좌골부 및 전자부 욕창의 재건을 위한 후대퇴근막 피판술

문구현,방사익 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적: 욕창은 장기적으로 반복되는 압박으로 인해 피부 및 연부조직에 생긴 괴사를 말하며 이는 주로 골 돌출부 주위에 잘 발생한다. 이러한 욕창은 교통사고 및 산업재해의 증가로 척추손상 및 지체마비 환자가 늘어나고 집중 치료를 요하는 의식불명, 만성병증의 환자수가 증가하면서 그 발생 빈도도 증가 하고 있다. 그리고 욕창은 천골부, 대전자부 및 좌골부 등에서 호발한다. 추후에 보행이 가능한 환자의 경우 근피판보다는 근육을 보존할 수 있는 근막피판을 사용하는 것이 수술 후 보행에 더 도움을 줄 수가 있다. 그러므로 기존에 수술적 치료를 시행한 환자의 경우나, 욕창의 크기가 큰 경우, 추후에 보행이 가능한 환자에게 있어서 사용할 수 있는 술식의 유용성을 확인하고자 했다. 대상 및 방법 : 1999년 9월부터 2000년 8월까지 본원에 입원 중이던 6 례의 전자부 욕창과 5례의 좌골부 욕창을 가진 남자환자 7명, 여자환자 4명을 대상으로 하였으며, 원인별로 볼 때는 하반신 마비가 가장 많았다. 하둔부동맥 및 대퇴 심동맥의 제 1, 2 심부관통동맥으로부터 혈액공급을 받는 후대퇴근막피판을 작성한 후 피판을 전위하는 방법을 사용하였다. 결과: 피부 괴사등의 합병증 없이 모른 예에서 결손 부위을 막을 수가 있었으며 적당한 연부조직을 함께 전위 시켜줌으로 해서 추적관찰 기간 동안 욕창의 재발을 방지 할 수 있었으며 보행이 가능한 환자에 있어서도 보행에 문제가 없었다. 결론: 하둔부동맥 및 대퇴 심동맥의 제 1, 2 심부관통동맥으로부터 혈액 공급을 받는 후대퇴근막피판술은 수술이 쉽고, 출혈이 비교적 적으며 수술시간이 짧고, 피판 공여부의 봉합이 쉬우며, 보행 가능한 환자에서는 하지 근육의 기능을 보존할 수 있고, 만약 욕창이 재발 시 피판을 재거상 하여 전진시킴으로서 치료가 가능하며, 근육의 손상을 주지 않으므로 재발시 다른 수술 적 방법을 고려할 수 있는 여러가지 장점이 있는 술식이라 판단된다. Purpose : Pressure sore is an area of ischemic tissue loss resulting from prolonged or often repeated pressure, usually over a bony prominence of body. There has been recent reports describing superior durability of fasciocutaneous flap in sore reconstruction over musculocutaneous flap. Contrary to common musculocutaneous flap using gluteus & harmstring muscle, posterior fasciocutaneous flap does not incorporate any muscle, making it useful especially in ambulatory patients. Material and Methods : From September 1999 to October 2000 we have used posterior thigh fasciocutaneous flap for coverage of six trochanteric sores and five ischial sores. Posterior thigh fasciocutaneous flap is perfused by first & second profunda femoris perforating arteries. Results: All the patients recovered without any serious complications. Three cases developed minimal hematoma but it was corrected by simple evacuation. During the follow up period none of the patients were recurred and for those patients who were able to walk, there was no problem in walking. Conclusion : Posterior thigh fasciocutaneous flap has several advantages. It is easier to elevate, less operation time, less hematoma formation, good donor site morbidity and making possible to preserve the muscle component.

Osseointegration을 이용한 절단된 수지 재건의 임상치험례

방사익,박양수,문구현 충북대학교 의과대학 충북대학교 의학연구소 1998 忠北醫大學術誌 Vol.8 No.2

연구목적 : 절단된 무지의 재건시 족지 유리전이술,무지형성술등이 시행되어왔으나 이는 숙련된 기술을 요하고 공여부의 희생이 문제되어왔다. 보다 기술적으로 용이하고 간편하며 쉽게 적용할 수 있는 수술법을 찾고자 골통합술을 무지결손환자에게 시도하였다. 재료 및 방법 : 수지절간 관절부위의 외상성 무지절단환자에서 골통합 티타늄 고정기을 이용하여 무지보형물을 무지근위지골에 접합시키려 2단계 수술을 시행하였다. 1단계로 장골 해면 질골이식과 같이 고정기를 근위지골 원위단 골수강래에 삽입시켰다. 고정기가 주변골과 통합이 되는 3개월째에 고정기를 노출시키고 그 위에 접합체를 고정시키는 수술을 실시하였다. 2주후 무지보형물을 접합체를 이용 고정기에 고정시킬수 있었다. 결과 : 술후 12개월간 추적관찰한 결과 고정기의 골통합이 유지되었고, 피부괴사 등의 합병증은 발생하지 않았으며 어느정도의 식별촉각을 보였다. 결론 : 절단된 수지의 재건에 있어서 골통합을 이용한 보형물법이 선택적 경우에 효과적인 대안이 될 수 있겠다 Purpose : Reconstruction of amputated finger is challenging field. Free toe-to-finger transfer, pollicization are well-known useful methods but require skillful techies, sacrifice of donor digit. To find and evaluate more readily appliable method, we tried to reconstruct amputated finger using osseointegration. Materials and Methods : A case with traumatic amputation of the thumb at the interphalangeal joint level underwent two stage reconstruction aimed at fixation of a thumb prosthesis to the first proximal phalangeal bone via an osseointegrated titanium fixture. The first stage included insertion of the fixture into the medullary cavity of the first proximal phalanx in combination with transplantation of cancellous bone from the iliac crest. After 3 months. when the fixture was firmly integrated into the bone, a skin-penetrating abutment was placed on top of the fixture, the surrounding skin being thinned to the thickness of a split-thickness skin graft to minimize relative mobility. A thumb prosthesis could then be firmly attached to this fixture. Results : At follow-up examination at 12 months postoperatively, good osseointegration of the implant persisted. There was no skin problems. Some extent of tactile discrimination was achieved in the prosthesis hypothetically based on transfer of tactile stimuli to endosteal nerves in the bone via the titanium fixture. Conclusion : Amputated finger can be successfully reconstructed using osseointegrated implant without sacrifice of donor toe or finger.

웹 기반의 모형과 지리정보시스템을 이용한 통합적 수환경관리기법

문현생(Mun Hyun-Saing),김준현(Kim Joon Hyun),김종철(Kim Chong-Chaul) 강원대학교 환경연구소 2001 環境硏究 Vol.18 No.-

성공적인 유역관리정보시스템을 구축하기 위한 전략

문현생 ( Hyun Saing Mun ),이혁 ( Hyuk Lee ),이윤아 ( Yun A. Lee ) 한국물환경학회 2004 공동 추계학술발표회 Vol.2004 No.-

주암호 전이대에서의 계절적 수질변동에 관한 연구

문현생 ( Hyun Saing Mun ),허유정 ( Yu Jeong Huh ),박수영 ( Su Young Park ),장남의 ( Nam Ik Chang ),최유진 ( Yu Jin Choi ) 한국물환경학회 2007 한국물환경학회·대한상하수도학회 공동 춘계학술발표회 Vol.2007 No.-

포스터발표 : 수질관리 ; 성공적인 유역관리정보시스템을 구축하기 위한 전략

문현생 ( Hyun Saing Mun ),이혁 ( Hyuk Lee ),이윤아 ( Yun A. Lee ) 대한상하수도학회 2004 공동추계 학술발표회 논문집 Vol.2004 No.-

웹 기반의 모형과 지리정보시스템을 이용한 통합적 수환경관리기법

문현생(Hyun Saing Mun),김준현(Joon Hyun Kim),김종철(Chong Chaul Kim) 한국환경영향평가학회 2001 환경영향평가 Vol.10 No.3

Since the middle of 1990s, in Korea a few researches on the optimal management technologies combining numerical model and GIS for the management of water environment in drinking watershed area and reservoir such as Paldang Lake have been carried out. In this study, the integrated water environment management system was been suggested to efficiently reflect the public awareness of the environment by integrating the web based distributed data collection system, GIS, public hearing system and water quality model. As all the components of the system have been developed using the World Wide Web and all data have been collected from the relevant agencies through the Internet, the water quality model could be implemented on the web directly. In consequence, the environmental geographic information in Paldang Lake could be acquired and analyzed through the Internet. The system can rapidly respond to the public right to know on environment, so the public will willingly participate in the governmental projects on environment. To verify the usability of the developed system, it has been applied to Paldang Lake. Especially when the web based model has been used, users can easily and confidentially get the prediction results by applying the minimum number of parameters for the water quality model. This model will provide clearness and scientific bases in the process of water quality prediction for the sensitive sites where there are critical conflicts between the residents and the developers. In this study, rapid water environment management technique without spatial and time limit has been suggested, which can contribute to the efforts on the government and the public participation.

전두동 골절 환자의 치료

방사익,문구현,이종희 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

The frontal sinus has importance from the aesthetic and functional points of view, so management of the frontal sinus should be conducted. The management may differ with the severity of displacement, the extent of displacement, as well as the involvement of the brain and nasofrontal duct. Fifteen patients with frontal sinus fracture were managed differently depending on the severity of their injuries for between 14 and 31 months, and then evaluated. During the follow-up period, encountered no complications and the overall result of the foreh ead contour was satisfactory.

천골부 욕창의 재건을 위한 둔부 V-Y 전진 근막 피판의 임상적 응용

방사익,문구현,이태섭 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.6

For treatment of the pressure sore, varieties of methods have been developed such as skin graftings, local flap, myocutaneous or fasciocutaneous flap, etc.. Except mild cases, myocutaneous flaps have been used commonly for the best coverage and padding of the wound. But the gluteus maximus muscle is not an expendable muscle, so the myocutaneous flaps using gluteus maximus muscle result in significant functional loss in ambulatory patients. Various methods as fasciocutaneous flap to reserve a function of the gluteus maximus muscle have been developed. We especially designed a bilateral fasciocutaneous flap in the fashion of interdigitating extended V-Y advancement in sacral sore when the defect is fusiform transversely in shape. With this design, we obtained reduced tension in the midline suture with less dissection in medial portion of the fasciocutaneous flap and made the flap more rleliable by including more parasacral perforators within the flap. We have experienced the eight cases of gluteal fasciocutaneous V-Y advancement flap and obtained the excellent results without flap necrosis. We conclude that a bilateral fasciocutaneous flap in the fashion of interdigitating extended V-Y advancement is useful in sacral sore when the defect is fusiform transversely in shape.

열 영상에서의 걸음걸이와 얼굴 특징을 이용한 개인 인식

김사문(Sa-Mun Kim),이대종(Dae-Jong Lee),이호현(Ho-Hyun Lee),전명근(Myung-Geun Chun) 대한전기학회 2016 전기학회논문지 P Vol.65 No.2

Gait recognition has advantage of non-contact type recognition. But It has disadvantage of low recognition rate when the pedestrian silhouette is changed due to bag or coat. In this paper, we proposed new method using combination of gait energy image feature and thermal face image feature. First, we extracted a face image which has optimal focusing value using human body rate and Tenengrad algorithm. Second step, we extracted features from gait energy image and thermal face image using linear discriminant analysis. Third, calculate euclidean distance between train data and test data, and optimize weights using genetic algorithm. Finally, we compute classification using nearest neighbor classification algorithm. So the proposed method shows a better result than the conventional method.