광범위한 안면경부 피판(extended cervicofacial flap)을 이용한 단단계 협부 재건

홍종욱,박재석,백롱민,백세민 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.5

Resurfacing of the face presents problems for repair in terms of satisfactory color and contour match. The physical characteristics of cheek skin are matched best by adjacent skin. The cervicofacial flap has been described as the treatment of choice for cheek repair by many authors because of its good viability and excellent cosmetic result. The extended cervicofacial flap to be introduced by authors is elevated down to the clavicular line and posterior to the imdpoint of posterior neck with the facial scars running in the normal expression lines and inconspicuous area. It is one of the best for total or subtotal reconstruction of the cheek following removal of burn scars, heangiomas or nevi, especially in young women who demands a good appearance and who do not have the cheek flaccidity for a simple rotation flap. We experienced 12 cases of one stage reconstruction of the cheek by the extended cervicofacial flap. It required neither delay procedures nor tissue expansion, and it gave excellent results in terms of both function and apprearance.

상악동에 발생한 粘液膿瘤腫-1예보고-

김수홍,김경식,양원용,전태준,백세민 大韓成形外科學會 1982 Archives of Plastic Surgery Vol.9 No.3

Mucocele involving the paranasal sinuses are commomly occurring lesions. The literature shows that the frontal, ethmoid, and sphenoid sinuses are most frequently involved, in that order, whereas involvement of the maxillary sinus is relatively rare?. Mucopyocele, mucocele in which the mucous secretion has become purulent, are less common in the maxillary sinus. The following case report is of interest because of the relative rarity of this destructive inflammatory process in the maxillary sinus and because, as in this patient, the lesion can sometimes be confused with a malignant neoplasm.

下顎骨 切骨術을 利用한 顔面成形術

홍성표,양원용,백세민 大韓成形外科學會 1984 Archives of Plastic Surgery Vol.11 No.2

The role of the chin has been emphasized as a balancing feature of face by Converse and others. The patients who have deformities of mandible become introverts, acquire inferiority complexes, are morose and suffer mental anguish. Also they have functional disabilities including malocclusion, improper mastication and speech difficulties. After Hullihen's original mandibular osteotomy in 1849, various mandibular procedures were employed and these osteotomies are developed from unidirectional to tridimensional correction. We obtained a good result by mandibular osteotomies for correction of jaw deformities.

설부 악성종양에 외과적 처치술

이혜영,양원용,백세민 大韓成形外科學會 1984 Archives of Plastic Surgery Vol.11 No.2

Very few cancers of tongue will be found on a routine examination, but ususally the patient presents himself at the doctor's office because of painfull ulcer, or foul order of tongue. The treatment of cancer of tongue is divided among radiologists and surgeons, depending on the anatomical location of primary cancer, the size and extent of involved adjacent tissue, and whether or not metastases have occurred. Recently the combined use of radiation, chemotherapy, and surgery arise the best means of treatment of tongue cancer. There is no difference in cure rates depending upon the location of primary cancer, but difference in distribution in the stage of disease at initial presentation. Composite resection, so-called "commando" operation is the standard surgical method for treating cancer of tongue. The technique for reconstruction of composite resection defect includes primary closure, skin graft, local flap, and myocutaneous flap. More recently pectoralis major myocutaneous flap have been suggested, and its abundant tissue with an excellent blood supply, anatomic proximity, and reliability all facilitate the immediate reconstruction of a variety of defects in head and neck area. Authors have good result using commando operation with pectoralis major myocutaneous flap and pull-through operation for treatment of cancer of tongue.

혈관조영술 소견에 중점을 둔 Buerger's병의 임상적 고찰

황종익,김수신,백세민 大韓成形外科學會 1987 Archives of Plastic Surgery Vol.14 No.2

Thromboangitis obliterans has been recognized clinical entity for more than half a century (Leo Buerger 1908). Buerger's disease is a specific recurrent, segmental, inflammatory, obliterative vascular disease involving principally the medium sized artery and vein and its classic type occurs relatively frequently in Orient, Korea and Japan, despite the rarity of atherosclerosis and of thromboembolic disease. 95 cases with Buerger's disease among the peripheral vascular occlusive disease were experienced at Department of Plastic and Reconstructive Surgery in Korea University Guro Hospital between January 1984 and March 1986. We made clinical study for this patients and the results were as follows: 1. All patients were male and the majority of the patients were between the age of 21 and 50 years, at onset of symptoms with range being 21 to 40. 2. Patients except 5 cases and smoked heavily at the onset of their symptoms with pain, claudication coldness and necrosis. 3. The most common extremities affected were both lower extremities, 19 cases revealed involvement of the both upper and lower extremities, and 1 case showed involvement of only upper extremities. 4. The most common sites of obstruction were, posterior tibial artery, anterior tibial artery and superficial femoral artery in femoral angiogram, and ulnar artery, radial artery and deep palmar arch in brachial angiogram in that order of frequency. 5. In 33 of 95 patients, it was possible to undertake 26 micro-endarterectomy, bypass in 1, micro-endarterectomy combined with bypass graft in 3, micro-endarterectomy with amputation in 1, and amputation in 2. Among the endarterectomy cases, we experienced 4 cases of reocclusion within 6 month and only 1 case showed poor prognosis, amputation.

기능성경부곽청술을 시행한 악성흑색종의 치험례 : A Case Report 1例 報告

정영덕,백세민 大韓成形外科學會 1986 Archives of Plastic Surgery Vol.13 No.4

The surgical management of malignant melanoma has long been a highly controversial subject. The basic principle of wide excision of the primary site is generally accepted as the proper management of the primary lesion. The controversy, however, surrounds the appropriate management of the regional lymph nodes. It is generally admitted that, in patients with Clark levels Ⅲ, Ⅳ, Ⅴ and all melanomas that are greater than 1.5mm in thickness, the nodes in neck should be removed, even if they are not clinically suspicious nodes. In the past, it was believed that the nodes in neck should be removed only by the classical redical neck dissection. But now the functional or modified neck dissection markedly increases as an elective operation, since it not only shows no significant difference in the risk of recurrence, compared with classical redical neck dissection, but also is functionally, esthetically, and physiologically acceptable. The ideal candidates of the functional neck dissection are those patients who have clinically No necks but whose primaries have signified chance of having microscopic metastases to the lymph nodes and, as such, are considered for elective neck dissection. The authors herein, experienced a patient with Clark level Ⅳ melanoma in the face and no suspicious lymph nodes in the neck, who was successfully managed wide reexcision and functional neck dissection through the incision of the cervicofacial flap.

유리피판술을 이용한 진행성 반안면 위축증(Romberg's Desease)의 치험

백롱민,정두성,백세민 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Romberg's disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue and bone. Facial asymmetry with soft tissue deficiency in Romberg's disease causes a significant disability affecting the social life and can bring about many psychological problems. The aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, silicone injections, cartilage and bone grafts, pedicled flaps and free flaps. We report our experience with 6 patients involving 6 free flaps with a minimun of 1 year follow-up who were treated from October 1989 to March 1998. All patients were classified as having moderate to severe atrophy. The average age of disease onset was 4.5 years. The average duration of atrophy was 5.2 years. No patient was operated on with a quiescent interval of less than 1 year. The average age at operation was 14.1 years, ranging from 10 to 24 years. Follow-up ranged from 1 to 9 years. Reconstruction was performed using 2 groin dermofat free flaps and 4 latissimus dorsi muscular free flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le-Fore 1 ½ leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angleplasty, rib and calvarial bone graft, correction of alopecia and additional dermofat graft. All patients were satisfied with the results. We believe that free flap is one of the best choices for contoured restoration of facial asymmetry in Romberg's disease.

두개 악안면 수술시 새로운 골대체물로 이용될 수 있는 계란껍질에 대한 연구

윤창신,백롱민,백세민 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.8

The first successful bone transplantation carried out in 1688 by Van Meek'ren, a Dutch surgeon. The ideal bone substitute should be biocompatible, osteoinductive or at least osteoconductive, available in unlimited quantity, low cost and have satisfactory mechanical properties. To accomplish these goals, autografts are still preferred material. However, bone harvesting procedures have been focused to solve the following problems; necessity of a second surgical site, morbidity and potential deformity of the donor site, an increased operative time, donor availability limitations, and resorption of autogenic bone grafts. Ten adult white New Zealand rabbits, three, 10 mm in diameter, full layer skull defects were made in the frontoparietal bone. Two bone defects were filled with hydroxyapatite and powdered eggshell, the other defect was not filled(control). All animals were sacrified at 10 weeks, the specimens were examined macroscopically to test for graft mobility. The graft with surrounding bone was then harvested and studied by histology. The results were as follows: 1. Control: Bone regeneration occurred nearly complete. 2. Hydroxyapatite: Macroscopically - No encapsulation. Despite a gross delineation between implant and bone, imlant was firmly united to bone. Histology - Bony trabeculae surrounded by proliferated connective tissue are observed in the defect site and implant. Osteoblastic rimming is noted along the bone fragments 3. Powdered eggshell: Macroscopically - Grafted site was encapsulated by proliferated connective tissue and palpable softer than the surrounding bone. Histology - The presence of eggshell particles encapsulated by fibrous connective tissue. Partial bone regeneration from the defect margin was noticed, but the bone healing was never complete. In conclusion, the use of safe and inexpensive material is recommended for filling limited bone defects in non-weight bearing areas. The use of powdered eggshell for bone substitute may also be considered, after further studies, to access its long term stability, porosity and biocompatibility.

조직확장기 사용의 임상적 고찰

한흥수,김우경,김수신,백세민 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.1

Recently, soft tissue expansion technique using tissue expanders has become a popular method for reconstruction of soft tissue defect because it provides high quality tissue with similar color, texture and hair bearing characteristics without significant donor site problems. During the period September, 1983 to December, 1988, we used tissue expanders to treat 36 patients with soft tissue defect, 3 scalp, 10 face, 6 neck, 4 trunk, 10 upper extremity, 3 lower extremity and evaluated the operative techniques, results and complications as follows. 1. We achieved favorable results in 31 cases(86.1%), especially in scalp, face and upper extremity, but poor results in lower extremity, especially below knee in location. 2. We experienced major complications in 2 cases(5.6%) such as implant exposure and minor complications in 7 cases(19.4%) such as hematoma, partial necrosis, infection, underlying bony depression etc. 3. Capsular excision is not desirable, but capsular release may permitted to acquire maximal length of the advancing flap. 4. In case of microtia, expanded tissue which was obtained from expanders is defficient for elevation of framework without skin graft. 5. Accurate and meticulous preoperative evaluation is the most important factor in achieving good and results.

반안면 왜소증의 수술적 교정: 5년간 65례의 고찰

백승준,김진오,백롱민,오갑성,백세민 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

Hemifacial microsomia is a descriptive term for the developmental anomaly affecting the tissues derived from 1st and 2nd branchial arches, expressed as asymmetric underdevelopement in facial bony skeleton. Conventional strategy of surgical correction for hemifacial microsornia consists of leveling though maxillary LeFort osteotomy and rotation, advancement and recession through bilateral sagittal split us osteotomy, which was reinforced by ancillary procedures such as mandibular augmentation with onlay bone graft, mandibular angle ostectomy, temporomandibular dibular joint (TMJ) reconstruction and malar reconstruction. But these like conventional methods for correction of hemifacial microsomia were emphasized on the correction of vertical asymmetry primarily, overlooked the asymmetry of horizontal plane, namely hypoplastic malar deformity. In general, correction of malar hypoplasia was achieved by rib or calvarial bone graft. These methods remain donor site deformity and the result can not be precisely predicted due to progressive resorption of bone. Moreover, the natural appearance of zygomatic complex could not be established by bone graft. Malar expansion by zygomatic osteotomy and spread-out technique was applied on correction for 34 case in total 65 cases of hemifacial microsomia from March 1991 to February 1996. We could get more natural appearance of malar complex and facial symmetry in the correction of hemifacial microsomia at one stage operation than conventional malar reconstruction methods.