• Journal of Chest Surgery
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• 제23권4호
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• pp.785-790
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• 1990

A 30-year-old male with a symptomatic aberrant right subclavian artery underwent surgical intervention on January 17, 1990. An aberrant right subclavian artery is a rare congenital anomaly, but it is the most common one of the aortic arch anomalies. This anomalous vessel usually does not produce symptoms, but occasionally symptomatic patients require surgical intervention. Although ligation and division of the aberrant right subclavian artery through left thoracotomy has been advocated by many surgeons, the ischemic symptoms of the upper extremity or the brain can occur. In the procedure described here, ligation and division of the aberrant artery and its anastomosis to the ascending aorta with Gore \ulcornerTex vascular graft was performed simultaneously through midsternotomy. With this procedure, we relieved the esophageal obstruction and established normal blood flow to the right arm. Hoarseness developed postoperatively. We consider that above symptom has been attributed to the injury of the left recurrent laryngeal nerve during dissection.

• Journal of Chest Surgery
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• 제21권1호
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• pp.184-190
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• 1988

The treatment of aortic aneurysm of ascending aorta has been fraught with difficult surgical problems. For the most part, these were resolved in 1968 with the introduction of a technique of total replacement of ascending aorta and reimplantation of the coronary arteries by Bentall and De Bono. This technique however, with all of its advantages, caries a certain problems. In chronic dissecting aneurysms, there is frequently a marked disparity in circumference between the true and false lumen distally. Distal perfusion is directed into both the true and false lumens by removing segment of the septum between the two lumens and constructing the distal graft anastomosis is to the outer layer of aortic adventitia. The distal false lumen, aortic branches and fenestrations have matured and healed in most cases. And importantly, major aortic tributaries may be solely dependent on the false lumen for perfusion. We are presenting two cases of chronic dissecting aneurysm of ascending aorta with aortic regurgitation, who have good result by surgical correction of so-called Bentall procedure with maintenance of blood flow directed into both true and false lumen.

• 대한기관식도과학회지
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• 제18권1호
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• pp.9-12
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• 2012

Boerhaave's syndrome is a very fatal condition occuring esophageal rupture during emesis and has the worst prognosis of the esophageal perforation. From May 2007 to March 2012 11 patients underwent surgical treatment for Boerhaave's syndrome at Inje University Sanggye Paik Hospital. There were 11 males whose mean age was 49.9 years ranging from 42 to 59. 2 cases of primary closure was performed and 9 cases of anastomosis using EEA (Esophago-Enteric Anastomisis) stapler. Mean operation time was 154.4 minutes and one patient who undergone primary repair died because of mediastinitis and sepsis on $35^{th}$ post-operative day. There was no leakage at other patients. Post-operative complication was one operative wound infection and one post-operative bleeding which was treated completely. Surgical treatment for Boerhaave's syndrome using EEA stapler is simple and effective technique but further studies with large number of cases should be carried out for better outcome.

• Archives of Reconstructive Microsurgery
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• 제26권1호
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• pp.1-8
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• 2017

Lymphedema is a frequent complication after the treatment of various cancers, particularly breast cancer, gynecological cancers, melanomas, and other skin and urological cancers. Lymphedema patients have chronic swelling of the affected extremity, recurrent infections, limited mobility and decreased quality of life. Once lymphedema develops, it is usually progressive. Over time, lymphedema leads to fat deposition and subsequent fibrosis of the surrounding tissues. However, there is no cure for lymphedema. Recently, the development of microsurgery has led to introduction of new surgical techniques for lymphedema, such as vascularized lymph node transfer. We report here the latest trends in the surgical treatment of lymphedema, as well as diagnosis and conventional treatments of lymphedema.

• Journal of Yeungnam Medical Science
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• 제40권4호
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• pp.426-429
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• 2023

Surgical site infection is a common healthcare-associated infection that rarely occurs several months after surgery. Herein, a case is described in which an abdominal mass lesion was found at a 6-month follow-up visit after gastrectomy was performed for early gastric cancer. Positron emission tomography-computed tomography revealed a 2.5 cm-sized mass with a high maximal standard uptake value (8.32), located above a previous anastomosis site. Locoregional recurrence of gastric cancer was diagnosed by multidisciplinary team discussion, and explorative laparotomy was performed. However, surgical and pathologic findings revealed that the mass was an intraabdominal abscess. In conclusion, differential diagnosis of delayed abscess formation should be considered if the possibility of tumor recurrence is low, especially after early gastric cancer surgery.

• Archives of Reconstructive Microsurgery
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• 제23권2호
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• pp.97-100
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• 2014

The number of patients with chronic renal failure who require renal replacement therapy is increasing and dialysis is still the mainly used renal replacement therapy. The first choice of surgical technique currently used is side-to-end anastomosis of the radial artery and the cephalic vein. The authors report on a case of an effective arteriovenous shunt operation performed using microscopy. A 53-year-old male with chronic renal failure was referred to plastic and reconstructive surgery department to undergo an arteriovenous shunt operation. Venography was performed before surgery in order to find the appropriate vessel for the arteriovenous shunt operation. The cephalic vein on the wrist showed a diameter of over 4 mm, which was appropriate for an arteriovenous shunt operation. Anastomosis of the vessels was performed under microscopy using Nylon #9-0. Blood flow and vessel diameter were evaluated by venography after surgery and showed well maintained function of the shunt. Complications such as bleeding, edema of the upper arm, and wound dehiscence did not occur. Many factors and certain complications may affect the long-term patency of an arteriovenous shunt; however, exquisite surgical technique is the most important factor in a successful operation. Thus, arteriovenous shunt operation using microscopy is thought to be a good treatment option.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.246-253
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• 2021

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient's pathology, the treatment plan should be carefully decided and individualized. At the authors' institution, the treatment plan is made individually based on each patient's symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient's pathophysiology, optimal outcomes can be achieved. Depending on each patient's pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.227-239
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• 2022

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권3호
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• pp.267-271
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• 2006

Lymphangiomas are benign tumors of the lymphatic system characterized by congenital lymphatic malformation such as anastomosis or obstruction of the lymphatic channels. They are most frequently diagnosed in children younger than 2 years, and the lymphangiomas in head and neck represent about 50-75% of all lymphangiomas. Spontaneous regression is rare, and rapid enlargement occurs secondary to infection or trauma. Enlargement may cause serious sequence such as airway obstruction, feeding difficulties, and cosmetic problems. Treatments previously used for lymphangiomas include surgical excision and intralesional injection of sclerosing agents. Problems associated with surgical excision include the risk of scarring, damage to surrounding vital structure and the high risk of incomplete excision. The sclerosing agents previously used have numerous local and systemic side effects as their problems. We present a case of lymphangioma occured in tongue that was treated by surgical excision and sclerotherapy with OK-432.

• Journal of Chest Surgery
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• 제54권3호
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• pp.206-213
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• 2021

Background: Tracheoesophageal fistula (TEFs) is a rare condition that requires complex surgical treatment. We analyzed the surgical outcomes of TEF reported in the literature and at Pusan National University Yangsan Hospital using standardized techniques. Methods: This retrospective study included 8 patients diagnosed with acquired benign TEF between March 2010 and December 2019. The surgical method was determined based on the size of the fistula observed within the endoscope. Results: TEF occurred in 7 patients (87.5%) after intubation or tracheostomy and in 1 patient (12.5%) after esophageal surgery due to conduit necrosis. For tracheal management, 5 and 2 patients underwent tracheal resection and end-to-end anastomosis and primary repair, respectively. The median length of resection was 2.5 cm (range, 1.3-3.4 cm). For esophageal management, 6 patients underwent primary repair and 1 patient underwent esophageal diversion. One patient underwent TEF division with a stapler. Interposition of a muscle flap was performed in 2 patients. TEF recurrence, esophageal stenosis, and dehiscence or granulation occurred in 1, 1, and 2 patients, respectively. A long-term tracheostomy tube or T-tube was used in 2 patients for >2 months. Conclusion: Although TEF surgery is complex and challenging, good results can be achieved if surgical standards are established and experience is accumulated.