말초 신경에 발생한 양성 종양의 비교

김준범,차진한,김상윤,Kim, Joon-Buhm,Cha, Jin-Han,Kim, Sang-Yoon 대한미세수술학회 1992 Archives of reconstructive microsurgery Vol.1 No.1

Benign peripheral nerve tumors, although infrequent, must be considered as a possible cause of pain and disability in the extremities. There are three varieties of these tumors that are of clinical importance: neurilemmomas, neurofibromas, and post-traumatic neuroma. Neurilemmomas are the most common primary solitary tumor of the peripheral nerve trunks, and are almost always benign, Neurofibromas may occur as a solitary nerve tumor, but can present as multiple lesions as in von Recklinghausen's disease. Clinically, this tumor may presents as a solitary mass in the subcutaneous tissue which is centrally located with the nerve fibers travelling through the tumor mass. Traumatic neuroma is the proliferation of nerve elements with connective tissue during the process of regeneration from severed nerves undergoing Wallerian degeration, and is therefore not a true neoplasm. A neuroma-in-countinuity is the result of partial severance of a nerve, or of a crushing or traction injury in which all or part of the epineurium and perineurium is intact. We experienced each of the three varieties. With magnification, the neurilemmoma was removed by meticulous dissection from the parent nerve preserving the normal fascicles to which it was attached. The neurofibroma was excised and the nerve was reconstructed with interposed vein graft and the neuroma-in-continuity was excised and reconstructed with sural nerve graft. We report histologic characteristics of each tumors and the methods to repair the nerve defects after tumor excision with brief discussion.

혈관부착 비골동맥 피부편을 이용한 하지재건술

정덕환,차진한,김진원,김인환,Chung, Duke-Whan,Cha, Jin-Han,Kim, Jin-Won,Kim, In-Whan,Han, Chung-Soo 대한미세수술학회 1992 Archives of reconstructive microsurgery Vol.1 No.1

손가락 끝의 손상에 쓰이는 새로운 도서형 피판술

박명철 ( Myong Chul Park ),차진한 ( Jin Han Cha ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.1

Department of Plastic and Reconstructive Surgery, College of Medicine, Konkuk University, Seoul, Korea Fingertip is the part of the hand most frequently injured. Nail bed and fingertip injuries often result in time lost from work and even can be permanently disabling if imporperly repaired. The ideal fingertip reconstruction should attempt to maintain length, preserve nail functon, and provide sensate soft tissue covering without pain during use. Two kinds of island flaps based on single neurovascular bundle were used for fingertip reconstruction. The step-advancement island flap incorperated the step ladder principle with full tactile sensibility in the required position with the good soft tissue support. Innervated reverse vascular pedicle digital island flap is based on the digital palmar arch which is the anastomosis between the radial and ulanr sides of the finger at the level of 1/2 of middle finger.Sensation could be provided by the anastomosis between divided digital nerve and dissected digital nerve branch of the island flap. We report 25 cases of fingertip inj ury repaired with two kinds of new island flap techniques.

수지 원위부 절단의 재접합술

차진한,박명철 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.1

Replantation of the upper extremity has been developed over 30 years from a laboratory experimental model to a common techique applicable to acute and reconstructive hand surgeries. Today, successful replantation of fingers proximal to the middle phalanx is common. yet salvage of amputated fingers, distal to the DIP joint is still a challanging problem. Technical expertise in microvascular surgery may allow the true replantation of parts amputed within the distal interphalangeal joint. The functional and cosmetic success of these replantations is excellent. The authors report replantation cases, distal to the distal interphalangeal joint of fingers and retrospective analysis of 20 cases which were treated at Min Joong hospital, Collge of Medicine, Kon Kuk university, from October 1988 to February 1992 The results were as follows : 1. The survival rate of amputated digits distal to the DIP joint was 85% 2. Important factors for the successful replantation were the type of injury and the degree of crushing. 3. Replanted digits were improved in esthetical and functional aspects 4. If possible, the authors tried the venous anastomosis in 13 cases among the total 20 of cases.

도서형피판이나 유리피판을 이용한 족부재건술

차진한 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.1

The foot has unique anatomic and functional characteristics, it endures constant weight loading or alternation stimulus of shoes while standing or walking. So the foot is the challening area for reconstructive. I have reconstructed 23 cases of foor defects with various island or free flaps from March 1990 to Feb. 1995. The patients exhibited variable causes and sizes of foot defects, 15 cases of acute trauma, 3 cases of skin cancer, 2 cases of scar of scar contacture, 2 cases of pressure sore and a case of diabetic ulcer. Free flaps were chosen in 10 cases, such as lateral arm flap, scapular flap, latissimus dorsi muscle flap, forearm flap and superficial temporal fascia flap. Island flaps were also chosen in 13 cases such as medial plantar flap, dorsalis pedis flap, reverse peroneal flap, aosterior tibial flap. All flaps were survived without necrosis. 23 cases were divided into 4 groups according to foot defect area, 9 cases of heel and plantar weight-bearing area, 3 cases of Achilles tendon area, 6 cases of heel and plantar weight-bearing area alteral malleolar area and 5 cases of dorsal foot. I rfecommend that medial plantar island flap is suitable for heel reconstruction, reverse peroneal island flap for Archiles thedon area, dorsalis pedis island flap for malleolar area, superficial temporal fascia free flap for dersal foot.

수배부에 발생한 결핵성 건초염(Tuberculous tenosynovitis)의 1례 보고

차진한,최은정,박명철 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.1

Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis it is chavacterized by the formation of granuloma in infected tissue and also by florid cell-mediated hypersensitivity. The usual site of the disease is the lung, but other organs may be involved. Tuberculous tenosynovitis is a less common, but far more disabling and recurrent infection than is generally appreciated. The age decade most commonly affected is the third, but there is a wide age distrbution. It is reported to occur more frequently in male than female and in palmar side than dorsum. Almost any long tendon or group of tendon may be involved but the wrist is by far the most common site. The tendons on the right side of the body are affected about twice as often as are those on the left probably because of increased trauma and use. Prominent symptoms of tuberculous tenosynovitis are swelling, pain, stiffness, crepitation, paresthesias or weakness of grip. It is difficult to diagnose before operation, but can be definitively diagnosed by the pathologic microscopic examination and guinea-pig inoculation of rice bodies. Tuberculous tenosynovitis is a chronic, slowly destructive disease, which respond much better to surgical excision of the affected tissue than it does to the conventional treatment of tuberculosis, namely, rest of the art by immobilization. Complete excision of the tuberculosis mass while it is still limited to the tendon sheath and before the disease has spread to the surrounding structure, especially bones and joints, is the treatment of choice. We report a case of tuberculous tenosynovitis in a 47-year-old female who has had soft mass of the right hand. We had surgical removal of the involved tendon sheath and recommended on antituberculous medication for 9 moths after operation. There was no functional defect on the right hand and no recurrence.

복합처치에 의한 비후성 반흔이나 켈로이드의 치료

차진한 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.1

1993년 10월부터 1995년 1월까지 본원에서 치료하였던 54례의 비후성 반흔이나 켈로이드의 치료후 최소한 12개월간 추적조사를 통하여 저자는 기존에 보고된 다양한 치료방법을 조합하여 각각의 장점을 보강하고 단점을 감소시키는 복합처치로 제1형의 비외과적 복합처치는 기본의 발표된 치료효과 보다 월등한 결과를 가져왔으며, 제2형의 외과적 복합처치는 증례수가 적고 추적조사가 단기간이나 재발률이 적게 발생하였다. 저자는 폭이 좁고 높이가 비교적 낮은 비후성 반흔이나 켈로이드는 비외과적 제 1형 복합처치를 추천하며, 반흔이 크고 재발한 켈로이드는 제2형 외과적 복합처치를 시행하는것이 바람직하다고 사료한다. Treating of established keloids or hypertrophic scars is difficult, several methods for skeloids treatment have been reported; intralesional steroid injection, application of silastic gel sheet, pressure garment and surgical excision. Three or four combined methods of them produced better results than single method. An attempt was made to assess the value of 2 categories of combined treatment, the category 1 was intralesional steroid injection in combination with pressure garment & silastic gel sheet in treating 43 keloids or hypertrophic scars, the category 2 was surgry in combination with nonsurgical treatments in treating 7 patients. Nonsurgical combined treatment(category 1)was found be effective in the eradication of symptoms(91% symtomatic relief), the texture change(93% success rate) and the height change(56% partial flatteneing & 37% full flattening). Surgery in combination with nonsurgical treatments(category 2) is also recommended as treatment for complicated recurrent keloids. However more cases and longer follow-up are necessary.

혈소판응집과 단백인산화에 대한 PHOSPODIESTERASE-억제제의 효과

차진한 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.3

There are many evidences suggesting that phosphodiesterase(PDE) inhibitors, amitriptyline(AM) and chlorpromazine(CP) inhibit the platelet aggregation. Therefore, the antiplatelet activities of several PDE inhibitors ; 3-isobutyl-1-methylxanthine(IBMX) and 4, 5-dihydro-6-(3-nitro-4-methoxyphenyl)-5-methyl-3-(2H)-pyridazinone ; KR30075(KR), sodium nitroprusside(SNP), amitriptyline(AM) and chlorpromazine(CP) were compared in terms of their inhibitory effects on aggregation and protein phosphoylation of the rabbit platelet in response to thrombin(0.25units/ml;TB), collagen(200mg/ml;CO), adenosine diphosphate(4.0×10-5M;ADP)and eqinephrine(4.0×10-6M;EP). The following results were obtained. 1. KR30075 inhibited the aggregation of platelets in response to EP>CO>ADP>TB in the order of its antiplatelet activities, showing IC50 of less than 1.7×10-7M. PDE inhibitors, showed the inhibitory effects on the platelet aggregation in response to several agonists in similar patterns. The antiplatelet activity of KR (IC50:less than 1.7×10-7M) was significantly greater than that of SNP(IC50:less than 1.57×10-6M). But the antiplatelet activity of other drugs used in this study was not so meaningful compared with those of KR and SNP. 2. The platelet aggregation induced by each of the agonists was accompanied with the increased phosphorylation of 41 kDa protein and the decreased 47 kDa and 20 kDa proteins. PDE inhibitors (KR, IBMX) and SNP significantly inhibited the increase of 41 kDa protein phosphorylation and produced somewhat of an attenuation of the decreases of 47 kDa and 20 kDa protein phosphorylations. AM and CP, however had little effect on the decrease of 47 kDa protein phosphorylation, but inhibited the decrease of 20 kDa protein phosphorylation. Even so KR, SNP and IBMX produced the increases of 43 kDa & 22 kDa protein phosphorylations in order of KR>SNP>IBMX. The antiplatelet activity of KR 30075 seems to correlate with the decrease of 41 kDa protein phosphorylation and the increases of 43 kDa and 22 kDa protein phosphorylations.

수부 역혈행성 도서형 피판술 : Long-term evaluations of sensory recovery in the transfered flap and circulatory disturbance in the hand 공여 수부의 혈류상태 및 이식피판의 감각상태에 대한 원격추적조사

차진한 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3

Bostwick reported the reverse flow temporal artery island flap in 1976, Lin described venous drainage of reverse flow flap in 1984, then the various reverse flaps of upper and lower extremities were reported, however there were no objective results of sensory recovery in the flaps and evaluation of circulatory disturbance in the hand. Fourty-three reverse flow island flaps for hand reconstruction were transferred. These included 29 digital island flaps, 3 dorsal metacarpal flaps, 3 radial forearm flaps, 2 ulnar flaps and 6 posterior interosseous flaps. Nineteen cases were sensated flaps ; 14 digital island flaps, 3 posterior interosseous flaps, 1 radial forearm flap and 1 ulnar forearm flap. After a follow-up ranging from 6 to 26 months, all flaps have survived completely without loss of flap tissue. The average static 2-point discrimination was 7.4mm in the sensated digital island flaps, 10.3mm in the nonsensated digital flaps and 16.3mm in the sensated flaps using the lateral or medial antebrachial cutaneous nerves for neural anastomosis. The radial forearm flaps, ulnar forearm flaps and digital island flaps have a well known disadvantage, which is the disruption of a major arterial supply to the hand or finger. Acute ischemia or late cold intolerance of the hand or finger was not developed clinically and in the evaluation with thermography. The use of sensated reverse island flap in the hand provide excellent sensory recovery in the flap. Provided that the other arteries in the hand are intact and well functioning, there is no circulatory disturbance to the operated hand.

안면골 성형 및 재건술 환자의 심리상태에 대한 연구

차진한,김우경,김수신,백세민,이임순 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.2

Cooperative management of facial bone deformities by maxillofacial surgeons and other specialities has resulted in tremendous growth in recent years. Frequently, these patients have suffered considerable emotional trauma from ridicule of their deformies. We evaluated 34patients excluding facial bone fracture which was operated primarily, from March 1987 to Feb.1988. These patients were divided into 4 groups according to etiology and operation methods. The first group included aesthetic facial bone surgery patients, the second group included posttraumatic facial doformity patients, the third group included facial bone tumor patients, the fourth group included congenital facial anomaly patients. After soco-psychological evaluation, we achieved the following results. 1. The primary motivation of many patients seeking facial bone surgery was aesthetic improvement. 2. Patients for aesthetic improvement and patients of post-traumatic facial bone deformities were well adjust to social relationships. Patients of facial bone tumor depended on familial support, and patients of congenital facial deformities were severely anxious. 3. Self-confidence of aesthetic surgery group was the highest of all groups. It also was decreasing from aesthetic surgery group. Posttraumatic group, facial bone tumor group and congenital anomaly group in that order. 4. All patients placed the highest value on social relationships and the lowest value on religion. 5. Our finding will help identify and prevent some of the pitfalls leading to patients dissatisfaction after surgery.