눈꺼풀처짐증 수술 후의 조기 재수술

송철홍,정재민,박대환 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.1

The challenge of accurately predicting eyelid height after blepharoptosis surgery is well-known problem even in complete hands. From May, 1988 to December, 2004, authors reviewed 182 cases(240 eyes) of blepharoptosis corrected by frontalis muscle transfer or levator resection and had experienced 10 cases(15 eyelids) of early reoperation around 1 week. The period from initial operation to reoperation are between six to eight days and mean period is seven days. Initial operative procedures were frontalis muscle transfer in 3 cases(4 eyelids) and levator resection in 7 cases(11 eyelids). Follow up period ranged from 6 months to 16 years. Early adjusting surgery was performed in accordance with the preoperative and postoperative degree of ptosis of patient and considering previous operative technique. The results are evaluated according to the criteria of an ideal correction by Souther and Jordan. Seven patients have good or satisfactory results(less than 1mm asymmetry, good in 5 cases and satisfactory in 2 cases). Three patients(5 eyelids) recorded as poor results(more than 2 mm asymmetry). Even if early or late reoperation can be effective in correcting unsatisfactory results after correction of blepharoptosis, early reoperation is better than later reoperation because early reoperation can offer a reduction in time to final result, the ease with which it is performed, potential cost savings. The experience of surgeon is also important factor for the treatment of recurred blepharoptosis.

마비성 안검외반증의 수술적 교정 : 새로운 접근방법 NEW APPROACH

박대환,한동길,송철홍 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.4

Paralytic ectropion can be corrected with static procedure or dynamic procedure, and there are various methods in each procedure, but it has been difficult to make a success in the severe type of paralytic ectropion because conventional methods were apt to correct paralytic ectropion by single method without considering simultaneous compound correction about laxity of orbicularis/canthal tendon complex, loss of support of tarsal plate, atrophy of lower eyelid which concomittently complicated in paralytic ectropion. Some recent methods include different types of cartilage graft and skin flap, and all were done to augment the atophied lower eyelid and to support the tarsal plate, so author named these methods using as augmentation procedure. Based on these findings, combined method using static procedure to correct laxity of orbicularis/canthal tendon complex and augmentation procedure to correct atrophy of lower eyelid and to support the tarsal plate were used for the 41 patients (52 eyelids) with paralytic ectropion from March 1995. to February 1996., and the method was proved as useful in correction of paralytic ectropion. We recommend the combined method to correct paralytic ectropion instead of a single method.

Lip Ashesion을 이용한 일측성 완전 구순열의 치료

박대환,안기영,한동길,송철홍 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

It is difficult to treat the complete cleft lip because of wide cleft and malaligned alveolar process, outward rotation of greater(medial) alveolar segment, and severe nasal deformity. Lip adhesion without presurgical orthopedic appliance was performed on 8 consecutive infants with unilateral complete cleft of the primary palate before denfinitive lip repair with Millard I procedure. Among 8 patients, 6 patients had complete unilateral cleft lip with alveolar cleft only and 2 patients were accompanied with complete cleft palate. All patients had more than a 10-mm-wide lip cleft with alveolar arch discrepancy. Lip adhesions were performed at 1-2 months of age and definitive repair was done at 5-6 months of age. Lip adhesions were performed by Randall's method and cheiloplasty was done by Millard I technique. Satisfactory results of lip and nose were obtained aesthetically in 8 cases after an average follow-up of 32 months. The vertical height of the medial and lateral lip segment were a symmetric appearance, while the vermilion tubercle, philtrum, and Cupid's bow were natural. Disadvantages included increased operating time and the sacrifice of same-lip tissue. In conclusion, preliminary lip adhesion can have better functional, esthetic and emotional results since the disadvantages are minor compared to the advantages.

두개악안면 수술에서의 내시경의 이용

박대환,한동길,안기영,송철홍 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.3

Endoscopic technique have become very popular in plastic and reconstructive surgery. They have provided advantages over previously closed techniques by minimizing scars, soft tissue manipulation and access with excellent visualization and magnification. More than twenty cases of facial bone surgery were performed over the past 3 years by endoscopic assistance. Our series consist of 3 cases of frontal bone contouring, 1 zygoma contouring, 3 fracture of zygoma, 9 fracture of orbit, 4 rhinoplasty for deviated nose. To accomplish this technique, a rigid 4mm, 30 degree down angled endoscope was used. The frontal bone or zygomatic arch is approached endoscopically through two or three small incisions on the temporoparietal scalp. All endoscopic instrument are then manipulated through these incisions. The approach for zygoma complex, maxilla and mandible needs intraoral incision. Recontouring by a power bur and osteotomy using a small saw are done with endoscopic visual assistance. Rigid fixation requires an additional small incision over the plate for trocar method. The other technique was same with routine standard rhinoplasty procedures. The duration of follow-up ranged 3 months to 27 months. The postoperative course were satisfactory with fewer complication than conventional technique. The extra-time need for the endoscopic procedures was about 1 hour. Endoscopically assisted facial bone recontouring, osteotomy and plate fixation can be performed with adequate visualization and direct manipulation of all facial bone. Complications usually associated with extensive incisions and poor visualization may be avoided. This technique may prove to be ideal for aesthetic surgery for facial skeleton with smaller scars and less morbidity.

부정교합을 동반한 상악골 골절의 치료

송철홍,한동길,안기영,박대환 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.2

Twenty-five Le Fort fractures accompanying palatal fracture or malocculsion had been studied from October 1990 to May 1997. The patients were analyzed on the basis of classification causes, operative procedure treatment of fracture, status of malocclusion and complication. The most common cause of fracture was a traffic accident and diagnosis was performed by history, physical examination, reontgenogram, and computed tomography. The follow-up period ranged from 5 months to 5 years, averaging 17 months. Internal fixations with plates and screws were performed in 22 cases and external fixations with halo apparatus were used in 3 cases. Intermaxillary fixations with arch bar were applied during the preoperative and postoperative period in all cases. In 6 cases of Le Fort fractures, acylic splints were applied. In 3 cases of palatal fractures, transverse wiring of the palatal arch were also used. Overall 19 of 25 patients were satisfied with the results. Six patients complained about depression of the midface because of undercorrection 4 patients had persisting hypoesthesia of the infraorbital nerve for more than 6 months postoperative. In summary, the dental plast and acrylic splint are very helpful in correcting malocclusion in severe maxillary fractures. Also, in cases of palatal fracture, it is important to minimize maloccusion by rigid fixation or transverse wiring of the palatal arch.

재발된 안검하수증의 교정

박대환,송철홍,한동길,안기영 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.5

From May 1988 to January 1997 authors had experienced 13 cases of recurred blepharoptosis. Previous operative procedures were frontalis muscle suspension in 10 cases and levator resection in 3 cases. Follow up period ranged from 11 months to 9 years. We have treated recurred blepharoptosis using frontalis myofascial flap, orbicularis oculi muscle flap and levator resection in accordance with the postoperative levator function and degree of ptosis of patient and considering previous operative technique. The results were that 12 patients have gained the levator excursion over 7 mm and reduced the height difference between both palpebral fissures less than 2 mm after reoperation (good in 6 cases and satisfactory in 6 cases). From these results we might conclude that the frontalis myofascial flap technique is a good secondary blepharoptosis operation for patient with less than 2 mm of levator function, orbicularis oculimuscle flap technique with 2-4 mm of levator function, levator resection with over than 4 mm of levator function. The expert technique and experience are also important factor for the treatment of recurred blepharoptosis.

나이에 따른 안검의 생체계측치

박대환,송철홍,안기영,한동길 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.6

The extensive knowledge of accurate anatomical morphology and acceptable proportion of the eyelid and orbit should be needed for plastic surgeons. The normal morphological and functional values of eyelids and orbits are variable according to races, sex and ages, and there are a few articles concerning them in Korea yet. The author measured eigt items of morphological and functional values of eyelids in Koreans and statistically analyzed them in 498 individuals including 234 males and 264 females. We divided them into nine age-related groups and measured the values. Especially, we subdivided 10 to 19 year-old group into three subgroup concretely because most of the values in the 10 to 19 year-old group reach the peak level of growth. The mean values in adults were recorded as follows: The horizontal dimension of the palpebral fissure was 27.0 ± 1.8 mm in males and 26.8 ± 1,7 mm in females and the vertical dimension of the palpebral fissure was 8.0 ± 1.0 mm in female. The slant of the palpebral fissure was 7.9 ± 2.4 degrees in males and 8.8 ± 2.3 degrees in females and the height of the opened upper eyelid was 12.4 ± 2.4 mm in males and 12.0 ± 1.9 mm in females. The height of double fold in closed eye was 6.6 mm in males and 6.5 mm in femals and the intercanthal distance was 38.4 ± 3.0 mm in males and 38.2 ± 2.8 mm in females. The interpupillary distance was 64.6 ± 2.9 mm in males and 63.6 ± 2.9 mm in females. A double fold was seen in 36.1% of Korean. The average height of the double fold in closed eye was about 6.5 mm. The epicanthus present in 58.6% of Korean eyes and the most commom type was epicantus tarsalis. The growth of eyelids reached the peak level at teenager in a great portion. After the peak level, the changing pattern of eyelids could be divided into 3 groups; the first one was increasing more, the second was stationary, and the third was decreasing gradually. The peak levle of growth reached at 10 to 13- year-old in the vertical dimension of the palpebral fissure, at 14 to 16-year-old in the intercanthal distance, at 17 to 19-year-old in the horizontal dimension of the palpebral fissure.

눈 주위 근육 피판의 선택적 이용에 의한 안검하수의 교정 및 합병증

한동길,송철홍,장경수,박대환,이재욱,안기영 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.3

Eighty-three cases with severe blepharoptosis were treated by the superiorly based muscle flaps around eye including orbicularis oculi muscle, frontalis muscle, levator muscle. The selection of the muscle flaps were done in accordance with the levator function of patients. The orbicularis oculi muscle flap technique in 32 patients who have 2-5 mm levator function, 21 cases of the interdigitated orbicularis oculi-frontalis muscle flap for 1-3 mm levator function, frontalis muscle flap technique for less than 2 mm levator function, 22 cases of levator muscle resection for 2-8 mm levator function, 7 cases of levator plication for 5-9 mm levator function. The majority of patients recorded as satisfactory results. There has been no complete failure but there were 14 cases of undercorrection, 4 cases of overcorrection, 2 cases of exposure keratitis, 3 cases of corneal erosion, 2 cases of sensory loss, hematoma, loss of wrinkle and a few cases of eyelid deformity such as notching, entropion, fading or unnatural fold. The orbicularis oculi muscle technique or the interdigitated orbicularis oculi-frontalis muscle flap technique offers several advantages over conventional frontalis muscle flap technique such as being a simple with a good operative field, single incision on supratarsal fold, no depression on the forehead, no risk of neurovascular injury and relatively easy technique with less complication. The levator resection or levator plication could offer good results by careful selection of patients. In conclusion, we would like to say that the interdigitated frontalis orbicularis oculi muscle flap technique is best in cases with less than 2 mm levator function, orbicularis oculi muscle flap technique in 2-4 mm levator function, levator resection in 4-8 mm levator function, levator plication in more than 8mm levator function.

Marcus Gunn 현상의 치험례

박대환,송철홍,안기영,한동길 대한미용성형외과학회 1999 Archives of Aesthetic Plastic Surgery Vol.5 No.2

두피에 발생한 혈관육종의 치험례

정재민,박대환,송철홍,Jung Jae-Min,Park Dae-Hwan,Song Chul-Hong 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.1

Angiosarcoma is a rare and high aggressive malignant tumor originated from endothelial cell. Angiosarcoma has four clinical types that are in the scalp and face of old age, in chronic lymphedema, in previously irradiated sites, and malignant angioendothlioma. We report one case of angiosarcoma of the scalp in a 74-year-old male patient. The patient had $4.0{\times}4.5cm,\;4.0{\times}3.5cm$ sized, localized, asymmetric several dome-shaped nodule and plaque with crust and ulcer on the parieto-frontal area of the scalp. We performed wide excision and subsequently covered with split-thickness skin graft. Postoperatively the patient underwent radiotherapy for prevention of recurrence and he had been followed up for 1 year without evidence of recurrence.