노화된 안검에서 상안검 교정술 시 안와 격막 접근법

오의선,윤인식,박병윤,Oh, Eui-Sun,Yun, In-Sik,Park, Beyoung-Yun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Blepharoplasty plays a vital role in facial rejuvenation. Aging eyelids are the result of relaxation of lid structures as the skin, the orbicularis muscle, and mainly the septum, with subsequent protrusion or pseudoherniation of intraorbital fat contents. Traditional blepharoplasty has often involved the excision of excessive lax skin and muscle and removal of fat, leaving the eyelid unnatural and even causing the brow ptosis. The authors propose the septal approach through which the amount of skin excision can be decreased and solid fixation can be achieved in the upper blepharoplasty. Methods: From November 2007 to February 2010, total of 15 patients underwent upper blepharoplasty with septal approach. In 9 patients, orbital septum anchored into the orbital periosteum only. But in 6 patients, the attenuated septum was strengthened through shortening and fixing into orbital periosteum with non-absorbable suture. Results: Pleasing results were obtained from most of the patients. But one patient who had septum anchoring procedure complained of slight undercorrection, therefore secondary operation with septum shortening procedure was followed. Conclusion: We found that the method using orbital septum fixation into orbital periosteum has several advantages: less amount of skin excision, less recurrence rate, and more natural appearance. And the results were reliable and satisfactory.

생비골 유리 피판술을 이용한 수부의 복합조직 결손의 재건

탁관철,강상윤,박윤규,이훈범,박병윤,Tark, Kwan-Chul,Kang, Sang-Yoon,Park, Yun-Gyu,Lee, Hoon-Bum,Park, Beyoung-yun 대한미세수술학회 2000 Archives of reconstructive microsurgery Vol.9 No.1

The advent of free bone flaps has made successful replacement of extensive areas of bone loss in the upper and lower extremities. The microvascular free bone flaps have faster healing without bony absorption or atrophy and can heal in the hostile environment of scarred bed or infection. Since the fibula free flap introduced by Taylor and colleague in 1975, it has been used extensively for skeletal reconstruction of extremities. In 1988, the folded vascularized fibula free flap was first described as a technique to reconstruct significant long bone defect of upper and lower extremities. During the same time, the fibular free flap has evolved to become most preferred choice of mandibular reconstruction. Up to present day, few reports have been made on the fibular free flap used for reconstruction of injured hand containing metacarpal bone and soft tissue defect. We present here our new and unique experiences with vascularized fibular osteocutaneous free flap as useful and satisfactory one for reconstruction of hand with composite defects.

Fluoroscope 시야에서 K-강선을 이용한 비골골절의 3차원적 지지법

김응삼 ( Eung Sam Kim ),박병윤 ( Beyoung Yun Park ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

Background: Fracture of the nasal bone is the most common fracture of a facial bone because, among the other structures, A nose is prone to be traumatized. The nasal bone fracture is simply reduced by using the conventional closed reduction method. Though several temporary expedients have been introduced to stabilite the reduced bony segments, long-term follow-up study shows grave results. Materials and Methods: From May 1999 to Mar 2001, 34 patients with nasal bone fractures were treated. Before the reduction, the type of fracture was precisely evaluated and reduced using a fluoroscope. After the anatomical reduction of the nasal bone, including the nasal septum, had been made, two K-wires were introduced through the triangular space between the nasal bone and the bony nasal septum. The direction of the K-wire was decided based on the type of fractures. The inserted K-wires were removed 14 days after the operation. Results: In all 34 cases, good cosmetic and functional results were observed without complications, and during a short-term follow-up period, no recurrences were found. Conclusion: This method may be helpful for reductions and fixations of fractured segments, but above all, it is a much more comfortable method for the patients during their daily lives.

기존의 창상봉합과 Histoacryl Blue^®를 이용한 창상봉합의 비교 분석: 전향적 무작위 임상실험

최종우,현경배,김용욱,박병윤,Choi, Jong Woo,Hyun, Kyung Bae,Kim, Yong Oock,Park, Beyoung Yun 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.1

Tissue adhesives have gained popularity for quicker and painless closure of lacerations. The use of tissue glue is currently popular for the closure of superficial lacerations, especially in children. Histoacryl $Blue^{(R)}$(2-N-butylcyanoacrylate) is a topical wound closure that precludes the need for foreign bodies to close wounds. The purpose of this study was to compare the applications of Histoacryl $Blue^{(R)}$(HAB) and conventional suture, regarding cosmetic outcome. To compare the short term and long term results of various repair methods, we designed the prospective, randomized, blind study. Patients with laceration undergoing repair were randomly allocated to conventional suture, subcutaneous suture plus HAB, and HAB only groups. The exclusion criterions were large wound that require large tension for repair or avulsion wound. An independent, blinded observer assessed cosmetic result at 7-10 days after repair and 3-9 months postoperatively. Physician's satisfaction with wound appearance was recorded on 100 mm Visual Analogue Scale(VAS)(0=worst, 100=best). The difference in VAS score between conventional suture method and subcutaneous suture plus HAB methods were not significant. Tissue glue being easy to use with no complications and still resulting in equivalent cosmetic outcomes has several benefits. Especially in the case of children, the wound closure with Histoacryl $Blue^{(R)}$ could be a good alternative for repair of laceration in emergency room.

개방형 근위 경골 절골술에서 골유합과 관련된 인자와 외측 피질골 골절 시 이식물에 따른 비교

서진혁(Jin-Hyeok Seo),김도훈(Do-Hun Kim),서승석(Seung-Suk Seo),김연구(Yeon-Gu Kim),김옥걸(Ok-Gul Kim),박병윤(Beyoung-Yun Park) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.5

목적: 개방형 경골 근위부 절골술에서 환자 관련 인자들과 외측 피질골 골절이 발생한 경우에 골이식물 종류가 골유합에 미치는 영향에 대하여 연구하였다. 대상 및 방법: Kallgren-Lawrence 2단계 이하의 환자 54명, 58예를 대상으로 2012년 5월부터 2014년 6월까지 후향적 연구를 시행하였다. 평균 추시 기간은 22개월(14-38개월)이었다. 환자 관련 인자들이 골유합과 연관성이 있는지를 분석하고, 외측 피질골 골절이 발생한 하위 집단에서 골이식물 종류(동종골, n=6; beta-tricalcium phosphate [β-TCP], n=6)에 따라 두 군으로 분류하여 술 후 6주, 3개월, 6개월, 1년에 방사선적, 임상적 평가 및 garding of van Hemert를 비교하였다. 결과: 하위 집단의 두 군 간에 임상적, 방사선적 결과는 유의한 차이가 없었고, grading of van Hemert는 술 후 6개월, 1년에 동종골 이식군에서 유의하게 높은 결과를 보였다. 비흡연 환자군과 외측 피질골 손상이 없는 환자군에서 유의하게 더 높은 골유합 등급을 보였다. 결론: 개방형 경골 근위부 절골술에서 외측 피질골 손상 시에 동종골 이식이 β-TCP보다 술 후에 더 나은 골유합을 보이며, 흡연과 외측 피질골 손상이 골유합을 지연시키는 위험 인자임을 관찰하였다. Purpose: The purpose of this study was to analyze patient factors including smoking, body mass index, correction angle, graft material, presence of lateral cortex fracture, and age for the effect on bone union after open-wedge high tibial osteotomy and the effect of graft material used for lateral cortex fractures. Materials and Methods: This retrospective study was conducted on 54 patients and 58 cases with osteoarthritic change Kallgren-Lawrence grade 2 or less from May 2012 to June 2014. Average follow-up period was 22 months (14–38 months). The patients were divided into two groups according to patient related factors and graft materials (allograft, n=6; beta-tricalcium phosphate [β-TCP], n=6) used for lateral cortex fractures and were analyzed for the relationship with bone union after open-wedge high tibial osteotomy. Radiographic and clinic analyses were performed, and van Hemert grading was used for grading bone union at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Results: The non-smoking group and the group without lateral cortex fracture showed significantly higher bone union rates than the control group. No significant clinical or radiological difference was observed between the two groups in 12 cases and the allograft group showed significantly higher rates of union at 6 months and 1 year postoperatively according to the van Hemert grading. Conclusion: Smoking and the presence of a lateral cortex fracture is a risk factor for nonunion in medial open-wedge high tibial osteotomy. The use of allograft material rather than β-TCP for lateral cortex fractures is thought to result in better bone union.

Prostaglandin E₁과 Allopurinol이 피판 생존에 미치는 영향

김응삼,나동균,탁관철,박병윤 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

Pathological vasospasm and free radical production contribute to skin flap survival. This study was undertaken to determine if combination therapy with anti-free radical agent-allopurinol and the vasodilatoprostaglandin E₁results in the synergistic enhacement of skin flap survival in rats. Twenty Sprague-Dawley rats were divided into four groups. With five rats in each group, group I being the control, group II was given intravenous allopurinol, group III was given transdermal PGE₁, and group IV was given both intravenous allopurinol and transdermal PGE₁. Control group demonstrated 27.7±3.0% skin flap survival. Compared to the control group, the increase in survival rate in PGE₁ group was statistically significant with a p value of less than 0.01. The group of both PGE₁ and allopurinol were given, mean flap survival rate was significantly higher than control group (p<0.01), but statistically insignificant compared to the single agent administered group. This study demonstrated combination therapy with the two agents-intravenous allopurinol and transd PGE₁-fails to confer additive benefit on flap survival in comparison with the groups given a single agent. This lack of additive effect may be due to a common final mechanism of action or to the presence of another pathological mechanisms of ischemic necrosis are present. Based upon this data, only single agent, transdermal PGE₁ is recommended for the pharmcological adjuvant of the compromising flap and further studies may be needed for the evaluation of the correct mechanisms of allopurinol in flap survival.

악관절강직증의 기능 및 미용상의 동시 교정술

탁관철,이훈범,이정훈,이영호,박병윤 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.5

Long-standing temporomandibular joint ankylosis presents disfiguring dentofacial deformity as well as functional problem of inability to open mouth. The goal of surgical treatment, therefore, should encompass the reconstruction of functional temporomandibular joint, correction of malocclusion and facial asymmetry. Because effective release of the ankylosed joint was so complicated and difficult in the first place, there had been technical problems in reconstruction of functional temporomandibular joint. Various authors described numerous surgical methods to correct the functional problem of temporomandibular joint ankvlosis, and they deferred the correction of facial asymmetry later as the secondary operation. During the last 7 years, 8 cases of temporomandibular joint ankylosis with severe dentofacial defromity were treated with one-stage operation. The method was first described by Munro et al. 1) The usual treatment consisted of costochondral graft to reconstruct the functional temporomandigular joint and multiple osteotomies such as LeFort Ⅰ osteotomy, sagittal splitting osteotomy of mandible ramus and genioplasty to correct the dentofacial deformity. In two cases free flap operation was performed to reconstruct the soft tissue defect resulted by soft tissue release of jaws. The results were gratifying in both functional and aesthetic standpoints. To prevent reankylosis, extensive bony release and soft tissue release of ankylosed tempormandibular joint should be done, followed by the reconstruction of functional temporomandibular joint with costochondral graft rather than any other autogenous tissue. Jaw osteotomies not only improve occlusal relationship but also improve facial asymmetry; furthremore, the patient can be free from psychologic burden caused by the facial deformity.

섬유성이형성증과 유사한 전두안와부의 양성골성종양

이영호,김진형,박병윤 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.6

The majority of benign bone tumors of the craniofacial skeleton, are in sites that easily leads to detection owing to the skull asymmetry or facial contour irregularities that often result. Tumor infiltration of the orbit may cause diplopia or visual disturbance, whereas involvement of the paranasal sinus is often relatively without symptom. Benign bone tumors occurring in the skull are rare(0.8% - 1%) and range in variety including osteoma, fibrous dysplasia, dermoid cyst, chondroma, giant cell tumor, aneurysmal bone cyst, osteoblastoma, neurofibroma, ossifying fibroma, Langerhans' cell histiocytosis, and hemangioma. We experienced two cases of osteoma, one case of osteoblastoma and a cavernous hemangioma. All tumors were totally resected and the defects were immediately reconstructed with bone grafts, and follow-up showed no evidence of recurrence. The clinical and radiological similarities of such lesions make differential diagnosis a difficult task, and in some cases, differentiating such benign tumors from malignancies pose a serious challenge. Bearing in mind the possibility of post-operative recurrence or malignant transformation, total wide resection of the tumor followed by esthetic and functional reconstruction is preferred.

회전 피판을 이용한 함몰유두의 교정

오영웅,박 철,유대현,박병윤 대한미용성형외과학회 1997 Archives of Aesthetic Plastic Surgery Vol.3 No.1

The patient with unilateral or bilateral inverted nipple has both functional and cosmetic impairments. The structural and histopathologic features of inverted nipple are that inverted nipple has less fibromuscular tissue than normal nipple and has short lactiferous duct and dense fibrous tissue. For these reasons, surgical correction of inverted nipple requires release of the short lactiferous ducts and providing the bulkiness under the nipple. We conbined the concept of both adding the bulkiness under the nipple and creating a tight neck at its base without sacrificing the duct system. We rotated the bilateral diamond shaped deepithelized dermal flaps around the nipple areolar complex for providing the nipple bulkiness without division of lactiferous duct and reinforced it with the purse-string suture around the dermal flap for providing the stability. This two rotational dermal flap method was applied 12 inverted nipple in 6 patients and followed up for 2 months to 24 months. We have got the satisfatory results in cosmetic and functional aspect without any complication such as sensory change, relapse, and nipple necrosis.

PGE₁(Prostaglandin E₁)의 국소도포가 Hairless Mouse 피부의 맥관형성에 미치는 영향

정섬,신극선,오승훈,설철환,박병윤 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

An important aspect of plastic surgery is skin flap survival. Among the prostaglandins, PGE₁is used clinically to improve peripheral circulatory disturbances due to its action of augmenting blood flow by vascular smooth muscle relaxation and its strong inhibitory action of platelet aggregation. Clinically, many investigators found that the effect of PGE₁was prolonged for a long period even after short-term application. So a new hypothesis emerges that the prolonged effect of PGE₁may be due to neovascularization and not due to vasodilatation alone. This study was designed to clarify the mechanism of the prolonged effect of topical PGE₁with regard to angiogenesis. A total of 9 male hairless mice were treated with a topical application of PGE₁onitment (PGE₁powder mixed in hydrogen base) on the experimental side and only a hydrogen base on the contralateral control side of the back skin, respectively, for 7 days, once a day. Then they were divided into 3 groups. In group 1, specimens were obtained on the 7th day post-treatment using 3 mm size punch biopsy from both sides. In group 2, specimens were obtained on post-treatment 14th day. In group 3, specimens were obtained on post-treatment 28th day. The number of blood vessels were compared between the experimental side and control side with respect to neovascularization after PGE₁application using an image-analysis program under hemtoxyline-eosin stain. Treatment on the experimental side did not affect its contralateral mate, since there was no evidence of a systemic effect. From our experimental data, we could conclude that PGE₁may induce angiogenesis by topical application without systemic effect.