McIndoe 술식을 이용한 무질증치험례

엄기일 최신의학사 1989 最新醫學 Vol.32 No.12

이차성 구순비 변형에서 비교정술을 이용한 비변위의 교정

류재만,김잉곤,홍승업,엄기일 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.6

The secondary cleft lip nose deformities show complex deformities of nasal cartilage, septum, nasal bone, piriform aperture and maxilla. The external characteristic of cleft lip nose deformity is conspicuously shown by alar deformities. The nasal septum and bone deformities on the cleft side have a tendency to deviate totally toward the non-cleft side. Occasionally the nasal septum is dislocated from the vomer and the anterior nasal spine and nasal septum are displaced toward the noncleft side. The anatomical structure of the nasal cartilage in the cleft lip nose is well known. There are also many methods of treatment for nasal cartilage deformities. But the anatomical structures as well as treatment methods for deformities of the nasal bone & septum in the secondary cleft lip nose deformity have rarely been reported. The author intends to explain the anatomical characteristics of deformities of the nasal bone, maxilla, and nasal septum and to suggest surgical treatment methods accordind to 98cases reported recently. The anatomic characteristics are deviation of nasal bony pyramid, deviation of anterior nasal spine and vomer, crooked septum, septal dislocation sometimes, turbinate hypertrophy. The surgical methods for radical corrective rhinoplasty include bilateral osteotomies of the lateral pyramids of the nasal bone, infracturing, sepal dislocation and fixation of the septum, turbinecomy, and submucosal resection, if needed. We performed 98 cases and follow-up period was from 6 months to 4 years. We have gained the results of median location of deviated nasal skeleton, improved nasal airway, good nasal symmetry. In conclusion, secondary cleft lip nose deformities are deviation of nasal bony pyramid, deviation of anterior nasal spine and vomer, crooked septum, septal dislocation sometimes, turbinate hypertrophy. Radical corrective rhinoplasty is needed for median location of deviated nasal skeleton, improved nasal airway, good nasal symmetry.

이차성 양측성 구순비 변형 환자에서 Fork flap을 이용한 비축주 연장

류재만,류현석,박진석,엄기일 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.3

A typical bilateral cleft lip nose presents a short columella, a depressed nasal tip, bilateral dislocation of alar cartilage, the attenuation and flaring of alar cartilage, and wide alar base. These characteristic factors may be present before primary lip repair and may remain as residual deformities. And so, correction of nasal deformity including the lengthening of the columella and philtral unit formation must be added for the complete bilateral cheiloplasty. There have been many methods for lengthening of the columella, which requires the transport of new tissue, such as central lip tissue, vertical scar flap, nasal floor and alar base advancement, nasal skin shifting, and free composite graft. Fork flap is a method using vertical scar flap. In primary bilateral cheiloplasty, fork flap could be stored into the nostril sill to lengthen the short columella at the next operation. If philtrum is ideal in size and upper lip scar is acceptable, this banked fork flap can be used for lengthening of the columella. But due to the upper lip tension from the reorientation of orbicularis oris muscle and/or the protruded premaxilla, the prolabium is apt to be expanded and lengthened. If the prolabium is widened, the fork flap was taken, including the bilateral lip scars and excess prolabium to create a philturm-shaped centerpiece. By using the fork flap, besides lengthening the coiumella, the acceptable philtral unit and the definitive lip contour could be obtained. There is a criticism of fork flap technique which is the vertical scars in the columella and may be problems with vascularity of flap tips. But in our experience, fork flap is thought to be a technique which can correct short columella, alar flaring, wide alar base, blunt nasal tip, simultaneously and also form the philtral unit.

여성형 유방증의 임상적 연구

김대섭,최희윤,김잉곤,류재만,김진,엄기일 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.6

Forty patients with histologically proven gynecomastia were analysed. We reviewed the clinical properties and histopathologic types of the gynecomastia, and suggest a reasonable approach to this clinical problems posed by the patient with breast enlargement. The result we found includes: 1) The peak incidence of 50% occurred in the teen-age group. 2) Bilateral gynecomastia was found in 11 patients. In 29 patients with unilateral gynecomastia the right breast was involved more often than left, 19 vs. 10, respectively. 3) All palpable masses were located at the central breast tissue including the subareolar region. 4) In 56% of the patients, the size of the mass was more than 5cm in diameter. 5) Associated pathologic conditions were found in 9 patients. They were Klinefelter's syndrome, pulmonary tuberculosis, hepatitis, true hermaphroditism, liver cirrhosis and hypertension. 6) Histopathologically, 50% were florid type, 37.5% were fibrous type, 12.5% were intermediate type.

복벽 성형술의 문제점 및 분류

최희윤,류재만,김잉곤,차상면,엄기일 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.2

Some patients requesting abdominal contour surgery may have all their deformity below the semicircular line. These patients were treated by the traditional procedure, but these patients has nerve satisfied because of long and wide scar. From a study of the deformities of each layer of the abdominal wall, we have categorized three types of abdominoplasties. For each type, we used a different surgical technique, aiming to sculpture the abdomen and treat each layer according to the deformity present in each patient. By classifying the various problems and by using the different approaches, only the specific deformities of the abdominal wall need be corrected. The results were judged good excellent by the surgeons and patients because of the more natural appearance of the final results.

일측성 구순열 교정에서 인중융선의 형성

엄기일 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.1

The philtral unit plays a key role in the appearance of the upper lip. And making the philtral column is extremely important in unilateral cleft lip repair for natural looking lip. Previously, Millard incision scar simulated philtral column, but making the true elevated philtral column was not easy. And many methods using muscle flap, scar flap and conchal cartilage graft were not satisfactory for making philtral column in the secondary cleft lip. So Author hypothesized 3 considerable points in making philtral column. 1) Skin excess over the repaired muscle of the lip. 2) Relief of tension 3) Insertion of tissue between skin and muscle along the line of philtral column. Point 1) & 2) is absolutely necessary and point 3) is relatively and occasionally necessary for making the philtral column. To Make philtral column by inserting something in the situation of lack of point 1) & 2), make the lip only thick. To relieve tension, author used Latham intraoral orthopedic appliance to narrow alveolar gap. The deviated septum was dislocated and fixed to the midline point and cinching was done. Supraperiosteal muscle dissection near the pyriform aperture to relieve the tension from the lateral lip segment wass done. We performed 156 cases of unilateral cleft lip repair from Mar. 1991 to Mar. 1993. In most cases we cannot see flat lip in the repaired cleft lip cases. Skin excess over the repaired muscle is most important to make a philtral ridge. And to relieve tension is also necessary not to make philtral column but to make a least scar line. Primary repair is the optimal time and Millard technique is method of choice to make a philtral column.

Hydrocolloid(comfeel)가 오염된 창상에 미치는 영향

류재만,이신규,김상범,엄기일 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.1

Fundamental principles in the treatment of infected wounds include the elimination of infection, the evacuation of pus, and the debridement of all necrotic material. The natural healing process of infected wounds can be expedited by the application of a wound cleansing agent which will effectively remove wound debris and eliminate infection without compromising the healing process. So, ideal local application material should absorb exudate, maintain high humiudity, allow gaseous exchange, provide thermal insulation, be impermeable to microorganisms and can be easily removable from the wound without causing trauma. Comfeel sheet consists of sodium carboxymethylcellulose particles embedded in an adhesive, elastic mass and its upper layer is covered with a water-poor thin polyurethane film. This study was undertaken to evaluate the efficacy of Hydrocolloid as a wound cleansing agent in the infected wounds on the back of rabbits. The histologic findings and wound culture were compared in each groups. We conclude that Hydrocolloid cleans wound and promotes granulation, so wound healing process can be shortened. It's advantages are as follows : 1. Infected wound cleasing and wound debris removal. 2. Increase reepithelization and induce rapid angiogenesis. 3. High flexibility and elasticity. 4. High cohesion. 5. Permeable to water vapour. 6. Impermeable to bacteria.

제주지역 기와가마와 생산·수급체계

엄기일,이정민 한국기와학회 2020 한국기와학회 학술대회 발표자료집 Vol.2020 No.11

양측성 구순열에서의 구순 접합술

변태호,엄기일 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.3

Bilateral cleft lips are clefts on both sides of the premaxilla. These clefts may be complete, incomplete or microform, Bilateral cleft lips vary their menifestation, however, the typical, complete type bilateral cleft lip show a distinct premaxillary malformation characterized by a protrusion of the entire premaxillary bone wits respect to the cartilaginous nasal septum and a protrusion of the tooth-bearing alveolar process. The protrusive premaxilla obliterates the columellar area of the nose so that the lip attaches directly to the nasal tip. There is loss of the intact alveolus, and there is an unlined labial sulcus. The orbicularis oris muscle usually is not present in the prolabium, and there is loss of the central dimple, the symmetrical philtral column, and the midline tubercle at the inferior vermilion border. In the prolabium, white roll is diminuted. In the nasal area, the alar bases are flared, the alar rims usually are aymmetrical and the airwaus usually are partially obstructed. In addition to all of these findings there is an abnormal nasolabial angle. As summarized by McCarythy, approximately 14-15% of surgically treated cleft lip reported by many authors were bilateral cleft lips. In authors' recent experience, twenty-seven cases of bilateral clefts were operated on between Jan. 1990 and Oct. 1992 among 310 primary operated cases of the cleft lips(8.7%). At the first step in correction, we applied the presurgical orthodontic appliance, in the second month of life. After the premaxilla and maxillary arches are in natural alignment, the appliance is removed and, gingivoperiosteoplasty and lip adhesion are carried out. With muscle reorientation beneath the prolabium the function of the lip was relatively good and fork flaps could be stored into the nostril sill to lengthen the short columella. Long-term follow-up observation and the lip scar was natural-looking from the protruded maxilla even after lip adhesion, making the proabium expanded and lengthened. By using the fork flap between the age of 3-4 to lengthen the columella and at the same time performing a bilateral cheiloplasty, an almost defintive lip can be obtained. We therefore report 27 cases of bilateral cleft lip repair by lip adhesion.

Microform Cleft Lip의 분류와 치료

변태호,엄기일 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.4

Cleft lip is an anomaly with variable expression ranging from complete cleft and palate to minor abnormality of the nose or lip. Microform cleft lip is the mildest expression of cleft lip and may be difficult to repair. A microform cleft lip has 3 major component: 1. A deformity of the nostril, 2. A narrow ridge of tissue or a depressed groove of upper lip from vermilion to nostril, 3. A minor defect of the upper vermilion border. The continuing attempt to improve results with the surgical repair of cleft lip is clearly evident by the frequent appearance of new methods or modifications of old techniques. However, there is little mention of the microform cleft lip. 35 microform cleft lip patients were operated between Jan. 1991 and Dec. 1993 in our department(15 males and 20 females). The ages of the patients ranged from 3 months to 38 years(Mean 8 years). We classified and treated the microform cleft lip as follows; Type I: Cleft lip nose without lip deformity or with slight short lip of cleft side. Type II: Mild lip deformity with blurring of Cupid's bow, vermilion notching and skin striae. Type Ⅲ. Mild lip deformity including Cupid's bow, deviation. The goals in the correction of a microform cleft lip are to obtain an esthetically pleasing upper lip and nose, and to reestablish muscle continuity for improved function. To try to attain these goals, we used above classification, and satisfactory results were obtained by treating the cleft following the classification.