• Archives of Plastic Surgery
• /
• 제35권2호
• /
• pp.214-218
• /
• 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.

• Journal of Chest Surgery
• /
• 제23권5호
• /
• pp.1027-1034
• /
• 1990

Pectus excavatum, commonest developmental anomaly of chest wall, is manifested by depression of the sternum and lower costal cartilages that is of surgical interest. From 1982 through 1990, fifteen patients have undergone surgery for treatment of pectus excavatum and treated by Ravitch operation: 5, Modified Ravitch operation; 4, Wada operation, 1 and Modified Wada operation, 5. There was familial history of pectus excavatum in 3 patients. Associated congenital anomaly were seen in 6 patients; scoliosis in 3 patients, right inguinal hernia in 1, polydactyly in 1 and patent ductus arteriosus in 1 patent. Postoperative minor complications were developed in 3 cases; pneumothorax, 2 cases; pleural effusion, 2 cases; wound infection and dehiscence, 1 cases; pressure sore due to strut malposition, 2 cases; flail chest and 2 cases; seroma. The incidence of the postoperative complications were more common in cases who were treated by metal strut, pin or other prosthetic materials for supporting the chest wall integrity than the standard corrective procedure. All cases have no recurrence of chest wall depression and operative death.

• 한국응급구조학회지
• /
• 제25권1호
• /
• pp.235-241
• /
• 2021

Cardiogenic syncope occurs due to arrhythmia (bradycardia and tachycardia) or decreased cardiac output, and if proper treatment is not provided, it can lead to acute sudden death. A detailed medical history and physical examinations are required to determine the cause of syncope, and clinical approaches, including 12-lead ECG, are important. The 12-lead ECG does not have a chest lead in the posterior wall of the left ventricle; therefore, ECG of the isolated posterior wall myocardial infarction caused by left circumflex artery occlusion is not observed with ST elevation. Therefore, the significantly higher appearance of ST depression and R waves than S waves from V1 to V3 of the chest lead must be interpreted meaningfully. Isolated posterior wall myocardial infarction is small in the area of myocardial necrosis, and tension is increased in the necrotic area due to the contraction of the normal myocardial muscle, which can cause ventricular wall rupture. Therefore, it is necessary to additionally check Beck's triad, such as jugular venous distension and decreased heart sound, in patients with low blood pressure with an isolated posterior wall myocardial infarction on 12-lead ECG in patients with syncope.

• Journal of Chest Surgery
• /
• 제32권4호
• /
• pp.399-403
• /
• 1999

배경: 누두흉은 가장 흔한 흉골기형으로 대부분이 선천적으로 흉골과 그 주위의 연골을 포함한 늑골의 일부가 함몰한 기형을 말한다. 누두흉의 수술방법은 Ravitch 술식에 의한 흉골거상법과 Wada 술식에 의한 흉골반전법이 주로 시행되어 왔다. 대상 및 방법: 1983년 1월부터 1996년 12월까지 누두흉의 수술적 교정을 받은 21명을 분석하였다. 환자의 연령별 분포와 동반된 기형의 종류, 동반된 증상, 각 수술방법에 따른 교정의 정도와 합병증의 유무, 환자의 술후 만족도를 조사하였다. 수술적 방법으로는 Wada술을 17례, Ravitch 술식을 4례 실시하였다. 수술적 적응증은 미용상의 이유가 가장 많았다. 결과: 술전의 Welch index는 평균 4.188 이었고 술후 3.46으로 개선되었고 Wada 술식에서 교정도가 높았다.(P=0.046) 합병증의 빈도는 Ravitch 변형술에서 높았으나 통계적 유의성은 없었다.(P=0.54) 수술후 합병증을 보인 1례를 제외한 전례에서 환자의 만족도, 술전의 정신,신체적 결함에서 회복되었고 함몰의 교정 정도에서도 만족할만한 결과를 얻었다. 수술후 외래 추적 결과 누두흉의 재발과 사망례는 없었다. 결론: 학동기전후연령과 함몰이 대칭성인 누두흉인 경우에서 흉골반전술이 좋은 술식이 된다고 생각한다.

• Journal of Chest Surgery
• /
• 제26권12호
• /
• pp.969-971
• /
• 1993

The sternal turnover has a limited use in an asymmetrical funnel chest. However we tried `One-half sternal turnover` as a new operative approach for an asymmetrical funnel chest. Through the bilateral submammary skin incision, median sternotomy was made from xiphoid process to midsternum and extended horizontally. The segment of ribs were cut at the angle of depression. The en-bloc resected chest wall segment contained one-half sternum as well as a part of ribs and left half of rectus muscle. After turning over the en-bloc segment, reapproximation with wiring was done. Sternotomy wound was closed in layer after placing of substernal drainage tube. Postoperatively, the chest wall was stable and the recovery course was uneventful except left-sided minimal pneumothorax which was cured spontaneaously. The patient was discharged on postoperative 14th day.

• Journal of Chest Surgery
• /
• 제55권2호
• /
• pp.183-187
• /
• 2022

Flail chest is a critical medical condition in which multiple segmentally fractured adjacent ribs cause paradoxical movement of the thoracic cage in patients with severe blunt trauma injury. Surgical stabilization is considered essential in patients who require mechanical ventilation. However, there is no consensus on which surgical procedure to choose among the various available techniques or when to perform surgery. We report the case of a patient with traumatic anterior flail chest due to bilateral multiple fractures of the ribs requiring surgical stabilization in whom weaning from mechanical ventilation had failed. The Nuss procedure using double bars with the bridge technique was performed for chest wall stabilization. The patient was weaned from mechanical ventilation on postoperative day 44 and she underwent bar removal on postoperative day 71. After extensive rehabilitation for multiple trauma, she was discharged successfully. The patient currently shows no recurrence of chest wall depression in outpatient follow-up.

• Journal of Chest Surgery
• /
• 제25권3호
• /
• pp.276-282
• /
• 1992

From Jan. 1981 to Dec. 1989 eleven cases of Funnel Chest, ten were males and one was female, were underwent an operation at the Department of Thoracic and Cardiovascular Surgery. Cheonbuk National University Hospital. The age of patients ranged from 3 to 29 years old. They all had symptoms of feeling inferiority about chest deformity. The degree of concavity on the funnel chest varied in extent, and the severity which was measured by water volume filled into it varied from 20 ml to 140 ml. Nine patients were corrected by Ravitch method and two patients were corrected by the Modified sternal turnover method. The Ravitch method was more effective in asymmetrical, severe depression deformity and in children. On the other hand the Modified sternal turnover method with preservation of vascular supply of repair was more simple and more effective in case of relatively less severe, wide symmetrical depression deformity of the chest and in case of associated with congenital or acquired heart disease and disease of the ascending aorta. This method has the advantage of maintaining chest wall stability in postoperative period.

• Archives of Plastic Surgery
• /
• 제37권6호
• /
• pp.808-814
• /
• 2010

Purpose: The sunken chest deformity without breast asymmetry is not a rare condition encountered in augmentation mammaplasty. Therefore, failure to recognize the deformity and improper surgical plan will lead to a suboptimal result. The authors review the experience of breast augmentation in simple sunken chest patient based on retrospectively collected data. Methods: From January, 2008 to January, 2009, patients with simple sunken chest underwent endoscopic submuscular augmentation mammaplasty through axilla, using silicone implants. Patient demographics were queried and outcomes were assessed. Results: Eleven patients (22 breasts) were followed up for 8.2 months after surgery. Sunken chests were augmented with implant size of approximately 248.9 cc (range: 213~286 cc) and contralateral chest with 211.4 cc (range: 180~235 cc). Simultaneous camouflaging the chest wall depression with breast augmentation resulted in good aesthetic outcome. All of the patients were satisfied with the surgery. There were no complications among all patients. Conclusion: We have demonstrated proper surgical planning with precise implant selection to optimize results in patients with small breast and simple sunken chest. Even though asymmetry still remains after the operation, it is still considered as acceptable.

• 한국동물위생학회지
• /
• 제35권3호
• /
• pp.251-254
• /
• 2012

Pectus excavatum (PE) is a ventral chest wall deformity, also known as funnel chest, sunken chest, chondrosternal depression or koilosternia. The 4 months old, 1.3 kg intact-female Pekingese dog was evaluated for acute semicoma and convulsion. The client reported that this patient have had chronic loss of appetite, intermittent dyspnea and palpable sunken breast. The other littermates did not show any abnormalities. On physical examination, cachexia (BCS 1/5), concave sternum, flatten thoracic cavity and cardiac murmur were observed. On radiographic study, the caudal sternum cave to vertebrae and narrowing thoracic cavity. The severities of thoracic deformity were evaluated by deformation indices such as-Frontosagittal index (FSI) and vertebral index (VI). Moderate to severe PE was founded by the radiological measurements.

• Journal of Chest Surgery
• /
• 제30권12호
• /
• pp.1247-1250
• /
• 1997

7년전 누두흉으로 Ravitch수술을 받은 13세 남아가 이차성 전흉벽기형과 운동시 호흡곤란(NYHA II)을 주소로 내원하였다. 술전 심초음파상 이차성 심방중격결손이 진단되었고, 폐기능검사상 WC가 2.03 L(72%), FEVI이 1.82 L(71%)로 감소된 것외에는 술전 검사상 이상소견은 없었다. 수술은 앙와위에서 흉골을 보존한 채 정 중흉절개를 통해 흉근판을 만든후 기형늑연골 잔유물과 섬유조직을 제거하여 이차성 전흉벽기형을 교정한 후 흉골을 90$^{\circ}$로 세움으로써 개심술을 위한 시야를 확보하여 심방중격결손을 동시에 교정하였다. 술후 1일째 급성호흡부전이 있어 기관내 재삽관 및 기계호흡을 시행하였고 술후 6일째 인공호흡기를 제거하였다. 환아는 합병증없이 회복되어 술후 19일째 퇴원하였다.