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하악골 과두하 골절의 이하선 경유 접근법을 통한 관혈적 정복술 증례보고
문민철,오석준,고성훈 대한두개안면성형외과학회 2009 Archives of Craniofacial Surgery Vol.10 No.1
Purpose: Fractures of the mandibular condylar area are common injuries that account for 29% to 40% of fractures of the facial bones and represent 20% to 62% of all mandibular fractures. Currently 3 main methods are being used in the treatment of mandibular subcondylar fractures: closed reduction; open reduction and internal fixation; Endoscopic reduction and internal fixation. Each method has its proponents and opponent as well as advantages and disadvantages, and indications for each vary among surgeons. There are six approaches of open reduction: submandibular, retromandibular, preaurilcular, postauricular, intraoral, transparotid approach. Among them, transparotid approach has been described for subcondylar exposure with dissection in the direction of facial nerve fibers to expose the bone through the parotid gland. This approach carries the risk of a parotid glandular fistula as well as facial nerve injury but has the advantage of being directly over the fracture site. We report safety and efficacy of surgical treatment using a transparotid approach for direct plating. Methods: A 43-year-old man sustained multiple facial bone fractures by driver traffic accident. Mandibular subcondyle was fractured and dislocated internally. We performed open reduction and internal fixation by transparotid approach. Fractured site was fixed by titanium mini plate & screw. We applicated arch bar for approximately 3 weeks. Results: Follow-up length was about 5months. Scar of surgical incision was indistinct, there was no symptoms and signs of facial nerve and parotid gland injury, and maximal mouth opening was measured 49.5 mm. Conclusion: Transparotid approach has high risks of facial nerve and parotid gland injury, but paradoxically it is the most effective technique in saving facial nerve. Open reduction and internal fixation of mandibular subcondylar fracture by transparotid approach with precise and versed procedure, best outcome can be expected.
Foot Reconstruction by Reverse Island Medial Plantar Flap Based on the Lateral Plantar Vessel
문민철,오석준,차정호,김유정,고성훈 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.2
Purpose: Tumor ablation and traumatic intractable ulceration of the plantar surface of the foot results in skin and soft tissue defects of the weight-bearing sole. Simple skin grafting is not sufficient for reconstruction of the weight-bearing areas. Instead, the island medial plantar flap(instep flap) and distally-based island medial plantar flap was used for proper reconstruction of the weight bearing area. However, there are some disadvantages. In particular, an island medial plantar flap has a short pedicle limiting the mobility of the flap and the distally-based island medial plantar flap is based on a very small vessel. We investigated whether good results could be obtained using a reverse island medial plantar flap based on the lateral plantar vessel as a solution to the above limitations. Methods: Three patients with malignant melanoma were cared for in our tertiary hospital. The tumors involved the lateral forefoot, the postero-lateral heel, and the medial forefoot area. We designed and harvested the flap from the medial plantar area, dissected the lateral and medial plantar artery and vena comitans, and clamped and cut the vessel 1cm proximal to the branch from the posterior tibial artery and vena comitans. The medial plantar nerve fascicles of these flaps anastomosed to the sural nerve, the 5th interdigital nerve, and the 1st interdigital nerve of each lesion. The donor sites were covered with skin grafting. Results: The mean age of the 3 subjects was 64.7 years(range, 57-70 years). Histologically, all cases were lentiginous malignant melanomas. The average size of the lesion was 5.3cm2. The average size of the flap was 33.1 cm2. The flap color and circulation were intact during the early postoperative period. There was no evidence of flap necrosis, hematomas or infection. All patients had a normal gait after the surgery. Sensory return progressively improved. Received October 24, 2009Revised November 23, 2009Accepted January 22, 2010Address Correspondence: Suk Joon Oh, M.D., Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan- gu, Anyang-si, Gyeonggi-do 431-070, Korea. Tel: 031)380-3781 /Fax: 031)380-5980/E-mail: sjoh@hallym.or.kr Conclusion: Use of an island medial plantar flap based on the lateral plantar vessel to the variable weight-bearing sole is a simple but useful procedure for the reconstruction of any difficult lesion of the weight-bearing sole.
Abnormal Activities of Tropical Cyclones in 2019 over the Korean Peninsula
문민철,김혜렴,하경자 한국기상학회 2021 한국기상학회 학술대회 논문집 Vol.2021 No.10
본 연구에서는 최근 30년(1990-2019)동안 북서태평양에서 발생한 열대 저기압과 한반도에 영향을 준 열대 저기압의 시공간적인 특성을 분석하고, 2019년 이례적으로 많은 열대 저기압이 한반도에 영향을 준 원인에 대하여 분석하였다. 2019년 북서태평양에서 발생한 열대 저기압은 기후값에 비하여 3월-6월은 평균이하로 나타났고, 9월-11월은 평균이상으로 나타났다. 한반도에 영향을 준 열대 저기압의 경우 5월-10월로 분포하던 기후값과 비교해 7월-9월로 집중되었다. 7-9월의 평균을 통해 대기의 하층부터 상층의 주요한 관련 인자들을 분석했다. 해수면 온도의 경우 5,6월부터 한반도 주변의 온난한 해수면 온도 아노말리가 나타나고 차가운 해수면 온도 아노말리가 배치되며, 열대저기압이 한반도를 향하기 좋은 조건이 발달하였다. 그리고 500 hPa 지위고도의 아노말리패턴을 통해 알루샨 저기압의 강화와 더불어 삼중구조의 기압배치를 통해 일본 부근의 고기압성 아노말리가 열대 저기압이 북상함에 있어 한반도를 향하게 만든 주요한 영향 중 하나로 나타났다. 그리고 저위도에서 바람시어의 아노말리가 동서로 이중구조를 나타내고, 중위도에서 일본 동쪽에서 강한 양의 아노말리가 발달하며 상대적으로 윈드 시어가 약한 한반도 부근에 열대저기압이 향하기 좋은 공간적 특성이 나타났다. 다음과 같은 공간패턴들을 기후값과 아노말리를 분리하여 열대저기압의 수치모형 실험을 통해 가장 지배적인 영향 인자가 무엇인지 규명하고자 한다.