• Archives of Plastic Surgery
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• 제36권4호
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• pp.462-468
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• 2009

Purpose: The liposuction has been generalized & undergone in the field of plastic surgery and it has had a great influence on fat graft. But despite of liposuction and fat injection being performed widely, we did not focus on complication associated with donor site. So we reported satisfactory result with the intraoperative sustained limited expansion & direct closure to donor site tissue necrosis after liposuction and analyzed the cause & measures of donor site necrosis with the literature investigation Methods: From November 2007 to June 2008, we treated four cases of tissue necrosis and infection surrounding the thigh and forearm. Necrosis after liposuction was 1 case, donor site necrosis after fat injection were 3 cases and MRSA was detected in 2 cases. first, we debrided the necrotic tissue and treated with potadine gauze soaking dressing & susceptible antibiotics. After confirmation of healthy granulation tissue, we used intraoperative sustained limited expansion and closed directly of defect & observed the results. Results: The patient was displeased and worried with the unexpected damage concerning the donor site and the procedure concerning time and financial exhaustion, but after confirming no contracture of the scar tissues and only a thin or slightly widened line of scar, showed satisfaction. Conclusion: Because it is fastidious to avoid donor site complication after liposuction & fat injection, enough explanation and understanding on possible complication to donor site are necessary and careful surgery procedure & materials are required. But if donor site necrosis were occurred although close consideration of possible causes of necrosis, we should think about not only wound healing process but also the sequela like scar contracture & cosmetic effect and treat the most adequate method to satisfying both concerns.

• 대한족부족관절학회지
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• 제28권3호
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• pp.102-106
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• 2024

A reverse sural flap is a surgical procedure to repair soft tissue defects, usually in the ankle region. This procedure involves moving a tissue flap from the calf to cover a defect in the ankle. The flap is turned 180° so that the tissue around the wound is supplied with blood by the vessels at the base of the flap, typically preserving the sural nerve and artery. This method is particularly valuable when thick and robust tissue is required to cover defects resulting from traumatic injuries, chronic wounds, or post-skin tumor removal when the local tissue is insufficient for direct closure. In this case, a patient who had undergone surgery for a chronic ulcerative lesion on the Achilles tendon three years prior to presentation at the authors' hospital was treated using a half-width reverse sural flap. Modifications to the sural flap design may be crucial considering the surgical history, blood supply, and defect size around the lower leg. In particular, previous surgeries for lower leg fractures or ligament damage may limit blood supply and require flap design modifications.

• 대한치과교정학회지
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• 제30권3호
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• pp.343-355
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• 2000

본 연구는 과도한 하안면 고경을 동반하는 하악전돌증 환자의 악교정수술시 하악골후퇴 술과 이부 감소 성형술을 동시에 시행한 경우의 경조직과 연조직의 변화에 대해 살펴보고, 그 상관성을 평가하여 향후 진단시 보조자료로서 사용하고자 시행되었다. 골격성 III급 부정 교합으로 진단되어 술전 교정치료를 받고 하악골 후퇴술만을 시행한 성인 환자 20명을 대조군(A군)으로, 안모의 수평적 및 수직적 부조화가 심한 골격성 III급 부정교합으로 진단되어 술전 교정치료를 받고 하악골 후퇴술과 이부 감소 성형술을 함께 시행한 성인 환자 20명을 실험군(B군)으로 하였다. 두 군의 경조직 변화에 대한 연조직 변화 양상과, 경조직 변화에 따른 연조직의 이동 비율을 비교 분석하여 다음과 같은 결론을 얻었다. 1. A, B군 모두에서 경조직의 후방 이동과 하안면 하부 2/3의 연조직(Ils, Pog', Me')의 수평적 변화는 높은 상관성을 보였으며, B군에서는 A군에서보다 Ls, Stm, Li의 수평적 변화에도 중등도 이상의 상관성을 보였다. 2. B군의 경조직의 수직 이동에 따른 연조직의 수직적 변화의 상관성은 Point B-Ils, Me-Me'을 제외하고는 A군보다 적은 것으로 나타났다. 3. 경조직의 변화에 대한 연조직의 변화율을 비교해 보면, B군의 경우Pog'의 후방이동 비율이 A군에서보다 적게 나타났고, B군의 Ils, Pog', Me'의 상방이동 비율은 각각 32%, 54%, 60%로 나타났다. 4. 안면의 수직 고경에 대해서는 A, B군 모두에서 하안면 고경의 유의한 감소로 전안면 고경에 대한 하안면 고경의 비율이 감소하였으나, B군에서는 하안면 상부 1/3(Sn-Stm)의 비율은 변화 양상이 유의성있게 나타나지 않았다. 5. 이부 감소 성형술은 하악후퇴술과 함께 시행시 하안면 상부 1/3(Sn-Stm)의 안모비율에 대한 변화가 적고, 하안면 하부 2/3(St-Me')의 고경을 감소시킬 수 있는 술식이다.

• Archives of Plastic Surgery
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• 제33권5호
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• pp.557-562
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• 2006

Purpose: Advanced carcinoma of the tongue is a devastating disease which may cause severe speech or swallowing dysfunction. But, none to date has provided all of the complex functions of the tongue. The purpose of this study is to review our experiences with individuals who underwent glossectomy followed by reconstruction using free tissue transfer. Methods: Between February 1998 and February 2005, twenty-four patients underwent glossectomy followed by free tissue transfer reconstruction. The defects of tongue caused by partial or subtotal glossectomy were reconstructed by means of radial forearm or lateral thigh free flap with nerve innervation. Especially for the patients who underwent total glossectomy, we reconstructed deglutition muscles anatomically with nerve reinnervation, a procedure that allows the grafted muscle to maintain good tongue bulk without obvious atrophy. Results: Patients were reviewed to determine their functional outcome as it related to speech, deglutition, and aspiration. All patients achieved oral intake of a soft diet and acceptable speech. Conclusion: Although reconstruction following glossectomy using free tissue transfer is not ideal, this procedure is safe and reliable, and provides predictable results. A future challenge is the development of a surgical procedure for reconstruction of a tongue that maintains mobility and sensation using neurotized flaps.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.451-459
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• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

• Journal of Periodontal and Implant Science
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• 제54권2호
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• pp.108-121
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• 2024

Purpose: The aim of this study was to compare changes in soft and hard tissue and the histologic composition following early implant placement in sites with alveolar ridge preservation or spontaneous healing (SH), as well as implant performance up to 1 year after crown insertion. Methods: Thirty-five patients with either intact buccal bone plates or dehiscence of up to 50% following single-tooth extraction of incisors, canines, or premolars were included in the study. They were randomly assigned to undergo one of three procedures: deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered by a collagen matrix (DBBM-C/CM), DBBM-C alone, or SH. At 8 weeks, implant placement was carried out, and cone-beam computed tomography scans and impressions were obtained for profilometric analysis. Patients were followed up after the final crown insertion and again at 1 year post-procedure. Results: Within the first 8 weeks following tooth extraction, the median height of the buccal soft tissue contour changed by -2.11 mm for the DBBM-C/CM group, -1.62 mm for the DBBM-C group, and -1.93 mm for the SH group. The corresponding height of the buccal mineralized tissue changed by -0.27 mm for the DBBM-C/CM group, -2.73 mm for the DBBM-C group, and -1.48 mm for the SH group. The median contour changes between crown insertion and 1 year were -0.19 mm in the DBBM-C/CM group, -0.09 mm in the DBBM-C group, and -0.29 mm in the SH group. Conclusions: Major vertical and horizontal ridge contour changes occurred, irrespective of the treatment modality, up to 8 weeks following tooth extraction. The DBBM-C/CM preserved more mineralized tissue throughout this period, despite a substantial reduction in the overall contour. All 3 protocols led to stable tissues for up to 1 year.

• 대한족부족관절학회지
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• 제13권2호
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• pp.129-132
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• 2009

Purpose: We evaluated the result of operative treatment of the hallux valgus in male patients. Materails and Methods: Total 11 cases (10 patients) of the hallux valgus deformity that treated with operation were evaluated. Following Mann's radiological classification system, there was 1 cases of mild, 8 cases of moderate, and 2 cases of severe. Preoperative, postoperative, postoperative 3 months and postoperative 6 months follow up standing radiographs were used as radiologic evaluation. And we evaluated radiological outcomes by hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA) and clinical outcomes by hallux-metatarsophalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS) score. Result: Radiologically, the mean preoperative HVA $37^{\circ}$ and IMA $13.7^{\circ}$ were improved postoperatively as HVA $11.9^{\circ}$ and IMA $4.7^{\circ}$, and the mean preoperative DMMA $29.4^{\circ}$ and PPAA $8.6$ were improved postoperatively DMMA $13.9^{\circ}$ and PPAA $7^{\circ}$. But, postoperative 6 months follow up HVA, IMA, DMMA and PPAA was increased at $14.2^{\circ}$, $6.3^{\circ}$, $16.1^{\circ}$ and $8.3^{\circ}$. Average AOFAS score were improved from 61.2 points to 75.2 points. Conclusion: In our study, operative treatment of hallux valgus in male patients with proximal metatarsal osteotomy and distal soft tissue procedure showed good results but it was necessary to pay attention to increase aspect of follow up radiologic measurements.

• 대한족부족관절학회지
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• 제9권1호
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• pp.87-93
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• 2005

Purpose: We conducted this study to examine the clinical results of the proximal metatarsal wedge osteotomy using a single screw fixation and the distal soft tissue procedure in patients with moderate to severe hallux valgus deformity. Materials and Methods: Between February 2002 and February 2004, we performed these procedures on 12 patients (15 cases). The 6 cases of all patients had mild to moderate instability in the first MTC (metatarsocuneiform) joint. We estimated the clinical outcomes, the radiological findings and complications. Results: AOFAS score was improved from preoperative 41.5 points to 87.7 points lastly on average. The mean correction angle of HVA and IMA was $23.8^{\circ}$ and $6.6^{\circ}$, respectively. The mean position of tibial sesamoid was 2.67 before surgery and 0.87 after surgery. The mean shortening of the first metatarsal bone was 3.07 mm after surgery. There was no pain and complications on the first MTC joint except the breakage of screw in one case and instability of the first MTC joint was improved postoperatively. Conclusion: We obtained good clinical and radiographic outcomes in our series. So, proximal metatarsal wedge osteotomy using a single screw fixation and distal soft tissue procedure seems one of the good surgical treatments for moderate hallux valgus deformity.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.739-742
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• 2008

Purpose: Breast augmentation is one of the common procedures in plastic surgery today. The shape, size and insertion plane of the implant is decided preoperatively by physical examination of the breast. Pectus excavatum is one of the most common anomalies of chest wall, characterized by a depression of the anterior chest wall. For patients with a mild type of pectus excavatum, the main purpose of the treatment is aesthetic rather than functional improvement. Two most surgical treatment options for skeletal deformity are the Ravitch technique and minimally invasive Nuss repair. Other options for soft tissue repair are implant insertion and autologous soft tissue augmentation. We performed a surgical operation with Nuss procedures and breast augmentation for a patient with mild pectus excavatum and hypoplastic breast. Methods: A 32 year-old female was presented with hypoplastic breast. Preoperative chest CT was performed, showing pectus excavatum. After Nuss procedure, we inserted saline implant(275 cc textured round breast implant, moderate profile) submuscularly to restore adequately projected breast. Results: Patient's postoperative course was uneventful without any complication. After 6 months of follow-up period, the patient had an excellent result, with high patient satisfaction and no complications. Conclusion: For patients with a mild type of pectus excavatum, who do not have cardiopulmonary symptoms and requires for aesthetic improvement, this simple approach with Nuss procedure and breast augmentation achieves excellent aesthetic correction with low complication rate and high patient satisfaction.

• The Journal of Advanced Prosthodontics
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• 제7권2호
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• pp.151-159
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• 2015

PURPOSE. To describe and characterize the surface topography and cleanliness of CAD/CAM manufactured zirconia abutments after steaming and ultrasonic cleaning. MATERIALS AND METHODS. A total of 12 ceramic CAD/CAM implant abutments of various manufacturers were produced and randomly divided into two groups of six samples each (control and test group). Four two-piece hybrid abutments and two one-piece abutments made of zirconium-dioxide were assessed per each group. In the control group, cleaning by steam was performed. The test group underwent an ultrasonic cleaning procedure with acetone, ethyl alcohol and antibacterial solution. Groups were subjected to scanning electron microscope (SEM) analysis and Energy-dispersive X-ray spectroscopy (EDX) to verify and characterize contaminant chemical characterization non- quantitatively. RESULTS. All zirconia CAD/CAM abutments in the present study displayed production-induced wear particles, debris as well as organic and inorganic contaminants. The abutments of the test group showed reduction of surface contamination after undergoing an ultrasonic cleaning procedure. However, an absolute removal of pollutants could not be achieved. CONCLUSION. The presence of debris on the transmucosal surface of CAD/CAM zirconia abutments of various manufacturers was confirmed. Within the limits of the study design, the results suggest that a defined ultrasonic cleaning process can be advantageously employed to reduce such debris, thus, supposedly enhancing soft tissue healing. Although the adverse long-term influence of abutment contamination on the biological stability of peri-implant tissues has been evidenced, a standardized and validated polishing and cleaning protocol still has to be implemented.