인조귀 부착술에서 직접 및 간접골통합법의 합병증에 대한 비교

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

Osseointegrated prosthetic auricular reconstruction can be classified as either direct or indirect. In the Brnemark system of direct osseointegration, implants are placed into the mastoid process of the temporal bone. In the Epitec system of indirect osseointegration, implants are inserted into a three-dimensional carrier plate that is fixed to the mastoid by means of screws. We experienced forty-four cases using the indirect system and seventeen cases using the direct system. We compared with two systems by complications, such as skin reaction, implant loosening, implant loss. There were no specific differences in the skin reaction around the implants and abutments in relation to age or system used. The degree of skin reaction was different according to the conditions around the implant: in cases of virgin microtia, a skin flap was used to cover the implant, in contrast to grafted skin coverage for failed autogenous reconstruction. In both systems, the skin reaction was more severe and frequent in skin flap than in grafted skin. Loosening of the implant was more frequent in the direct system; however, accidental detachment of the implant from the abutment was more frequent in the indirect system. To reduce complications of skin reaction in osseointegrated prosthetic auricular reconstruction, it is important for soft tissue around implant to immobilize. Therefore, grafted skin is better than skin flap as soft tissue around implant. And immobilization of soft tissue around implant by wound dressing is major facter.

聽覺障害兒의 視覺-運動知覺發達 및 情緖的 特性

朴茂植,金炳廈 韓國社會社業大學特殊敎育硏究所 1978 特殊敎育硏究 Vol.6 No.-

This study is to explore the characteristics of the visual-motor perceptual abilities and emotional adjustment of the hearing impaired by Koppitz's Bender Gestalt Test. the subjects were 35 hearing impaired children from 1st to 3rd grade attended in Young-wha School for the Deaf, and all of the subjects were the above IQ 75 by K-WISC performance test and had no known additional handicap. The main results of this study are as following: 1. The visual-motor perceptual abilities of the hearing impaired who entered in school as the above 7 years, was no difference with that of the hearing children who are the Koppitz's normative group. The markedly deviated items of the hearing impaired in BGT were 'Distortion of Shape'. 2. The visual-motor perceptual maturisties of the hearing impaired related to the age of onset of deafness statistically in 5% level, while statistically had no significant relationship, slightly related to school achievement and oral communication skills, but had no significant relationship of Bender Test to degree of hearing loss and socio-economic status. 3. The emotional indicator of the hearing impaired significantly appeared in the overt aggressiveness and impulsion by the overwork or reinforced lines, and lack of stabilities by the confused order, and anxiety and compression by the small sixe in Bender Gestalt. 4. In emotional indicator, the relationship of Bender Test to degree of hearing loss, age of onset of deafness, communication skills, and academic achievement of the hearing impaired had no significant correlation. But the relationship of Bender Test to shcool achievement and age of onset of deafness int he hearing impaired should be reconsidered by the following other study.

국가 예방접종 인터넷정보시스템 개발을 위한 의원정보시스템의 예방접종 모듈 평가연구

이무식(Moo-Sik Lee),이건세(Kun-Sei Lee),이석구(Seok-Gu Lee),신의철(Eui-Chul Shin),김건엽(Keon-Yeop Kim),홍지영(Jee-Young Hong),나백주(Bak-Ju Na),김윤정(Yun-Jeong Kim),박숙경(Sook-Kyung Park),김보경(Bo-Kyung Kim),권윤형(Yun-Hyung Kwon 한국농촌의학 지역보건학회 2004 농촌의학·지역보건 Vol.29 No.1

신체 부위에 따른 지방조직의 특성: 컴퓨터단층촬영 및 조직학적 소견

신동우,손대구,박무식,김준형,한기환,Shin, Dong-Woo,Son, Dae-Gu,Park, Mu-Shik,Kim, Jun-Hyung,Han, Ki-Hwan 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: The subcutaneous fat tissue is separated into 2 layers by the subcutaneous fascia: the superficial and deep fat layers. The two fat layers have different structures according to the body regions. The purpose of this study is to evaluate the distribution and pattern of the two fat layers in the human body by computed tomography (CT) and histological analysis according to age, sex, anatomical region, and body mass index (BMI). Methods: This study included 200 males and 200 females who underwent 64-channel dynamic CT in our hospital. The patients were divided into 5 groups according to 10 years of their ages separately in either male or female gender. The thickness of the superficial and deep fat layers was measured in the abdominal, pelvic, and femoral regions, and we analyzed the values. Statistical analyses were performed using SPSS software. The $3{\times}3$-cm whole fat layers were harvested from the same sites of 3 cadavers for histological examination, and one cadaver was dissected for gross evaluation. Results: The total thickness of subcutaneous fat tissue was greater in females than in males, and the ratio of the superficial fat layer to the whole fat layer was higher in females. The superficial fat layer became thinner with increasing age in males. As BMI increased, the total fat layer became thicker, and the superficial fat layer became thicker than the deep fat layer. On histological examination, the superficial fat layer had small adipose lobules and showed a densely distributed pattern in the abdominal region, whereas in the femoral region, it had large adipose lobules and showed a sparsely distributed pattern. There were no significant differences in the histological findings of the deep fat layer between the 3 body regions. Conclusion: Significant differences in histological findings of the two fat layers were found in relation to age, sex, anatomical region, and BMI. The superficial fat layer became thinner with increasing age in males, but it was constant in females. As BMI increased, the total thickness of subcutaneous fat tissue became greater, and the superficial fat layer became thicker than the deep fat layer. Our measurements can be used to understand the characteristics of the fat layers in relation to age, sex, anatomical region, and BMI.

일측구순열비변형에서 물갈퀴일측지Z성형술을 이용한 외비공과 비주의 재건: 사진계측학적 연구

한기환,김대진,박무식,김준형,손대구 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.6

Purpose: In the treatment of the unilateral cleft lip nasal deformities, the correction of the low-nostril height and short-columella are very difficult problems. We report the treatment outcomes of web uni-limb Z-plasty used for correction of unilateral cleft lip nasal deformities by using photographic analysis. Methods: A total of 36 patients with unilateral cleft lip nasal deformities were enrolled in this study, who underwent web uni-limb Z-plasty and were followed up for at least 6 months. First, a triangular flap was made on the medial side of alar-columella web. The nostril apex of cleft side was corrected to a higher point compared to noncleft side by 2 mm. The flap was transposed into the defect of the vestibule. To reduce the bulging of the flap, horizontal cinching sutures were added. Postoperative outcomes were evaluated by using photographic analysis. 2 indices and 1 angle were measured on their photographs taken before and after the surgery. Symmetry was also evaluated by means of the noncleft side to cleft side index. For anthropologic assessment, observers described postoperative outcomes, using Ordinary Scale Method. Results: The postoperative values obtained in photographic analysis improved compared to preoperative ones. More improving anthropologic assessment was shown in post-than pre-operative.Conclusion: Although, further long term follow up is needed, we found this technique to be an effective procedure to the symmetry of nostril apex level and the lengthening of columella in the unilateral cleft lip nasal deformities.

전비중격연장이식술을 이용한 일측 구순열비변형교정술: 다공성 고밀도폴리에틸렌 판과 비중격연골의 사진계측학적 비교

한기환,정진욱,박무식,김준형,손대구,Han, Ki-Hwan,Jeong, Jin-Wook,Park, Mu-Sik,Kim, Jun-Hyung,Son, Dae-Gu 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Complete septal extension grafts have been widely used in rhinoplasty for effective projection of the short retruded columella in Asian patients. Autologous septal cartilages and porous high-density polyethylene sheets are frequently used as septal extension grafts. This study was conducted to compare the postoperative results of porous polyethylene sheets and septal cartilages used for correction of unilateral cleft lip nasal deformities by using photogrammetric analysis. Methods: This study investigated a total of 49 patients with cleft lip nasal deformities who underwent corrective surgery, and were followed up for at least 6 months. Septal cartilages were used in 39 patients, and porous polyethylene sheets were used in 10 patients. In all patients, through the open rhinoplasty, complete septal extension grafts were sutured to the caudal margin of the septal cartilage, and the alar cartilage was sutured with suspension. The cleft side alar cartilage was overcorrected by approximately 3 - 5 mm. Postoperative outcomes were evaluated by using photogrammetric analysis. Five indices and 4 angles were measured on their photographs taken before and after the surgery. In patients with unilateral cleft lip nasal deformities, symmetry was also evaluated by means of columellar length index. Results: The postoperative values obtained in photogrammetric analysis showed improvements in comparison with the preoperative ones. The polyethylene group produced more improved outcomes than the septal cartilage group but also resulted in more complications at the same time. Conclusion: The results of this study indicates that complete septal extension grafts are efficient for the correction of unilateral cleft lip nasal deformities. However, since postoperative complications occur more frequently in the polyethylene group than in the septal cartilage group, caution is advised in using porous high-density polyethylene sheets in patients with cleft lip nasal deformities.

감염된 만성창상에서 국소음압세척치료의 이용

정진욱,김준형,정영진,박무식,손대구,한기환,Jeong, Jin-Wook,Kim, Jun-Hyung,Jung, Yung-Jin,Park, Mu-Sik,Son, Dae-Gu,Han, Ki-Hwan 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Continuous irrigation method is an important step in managing wound infection. V.A.C. devices have been used in intractable wounds for reducing discharge, improving local blood flow, and promoting healthy granulation tissue. We expect synergistic effects of reduced infection and more satisfactory, accelerated wound healing when using both methods simultaneously. This study evaluated continuous irrigation combined with V.A.C. appliance for treatment of infected chronic wounds. Methods: We reviewed data from 17 patients with infected intractable chronic wounds. V.A.C. device (Group A) was used in 9 patients, and V.A.C. with antibiotics irrigation (Group B) was used in 8 patients. We placed Mepitel$^{(R)}$ on the surface of wound and placed an irrigation and aspiration tube on each side. A sponge was placed on the Mepitel$^{(R)}$ and covered with film dressing. The wound was irrigated continuously with mixed antibiotics solution at the speed of 200 cc/hr and aspirated through the wall suction at the pressure of -125 mmHg. V.A.C. applied time, wound culture and wound size were compared between the two groups. Results: No complication were seen in two groups. Compared with Group A, in the Group B, V.A.C. applied time was shortened from 32.7 days to 25.6 days and showed efficacy in the reduction rate of wound size. No statistical differences were shown in bacterial reversion. Conclusion: V.A.C. appliance with continuous irrigation is an effective new method of managing infected chronic wounds and useful to reduce treatment duration and decrease wound size. Moreover it could be applied more widely to infected wound.

[좌담] 한 떨기 붉은 장미꽃, 배주영 선생

이주영(사회자),김헌택(토론자),박무식(토론자),배용환(토론자),이용우(토론자),차영민(토론자),신명철(사진) 우리교육 2016 우리교육 Vol.265 No.-