원위기저 비복동맥 피판술

이동걸,이동훈,이정형,조병채,백봉수 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

Reconstruction of soft tissue defect with exposure of the tendons and bone in the lower third of the leg and the heel represents a challenge to plastic surgeons. The sural artery flap is a fasciocutaneous flap supplied by the sural artery that accompanies the sural nerve and connects with a septocutaneous perforator of the peroneal artery via a suprafascial network of vessels. For the coverage of soft tissue defects, we operated on 10 patients using a distally-based sural artery flap. The sites of the soft tissue defect were the lower third of the leg in 7 cases and the heel in 3 cases. The size of flap varied from 3.5x4cm to 12x18cm. Nine of 10 flaps survived completely. One flap in which the sural nerve was preserved showed partial necrosis but healed spontaneously. Two flaps showed slightly venous congestion which disappeared after a few days. The advantages of the sural flap are a reliable blood supply, easy and quick elevation of the flap, preservation of the major artery and minimal donor site morbidity. The disadvantage of the flap is hypoesthesia at the lateral part of the foot. In conclusion, the distally-based sural artery flap can be used safely for soft tissues coverage in the lower third of the leg and the heel.

벨마비 환자의 예후와 신경생리 검사소견의 관련성

백봉수,박성파,서정규 대한신경과학회 1999 대한신경과학회지 Vol.17 No.5

유륜주위절개를 이용한 유방축소술

백봉수,이신일,신동필,박재우,조병채 大韓成形外科學會 2001 Archives of Plastic Surgery Vol.28 No.4

Limberg氏 皮膚瓣과 Dufourmentel氏 皮膚瓣의 使用

白鳳壽 大韓成形外科學會 1977 Archives of Plastic Surgery Vol.4 No.2

Many elliptical defects which surgeons create after excision of skin lesions can be closed directly but as the lesion increase in size, the long axis of the ellipse may be too long for the local anatomy or cosmetic result and the short axis may be too wide to permit direct sutures. In such cases, surgeons can create rhomboid defects instead of elliptical defects and use the Limberg flap or Dufourmentel flap as a local flap. One advantage of the Limberg flap is the simplicity of the design, all angles being 60° or 120°, all sides being equal. Dufourmentel flap is more difficult to learn and to plan than the Limberg flap but in closing defects with the acute angle of which lies between 60° and 90°, Dufourmentelflap is of use. The design and application of the limberg & Dufourmentel flap will be described separately. Author applied these flaps for the rhomboid defects after excision of the basal cell carcinoma on the cheek, decubitus ulcer on the sacrococcygeal area and skin ulcer on the lower anterior leg and results are reported.

정맥피판의 생존에 지연조작술과 Fibronectin 및 Basic fibroblast Growth Factor의 효과

이정형,조병채,백봉수 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.5

This study was conducted to evaluate the survival rate of three groups of venous flaps The first group is a proximal pedicled venous flap with one vein, and the second group is a delayed proximal pedicled venous flap with one vein and this second group was subdivided into 5,7,10, and 14days delayed groups. The third group consists of a fibronectin injection group and a basic fibroblast growth factor injection group to the group 1 and group 2. 10 venous flaps were elevated from the posterior surface of rabbit's ears for each group. The results were as followings : The survival rate of a proximal pedicled venous flap with one vein(the first group) was 38.5%. The survival rates of delayed proximal pedicled venous flap with one vein(the second group) were 51.4, 65.2,97.1 and 99.0% in 5,7,10 and 14 days delay. There was a significant increase in survival rate than the first group(p<0.001). In the fibronectin injection group, survival rates were 75.6% in the first group, and 72.1, 80.5,99,99.0% in 5,7,10,14 days delayed second group. The survival rates were significantly increased than those of the first and second group(p<0.001). In the basic firboblast growth factor injection group, the survival rates were 78.3% in the first group, and 79.7,83.2,99.05% in 5,7,10,14 days delayed second group. The survival rates were also significantly increased than those of the first and second group(p<0.001). These findings suggest that delay procedure, fibronectin and basic fibroblast growth factor increase the survival rate of a venous flap.

뮐러근과 올림근널힘줄로 구성된 복합피판의 전진술에 의한 눈꺼풀처짐의 치료

백봉수,석정훈,최원석,양완석 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.2

Purpose: Even in a small levator resection for blepharoptosis, 10-13mm of Müller's muscle and levator aponeurosis is resected. To solve the problem, Müller's muscle was detached from the superior tarsal border and conjunctiva, and the muscle with overlying levator aponeurosis was advanced on the upper tarsus as a composite flap. The purpose of this study is to evaluate the effectiveness of the Müller's muscle-levator aponeurosis complex advancement technique for the correction of blepharoptosis. Methods: From 2003 to 2008, 107 patients(183 eyes) underwent the advancement procedure of the Müller’s muscle-levator aponeurosis composite flap for blepharoptosis. The advanced composite flap was fixed 3 mm below the superior tarsal border and 2-3mm of distal flap stump was left after trimming up to 5mm. The results of the operations were evaluated. Results: The mean age of the patients was 35.2 years and 83 patients(145 eyes) were followed up for a mean of 16.7 months. 128 eyes(88.3%) showed a normal level of upper eyelid margin(MRD1 4.1-5.0mm) or less than 1mm ptosis(MRD1 3.1-4.0mm). 10 eyes(6.9%) showed 1-2mm ptosis(MRD1 2.1-3.0mm). 7 eyes(4.8%) showed more than 2mm ptosis which required secondary correction. About 80% of the 183 eyes needed no trimming of the flap stump with 5-6mm of composite flap advancement and 20% had about 3mm of the flap stump trimmed with 8-9mm of composite flap advancement (shortening of the levator complex). Conclusion: Müller’s muscle-levator aponeurosis complex advancement technique offers several advantages: There is no, or minimal, sacrifice of the normally functioning Müller’s muscle; it is more physiological; it is reproducible and it is predictable-with gratifying results for blepharoptosis.

植皮術 後 皮膚供與部의 創傷處置를 위한 豚皮의 利用

朴大煥,白鳳壽 大韓成形外科學會 1982 Archives of Plastic Surgery Vol.9 No.3

The most important goal of donor site care is rapid reepithelization without infection and minimum discomfort to the patient. Mediskin?(Pigskin) is a kind of biological dressing and the effects of Mediskin in the treatment of second degree burn were reported by authors. The healing processes of split-thickness skin graft donor site is the same as that of second degree burn. During the past one and half years, skin graft was performed in 90 cases and treatment of the donor sites divided into 5 groups; Mediskin; Sofratulle group (50 cases) Mediskin; Amniotic membrane group (10 cases) Mediskin; Saline gause group (10 cases) Mediskin; Madecassol gause group (10 cases) Mediskin; Vaseline group (10 cases) These groups were divided again into 3 minor groups according to thickness of skin graft; thin, intermediate and thick. We used semi-open method in dressing and checked infection rate and healing time. The infection rate of the donor site was highest in the Mediskin group and the time of re-epithelization was also longest in the Mediskin group. But there were no significant differences between gauze groups in infection rate and healing time. Mediskin could alleviate pain in the donor site and be simple for dressings. These results conclude that the effect of Mediskin in the treatment of split-thickness skin graft donor site not so good because of high infection rate, delayed healing time and high cost.

눈꺼풀처짐을 수반한 눈구석벌어짐증

백봉수,지소영,최재일,석정훈,양완석 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.4

Purpose: Blepharoptosis is often associated with telecanthus and the presence of epicanthal fold in telecanthus is one of unique features in Asian eyelids. The purpose of this article is to define telecanthus and pseudotelecanthus, and to determine optimal surgical procedure depending on classification of telecanthus. Methods: Among 187 patients with blepharoptosis who had the advancement procedure of the Muller’s musclelevator aponeurosis composite flap for ptosis, 55 patients underwent Flowers' split V-W plasty concomitantly with shortening the medial canthal tendon for correction of telecanthus from September 2003 to January 2011. Among them, 52 patients were followed up for 16 months. We newly defined telecanthus because Mustarde ratio is inaccurate to measure in certain cases and then made a definition of pseudotelecanthus. Besides, we also classified telecanthus into mild, moderate and severe types based on its severity. Results: Telecanthus is defined when the ICD (inner canthal distance) is greater than 110% of normal ICD. Pseudotelecanthus is a telecanthus like a wide skin bridge formed between the eyes because of the epicanthal fold in the normal ICD. Flowers' split V-W plasty combined with shortening medial canthal tendon was very effective in mild and moderate telecanthus with almost invisible scar and no recurrence occurring. In severe types, however, it showed high incidence (28%) of incomplete correction of telecanthus. Conclusion: New definition of telecanthus can be easily applied to any case and we think the classification of telecanthus is useful to select an appropriate operative procedure. Split V-W plasty with shortening of medial canthal tendon is a very effective procedure in mild and moderate telecanthus. Besides, it is also effective in improving the treatment outcomes of ptosis in cases of blepharoptosis associated with telecanthus.

이개재건을 위한 한국성인 이개의 생체계측치

변진석,박재우,백봉수 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.3

Ear reconstruction in congenital microtia or traumatic absence has been a challenge for plastic surgeon because of the complexity of its structure. Attempts have been made using different techniques, but the problem always has been the adequate from, proportion, appropriate position and protrusion. For this reason, accurate surface measurements of normal ears are essentisal of plastic surgeon. The author measured the size, the proportion, the location, the level, the inclination, and the protrusion of normal healthy Korean ears including 100 males and 100 females, ranging between 21 and 30 years of age. Using this statistical analysis, it is comfirmed that the size and the depth of the concha consist of a larger part of the width in normal ear, and the antihelix at the middle one third of the auricle is more prominent than helix. This characteristic feature can be created by the vertical augmentation of the antihelix.

전기화상으로 인한 혈관의 병변과 근육손상의 상호관계에 대한 실험적 연구

김인규,손윤호,변진석,백봉수 大韓成形外科學會 1988 Archives of Plastic Surgery Vol.15 No.2

The aim of this study was to determine the degree the degree & progression of tisse damage after electric burn by observing blood vessels and muscle tissue. 45 rats were divided into 9 subgroups by post-burn periods with 5 rats in each group: thirty-minutes, six-hour, twelve-hour, one-day, two-day, four-day, seven-day,fourteen-day and twenty-one-day groups. Light microscopic studies studies were done in each group to see the changes of the blood vessels and muscles and electron microscopical studies were done in the six-hour, twelve-hour, one-day, and two-day groups for detailed changes of blood vessels. The results were as follows: 1. Under the light microscope, vessels and muscles were compared in relation to progression of tissue damage. Vascular changes are following : In the six-hour group, thrombosis was first seen in the small intramuscular capillaries. In the twelve-hour group, thrombosis was seen in the large artery. In the two-day group, the length of thrombosis in the large artery grew to 1-1.5cm. After the two-day group, there was no progression of the thrombosis. The muscular changes were remarkable : The muscles showed immediate necrosis. In the two-day group, there was rapid progression of the necrosis to a length of 2-2.5cm. In the four-day group, there was slow progression of the necrosis, when compared to the two-day group, and the necrotic muscle length was 2.5-3cm. After the four-day group, there was no progression. 2. Under the electromicroscope, the changes of the blood vessels showed that endothelial cells were detached from the internal elastic lamina, the internal elastic lamina was thining and the cells of tunica media showed cellular edema and degeneration. in the one-day group, the internal elastic lamina was seen to be fragmentated and the smooth muscle cells of tunica media showed marked interstitial edema and cellular degeneration. In the two-day group, the internal elastic lamina showed deterioration and fragmentation. Theses findings suggested that the damage to the muscles was considerably greater than that to the blood vessels and that damage to muscles and vessels after electric burns was not progressive after the fourth day.