혈관문합 연습을 위한 보존된 복재정맥의 활용

송제니퍼김,황소민,임광열,정용휘,Song, Jennifer K.,Hwang, So-Min,Lim, Kwang-Ryeol,Jung, Yong-Hui 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Given that the critical nature of the microvascular anastomosis to what is often a long and difficult reconstructive operation, trainees need to have a high level of microsurgical competence before being allowed to perform microsurgery on patients. Some artificial substitutes and dead or live animal models have been used to improve manual dexterity under the operating microscope. Yet, most surgeons are not equipped with such models, so search for easy available and appropriate microsurgical practice model have been an issue. Umbilical artery, placental vessels and gastroepiploic arteries have been previously suggested as a microsurgical training model, which involves other surgical departments. The purpose of this article is to introduce that saphenous vein specimen obtained from varicose vein surgery is useful and has many advantages as training model for the practice of microvascular anastomosis. Methods: The conventional technique using perforation/inversion method with a metallic stripper is widely performed for varicose vein patients. The stripper is inserted through disconnected safeno-femoral junction and retrieved at the knee or the medial side of ankle. The length of saphenous vein specimens removed is about that of one's leg and inversed from inside out. Obtained saphenous vein specimens are re-inversed and cleansed with normal saline, to be readily available for microsurgical practice. Preserved in a squeezed wet saline gauze and refrigerated, frozen or glycerated specimens were investigated into their comparative quality for microsurgical practice. Results: Varicose vein surgery remains one of the common operations performed in the field of plastic surgery. Convenient informed consent regarding the vessel donation can be easily signed. The diameter of the obtained saphenous vein is as variable as 1.5 to 6 mm, which is already stripped, and is in sufficient length corresponding to that of patient's leg. Vessels specimens were available for microsurgical practice within 1 week period when preserved with squeezed wet saline gauze, and the preservation period could be extended monthly by freezing it. Conclusion: Saphenous vein obtained from varicose vein patients provide with variable size of vessel lumen with sufficient length. The practice can be cost effective and does not require microsurgical laboratory. Additionally there is no need of involving other surgical departments in acquiring vessel specimens. Furthermore, simple preservation method of refrigerating for a week or freezing with squeezed wet saline gauze for a month period, allow the saphenous vein obtained after varicose vein surgery as an excellent model for the microsurgical practice.

남성에서 두피 전층 결출 손상의 치험례

송제니퍼김,김민욱,황소민,임광열,정용휘,안성민,Song, JenniferKim,Kim, Min-Wook,Hwang, So-Min,Lim, Kwang-Ryeol,Jung, Yong-Hui,Ahn, Sung-Min 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.1

Total scalp avulsion is rare but a devastating injury. This condition burdens the patient with disfigured cosmetic appearance and permanent psychosocial trauma. Throughout history, this condition has been favored in women working with mechanics since the long hair function as a vector appliance for oblique pull of the hair into a stationary torque. We present our experience of the replantation of the total avulsed scalp in male, first to be reported in Korea. Warm ischemic time was exceeding 16 hours along with severe crushed condition of the detached margin, a relatively satisfactory result was obtained.

콧등에 발생한 화골성 근염 -1예 보고-

송제니퍼김,황소민,임광열,정용휘,안성민 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.1

Purpose: Myositis ossificans is a benign condition of heterotopic bone formation that still requires more of its pathologic explanation. The lesions are localized predominantly to the high - risk sites of injury, involving flexor muscles of the upper limbs and thigh, but rarely in the head and neck area. Methods: A case of 44 – year - old male patient presented with a palpable hard mass on nasal dorsum. Patient experienced a similar lesion on upper limb few years ago. On computed tomographic image, the lesion presented focal definite increase in opacity compatible to adjacent bone densitiy on nasal dorsum. Results: The lesion was excised under open rhinoplasty incision. The pathologic report revealed focal bone formation and calcification within skeletal muscle. Conclusion: We describe a unique and only case of a myositis ossivicans on nasal dorsum which is indifferent from previous concept.

안성형 수술에 있어 누루의 임상적 고찰

황소민,송제니퍼김,오경석,임광열,최재원 대한미용성형외과학회 2008 Archives of Aesthetic Plastic Surgery Vol.14 No.2

Lacrimal fistula, a rare developmental disorder, may result from an abnormal budding of the epithelial cord of the lacrimal system. Most cases are unilateral, however, bilateral cases are still more rare, which are combined with other systemic diseases or accompanying disorders. This entity has so far been known only to ophthalmologist. We would like to illustrate lacrimal fistula in patients who were referred to our clinic for periorbital cosmetic surgery, such as blepharoptosis and epicanthus, from April 2005 to December 2007. Fistular orifices of all 6 patients were had been located inferomedial to medial canthi along the epicanthal fold. Out of 6 patients, 4 patients presented with unilateral lacrimal fistula; right side in 3 patients and left side in 1 patient, and bilateral lacrimal fistulas in 2 patients. Three cases were found to have positive connection between the nasolacrimal apparatus, and blind pouch type in 5 cases. Three out of six patients underwent fistulectomy with concurrent cosmetic periorbital surgery. In 2 patients who presented with connection with the nasolacrimal apparatus, fistulectomy and lacrimal sac or the common lacrimal canaliculi repair was performed as well. The remaining one patient with bilateral blind pouch type of lacrimal fistulas underwent a simple fistulectomy. There were no postoperative complications or any recurrences.

비골골절 시 골절정복과 동시에 시행된 융비술

임광열,송제니퍼,김형도,황소민,정용휘,안성민 대한두개안면성형외과학회 2010 Archives of Craniofacial Surgery Vol.11 No.2

Purpose: The nasal bones are the most common fracture sites of the facial bones, and a careful reduction may still result in secondary deformities, such as saddle nose, deviated nose, hump nose etc,requiring secondary cosmetic rhinoplasty. Therefore, this study examined the clinical characteristics of nasal bone fractures to propose guidelines for patient selection and surgical procedures to achieve more satisfactory results and to prevent secondary deformities with simultaneous augmentation rhinoplasty and bony reduction. Methods: The study was based on 26 out of 149 nasal bone fracture patients who underwent simultaneous augmentation rhinoplasty with bony reduction between May 2008 and April 2009. Retrospective analysis was performed according to the clinical data, surgical techniques and postoperative results. Results: Of the 26 patients, there were 15 males and 11 females. The incidence according to the Stranc’s classification revealed that 62% of patients were injured by a frontal impact and 38% by a lateral impact. Frontal impact plane I (50%) was the most frequent type. At the follow up, 18 (81.2%) out of 22patients were satisfied with their postoperative outcome, and the remaining 4 patients were fair. No one was dissatisfied. However, 5 cases in 3 patients (23%) had some complications; minimal implant deviation in 2 cases, minor irregularity on the nasal dorsum in 2 cases and palpable implant movement under palpation in 1 case. None of these cases required surgical correction. Conclusion: With the proper guidance, simultaneous augmentation rhinoplasty with bony reduction can prevent secondary deformities and satisfy the cosmetic outcomes. (J Korean Cleft Palate Craniofac Assoc 11: 77, 2010)

비골 골절에서 외측 비골 절골술의 적용

임광열,송제니퍼김,황소민,정용휘,조가형,Lim, Kwang Ryeol,Song, Jennifer K.,Hwang, So Min,Jung, Yong Hui,Cho, Ka Hyung 대한두개안면성형외과학회 2012 Archives of Craniofacial Surgery Vol.13 No.2

Purpose: Who may dare to state that optimal choice of treating nasal bone fracture is closed reduction? Few decades of authors' experience in nasal bone fracture has lead to believe that more active and assertive approach in nasal bone fracture by performing simultaneous lateral osteotomy may be applied in proper indications to acquire more accurate reduction and cosmetically satisfying result. Methods: From May 2008 to October 2009, among 241 nasal bone fracture patients, 20 patients underwent simultaneous lateral osteotomy with nasal bone fracture reduction. Followed by rigid septal correction, nasal cavity is packed to stabilize the fracture segment for safer osteotomy. Through intranasal incision, in selected cases of difficult reduction or for cosmetic purposes, various types of lateral osteotomy was performed corresponding to the fracture anatomy, conditions of the nasal cavity. Postoperative nasal packing was retained for one week and nasal dorsum splint for 3 weeks. Results: Lateral osteotomy was utilized for difficult cases of closed reduction, for correction of wide nose, hump and deviation in 9, 5, 2, and 4 cases, respectively. Patient satisfaction was scaled 90% in satisfaction and moderate in 10% (2 cases), complaining of mild nasal tip deviation. Physicians detected 2 cases of apparent deformity with patient recognition; one patient with mild step deformity at the osteotomy site and the other patient with minimal implant mobility. Conclusion: By accompanying profound understanding of the fracture anatomy, more active and assertive approach in nasal fracture reduction can be coincide with simultaneous lateral osteotomy to reduce the rate of secondary deformity and to obtain more cosmetically satisfying result.

뮬러근 내에 발생한 이소성 눈물샘 1례

황소민,송제니퍼김,임광열,정용휘,류민희 대한미용성형외과학회 2009 Archives of Aesthetic Plastic Surgery Vol.15 No.3

Ectopic lacrimal gland is a rare clinical condition. Cases have been recorded in literature describing that ectopic lacrimal tissue has been found at varying sites in and around the eye. Before performing aesthetic blepharoplasty, however, it should be kept in mind that anomalous condition of the lacrimal complex can lead to alterations in ocular lubrication. A 54 year-old female presented with an aging eyelid, but accompanying no other ophthalmologic symptoms. While performing skin incision during blepharoplasty, the right upper lid was directly exposed with prolapsed orbital lobe of lacrimal gland, and diffuse infiltrating hyperplasia of ectopic lacrimal gland tissue in the Müller muscle bulging out beneath the levator aponeurosis. The left upper lid also revealed ectopic lacrimal gland tissue beneath the aponeurosis. Carefully preserving the main lacrimal complex, ectopic lacrimal gland mass was excised. Histopathology revealed the tissue as lobules of lacrimal gland with some dilated ducts. The ectopic lacrimal gland tissue is a rare clinical entity, and the diagnosis is rarely made on physical bases alone. Therefore, we herein describe a unique clinical case of an ectopic lacrimal gland generated within the Müller muscle. To our best knowledge, such a case has not yet been described in literature.

광대뼈 축소술에 있어서 재배치와 고정

황소민,송제니퍼김,백세민,백롱민 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.3

Purpose: It has always been an aspiration for Asians to look more balanced and feminine, considering their facial features regarding relatively flat midface with marked prominences of the zygoma. Many studies have been dealt in this subject. However, the authors would like to emphasize the concept and introduce the technique of repositioning of the malar complex to a cosmetically beneficial point and stationing it on proper position by fixation on zygoma body and arch. Methods: From January 1998 to December 2007, this method was performed in 50 patients of mild to moderate prominence and malposition of the malar complex. A simplified technique of lateral orbital osteotomy and oblique osteotomy on zygomatic arch through intraoral and preauricular incision was developed. Then, liberal malar complex can be moved to a supero-posterior direction and repositioned to a more cosmetically beneficial point. To maintain the stationed position and to protect from vector affected by the attached masticating muscle to zygomatc bone, fixation was done on both zygoma body and arch. Results: We have obtained satisfactory results using this procedure without any observable complications. The advantages of this procedure are proper exposure, inconspicuous scar, safe, more natural contour, improved stability, and shorter healing time. Conclusion: The authors suggest that reduction malarplasty should be approached with underlying concept of repositioning and fixation. In mild moderate malar prominent cases, our technique will provide with maintenance of aesthetic concept, equal to the malar reduction performed under coronal approach and provide with more natural facial contour with stability even with less invasive surgical approach.

지방주입술 후 발생한 표피 낭종 - 1례 보고 -

김홍일,황소민,송제니퍼김,임광열,정용휘,안성민 대한미용성형외과학회 2011 Archives of Aesthetic Plastic Surgery Vol.17 No.3

Epidermal inclusion cysts are caused by an implantation of the epidermal elements. Primary or congenital epidermoid cysts are related to implantation of ectoderm at time of closure of the neural groove, or of other epithelial lines. Secondary or acquired epidermoid cysts are usually caused by post traumatic or iatrogenic inclusion of surface epithelium. We are reporting a case of secondary epidermoid inclusion cyst on left nasolabial fold after fat injection, which is extremely rare. A 57-year-old female patient presents with gradually progressive protruding palpable mass on left nasolabial fold. The patient had history of fat injection 1 year before, and mass was found under the previous fat injection site. There was no other history of trauma. The mass was excised and histological examination confirmed the diagnosis of an epidermoid cyst. Secondary epidermoid cysts are rare and occur mainly in the fingers, palms, and soles. The cause of secondary epidermoid cysts has been reported following trauma, radiotherapy, and after surgical procedures such as needle biopsy. During fat injection, needle injection may cause disruption of the epithelium and leading to the occurrence of this cyst. So. we suggest a careful procedure during fat injection. (Archives of Aesthetic Plastic Surgery 17: 181, 2011)

현수봉합을 이용한 귀주위 최소박리 하안면- 경부거상술

정필구,황소민,송제니퍼김,오경석 대한미용성형외과학회 2007 Archives of Aesthetic Plastic Surgery Vol.13 No.2

To reverse the wrinkling & sagging of the skin on lower face and neck, there are various surgical methods such as suspension suture method, classical cervicofacial lift, SMAS-platysmal facelift, deep-plane facelift and composite facelift. Aging of lower face and neck present not only with sagging skin, but also is aggravated due to loss of elasticity of the SMAS and platysmal muscle. Successful surgical outcome is expected when tugging of the SMAS and platysma is performed with proper skin excision of lower face. Practically, deep-plane facelift methods present more satisfying outcome than the subcutaneous dissection, but takes longer recovery period and higher risk of postoperative complication. The authors would like to present a new method of lower face and neck lift, with periauricular minimally invasive suspension suture method, which does not required hospitalization, and gives higher patient satisfaction.In this study, 30 patients(26 females, 4 males) were operated from December of 2004 to February of 2007. Minimal periauricular subcutaneous dissection was performed. While measuring the sagging of the soft tissue on lower face and neck, suspension suture was performed anchoring platysma muscle from the submandibular slit incision site to the fascia of the mastoid process and stretched SMAS of the lower face was suspended to the fascia of the mastoid process with PDS 3-0 sutures. Most of the patients were satisfied without specific problems. The procedure carries advantages of simple operative method, easier access under intravenous sedation, much lesser risk of hematoma formation or facial nerve injury, shorter recovery period, improvement on the cervicomental angle and jaw line, and minimal postoperative scar.