• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.4
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• pp.326-329
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• 2002

Adequate alveolar bone height and width are required for the successful placement of dental implants. Conventional therapeutic regimens for alveolar atrophy are bone grafts or augmentation using allografts and membrane (GBR). Conventional graft techniques have some limitations and complications such as infection, soft tissue problem and high resorption rate. Recently, distraction osteogenesis of alveolar bone is considered as a new alternative for ridge augmentation. Distraction osteogenesis was originally defined and popularized by Ilizarov for lengthening of long bone. Some clinicians have tried to apply distraction osteogenesis in treatment of maxillofacial discrepancies. It was also used to augment alveolar bone. Cologne study group successfully applied the technique for augmentation of alveolar bone and designed several miniplate-distractor systems fabricated by Martin Medizintechnik GmbH in Germany. Vertical distraction of alveolar bone was successfully completed in 104 patients with miniplate-distractor systems. The mean distance of distraction was 10.2mm (range: 6-15 mm) and the mean length of segment was 45 mm (range: 6-127 mm). 162 dental implants in 54 patients were placed immediately or 4 weeks later after removal of the distractor. The results of our study show that vertical distraction of alveolar bone is an effective and reliable technique to restore alveolar atrophy and alveolar vertical defect caused by trauma or tumor.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.755-758
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• 2008

Purpose: In order to determine the amount of wound healing, objective sequential assessments of changes in wound size and depth are essential. Although a variety of measurements for wound healing have been proposed, a gold standard for quantifying day-to-day changes in healing has not been established. We present here a simple and non-invasive wound measurement method that quantitatively and accurately documents changes of the size of a raw surface and the volume of a soft tissue defect using a stereoimage optical topometer(SOT) system. Methods: Using a 5mm diameter biopsy punch, four circular wounds were created on abdominal area of a diabetic mouse. Photographs were taken using SOT system at baseline, 5th day and 10th postoperative day. The wound margin was traced on a digitalized photo and evaluated the area and the volume of the wound by SOT system. Results: The SOT system calculated a mean wound surface of $15.93{\pm}0.29mm^2$ and volume of $827.50{\pm}88.86$ intensity/pixel${\times}$area(I/PA) immediately after wounding. On the 5th day after the operation wound surface declined by $10.73mm^2$ and on the 10th day declined by $5.95mm^2$. The wound volume also declined from 827.50 I/PA to 161.75 I/PA and 30.50 I/PA on 0, 5th and 10th day, respectively. Conclusion: The SOT system described in this study represents a reliable, simple, practical, and non-invasive technique to accurately monitor and evaluate wound healing.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.251-256
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• 2011

Purpose: A nasolabial cyst is a rare non-odontogenic, soft-tissue, developmental cyst arising anywhere on the face inferior to the nasoalar region. It is thought to arise from either epithelial remnants trapped along the lines of fusion during the development of face or the remnants of the developing nasolacrimal duct. This study examines various features of nasolabial cysts with bony involvement to provide a basis for correct diagnosis and treatment. Methods: Eight cases of nasolabial cyst treated in Soonchunhyang Hospital between March 2002 and July 2010 were examined in terms of their clinical features and radiological and histological findings. Seven patients underwent surgical excision of the cyst via an intraoral, sublabial approach. One underwent incision and drainage. Results: Our eight patients were seven women and one man. The most frequent symptoms and signs were facial deformity and swelling of the nasolabial fold. Computed tomography (CT) showed a well-circumscribed cystic mass lateral to the pyriform aperture. Seven cases had erosive lesions on CT, and the intraoperative findings were consistent with a nasolabial cyst with a bony defect. Typical histopathological findings showed that these cysts were most frequently lined with respiratory epithelium with ciliated columnar cells and cuboid cells. No patient developed complications or recurrences. Conclusion: A nasolabial cyst is often unrecognized or confused with other intranasal masses, including fissural and odontogenic cysts, midface infections, or swelling in the nasolabial area. Therefore, a careful clinical and radiological evaluation should be preformed when considering the differential diagnosis. We present eight patients with nasolabial cysts treated via a gingivobuccal approach with excellent functional and cosmetic results.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.20.1-20.7
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• 2015

Background: The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. Methods: Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. Results: All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. Conclusions: The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.352-357
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• 2007

Purpose: The coverage of distal soft tissue defects and bony exposure of the lower extremity has long been recognized to be difficult clinical problem. Covering with a local skin flap is usually impractical because of the extensive and deep crush, hence free flap has been used commonly for the coverage of the wound. Although it can provide good results, it has many disadvantages. Designing an adipofascial flap raised on perforating vessels of the posterior tibia artery is a reliable and simple method to perform, and it can solve these problems. Methods: From May 2005 to May 2006, 8 patients underwent reconstruction of lower leg defects utilizing various type of the posterior tibial artery perforator adipofascial flaps. The flap provided a durable and thin coverage for the defect, as well as a well vascularized bed for skin grafting. Results: The flap size ranged $15-80cm^2$, and skin graft was done for the recipient site. The flap were successfully used for the lower extremity reconstruction in most cases. Minor complications occurred in 4 cases. There was no functional disability of the donor site with esthetically pleasing results. Furthermore, these flaps were both easy to raise and insured sufficient arterial blood supply. Conclusion: We believe there are many advantages to this posterior tibial artery perforator adipofascial flap and that it can be highly competitive to the free flaps in the lower extremity reconstruction.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.214-218
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• 2008

Purpose: Reconstruction of microtia using costal cartilage graft is commonly used technique nowadays. The chest wall depression at the donor site after the graft, however, has been noticed in many articles. Prevention or correction technique for the depression at the donor site also has been reported and we also have been concerned about the problem. This article is a case report about a new technique preventing chest wall depression after costal cartilage graft. Methods: We selected total 15 microtia patients who visited our clinic, from December 2005 to July 2007. They were 10 male and 5 female patients and the mean age was 11.9 years. The average follow up period was 9.2 months(2 to 15 months). We used 6, 7, and $8^{th}$ costal cartilage for microtia reconstruction. And then we turned over pivot of cartilage resection margin, after bihalving costal cartilage involving about 5-6 cm of $6^{th}$ and $7^{th}$ rib bone. After microtia reconstruction, chest donor sites were evaluated by physical examination and radiography. Results: Postoperative depression at the donor site was much less when the costal cartilage turnover technique was performed. Postoperative physical examination and three dimensional reconstruction CT showed that the rest part of rib bone was turned over and it supported the soft tissue defect during respiration. Conclusion: We expect that the turnover rib bone will not be absorbed after graft, as well as offering mechanical support, compared to the other reports.

• Archives of Plastic Surgery
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• v.41 no.4
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• pp.337-343
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• 2014

Background The reconstruction of large skin and soft tissue defects on the lower extremities is challenging. The skin graft is a simple and frequently used method for covering a skin defect. However, poor skin quality and architecture are well-known problems that lead to scar contracture. The collagen-elastin matrix, Matriderm, has been used to improve the quality of skin grafts; however, no statistical and objective review of the results has been reported. Methods Thirty-four patients (23 male and 11 female) who previously received a skin graft and simultaneous application of Matriderm between January 2010 and June 2012 were included in this study. The quality of the skin graft was evaluated using Cutometer, occasionally accompanied by pathologic findings. Results All 34 patients showed good skin quality compared to a traditional skin graft and were satisfied with their results. The statistical data for the measurement of the mechanical properties of the skin were similar to those for normal skin. In addition, there was no change in the engraftment rate. Conclusions The biggest problem of a traditional skin graft is scar contracture. However, the dermal matrix presents an improvement in skin quality with elastin and collagen. Therefore, a skin graft along with a simultaneous application of Matriderm is safe and effective and leads to a significantly better outcome from the perspective of skin elasticity.

• Archives of Reconstructive Microsurgery
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• v.18 no.1
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• pp.31-34
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• 2009

Purpose: Merkel cell carcinoma, also called neuroendocrine carcinoma, is a very rare type of skin cancer that develops as Merkel cells grow out of control. Merkel cell carcinoma is reported below 1% of whole skin neoplasms in the United States and is known that the 2-year survival rate is about 50~70%. The principles of treatment are wide excision of primary lesion with radiotherapy and/or chemotherapy that decrease the local recurrent rate. There has been no report of reconstruction with free flap after resection of Merkel cell carcinoma in Korea. Methods: We reconstructed the skin and soft tissue defect after wide excision of Merkel cell carcinoma with anterolateral thigh perforator free flap in two cases. No distant metastasis was found at the preoperative imaging work-up. In one case, preoperative chemotherapy was performed and the size of lesion was decreased. Results: There were no recurrence and significant complications. Functionally and aesthetically satisfactory results were obtained with reconstruction. Conclusion: Wide excision and reconstruction with anterolateral thigh perforator free flap for Merkel cell carcinoma patient is the first report in Korea. We regard this method as the treatment of choice in Merkel cell carcinoma.

• Archives of Reconstructive Microsurgery
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• v.22 no.1
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• pp.33-37
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• 2013

Purpose: The concept and development of perforator free flaps have led to significant advances in microsurgery. Ongoing developments in perforator free flap surgery are aimed at reducing complications and improving surgical outcomes. The aim of this study was to evaluate the effectiveness and application of supermicrosurgery in free flap surgery. Materials and Methods: A total of 267 patients with soft tissue defects of the lower extremity due to various etiologies from January, 2007 to January, 2013. The patients received either an anterolateral thigh free flap (n=83), a superficial circumflex iliac artery free flap (n=152), an upper medial thigh free flap (n=19), or a superior gluteal artery perforator free flap (n=13). Microanastomosis was performed using a perforator-to-perforator technique, either end-to-end or end-to-side. Results: The mean postoperative follow up period was eight months (range: one to 16 months) and flap loss occurred in 11 cases out of 267. All cases of flap loss occurred within two weeks of surgery due to either arterial insufficiency (n=5) or venous congestion (n=6). Conclusion: Supermicrosurgery enables the selection of the most efficient perforator for microanastomosis at the defect site. It also reduces the time required for dissection of recipient vessels, and reduces the possibility of injury to major vessels. Microsurgery using a vessel of less than 1 mm has been reported to increase the risk of flap failure; however, using the most advanced surgical tools and developing experience in the technique can produce success rates similar to those found in the literature.

• Journal of Periodontal and Implant Science
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• v.24 no.1
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• pp.120-130
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• 1994

The purpose of the present investigation was to compare the effectiveness of porous hydroxyapatite (PHA) and coralline based porous calcium carbonate(PCC) as implant materials in human periodontal osseous defects. 10 adult patients having periodontitis and 2 similar angular osseous defects ${\ge}$5mm as verified by radiographic analysis and clinical probing depth ${\ge}$4mm were selected. The measurements were recorded just before surgery and after 6 month. Clinical parameters used in this study included gingival recession, pocket depth, probing attachment level, Sulcus Bleeding Index, Plaque Index, tooth mobility and bone defect depth measurements. After initial therapy, patients were treated with mucoperiosteal flap surgery. The contralateral bony defects in each patient randomly assigned to either bone graft material, one with PHA(Interpore 200) and the other with coralline based calcium carbonate(Biocoral). After 6 month both groups showed statistically significant reduction of pocket depth, Sulcus Bleeding Index, Plaque Index and significant improvement in probing attachment level. No statistically significant differences were found between the groups. There were 3.0mm or 68% of bone repair with PHA and 3.1mm, 61% with PCC. These values were likewise not significantly different. The data and clinical impression strongly suggest that both PHA and PCC are alloplastic implants with clinically apparent acceptance by the soft and hard tissue and that they can be used as bone graft materials successfully.