확장된 가토피부의 피판생존과 조직학적 변화

한기택,조문제,마흥수 大韓成形外科學會 1987 Archives of Plastic Surgery Vol.14 No.3

Since introduction of using expanded skin made by subcutaneous implantation and gradual mechanical inflation of rubber balloon by Neuman in 1957, this method has been widely used and popularized in reconstructive plastic surgery. The method has merits of technical simplicity, aesthetically more satisfactory outcome and less morbidity of donor site. In spite of the merits this method has been used with great fear of flap necrosis, as blood supply of the expanded skin may be interrupted by the surgical procedures and trauma of the mechanical expansion with a subsequent decrease in cutaneous blood supply. Therefore, this study was aimed to investigate the flap viability and the histological changes of expanded skin in 35 rabbits. The animals were divided into experimental (n=28) and control groups (n=7). Expansions of skin were made on the lateral thoracic wall of rabbits by insertion of 100ml, rectangular tissue expanders beneath the panniculus carnosus. The experimental group was divided into 4,6,8 and 10wk. subgroups by expansion perod, and had 7 rabbits for each. The rubber balloon was inflated to their maximum capacity by injecting 50ml, 25ml, 16.5ml and 12.5ml of saline solution at weekly over a period of 3,5,7 and 9wks respectively with each group. Each expander was removed 1 wk. after its last inflation. After removal of the expander, a flap(1.5x9 cm) was raised from the expanded skin and sutured to its bed. Also, a piece of specimen was taken from the expand-skin, and stained with hematoxylin-eosin for histologic observation. The rates of survival area were calculated on 7 days after the flap elevation. In the control group, skin flaps were raised in 7 rabbits in same size and in same location as in experimental group, and survival rates and histological observation were investigated on the 7th postoperative day. The results were as follows; 1. In the control group, the mean survival rate was 57.8 ± 9.5%, however, the experimental groups showed the mean survival rates of 70.2 ± 9.1% (P<0.05), 71.5 ± 9.1% (P<0.01), 71.3 ± 7.4% (P<0.01), and 77.3 ± 7.9% (P<0.01)in 4,6,8 and 10wk. subgroup respectively (TableⅠ). 2. There was no relation between mean survival rates and the expansion period(TableⅠ). 3. The histological observations showed slight increases of dilated capillaries in dermis and prominent increase of dilated capillaries in the layer between the panniculus carnosus and the capsule formed around the expander (Fig. 3∼10).

遊離頭皮 被瓣術을 利用한 前方前頭部의 毛線再建 治驗例

馬興洙,金鎭喆,林豊 大韓成形外科學會 1984 Archives of Plastic Surgery Vol.11 No.1

Facial burn often brought about both loss of hair bearing scalp and obliteration of anterior frontal hairline which resulted esthetic deformity to the patients with many social and psychological problems. For many decades plastic surgeons have used a variety of method (such as single hair transplantation, punch or strip graft, and local flaps) to solve these problems. But the results are commonly unsatisfactory due to the poor vascularity, which leads to partial loss of the flap, unnatural hair direction and sparse desity. However, since the introduction of microsurgery, Harii applied a new method of microvascular free scalp transfer and reported its satisfactory results in 1974. The authors performed this microvascular free scalp flap transfer to a 8 years old boy who had lost extensive scalp hair to deep burn. Therefore the authors made this case report with the favorable result.

Extramammary Paget's Disease의 증례 : -A Case Report-

마흥수,김진철,함기선,이강우 大韓成形外科學會 1983 Archives of Plastic Surgery Vol.10 No.1

30Extramammary Paget's disease is a rare disorder and represents as infiltrated reddish patches or gray-white plaques which are eczematoid, crusty scaling, papillo-matous in the skin and mucous membrane of the anogenital or axillary regions, where generous apocrine glands exist. At present 2 hypotheses are generally accepted in regard to pathogenesis. Woodruff and Richardson(1957) support that it is a carcinoma of epithelial origin, wherase by Weiner(1937), Dockerty and Pratt(1952) it is migrated into the skin from an underlying apocrine gland carcinoma. But many controversies have still been existed and never clarified. The keratinizing squamous cell carcinoma, non-keratinizing cancer(basal cell epithelioma, Bowen's disease and malignant amelanotic melanoma) and eczematous lesions make clinical diagnosis difficult. Thus a biopsy is necessary for a definite diagnosis. Also it must be histopathologically differenciated from Bowen's disease and pagetoid type of malignant melanoma in situ. The treatments were not satisfactory with x-ray irradiation, topical therapy, desiccation, curettage except for deep and wide excision. We have experienced a case of extamammary Paget's disease occuring on the left inguinal, scrotal area and obtained satisfactory result following surgical excision & skin graft.

측부 인두강 조절 피판술(Lateral port Control Postrior Pharyngeal Flap)의 임상적 고찰

마흥수,정중길,함기선 大韓成形外科學會 1983 Archives of Plastic Surgery Vol.10 No.2

In 1973, Hogan first reported the lateral port control(L.P.C.) pharyngeal flap surgery, modification of the superiorly based posterior pharyngeal flap, introducing the concept of positive port control utilizing a “catheter technique”. This modification is superior to the classical posterior pharyngeal flap for speech improvement, but there have been some reports that complications occurred during the postoperative period. This method of operation has not been fully accdepted by plastic surgeons throughout the world, even though it has many advantages for better speech improvement. So, there are still many unclarified clinical problems: what are the reasons for the occurrence of complications following the surgery, how long the insertion of the catheter should be kept or how the complications can be reduced. There are some recent interesting reports about the reduction of these complications to the same level as in the classical flap when operation is performed after a complete preoperative study including nasopharyngoscopy and lateral or basal cineradiography for an accurate evaluation of velopharyngeal function. The authors caried out this analysis based on a retrospective review of clinical recordings of 217 patients operated on during the past 5 years from 1977 to 1982 at St. Mary's Hospital in Seoul. 142 patients out of the 217 underwent nasoendoscopy and lateral cineradiography study, and 87 patients of the 142 were subjected to complete speech evaluation by the above examinations. The study of complications was made on the 142 patients by two objective fimls, and the speech evaluation was conducted for the 87 patients by means of two objective films and a subjective examination. The patients were divided into three groups preoperatively according to the width & distance of velophavryngeal gap on endoscopy and lateral cineradiography. The incidence of complications was observed as to the duration of cthete insertion, with the catheter remoed within three days after operation in one group and fie days in another group. The following results were obtained. 1. Speech improvement has no relation with the degree of the preoperative V.P.I., but L.P.C. has a higher frequency of speech improvement and the frequency of complications is similar to that in the clasical posterior pharyngeal flap surgery. 2. Based on endoscopic findings and a long-term follow-up study, it is recommendable that the catheter by inserted for five days for the acquisition of an adequate port size and resulting speech ability. 3. The most frequent complications were nasal obstruction, oral breathing and snoring.

냉수처치가 흰쥐의 화상조직에 미치는 영향

마흥수,함기선,주상용,박경희,안용팔 大韓成形外科學會 1982 Archives of Plastic Surgery Vol.9 No.1

Lewis(1930) & Langohr (1949) suggested that cold water therapy (CWT) reduces tissue metabolism, oxygen debt and dilates minute vessels, therefore increasing blood flow, on the burned tissue in rats. So this method diminishes tissue damage due to impaired circulation and may retard the development of infection. These experiments were performed to study the effects of CWT on the burned tissue in rats. Full thickness scald burns(‘80c’10sec)were inflicted on the backs of the 42 rats. Burned rats were divided into 2 groups: 27 rate as an experimental group (immediate and delayed CWT) and 15 rats as an untreated control. The untreated control was sacrificed on the 1/2th, 1st, 8th, 24th and 72th hour after burn. Immediate CWT group was immersed immediately into the cold water (1-2℃, 10min) after burn and sacrificed as same as the time of untreated control. Delayed CWT group was burned and CWT was performed after 5 min, 10min and 30 min delay. They were sacrificed on the 24th hour after burn. The specimens taken from all experimental animals were fixed in 10% neutral formalin embedded in paraffin wax, sectioned at a thickness of 5um, and stained with hematoxylineosin for general histologic findings. Observation was made of morphological changes in the collagen fibers, capillaries and separations between collagen fibers located in the skin of rats. The results were as follows: 1. The tissue injury of immediate CWT group was less severe than untreated control. 2. The more CWT is delayed, the more tissue injury is aggravated. So immediate CWT is the most effective modality in the CWT of bumed tissue.

비부의 파라핀종에 동반한 기저세포암의 증례

마흥수,함기선,조문제 大韓成形外科學會 1980 Archives of Plastic Surgery Vol.7 No.2

During the last few decades,the paraffin had been used popularly as an implanted material for cosmetic and reconstructive purposes.It has been known that the injected paraffin proveke many unexpected complications such as tissue necrosis,granuloma formation, hypersensitivity, embolism, and even carcinoma.And many authors have suggested that the carcinoma may depend on the purity of paraffin,amount of injected paraffin and individual susceptibility.Yamagiwa and Ichikawa(1920) reported that the malignant change originated from the irritation of paraffin for a long times. Since World warⅡ,western civilization has brought about a great change in the Oriental countries.Some oriental people were disired to get Occidental appeatance and their noses and breasts were especially augmented with paraffin injection.So we can be faced many interesting cases related with paraffin in clinic. This paper reviews our experience of a case of basal cell carcinoma who had been performed augmentation rhinoplasty with paraffin injection 12 yeara before.

하악각 축소술의 합병증

마흥수,임풍,안상태,한기택,오영환 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.4

A prominent mandibular angle produces a characteristic quadrangular, coares and muscular appearance. Reduction of a prominent mandibular angle and partial resection of hypertrophic masseter muscle were frequently performed for cosmetic reasons. We discussed the complications and their causes and methods of prevention through the experiences of 87 patients of mandibular angle reduction from March, 1984 to September, 1989. The complications were divided into aestheic(asymmerty 3, undercorrection 1, secondary angle formation 2) and surgical(infection 2, subcondylar fracture 2, transient facial palsy 1, massive hemorrhage 2, trismus 10)

長掌腱(palmaris Longus Tendon)을 이용한 先天性 眼瞼下垂症의 治驗例

鄭求忠,馬興洙,李鐘建,李在雄 大韓成形外科學會 1986 Archives of Plastic Surgery Vol.13 No.3

The result of the surgical correction of the congenital blepharoptosis is determined by the nature of ptosis, operative method, operator's technique and post operative care. Among the factors levator function is most important, therefore, preoperative assessment of the levator function and surrounding structures must be carefully performed for the best operative result. Frontalis suspensions using autogenous fascia have been widely used in the cases whose levator funtions are less than 2mm. But the method may develop some postperative problems; recurrence due to absorption or loosening of fascia lata, complexity of the operative procedures, herniation of the muscles in lateral thigh and hematoma. Because of these problems, many considerations were prompted to use the autogenous tendon. Authors report 3 cases of congenital blepharoptosis who have been satisfactorily corrected by frontalis suspension method using palmaris longus tendon.