• Archives of Plastic Surgery
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• 제44권3호
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• pp.210-216
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• 2017

Background In treating minor-form or microform cleft lip, obtaining an optimal result is a challenge because of the visible scarring caused by traditional surgery. We present a refined method using muscle overlapping with a minimal skin incision in patients younger than 3 years, a group characterized by thin muscle. Methods The surgical technique involves restoration of the notched vermillion using Z-plasty, formation of the philtral column using overlapping of an orbicularis oris muscle flap through an intraoral incision, and correction of the cleft lip nasal deformity using a reverse-U incision and V-Y plasty. A single radiologist evaluated ultrasonographic images of the upper lip. Results Sixty patients were treated between September 2008 and June 2014. The age at the time of operation ranged from 6 to 36 months (mean, 26 months). The follow-up period ranged from 8 to 38 months (mean, 20 months) in minor-form cases and from 14 to 64 months (mean, 37 months) in microform cases. A notched cupid's bow was corrected in 10 minor-form cases and 50 microform cases. Ultrasonographic images were obtained from 3 patients with minor-form cleft lip and 9 patients with microform cleft lip 12 months after surgery. The average muscle thickness was 4.5 mm on the affected side and 4.1 mm on the unaffected side. Conclusions The advantages of the proposed procedure include the creation of an anatomically natural philtrum with minimal scarring. This method also preserves the continuity and function of the muscle and provides sufficient augmentation of the philtral column and nostril sill.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.639-643
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• 2010

Purpose: Cryptotia is a congenital deformity in which the upper third of the auricle is buried under the temporal skin. It is rare in Caucasians, yet it is more common in Asians. Although a variety of methods to treat cryptotia have been introduced, there is still no acceptable single procedure that can successfully manage this deformity in its entity. We present a triangular V-Y advancement flap and rhomboid flap for correcting cryptotia that can overcome the diverse shortcomings of the conventional methods. Methods: This operative method was used to correct 18 auricles in patients ranging in age from 4 to 33 years. A triangular flap was prepared over the auricle by making a skin incision according to Ohmori's method. Then a rhomboid flap with a side length of about 8 to 10 mm that sets the lower portion as a pedicle in the anterior region was prepared to supplement the contracted portion of the helix. The cartilage deformity was corrected by the banner flap or the radiating cartilage incisions with cartilage graft or high density polyethylene graft. Results: We have treated 16 patients with severe cryptotia using this method and have obtained good aesthetic results. All cases showed widened scaphoid fossa and smooth triangular fossa of antihelix. There were no major postoperative complications, such as necrosis or infection of the flaps. Conclusion: Correction of cryptotia using the triangular V-Y advancement flap and rhomboid flap is useful a method for certain conditions, when a severe contraction of the helix is present.

• Archives of Plastic Surgery
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• 제32권3호
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• pp.304-310
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• 2005

Bulging of the lower eyelid & tear trough groove is regarded as a sign of aging. In the past, the surgical excision of the fat pad has been the mainstray of the management of lower palpebral bag in cosmetic blepharoplasty, Recently, fat pad sliding method has been introduced to make more attractive lower eyelids. We used the fat pad for covering the hollowness of the lower eye lid. And we use redundant fat pad for filling & augmentation of the lower eye lid by reflexion. Redraping of the orbicularis arc, with its accompanying midfacial fat repositioning, anatomically restores the cheek and lower lid to make more youthful contour. By redraping and fixing the orbicularis arc on the medial surface of the orbital rim, it becomes a more attractive midface and may prevent of ectropion. From August, 2002 to July, 2004 in correction of lower palpebral bulge & tear trough groove, these two technique were performed in 42 consecutive individuals (84 lower eyelid) for two-year period. Follow up ranged from 3 to 15 months. (an average of 9 months) Palpebral bulge & tear trough groove were corrected and obtained a youthful midface. Complication was rare. The advantages of these techniques are that: prevent in of secondary palpebral bulge and irregularity of lower eyelid by using of reflexed fat fad; prevent in of ectropion. Thus an attractive midface is obtained by redraping of orbicularis arc.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.237-240
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• 2006

The simultaneous correction of the hypertelorism and exophthalmos combined with craniosynostosis is very rarely performed operative procedures in the world. The craniosynostosis is the congenital anomaly that designates premature fusion of one or more sutures in either cranial vault or cranial base. Hypertelorism is not a distinct clinical syndrome in itself, but is a physical finding secondary to facial and cranial maldevelopment and it is defined as a increase in the distance between the medial orbital walls. Exophthalmos can occur following the decrease in the size of the orbit in patients with developmental skeletal disorders such as craniofacial synostosis. The authors experienced 9-year-old male patient, who has complex cranio-facial abnormality. The craniosynostosis was oxycephaly type and primary fronto-orbital advancement surgery had been performed in other hospital. The abnormal cranial vault combined with hypertelorism and exophthalmos due to maldeveloped both orbital walls. Surgical correction was obtained by various cranio-fronto-orbital remodeling technique such as calvarial bone craniotomy, fronto-orbital advancement, paramedian resection, medial canthopexy, Tessier-Wolfe three wall orbital expansions. We achieved a quite satisfactory result both functionally and aesthetically in a complex cranio-facial deformity patient by combination and modification of previously developed various cranio-facial plasty technique and hereby report the case with brief discussion and review of literature.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.687-691
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• 2008

Purpose: An inverted nipple presents both cosmetic and functional problems. It is a source of repeated irritation and inflammation, and interferes with nursing. In addition, its abnormal appearance may cause psychological distress. With consideration of its underlying pathophysiologic components and severity, a number of techniques have been introduced for correction of this anomaly. The diversity of techniques indicates the lack of a good, sustainable, and durable solution for this quite common problem. We report our method as an alternative solution for correcting of the inverted nipple. Methods: From August 2003 to November 2007, 273 nipples in 147 patients were treated. 126 patients had bilateral inverted nipples. Patient age at the operation ranged from 21 to 63 years(mean age, 34 years). All nipples were congenital anomaly. 45 nipples were graded as grade I, 179 nipples as II, and 49 nipples as III. In the our study, we made some modification to the classic purse-string suture: (1) twice purse-string suture: (2) excision of diamond-shaped skin at the nipple neck: (3) buried suture of the breast parenchyma at the nipple base: (4) some timely release of retraction using Bovie's electrocautery dissection at inner surface of the nipple neck. Results: The operation time averaged 15 minutes. The mean follow-up period ranged from 3 to 48 months, with an average of 8.4 months. There were no complications associated with the surgery, such as infection, hematoma, permanent sensory disturbance, or total nipple necrosis except temporary sensory loss in 9 cases, partial nipple necrosis in 7 cases, and recurred inversion in 15 cases. All patients except recurred inversion were satisfied with their results. Conclusion: We believe that our modified purse-string suture is a reliable, simple, safe, and effective method for correcting the inverted nipple.

• Archives of Plastic Surgery
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• 제46권3호
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• pp.221-227
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• 2019

Background Gynecomastia is a common condition that can cause severe emotional and physical distress in both young and older men. Patients in whom symptomatic recalcitrant gynecomastia persists for a long time are potential candidates for surgery. Methods From January 2014 to January 2016, 15 patients underwent correction of gynecomastia through a single 3-mm incision at our institution. Only patients with true gynecomastia underwent surgery with this new technique. Through the small incision, sharp dissection was performed in a clockwise and counterclockwise direction describing two half-circles. Health-related quality of life and aesthetic outcomes were evaluated using a modified version of the Breast Evaluation Questionnaire (BEQ). Results The patients' average age was 23.5 years (range, 18-28 years), and their average body mass index was $23.2kg/m^2$ (range, $19.2-25.3kg/m^2$). One case was unilateral and 14 cases were bilateral. The weight of glandular tissue resected from each breast ranged from 80 to 170 g. No excess skin was excised. Bleeding was minimal. The mean operating time was 25 minutes (range, 21-40 minutes). No complications were recorded. All lesions were histologically benign. The patients' average score was 3.5 (on a 5-point Likert scale) in all domains of the BEQ for themselves and their partners. Conclusions In this study, we demonstrated the safety and reliability of a new technique that allows mastectomy through an imperceptible 3-mm incision. We obtained high patient satisfaction scores using our surgical technique, and patients reported considerable improvement in their social, physical, and psychological well-being after surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권2호
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• pp.135-142
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• 1997

Despite the current accomplishments with the repair of cleft lips, the surgical management of the nasal deformity remains a functional and aesthetic dilemma for patients, their families, and reconstructive surgeons. Recent improvements in the understanding and technical execution of te primary cleft lip repair have significantly reduced secondary sequelae and the consequent need for secondary surgical correction. But, secondary surgical corrections are necessary according to numerous factors. Such factors include the secondary surgical corrections are necessary according to numerous factors. Such factors include the severity of the initial deformity, the surgical plan, precision of execution of the primary repair, and success of the postoperative management. We preformed the secondary correction of cleft lip and palate in 11 patients via various methods. In conclusion, primary repair of cleft lip and palate patients is the most important to prevent the secondary deformities, and most of cleft lip and palate with secondary deformities must be treated with combined cheiloplasty and rhinoplasty.

• Archives of Reconstructive Microsurgery
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• 제14권1호
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• pp.70-76
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• 2005

The Z-plasty has been known as a most common surgical treatment of congenital circumferential constriction band syndrome of the hand. There were thirteen patients of congenital circumferential constriction band syndrome of the hand. All patients underwent Z-plasty under microscope. we did microsurgical dissection to minimize vascular, neural and lymphatic injury, and then considering secondary correction and scar contracture, tried to preserve as much subcutaneous fat and skin flap as possible without any excision. There were less skin necrosis and lymphedema as a result of vascular compromise. Using microscope offers several advantages. First, preventing vascular, neural and lymphatic injury. Second, getting an accurate suture approximation. finally, preserving as much subcutaneous fat and skin flap as possible without any excision. The outcome of digit growth and contour can be excellent than we expected. As a results, we believe that correction of congenital circumferential constriction band syndrome of the hand under the microscope have better results.

• 대한조선학회논문집
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• 제56권5호
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• pp.389-395
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• 2019

Turret mooring type Floating Production Storage and Offloading (FPSO) is designed to rotate the hull around a turret system. The system is mounted inside a cylindrical moon-pool structure of the ship hull structure. The upper part of the moon-pool structure called Bogie Support Structure (BSS) is supported on ring type rail structure (bogie), so high roundness is required at the top of the structure. In this study, the deformation measured during BSS installation was compared with the predicted values through the thermal elasto-plastic analysis, and the causes of deformation were analyzed. Deformation behavior of cylindrical structure with a very large diameter compared to the thickness was investigated. In addition, a proper welding sequence and correction method for the deformed structure were proposed. This study can be an example of the solution to the tolerance problem of large cylindrical structures.

• 대한조선학회논문집
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• 제55권5호
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• pp.379-384
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• 2018

This study showed the development process of structural design method of BHB(Blast Hardened Bulkhead) which are applicable in preliminary design stage. In the previous 1st report, the simplified structural scantling equations of BHB were formulated theoretically using the modified plastic hinge method supplemented by considering the membrane effects due to large plastic deformation. And the scantling methodology of plate thickness and section area of stiffeners of the curtain plate type BHB was dealt with. In the present 2nd report, derivation process of the correction factors which can adjust the developed scantling equations considering the uncertainties contained in the design parameters was introduced. Considering the actual BHB structures of 3 warship, the correction factors for the developed scantling equations for curtain plate type BHB were derived. Finally the applicability, validity of them and the strategy of future improvement were considered.