구순열 성형술에 있어 구륜근의 정확한 복원의 중요성

박철규,하범준 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.6

Most of the attempts and efforts in cleft lip repair have been directed toward the skin incision, and the importance of the orbicularis oris muscle repair has been emphasized in the recent years. Although the well-designed skin incision with simple repair of the orbicularis oris muscle has produced the considerable improvement of appearance of the upper lip, the repaired upper lip seems to get changed out of its shape in motion and has a tendency to be distorted with age if the orbicularis oris muscle is not repaired precisely and accurately. Following muscle dissection in cadaver with congenital unilateral cleft lip, we could find two different components in the orbicularis oris muscle, superficial and deep. One is a rectractor and the other is a constrictor of the lip. They have antagonistic actions to each other during lip movement. We can also identify these two different components of the muscle in the cleft lip patient during operation. We think inaccurate and mixed connection between these two different functional components can make the repaired lip distorted and unbalanced during growth. By identification and separate repair of two different components of the orbicularis oris muscle (i.e. repair of the superficial and deep components of the cleft side to the corresponding components of the philtral side), better results in the dynamic and three-dimensional configuration of upper lip can be achieved and unfavorable growth deformity can be avoided. The cleft lip repair has been performed by author's method in 126 cases of unilateral cleft lip, among which 20 cases have been followed up for over 10 years. We have obtained the following conclusions : the accurate repair of orbicularis oris muscle, superficial and deep portions separately, is essentia1 to obtain the balanced lips and normal growth of the repaired lips.

선천성 이개 기형의 조기 비수술적 치료

민경원,김석화,최중환,하범준 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.2

Some types of auricular deformities which show abnormal plical folding rather than hypoplasia, including lop ear, prominent ear, Stahl's ear, and cup ear, can be corrected nonsurgically, although surgical reconstruction in the management of the auricular deformities with severe hypoplasia, such as microtia and anotia. The incidence of the auricular deformities without severe hypoplasia in the nursery of Seoul National University Hospital from January to March, 1993 was 19.6% of 347 normal full-term newborn babies. The incidence of lop ear deformity was 11.2%, and those of Stahl's ear and prominent ear were 6.1% and 3.2% respectively. We started the nonsurgical treatment in 34 cases within the first week after birth, before the auricles lost their plasticity. Dental compound was used as splint and maintained for about 4 weeks. And we could eliminate the abnormal plical folding by compression, and mold new folds or shift the existing folds. 14 lop ears, 7 Stahl's ears, 6 prominent ears, and 2 cup ears were treated nonsurgically, 76% of which showed the satisfactory reuslt. Wide and deep concha of cup ear tends to resist the nonsurgical treatment. Lop ear deformities with sufficient amount of skin and cartilage at superior one third of auricle showed the remarkable improvement in formation of the superiorcrus and scapha, regardless of the size of the hood. 2 lop ears without sufficient tissue, on the contrary, were hard to be molded satisfactorily. stahl's ear and prominent ear could be corrected easily. These suggests that the amount of cartilage and soft tissue at the lesion to be corrected seems to be closely related to the results of the early nonsurgical treatment.

정확한 인각본 모양의 실리콘 삽입물을 이용한 안면 함요부의 교정

신명수,박종수,현원석,박영진,김재중,하범준 大韓成形外科學會誌 2000 Archives of Plastic Surgery Vol.27 No.1

We introduce a new silicone implanting method to correct facial depression caused by trauma or congenital anomaly. It resulted in good facial aesthetics in patients with facial depression. From August 1997 to January 1999, 5 patient (3 males and 2 females), in ages from 19 to 34 years, underwent silicone implantation for facial depression using our method. Three males were injured by traffic accident and had facial depression with or without bone defect. Two females had congenital forhead depression and requested aesthetic contouring. An impression of the face was taken with alginate backed with quick setting plaster. When set, a further stone plaster model was taken from the alginate-plaster, which was removed after fixation. Wax was then carved into the patient's stone model to fill the depression. Another stone cover was taken to cover this was-stone model. Then wax was melted away and medical implant grade room temperature vulcanized silicone adhesive was squeezed into the empty space. After cured, this precisely-shaped silicone imlant was inserted into the patient. We did not experience major complicaion such as infection, implant extrusion during 4 to 18 months' follow-up periods. All patients were satisfied with the results. The clinical result of this technique would be useful for accurate and excellent aesthetic implantation.

우레탄계 형상기억 폴리머의 생체친화성에 대한 연구 : TOXICITY TEST ON THE AGAR OVERLAY TEST 한천중층법에 의한 독성시험

하범준,민경원 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.3

Recently large number of implantable materials have developed in the medical field. These materials are tested by various methods, In vitro testing methods using cell culture have become common in the evaluation of the biologic effects of implants. One of these tests is described in this paper. It is an in vitro test using cell culture to determine the general cytotoxic effect of the urethane shape memory polymer which is different material from shape memory metal. The agar overlay test was used for the cytotoxicity screening of the urethane shape memory polymer and silastic rubber. A 24-hour culture of human Heal cells was used in this test. Findings of cell culture plastic and asbestos were used as controls in comparing interpreting the result. In conclusion, less than 5% of the cells were disintgrated by silicone rubber in areas underneath it. However the urethane shape memory polymer produced no discoloration in areas sur-rounding or underneath it. There were no disintegrated cells in these areas.

외측대퇴 유리피판을 이용한 넓고 긴 피부결손의 재건

하범준,김현수 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.5

Plastic surgeons have frequently encountered wide and long skin defects which require flap coverage. These include defects that occur after radical tumor resection of the head and neck region, release of severe bum scar contracture, and defects with exposure of the bone or tendons in upper and lower extremities. Lateral thigh fasciocutaneous flap, first introduced by Baek in 1983, has a long and wide skin territory. By using this flap, we performed 6 cases of burn scar contractures and 2 cases of head and neck cancer defects. In the flap elevation, it is not necessary to change the patient's position, therefore, the two-team approach shortens the operating time. The donor site can be closed primarily if the width of flap is not over 8 cm. The donor scar of the thigh is easily concealed. The lateral thigh flap can also be used as a composite or sensate flap. We conclude that, due to the lateral thigh flap being a thin and pliale fasciocutaneous flap which has a long and wide skin territory, it is very useful for reconstruction of large skin defects.

전거근 유리피판을 이용한 Romberg씨 환자의 안면 연부조직 재건의 치험례

하범준,민경원 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.3

Augmentation of facial soft tissue is frequently encountered in various in various diseases, one of which is Romberg's disease, progressive hemifacial atrophy. By serratus anterior free flap, the authors successfully augmented the depressed lesion of the face in 2 cases of Romberg's disease. This muscle free flap has several advantages in reconstruction of facial deformity. First, this muscle jas enough volume to augment the atrophic lesion of the face. Second, the form of slips of serratus anterior muscle and the posterior entry of the vascular pedicle allow separation of the slips anteriorly, and therefore, serratus anterior free flap is useful to fill the irregular defect selectively, Third, this muscle can be transfered in combination with other muscles, skin, and bones, and has versatility to provide various components of tissues. Fourth, as muscle flap has adequate structureal strength, it will not sag as omentum free flap does, and will not distort the facial expression. Furthermore, in the cases with facial palsy, functional reconstruction is possible by reinnervation. Finally, this muscle flap has an abundant blood flow, an the implantation of this free flap provides a new plentiful source of blood into the atrophic lesion, which may be expected to have a beneficial influence on the disease coures.

전 상악골 절제술 후 양경 유리 견갑 골-피부 피판을 이용한 재건 3례

김정민,하범준,문구현,현원석,방사익,오갑성,Kim, Jung-Min,Ha, Bom-Jun,Mun, Goo-Hyoun,Hyun, Won-Sok,Bang, Sa-Ik,Oh, Kap-Sung 대한미세수술학회 2003 Archives of reconstructive microsurgery Vol.12 No.1

We used bipedicled scapular osteocutaneous free flap for total maxillectomy defect reconstruction in 3 cases of malignant maxillary tumor. We elevated two flaps of the skin paddle and the bone flap with one common pedicle - the subscapular artery - which was devided to the angular branch of the thoracodorsal artery and the circumflex scapular artery to reconstruct the nasal cavity, the palate and the zygoma. The angle between the two flaps was free enough so that we could transfer the two flaps through a single microanastomosis. After the operation, patients could swallow and pronounce well, and the wound contracture was minimal so that we could get aesthetically good result.

변형 Biemer 방법에 의한 요골부위 전박 유리피판을 이용한 음경재건

김성덕,하범준,문구현,현원석,방사익,오갑성 大韓微細手術學會 2002 Archives of reconstructive microsurgery Vol.11 No.2

주혈관이 하나만 남은 하퇴부 연부조직 결손 환자에서 비복혈관(sural vessel)을 수혜혈관으로 한 유리피판 전이

변재경,하범준,현원석,김재중,신명수 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

Free flaps have been widely used in lower leg reconstruction. However, in cases with extensive injury to the vessels as well as to the bone and soft tissues, and having only one intact major vessel in the lower leg(single vessel leg), careful selection of recipient vessels for the free flap transfer is mandatory for preventing further vascular compromise of the distal lower leg. The sural artery and its vena comitantes are frequently protected form externally harmful forces by the bulky surrounding gastrocnemius muscle and can be used as recipient vessles for free flaps without any detrimental influence on the vascularity of the distal lower leg. In our department, three latissimus dorsi muscle free flap were transferred with sural vessels as recipient vessels in the reconstruction of the single vessel legs. Except for one case of flap failure due to serious infection at the microvascular anastomoses site, all the other cases were successfully reconstructed without any necrosis of the gastrocnemius muscle or the distal leg. In addition, the sural vessels were easily accessed in any patient position and their caliber was similar to that of the vascular pedicles of the donor muscle flaps. In conclusion, the sural vessels can be another useful option in selecting recipient vessels for free flap transfer in the reconstruction of the single vessel leg.

선조작 요골측 전완부 유리피판을 이용한 이재건술 2례 보고

신현덕,하범준,이지혁,문구현,현원석,방사익,오갑성 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.4

Deformities of the auricular region that have been resulted from burns or other traumatic injuries emotionally devastate the patients and frustrate the surgeons. The surgical procedure for ear reconstruction varies depending upon the quality and quantity of available skin in the auricular region after burns and other facial trauma for the coverage of cartilage framework. Postauricular skin, postauricular fascia, temporoparietal fascia have been used for traumatized ear reconstruction according to the literature. But toral ear reconstruction in the cases of severe trauma like burn or traffic accident is one of the most difficult problems because of its paucity and poor quality of the available skin in the auricular region. The author reports two cases of traumatized ear reconstruction using a prefabricated radial forearm fasciocutaneous free flap made of an autogenous costal cartilage framework. This flap is valuable for the reconstruction of severely traumatized ear when local tissue or other free flaps are improper to select.