• Title/Summary/Keyword: Anatomic repair

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Surgical Experience of Persistent Type 2 Endoleaks with Aneurysmal Sac Enlargement after Endovascular Aneurysm Repair

  • Bang, Seung Ho;Park, Jae Bum;Chee, Hyun Keun;Kim, Jun Seok;Jang, Il Soo
    • Journal of Chest Surgery
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    • v.47 no.2
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    • pp.167-170
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    • 2014
  • Herein, we present a case of a successful treatment of persistent type 2 endoleaks associated with aneurysmal sac enlargement after endovascular aneurysm repair in an elderly patient. We confirmed the diagnosis by abdominal computed tomography and selective angiography revealing an 11.0-cm aneurysm sac with type 2 endoleaks. An attempt for the endovascular embolization of collateral arteries was unsuccessful due to anatomic variations and their multiple complex communications. Instead, transperitoneal sacotomy and direct suturing on the feeding target vessels was successfully performed without any endograft damage. In conclusion, sacotomy appears to be a feasible therapeutic substitute where endovascular or other techniques have a high risk of failure and lead to unsuccessful results.

Chronic Lateral Ankle Instability (만성 외측 발목 불안정)

  • Kim, Dae-Wook;Sung, Ki-Sun
    • Journal of Korean Foot and Ankle Society
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    • v.22 no.2
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    • pp.55-61
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    • 2018
  • Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients' history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified $Brostr{\ddot{o}}m$ operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.

Scar Revision in Patient with Secondary Cleft Lip Deformity Using Straight Line Repair-Report of Case (직선 봉합법을 이용한 편측 구순열의 반흔성형술 증례)

  • Lee, In-Woo;Lee, Ju-Hwan;Seo, Byoung-Moo
    • Korean Journal of Cleft Lip And Palate
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    • v.12 no.2
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    • pp.95-100
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    • 2009
  • In spite of all fine methods developed for treating cleft lip, a certain percentage of cases might still need secondary correction. Generally, secondary revision of cleft lip is much difficult to produce esthetic outcome, because the cleft lip scar gives a variable symmetrical and anatomic defect that may not be possible to make inconspicuous of this scar and rebuild good esthetics. In this case report, a five year-old girl was underwent secondary cleft lip repair using straight line technique to correct unfavorable postoperative scar, peaking of Cupid's bow, notching of vermillion and shortened lip on cleft side with simultaneous repairing cleft palatal fistula. After operation, the secondary deformity was much improved, but, long term follow up is needed to evaluate the additional postoperative deformity might be happen during growth.

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Lateral Ankle Ligament Reconstruction using Achilles Allograft for Chronic failed Instability - Two Cases Report - (동종 아킬레스건을 이용한 만성 족관절 불안정성의 외측인대 재건술 -2예 보고-)

  • Choo, Suk-Kyu;Suh, Jin-Soo;Amendola, Annunziato
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.2
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    • pp.197-200
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    • 2005
  • We performed lateral ankle ligament reconstructions using Achilles allograft on patients who had failed previous Brostrom repair. The bone plug is fixed with an interference screw into the calcaneus, the tendon graft is passed through a fibular tunnel, and then anchored into the talus with the biotenodesis screw. The graft is strong enough to maintain joint stability until graft incorporation and remodeling occurs. In patients with chronic failed lateral ankle instability requiring graft for ligament reconstruction, this technique allows anatomic reconstruction without the need to sacrifice autogenous peroneal tendons.

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Modified Anatomic Repair of Corrected Transposition of the Great Arteries with Ventricular Septal Defect and Pulmonary Outflow Obstruction (심실중격결손과 폐동맥유출로 협착을 동반한 교정형 대혈관전위증의 해부학적 교정수술)

  • 박계현
    • Journal of Chest Surgery
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    • v.24 no.11
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    • pp.1149-1153
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    • 1991
  • A modified procedure for the operative management of the corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis or atresia was performed in 4 patients. (age ; 18 months-9 years). The operation consists of a venous switch procedure (Senning), intraventricular baffling directing the blood flow from the morphologic left ventricle into the aorta via ventricular septal defect through the right ventriculotomy, and insertion of valved conduit between the morphologic right ventricle and the pulmonary artery. All the four patients had large non-restrictive ventriular septal defects and no evidence of significant mitral valve regurgitation. Both ventricles were well-developed. Three cases had pulmonary atresia, and the remainder had severe subpulmonic stenosis. Postperatively, all patients showed no findings of systemic or pulmonary venous obstruction withnormal sinus rhythm. One patient died of sepsis due to infection by Methicillin-resistant S. aureus on the thirteenth postoperative day. Follow-up is done on the survivors, and all of them are dong well with regular sinus rhythm, with their functional class I or II at 2 to 8 months after the operation.

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Reconstruction of Chronic Ankle Instability with the Toe Extensor Tendon (족지 신전건을 이용한 만성 족관절 불안정성의 재건)

  • Ahn, Jae-Hoon
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.6 no.2
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    • pp.88-91
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    • 2007
  • Persistent instability following an acute lateral ankle sprain eventually require ligamentous reconstruction in some cases. Over 50 surgical procedures have been described to reestablish lateral ankle stability varying from direct in situ repair of the anterior talofibular ligament and the calcaneofibular ligament to augmented reconstructions with either autograft or allograft tissue. The author describes the rationale and the technique of anatomic ankle ligament reconstruction with the 4th extensor digitorum longus tendon.

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OPEN REDUCTION OF MANDIBULAR CONDYLE FRACTURES WITH AND WITHOUT DISCAL INJURY : A CASE REPORT (관절원판의 손상과 관련된 하악과두 골절의 관혈적 정복술의 치험례)

  • Song, Sun-Chul;Kang, Souk-Ki;Kang, Jung-Hoon;Kim, Jin;Kim, Kyung-Wook;Yim, Chang-Joon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.13 no.3
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    • pp.300-304
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    • 1991
  • This is case report of open reduction of condylar fractures with or without discal injury. Many articles described open reduction and internal fixation of condylar fractures emphasize the method of bony reduction and fixation without mention of the position of the disc. So we like to present our cases of open reduction of condylar fractures in conjunction with reconstruction of the disc and associated structures. The pupose of this presentation is to emphasize several well - established principles of trauma management and management of temporomandibular joint injuries, such as 1) in situations of traumatic injury, anatomic restoration is the goal of treatment and, 2) anatomic alignment of the TMJ disc over the condyle is preferable to disc subluxation because the latter may lead to chronic pain, limitation of opening and degenerative arthritis. Although our case is small with short term follow up, we believe that open reduction and internal fixation of condylar fractures in conjunction with disc repair is a biologically sound approach to those fractures indicated for open surgery. Long term follow up will allow better judge the validity of this treatment approach to us.

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Anatomic reconstruction for acromioclavicular joint injuries: a pilot study of a cost-effective new technique

  • Pattu, Radhakrishnan;Chellamuthu, Girinivasan;Sellappan, Kumar;Kamalanathan, Chendrayan
    • Clinics in Shoulder and Elbow
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    • v.24 no.4
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    • pp.209-214
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    • 2021
  • Background: The treatment for acromioclavicular joint injuries (ACJI) ranges from a conservative approach to extensive surgical reconstruction, and the decision on how to manage these injuries depends on the grade of acromioclavicular (AC) joint separation, resources, and skill availability. After a thorough review of the literature, the researchers adopted a simple cost-effective technique of AC joint reconstruction for acute ACJI requiring surgery. Methods: This was a prospective single-center study conducted between April 2017 and April 2018. For patients with acute ACJI more than Rockwood grade 3, the researchers performed open coracoclavicular ligament reconstruction using synthetic sutures along with an Endobutton and a figure of 8 button plate. This was followed by AC ligament repair augmenting it with temporary percutaneous AC K-wires. Clinical outcomes were evaluated using the Constant Murley shoulder score. Results: Seventeen patients underwent surgery. The immediate postoperative radiograph showed an anatomical reduction of the AC joint dislocation in all patients. During follow-up, one patient developed subluxation but was asymptomatic. The mean follow-up period was 30 months (range, 24-35 months). The mean Constant score at 24 months was 95. No AC joint degeneration was noted in follow-up X-rays. The follow-up X-rays showed significant infra-clavicular calcification in 11 of the 17 patients, which was an evidence of a healed coracoclavicular ligament post-surgery. Conclusions: This study presents a simple cost-effective technique with a short learning curve for anatomic reconstruction of acute ACJI. The preliminary results have been very encouraging.

Changes of the Biventricular Outflow Tract after a Half Turned Truncal Switch Operation in Patients with Transposition of the Great Arteries, a Ventricular Septal Defect and Pulmonary Stenosis - 2 case reports - (반회전 동맥간 전환술 후 양심실 유출로의 중단기 변화 - 2예 보고 -)

  • Kim, Jeong Won;Cho, Joon-Yong;Kim, Gun-Jik;Lee, Jong-Tae;Kim, Kyu-Tae
    • Journal of Chest Surgery
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    • v.43 no.1
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    • pp.58-62
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    • 2010
  • Rastelli repair has been considered the procedure of choice for surgically repairing transposition of the great arteries combined with ventricular septal defect and pulmonary stenosis. However, the long term results have been less than optimal and these patients who ungo this procedure can eventually display conduit obstruction, left ventricular outflow tract obstruction and arrhythmias. Many new procedures are now available and they are technically challenging for making a more normal anatomic repair. In our hospital, two patients who had a TGA with VSD and PS have been repaired with a Half Turned Truncal Switch Operation and a Lecompte maneuver in 2003 and 2006, respectively. We report on our two experiences with performing a Half Turned Truncal Switch Operation, and we discuss the changes of the biventricular outflow tract.

Repair of Complete Atrioventricular Septal Defect with Surgical Modification (변형술식에 의한 완전방실중격결손의 교정)

  • 김웅한;김수철;이택연;한미영;정철현;박영관;김종환
    • Journal of Chest Surgery
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    • v.32 no.7
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    • pp.628-636
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    • 1999
  • Background: Recent advances in understanding the anatomy of the complete atrioventricular septal defect(including right-dominant unbalanced atrioventricular septal defect) have led to alternative methods of repairing these defects. Material and Method: From May 1997 to July 1998, 8 consecutive infants(age range, 2 to 28 months, mean body weight 6.0$\pm$2.2 kg) received a single-stage intracardiac repair of the complete atrioventricular septal defect with modified surgical methods. Depending on the specific anatomic structure, the procedure was simplified in 3 patients by a direct closure of the ventricular element of the defect(Group I). Two patients judged unsuitable for direct closure due to a potential left ventricular outflow tract obstruction had received a standard two-patch repair(Group II). The remaining 3 patients with right-dominant unbalanced complete atrioventricular septal defect underwent biventricular repair; to enlarge the orifice of the left atrioventricular valve, the ventricular septal patch was placed slightly more to the right of the ventricular crest, a left sided bridging leaflet was augmented with an autologous pericardial patch, and the leaflet was repaired with a double- orifice(Group III . Result: In all 8 patients, the postoperative echocardiography demonstrated good hemodynamics. Seven patients were weaned from the ventilators after a mean 3$\pm$1 days, and 1 patient was weaned after 24 days due to a reoperation and emphysematous lung problem. A reoperation was performed in 1 patient for progressive left atrioventricular valve regurgitation due to leaflet tearing. There were no early and late mortalities. At the time of the latest review, judging from the echocardiographic criteria, left atrioventricular valve stenosis was mild in 1 patient(mean pressure gradient 6.5 mmHg, 13.5%), left atrioventricular valve regurgitation was absent or grade I in 7 patients(87.5%). The right atrioventricular valve regurgitation was absent or grade I in all 8 patients(100%). Conclusion: Infants with complete atrioventricular septal defect were treated with either a simplified approach with direct closure of the ventricular element of the defect or a modified surgical technique for a right-dominant unbalanced atrioventricular septal defect, depending on the anatomic structure. The results were no operative mortalities and low morbidity.

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