• Journal of Chest Surgery
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• v.31 no.5
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• pp.525-530
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• 1998

Thoracoscopic thoracic sympathectomy for primary palmar hyperhidrosis has been known to be effective and to have cosmetic merits compared to conventional open sympathectomy. In spite of its cosmetic advantages over thoracotomy, VATS using 5 mm or 10 mm instruments still has the problem of operative wound as well as pain on trocar sites. Recently, 2 mm thoracoscopic instruments have been used. The purpose of this study was to examine the results of thoracoscopic sympathectomy for palmar hyperhidrosis with 2 mm thoracoscopic instruments. From January 1997 to April 1997, 46 patients underwent bilateral thoracoscopic sympathectomy with 2mm instruments at Seoul National University Hospital. T-2 ganglion was carefully dissected and resected out in all patients. In one patient, the lower third of T-1 ganglion was inadvertently resected together with T-2 ganglion due to poor anatomical localization. In 4 patients who also complained of excessive axillary sweating, T-3 ganglion was resected as well. The instruments were removed without leaving any chest drain after reexpansion of the lung. Trocar sites were approximated with sterile tapes. All patients were relieved of excessive sweating in their upper extremities immediately after the operation. Nine patients(19.6%) showed incomplete reexpansion of the lung, and two of them required needle aspiration. Complications related to the surgical procedures, such as Horner's syndrome, hemothorax, and brachial plexus injury, were not detected in any cases. Most patientsdid not complaine of pain. All patients were discharged from the hospital on the day of operation. Despite a narrow operative viewfield, thoracic sympathectomy with 2 mm thoracoscopic instruments can be performed without increasing any severe complications. We recommend 2 mm instruments for thoracoscopic sympathectomy because they make as the more cosmetic, less painful, and equally effective compared to thoracoscopic sympathectomy using 5 mm or greater instruments.

• Korean Chemical Engineering Research
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• v.58 no.1
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• pp.29-35
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• 2020

In this study, the skin permeability was measured by adding cell penetrating peptides, arginine oligomers; (tetra-D-arginine (R4) and hexa-D-arginine (R6)) to little skin-permeable anti-wrinkle peptides (GHK, GHK-Cu, and Pal-GHK), and the results were analyzed by the following six cases. First, in cases where only anti-wrinkle peptides were contained, copper ions (Cu₂⁺) and palmitic acid enhanced the transdermal permeability. Second, when arginine oligomers (R4, R6) were added to GHK, arginine oligomers (R4, R6) increased percutaneous permeability, and R4 showed better percutaneous permeability. Third, the addition of R4 and R6 to GHK-Cu resulted in increased percutaneous transmittance, followed by R6 < R4 percutaneous transmittance. Fourth, when R4 and R6 were added to Pal-GHK, the percutaneous permeability increased with results in R6 < R4 order. Fifth, when R4 was added to GHK, GHK-Cu, and Pal-GHK, the transdermal permeability increased in the order of GHK+R4 < GHK-Cu+R4 < Pal-GHK+R4. Finally, the addition of R6 to GHK, GHK-Cu and Pal-GHK also resulted in increased percutaneous transmittance in the order of GHK+R4 < GHK-Cu+R4 < Pal-GHK+R4. This study provides optimal conditions for enhancing skin absorption of anti-wrinkle peptides GHK, GHK-Cu, and Pal-GHK, and propose a wide range of applications in anti-wrinkle functional cosmetics by suggesting ways to maximize their efficacy.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.731-735
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• 1990

Simultaneous and non simultaneous bilateral spontaneous pneumothorax patients[273] were reviewed retrospectively from April 1986 to March 1990 in the Dept. of Thoracic and Cardiovascular Surgery, Kyung Hee University Medical College. The incidence of bilateral spontaneous pneumothorax was 13.6%[37] and sexual distribution was male dominant [Male:33, Female:4]. The patients were classified into three major groups according to therapeutic methods: Group I [7]; who were treated with simultaneous bilateral operation for unilateral recurred spontaneous pneumothorax through median sternotomy. Mean age was 20.7 years[17 \ulcorner28] and follow up duration was 7.7 months [3 weeks \ulcorner2 years]. Group II [23];who were treated with staged lateral thoractomy, unilateral thoracotomy and non simultaneous contralateral closed thoracostomy, or simultaneous or non simultaneous bilateral closed thoracostomy. Mean age was 28.6 years [17 \ulcorner56] and follow up duration was 9.8 months[one week \ulcorner3.5 years]. Group III[10] ;who were treated with simultaneous bilateral operation for simultaneous or non simultaneous bilateral spontaneous pneumothorax through median sternotomy. Mean age was 21.4 years[17 \ulcorner28] and follow up duration was 12.8 months[2 weeks \ulcorner2.7 years]. Among the patients managed through median sternotomy simultaneously [Group I and III], there were visible blebs or bullous changed lesions mainly in the apicoposterior segment bilaterally in 15 patients[88.2%] Postoperative complications were 3 cases in Group II [wound infection:2 cases, temporary left wrist drop: one case] but none in Group I and III. Spontaneous pneumothorax recurred in 2 cases, one in Group II and another in Group III but none in Group I. 12 cases of 94 patients[12.8%o] who were treated with unilateral thoracotomy needed contralateral thoracotomy mean 14.9 months[7.5 \ulcorner 25 months] later. Mean age was 20.9 years [17 \ulcorner28]. In conclusion, simultaneous bilateral operation through median sternotomy should be considered in managements of spontaneous pneumothorax, especially in late teens and early twenties except young women for cosmetic reasons.

• Archives of Plastic Surgery
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• v.44 no.4
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• pp.283-292
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• 2017

Background Settlements between doctors and patients provide a solution to complicated disputes. However, some disputes may be renewed as a result of negligence by both parties. The purpose of this study was to review the legal issues that may potentially arise during the preparation of settlement agreements and to propose a list of requirements for ensuring the effectiveness of these settlement agreements. Methods Data from 287 civil cases concerning aesthetic surgery that took place between 2000 and 2015 were collected from a court database in South Korea. Factors that influenced the effectiveness of settlement agreements were analyzed. Results Among the 287 court precedents, there were 68 cases of covenant not to sue. Eighteen cases were dismissed because the settlement agreements were recognized as effective, and 50 cases were sent forward for judgment on their merits because the agreements were not recognized as effective. The types of surgery and types of complications were classified by frequency. We evaluated the geographical distribution of the precedents, the settlement timing, and the effectiveness and economic impact of the settlements. We found that there was no statistically significant relationship among these factors. Four major factors that made a settlement agreement legally effective were identified, and the data showed that fee-free reoperations were not considered by the court in determining the compensation amount. Conclusions When preparing a settlement agreement, it is advisable to review the contents of the agreement rather than to take the preparation of a settlement agreement per se to be legally meaningful.

• Archives of Plastic Surgery
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• v.34 no.1
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• pp.64-69
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• 2007

Purpose: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. Methods: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. Results: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. Conclusion: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.68-72
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• 1998

With the advent of microvascular free-tissue transfer, this single stage resurfacing method for large scar and soft tissue defects around the wrist in the patients of electrical burn has distinctive advantage over the conventional multistage pedicle-flap transfer. Between 1992 and 1996, we treated 9 cases of 8 patients who had large scar around the wrist due to old electrical burn with free flaps as a preparation of staged tendon graft. Mean age was 30.3 years and average scar area was $6{\times}11cm$. The length of time the injury and free flaps was 9 months on an average. Prior to the free flap, we performed the angiography to all patients in order to evaluate the circulation of the forearm and hand and to choose the recipient vessel. In all cases, proximal ulnar arteries in the forearm remained intact and all radial arteries remained intact in 8 of 9 cases on angiogram. The interosseous arteries were well visualized in all cases. We used the ulnar arteries as a recipient artery. The types of flaps used were f scapular cutaneous flaps, 2 dorsalis pedis flaps and a radial forearm flap. Flap survial was 100 percents with satisfactory functional and cosmetic results. Free flaps using ulnar artery as a recipient artery is one of the useful reconstruction methods for the resurfacing of large scar around the wrist in the patients of old electrical burn.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.28-34
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• 1998

The traditionally useful coverage methods of the wrist and hand soft tissue defect are the chinese forearm flap, the ulnar forearm flap. But, this flaps are inevitably sacrifice major vessel to the hand. Advantages of the posterior interosseous artery island flap(PIA Flap) is no need to sacrifice blood supply to the hand and supply relatively large thin, good quality flap and more cosmetic than other forearm flaps. But, it is difficult to dissect and raise because of deep seat, close relation with the posterior interosseous nerve and anatomic variation. Authors evaluated 8 cases of 7 patients in the department of orthopaedic surgery, college of medicine, Hallym University from January, 1993 to December, 1995. The results are as follows: 1. The satisfactory coverage was achieved 7 cases and 1 case failed because of anatomic variation. 2 The pedicle length is average 9cm and the flap size is variable from 3cm by 4cm to 5cm by 8cm. 3. The donor site defect was repaired by direct closure in 5 cases, remained 3 cases combined with skin graft. From our experience we conclude that the PIA flap is one of the useful coverage methods of the wrist and hand soft tissue defect.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.2
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• pp.244-248
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• 1995

Glomus tumor is uncommon tumor with an incidence of about 1% in soft tissue tumors and the single most common location is the subungual region of the finger. Many reports have emphasized that glomus tumors were difficult to diagnose and that the result of surgical removal was good, but nail deformity has received little attention. Most of authors removed the entire nail or partially splitted the nail to exposure the nail bed and tumor. Nobody reported whether nail deformity after operation was present or not. But, an abnormal nail is both a cosmetic and a functional problem in that catches on objects. In this study, our attention was postoperative nail deformity as well as the results of surgical removal. Seven patients(eight cases) who were diagnosed as a subungal glomus tumor in the hand were treated by surgical excision without removal of the nail and followed over twenty two months. And then we report on our experience with 8 cases of subungual glomus tumor which were successfully treated by complete excision without nail deformity.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.539-544
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• 2008

Purpose: There have been limited reports on breast reconstruction after excision of phyllodes tumor. This paper reports four patients who had immediate reconstruction of the breast following excision of phyllodes tumor. Methods: We retrospectively reviewed the medical records of 14 patients from March 2000 to March 2008. Clinical data were analyzed including age, presenting symptoms and signs, type of surgery and metastasis. Results: The mean age was 38.6 years. The mean follow-up period was 40.6 months. Reconstruction was performed with latissimus dorsi musculocutaneous flap in 3 patients and transverse rectus abdominis musculocutaneous flap in 1 patient. Other cases were covered with skin graft or primary repair. 2 local recurrent cases were noted. Conclusion: The breast affected by phyllodes tumor must undergo complete excision. Followed by mastectomy, immediate reconstruction of breast improved cosmetic results, and allowed a wider surgical excision margin of tumor.

• Journal of Yeungnam Medical Science
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• v.9 no.1
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• pp.23-28
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• 1992

Fifty-four marginal rotation procedures for cicatrical entropion and marginal entropion were performed in twenty-eight patients(8 males, 20 females). The age ranged from 4 to 74 years old(mean 51.1 years old). After the follow up periods of 6 to 48 months, excellent correction of the eyelid margin and good cosmetic appearance were noticed in most cases, but nine cases combined with severe trichiasis showed recurred trichiasis requiring reoperation.