• Journal of Chest Surgery
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• 제31권7호
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• pp.697-702
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• 1998

손바닥, 액와부의 다한증은 많은 사람에서 생활의 질에 강한 부정적인 영향을 준다. 기존의 비수술적 치료방법은 이상적이지 못하고 확실한 치료는 상흉부 교감신경절(T2-4) 절제로 얻을 수 있다. 과거에는 전통적인 흉부개방창에 의한 수술이 주요한 방법이었으나 최근에 흉강내시경을 이용해 교감신경절제술을 시행하고 있다. 1995년 1월부터 1997년 8월까지 흉강내시경을 이용해 양측 교감신경절제술을 40명의 환자에서 시행하여서 사망이나 생명을 위협하는 합병증은 없었고 유일한 부작용은 보상성 다한증이었으나 모든 환자에서 만족스러운 증세의 호전을 얻을 수 있었다. 결론적으로 흉강내시경하 제 2, 3, 4 흉부 교감신경절제술은 수장부, 액와부의 다한증 치료에 있어서 효과적이고 안전하며, 경제적인 최소한의 침습성 수술방법이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권2호
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• pp.148-154
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• 2012

Peripheral nerve injuries in the oral and maxillofacial regions require nerve repairs for the recovery of sensory and/or motor functions. Primary indications for the peripheral nerve grafts are injuries or continuity defects due to trauma, pathologic conditions, ablation surgery, or other diseases, that cannot regain normal functions without surgical interventions, including microneurosurgery. For the autogenous nerve graft, sural nerve and greater auricular nerve are the most common donor nerves in the oral and maxillofacial regions. The sural nerve has been widely used for this purpose, due to the ease of harvest, available nerve graft up to 30 to 40 cm in length, high fascicular density, a width of 1.5 to 3.0 mm, which is similar to that of the trigeminal nerve, and minimal branching and donor sity morbidity. Many different surgical techniques have been designed for the sural nerve harvesting, such as a single longitudinal incision, multiple stair-step incisions, use of nerve extractor or tendon stripper, and endoscopic approach. For a better understanding of the sural nerve graft and in avoiding of uneventful complications during these procedures as an oral and maxillofacial surgeon, the related surgical anatomies with their harvesting tips are summarized in this review article.

• Medical Lasers
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• 제8권1호
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• pp.7-12
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• 2019

Background and Objectives Skin and soft tissue defects can be treated according to a range of strategies, such as local flap, skin graft, biological dressing, or free flap. On the other hand, free tissue transfer usually leaves a distinct scar with an inconsistency of color or hypertrophy. This problem is highlighted if the defect is located on the face, which could have devastating effects on a patient's psychosocial health. Materials and Methods The authors used an erbium : yttrium-aluminum-garnet (Er:YAG) laser to resurface the free flap skin and match the color with the surrounding facial skin. This study evaluated the effectiveness of laser skin resurfacing on the harmonious color matching of transferred flap. Patients who had undergone laser resurfacing on facial flap skin between January 2014 and December 2018 were reviewed retrospectively. An ablative 2,940-nm fractional Er:YAG laser treatment was delivered to the entire flap skin at 21 J/cm² with the treatment end-point of pinpoint bleeding. Several months later, the clinical photographs were analyzed. The L^*a^*b^* color co-ordinates of both the flap and surrounding normal skin were measured using Adobe Photoshop. The L^*a^*b^* color difference (ΔE) for the scar and normal surrounding skin were calculated using the following equation: ${\Delta}E=\sqrt{({\Delta}L)^2+({\Delta}a)^2+({\Delta}b)^2}$ Results All five patients were satisfied with the more natural appearance of the flaps. The ΔE values decreased significantly from the pre-treatment mean value of 19.64 to the post-treatment mean value of 11.39 (Wilcoxon signed-rank test, p = 0.043). Conclusion Ablative laser resurfacing can improve the aesthetic outcome of free tissue transfer on the face.

• Medical Lasers
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• 제8권1호
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• pp.13-18
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• 2019

Background and Objectives High-intensity focused ultrasound (HIFU) can produce small zones of thermal damage. A HIFU procedure is non-invasive and it can achieve rejuvenation of facial skin. Fractional CO₂ laser resurfacing delivers thermal damage to the pixilated columnar zone of the skin and so evoke collagen remodeling, the same as HIFU. In many cases, the patients who want rejuvenation with HIFU are also good candidates for cutaneous photorejuvenation such as can be accomplished via fractional CO₂ resurfacing. If patients are treated in a single session by remodeling both the superficial and deep compartments of skin by using both modalities, then improvement in rhytides and tightening of sagging skin will optimize the aesthetic result. Materials and Methods Between May 2014 and January 2018, a total of 44 patients were treated with combination HIFU and fractional CO₂ laser resurfacing according to our protocol. First, the HIFU was applied to the entire face with an average of 300 treatment lines. Immediately after HIFU treatment, the ultrasound gel was washed off and then fractional CO₂ laser resurfacing was performed. We evaluated the patients using 4-point grading scales. The clinician examined the skin for evidence of complications after the completion of treatment. Results All the patients' skin quality showed improvement. Further. the clinical results after duel modality treatment were substantially better than that after the use of either modality alone. The recovery times and the incidence of adverse events when quickly and consecutively performing both treatments were similar as compared to those with employing stepwise treatment. We encountered no complications whatsoever. Conclusion When compared with stepwise therapy, combination therapy with HIFU and fractional CO₂ resurfacing offers better, safer and more effective clinical results. Thus, for targeting multiple layers of aging facial skin, this combination therapy can be safely performed in a single treatment session.

• Archives of Plastic Surgery
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• 제45권2호
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• pp.102-110
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• 2018

Debridement is a crucial component of wound management. Recent technologies such as hydrosurgery (Versajet), ultrasound therapy (the MIST therapy device), or plasma-mediated bipolar radio-frequency ablation therapy (Coblation) seem to represent interesting alternatives for wound debridement. The purpose of this systematic review was to describe, evaluate, and compare these three recently developed methods for the management of chronic wounds. In January 2016, an electronic database search was conducted of MEDLINE, PubMed Central, and Embase for articles concerning these three innovative methods for the management of chronic wounds. A total of 389 references were identified by our search strategy, and 15 articles were included. We extracted data regarding the number and age of patients, indications, operating time, number of procedures, costs, wound healing time, decrease in exudation, perioperative blood loss, bacterial load, and the occurrence of complications. The 15 articles included studies that involved 563 patients who underwent hydrosurgery (7 studies), ultrasound therapy (6 studies), or Coblation (2 studies). Six randomized controlled trials were included that compared the use of a scalpel or curette to hydrosurgery (2 studies) or ultrasound therapy (6 studies). Hydrosurgery, in addition to being a very precise and selective tool, allows significantly faster debridement. Ultrasound therapy provides a significant reduction of exudation, and improves the wound healing time. No comparative study dedicated to Coblation was identified. Despite the obvious clinical interest of the topic, our review of the current literature revealed a lack of prospective randomized studies comparing these devices with each other or with standard techniques, particularly for Coblation and hydrosurgery.

• Journal of Chest Surgery
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• 제42권2호
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• pp.238-243
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• 2009

배경: 하지 정맥류의 치료에 있어 최소 침습 술기의 발달로 고주파 열폐쇄술이나 혈관 내 레이저)를 이용한 수술이 시행되고 있다. 빠른 시간 내에 효과적으로 혈관을 폐쇄시킬 수 있는 7 Fr. VNUS $ClosureFAST^{(R)}$ 고주파 열폐쇄 System이 국내에 소개되었으며, 본 연구는 이 시스템을 이용한 하지정맥류 치료의 조기 결과를 알아보고자 시행되었다. 대상 및 방법: 2007년 5월 2일부터 2008년 5월 31일까지 고주파 열폐쇄술을 이용하여 수술을 받은 90예의 환자를 대상으로 본 연구를 시행하였다. 남자가 67명(74.4%)이었고 환자들의 평균 연령은 $57.9{\pm}11.0\;(23{\sim}78)$세였다. 수술 후 3주와 이후 3개월 간격으로 혈관 초음파와 임상 양상을 분석하였다. 결과: 수술 후 합병증은 반상 출혈(85예, 94.4%)이 가장 많았으며, 통증을 호소하는 경우가 27.8%, 감각 이상 25.6%, 수포 형성 8.9%, 부종 6.7%, 정맥염 2.2% 등이었다. 술후 3주에 시행한 초음파에서 정맥의 역류나 부분적 혈류 재개가 있었던 환자는 1예로, 치료 성공률은 98.9%였다. 3개월 후 초음파 검사상 혈류 재개가 1예에서 더 관찰되었으며, 이후 3개월 간격으로 시행한 혈관 초음파상 혈류 재개가 관찰되었던 환자는 없었으며, 1년 치료 성공률은 97.6%를 보였다. 혈류 재개를 보였던 2예의 환자는 계속 외래 추적 관찰 중이며, 현재까지는 수술 전 보였던 하지 부종이나 저림 등의 증상을 호소하지 않고 있다. 결론: 저자들은 국내에 처음으로 도입된 7 Fr. VNUS $ClosureFAST^{(R)}$ System을 이용하여 하지 정맥류 수술을 효과적으로 시행하였으며, 고위 결찰이나 기존의 고주파 열폐쇄술, 그리고 혈관내 레이저 치료와 장기적인 비교 분석이 필요할 것으로 사료된다.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.92-100
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• 2006

Radial forearm free flap (RFFF) has been established itself as a versatile and widely used method for reconstruction of the head and neck, although it is still criticized for high mortality of donor site. Delayed wound healing, cosmetic deformity, vascular compromise and potentially reduced wrist function have many plastic surgeons hesitate to adapt it as a first choice in micro-reconstruction. To overcome these drawbacks, some techniques for donor-site repair such as V-Y advancement with full thickness skin graft (FTSG), application of artificial dermis ($Terudermis^{(R)}$) or acellular dermal matrix ($AlloDerm^{(R)}$), and double-opposing rhomboid transposition flap have been reported. Authors performed 4 cases of RFFF in old-aged patients of the head and neck cancer from April 2005 to February 2006. We compared the outcomes of donor site of RFFF which were resurfaced with split thickness skin graft (STSG) only and STSG overlying an $AlloDerm^{(R)}$. Patients were all males ranging from 59 to 74 years old (mean, 67.5). Three of them had tongue cancers, and the other showed hypopharyngeal cancer. All cases were pathologically confirmed as squamous cell carcinomas. We included the deep fascia into the flap, so called subfascially elevated RFFF in three cases, and in the other one, we dissected the RFFF suprafascially leaving the fascia intact. The donor site of the suprafascially elevated RFFF was resurfaced with STSG only. Among three of subfascially elevated RFFFs, donor-sites were covered with thin STSG only in one case, and STSG overlying $AlloDerm^{(R)}$ in two cases. All RFFFs were survived completely without any complication. The donor site of the suprafascially elevated RFFF was taken well with STSG only. But, the partial graft loss exposing brachioradialis and flexor carpi radialis muscle was unavoidable in all the subfascially elevated RFFFs irregardless of $AlloDerm^{(R)}$ application. Considering that many patients of the head and neck cancer are in old ages, we believe the RFFF is still a useful and versatile choice for resurfacing the head and neck region after cancer ablation. Its reliability and functional characteristics could override its criticism for donor site in old-aged cancer patients.

• 대한골관절종양학회지
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• 제10권2호
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• pp.88-95
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• 2004

목적: 통증을 동반한 유골 골종의 치료는 일반적으로 수술적 절제로 이루어졌으나, 그 침습성으로 인하여 술후 통증 및 일정 동안의 회복 시간이 필요하였다. 최소 침습적인 방법인 경피적 고주파 열치료를 이용한 유골 골종의 치료는 술 후 통증이 적고, 회복이 빠르며, 재발은 수술적 방법과 비슷한 것으로 보고되어 있다. 이에 저자들은 본원에서 시행한 경피적 고주파 열치료의 임상 결과를 보고하고자 한다. 대상 및 방법: 1999년 4월에서 2004년 5월 사이에 삼성서울병원에 내원하여 유골 골종으로 진단된 환자 22명, 22례를 전산화 단층 촬영 도움 하에 경피적 고주파 열치료를 시행하였다. 평균 연령은 26.5(7~55)세였고, 남자가 15명, 여자가 7명이었다. 이 중 2례는 외부에서 치료 받은 후 재발한 경우였다. 병변의 위치는 대퇴골 13, 경골 4, 비골 1, 상완골 1, 장골 1, 좌골 1, 천골 1례였다. 시술 전 3례에서 경피적 생검을 시행하여 확진 하였고, 나머지는 임상양상 및 방사선 소견으로 진단하였다. 전신 또는 척추 마취 하에 전산화 단층 촬영으로 병소의 위치를 확인한 후 고주파 전극을 병소의 중심부에 위치한 후, 섭씨 80에서 90도로 평균 6(3~8)분간 가열하였다. 외래 추시 및 전화 통화로 증상 호전 여부 및 일상 생활 정도를 추적 관찰하였으며, 평균 추시 기간은 30(4~62)개월 이었다. 결과: 추시 중 19례(86%)에서 통증이 소실되었고, 2례에서는 시술 후 각각 5개월, 12개월에 병변이 재발하였으며, 1례에서는 재발의 증거 없이 지속되는 통증이 있었다. 시술 후 4시간 정도 침상 안정 후 바로 보조기 없이 보행이 가능하였으며, 화상으로 인한 근육 손상이 발생한 1례를 제외한 21례 환자들은 합병증 없이 시술 후 평균 1.9일에 퇴원하였다. 재발이 확인된 2례는 다시 고주파 열치료를 시행하여 증상이 모두 소실되었다. 결론: 유골 골종의 치료에 있어서 전산화 단층 촬영 도움 하 경피적 고주파 열치료는 최소 침습적인 방법으로 술후 통증이 적으며, 회복이 빠르고, 안전하면서, 이제까지 보고된 수술적 절제의 결과와 비교할 만한 우수한 성적을 나타내었다.

• 분석과학
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• 제23권1호
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• pp.1-14
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• 2010

모든 전기전자제품에 대한 유해 중금속 규제법(RoHS)이 유럽과 중국 등 세계 각 나라에서 시작 되면서 이에 대한 중요성이 대두되고 있다. 이와 관련하여, 현재 세계 전기전자 협회(IEC)에서 발표된 IEC 62321 문건은 기존의 표준 분석 규격들과 마찰이 있을 수 있다. 반면에, IEC기술위원회(TC 111) 에서 발표된 시료 채취 및 처리 방법(sampling)에 관한 일반공개규격(Publicly Accessible Specification: PAS)은 기존 규격들과 상호보완적으로 응용될 수 있다. 이 실험에서는 PAS에 준하여 휴대폰시료를 분리 및 분해하는 방법을 찾고, 기존의 분석장치를 이용한 스크리닝방법과 비교하고자 하였다. X선 형광분석법(XRF)은 시료의 전 처리가 필요 없어서, 신속한 분석이 가능하므로 스크리닝에 탁월한 기능을 보여준다. 하지만 이 방법은 표면의 유해물질 정보만 알 수 있으며, 심각한 매트릭스 간섭과 정량을 위한 다양한 표준물질이 없다는 제약이 따르기 때문에, 이를 보완할 수 있는 방법이 필요하다. 본 연구에서는 레이저 박리 유도결합플라스마 질량분석장치(LA-ICP-MS), 에너지 분산형 XRF (ED-XRF) 와 전자주사현미경 에너지분산 X선분광기(SEM-EDX)를 휴대폰 스크리닝에 적용하여 보았으며, 유해중금속이 검출된 일부 부품의 경우에는 흑연로 원자흡수분광분석법(GF-AAS)을 수행하여 농도를 측정하였다. 이 실험결과, 배터리 일부 부품의 경우, GF-AAS와 XRF의 Pb 측정결과는 각각 0.92%와 5.67%로서 차이가 많이 나는 것을 알 수 있었다. 또한, XRF의 상대편차 범위 23-168%는 LA-ICP-MS의 편차 범위인 1.9-92.3% 보다 월등히 큰 것으로 나타났다. 결론적으로, 스크리닝 목적으로 XRF 분석방법을 이용하였다 할지라도, 정확한 함량을 얻기 위하여 GF-AAS의 분석을 수행해야 할 것으로 판단된다. 그리고, 기존 IEC 문건의 스크리닝 방법에는 언급되어 있지 않으나, 본 연구에서는 LA-ICP-MS가 전기전자제품 내에 있는 유해물질들에 대한 정보를 신속하게 얻을 수 있는 스크리닝 방법으로 활용될 수 있음을 확인하였다.

• 한국표면공학회:학술대회논문집
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• 한국표면공학회 2009년도 춘계학술대회 논문집
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• pp.111-112
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• 2009

Diamond-like carbon (DLC) is a convenient term to indicate the compositions of the various forms of amorphous carbon (a-C), tetrahedral amorphous carbon (ta-C), hydrogenated amorphous carbon and tetrahedral amorphous carbon (a-C:H and ta-C:H). The a-C film with disordered graphitic ordering, such as soot, chars, glassy carbon, and evaporated a-C, is shown in the lower left hand corner. If the fraction of sp3 bonding reaches a high degree, such an a-C is denoted as tetrahedral amorphous carbon (ta-C), in order to distinguish it from sp2 a-C [2]. Two hydrocarbon polymers, that is, polyethylene (CH2)n and polyacetylene (CH)n, define the limits of the triangle in the right hand corner beyond which interconnecting C-C networks do not form, and only strait-chain molecules are formed. The DLC films, i.e. a-C, ta-C, a-C:H and ta-C:H, have some extreme properties similar to diamond, such as hardness, elastic modulus and chemical inertness. These films are great advantages for many applications. One of the most important applications of the carbon-based films is the coating for magnetic hard disk recording. The second successful application is wear protective and antireflective films for IR windows. The third application is wear protection of bearings and sliding friction parts. The fourth is precision gages for the automotive industry. Recently, exciting ongoing study [1] tries to deposit a carbon-based protective film on engine parts (e.g. engine cylinders and pistons) taking into account not only low friction and wear, but also self lubricating properties. Reduction of the oil consumption is expected. Currently, for an additional application field, the carbon-based films are extensively studied as excellent candidates for biocompatible films on biomedical implants. The carbon-based films consist of carbon, hydrogen and nitrogen, which are biologically harmless as well as the main elements of human body. Some in vitro and limited in vivo studies on the biological effects of carbon-based films have been studied [$2{\sim}5$].The carbon-based films have great potentials in many fields. However, a few technological issues for carbon-based film are still needed to be studied to improve the applicability. Aisenberg and Chabot [3] firstly prepared an amorphous carbon film on substrates remained at room temperature using a beam of carbon ions produced using argon plasma. Spencer et al. [4] had subsequently developed this field. Many deposition techniques for DLC films have been developed to increase the fraction of sp3 bonding in the films. The a-C films have been prepared by a variety of deposition methods such as ion plating, DC or RF sputtering, RF or DC plasma enhanced chemical vapor deposition (PECVD), electron cyclotron resonance chemical vapor deposition (ECR-CVD), ion implantation, ablation, pulsed laser deposition and cathodic arc deposition, from a variety of carbon target or gaseous sources materials [5]. Sputtering is the most common deposition method for a-C film. Deposited films by these plasma methods, such as plasma enhanced chemical vapor deposition (PECVD) [6], are ranged into the interior of the triangle. Application fields of DLC films investigated from papers. Many papers purposed to apply for tribology due to the carbon-based films of low friction and wear resistance. Figure 1 shows the percentage of DLC research interest for application field. The biggest portion is tribology field. It is occupied 57%. Second, biomedical field hold 14%. Nowadays, biomedical field is took notice in many countries and significantly increased the research papers. DLC films actually applied to many industries in 2005 as shown figure 2. The most applied fields are mold and machinery industries. It took over 50%. The automobile industry is more and more increase application parts. In the near future, automobile industry is expected a big market for DLC coating. Figure 1 Research interests of carbon-based filmsFigure 2 Demand ratio of DLC coating for industry in 2005. In this presentation, I will introduce a trend of carbon-based coating research and applications.