Although there are many kinds of method in treatment of tracheal stenosis, tracheal resection and primary anastomosis can be performed for management of various kinds of tracheal stenosis because it is considered the most anatomical ideal therapeutic modality. During a 10-year period we performed 18 tracheal resection on 18 patients with no operative mortality and some morbidity. 13 patients had tracheal stenosis caused by endotracheal intubation [eight patients or tracheostomy [five patients ; and five patients caused by a variety of neoplastic lesions [four primary and one secondary . The length of tracheal stenosis were various from 1.5cm to 5.5cm and site of tracheal stenosis were cervical[17patients and thoracic [one patient . Operative techniques were tracheal resection and primary anastomosis[18 patients and additional procedures were cricoid cartilage reconstruction with costal cartilage [one patient , primary repair of esophagus[one patient and suprahyoid laryngeal release technique[eight patients without any complications. We have eight complications; tracheal restenosis were developed in five patients[growth of grannulation tissue at anastomotic site in three patients, delayed restenosis in two patients , anastomotic disruption in one patient, hoarseness and pneumonia in each of two patients. We managed tracheal complications with T-tube insertion in two patients, permanent tracheostomy in three patients and insertion of Gianturco tracheal stent in one patient, but tracheal stent did not reveal good result because it caused persistent production of sputum. We concluded that it is necessary to access full length of normal trachea including suprahyoid laryngeal release technique to avoid anastomotic tension in tracheal surgery and develope new ideal techniques to manage postoperative tracheal complications, because we suppose tracheal complications are developed due to anastomotic tension.
The submandibular gland is one of the major salivary glands, salivary diseases frequently occuring site due to its anatomical weakness. This retrospective study evaluated data pertaining to history, sex, operation method, age distribution, diagnosis through the chart, operation record, radiographs, histologic finding of 51 patients operated on for the submandibular gland excision from 1986 to 1995 in our hospital so that we improve on the understand of the salivary gland diseases. The results were as follows ; 1. The chief complaints was mass, swelling mainly. 2. The ratio of affected site was 47.1 : 51 in left : right respectly, both sites was 1 case especially. 3. The ratio of men to women was 56.9 : 43.1 4. The operation performed all through the extraoral approach. 5. The sialolith presented at 24 cases. 6. The most patients had a two weeks duration period. 7. The age distribution was the third decade(29.4%), the second decade(27.5%) in order. 8. The symptoms accompanied the chief complaints was pain(37.3%), mass(17.6%), swelling(13.7%), trismus(13.7%) in order. 9. The diagnosis was sialadenitis with stone(S.W.S.) (45.1%), sialadenitis without stone(S.W.O.S.) (17.6%), pleomorphic adenoma(P.A.) (15.7%), abscess(Abs) (5.9%), tuberculosis(Tbc) (5.9%) in drder.
Park Yoon-Kyu;Yoo Bong-Ok;Seel David J.;Lee Young-Sik;Chun Kyung-Doo
Korean Journal of Head & Neck Oncology
/
v.3
no.1
/
pp.15-24
/
1987
This study is limited to epidermoid carcinoma arising in the larynx. The 623 patients in this series comprised 1.6% of all malignant neoplasms seen during the 20-year period .from 1965 to 1984 ; it comprised 13.2% of all cancers of the head and neck registered during this period. The male: female ratio was 11:1, and the highest incidence was in the fifth decade of life. Analysis by anatomical site revealed that 51.7% were supraglottic, 36.1% glottic, and 6.8% subglottic in oriain. One-hundred eighty-nine(79%) were clinically Stage III or Stage IV lesions at the time of the first visit. Of the total of 263 cases, 113 refused treatment, 4 definite radiation for $T_1$. lesion,21 underwent palliative therapy only, and 125 underwent surgical management with intent to cure. This surgical category included 53 patients who had surgical treatment only and 72 who underwent combined therapy(preoperative radiation, postoperative radiation, or inductive chemotherapy followed by surgery and postoperative radiation). The surgical management varied from partial laryngectomy to widefield laryngectomy and ipsilateral neck dissection. In 14.4% pathologically positive node or nodes were found in the clinically negative contralateral neck nedes. Such contralateral spread was most common in supraglottic site of origin(222%). Combined modality of management was compared to single therapy. Although results at three years showed no difference in determinate disease-free survival between patients treated by surgery only and those treated by surgery followed by postoperative radiation therapy at 5 years a statistically significant difference emerged, only 36% of those receiving surgery alone surviving as compared to 65.4% in the surgery with radiation group.
A retrospective study has been made of 170,026 cases of motor vehicle accidents which had been reported to the National Police Headquarters of Republic of Korea, 1983. Also a study has been made of 264 cases of road traffic casualties who were treated at the Eul-ji General Hospital from Jan. 1, 1983 to Dec. 31, 1983. This study was conducted to find out the nature and pattern of the traffic accidents from the clinical and epidemiological view points. In additions, the modes of injury from the road accidents were persued which might help to reduce the traffic accident rate. The results of the study were summarized as follows; 1. In this study, the highest incidence was in the age group between $21{\sim}30$ years (21.29%). And the age group of highest death rate was under 10 years (7.28%). 2. In the comparison of sexual differences, male was dominated in accidents number and death rate. (Casualty rate; 61.66%). 3. In the comparison of each hour differences, the accident was mostly occured during afternoon from 16:00 to 18:00(12.23%). 4. The most common day of week was Sunday (14.74%). 5. The most common season of year was Autumn (27.92%). 6. In the comparison of occupational differences, the high incidences were showed in labor men (31.06%) and business men (12.12%). 7. In the comparison of accidental vehicles, the most common vehicle were cars and the next were trucks and buses. 8. The most common mechanism of accidents was collision (57.41%). 9. In the comparison of clinical differences, orthopaedic and neurosurgical injuries were most common types of the hospitalized casualties. 10. In the comparison of anatomical fracture sites, the most common site was tibia (15.81%) and the next site was femur (12.56%).
The incidence of brachial plexus injury is increasing because of the development of motor vehicle but the the results of treatment was reported poor due to its complex anatomical structure and changes of function and sensory during the recovery after trauma. But the results of treatment has been improved by the recently introduced high sensitive diagnostic method that can evaluate accurately the site and extent of the injury and treatment method. Restoration of the elbow flexion is the most important goal of treatment after brachial plexus injury and nerve graft, neurotization and muscle transfer were used for methods of treatment. From December 1992 to May 1994, the author performed 6 cases of latissimus dorsi transfer at the same side for the improvement of elbow flexion in the patients of brachial plexus injury. There were 5 cases of male, one case of female and average age was 22 years old. The causes of injury were traffic accident in 3 cases, gun shot injury, falldown and birth injury in each one case and in all cases, the type of injury were upper arm type. The average follow up period were 1 year 5 months ranging from 12 months to 4 years 5 months. In all cases, active elbow flexion was impossible before operation and average muscle power was grade I. We analysed the active range of motion, muscle power and the functional results. At the last follow up, range of active elbow flexion was average $124^{\circ}$ and flexion contracture was average 11 degrees and the average of muscle power was grade IV. In the functional analysis, there were two cases of excellent, three cases of good and 1 case of fair. There was no complications including wound infection, vascular compromise and donor site problem. The results of latissimus dorsi transfer for improvement elbow flexion in the patients of brachial plexus injury is one of the useful mettled for the restoration of elbow flexion.
Yun, Min Ji;Eun, Seok Chan;Kim, Min Ho;Baek, Rong Min
Archives of Craniofacial Surgery
/
v.12
no.2
/
pp.111-115
/
2011
Purpose: Reconstruction of a full thickness defect of the nose is a difficult task for plastic surgeons because the anatomical characteristic, shape, and function of the nose all need to be taken into consideration. Most often, a local flap or a composite graft is used, but for a large defect, reconstruction using free flaps is the most ideal method. In free flap reconstruction, the chondrocutaneous preauricular area can be a suitable donor site. We performed a chondrocutaneous preauricular free flap with an interpositional vascular graft for reconstruction of a nasal ala. Methods: A 46 year-old male presented to the hospital with a right alar deformity induced by a dog bite. During the surgery, the existing scar tissue was removed and thereby a newly formed full thickness defect was reconstructed using the chondrocutaneous preauricular free flap with an interpositional vascular graft harvested from the descending branch of the lateral femoral circumflex vessel between the facial and superficial temporal vessels of the free flap. Results: The flap survived without flap loss and showed symmetry in its overall shape, contour, texture, and color. The patient was satisfied with the results and the surgery yielded no additional scars at the nasolabial fold area. Conclusion: The chondrocutaneous preauricular free flap is a valuable method in reconstruction of full thickness defects of the nose, and using the descending branch of the lateral femoral circumflex vessel as the interpositional vascular graft at the anastomotic site produces reliable results.
Background Reactive oxygen species cause serious damage to the physiological function of tissues. Determination of total antioxidant capacity of skin tissue is one of the determinants of damaged tissue function. Mast cells (MCs) are one of the groups of cells that are invited to the site of injury. The healing process begins with the rapid release of various types of MCs' intermediate factors at the site of injury. Bone marrow mesenchymal stem cell (BMMSC) production and secretion have been shown to regenerate the skin. The aim of this research was to evaluate the wound-healing and antioxidant effects of BMMSCs per MCs. Methods Fifty-four albino Wistar male rats were divided into three groups: (1) nonsurgery, (2) surgery, and (3) surgery + BMMSCs. Groups 2 and 3 were operated with a 3 × 8 cm flap and in group 3, cell injections (7 × 109 cell injection at the time of surgery) were performed. After days 4, 7, and 15, percentage of the surviving tissue, histological characteristics, superoxide dismutase (SOD) activity, and amount of malondialdehyde (MDA) were measured in the groups. For results, Graph Pad Prism 8 software was used, and data were analyzed and compared by analysis of variance and Tukey test. Results BMMSCs' application decreased the amount of MDA, increased SOD activity and survival rate of the flaps, and improved the histological characteristics. Conclusion This study revealed the protective effects BMMSCs alongside MCs against oxidative stress on the survival of the flaps. However, for clinical use, more research is needed to determine its benefits.
A 6-year-old intact male Cane Corso dog weighing 40 kg with a 2-month history of dysuria, dyschezia, anorexia, intermittent panting, and penile discharge presented to the Veterinary Medical Teaching Hospital of Jeju National University. Examination revealed a giant paraprostatic cyst (PPC) that occupied a large part of the abdomen and caused displacement of organs. Radiography, ultrasound, and computed tomography (CT) scans confirmed that the PPC had spread to the pelvic regions. Subtotal resection was performed, leaving two sites with PPC remnants. One site was the prostate gland, which communicated with, and adhered to, the PPC; the other site was the pelvic region, where the PPC had spread. The reason for leaving two remnants was that an anatomical approach for complete resection was difficult, and to avoid complications associated with prostatic urethra damage. Routine omentalization and castration were performed. Partial cystectomy was performed because of the presence of a diverticulum-like lesion in the ventral part of the urinary bladder. The patient's clinical symptoms, including dysuria, completely resolved, and voluntary urination was possible 1 day post-operatively. Histopathological examination revealed osseous metaplasia of the PPC. The patient was well-managed and had no post-operative complications or recurrence until day 180 of follow-up.
There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.
The purpose of this study is to investigate the developmental process of plant community during the secondary succession through the analysis of floristic composition, life form etcectra in burned site, and the structure of forest stand before forest fire occurrence was estimated by the method of anatomical wood identification for dead trees in burned site, Cheisuk-bong in Mt. Chiri of Korea. Plant community before forest fire occurrence was estimated the high mountain conifer stand of the last successional stage to consist of Pinus koraiensis(75%), Abies koreana(15%) and Picea jezoensis(10%), and Betula costata was survived only one species after forest fire occurrence. The total number of plant species in the investigated area was 19 families and 23 species that was identified. The dominate species in burned site were Festuca ovina and Arrhenatherum elatius, Carex humilis, Ligularia fischeri etcectra in the investigated area flora. The life form of plant in burned site was the erect from 47.8%, the tufted from 30.4%, the branched and the prostrate from was both 8.7%, It was assumed that dominant species in the burned sites were Gramineae (Festuca ovina, Arrhenatherum elatius), Carex humilis ${\rightarrow}$Sorbus commixta, Rhododendron schrippenbachii, Sambucus williamsii var. coreana, Tripterygium regelii ${\rightarrow}$Acer pseudo-sieboldianum var. koreanum, Betula costata, Quercus mongolica${\rightarrow}$Pinaceae forest(Pinus koraiensis, Abies koreana, Picea jezoznsis).
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