시상봉합 조기유합증의 전두개관 개조술에서 직각 Z-절골술

오득영,변준희 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.4

Sagittal synostosis is the most common isolated craniosynostosis and usually recognized in early infancy. Numerous surgical techniques including strip craniectomy, the pi procedure, subtotal calvariectomy have been used, and they are usually successful if carried out in early infancy. Unfortunately, some children with sagittal synostosis are not considered for surgical correction by the age of 2 years. From March 2001 to February 2002, we have experienced two children older than 2 years of age with sagittal synostosis, and in all cases, performed total cranial vault remodeling with minimal bony defect. Reconstruction consisted of shortening of the sagittal midline strut, barrel stave osteotomy of temporal region, and right angled Z-osteotomy of parieto-occipital region. Using right angled Z-osteotomy, we can easily reshape and fix parieto-occipital bone flap with good stability and esthetic results. We report our technique for the late correction of scaphocephaly in two children with satisfactory results

Braden Scale에 기초한 욕창발생 위험군 선별도구를 이용한 욕창의 예방

오득영,김지훈,이백권,안상태,이종원 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.4

Poland 증후군 환자의 흉벽 및 유방 재건술

오득영,이백권,서병철,이종원,안상태 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.3

Purpose: As a rare congenital anomaly, Poland's syndrome has been known to show hypoplasia in breast and nipple, absence of pectoralis major muscle, and aplasia or deformity of rib or costal cartilage which has been reported to be more common in male. However, most patients who are seeking operation are female patients having one-side deformity. In the field of plastic surgery, the major surgical indications could be asymmetric chest wall depression in man or breast hypoplasia in woman. There are many reconstruction options according to the degree of patient's deformity: a prosthetic implant, breast implant with or without tissue expander, latissimus dorsi musculocutaneous pedicled flap with or without implant and/or tissue expander, and free tissue transfer with or without tissue expander.Methods: The authors have treated 4 patients(2 male, 2 female) who had a diagnosis of Poland's syndrome. According to the degree of patient's deformity, all patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with one-staged or two-staged reconstruction.Results: All patents were satisfied with the results and there occurred no specific complications.Conclusion: The authors propose the treatment plan for patient with Poland's syndrome, according to the degree of patient's deformity. In case of male patient with mild deformity, the prosthetic implant or latissimus dorsi musculocutaneous pedicled flap will simulate the missing pectoralis and improve the contour deformity. In case of female patient with moderate to severe breast asymmetry and upward displaced nipple areolar complex (NAC), NAC can be lowered with tissue expander, breast can be enlarged with autologous free flaps or latissimus dorsi musculocutaneous pedicled flap with implant.

노출된 영구 심박조율기의 치험례

오득영,김태형,이종원,이백권,한기택,안상태,최윤석 대한성형외과학회 2005 Archives of Plastic Surgery Vol.32 No.6

In the cases of severe arrythmia and conduction failure, a permanent implanted pacemaker is considered an essential treatment modality with less complication rate, broad indications and low morbidity. However, some pacemakers needs to be removed or replaced due to infection, in need of a lead upgrade, elective replacement, conduction failure or insulation failure. The most common indication for pacemaker extraction is infection. Conservative treatments such as administration of intravenous antibiotics and limitation of debridement are not effective and the removal of the entire pacing system is considered to be the best approach to pacemaker pocket infection. Although a locking stylet, a laser sheath and other newer methods of transvenous lead extraction have been proven to be effective, all leads cannot be removed. Moreover, major complications such as, cardiac tamponade and respiratory arrest during leads extraction procedure should not be ignored. We experienced two cases of exposed pacemakers in the subclavicular region. After removing the pacemaker body, exposed proximal lead was pulled out and cut off. The end of remnant external insulation tube was tied to prevent infection propagation between external insulation tube and inner metalic coil. Wounds were covered by local flap coverage. No other problems were detected during the one-year follow-up. Since there are few reports on lead-preserving method of treating limited infection of exposed pacemakers, we would like to present our new method for treating exposed pacemakers.

피부 석회증의 치험례

오득영,이종원,변준희,김선옥 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.2

Despite the careful regulation of serum calcium, calcification of cutaneous and subcutaneous tissues may occur. Calcification is the deposition of insoluble calcium salts; when it occurs in cutaneous tissues, it is known as calcinosis cutis. Calcinosis cutis is classified into four types: metastatic calcinosis cutis, dystrophic calcinosis cutis, idiopathic calcinosis cutis, and subepidermal calcified nodule. From January 2000 to May 2001, we have experienced 3 patients with calcinosis cutis. Two cases were dystrophic calcinosis cutis associated with radiation therapy and old burn scar with complications of delayed wound healing after punch biopsy, despite of conservative treatment for several weeks. Another was idiopathic calcinosis cutis. We performed surgical treatments in all cases: wide excision and pectoralis major muscle rotational flap coverage, wide excision and split-thickness skin graft, and excision and direct closure. No patients experienced wound healing problems. We believed surgical excision and appropriate reconstruction procedure is an effective theraphy in localized or ulcerated and chronic infected calcinosis cutis.

손가락에 발생한 평활근종: 증례보고

김현수,오득영,이종원,안상태,서제원 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.4

Purpose: Leiomyoma is a rare benign tumor of nonstriated muscles. Leiomyoma is most commonly found in the uterus and rarely occur in the hand. 150 cases of leiomyoma of the hand have been reported in the English literature; however, to the best of our knowledge only four of these have been in children and none were reported in Korean literature. We present a case of leiomyoma in the hand of a 8 - year - old boy, which is a rare site for localization and unusual for age. Methods: A 8 - year - old boy presented with a painless mass on the ulnar side of his thumb. Physical examination revealed a 1.2 × 1.2 ㎝ round, rubbery mass that was nontender to palpation. The vascular, sensory, and motor exams were otherwise unremarkable. Further evaluation with CT demonstrated an enhancing mass at dorsoulnar aspect of 1st proximal phalangeal region suggestive of a hemangioma versus other enhancing solid mass. The diagnosis of a leiomyoma was confirmed following surgical excision with histologic evaluation. Results: At 3 months follow - up, the incision was healed, motor and sensory function were intact, and there were full range of motion. Neither recurrence nor postoperative complication were observed. Conclusion: Leiomyoma is a rare tumor of the hand, especially in children. Diagnosing hand tumors in children is more difficult than in adults, hand surgeons should be aware of the diagnostic possibilities based on examination and imaging of a hand tumor ; however, surgical excision with histologic examination is required for definitive diagnosis.

하악에 발생한 중심성 거대세포육아종의 치험례

정진욱,오득영,서제원,문석호,이중호,이종원,안상태,김창현,Chung, Jin-Wook,Oh, Deuk-Young,Seo, Je-Won,Moon, Suk-Ho,Lee, Jung-Ho,Rhie, Jong-Won,Ahn, Sang-Tae,Kim, Chang-Hyun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Central giant cell granuloma is a rare, benign giant cell tumor which commonly develops in areas near the teeth. It accounts for approximately less than 7% of benign tumors of the mandible. Clinically, central giant cell granuloma is classifed into aggressive and non-aggressive type, and usually requires surgical treatment. There has been no report of central giant cell granuloma in plastic surgery field of the country, and we report a case with a brief review of the diagnosis and treatment of the disease. Methods: A 23-year-old male presented with a hard, non-tender, growing mass with the size of $4.0{\times}3.0\;cm$ on mandible for several months. Computed tomography scan showed a solid mass within thinned outer cortex on mandible. The thinned outer cortex was excised with the mass and the inner cortex was partially removed burring. After the tumor removal, mandible was fixed by reconstruction plate. Results: Pathologic report showed numerous large multinucleated giant cells, diffusely distributed in a background of ovoid-to-spindle-shaped mononuclear cells. There was no evidence of recurrence after 1 year follow up. Bony defect was regenerated and we removed the reconstruction plate. Conclusion: Removal of central giant cell granuloma results in defect of outer cortex, which can be reconstructed by using reconstruction plate, autologous bone graft or bone cement. We used reconstruction plate as a conservative method to induce secondary healing of the outer cortical defect area, which resulted in normal mastication and occlusion with no recurrence.

소뇌 종양 적출 후 두개강 내 발생한 난치성 뇌척수액 고임의 치험례

나은영,오득영,김혜영,이중호,문석호,서제원,이종원,안상태 대한두개안면성형외과학회 2010 Archives of Craniofacial Surgery Vol.11 No.2

Purpose: CSF (Cerebrospinal fluid) leakage is the most common complication of neurosurgery. Early management with conservative care or surgery must be followed appropriately due to the increased risk of lethal complications, such as meningitis. We report a case of intractable CSF leakage that occurred after a cerebellar tumor resection, which was treated successfully. Methods: A 53-year old male consulted our department for continuous CSF leakage for 3 months after having received conservative care and lumbar drainage. CSF collection was observed in the dead space of the posterior fossa after a cerebellar tumor resection and postoperative radiotherapy. Using a free latissimus dorsi muscle flap, the dead space within the skull was filled and the defects were covered successfully. Results: At 6 weeks after surgery, the follow-up MRI and CT revealed proper coverage and filling in the area where cerebellar tumor had been removed. No CSF leakage was observed at the postoperative 3 month follow-up. Conclusion: Recurrent CSF leakage was treated after cerebellar tumor resection with a relatively satisfactory result. In terms of the patient's treatment, much better results can be achieved by performing dead space filling using a flap with a sufficient size, in addition to coverage of the defects of the dura. (J Korean Cleft Palate Craniofac Assoc 11: 95, 2010)

신속 조형 모델을 이용한 안와바닥 골절 정복술

김혜영,오득영,이우성,문석호,서제원,이중호,이종원,안상태,Kim, Hye-Young,Oh, Deuk-Young,Lee, Woo-Sung,Moon, Suk-Ho,Seo, Je-Won,Lee, Jung-Ho,Rhie, Jong-Won,Ahn, Sang-Tae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Orbital bone is one of the most complex bones in the human body. When the patient has a fracture of the orbital bone, it is difficult for the surgeon to restore the fractured orbital bone to normal anatomic curvature because the orbital bone has complex curvature. We developed a rapid prototyping model based on a mirror image of the patient's 3D-CT (3 dimensional computed tomography) for accurate reduction of the fractured orbital wall. Methods: A total of 7 cases of large orbital wall fracture recieved absorbable plate prefabrication using rapid prototyping model during surgery and had the manufactured plate inserted in the fracture site. Results: There was no significant postoperative complication. One patient had persistent diplopia, but it was resolved completely after 5 weeks. Enophthalmos was improved in all patients. Conclusion: With long term follow-up, this new method of orbital wall reduction proved to be accurate, efficient and cost-effective, and we recommend this method for difficult large orbital wall fracture operations.

파절기에 의한 수지손상

임영민,오득영,정성노,이종원,안상태,권호 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.1

Purpose: Finger injury by green onion cutting machine is one of the common hand injuries in the kitchen. It has a unique feature: there are multiple parellel laceration 3 -5mm wide. There are two directions of injuries(vertical, oblique). It may involve bone, tendon, nerve, and vessel injuries. We discuss its management and the long -term progress. Methods: We have treated six patients from 2003 to 2007. We carried out low tension approximation with thin suture materials to avoid ischemia and performed the additional operation as nail bed repair, tenorrhaphy, open reduction, vessel anastomosis, and composite graft. We reviewed the record of initial injury and collected the follow-up record. Results: They were all middle aged - women who had worked in the kitchen. Right hand was dominent over left hand. The ratio of the directions was 3:3 (vertical:oblique). They were all competely healed although there were three atrophy, four hyperesthesia, and one nail deformity. Conclusion: Finger injury by green onion cutting machine is a unique pattern of laceration with various accompanied injuries. It may look like a severe form of injury, but in most cases have relatively favorable progress. We have to perform careful examination of accompanied injuries and carry out the proper management. First and foremost, the user especially in the middle aged women should be warned to be careful in handling this risky machine.