• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.28-34
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• 1998

The traditionally useful coverage methods of the wrist and hand soft tissue defect are the chinese forearm flap, the ulnar forearm flap. But, this flaps are inevitably sacrifice major vessel to the hand. Advantages of the posterior interosseous artery island flap(PIA Flap) is no need to sacrifice blood supply to the hand and supply relatively large thin, good quality flap and more cosmetic than other forearm flaps. But, it is difficult to dissect and raise because of deep seat, close relation with the posterior interosseous nerve and anatomic variation. Authors evaluated 8 cases of 7 patients in the department of orthopaedic surgery, college of medicine, Hallym University from January, 1993 to December, 1995. The results are as follows: 1. The satisfactory coverage was achieved 7 cases and 1 case failed because of anatomic variation. 2 The pedicle length is average 9cm and the flap size is variable from 3cm by 4cm to 5cm by 8cm. 3. The donor site defect was repaired by direct closure in 5 cases, remained 3 cases combined with skin graft. From our experience we conclude that the PIA flap is one of the useful coverage methods of the wrist and hand soft tissue defect.

• Archives of Reconstructive Microsurgery
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• v.26 no.1
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• pp.9-13
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• 2017

Purpose: Fingertip amputations are the most common type of upper limb amputations. Composite grafting is a simple and cost-effective technique. Although many factors have investigated the success of composite grafting, the success rate is not high. Therefore, this study was conducted to investigate whether the microscopic procedure process during composite grafts improves the success rate. Materials and Methods: Thirteen cases of unreplantable fingertip amputation underwent a microscopic resection procedure for composite graft in the operating room. The principle of the procedure was to remove the least devitalized tissue, maximize the clean tissue preservation and exact trimming of the acral vessel and to remove as many foreign bodies as possible. Results: All fingertips in the thirteen patients survived completely without additional procedures. Conclusion: Composite grafting allows for the preservation of length while avoiding the donor site morbidity of locoregional flaps. Most composite grafts are performed as quickly as possible in a gross environment. However, we take noticed the microscopic resection. This process is thought to increase the survival rate for the following reasons. First, the minimal resection will maximize the junction surface area and increase serum imbibition. Second, sophisticated trimming of injured distal vessels will increase the likelihood of inosculation. Third, accurate foreign body removal will reduce the probability of infection and make it possible to increase the concentration and efficiency in a microscopic environment. Although there is a need for more research into the mechanisms, we recommend using a composite graft under the microscopic environment.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.683-688
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• 2022

Background Reconstruction of large soft tissue defects of the lower extremity often requires the use of free flaps. The main limiting factor and potential for complications lie in the selection of proper donor and recipient vessels for microvascular anastomosis. While the superficial veins of the lower leg are easier to dissect, they are thought to be more vulnerable to trauma and lead to a higher complication rate when using them instead of the deep accompanying veins as recipient vessels. No clear evidence exists that proves this concept. Methods We retrospectively studied the outcomes of 97 patients who underwent free flap plasty to reconstruct predominantly traumatic defects of the lower extremity at our institute. The most used flap was the gracilis muscle flap. We divided the population into three groups based on the recipient veins that were used for microvascular anastomosis and compared their outcomes. The primary outcome was the major complication rate. Results Overall flap survivability was 93.81%. The complication rates were not higher when using the great saphenous vein as a recipient vessel when comparing to utilizing the deep concomitant veins alone or the great saphenous vein in combination to the concomitant veins. Conclusions In free flap surgery of the lower extremity, the selection of the recipient veins should not be restricted to the deep accompanying veins of the main vessels. The superficial veins, especially the great saphenous vein, offer an underrated option when performing free flap reconstruction.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.180-192
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• 2007

Background: As determined from the recent investigations of discordant cardiac xenotransplantation, hyperacute rejection occurs mainly at the endothelial cells in donor microvascular systems, but this does not occur at cardiac valve leaflets or at medium-to-large caliber vessels. On the basis of this background, this study was performed to look into the biocompatibility for transplantation of a middle or large diameter xenogenic blood vessel by conducting xenogenic arterial transplantation with the carotid artery in a pig-to-goat model. Material and Method: The experimental group was composed of 10 pairs of pig-to-goat combinations. They were divided into each period of 1 week, and 1, 3, 6 and 12 months. Four carotid artery grafts obtained through collection of the bilateral carotid arteries from two pigs were preserved at $-70^{\circ}C$ without other treatment, and then they were transplanted into the bilateral carotid arteries of two goats. Doppler ultrasonography was done on a periodic basis after transplantation to evaluate the patency of the grafted blood vessel. At the ends of a predetermined period, the grafts were explanted from the goats and they underwent gross examination. Hematoxylin-eosin and Masson's trichrome staining were conducted. In addition, in order to examine the immunological rejection of the grafted xenogenic blood vessel, immunohistochemical staining was conducted with T-lymphocyte indicator and von Willebrand factor. Result: Two goats at the each one-week period and the one-year period died during the experimental period because of a reason unrelated to the experimental procedure, and the remaining 8 goats survived until the end of each experiment period. On Doppler ultrasonography, unilateral carotid artery occlusion was found in a goat, whose period was specified as 3 months, among the 8 survived goats. However, the vascular patency was maintained well and there was no graft that formed aneurysms in the other goats. On gross examination, the region of vascular anastomosis was preserved well, and calcification of the grafted blood vessel was not shown. Histologically, the endothelial cells of the graft disappeared one week after transplantation, and then there was progressive spread of the recipients' endothelial cells from the anastomotic site. The reendothelialization occurred over the whole graft at one month after transplantation. The neointimal thickening and adventitial inflammation became severe by 3 months after transplantation, but this lessened at 6 months and 12 months, respectively. The rate of CD3 positive cells was very low among the infiltrated inflammatory cells. Conclusion: The fresh-frozen xenogenic artery kept its patency without being greatly influenced by xenogenic immune reaction.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.1-13
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• 2005

Purpose: The purpose of this study is to present extended indications for the use of arterialized venous flaps in reconstructing soft tissue, tendon, nerve, blood vessel, and composite tissue defects of the hand of various sizes based on researches and clinical experiences of the authors. Moreover, procedures to achieve complete flap survival and postoperative results are presented. Materials & methods: This study is based on 154 cases of arterialized venous flaps performed to reconstruct the hand during the past 11 years. The most common cause of injury was industrial accidents with 125 cases. One hundred thirty patients or 84% of the cases had emergency operation within 2 weeks of the injury. The flaps were categorized depending on the size of the flap. Flaps smaller than $10\;cm^2$ were classified as small (n=48), those larger than $25\;cm^2$ classified large (n=42) and those in between medium (n=64). Classified according to composition, there were 88 cases (57.1 %) of venous skin flaps, 28 cases of innervated venous flaps, 15 cases of tendocutaneous venous flaps, which incorporated the palmaris longus tendon, for repair of extensor tendons of the fingers, and 17 cases of conduit venous flaps to repair arterial defect. There were 37 cases where multiple injuries to multiple digits were reconstructed. Moreover, there were 6 cases of composite tissue effects that involved soft tissue, blood vessels and tendons. The donor sites were ipsilateral forearm, wrist and thenar area, foot dorsum, and medial calf. The recipient sites were single digit, multiple digits, first web space, dorsum and palm of hand, and wrist. Results: There were seven cases (4.5%) of emergent re-exploration due to vascular crisis, and 3 cases of flap failure characterized by more than 50% necrosis of the flap. The survival rate was 98.1 % (151/154). In small flaps, an average of 1.01 afferent arteries and 1.05 efferent veins were microanastomosed, and in large flaps, an average of 1.88 afferent arteries and 2.19 efferent veins were anastomosed. In 8 cases where innervated flaps were used for reconstructing the palm of the hand, the average static two-point discrimination was $10\;(8{\sim}15)\;mm$. In 12 cases where tenocutaneous flaps were used, active range of motion at the proximal interphalangeal joint was 60 degrees, 20 degrees at the distal interphalangeal joint, and 75 degrees at the metacarpophalangeal joint. Conclusion: We conclude that the arterialized venous flap is a valuable and effective tool in the reconstruction of hand injuries, and could have a more comprehensive set of indications.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.1-5
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• 2000

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.

• Archives of Pharmacal Research
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• v.24 no.1
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• pp.64-68
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• 2001

Endothelin-1 (ET-1 ), a novel and potent vasoconstrictor in blood vessel, is known to have some functions in the rat central nervous system (CNS), In order to investigate the central functions of ET-1 , ET-1 was administered to the periaqueductal gray area (PAC) of anesthetized rats to induce barrel rolling and increase the arterial blood pressure (ABP). ET-1 had a modulatory effect on central cardiovascular and behavioral control. The selective N-methyl-D-aspartate (NMDA) receptor antagonist MK-801 (3${u}m/ol/kg$, i.p.) blocked the ET-1 induced responses, and both the nitric oxide synthase (NOS) inhibitor L-NAME (N-nitro-L-arginine mIThyl-ester 1 nmol/rat) and the nitric oxide (NO) scavenger hemoglobin (15 nmol/rat) had similar effects in redtAcing the IT-1 (10 pmol/rat)-induced behavioral changes and ABP elevation. However, NO donor sodium nitroprusside (SNP 10${u}g$, 1${u}g/rat$) decreased the ET-1 induced ABP elevation, and recovered the ET-1 -induced barrel rolling effect that was reduced by MK-801. These results suggest that ET-1 might have neuromodulatory functions such as ABP elevation and barrel rolling induction in the PAG of the rats via the NMDA receptor and NO.

• Development and Reproduction
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• v.11 no.3
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• pp.219-226
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• 2007

This study was conducted to identify optimistic primordial germ cells'(PGCs) migration activity using heat activated busulfan treatment for the increasing germline chimerism. Donar PGCs viability tests of important conditions for useful germ line chimerism indicated approximately $70{\sim}80%$ viability was time dependent. Transplantation experiments of PGCs into recipient embryos after busulfun treatment, showed the treatment group having 23.5% viability. By comparison, the control group showed 4.8% viability. The 96 hour treatment group and the 118 hour treatment group of the cultured PGCs showed high migration activity. Generally, the transplantation method would consider morphological and physiological characteristics before transplantation. In the present study, the effect of busulfan on migration activity showed viability highest at 53.4% after 48-hour incubation time. However, a previous study showed the best condition for transplantation time to be prior to the 48-hour incubation period, when the chicken embryo does not yet have a developed blood vessel system. In conclusion, an important condition for the production of a transgenic chicken is that most donor PGCs migrate into the recipient embryo without any inhibitory factors. The present results suggest, perhaps by using this modified method of transplantation, it can produce a more efficient chimeric germ line, transgenic chicken.

• Journal of Animal Environmental Science
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• v.15 no.2
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• pp.91-98
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• 2009

Object of this study were to determine the influence of collection times of rumen fluid on in vitro dry matter digestibility (IVDMD) of forage crops. The donor cow was fed concentrate once a day and given free access to grass-legume mixture hay. Main plot was consisted of different collection time of rumen fluid; T1: 1 hour before concentrate feeding, T2: 1 hour after feeding, T3: 4 hour after feeding and T4: 8 hour after feeding. A total of 7 samples of 4 different forage crops (barely, Italian ryegrass, crimson clover, rye) were used for the estimation of IVDMD and tested in three replicates. For the $DAISY^{II}$ incubation, each sample was inserted into each filter bag then heat-sealed and incubated in a digestion vessel for 48 h at $39^{\circ}C$. The times of rumen fluid collection had no significant effect on the IVDMD values over all varieties except for 2 breeds of IRG (Kogreen and Kospeed). IVDMD values with T1 over all varieties were slightly higher than other treatments, however those with both T1 of Kogreen and Kospeed varieties were significantly higher than T2 (p<.05).