and therapeutic options of the rare case of KD with review of the previous articles.

복합처치에 의한 비후성 반흔이나 켈로이드의 치료

차진한 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.1

1993년 10월부터 1995년 1월까지 본원에서 치료하였던 54례의 비후성 반흔이나 켈로이드의 치료후 최소한 12개월간 추적조사를 통하여 저자는 기존에 보고된 다양한 치료방법을 조합하여 각각의 장점을 보강하고 단점을 감소시키는 복합처치로 제1형의 비외과적 복합처치는 기본의 발표된 치료효과 보다 월등한 결과를 가져왔으며, 제2형의 외과적 복합처치는 증례수가 적고 추적조사가 단기간이나 재발률이 적게 발생하였다. 저자는 폭이 좁고 높이가 비교적 낮은 비후성 반흔이나 켈로이드는 비외과적 제 1형 복합처치를 추천하며, 반흔이 크고 재발한 켈로이드는 제2형 외과적 복합처치를 시행하는것이 바람직하다고 사료한다. Treating of established keloids or hypertrophic scars is difficult, several methods for skeloids treatment have been reported; intralesional steroid injection, application of silastic gel sheet, pressure garment and surgical excision. Three or four combined methods of them produced better results than single method. An attempt was made to assess the value of 2 categories of combined treatment, the category 1 was intralesional steroid injection in combination with pressure garment & silastic gel sheet in treating 43 keloids or hypertrophic scars, the category 2 was surgry in combination with nonsurgical treatments in treating 7 patients. Nonsurgical combined treatment(category 1)was found be effective in the eradication of symptoms(91% symtomatic relief), the texture change(93% success rate) and the height change(56% partial flatteneing & 37% full flattening). Surgery in combination with nonsurgical treatments(category 2) is also recommended as treatment for complicated recurrent keloids. However more cases and longer follow-up are necessary.

도서형피판이나 유리피판을 이용한 족부재건술

차진한 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.1

The foot has unique anatomic and functional characteristics, it endures constant weight loading or alternation stimulus of shoes while standing or walking. So the foot is the challening area for reconstructive. I have reconstructed 23 cases of foor defects with various island or free flaps from March 1990 to Feb. 1995. The patients exhibited variable causes and sizes of foot defects, 15 cases of acute trauma, 3 cases of skin cancer, 2 cases of scar of scar contacture, 2 cases of pressure sore and a case of diabetic ulcer. Free flaps were chosen in 10 cases, such as lateral arm flap, scapular flap, latissimus dorsi muscle flap, forearm flap and superficial temporal fascia flap. Island flaps were also chosen in 13 cases such as medial plantar flap, dorsalis pedis flap, reverse peroneal flap, aosterior tibial flap. All flaps were survived without necrosis. 23 cases were divided into 4 groups according to foot defect area, 9 cases of heel and plantar weight-bearing area, 3 cases of Achilles tendon area, 6 cases of heel and plantar weight-bearing area alteral malleolar area and 5 cases of dorsal foot. I rfecommend that medial plantar island flap is suitable for heel reconstruction, reverse peroneal island flap for Archiles thedon area, dorsalis pedis island flap for malleolar area, superficial temporal fascia free flap for dersal foot.

혈소판응집과 단백인산화에 대한 PHOSPODIESTERASE-억제제의 효과

차진한 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.3

There are many evidences suggesting that phosphodiesterase(PDE) inhibitors, amitriptyline(AM) and chlorpromazine(CP) inhibit the platelet aggregation. Therefore, the antiplatelet activities of several PDE inhibitors ; 3-isobutyl-1-methylxanthine(IBMX) and 4, 5-dihydro-6-(3-nitro-4-methoxyphenyl)-5-methyl-3-(2H)-pyridazinone ; KR30075(KR), sodium nitroprusside(SNP), amitriptyline(AM) and chlorpromazine(CP) were compared in terms of their inhibitory effects on aggregation and protein phosphoylation of the rabbit platelet in response to thrombin(0.25units/ml;TB), collagen(200mg/ml;CO), adenosine diphosphate(4.0×10-5M;ADP)and eqinephrine(4.0×10-6M;EP). The following results were obtained. 1. KR30075 inhibited the aggregation of platelets in response to EP>CO>ADP>TB in the order of its antiplatelet activities, showing IC50 of less than 1.7×10-7M. PDE inhibitors, showed the inhibitory effects on the platelet aggregation in response to several agonists in similar patterns. The antiplatelet activity of KR (IC50:less than 1.7×10-7M) was significantly greater than that of SNP(IC50:less than 1.57×10-6M). But the antiplatelet activity of other drugs used in this study was not so meaningful compared with those of KR and SNP. 2. The platelet aggregation induced by each of the agonists was accompanied with the increased phosphorylation of 41 kDa protein and the decreased 47 kDa and 20 kDa proteins. PDE inhibitors (KR, IBMX) and SNP significantly inhibited the increase of 41 kDa protein phosphorylation and produced somewhat of an attenuation of the decreases of 47 kDa and 20 kDa protein phosphorylations. AM and CP, however had little effect on the decrease of 47 kDa protein phosphorylation, but inhibited the decrease of 20 kDa protein phosphorylation. Even so KR, SNP and IBMX produced the increases of 43 kDa & 22 kDa protein phosphorylations in order of KR>SNP>IBMX. The antiplatelet activity of KR 30075 seems to correlate with the decrease of 41 kDa protein phosphorylation and the increases of 43 kDa and 22 kDa protein phosphorylations.

근신경판의 선가공에 의한 혈행화된 신경공여부의 실험적 연구

차진한 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

Regeneration through vascularized nerve graft seems to be better than nonvascularized nerve graft, especially in the scarred bed. I report on an experimental technique of prefabrication of vascularized nerve graft by creation of myoneural flap. The aim of this study is to investigate revascularization and fibrosis of the nerve in the myoneural flap, adiponeural flap and conventional nerve graft. Forty five Sprauge-Dawley male rats were divided into three groups : The myoneural flap group(n=15), in which 10 mm length of segment of left sciatic nerve was embedded in the 1.8 cm ×1.5 cm width of right adductor muscle flap, the adiponeural group(n=15), in which the same length of nerve segment was also embedded and entublated in the 1.8 cm ×1.5 cm width of right lower abdominal adipose flap, the conventional nerve graft group(n=15), in which 10 mm length of left sciatic nerve was cut and repaired. Five weeks later the sciatic nerve was evaluated through gross bleeding of nerve ending, histologic finding(fibrosis & revascularization). The results obtained were as follows. 1. Two animals of myoneural group died in the immediate postoperative period, presumably due to massive bleeding. 2. In all 43 cases in our study, bleeding from nerve ends was demonstrated. 3. The fibrosis of the endoneurium, perineurium and epineurium of the entublated nerve in myoneural group was more prominent than the nerve in the conventional nerve graft group, but less than the nerve in the adiponeural group. There was significant differences of fibrosis grade between each groups(Pr > 0.0001) 4. The epineurium and perineurium of the nerve in myoneural group were well vascularized in comparison to the nerve in adiponerual group, but poorly to the conventional nerve graft. There was significant differences of vascularization grade of the perineurium and epineurium between each groups(Pr > 0.0001). Our results seem that the revascularization of embedded nerve in the myoneural flap is good enough to regenerate the grafted nerve in the hostile bed. This is a preliminary report. An ongoing study in our nerve in the hostile bed. This is a preliminary report. An ongoing study in our department investigates nerve regeneration of these myoneural group compared with other two groups.

수지 원위부 절단의 재접합술

차진한,박명철 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.1

Replantation of the upper extremity has been developed over 30 years from a laboratory experimental model to a common techique applicable to acute and reconstructive hand surgeries. Today, successful replantation of fingers proximal to the middle phalanx is common. yet salvage of amputated fingers, distal to the DIP joint is still a challanging problem. Technical expertise in microvascular surgery may allow the true replantation of parts amputed within the distal interphalangeal joint. The functional and cosmetic success of these replantations is excellent. The authors report replantation cases, distal to the distal interphalangeal joint of fingers and retrospective analysis of 20 cases which were treated at Min Joong hospital, Collge of Medicine, Kon Kuk university, from October 1988 to February 1992 The results were as follows : 1. The survival rate of amputated digits distal to the DIP joint was 85% 2. Important factors for the successful replantation were the type of injury and the degree of crushing. 3. Replanted digits were improved in esthetical and functional aspects 4. If possible, the authors tried the venous anastomosis in 13 cases among the total 20 of cases.

안면골 성형 및 재건술 환자의 심리상태에 대한 연구

차진한,김우경,김수신,백세민,이임순 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.2

Cooperative management of facial bone deformities by maxillofacial surgeons and other specialities has resulted in tremendous growth in recent years. Frequently, these patients have suffered considerable emotional trauma from ridicule of their deformies. We evaluated 34patients excluding facial bone fracture which was operated primarily, from March 1987 to Feb.1988. These patients were divided into 4 groups according to etiology and operation methods. The first group included aesthetic facial bone surgery patients, the second group included posttraumatic facial doformity patients, the third group included facial bone tumor patients, the fourth group included congenital facial anomaly patients. After soco-psychological evaluation, we achieved the following results. 1. The primary motivation of many patients seeking facial bone surgery was aesthetic improvement. 2. Patients for aesthetic improvement and patients of post-traumatic facial bone deformities were well adjust to social relationships. Patients of facial bone tumor depended on familial support, and patients of congenital facial deformities were severely anxious. 3. Self-confidence of aesthetic surgery group was the highest of all groups. It also was decreasing from aesthetic surgery group. Posttraumatic group, facial bone tumor group and congenital anomaly group in that order. 4. All patients placed the highest value on social relationships and the lowest value on religion. 5. Our finding will help identify and prevent some of the pitfalls leading to patients dissatisfaction after surgery.

급성 수부손상환자의 심리상태에 대한 연구

차진한,백세민,박명철,이임순,김수신 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.4

patients who are the victims of physical trauma may also develop immediate and delayed emotional problems. Psychological interventions because of altered body image, acute stress reaction and post-traumatic disturbances are well documented and also the management of these complications is an extension of trauma care. The preinjury psychopathology of traumatic victims are not well described; however, we studied the preinjury psychopathology of 73 patients in acute hand injury, analyzed their correlation between acute hand injury, socio-environmental factor, characteristics of personality and occupational affinity in this population. We obtained the following results: 1.The incidence of acute hand injury increase in the unskilled population attached to their short employment period, insufficient knowledge of prevention and poor working environment. 2.There is no correlation between acute hand injury and decrease of occupational affinity. 3.There is no evidence of much accidental rate because of personality disorder in this population. 4.In order to decrease the accidental rate in the acute hand injury, the sufficient preventive education and industrial environment must be developed.

초음파를 이용한 비골골절의 진단

차진한,김양우,권택근 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3

Early and accurate recognition and treatment of nasal trauma is very important to prevent late deformity. There are many methods to evaluate nasal trauma, but the role of ultrasound has rarely been documented in the facial area. This study includes thirty one patients with sustained nasal trauma who were evaluated using ultrasound and compared the diagnostic accuracy of ultrasound with plain films and CT scans. CT scans and ultrasound showed same fractured shapes of nasal skeletons with positive correlation and revealed a positive correlation between the ultrasound and CT findings. In conclusion, nasal ultrasound is an accurate diagnostic modality of nasal trauma and correlates well with CT findings.