다양한 방법을 이용한 이차성 구순열비변형의 비익기저 증대술

권인오 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.3

The definitive correction of secondary lip nasal deformities is a great challenge for plastic surgeons. To rectify the secondary lip nasal deformities, various procedures and its modifications have been reported in many centers. However, no universal agreement exist to correct the various components of secondary nasal deformities.The secondary nasal deformity of the unilateral cleft lip has its own characteristic abnormalities including the retroplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, short columella, depressed alar base and so forth. Among these components of secondary nasal deformity, maxillary hypoplasia, especially in the area of piriform aperture, and alveolar bone defect can make the alar base depressed, which in turn, leads to wide and flat nasal profile, obtuse nasolabial angle coupled with subnormal nasal tip projection in aspect of aesthetic consideration. Moreover, the maxillary hypoplasia contributes to reduced size of the nasal airway in combination with other component of external nasal deformity and therefore the nasal obstruction may be developed functionally.Therefore, the current authors have performed corrective rhinoplasty with the augmentation of alar base with various methods which include rearrangement of soft tissue, vertical scar tissue flap and use of allogenic or autologous materials in 42 patients between 1998 and 2003.The symmetric alar base could be achieved, which provides the more accurate evaluation and more appropriate management of the various component of any coexisting secondary nasal deformity. In conclusion, the augmentation of alar base, as a single procedure, is a basic and essential to correct the secondary lip nasal deformities.

흉벽의 오래된 화상 흉터에서 발행한 악성 섬유성 조직구종

최의철,권인오,박은수,김용배 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.6

Purpose: Malignant changes of Marjolin’s ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to 3.5×5cm chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

라식수술을 시행한 환자에서 결막절개를 통한 하안검성형술 시 발생한 각막손상

신종인,권인오,김창연 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.4

Purpose: LASIK, one of the currently popular ophthalmic procedures, can sometimes result in dry eye symptoms. In the patient who had underwent LASIK operation, the periorbital surgery may be more likely to lead to such a complication as dry eye symptom. We would like to report a case of corneal abrasion occurred after transconjunctival blepharoplasty in post-LASIK state and suggest the method about preventing the complication. Methods: A 30-year-old female patient underwent transconjunctival blepharoplasty and microfat graft into the face. She had history of LASIK operation 2 years ago. Corneal protector was applied to both eye during transconjunctival operation. After the surgery, she complained of visual blurring at left side. Ophthalmic examination revealed corneal abrasion of left eye. Results: Cornea protecting lens was applied to left eye for 2 weeks. Steroid and antibiotic eye drops were applied for relieving the symptoms and the prevention from progressing of complication. After 1 week, visual power and acuity was recovered to preoperative state. No other specific complications happened. Conclusion: Post-LASIK patient may have possibility of decreased corneal sensation and tear production. Preoperative ophthalmic examination is recommended for the prevention of complication. When corneal protector is applied, we suggest Optagel^® as a useful lubricant.

눈밑지방의 불룩함과 눈물고랑 교정을 위한 경결막 골막하 안와격막 재위치

신종인,권인오,김창연 대한미용성형외과학회 2011 Archives of Aesthetic Plastic Surgery Vol.17 No.2

Transconjunctival lower blepharoplasty has gained interest because of less-invasiveness and fast recovery. This is a study about operative skill, strength, and weakness of transconjunctival lower blepharoplasty and a trial for suggesting the guidelines for patient selection. The authors reviewed the medical records and photographs of 530 patients (M:F=470:60) who underwent transconjunctival lower blepharoplasty with orbital fat reposition and subperiosteal septal reset, retrospectively. Most of the patients were satisfied with results for correction of orbital fat bulging and tear trough deformity. Eighteen patients (3.4%) developed relapse of fat bulging requiring revision with subsequent fat removal (seventeen patients) or fat reposition (one patient). Two patient (0.4%) developed entropion. One case was corrected with revisional surgery and the other case was recovered after an injection of triamcinolone. Delayed hematoma was developed in five patients. Surgical evacuation was required in 3 cases. Minor problems included postoperative swelling, bruise, and transient paresthesia that resolved spontaneously. Transconjunctival lower blepharoplasty is an excellent surgical choice for correction of orbital fat bulging and tear trough in the patients who have proper tension of soft tissue. Invisible scar, fast recovery, and low complication rate are merits of this method. (Archives of Aesthetic Plastic Surgery 17: 83, 2011)

눈밑 다크써클의 원인에 따른 치료접근법

신종인,권인오,김창연 대한미용성형외과학회 2011 Archives of Aesthetic Plastic Surgery Vol.17 No.2

Infraorbital dark circles refer to the darkness of lower eyelids and can be a significant cosmetic problem for the people of any age and sex. Although the general concern for dark circles is increasing, little has been published about the treatment of dark circles in the scientific literature. Dark circles are not a single disease but combination of causative symptoms. We classified patients to five groups according to patients’ symptoms; bulging of infraorbital fat (Ia), sunken lower eyelids (Ib), depression or groove on midface (Ic), thin translucent skin (IIa), and excessive pigmentation (IIb). We reviewed medical records and photographs of patients retrospectively. The classification of patients and the treatment of the groups were evaluated. Problems of shape, especially bulging of infraorbital fat was the main cause of dark circles in most patients (65.2%). The treatment of each group included transconjunctival fat reposition or removal (Ia), single fat cell graft (Ib,IIa), microfat graft (Ic), and various dermatologic therapies (IIb). We obtained better results when we did combination of the treatments according to symptomatic groups. (Archives of Aesthetic Plastic Surgery 17: 91, 2011)

Threaded Kirschner Wire와 외부 고무줄 견인을 통한 소아 하악골 관절돌기 골절의 치료

남두현,안형식,권인오,김준혁,이영만 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.2

Purpose: The treatment of children mandibular condyle fracture that is severely displaced is controversial. The conservative treatment of it may lead to complications- mandibular deficiency, asymmetry, malocclusion and temporomandibular joint dysfunction. Moreover, open reduction carries risks for growth retardation, facial nerve injury, scarring and joint stiffness. The aim of this article is to present an alternative technique of the treatment by using a threaded Kirschner wire and external rubber traction. Methods: From November 2005 to May 2008, three patients underwent the management by using a threaded Kirschner wire and external rubber traction. A threaded Kirschner wire was inserted in the condylar segment by using a C-arm. We applied the external rubber traction, and we reducted the segment progressively until complete reduction. The mandibular-maxillary fixations were removed after 3 weeks, and patients were sent to training for mouth opening. Results: The technique didn't result in complications- joint dysfunction, facial nerve injury, sore, infection and nonunion during follow-up period. Radiologic follow-up examinations revealed correct reduction in all patients. In all cases, we found restoration of preinjury occlusion and temporomandibular joint function. Conclusion: Closed reduction of children mandibular condyle fracture by using a threaded Kirschner wire and external rubber traction did achieve anatomic reduction and restore mandibular height. This alternative technique is simple, effective, inexpensive, easy to apply and minimally invasive.