발육중인 흰쥐 스장벽의 신경총에서 Somatostatin 함유 신경원에 대한 면역조직화학적연구

한예식,이혜연,정인혁 대한해부학회 1989 Anatomy & Cell Biology Vol.22 No.1

액취증에서 투메슨트와 최소절개를 통한 피하조직 절제술의 치료 효과

한예식 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Purpose: Axillary osmidrosis is a condition of abnormal unpleasant body odor caused mostly by apocrine gland secretion. Surgical excision of the subcutaneous tissue has been the treatment of choice for several decade. However, there are risks for complications including wound necrosis, hematoma, seroma, obvious scars following surgical treatment. We report our method of treatment of subdermal excision with small skin incision under local anesthesia with tumescent infiltration. Methods: From December 2008 to August 2010, 33 consecutive patients underwent subdermal excision with small transverse incision under tumescent anesthesia for axillary osmidrosis. The average age of the patients was 22 years (range, 13 to 62 years) and the average follow-up period was 7.6 months (range, 3 to 22 months). Result: Through a questionnaire that was answered by 33 patients, 97% reported satisfactory reduction of malodor. Complication included small hematoma (1.5%) and superficial epidermal necrosis (1.5%) which healed spontaneously. According to the postoperative histologic examination, only a few remnant of apocrine and eccrine glands were found. Conclusion: The subdermal excision with small incision using tumescent anesthesia for axillary osmidrosis decreases the bleeding during procedure and enables removal of sweat glands easily under direct vision. Therefore this operation has the advantages such as a high success rate, rapid recovery and a low complication and recurrence rate.

근피판을 이용한 두경부 재건

한예식,유태현 高神大學 醫學部 1986 高神大學醫學部 論文集 Vol.2 No.1

두피에 발생한 혈관 육종 증례 보고 2례

한예식 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Background: Angiosarcoma of the scalp is rare vascular tumor originating from endothelial cell. The prognosis is very poor with high propensity of local recurrence and distant metastasis. The author reports experiences with the latissimus dorsi free flap in the reconstruction of soft tissue defect of scalp caused by excision of angiosarcoma. Methods: Two patients visited the hospital with 9x10cm, 8x11cm sized lesion on scalp. Distinguishing features were frequent occurrence of a peripheral erythematous ring, satellite nodules, intratumoral hemorrhage, and the tendency to bleed spontaneously. Both lesions in each patient had developed and increased in size for 5 months and for 3 months, respectively. Results: Two patients were diagnosed as an angiosarcoma. Prior to the operations, the patients had evaluations preoperatively including brain CT, brain MRI and whole-body PET-CT. There were no evidence of metastasis. We performed wide excision and reconstruction by latissimus dorsi musculocutaneous free flap with split thickness skin graft on both cases. In case 2, radiation therapy was done within 1 month of tumor excision. Multiple distant metastasis occurred in case 1. Conclusion: Angiosarcoma is a highly malignant tumor with poor prognosis. Treatment and reconstruction method was not yet established. Reconstruction methods include free flap, split thickness skin graft, local flap. We performed latissimus dorsi musculocutaneous free flap as reconstruction method. This method has advantages that have sufficient blood supply and bulk that offer durability to radiation therapy. However, it has a disadvantage in detection of local recurrences. And it has high potency than other reconstruction method for distant metastasis due to sufficient blood supply. Further discussion between doctor and patient is needed for the best possible selection of treatment.

비골골절 정복술 후 복합 환기실리콘부목과 바세린 거즈를 이용한 비강충전

한예식 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Background: The majority of nasal bone fractures have been managed by closed reduction and intranasal packing. Various packing methods have been used for maintaining stability of nasal bone and reducing patient's discomfort. In this study we compare previous procedure with only vaseline gauze and nasal packing with airway silicone splint and vaseline gauze after closed reduction of nasal bone fracture. Methods: We performed a prospective study with 60 patient treated nasal bone fracture from Dec. 2009 to Oct. 2010. Sixty patients were divided into vaseline gauze packing group and airway silicone splint and vaseline gauze packing group. Airway silicone splint (Doley Combo Splint®) consists of silicone sheet, hemicircular airway tube and Rhinocell®. We evaluated the patients' discomfort such as nasal obstruction through questioning survey and recorded packing periods and accidental packing material removal. Results: Nasal obstruction, dry mouth, swallowing difficulty and headache associated with intranasal packing were significantly improved among the patients who underwent packing with airway silicone splint and vaseline gauze. And packing period of airway silicone splint packing group was longer than other group Conclusion: Intranasal packing with airway silicone splint and vaseline gauze can be a useful method for reducing patients' discomfort associated with nasal obstruction. And this method can be used in the others surgery such as septoplasty and corrective rhinoplasty

근피판을 이용한 두경부 재건

한예식,유태현 고신대학교 의학부 1986 高神大學校 醫學部 論文集 Vol.2 No.1

Large defects from resection of tumor in head and neck area may result functional and esthetic disturbance. Several methods of repair are known which utilize flap designed from the forehead, neck, and deltopectoral area. But, these flaps often failed because of the poor vascular supply due to previous surgery and irradiation in this area. Recently, the development of myocutaneous flap can facilitate the reconstruction of the head and neck immediately. The pectoralis major myocutnaeous flap, sternocleidomastoid myocutaneous flap, latissimus dorsi myocutaneous flap, and trapezius myocutaneous flap, latissimus dorsi myocutaneous flap, and trapezius myocutaneous flap were used for head and neck reconstruction. Each flap has advantage and disadvantages. But, the pectoralis major myocutaneous flap was more utilizing and less complicated than other procedures. In this paper, we present our experiences of two pectoralis major myocutaneous flaps and one sternocleidomastoid myocutaneous flap.

위볼기 동맥 천공지 프로팰러 피판을 이용한 천골부 욕창의 재건

한예식 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Purpose : Superior gluteal artery perforator(SGAP) flaps are surgical options in pressure sore reconstruction. There are several advantages in reliability, preservation of muscle, versatility in flap design, and low donor site morbidity. An anatomical study was carried out to improve the flap's effective value. SGAP propeller flap can be successfully used in sacral pressure sore reconstruction. so we report this clinical experiences with review of the literatures Methods : 5 cadaver were dissected to investigate localization, distribution of the perforators and to measure thickness of subcutaneous tissue on gluteal region. and SGAP propeller flaps were performed in 3 patients with sacral pressure sore. The fasciocutaneous flap based on the SGAP was designed in elliptical shaped pattern from sacral region toward the inferolateral aspect of buttock and was elevated from adjacent tissue. The flaps rotated 120~180 degree to cover sacral defect. Donor defect was repaired primarily. Results : Several perforators were found under the SGAP propeller flap area. Its mean number was 3. The thickness of elevated flap were 2.02cm in medial side and 4.49cm in lateral side. The patients' mean age was 52.3 and the average follow up period was 9 months. No serious complications such as flap necrosis or infection occurred except 1 hematoma in postoperative day 3. No functional disturbances in walking were observed. The long term results were satisfied in proper soft tissue bulk and low recurrence rate. Conclusion : The anatomical study suggests that the SGAP flap as propeller type is possible in its enough volume and perforators' location. The SGAP propeller flap may be a reliable method in sacral sore reconstruction especially in patients who expected ability in walking after rehabilitation

근피판을 이용한 두경부 재건

한예식,유태현 고신대학교(의대) 고신대학교 의과대학 학술지 1986 고신대학교 의과대학 학술지 Vol.2 No.1

Large defects from resection of tumor in head and neck area may resuit functional and esthetic disturbance. Several methods of repair are known which utilize flap designed from the forehead, neck, and deltopectoral area. But, these flaps often failed because of the poor vascular supply due to previous surgery and irradiation in this area. Recently, the development of myocutaneous flap can facilitate the reconstruction of the head and neck immediately. The pectoralis major myocutaneous flap, sternocleidomastoid myocutaneous flap, latissimus dorsi myocutaneous flap, and trapezius myocutaneous flap were used for head and neck reconstruction. Each flap has advantages and disadvantages. But, the pectoralis major myocutaneous flap was more utilizing and less complicated than other procedures. In this paper, we present our experiences of two pectoralis major myocutaneous flaps and one sternocleidomastoid myocutaneous flap.

두개골 조기유합증의 임상적 경험

박선호,이정윤,안희창,한예식 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.5

Surgical corrections of 9 craniosynostosis are presented, with ages ranging from 4 months to 3 years(average 6months at the time of surgery). Early frontal bone advancement and cranial vault remodeling demonstrated the efficacy and safety of the techniques. Satisfactory cranio-orbital from was achieved in the majority the patients, although one patient presented calvarial contour irregularity. Infancy is the ideal time to treat isolated craniosynostosis. Frontal bone advancement was ideally performed in the infant because of malleable bone. Cranial vault remodeling was rapidly achieved by the growing brain the and early release of stenosed area is benificial to adjacent both functionally and asthetically, and promote normal growth of the adjacent stuctures.

전하구순 재건 치험례

유재덕,신극선,박병윤,한예식 大韓成形外科學會 1983 Archives of Plastic Surgery Vol.10 No.3

Whatever the cause, be it trauma, newplasm, or congenital defect, the defect of the lower lip may be divided into three classes; Partial loss of the lower lip, Total loss of the lower lip, and Loss of the lower lip and associated structures. Among these, total reconstruction of the lower lip is a difficult and intrianguing problem. For succesful reconstruction of the whole of the lower lip, the following major points should be taken into consideration; 1. The flap used should be local flaps, including innervated muscle. 2. All the suture lines should be in natural facial crease. 3. The flap should be large enough to make good the tissue loss. In reviewing literature, full thickness nasolabial fold flap, Bernard's operation, and Diffenbach's operation were discussed. They posses advantage and disadvantage, but in our experience, Bernard's operation is relatively good appearance and more satisfactory function than others.