광대뼈 축소술에 있어서 재배치와 고정

황소민,송제니퍼김,백세민,백롱민 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.3

Purpose: It has always been an aspiration for Asians to look more balanced and feminine, considering their facial features regarding relatively flat midface with marked prominences of the zygoma. Many studies have been dealt in this subject. However, the authors would like to emphasize the concept and introduce the technique of repositioning of the malar complex to a cosmetically beneficial point and stationing it on proper position by fixation on zygoma body and arch. Methods: From January 1998 to December 2007, this method was performed in 50 patients of mild to moderate prominence and malposition of the malar complex. A simplified technique of lateral orbital osteotomy and oblique osteotomy on zygomatic arch through intraoral and preauricular incision was developed. Then, liberal malar complex can be moved to a supero-posterior direction and repositioned to a more cosmetically beneficial point. To maintain the stationed position and to protect from vector affected by the attached masticating muscle to zygomatc bone, fixation was done on both zygoma body and arch. Results: We have obtained satisfactory results using this procedure without any observable complications. The advantages of this procedure are proper exposure, inconspicuous scar, safe, more natural contour, improved stability, and shorter healing time. Conclusion: The authors suggest that reduction malarplasty should be approached with underlying concept of repositioning and fixation. In mild moderate malar prominent cases, our technique will provide with maintenance of aesthetic concept, equal to the malar reduction performed under coronal approach and provide with more natural facial contour with stability even with less invasive surgical approach.

A Rare Case of an Epidermal Inclusion Cyst in the Joint Capsule of the Thumb

황소민,이상환,김민욱,김활웅 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.2

Reduction of Nasal Bone Fracture using Ultrasound Imaging during Surgery

황소민,Hao-Ching Pan,김홍일,김형도,황민규,김민욱,이종서 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.1

Background: Most nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction. Methods: A single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey. Results: The experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasoundguided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043). Conclusion: Our study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

천공 프레스 기계에 의해 손상된 수지의 재건

황소민,이종서,김형도,정용휘,김홍일 대한수부외과학회 2013 대한수부외과학회지 Vol.18 No.4

목적: 천공 프레스 기계에 의한 수지의 분절 절단 손상 시, 손상 부위의 원위부는 반대측의 정상 수지 동맥을 통해 혈액순환이 온전하게 유지된다. 절단부 조직의 유무에 따라 적절한 재건술을 시행하여야 윈위부의 정상 조직들을 보전할 수있다. 방법: 천공 프레스 기계에 의해 수지가 손상된 4명의 환자, 총 5수지를 대상으로 분석하였다. 능동 관절 운동 범위 및정적 이점 식별능력, 집게력을 측정하여 수지의 기능을 평가하였다. 결과: 절단부 조직이 보존된 3수지는 재접합술을 시행하였다. 수술 후 한 예에서 부분 조직 괴사 발생하여 괴사조직 제거 후 국소 피판술을 시행하였으며, 다른 2예는 건이식술을 시행하였다. 절단부 조직이 없는 2예는 손가락 길이 단축후 관절 고정술을 시행하였다. 재건술 후 평가한 수지의 기능은 만족할만한 결과를 보였다. 결론: 천공 프레스 기계에 의해 손상된 수지의 재건은 절단부 조직이 잘 보존되어 있는 경우 재접합술을 우선적으로고려하여야 한다. 절단부가 없다면 수지 단축 후 관절 유합술을 시행하여 기능 및 외관상 만족할만한 결과를 얻을 수있다 Purpose: Digits injured by punch press machines show peculiar types with segmental loss of middle part of digits. Although the distal parts of finger survived,thr results is frequently unfavorable with respect to function and appearance after inappropriate reconstruction. Methods: From August 2008 to February 2013, five digits injured by punch press machines in four patients were managed. Pinch strength, two-point discrimination and active range of motion were measured to evaluate finger function. Results: Three digits with a preserved amputated segment underwent replantation. Partial necrosis occurred in one digit in which local flap was performed. Secondary tendon graft was performed in the other digits. Two digits without segment was reconstructed by arthrodesis after shortening the length. The patients were generally satisfied with function and appearance. Conclusion: Reconstruction of digits injured by punch machines are technically difficult. Replantation is the best method in cases of preserved segment, while arthrodesis with shortening is appropriate in cases without segment.

남성 가성 반음양 환자의 기능적 성전환술의 경험

황소민,박재석,선욱,김동일 인제대학교 1995 仁濟醫學 Vol.16 No.4

male-to-female 성전환술에 대한 사회적 인식 및 많은 연구로 수술방법도 다양하게 발전해 왔다. 이에 본 교실에서 경험한 남성 가성 반음양 환자에 있어, 보다 안전하고 기능적인 방법을 이용한 수술을 토대로 성전환술에 대해 보고하는 바이다. Intersex is the state of haying ambiguous or inappropriate genitalia due to aberration of the normal mechanism for sexual development. Sex change operation is being a more commonly receptive concept with social reception, studies and experiences about these operations. We experienced one case of male pseudohermaphroditism due to androgen insensitivity. The patient underwent the one-swage male-to-female surgery by orchiectomy, penectomy, vaginoplasty using the penile & scrotal flap, preserving part of the glans penis as a clitoris. This operative method made more safe & functional results.

불완전 합지증 교정을 위한 변형된 일곱 피판성형술

황소민,김홍일,안성민,임광열,정용휘,송제니퍼김 대한수부외과학회 2012 대한수부외과학회지 Vol.17 No.2

Purpose: Incomplete syndactyly, due to either congenital or acquired, is uncommon. Many different surgical methods have been descirbed. We introduce the modification of seven flap-plasty for incomplete syndactyly and report functional improvement after correction by modified seven flap-plasty without skin graft. Materials and Methods: Twelve patients with an incomplete syndactyly who underwent modified seven flap-plasty were analyzed. Age ranged from one to 40-year-old (average age 21). There were 8 males and 4 females, and the degree of syndactyly was near proximal interphalangeal joint. Two different operative methods were performed. Modification I modified two half-Z flaps in parallelogram shape, and modification II modified V flap of V-M flap in YV flap. Functional improvements was measured by maximal abduction distance and maximal abduction angle change. Results: All cases were corrected by using the modified seven flap plasty. Flap tip necrosis was found in two cases of severe burn scar patients, but did not require additional surgery. There was no specific complications. Maximal abduction distance was increased in 6 mm, and maximal abduction angle was increased in 5.8°. Conclusion: Incomplete syndactyly near proximal interphalangeal joint was corrected by modified seven flap plasty and was able to get a satisfactory result. 목적: 본 연구는 변형된 일곱 피판성형술을 소개하고 불완전 합지증에 변형된 일곱피판성형술을 시행하여 기능적 개선 정도를 평가하였다. 대상 및 방법: 12예의 변형된 일곱 피판성형술을 시행받은 근위지관절 근처의 불완전합지증 환자를 대상으로 하였다. 기존 일곱 피판성형술에서 양쪽에 2개의 half-Z 피판을 평행사변형꼴로 길게 변형시킨 응용형태 I과 V-M 피판의 V 피판을 Y-V 피판형태로 변형시킨 응용형태 II로 수술을 시행하였으며, 근위지 관절 사이의 최대 외전거리 및 최대 외전 각도의 변화를 측정하였다. 결과: 심한 화상환자 2예에서 피판 첨부에 부분 괴사가 있었지만 특별한 부작용이나재발은 없었다. 술 후 최대 외전 거리는 평균 6 mm 증가, 최대 외전 각도는 평균5.8˚ 증가되었다. 결론: 불완전 합지증을 변형된 일곱 피판성형술을 이용하여 피부 이식술 없이 교정하여 만족할만한 결과를 얻었다.목적: 본 연구는 변형된 일곱 피판성형술을 소개하고 불완전 합지증에 변형된 일곱피판성형술을 시행하여 기능적 개선 정도를 평가하였다. 대상 및 방법: 12예의 변형된 일곱 피판성형술을 시행받은 근위지관절 근처의 불완전합지증 환자를 대상으로 하였다. 기존 일곱 피판성형술에서 양쪽에 2개의 half-Z 피판을 평행사변형꼴로 길게 변형시킨 응용형태 I과 V-M 피판의 V 피판을 Y-V 피판형태로 변형시킨 응용형태 II로 수술을 시행하였으며, 근위지 관절 사이의 최대 외전거리 및 최대 외전 각도의 변화를 측정하였다. 결과: 심한 화상환자 2예에서 피판 첨부에 부분 괴사가 있었지만 특별한 부작용이나재발은 없었다. 술 후 최대 외전 거리는 평균 6 mm 증가, 최대 외전 각도는 평균5.8˚증가되었다. 결론: 불완전 합지증을 변형된 일곱 피판성형술을 이용하여 피부 이식술 없이 교정하여 만족할만한 결과를 얻었다.

비전형적 거대세포종의 치험례

황소민,안성민,정필구,오경석,김진형 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.6

Purpose: Giant cell tumor is the second most common benign neoplasm in upper extremity. Unlike usual chief complaint of painless mass, an atypical case with giant cell tumor presented a distinguishing characteristics of which accompany pain and tenderness and is histologically giant-cell free.Methods: A 31-year-old male patient complained of a rapid growing painful mass on the proximal phalanx of the left ring finger. Under microscopic operation, a 1.6 ×1.3cm sized mass was found to be surrounded by areolar tissue and attached to a tendon sheath, encircling the digital nerve and artery. Diagnostic confirmation was assisted by positive finding in histologic immunohistochemical stain-CD68. Characteristic pathologic finding is an atypical distribution of spindle cells & histiocytes without giant cells in fascicular pattern.Results: Giant cell tumor was carefully removed under microscopic approach, while preserving digital nerve & artery. In postoperative 13th month, the patient presented with a 6mm of static two-point discrimination test, similar to that of the adjacent fingers. Conclusion: We report an atypical case with painful mass on tendon sheath, surrounding the digital nerve and artery that was diagnosed of giant cell tumor, but without giant cells on pathology. This case provides broader understanding of the giant cell tumor that should not only rely its typical findings of the painless mass and positive sign on H&E stain.

뮬러근 내에 발생한 이소성 눈물샘 1례

황소민,송제니퍼김,임광열,정용휘,류민희 대한미용성형외과학회 2009 Archives of Aesthetic Plastic Surgery Vol.15 No.3

Ectopic lacrimal gland is a rare clinical condition. Cases have been recorded in literature describing that ectopic lacrimal tissue has been found at varying sites in and around the eye. Before performing aesthetic blepharoplasty, however, it should be kept in mind that anomalous condition of the lacrimal complex can lead to alterations in ocular lubrication. A 54 year-old female presented with an aging eyelid, but accompanying no other ophthalmologic symptoms. While performing skin incision during blepharoplasty, the right upper lid was directly exposed with prolapsed orbital lobe of lacrimal gland, and diffuse infiltrating hyperplasia of ectopic lacrimal gland tissue in the Müller muscle bulging out beneath the levator aponeurosis. The left upper lid also revealed ectopic lacrimal gland tissue beneath the aponeurosis. Carefully preserving the main lacrimal complex, ectopic lacrimal gland mass was excised. Histopathology revealed the tissue as lobules of lacrimal gland with some dilated ducts. The ectopic lacrimal gland tissue is a rare clinical entity, and the diagnosis is rarely made on physical bases alone. Therefore, we herein describe a unique clinical case of an ectopic lacrimal gland generated within the Müller muscle. To our best knowledge, such a case has not yet been described in literature.

Prevention of Lower Eyelid Ectropion Using Noninsional Suspension Sutures after Blepharoplasty

황소민,이상환,오경석,김형도,정용휘,김홍일 대한미용성형외과학회 2014 Archives of Aesthetic Plastic Surgery Vol.20 No.3

Blepharoplasty is one of the most common anti-aging operations. Although rare,complicationssuch as ectropion may occur. Thus, we introduced an operativetechnique toprevent ectropion of the lower lid after blepharoplasty. From January 2012 to August2013, we performed a nonincisional suspension suture (NISS) technique for 30 patientswho visited our clinic for lower blepharoplasty. These patients had adistance of greaterthan 7 mm on the distraction test and were suspected of havinghorizontal lid laxity. We performed a slit incision 3 mm superior to the junction between the lateralepicanthus and the orbital bone during lower blepharoplasty. We passed a 7-0 nylon suturethrough the subcutaneous layer and the orbicularis oculi muscle. Then, wepuncturedthe tarsal plate at the lateral limbus and fixed it to the lateral orbital rim bypuncturingthe periosteum. We tied a suspension knot through the slit incision. Thirtypatients hadsatisfactory results without major complications, such as scleralexposure or ectropion. The NISS technique could be an effective method by which to prevent postoperativeectropion in cases with a mild to moderate degree lower lid laxity. The use of a NISSprocedure is also a simple surgical technique, which saves time and is minimallyinvasive.

안성형 수술에 있어 누루의 임상적 고찰

황소민,송제니퍼김,오경석,임광열,최재원 대한미용성형외과학회 2008 Archives of Aesthetic Plastic Surgery Vol.14 No.2

Lacrimal fistula, a rare developmental disorder, may result from an abnormal budding of the epithelial cord of the lacrimal system. Most cases are unilateral, however, bilateral cases are still more rare, which are combined with other systemic diseases or accompanying disorders. This entity has so far been known only to ophthalmologist. We would like to illustrate lacrimal fistula in patients who were referred to our clinic for periorbital cosmetic surgery, such as blepharoptosis and epicanthus, from April 2005 to December 2007. Fistular orifices of all 6 patients were had been located inferomedial to medial canthi along the epicanthal fold. Out of 6 patients, 4 patients presented with unilateral lacrimal fistula; right side in 3 patients and left side in 1 patient, and bilateral lacrimal fistulas in 2 patients. Three cases were found to have positive connection between the nasolacrimal apparatus, and blind pouch type in 5 cases. Three out of six patients underwent fistulectomy with concurrent cosmetic periorbital surgery. In 2 patients who presented with connection with the nasolacrimal apparatus, fistulectomy and lacrimal sac or the common lacrimal canaliculi repair was performed as well. The remaining one patient with bilateral blind pouch type of lacrimal fistulas underwent a simple fistulectomy. There were no postoperative complications or any recurrences.