방사선궤양 및 기타 만성피부의 궤양

황나현,정재호,김덕우 대한의사협회 2015 대한의사협회지 Vol.58 No.9

Radiation ulcers are wounds caused by acute or chronic effects of ionizing radiation. The injury may involve the skin, underlying soft tissue, and even deeper into bones. Radiation is used alone or in combination with surgery and chemotherapy. Although it is useful to affect tumor death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment leads to fibrosis, nonhealing ulcers, lymphedema and radionecrosis amongst others.

Adaptive Planning and Overcoming Pitfalls in Asian Rhinoplasty

황나현,한승규,동은상 대한미용성형외과학회 2014 Archives of Aesthetic Plastic Surgery Vol.20 No.1

Background This anthropometric planning is devised for surgeons who assess the esthetic perspectives in Asian rhinoplasty and to provide an easy clinical method usingtwo dimensional photograph. And specific planning in Asian secondary rhinoplastyare also depicted accordingly. Method & Discussion In order to use a 2-dimensional digital photograph as a tool for the soft tissue cephalometric analysis (STCA) the surgeon can subjectively rotate the photograph to decide the ideal landmarks. Once this is done, consultation and planningbegins. Complicated concepts can be simplified and adaptive ideal points neededin rhinoplasty can be determined according to the Asian concepts of beauty so that it will be used under a clinical setting. Initiation of planning starts by identifying the ideal Sellion and Subnasale, thus, determining the length of the nose. Determinationof these two points is the foremost important step in planning. Thereafter, an ideal Tip forms naturally from the nasofrontal angle and the columellar-labial angle. Even with the well performed preoperative planning, the shortcomings in secondary Asian rhinoplasty, such as unexpected scar, may be totally different pitfalls to overcome. Conclusions With two-dimensional digital photograph and simplified planning in STCA, planning ideal points will bring clarity to a relatively different planning process from western rhinoplasty for surgeons undertaking primary or secondary Asian rhinoplasty.

Using Acellular Dermal Matrix to Treat Repetitive Tendon Rupture after Excision of Ruptured Intratendinous Ganglion

손성민,황나현,정재호,Seung-Ha Park,윤을식 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.1

Existing literature has not explored repeated tendon ruptures caused by torn intratendinous ganglions. The treatment of intratendinous ganglion of the hand remains a challenge, as it is difficult to completely excise the ganglion while also preserving the tendon. Herein is a report on a case of ruptured intratendinous ganglion in the extensor digitorum communis which resulted in repeated tendon reconstruction surgeries. The authors incorporated an acellular dermal matrix with tendon transfer, demonstrating great clinical improvement and successful repair thus far.

Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair

심정환,황나현,윤을식,동은상,김덕우,김상대 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.1

Background The global prevalence of myelomeningocele has been reported to be 0.8–1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution. Methods Patients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed. Results A total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely. Conclusions Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

Transconjuctival Incision with Lateral Paracanthal Extension for Corrective Osteotomy of Malunioned Zygoma

정재호,유희진,황나현,김덕우,윤을식 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.3

Background: Conventional correction of malunioned zygoma requires complete regional exposure through a bicoronal flap combined with a lower eyelid incision and an upper buccal sulcus incision. However, there are many potential complications following bicoronal incisions, such as infection, hematoma, alopecia, scarring and nerve injury. We have adopted a zygomaticofrontal suture osteotomy technique using transconjunctival incision with lateral paracanthal extension. We performed a retrospective review of clinical cases underwent correction of malunioned zygoma with the approach to evaluate outcomes following this method. Methods: Between June 2009 and September 2015, corrective osteotomies were performed in 14 patients with malunioned zygoma by a single surgeon. All 14 patients received both upper gingivobuccal and transconjunctival incisions with lateral paracanthal extension. The mean interval from injury to operation was 16 months (range, 12 months to 4 years), and the mean follow-up was 1 year (range, 4 months to 3 years). Results: Our surgical approach technique allowed excellent access to the infraorbital rim, orbital floor, zygomaticofrontal suture and anterior surface of the maxilla. Of the 14 patients, only 1 patient suffered a complication—oral wound dehiscence. Among the 6 patients who received infraorbital nerve decompression, numbness was gradually relieved in 4 patients. Two patients continued to experience persistent numbness. Conclusion: Transconjunctival incision with lateral paracanthal extension combined with upper gingivobuccal sulcus incision offers excellent exposure of the zygoma-orbit complex, and could be a valid alternative to the bicoronal approach for osteotomy of malunioned zygoma.

Soft Tissue Reconstruction for Basaloid Squamous Cell Carcinoma on the Hemiface

정재호,유희진,황나현,김덕우 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.6

Empirical Treatment of Highly Suspected Nontuberculous Mycobacteria Infections Following Aesthetic Procedures

김형록,윤의식,김덕우,황나현,손유석,이병일,박승하 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.6

Background: Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead todestructive results. We empirically treated a series of patients with clinical suspicion of NTMinfection prior to the identification of the pathogen. Methods: A total of 12 patients who developed surgical site infections between January 2011and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistantto standard management over two weeks, and previous history of aesthetic procedures withinthree months were regarded as highly suspected of having an NTM infection. A variety ofdiagnostic modalities were examined simultaneously, along with starting empirical treatmentincluding a combination of clarithromycin and moxifloxacin, and surgical debridement. Results: All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2months, and none of the patients developed relapse. Specific NTM pathogens were identifiedin six patients. Eight patients showed caseating granuloma implying an NTM infection. Onepatient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complicationssuch as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions: NTM should be considered in the differential diagnosis of an unusual skin andsoft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin asan efficient treatment option for an NTM infection.

Dalvik명령어 유사도 비교를 통한 안드로이드 표절 탐지 기법

최성하 ( Sung-ha Choi ),황나현 ( Na-hyun Hwang ),박희완 ( Heewan Park ) 한국정보처리학회 2012 한국정보처리학회 학술대회논문집 Vol.19 No.1

스마트폰 애플리케이션 중에서 안드로이드 앱은 자바를 기반으로 한다. 따라서 자바 프로그램과 마찬가지로 디컴파일러 도구를 활용하여 원본 소스 코드를 얻어낼 수 있기 때문에 코드 도용에 대해서 매우 취약하다. 본 논문에서는 안드로이드에 대한 코드 도용과 표절을 막기 위한 기법을 제안한다. 효과적인 코드 도용 및 표절 여부를 탐지하기 위한 방법으로서, 안드로이드 달빅(Dalvik) 코드에 대해서 요약 단계를 거친 후 유사도를 측정하는 방법을 사용한다. 기존의 안드로이드 유사도 비교 연구에서는 달빅 코드가 정확하게 일치해야만 유사도가 높게 측정될 수 있었지만, 요약 단계를 통해서 변환된 달빅 코드를 비교하면 코드 도용시 일부 코드의 의도적인 수정이 있더라도 유사도가 높게 측정된다. 그 결과, 본 논문에서 제안하는 표절 탐지 기법이 기존 연구와 비교하여 표절에 대한 탐지 능력이 우수함을 확인하였다.

Bacterial profile of suction drains and the relationship thereof to surgical-site infections in prosthetic breast reconstruction

Jeongmin Yoon,정재호,황나현,Byung Il Lee,Seung-Ha Park,Eul-Sik Yoon 대한성형외과학회 2018 Archives of Plastic Surgery Vol.45 No.6

Background Despite the increasing popularity of prosthetic breast reconstruction, scant data exist on the microbiological profile of drainage fluid from closed-suction drains and the relationship thereof to surgical-site infections (SSIs) in breast reconstruction surgery. This study aimed to determine whether bacteria isolated from drainage fluid were associated with the development of SSIs, and whether the bacterial profile of drainage fluid could be a clinically useful predictor of SSIs. Methods We performed a retrospective chart review of 61 women who underwent tissue expander/implant or direct-to-implant reconstructions. Patient demographics and culture studies of drainage fluid from suction drains collected on postoperative day 7 were evaluated. Results Sixteen patients (26.23%) were culture-positive, and 45 patients (73.77%) were culture- negative. The most frequently isolated bacteria were coagulase-negative staphylococci, followed by Staphylococcus aureus. SSIs were diagnosed in seven patients and were mostly resolved by systemic antibiotics; however, the tissue expander or implant was explanted in two patients. Positive culture of drainage fluid from closed-suction drains was significantly associated with the development of SSIs (P<0.05). The positive predictive value was 37.50%, and the negative predictive value was 97.78%. Conclusions To our knowledge, this study is the first to demonstrate a significant association between the microbiological profile of drainage fluid from closed-suction drains and the development of SSIs in patients with prosthetic breast reconstructions. The high negative predictive value suggests that microbial testing of drainage fluid from closed-suction drains may have clinical utility. Further prospective studies with larger sample sizes are required to confirm our findings.

A Silent Closed Rupture of the Flexor Digitorum Profundus on the Index Finger: An Unsolved Mystery

Hyun-Dong Yeo,황나현,박승하,이병일,윤을식,정재호 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.2

We report the case of a patient who fully recovered from a closed flexor tendon rupture through a two-stage flexor tendon reconstruction using silicone rods, despite a considerable delay in treatment. A 17-year-old male patient visited our clinic with a sudden inability to flex his left index finger, although there were no signs of injury. Magnetic resonance imaging revealed an extensive rupture of the flexor digitorum profundus from the base of the distal phalanx to the proximal phalangeal joint of his left hand. After a two-stage tendon graft operation was performed, the patient regained full flexion of the index finger and was able to hold a fist without any limitations in range of motion. Complete rupture of tendons usually accompanies history of trauma or underlying tendon pathology. In our case, however, the tendon rupture occurred silently with no obvious underlying causes. It is important to recognize the signs to evaluate the underlying structures for appropriate management and treatment. Even with considerable delay, the patient may regain full function of the tendon.