박피술 및 자가표피이식술을 이용한 탈색소 반흔의 치료

범진식,오석준 대한미용성형외과학회 1995 Archives of Aesthetic Plastic Surgery Vol.1 No.2

Manual Kirschner-Wire Insertion through the Soft Tissue for Finger Immobilization after Scar Contracture Release

범진식,이준희,이강우,양원용,강상윤 대한수부외과학회 2015 대한수부외과학회지 Vol.20 No.1

Purpose: Finger immobilization by Kirschner-wire (K-wire) insertion may be used for postoperative stability after release of scar contracture. K=wire insertion through the phalangeal bone requires drilling and can result in joint and/or tendon injury or pain during wire removal. To prevent these problems, we inserted the K-wire through the soft tissue. Methods: Seventy-five fingers of 45 patients who underwent reconstruction of scar contracture of the fingers were immobilized by K-wire. After contracture release, just before skin grafting and/or local flap surgery, in full extension of the finger, a K-wire was inserted manually from the fingertip to the proximal phalanx of metacarpal bone through the soft tissue or the K-wire was felt on the recipient bed, the K-wire was inserted on the dorsal side of the finger. K-wires were manually removed two weeks after surgery. Results: In most cases, the time to insert the K-wire was 2-3 minutes per finger, and immobilization and stability was maintained for two weeks. In two fingers, the K-wire came out prematurely during wound care; this did not affect the overall outcome. There were no complications due to K-wire insertion of pain during removal. Conclusion: Finger immobilization by K-wire insertion through soft tissue is simple to perform, leads to stable immobilization, has no adding prodedure. This method is useful for temporary finger immobilization in full extension.

Consistent Reconstruction of Sacrococcygeal Pressure Ulcers using Modification of En Bloc Sliding Gluteus Maximus Myocutaneous Flap Technique

범진식,Eun Choang Cha,박준 대한창상학회 2024 Journal of Wound Management and Research Vol.20 No.1

Background: The en bloc sliding gluteus maximus myocutaneous flap was introduced to preserve the vasculature, muscular integrity, sensory innervation, and normal gluteal contour with a midline scar in sacrococcygeal pressure ulcer reconstruction. However, its critical disadvantages include incomplete detachment of the origin of the gluteus maximus and central tension of the closed wound due to round ulcer excision. Therefore, we reviewed the surgical anatomy and applied modifications to achieve sufficient flap mobilization and to decrease complications.Methods: After fusiform or rocket-shaped ulcer excision, submuscular flap elevation was initiated by completely detaching the origin of the gluteus maximus, including the posterior iliac crest, followed by comprehensive lateral submuscular dissection in the gluteal space while preserving the neurovascular pedicles. Bony protrusions were tangentially resected from the lower sacrum and upper coccyx. After en bloc medial advancement of the bilateral flaps, defects were closed in layers, with muscle ligament fixation at the midline.Results: Twenty-nine patients underwent surgery for sacrococcygeal pressure ulcers (primary, n=22; recurrent, n=7). Transverse width of the excised ulcers was 5–12 cm (final defect, 7–15 cm). During the follow-up period (6 months to 7 years), no early postoperative complications or late aesthetic or functional discomfort occurred; however, intermittent skin sloughing occurred in four cases and one coccygeal sore recurrence occurred. The recurrent ulcer was treated using the same surgical method, with no recurrence after 2 years.Conclusion: This modification can be successfully used for the reconstruction of primary and recurrent sacrococcygeal pressure ulcers.

속눈썹밑 접근법에 의한 아래눈꺼풀 합병증의 예방: 일시적 아래눈꺼풀 걸기술

범진식,김부영,김양우 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.4

Purpose: Subciliary approaches to orbitozygomatic fractures have high incidence of complications such as scleral show and ectropion. Abnormal rearrangement of eyelid flaps may be a very important factor to induce abnormal cicatrical and consequent contracture. To prevent this problem, we used temporary lower eyelid suspension. Methods: A total of two hundred five patients were investigated for lower eyelid complication of orbitozygomatic fractures that underwent reconstruction with subciliary approach. The lower eyelid margin was pulled up toward the forehead using lower eyelid suspension suture to stretch the lower lid flaps. The lid suspension was maintained for one day after surgery. Results: The complications of the lower eyelid were in 15 cases(7.3%); seven cases(3.4%) of visible depressed scar, three cases(1.4%) of scleral show, two cases(1%) of ectropion, two cases(1%) of conjunctival swelling and one case(0.5%) of hematoma. Conclusions: The lower eyelid suspension seems to allow adhering lid flap in proper anatomical position and in the status of the maximal stretch and consequently preventing the severe complications such as scleral show and ectropion caused by scar contraction after subciliary approach.

유리조직이식술을 이용한 심부화상의 치료

안경식,정철훈,이종욱,오석준,범진식 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.4

In small or superficial burns, wound coverage can be attempted using skin grafts, local or distant flaps. When more severe burns that involve bone, tendons or other soft tissues are present, the use of free tissue transfers allowed healing and ultimately satisfactory function. We performed 42 free tissue transfers for 40 patients with severe burns for 15 years. Their ages ranged from 17 to 72, with average age of 33.31 patients were male and 9 female. In the causes of burn, there were 20 cases of acute burns; 1 flame burn, 6 contact burns, 12 electrical burns, and 1 chemical burn. 20 cases were scar deformities after burn injuries; 2 flame burna, 12 scalding burns, 1 contact burns, 5 electrical burns. In the affected sites, 7 cases were head and neck areas, 22 upper extremities, and 11 lower extremities. In the free tissue transfers, 27 cases were cutaneous flap, 4 myocutaneous flap, 6 tenocutaneous flap, 1 tenomyocutaneous flap, 2 osteocutaneous flap, and 2 omental flap. As for accompanied surgical procedures, 5 cases were for tendon graft, and 6 for nerve graft. Complications were 4 marginal necroses of flap by wound infection and 1 total loss due to vascular thrombosis. But they were all completely restored with wound dressing, skin graft or local flap. Free tissue transfers were useful for the coverage of composite tissue defect in severe burns.

Melatonin의 국소 도포가 자외선을 조사한 흑색 마우스의 표피 멜라닌세포에 미치는 영향

이성하,정철훈,이종욱,오석준,범진식 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.3

Melatonin was derived from pineal gland, act as hormone and is known to be extremely active in certain biological systems. To observe the depigmentation effet of melatonin, author induced activation of melanocytes and melanin by UVB irradiation for seven days and then melatonin ointment or ointment base was applied topically on the ear skin of C57 B1 mouse. Tissue samples were obtained from 4 mice in each group before and after UVB irradiation for given days(1,3,5 and 7 week). The morphological, numerical, and ultrastructural changes of epidermal melanocytes were observed with light microscope and electron miroscope after DOPA stain. The results were as follows: 1) In all groups, the number of DOPA positive melanocytes began to decrease from 1 week. 2) The number of DOPA-positive melanocytes in melatonin ointment applied group was significantly lower than in control group. 3) In the electron microscopic findings, the number of melanosomes markedly decreased from 1 week to 7 weeks and a small amount of destructed melanosomes(vacuoles) and destroyed or swollen mitochondria in cytoplasm of th melanocyte appeared more significant in 3% melatonin ointment applied group compared to ointment base applied group from 5 weeks.

수지 조갑하 사구종양과 사구맥관육종의 치험례

정찬민,전훈봉,이종욱,오석준,이진영,정철훈,범진식 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.2

Glomus tumor is rare benign tumor of the normal glomus, which is a neuroarterial canalsystem called the Sucquet-Hoyer canal. The function of the glomus appears to be to regulate local blood pressure and local heat by blood flow. The etiology of its development is unknown, but some patients have history of trauma. Glomus tumor has been described in the trunk as well as in upper and lower extremits hand (the most common location). The triad of pain, tenderness and sensitivity to cold is characteristics of glomus tumor of the hand. Treatment consists of surgical excision of the lesion under the tourniquet control and magnification for complete removal of the lesion. Glomangiosarcoma or malignant form of glomus tumor is exceptionally rare. Only a few cases have been reported. We experienced five cases of glomus tumor and a cases of glomangiosarcoma treated by complete removal of tumors through partial elevatioin of nail. Typical pain of the lesion was disappeared after operation, also nail deformity did not occurred.

수부의 양성종양

김용현,정철훈,이종욱,오석준,범진식 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.4

The benign tumors which occur in the hand arise from the skin, subcutaneous tissue, blood vessels, nerves, tendons and bones, and are of many different types. This study reviews the experience of the author, Kang Dong sacred Heart Hospital in the management of 164 benign tumors of the hand seen during the period October 1986 to August 1994. Male- to- female ratio is 57 vs. 107, the age distribution is ranged from 5 to 70 years and mean age is 28.6 years. Benign hand tumors occur most commonly in the second, third, and fourth decade of life(67.1%). Ganglia is the most common tumor of the hand, occured 125 cases (76%) in our study, and enchondroma 13 cases (7.9%), vascular anomaly 11 cases (6.7%), giant cell tumor 3 cases (1.8%), neurilemmoma 3 cases (1.8%). The common location of the ganglia is as follows : 70 cases (55%) on the dorsum of the wrist, 27 cases (29%) on the radial volar aspect of the wrist, 9 cases (7.2%) on the MP joint and 6 cases (4.8%) on the DIP joint. From, this eight-year survey and review of 164 cases, We have made the following observations : Benign tumors of the hand are many and varied and present interesting problems in diagnosis and treatment, and best treated by complete excision under aid of magnifying instrument.

외이의 화상후 비후성 반흔의 중심 적출술

오석준,오세원,정철훈,범진식 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

Hypertrophic scarring is common in burn patients. The treatment of such scarring is difficult, and recurrence of the hypertrophic change after scar revision is not uncommon. It has been done intramarginal excision to diminish the chances of recurrent hypertrophic scarring. Core scars in the auricle are easily separated from auricular cartilage and overlying soft tissue because there is loose areolar tissue between them. We therefore reviewed our experience with core extirpation of post-burn hypertrophic scars in the auricle. Between June 14, 1991, and August 6, 1994, we excised 10 hypertrophic scars in the auricle in 5 burn patients. Core extirpations of hypertrophic scars were performed under local anesthesia with longitudinal incision along long axis of scars. The wounds were closed directly in one layer after marginal trimming. We observed that core extirpation yielded good results in post-burn hypertrophic scars in the auricles.

Raynaud 증후군의 임상 치험례

오석준,은석찬,노태석,범진식 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.6

Raynaud's phenomenon manifests as triphasic color change episodes of blanching, cyanosis, and reddening of the digits, induced by exposure to low temperature or emotional stress. It is a relatively common disorder, estimated to affect 5-10% of the general population and 20-30% of otherwise healthy women. Most cases of primary Raynaud's phenomenon also called Raynaud's disease, are mild and self-limited. Secondary Raynaud's phenomenon presents as a secondary manifestation of an underlying disease and are complicated by ulcerations and tissue necrosis. From March 1996 to August 1998, we experienced 4 patients with Raynaud's phenomenon. Two patients were diagnosed Raynaud's disease and the other two were secondary. Raynaud's disease responded to drug therapy and sympatetic ganglion block. Secondary Raynaud's syndrome was treated with vein graft and free tissue transfer. During postoperative follow-up of 33-49 months, both severity and symptomatic intervals were improved.