• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.30.1-30.8
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• 2019

Background: Advancements in the field of microvascular surgery and the widespread adoption of microvascular surgical techniques have made the use of osteocutaneous fibula free flaps the standard of care in the surgical management of segmental mandibular defects. Although the literature possesses abundant evidence to support the effectiveness of fibula free flaps as a reconstructive method, there are relatively few studies reporting on outcomes as objectively measured by videofluoroscopic swallowing studies (VFSS). The purpose of this study is to explore the potential correlation between early postoperative VFSS and the long-term swallowing outcomes in patients who underwent mandibular reconstruction with fibula free flaps. Methods: We performed a retrospective chart review of 36 patients who underwent mandibular reconstruction with osteocutaneous fibular free flaps between 2009 and 2012. Demographics, clinical variables, VFSS data, and diet information were retrieved. Penetration and aspiration findings on VFSS, long-term oral feeding ability, and the need for gastrostomy tube were statistical endpoints correlated with postoperative clinical outcomes. Results: Thirty-six patients were reviewed (15 females and 21 males) with a mean age of 54 years (7-81). Seventeen cases were treated for malignancy. The size of the bony defect ranged from 3 to 15 cm (mean = 9 cm). The cutaneous paddle, a surrogate for soft tissue defect, ranged from 10 to 125 ㎠ (mean = 52 ㎠). A gastrostomy tube was present in patients preoperatively (n = 8), and postoperatively (n = 14). Seventeen patients had neoadjuvant exposure to radiation. Postoperative VFSS showed penetration in 13 cases (36%) and aspiration in seven (19%). Overall, 29 patients (80.6%) achieved unrestricted diet, and this was statistically correlated with age (p = 0.037), radiation therapy (p = 0.002), and preoperative gastrostomy tube (p = 0.03). The presence of penetration or aspiration on VFSS was a strong predictor for long-term unrestricted oral diet (p < 0.001). Conclusion: Early postoperative VFSS is an excellent predictor for long-term swallowing outcomes in patients undergoing mandibular reconstruction with osteocutaneous fibula free flaps.

• Clinical and Experimental Pediatrics
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• v.49 no.6
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• pp.635-642
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• 2006

Purpose : The purpose of this study is to determine whether the new pulmonary valve reconstruction technique prevents short-term postoperative pulmonary regurgitation and improves early and mid-term clinical outcome. Methods : We reviewed postoperative echocardiographic variables and chest X-ray films from 31 patients who had undergone valve reconstruction(pulmonary valve reconstruction group : PVR) for the repair of TOF between April 2000 and August 2004. We compared the clinical data of these patients with those from 47 patients who had right ventricular outflow tract reconstruction with a monocusp valve(monocusp ventricular outflow patch group : MVOP) and 22 patients who had a transannular patch repair without a monocusp valve(transannular patch group : TAP). Results : In the PVR group, 25 patients(81 percent) had trivial or mild pulmonary regurgitation in their early post operative echocardiogram. Only 12 patients(26 percent) in the MVOP group had mild pulmonary regurgitation; and no patient in the TAP group had it. Pulmonary valve function was good in 96 percent of the PVR group, 36 percent of the MVOP group, and none in the TAP group in early post-operative echocardiogram. Follow-up echocardiogram(1, 2, 3, 4 years later) of the MVOP and TAP groups showed moderate pulmonary regurgitation and severely decreased valve function in almost all cases. However, in the PVR group 54 percent(16/28), 50 percent(14/28), 37 percent(9/24), and 31 percent(5/16) of the patients had trivial or mild pulmonary regurgitation 1, 2, 3 and 4 years after operation, respectively. The valve function remained good in 80 percent(24/30), 64 percent(18/28), 57 percent(12/21), and 31 percent(5/16) of the patients 1, 2, 3 and 4 years after operation respectively. Conclusion : Pulmonary valve reconstruction is effective in reducing pulmonary regurgitation and right ventricular dilatation in the repair of TOF, even though regurgitation increases with time. Further study is needed to determine long-term results.

• Journal of Chest Surgery
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• v.28 no.4
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• pp.416-418
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• 1995

The microwave tissue coagulation therapy was originally used for hemostasis in the hepatic surgery, which is effectively applied in the endoscopic surgery such as the hemostasis of gastric ulcer or tumor bleeding, stenosis relieving of esophageal or rectal stenosis and tumor reduction in inoperable early cancer cases.We experienced one case of the restenosis after the tracheal reconstruction. The patient, who was 42 year-old male, had severe dyspnea due to the tracheal stenosis for 4 years. The resection of tracheal stenosis and tracheal reconstruction was done. But the restenosis occurred at the tracheal anastomosis site because of the protrusive granulation at one month after operation. The patient was successfully treated by the microwave tissue coagulation therapy.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.86-90
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• 1997

Good stability and complete range of motion should be the ultimate goal of a rehabilitation program after ACL reconstruction. In previous years. the rehabilitation of the ACL reconstructed knee focused on protecting the new ligament by blocking terminal knee extension, hut, despite good stability, this approach led to numerous postoperative complications. Nowadays, most of surgeons agree the accelerated rehabilitation program based on the concept of ligamentization and clinical experience. Accelerated rehabilitation program consists of maintain of full extension of the knee, early weight bearing and prompt recovery of ROM, and closed kinetic chain exercise. Meeting this goal requires effective communication between-members of the health care team-the physician, physical therapist, atheletic trainer, and the patient. We have to know the importance of rehabilitation, knowlege about the physical therapy, and to introduce for special physical therapist and equipment.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.120-129
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• 1999

There were many difficulties in the treatment of extensive, massive, and composite defect in the lower extremity until early 1980's. Recently, microscopic reconstruction of wide soft tissue defect is popularized. But, the combined flap, which requires wide coverage of lower extremity after soft tissue sarcoma excision or traffic accident, is still challenging to the orthopaedic surgeons. We experienced 12 cases of combined scapular and latissimus dorsi flap from 1983 to 1997 in the lower extremity reconstruction of soft tissue defect with satisfactory result. There were no serious donor site complications such as functional disturbance of shoulder joint.

• Korean Journal of Bronchoesophagology
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• v.3 no.2
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• pp.327-331
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• 1997

One of the most difficult airway problems is a subglottic stenosis combined with a tracheal stenosis. Laryngotracheal stenosis has not been completely solved with classic methods like cricotracheal split with autogenous cartilage graft, thyrotracheal anastomosis, and free hyoid or hyoid-sternohyoid myo-osseous flap reconstruction. A 28-near-old male patient who had had laryngotracheal stenosis was successfully treated by laryngotracheal reconstruction using vascularized clavicle. This method has a several advantages: the vascularized clavicle harvesting in the same operative fields, one stage operation, less restenosis due to plentyful blood supply, md prevention of airway collapse due to a clavicle provided framework. It is too early to make a definite conclusion, but the authors suggested that this method could become one of the most effective methods of laryngotracheal stenosis.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.319-323
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• 2022

Total eyelid defect comprises full-thickness loss of both upper and lower eyelids in a patient. It is a rare and devastating condition with serious implications related to vision, which mandates early and functional reconstruction when associated with intact globe. The primary goal is to give a stable coverage for orbital protection but at the same time provide a functional reconstruction of the defect, to allow for adequate mobility of the eyelids so that the patient's vision is restored to normal with minimal disability. When the defect is massive, and in the absence of loco-regional flaps, microvascular tissue transfer is needed. In this report we describe a radial-artery-based microvascular tissue transfer with a unique innovation utilizing the contralateral frontalis muscle to reconstruct a case of unilateral total upper and lower eyelid loss.

• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.126-130
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• 2024

Anterior glenohumeral instability with an irreparable subscapularis tear is a challenging problem for the orthopedic shoulder surgeon. Current techniques, including tendon transfers, yield inconsistent results with high rates of recurrent instability. Acellular dermal allografting has been used in young patients with massive superior rotator cuff tears with early success, but acellular dermal allografting is comparatively unstudied in anterior deficiency. We present two cases of anterior capsular reconstruction with an acellular dermal allograft in patients ages 66 and 58 years with irreparable subscapularis tendon tears. Follow-up for both patients exceeded 4 years, with forward flexion >140°, external rotation exceeding 60°, a Single Assessment Numeric Evaluation score >90 points, a visual analog scale score of 0 points, and an American Shoulder and Elbow Score of 98 points. In conclusion, acellular dermal allografting can be used to reconstruct the anterior capsule in patients with massive irreparable subscapularis tears, similar to its use in superior capsular reconstruction in patients with massive posterosuperior rotator cuff tears.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.99-105
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• 1996

The reconstruction of esophageal defect after ablative surgery have more difficult than other digestive tract tumor because the restoration of anatomical and physiologic function is difficult, the risk of tumor invasion into the adjacent tissue is large. The reconstruction of cervical esophus was depended on the degree of resection of the esophagus, various reconstruction method was developed to minimize functional deficiency and deformity of cervical region. Recently, the free jejunal transfer or free radial forearm flap was commonly utilized for esophageal reconstruction due to development of technique of the microvascular anastomosis. After the esophageal reconstruction used by free jejunal transfer was reported by Seidenberg in 1951, jejunum is most commonly used for reconstruction of esophgus. Becaue of, it have been tubed anatomical similarity with muscular layer, relative small risk of complication, possible of oral intake within 10 days after operation, and early rehabilitaion. Authors have been treated esophageal defect with free jejunal transfer in 7 patients after resection of lesion in 6 eshageal cancer and 1 esophageal stricture from December 1994 to January 1996. We were transferred jejunum used by intercostal artery as recipient artery in 3 cases, it was satisfied with results. If intercostal artery was utilized as recipient artery for free jejunal transfer, we believe that any site of intrathoracic or intraabdominal esophageal defect is possible to recontruction.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.324-332
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• 2020

Background The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction. Methods A 7-year retrospective cohort study (2008-2015) of a single-surgeon's DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression. Results The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients' mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001). Conclusions Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.