의료기관의 성과관리와 질 향상 연계체계 구축을 위한 임상적 성과지표 개발

장금성(Jang, Keum Seong),이삼용(Lee, Sam Yong),김윤민(Kim, Yun Min),황선영(Hwang, Sun Young),김남영(Kim, Nam Young),류세앙(Ryu, Se Ang),박순주(Park, Soon Joo),최지윤(Choi, Ja Yun) 한국간호과학회 2005 Journal of Korean Academy of Nursing Vol.35 No.7

누소관 열상환자에서 Mini Monoka$^{(R)}$를 이용한 지연된 스텐트 삽입술

황재하,김홍민,김지훈,김광석,이삼용,Hwang, Jae-Ha,Kim, Hong-Min,Kim, Ji-Hoon,Kim, Kwang-Seog,Lee, Sam-Yong 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.1

Purpose: Canalicular laceration is relatively common due to its exposed, vulnerable location in case of facial trauma. Conjunctivodacryocystorhinostomy has been the standard treatment for canalicular obstruction secondary to unrepaired canalicular laceration. In spite of a high rate of relieving tear-duct obstruction, this method is noted to be associated with low rate of patient satisfaction and a number of complications. The goal of this study is to report the good results of delayed lacrimal stent implantation with Mini Monoka$^{(R)}$ for patients whose canaliculi were not repaired by initial surgery. Methods: From May of 2005 to February of 2007, four patients who underwent delayed lacrimal stent implantation using Mini Monoka$^{(R)}$ in canalicular laceration were retrospectively reviewed. First, the previous scar incision was made over the lower lid and we identified the cut end of proximal lacerated canaliculus. The Mini Monoka$^{(R)}$ was passed through the punctum to the cut end of the proximal lacerated canaliculus. We identified the cut end of the distal lacerated canaliculus, whose cut end has rolled white edges after careful excision of the scarred lid tissue. We then passed Mini Monoka$^{(R)}$ through the lacerated inferior canaliculus. Using an operating microscope, we placed three interrupted sutures of 8-0 Ethilon to join the canalicular ends. Silicone stent was left in place for 6 months. The mean age of the patients was 48.5 years (range, 35 to 59 years). The time interval from initial trauma to delayed lacrimal stent implantation was between 3 and 31 days. Follow-up periods ranged from 12 and 20 months. Results: The results of reconstruction were classified into normal, fair and poor. Patent lacrimal drainage systems were achieved in three of the four cases. In one case, epiphora was encountered. No cases of stent displacement, conjunctivitis or granuloma formation were encountered. Conclusion: Even though canalicular reconstruction was delayed for a long time, attempting canalicular reconstruction would be acceptable before considering secondary operations like dacryocystorhinostomy and conjunctivodacryocystorhinostomy.

뚜껑문 안와저 골절에 있어서 망상 흡수성 판을 이용한 관혈적 정복술 및 내고정술

권유진,김지훈,황재하,김광석,이삼용,Kwon, Yu-Jin,Kim, Ji-Hoon,Hwang, Jae-Ha,Kim, Kwang-Seog,Lee, Sam-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Trapdoor orbital blowout fracture is most common in orbital blowout fracture. Various materials have been used to reconstruct orbital floor blowout fracture. Absorbable alloplastic implants are needed because of disadvantages of nonabsorbable alloplastic materials and donor morbidity of autogenous tissue. The aim of the study is to evaluate usefulness of absorbable mesh plate as a reconstructive material for orbital blowout fractures. Methods: From December 2008 to October 2009, 18 trapdoor orbital floor blowout fracture patients were treated using elevator fixation, depressor fixation, or elevatordepressor fixation techniques with absorbable mesh plates and screw, depending on degree of orbital floor reduction, because absorbable mesh plates are less rigid than titanium plates and other artificial substitutes. Results: Among 18 patients, 5 elevator fixation, 4 depressor fixation, and 9 elevator and depressor fixation technique were performed. In all patients, postoperative computed tomographic (CT) scan showed complete reduction of orbital contents and orbital floor, and no displacement of bony fragment and mesh plate. Mean follow-up was 10 months. There were no significant intraoperative or postoperative complications. Conclusion: Three different techniques depending on the degree of orbital floor reduction are useful for open reduction and internal fixation of trapdoor orbital floor blowout fracture with absorbable mesh plates.

안면 동종이식에 대한 위험 승인도와 기대치 조사

박상렬,김지훈,황재하,김광석,이삼용,Park, Sang-Ryul,Kim, Ji-Hoon,Hwang, Jae-Ha,Kim, Kwang-Seog,Lee, Sam-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Facial allotransplantation (FA) could provide an excellent alternative to current treatments for facial disfigurement. However, despite being technically feasible, there continues to be various ethical and psychosocial issues associated with the risks and benefits of performing FA. The purpose of this study is to investigate risk acceptance and expectations in FA. Methods: In a quantitative assessment of risk versus benefit with respect to FA, from 2004 to 2008, Barker et al. developed and published a questionnaire-based instrument (Louisville Instrument for Transplantation [LIFT]), which contained 237 standardized questions. In the current study, the authors assessed risk versus benefits and expectations of FA using a Korean version of the LIFT. Respondents in three study groups (lay public, n=140; medical students, n=120; doctors, n=34) were questioned about risk acceptance as related to immunosuppression and tissue rejection, and expectations as related to quality of life improvement, and functional and aesthetic outcomes. A summary of the data has been provided and statistical analyses were performed. Results: Among the three study groups, results indicated that doctors accept the least amount of risk for a facial allotransplant, followed by medical students, and finally lay public. There was a significant statistical difference in three of the four questions regarding risk acceptance between the groups (p < 0.05). In general, lay public exhibited higher expectations for facial allotransplantation than the other groups. Additionally, there was a significant statistical difference in the importance of aesthetic outcome between the groups (p < 0.05). Conclusion: The authors' data indicate the three populations have vastly different levels of risk acceptance and expectations with regard to FA. Therefore, it is very important that surgeons establish clear, open, and thorough communication with patients in their consultations regarding FA. This is particularly important with respect to whether or not a patient's level of risk acceptance and expectations are progmatic.

V-M 성형술을 이용한 지간구축 및 합지증의 교정 임상례

김의식,박상렬,황재하,김광석,이삼용,Kim, Eui-Sik,Park, Sang-Ryul,Hwang, Jae-Ha,Kim, Kwang-Seog,Lee, Sam-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.1

Purpose: The loss of web space is caused by congenital syndactyly or acquired burn injury, trauma or surgery. Numerous surgical procedures have been described for restoration of the web space. Local flaps are usually preferred because of the easiness to perform and tolerable postoperative outcome. Among the various local flaps, the authors introduce V-M plasty for correction of web space contracture and syndactyly. Method: From March 2007 to Jun 2008, 4 patients underwent V-M plasty for correction of web space contracture and syndactyly. V-M plasty consists of 3 distinct triangular flaps. One triangular flap is designed next to the web region on the dorsal site of the hand, whereas the remaining 2 triangular flaps are placed on the volar site. The dorsal triangular flap is then placed between the volar adjacent triangular flaps. At the end of the operation, the involved fingers or toes are positioned in abduction to avoid kinking of the triangular flaps. Result: All the patients gained web functions with good esthetic appearance without any recurrence or complications. Mean follow-up was 8 months. Conclusion: V-M plasty is a safe, easy and rapid procedure to design and apply by using local tissues without the needs for a skin graft or risk of linear scarring and recurrence. The authors advise this versatile technique both in primary and recurrent cases of web space contracture and syndactyly.

심부하복벽동맥 천공지 유경 피판을 이용한 이영양성 수포성 표피박리증에 합병된 서혜부 편평 세포 상피암의 치료 - 증례 보고 -

김경필,김지훈,김의식,황재하,김광석,이삼용,Kim, Kyung-Pil,Kim, Ji-Hoon,Kim, Eui-Sik,Hwang, Jae-Ha,Kim, Kwang-Seog,Lee, Sam-Yong 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.2

Purpose: Epidermolysis bullosa is a rare genetic disease, characterized by the presence of extremely fragile skin and formation of recurrent blister resulting from even a minor mechanical injury. Squamous cell carcinoma (SCC) is recognized as a complication of the chronic scarring associated with dystrophic epidermolysis bullosa (DEB). When a soft tissue defect happens in a patient with epidermolysis bullosa, it is difficult to cover it with a skin graft or a flap. We describe the successful use of a pedicled deep inferior epigastric perforator flap for the reconstruction of SCC associated with DEB in the groin. Methods: A 29-year-old man diagnosed with DEB at birth sustained an ulcer increasing in the right groin for the last 7 months. Under general anesthesia, the mass lesion and lymph nodes were removed and the resulting defect was covered with a pedicled deep inferior epigastric perforator flap. Results: The flap survived completely and his postoperative course was uneventful. Histopathological examination revealed a SCC in the right groin and malignant tumor cells in the removed lymph nodes as well. Additional positron emission tomogram showed a malignant lesion in the ileocecal area with regional lymph node metastasis. The patient was referred to an oncologist for chemotheraphy, but the patient refused to take it. During a 4-month follow-up period, there was no recurrence in the right groin. Conclusion: We suggest that perforator flaps can be considered as a reliable alternative for the reconstruction of soft tissue defects in a patient with DEB.

내경정맥의 변형을 유발한 거대 경부 지방종

최준호(Jun Ho Choi),오상성(Sang Seong Oh),김광석(Kwang Seog Kim),황재하(Jae Ha Hwang),이삼용(Sam Yong Lee) 대한두경부종양학회 2022 대한두경부 종양학회지 Vol.38 No.2

Lipoma is one of the most common benign soft tissue tumors. However, giant lipomas compressing and deforming the neurovascular structure rarely occur in the lateral neck. A 70-year-old man visited our outpatient clinic for treatment of a visible painless neck mass that had been identified 2 years prior. Neck magnetic resonance imaging revealed that a 10 × 9 × 4 cm fatty mass located between the sternocleidomastoid and sternohyoid muscles invaded the carotid sheath. Under general anesthesia, the mass was excised without damage to the adjacent neurovascular structures. Upon histopathological examination, the mass was identified as a lipoma. During the surgery, enlargement of the internal jugular vein was observed under the resected mass. However, on ultrasound examination, the function of the internal jugular vein was evaluated as good. No recurrence or neurological and vascular complications were reported during a 6-month follow-up after the surgery. As a giant lipoma located in the deep layer of the lateral neck can deform important cervical structures, its impact on the surrounding structures should be carefully assessed preoperatively to minimize the rate of possible complications.

화상 환자 531예에 대한 임상적 고찰

조백현,김병삼,임기영,류봉수,이삼용 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.2

During the 10 years from January, 1981 to December, 1990, 531 cases of burn patients were admitted into the Department of Plastic & Reconstructiove Surgery, Chonnam Medical School Hospital. The following results were obtained after the analysis of these burn patients. 1) Male were affected more frequently than female, the incidence being 197 cases(60%) and 212 cases (40%). The male to female ratio was 1.5:1 2) The hightest incidence was noted in winter, 180, cases(33.9%) and the least in summer, 108 cases (20.4%) The highest incidence was noted in March, 68 cases(12.8%) and the least in May, 22 cases (4.1%) 3) The most common cause of the burns was scalding : 226cases(42.5%) 4) In 81.6% of all cases, the burned surfaces covered less than 30% of the total body and in 34.1% of them, the burned surfaces covered less than 10% of total body surface area. 5) 357 cases(67.2%) required fluid rescucitation, and 239 cases(66.9%) were rescucitated by the parkland formula. 6) The topical antibacterial agents were as follows: Sliver sulfadiazine cream 192 cases(36.2%), Sofra-tulle 150 cases, Gentamycin ointment 75 cases(14.1%), Cambison ointment? 47 cases(8.9%) in order of frequency. 7) The cultures of wound surface revealed Pseudomonas aeruginosa(41.0%), Staphylococcus aureus(16.0%), E-coli(14.0%), Staphylcoccus albus (77.5%) etc. in order of frequency. 8) The surgery was perfomed in 291 cases and the most frequent method of surgery was split thickness skin graft. 9) The graft loss rates of topical antimicrobial agents after grafting were as follows: Saline gauze(23%), Cambison ointment (15%), Gentamicin ointment(11%), Sofra tulle(8%) 10) The Complications were as follows 58 cases(14.8%), gastrointestinal tract complications 55 cases(14.0%), conjunctivitis 21 cases (5.4%), genitourinary tract infections 18 cases(4.6%) etc. in order of frequency. 11) The mortality rate and cause of death were as follows: (1) The total mortality rate was 3.2%(17cases). (2) The most common cause of death was sepsis in 8 cases(47.0%) (3) The mortality rate of the early children and old age group was high. (4) The most common period of intervals between the time of the accident and death was within 3days.

피부종양의 Epidermal Growth Factor 표현에 관한 연구

박희만,최석현,이삼용 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.4

Epidermal growth factor(EGF) is extracted first from the submandibular gland of a mouse by Cohen, and the expression of EGF in normal squamous epithelium, fibroblasts and marrow cells has been reported. Since EGF is expressed and increased in neoplastic tissue, study on possibility of EGF as a tumor marker has been attempted. The author performed immunoperoxidase staining for EGF on the common skin tumors such as squamous cell carcinoma, Bowen's disease, basal cell epithelioma, proliferatin trichilemmal tumor, keratoacanthoma, and neveus sebaceus to confirm the patterns of EGF expression and the relationships between EGF expression and cellular differentiation of malignant potentiality of tumors, and the results obtained were as follows. 1. Positive expression of EGF was characteristic in the cells with intracytoplasmic keratinization in squamous cell carcinoma, keratoacanthoma, Bowen's disease, and proliferating trichilemmal tumor. And the intensity was more strong to the degree of keratinization, but negative in keratin pearls. 2. In basal cell epitelioma, EGF was not expressed or weakly expresse. 3. EGF was expressed in the sebaceous cells in nevus sebaceus, and also expressed in neighboring normal eccrine glands. From the above results, the expression of EGF in skin tumors was related to cellular differentiation, especially toward squamous cells, but there was no any relationship to malignant behavior.

칼슘 차단제 전신처리가 백서의 임의형 피부판 생존에 미치는 영향

백영홍,최석현,조백현,박희만,이삼용 大韓成形外科學會 1989 Archives of Plastic Surgery Vol.16 No.3

Skin flap necrosis can be a catastrophe in reconstructive surgery. Many attempts have been made clinically and experimentally to improve the survival in random pattern flaps. As the delay phenomenon theory, that is, vascular smooth muscle relaxation augments the blood flow to the capillary bed of the skin flap, experimental study using the Sprague-Dawley rats performed with the calcium antagonists which cause the dilatation of vascular smooth muscle by blocking the calcium-influx into the cells. Total 100 rats were grouped into control group(10) and 3 experimental groups. Each experimental group was subdivided into pre-operation, post-operation and pre-operation & post-operation group in accordance with the injection period of calcium antatonists, nifedipine and diltiazem. All the experimental groups increased the surviving skin flap area than the control group. This suggests that sustained vasodilatation by the calcium antagonists ia a major factor of flap survival increment. The mean survival area in all experimental groups was significantly greater than that in the control group.