변형된 비골격 교정의 임상적 연구

조세흠,유환열,방난석 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

The nose located in the center of face is easily deformed by external force and the balance of the face is lost even at a little deformation. So the nose is the most important portion of the face not only in the functional aspects but also in the cosmetic aspects. Asthetics are the surface image of a deeper anatomical reality. The adequate support of the nose is important in nasal reconstruction. A total of 49 patients who were treated for nasal deformities was followed up from Aug. 1987 to Aug. 1995 with a mean perid of 34 months. In the pathologic classification, there were deviated nose of 28 cases, depressed(saddle) nose of 12 cases and combined patient of 12 cases. The operative methods were only corrective rhinoplasty in 28 cases, cantilever bone graft with autogenous bone graft 7 cases, cantilever bone graft with Medpor implants 2 cases, autogenous bone graft 3 cases, alloplastic implants(Medpor) 6 cases, composite graft 2 cases and cartilage graft 1 case. The choice of proper donor site, surgical method, and consideration of esthetic aspects were discussed.

검열축소증(Blepharophimosis)환자의 안검하수 교정술 및 내안각 성형술

양현진,하지운,방난석 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.1

Blepharophimosis is a congenital anomaly characterized by telecanthus, epicanthus inversus, epicanthus inversus, and blepharoptosis. It has been known that it is transmitted as an autosomal dominant and it occurs more frequently in Orientals than in Occidentals. Many authors have described and reported about the surgical procedures for correction of blepharophimosis and their results. Over the past 9 years, we have surgically treated 7 cases of blepharophimosis using procedures in which frontalis suspension and medial canthoplasty were performed in one stage. Blepharoptosis was corrected by frontalis suspension with fascia lata. Epicanthus inversus was corrected by Mustarde's four-flap technique and the medial canthal tendons were fixed into the bony openings of the medial orbital walls by transnasal wiring. We used an spinal puncture needle and a mallet for making transnasal opening. In small children a single screw was used for fixation of medial canthal tendon. More details about surgical procedures and results are described.

A Csse of Multiple Deep Glutea Dimples : One of the Cutaneous Lesions of the Spinal Dysraphism(?)

Ha, Ji Woon,Bang, Ran Suck 한림대학교의료원 1994 人間科學 Vol.18 No.1

매치실린 저항성 포도당 구균 감염창에 대한 Gentian Violet Dressing

서현호,방난석,권영대,하지운,김창식 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6

Methicillin Resistant Staphylococcus Aureus(MRSA) is hardly controllable organism among the pathogen of nosocomial infection, because ti is resistant to most antibiotics except vancomycin and local treatment with most antiseptics are not effective to eradicate MRSA from the infected wounds. There is increasing fear that MRSA infection can be spread widely in the hospitals. The effectiveness of gentian violet against MRSA was reported by Saji et al in 1992 for the first time. We tried gentian violet dressing on MRSA infected wounds to evaluate whether or not the gentian violet is effective to eradicate MRSA which existed in the open wound. 12 patients were treated by wet dressing with 0.1% gentian violet soaked gauze twice daily. They included 5 cases of sacral and trochanteric pressure sore, 3 cases of postoperative wound infections, 2 cases of posttraumatic skin defects, 1 case of postinfectious skin defect and 1 case of electrical burn. The wound culture was done twice weekly for evaluation of MRSA infection elimination. The clinical results revealed that MRSA was not detected in all cases within 34 days (average 12.3 days) after topical adminstration of 0.1% gentian violet. We herein report that topical administration of 0.1% gentian violet is a useful treatment method of the MRSA infected wound.

자가골 이식과 인공삽입물을 이용한 두개성형술의 비교

김창식,조세흠,방난석,조용준 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.4

The cranioplasty has important meaning in cosmetic and functional consideration for reconstruction of the skull defect and correction of the deformed calvarial contour. Since prehistoric period many operative methods were elaborated to reconstruct the skull defect. The operative methods were subdivided by using an autogenous bone graft and an alloplastic material. From May 1987 to February 1995, we experienced 80 cases of cranioplasty : 4 cases by primary repair within a few days from trauma onset, 8 cases with craniectomy bone embedded in the subcutaneous fat tissue of abdomen, 3 cases with vascularized calvarial bone flap, 3 cases with rib bone graft, 60 cases with methylmethacrylate and 2 cases with medpor. We experienced 9 cases of complications. After using the methylmethacylate, 5 cases of local infection and 1 case of implant exposure were noted. After rib bone graft, 2 cases showed contour irregularities, and 1 case developed pleural effusion. We concluded that the operative method should be determined by size and site of the skull defect, and healing capacity of the recipient tissue. Methymethacrylate is relatively safe material for carefully selected cases which had good recipient conditions.

안면부 Lymphangioma에 의한 Orbital Dystopia의 치험

고영초,정철현,방난석,하지운 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.4

Vertical orbital dystopia is an abnormally low or high position of one orbit in comparison with the other side which is supposedly normal. The causes of vertical orbital dystopia include Congenital(craniosynostosis, hemifacial microsomia and facial clefting syndrome etc.), Trauma(orbital fracture and irradiation injury etc.), Neoplasms(fibrous dysplasia, antrum carcinoma, intracranial tumors, frontal and ethmoid sinus tumor and angiomatoses etc.) From the stand point of both visual function and asthetic aspects, the correction of vertical orbital dystopia is more difficult for the surgeon than in the case of equally great horizontal displacment. Uncorrected vertical orbital dystopia produce significant facial asymmetry and severe deformity than similar amount of horizontal deformity. The case of a 22 year - old female patient with vertical orbital dystopia associated with large cavernous lymphangioma on right forehead and supraorbital region is presented. The patient had aesthetically good result by correction of vertical orbital dystopia through intracranial approach in spite of impossible complete resection of cavernous lymphangioma.

초음파검사를 이용한 공여부 유리피판두께 측정에 관한 고찰

서인석,박규남,방난석,하지운 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.4

Clinical application of microvascular free flaps has expanded widely in the past decades by evolved research of microanatomy and physiology of cutaneous tissue. Now, free flap donor sites, which is needed for resurfacing of defects, have become numerous. Choice of a suitable donor site is determined carefully depending on the following factors; In recipient site-site & volume(size, thickness), condition of recipent. bed, vessel condition etc., In donor site-age, sex, past tisstory, obesity, thickness & texture of flap, difficulty of flap elevation, length & diameter of vessel, morbidity of donor site etc., One of the most important factors is the thickness of suncutaneous tissue layer. Methods for preoperative evaluation of subcutaneous thickness are skin fold, soft tissue reontgenogream, needle puncture, skin incision, electroconductivity test and ultrasonic measurement, The ultrasonic measurement of subcutaneous tissue thickness may be more accurate than other methods. Subutaneoous tissue thickness was measured ultrasonically on 51 individuals of ages between 6 and 59 years. Measurements were obtained at nine sites ; pectoralis major, rectus abdominis, groin upper arm, forearm, scapula, latissimus dorsi, lateral thigh and dosalis pedis, The thickest skin and subcutaneous tissue was noted at the rectus abdominis(10.2mm) and the thinnest at the dosalis pedis(3.8mm). The subcutaneous tissue thickness of children was more thicker than adults at the lateral thigh, upper arm and forearm. Ultrasonic measurement of subcutaneous tissue thickness is an excellent. parameter of preoperative evaluation and postoperative evaluation in free flap bulkiness.