토끼의 하악각절제 후 동반되는 교근의 위축

송홍식 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.2

In order to get information about the changes of masseter muscle when operation is performed on the mandible angle area, we classified seventy white New Zealand rabbits into group O & group D. In the group O, we performed unilateral ostectomy of mandible angle, while in the group D, we dissected unilateral masseter muscle on the mandible abgle area. Then, we compared morphological, histological and histochemical changes of masseter muscle with those of opposite, normal, control masseter muscle. We examined every five rabbit in each group at the following postoperative weeks: 1wk, 2wks, 4wks, 6wks, 8wks, 12wks, 24wks. In the group D, there were no remarkable changes on all examinations. In the group O, there was 30% decrease of experimental muscle mass compared with normal side. On examination of muscle fiber types, decrease of type Ⅰ fibers and increase of type ⅡA, ⅡB fibers were significantly noticed (P〈0.05). Each experimental muscle fiber became more irregularly and angularly shaped and mean fiber areas were also reduced. Sarcomere length of muscle fibers on the operated side was significantly reduced to 80% values of controls (P〈0.05) during the first four weeks, but after six weeks it was lengthened to control values. Collagen and fibrin did not show much difference between experimental and control muscles. All of the above findings imply that masseter muscle atrophy after ostectomy of mandible angle is not due to connective tissue changes but to individual muscle fiber atrophy accompanied with functional adaptation of sarcomeres and changes of muscle fiber type.

안면하부 변형을 동반한 한국인에 있어서 연부조직 두개계측학적 연구

박철규,박흥식,송홍식 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.3

The present techniques of orthognathic surgery have been a great help to the patients with facial deformities both esthetically and functionally, Treatment plans and follow-up for patients who require maxillofacial and esthetic orthognathic surgery should include both hard & soft tissue cephalometric analysis. Measuring the facial convexity angle, lip posture with Ricketts method and Burstone method, authors have analysed the preoperative and postoperative soft tissue profile in Korean adult patients who had been operated with orthognathic surgery because of lower face deformities. The purposes of this study were to find the correlation of the changes in soft tissue parameter after orthognathic surgery by comparing preoperative soft tissue cephalometric analysis with postoperative analysis in lower face esthetics, and to investigate the difference between the Korean standard ideal facial profile and the Caucasian standard ideal facial profile in Korean adult patients. From March, 1990 to February, 1993, 45 patients with lower face deformities were operated on and followed up over 6 months and analysed in preoperative and postoperative stages. So through the analysis we wish to suggest (1) the applicability of the soft tissue cephalometric analysis in planning of treatment and postoperative follow-up, (2) the necessity of Korean standard of facial profile for applying to the Korean patients, (3) great discripancy of Korean and Caucacian in soft tissue profile, (4) consideration of need for adjuvant genioplasty & rhinoplasty for more ascess to ideal facial plane after orthognathic surgery.

두피의 악성 종양의 외과적 치료에 대한 연구

민경원,박철규,송홍식 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.2

Primary malignant tumors of the scalp may arise from any elements which comprise epithelial, glandular or somatic tissue. Generally, these malignant timors have unique characteristics different from that of other skin cancers found elsewhere. Because of the hairs, detection is often delayed and because of so many unannoying benign skin lesions in the scalp, patients occasionally do not ask for early medical care. However, if appropriate treatment is deferred, tumors may fatally invade adjacent calvarial bone or underlying brain, and reconstruction method is not simple which requires intact bony vault and hairy skin. Authors have experienced 7 cases of basal cell carcinoma, 12 cases of squamous cell carcinoma, 4 cases of malignant melanoma. Except inoperable one case that tumor invades occipital lobe and sagittal sinus, we have performed radical excision and reconstruction which are divided by the following groups according to the depth of invasion. In Group A, radical excision was done on the subgaleal plane and reconstruction is performed with use of local flaps. In Group B, outer table of calvarial bone was removed and scalp was reconstructed with local flaps and skin graft. In Group C, full layer of calvarial bone was removed and cranium was reconstructed with autogenous calvarial bone or rib bone and scalp was reconstructed with local flaps or myocutaneous flap and skin graft. In Group D, neurosurgical excision was added. We have perfomed above surgical treatment in 22 cases with satisfactory results and we will present our cases with brief review of literatures.

조직확장기 및 광배근 전이를 이용한 Poland 증후군 유방 재건술

송홍식,박철규 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.6

Poland's syndrome has been reported by Afred Poland in 1841, and its clinical characteristics have been identified:abscence or deficiency of breast tissue, abscence or deficiency of skin and subcutaneous tissue on axilla and chest wall,abscence of sternal head of pectoralis major, and varios abnormalities of hands.Since deformities of breast and chest wall have been serious physcial and psychological problems to young female, various kinds of methods such as autogeneous fat graft or silicone implant have been developed to reconstruct breast tissue. In Poland's syndrome,however, simple breast reconstruction cannot provide symmetrical chest appearance which needs sufficient soft tissue of chest wall and definite anterior axillary line. For reconstruction of anterior axillary fold, transposition of latissimus dorsi muscle, by moving the insertion of latissimus dorsi muscle to the defected site of sternal head of pectoralis major, has been introduced and for reconstruction of dificient soft tissue, the method which enlarges skin and soft tissue by using tissue expander has been applied.Authors have experienced two cases of breast reconstruction in Poland's syndrome. We inserted tissue expander through the small axillary Z-incision to expand the necessary amount of soft tissue and later made dissection and transposition of latissimus dorsi muscle with easy by adding Bra incision on the back, avoiding unnecessry periareolar incision or submammary incision. We substituted the tissue expander locating under the latissimus dorsi muscle with permanant implant and sucessfully reconstructed the symmetrical anterior axillary fold and breast tissue. We have represented our surgical method and cases with a brief review of literatures.

고압전기화상 환자에서 각종 역행성 피판술을 이용한 원위족부 결손의 재건

송홍식,김성철 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Distal foot defect is frequently encountered as an output site in high-tension electrical burn injuries, and proper treatment methods should be applied in order to achieve a properly-functioning foot. However, in distal foot defects around the metatarsal heads or metatarsophalangeal joints, conventional methods have not been ideal, replaced by such methods as secondary healing, amputation or skin graft because there was insufficient tissue in the distal foot and the general condition of the patient was unsuitable for distant or free flap surgeries. So, in order to establish convenient, promising methods for the reconstruction of distal foot defects in severe electrical burns, we classified the distal foot into four zones according to their blood supply and we defined or created ideal reverse flaps in each zone. From April 1996 to March 1999, we reconstructed 43 cases of distal foot defects in fourth-degree high voltage electrical burn wounds. In 19 cases of MP(medial plantar) zone injuries, we used reverse medial plantar island flap and in 5 cases of DP(dorsalis pedis) zone, we created a reverse dorsalis pedis island fascia flap, In 11 cases of P(peroneal) zone, we created reverse peroneal fascia flap and in 8 cases of Ⅰ(intermediate) zone, we modified a reverse posterior tibial island flap, There was partial flap necrosis or grafted skin loss in five cases, but those were extremely minor problems and we successfully reconstructed distal foot defects in all 43 cases. In conclusion, proper reverse flaps according to the zone of the distal foot are ideal reconstructive methods because they provide good vascularization, sufficient tissue from the proximal parts and they require short operative time with relatively easy procedures.

일측성 구순열 비변형에서 저발육된 Pyriform Aperture 교정을 위한 두개골 이식술

박철규,송홍식,김진환 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.1

General anatomical structures of the unilateral CLN deformity have been well known. Various kinds of operation methods have been applied based on this knowledge. The degree of the unilateral CLN deformity varies depending on individual and type of cleft lip. Therefore, the correction parts and operation methods have to be modified depending on the cases. Hypoplastic pyriform aperture is major external factor which causes the unilateral CLN deformity and, it also causes deformities of alar cartilage and nasal tip, and septal deviation, which has been well explained with the concept of 'Tilted Tripod' by Hogan and Coverse in 1971. The correction of hypoplastic pyriform aperture which tilts nasal tripod gives satisfactory result of symmetric nasal tripod including its base. For the correction of hypoplastic pyriform aperture, autogenous rib bone or iliac bone graft, autogenous cartilage graft, homologous cartilage graft and implant have been used, but scar deformity of donor site, and permanence of implant turned out to be problems. Authors used outer table of calvarial bone graft on 25 patients for the recovery of the collapsed pyriform aperture. Of these, 14 patients were male and 11 were female. The youngest was 5 years of age, the eldest was 30 years, and 7 patients were under 16 years. We performed external rhinoplasty upon the symmetric pyriform aperture corrected with calvarial bone graft and achieved satisfactory results, thus we represent our methods and cases with review of literatures.

고압 전기화상 환자에서 유리피판술을 이용한 손목 결손의 재건

김기선,송홍식,나민화,이태섭,이동은 大韓成形外科學會 2001 Archives of Plastic Surgery Vol.28 No.5

전기화상 환자에서 전완부피판을 이용한 수부의 재건

김기선,송홍식,나민화,이태섭,이동은,Kim, Ki-Seon,Song, Hong-Shick,Na, Min-Wha,Lee, Tae-Seop,Lee, Dong-Eun 대한미세수술학회 2001 Archives of reconstructive microsurgery Vol.10 No.1

The hand is a frequently affected area in high voltage electrical burn injury as an input or output sites. Therefore, early debridement and synchronous flap coverage are generally accepted as a primary treatment of several electrical burns complicated by exposure of tendons, neurovascular structures, and bones. So, in order to establish convenient, promising methods for the reconstruction of hand defects in electrical burn patients, we performed various reverse forearm flaps. From March 1997 to February 2000, we reconstructed 12 cases of hand defects in high voltage electrical burn wounds with reverse forearm flaps. Reverse radial fasciocutaneous flap were 3 cases, reverse ulnar fasciocutaneous flap were 3 cases, reverse ulnar fasciocutaneous flap and STSG were 4 cases, reverse ulnar fascial flap and STSG were 2 cases. We successfully reconstructed hand defects in all 12 cases, and obtained following conclusions. 1 Various reverse forearm flaps provide well vascularized, profitable tissues and they require short operative time with relatively easy procedures. 2. Reverse fascial flap and STSG, reverse fasciocutaneous flap and STSG provide thin flaps with good aesthetics and minor donor site morbidity.