글로벌 시장에서 본 ‘강남스타일’열풍

박봉권 관훈클럽 2012 관훈저널 Vol.- No.125

‘파워엘리트가 한자리에’ 다보스포럼에 가다

박봉권 관훈클럽 2013 관훈저널 Vol.- No.126

Modified W-plasty를 이용한 하구순의 편평세포암 치험례

박봉권,안덕균 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

Squamous cell carcinoma of the lower lip is very common and it is easier to cure compared with any other form of oral cancer. Aggresive therapeutic approach is preferred for the treatment of the squamous cell carcinoma. Its approach varies by the size and the extent of the tumor. The relationship between defect size and surrounding structures has to be considered before operation. However, successful reconstruction of a lower lip is difficult and complicated. The aims of lower lip reconstruction are for both aesthetical and functional restoration. The ideal procedure should result in a normal lip without tightness, with a vermilion border, an adequate sulcus, good sensation and good muscle tone. It must be aesthetically pleasing and must be able to permit chewing, prevent drooling, and perform labial consonant formation. We selected the technique for reconstruction of the ablative lip defect by its size and location. Squamous cell carcinoma occurs mostly with people who are in their sixties. They have advantage in lower lip reconstruction due to their characteristical tissue redundancy. Recently the authors have succesfully reconstructed a partial loss of lip after cancer resection by the Modified W-plasty, and the result were quite satisfactory both functionally and cosmetically. There have been no recurrences or lymph node metastasis.

엘라스토머 임플란트를 사용한 엉덩이 확대 성형술

박봉권,김연환,안희창 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.2

Purpose: The buttocks region has been associated with allure and sex appeal for centuries. Gluteal implants enable buttocks remodeling in a way that is not possible with other methods. One of the reasons that render gluteal implant surgeries unpopular is the fear of complications, the main problems being seroma, wound dehiscence, extrusion, and a visible or palpable implant. The authors present the XYZ technique, which provides anatomical reference points to guide the intramuscular dissection procedure in a feasible and safe way, resulting in a lower complication rate. Methods: The XYZ procedure was done for buttock augmentation on 8 patients from December 2009 to June 2010. Patient’s ages ranged from 27 to 44 years old with a mean age of 36 years old. Seven patients used the 250cc sized Elastomer implants with one patient using the 290cc sized implant. Preoperative marking was done with the patient in the standing position. Bisection of the gluteus maximus muscle was done at the midpoint thickness to create a plane for implant insertion, which is called the sandwich plane. Results: The 8 cases were performed safely without major complications. However one patient had minor wound dehiscence, and was managed with conservative treatment. Another patient had a discomfort on the buttocks for a long time. The patients were followed up for average 6 months. All patients were satisfied with the aesthetic results. Conclusion: In performing the XYZ technique for gluteal augmentation, the surgeon must split the muscle into two equal halves with anatomical reference points to guide the muscle detachment in a symmetrical way at an adequate depth. This method provides a guideline for the surgeon in determining the ideal plane during intramuscular dissection and gives predictable results with low complication rates. Intramuscular gluteoplasty with gluteal implants offers predictable, aesthetically pleasing results without contour irregularities and only a low incidence of major complications.

손바닥동맥활에 관한 형태계측 연구

박봉권,최승석,안희창,장수원 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.6

Purpose: Deviations of arterial palmar arches in the hand can be explained on the embryological basis. The purpose of this study is to provide new information about palmar arches through cadaver's dissection. The values of the location and diameter in these vessels were analyzed in order to support anatomical research and clinical correlation in the hand. Methods: The present report is based on an analysis of dissections of fifty-three hands carried out in the laboratory of gross anatomy. A reference line was established on the distal wrist crease to serve as the X coordinate and a perpendicular line drawn through the midpoint between middle and ring fingers, which served as the Y coordinate. The coordinates of the x and y values were measured by a digimatic caliper, and statistically analyzed with Student's test. Results: Complete superficial palmar archs were seen in 96.2 % of specimens. In the most common type of males, the superficial arch was formed only by the ulnar artery. In the most common type of females, the superficial arch was formed anastomosis between the radial artery and the ulnar artery. The average length of the superficial and deep palmar arch is 110.3±33.0mm and 67.9±14.0mm respectively. Regarding the superficial palmar arch, ulnar artery starts -16.1±5.1mm on X-line, and 2.5±24.5mm on Y-line. Radial artery appears on palmar side 7.7±3.2mm on X-line, and 20.9±10.9mm on Y-line. But radial artery starts on 6.3±3.6mm on X-line, and 3.4±5.1mm on Y-line. Digital arteries of superficial palmar arch starts on 6.1±3.7mm, 33.9±8.8mm on index finger, 1.8±3.4 mm, 40.1± 7.3mm on middle finger, -3.2±4.9mm, 42.6± 7.0mm on ring finger, and -8.9±5.1mm, 42.5± 80mm on little finger in respective X and Y coordinates. Radial artery of deep palmar arches measured at the palmar side perforating from the dorsum of hand. It's coordinates were 9.7± 4.8mm on X-line, 21.7±10.2mm on Y-line. Ulnar artery was measured at hypothenar area, and it's coordinates were -20.4±6.3mm on X-line, and 30.6 ±7.4mm on Y-line. Conclusions: Anatomically superficial palmar arch can be divided into a complete and an incomplete type. Each of them can be subdivided into 4 types. The deep palmar arch is less variable than the superficial palmar arch. We believe these values of the study will be used for the vascular surgery of the hand using the endoscope and robot in the future.

새로이 도안된 하대둔근 도상 근피판술에 의한 좌골부 욕창의 치료

안희창,박봉권 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

The area overlying the ischium is the most frequent site for the development and recurrence of pressure sores in the paraplegic patient. This report describes a newly-designed inferior gluteus maximus myocutaneous island flap that is useful for the repair of ischial pressure sores in paraplegic patients. Sacral sore develops a wide and flat ulcer crater. However, ischial sore seems to develop large and deep bursa with relatively small openings. We have used a newly-designed gluteus maximus myocutaneous island flap according to the specific characteristics of ischial sore. The flap is designed in the fashion of a small skin island with a large muscle flap. This flap with its abundant and constant blood supply had proved very reliable in the surgical management of ischial pressure sore. There is also the possible advantage of cushioning with the bulk of muscle for greater long-term durability. Incision could be extended for a complete bursetomy and partial ischiectomy. The reliability, versatility and low morbidity of the inferior gluteus maximus island flap has been demonstrated by its use in our consecutive series of 7 patients with 8 ischial pressure sores. We conclude that this newly-designed inferior gluteus maximus myocutaneous island flap can be applied in deep, infected ischial sore according to the specific characteristics of ischial sore, and it is a very useful method in comparison to other flaps.

노인에서의 미세수술에 의한 재건술

전명곤,박봉권,안희창,Jun, Myung Gon,Park, Bong Kweon,Ahn, Hee Chang 대한미세수술학회 2000 Archives of reconstructive microsurgery Vol.9 No.1

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.

반안면 왜소증 환자의 악골교정술과 골, 진피지방의 동시 이식을 통한 안면부 교정 치험례

최희윤,박봉권,최봉근,안희창,안덕균,류재만 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

Hemifacial microsomia is a common congenital craniofacial deformity involving bone and soft-tissue. Mandibular hypoplasia is the most obvious skeletal manifestation of hemifacial microsomia. In the past, complete realignment of the skeleton was preferred to soft-tissue correction, which was clearly second choice. However, in this study, simultaneous correction of bone and soft tissue deformities were equally important in treatment of hemifacial microsomia. One-stage and simultaneous bone and soft tissue reconstruction is possible and staged operations of the skeleton and soft tissue are no longer necessary, except in special cases. Even in children and adolescents, good results and normal growth potential can be achieved with simultaneous correction of bone and soft tissue.

유리 피판술을 실패한 환부 : 그 대책은?

안희창,박봉권,김정철,Ahn, Hee-Chang,Park, Bong-Kweon,Kim, Jeong-Chul 대한미세수술학회 1999 Archives of reconstructive microsurgery Vol.8 No.1

저자들은 1988년부터 1998년까지 시행한 252예의 유리피판술 중 9예에서 미세혈관 문합부의 혈전 등의 이유로 실패하였으며, 이들 중 두경부 및 하지의 7예에서는 첫 수술 4-16일 사이에 제 2의 유리피판술을 성공적으로 시행하여 환부를 치유시키고, 처음에 계획하였던 수술적 목표를 달성하였다. 수부의 2예는 환자 및 보호자와 충분한 상의하여 원거리 피판과 피부이식 등 고식적인 치료 방법을 선택하였다. 수부의 경우는 다른 부위보다 고식적 치료 방법이 덜 부담되었던 것으로 생각되었으며, 두경부와 하지는 환부의 특성상 제 2의 유리 피판술이 최선의 선택으로 생각되었다. 유리 피판술이 실패한 환부에서 계속된 제 2의 유리 피판술을 시행하는 것은, 처음의 수술보다 면밀한 술전 계획과 준비, 완벽한 수술, 수술후의 철저한 환자 관리가 요구되었으나, 이들 환부의 처치에 매우 효과적이고 환자의 기대에 부응할 수 있는 방법이라고 생각된다. There are lots of reconstructive ways like direct closure, skin graft, local flap, regional flap, distant flap, free flap and so on. Microsurgical reconstruction is regarded as the last step in various reconstructive methods. So the failure of this last step causes the troublesome situation for both of patients and surgeon. The purpose of this paper is to investigate the problems in failed free flap surgery and to introduce the strategy of appropriate management in wound of free flap failure. We performed 252 cases of free flap surgeries from May, 1988 to June, 1998. Among these cases, we failed 9 cases of free flaps. Patients' age ranged from 19 to 63. There were 7 males and 2 females. Site of failure were 3 head and neck areas, 2 hands, and 4 lower extremities. However there was no failure in breast, trunk, buttock, and genitalia. 7 patients who had region of head and neck, and lower extremity underwent the second free flap surgery successfully in postoperative 4 to 16 days following debridement of necrotic tissue. However 2 patients who had region in hand were managed with conventional treatment like skin graft and distant flap. Vein grafts were needed in 3 cases of 7 second free flaps, and 1 patients needed sequentially-linked free flaps with two flaps. The second free flaps were inevitable for head and neck area because the large complex wound may cause the lifethreatening condition without immediate coverage with well vascularized flap. Lower extremity also needed second free flap for limb salvage. Hand could be managed with conventional method, even though healing time was quite delayed. We thought second free flap surgery in free flap failure cases should be performed with more careful preoperative evaluation and refined surgery. Success of second free flap surgery could recover the very difficult situation due to previously failed operation.

피부보존 유방절제술후 횡복직근 유리피판에 의한 즉시 유방재건술

정지용,박봉권,안희창 大韓成形外科學會 2001 Archives of Plastic Surgery Vol.28 No.6