짓니긴 및 벗겨진 손상에서 가로손가락손바닥활을 이용한 손가락 재건

최환준,이인수,최창용,김미선,김준혁,Choi, Hwan-Jun,Lee, In-Soo,Choi, Chang-Yong,Kim, Mi-Sun,Kim, Jun-Hyuk 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: In the finger, there are three major palmar arches in the arterial system. The location of this arches are constant. The middle and distal transverse arches are consistently large (almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. This paper describes our experiences in reconstruction and replantation of the finger using rerouting the transverse digital palmar arch. Methods: 31 patients with injuries according to our classification were treated from March of 2005 to October of 2008. In this study the authors subdivided injuries into those with amputation distal to the insertion of the flexor digitorum profundus (Class I, 31 fingers); those with amputation distal to the insertion of the flexor digitorum superficialis (Class II, 4 fingers). Replantation was performed using the artery-only technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration or converting the arch. Venous drainage was provided by an external bleeding method with partial nail excision, medical leech, and repaired margin. Results: The success rate was 87% (n=27) in class I and 75% (n=4) in class II. The authors conclude that crushing and complete avulsion injuries & amputations are salvageable, with acceptable functional results in select patients, especially those with amputation distal to the insertion of the flexor digitorum superficialis. Conclusion: We performed replantation and reconstruction with only-arterial transposing anastomosis successfully, resulting in good recovery of aesthetic and functional outcome. Three major digital palmar arches, especially distal two branches, give us additional treatment options. In the finger replantation and reconstructive techniques using rerouting healthy the transverse digital palmar arch increase the survival rate of the finger.

반복적인 얕은손가락굽힘근힘줄 폐쇄성 손상 후 발생한 방아쇠 손가락 증례

최환준,최의철,김용배,Choi, Hwan-Jun,Choi, Eui-Chul,Kim, Yong-Bae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Many causes for triggering or locking of the fingers have been discussed in other literatures. The most common one is known stenosing tenosynovitis, which causes, a mismatch between the volume of the flexor tendon sheath and its contents. However, repeated trauma to the hand is uncommon cause of trigger finger. Therefore, we present a case of a rare condition of stenosing tenosynovitis which developed from a repeated relatively weak superficial flexor tendon injury. Methods: The patient was a 62-year-old woman who showed a painless, fixed and round mass on her right hand with no particular cause. Active and passive range of motion of the metacarpophalangeal joint of long finger was limited in flexion and extension. Ultrasonographic finding showed injured flexor digitorum superficialis tendon had fibrillar architecture with swelling between hyperechoic synovial membrane and hypoechoic surrounding area. Surgical exploration revealed that a bunched portion of the flexor digitorum superficialis and A1 pulley cause triggering during operation after adhesiolysis of scar tissue. Results: After releasing the A1 pulley, the range of motion of the metacarpophalangeal joint of long finger showed no limitation and histological examination of the subcutaneous tissue revealed fibrous fatty degeneration. In this case, releasing the A1 pulley with adhesiolysis of the subcutaneous scar tissue was successful and we obtained good functional outcome. Conclusion: We examined a patient in whom a repetitive impact forces to the palm caused longitudinal tear of the flexor tendon, leading to trigger finger. We experienced a rare case of stenosing tenosynovitis and trigger finger caused after close injury to flexor digitorum superficialis and its degenerative changes that caused mass like effect. To the best of authors' knowledge, our case of close injury to the flexor digitorum superficialis and unique morphologic change before rupture of tendon is rarely to be reported.

부악하선에서 유발된 양측성 몰입성 하마종

최환준,김선주,이영만,Choi, Hwan-Jun,Kim, Sun-Joo,Lee, Young-Man 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: Whereas oral ranula is relatively common and presents as a cyst in the mouth, the plunging ranula is rare and manifests itself as a mass in the neck with or without an associated oral lesion. The purpose of this study is to examine the clinical characteristics of rare bilateral plunging ranula arising from accessory submandibular gland in order to provide our experience for its correct diagnosis and treatment. Methods: A 13-year-old girl manifests as a slow growing painless, non-mobile swelling in the anterior neck. She underwent surgery via a cervical approach. A pseudocyst was extirpated and adjacent accessory gland tissue and related lymph node were removed. Results: The histologic appearance is characteristically of a cyst, devoiding of epithelium or endothelium, with a vascular fibro-connective tissue wall containing some chronic inflammatory cells and macrophage stuffed with mucin. Pathologic findings represented a form of myxomatous degeneration and lined by condensed connective tissue and granulation tissue. The nature of the accessory gland tissue was same as subligual gland. Although total submandibular or sublingual gland excision was not performed, no recurrence was observed during 6 months follow-up periods. Conclusion: Usually, unilateral plunging ranula develops commonly because of rupture of sublingual gland duct by trauma and extravasation of salivary secretion to the adjacent tissue. But our case developed because of bilateral congenital accessory submandibular gland. This is thought to be a result from a congenital failure of canalization of the terminal end of the duct. Finally, the correct diagnosis is essential for the most effective treatment, which is excision of the ranula and related accessory salivary gland. We performed excision of accessory submandibular gland and plunging ranula and had a good result without recurrence.

안저골절 정복술 후 풍선 달린 카테터와 방사선조영제의 이용

최환준,이한정,양형은,이영만,Choi, Hwan-Jun,Lee, Han-Jung,Yang, Hyung-Eun,Lee, Young-Man 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. Methods: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. Results: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. Conclusion: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

후두부에 발생한 유피낭종의 특징

최환준,탁민성,최창용,강상규,이영만,Choi, Hwan-Jun,Tark, Min-Seong,Choi, Chang-Yong,Kang, Sang-Gue,Lee, Young-Man 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Congenital dermoid cysts develop during the fusion of the embryo when the ectodermal tissue gets trapped in the line of fusion. Dermoid cysts of the head are rare lesions comprised of epidermal and mesodermal elements. Furthermore, dermoid cysts in the occipital area are extremely rare. Only a few cases of dermoid cysts in the posterior scalp have been reported. Especially, A bilateral, synchronous presentation in this location has not been reported previously in the literature. Methods: All 5 cases had a gradually enlarging mass of the posterior aspect of the scalp. The cysts were mobile, noncompressible, and non-tender, without evidence of an associated sinus tract, skin dimpling, discoloration, or communication with adjacent structures. The CT scan displayed a hypodense cystic lesions about -87 to +24 HU (Housefield units, average +3.2 HU) with hypodense capsule and no postcontrast enhancement. All tumors were found just under the skin, and were well encapsulated, so they were completely removed the mass with adjacent periosteum. Results: On gross findings, all tumors were oval-or round-shaped, and when the cystic tumor was cut open it presented a greasy and caseous substance. Histologically, all specimens contain desquamated squamous epithelium and keratin in the lumen and are encapsulated and lined by keratinized stratified squamous epithelium. And, all cases of posterior mass are the presence of adnexal structures. Conclusion: Appropriate diagnosis requires not only an index of suspicion for this rare tumor a very careful history and search for skin changes. Especially, CT can reveal the exact location of the cyst, its relationship with the adjacent structures. We think that occipital dermoids divide into superficial and deep type. In our cases, because they did not have intra-cranial involvement or fistula formation, they are superficial type. This report describes the clinical and operative aspects of the superficial dermoid cysts and provides a review of the literatures.

손가락동맥과 동반정맥 구조에 대한 해부학적 연구

최환준,심병관,김철한,탁민성,김준혁,정성균,이영만,Choi, Hwan-Jun,Shim, Byung-Kwan,Kim, Cheol-Han,Tark, Min-Seong,Kim, Jun-Hyuk,Jung, Sung-Gyun,Lee, Young-Man 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.2

Purpose: Many descriptions of the digital arterial anatomy including skin territory of the finger have been published. Relatively few studies on venous architecture of the finger have been performed in this area, in part, attributable to the technical difficulties encountered in dissecting small vessels. The purpose of this study is to present the precise microsurgical anatomy of the vein related to the digital artery and venae comitantes of the components. Methods: Arterial and venous anatomy of their relation to the fingers were examined in 38 specimens of two fresh cadavers and 36 clinical cases. All specimens were evaluated grossly, surgical microscopically, or / and light microscopically to observe the three & two-dimensional structure of the artery and joining vein, evidence of the venae comitantes, and venous valve. Results: No longitudinal venae comitantes along the digital artery were found in any specimens. The size of the venae comitantes of each digital artery was much smaller than other vein, but always existed any level of digital artery. One or two venae comitantes in the digital artery ran spiral, oblique, helical, fibrillar, or irregular branched shape. The authors also found the vein of the finger, that had bicuspid valves, but not in venae comitantes. Conclusion: Recently, venous outflow problem rather than arterial circulation is the most common cause tissue failure after microvascular surgery in the hand. Sometimes, if it is not recognized early, there is an increased risk of tissue damage and loss. The authors concluded that this study presents a useful knowledge for the characterization of the venous structure and evidence for venae comitantes like a venule in the digital artery at varying levels of the finger.

경부 새성기형 3례

최환준,김현성,최창용,양형은,탁민성,Choi, Hwan-Jun,Kim, Hyun-Sung,Choi, Chang-Yong,Yang, Hyung-Eun,Tark, Min-Seong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Failure of proper migration, fusion, or maturation of the branchial apparatus components results in a variety of congenital defects. Of these, cartilaginous rests are infrequent, while branchial cysts and sinuses are more common, relatively. The purpose of this study is to examine the clinical and pathological features of rare cervical branchial remnants in order to provide basis for its correct diagnosis and treatment. Methods: We report three cases of cervical branchial remnants which were treated in our hospital from December 2004 to December 2009. These cases were examined their clinical features, histologic findings and treatments. The patients had been operated with simple excision, excision of the combined components and preoperative antiboitics. Results: A retrospective review produced 2 cases of the cervical branchial remnants and 1 case of the cervical chondrocutaneous branchial remnant. All cases were on the left side of the neck, and anterior to the sternocleidomastoid muscle. Histopathological examination showed that fistula & sinus were lined with stratified squamous epithelium, additionally, they were consisted of a cutaneous envelope containing sebaceous glands, hair follicles, various amounts of adipose tissue, and elastic fibers. And, One case revealed containing hyaline cartilage. No patient developed complications or reccurences. Conclusion: The authors recommend simple surgical excision of the remnants when discharge, infection, or cosmetic problem occur. Finally, these lesions do not have fistulous tracts or connections with important, deeper organs, and so can be safely transected at the level of the superficial musculature.

손가락끝 손상의 치료 시 인조손톱의 유용성

최환준,권준성,탁민성,Choi, Hwan-Jun,Kwon, Joon-Sung,Tark, Min-Seong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: The fingertip is the most commonly injured part of the hand and its injury frequently results in avulsion or crushing of a segment of the nail bed and fracture of the distal phalangeal bone. Restoration of a flat and smooth nail bed is essential for regrowth of a normal nail, which is important not only for cosmetic reasons but also for tactile capability of the fingertip. It is also anatomical reduction of the distal phalanx to promote patient's cosmetics and prevent nail bed deformity. Absence or no replacement of the nail plate results in obliterated proximal skin fold. When the avulsed nail plate cannot be returned to its anatomic position or when it is absent, we use a synthetic material for splinting the nail bed and alternative reductional method for distal phalangeal bone fracture, especially, instead of hardwares. Methods: From January of 2006 to June of 2009, a total of ten patients and fourteen fingers with crushing or avulsion injuries of the fingertip underwent using the artificial nails for finger splint. We shaped artificial nails into the appropriate sizes for use as fingernail plates. We placed them under the proximal skin fold and sutured to the fold proximally and to the lateral and medial edges of the nail bed or to the distal fingertip. Our splints were as hard as K-wire and other fixation methods and more similar to anatomic nail plates. Artificial nails were kept in place for at least 3 weeks. Results: No artificial nail related complication was noted in any of the ten cases. No other nail fold or nail bed complications were observed, except for minor distal nail deformity because of trauma. Conclusion: In conclusion, in order to secure the nail bed after injury and reduce the distal phalangeal bone fracture, preparing a nail bed splint from a artificial commercial nail is a cheap and effective method, especially, for crushed or avulsion injuries of the fingertip.

순환 연산 기반 차세대 MIMO 신호 검출 기법에 관한 연구

최환준(Hwan-Jun Choi),유승준(Seung-Jun Yu),하동현(Dong-Hyun Ha),송형규(Hyoung-Kyu Song) 한국통신학회 2014 한국통신학회 학술대회논문집 Vol.2014 No.1

무선 통신 시스템에서 멀티플렉싱 성능 향상을 위한 협력 통신 기법에 관한 연구

최환준(Hwan-Jun Choi),송형규(Hyoung-Kyu Song),우용제(Yong-Je Woo),박경원(Kyoung-Won Park),권기원(Ki-Won Kwon) 한국통신학회 2014 한국통신학회 학술대회논문집 Vol.2014 No.6