• Archives of Plastic Surgery
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• v.39 no.4
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• pp.397-403
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• 2012

Background Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. Methods Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. Results Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. Conclusions Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.636-641
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• 2011

Purpose: There are multiple dependent variables commonly attributed to survival of replanted digits. The ischemia time is thought to be a clinically relevant factor. However, controversy exists as large hand centers have reported successful replant outcomes independent of ischemic time. In this study, we present a single institution experience on the effect of ischemia time on the survival of completely amputated digits. Methods: A retrospective review of a single institution experience was performed. This cohort included all comers who had suffered complete amputation of a digit (Zone 2-4) and underwent replantation from 2003 to 2009. Demographic information as well as injury mechanism, ischemic time, and replantation outcome were recorded for each patient. Chi-square was used to analyze the result. Results: Mean age was 35.5 years old (2-69). Mean replantation survival was 89.5% (37/317). Survival rates were 94, 88, and 88% in respective groups of 0~6, 6~12, of > 12 hours of ischemia time. In chi-square analysis, there was no difference with $p$ value of 0.257. No other independent patient factors showed statistically significant relationship to replant survival rate. In the group with longest ischemia time (12~18 hours) replant survival rate was 88% (37/42). Conclusion: Prolonged ischemia time is commonly believed to be a contributing factor for replant survival. However, our experience has shown that survival rate is uniform up to 18 hours of ischemia.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.571-577
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• 2009

Purpose: The Provision of thin and pliable tissue and the adequate coverage of tendon - gliding surface is necessary for a soft tissue defect of the hand with exposure of bone, tendon and muscle. This report will discuss our experience with anterolateral thigh fascial free flap for the reconstruction of the soft tissue defect of the hand. Methods: Between February 2004 and August 2008, seven patients with full - thickness soft tissue defects of the hand were reconstructed by means of a composite anterolateral thigh fascial free flap. There were soft tissue defects associated with trauma (n=5), scar contracture (n=1) and necrosis due to ischemia (n=1). Flaps were harvested from the anterolateral thigh as adipofascial flaps with only a small sheet of fascia and fatty tissue above it. The fascia and the skin of the donor site was closed directly and delayed split - thickness skin graft was performed. Result: All flaps survived completely. The size of the transferred flap ranged from $2{\times}4cm$ to $5{\times}8cm$. Thin flap coverage was possible without secondary debulking operations. It left minimal donor site morbidity with a linear scar. In one case, the thigh muscle herniation in the donor site was developed. Conclusion: The anterolateral thigh fascial free flap provided thin and pliable tissue which can establish a tendon - gliding mechanism, minimal bulk, minimal donor site morbidity. The disadvantages of this technique were the need for a skin graft and the muscle herniation of donor site.

• Korea Journal of Hospital Management
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• v.26 no.4
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• pp.59-66
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• 2021

Purposes: This study aimed to identify relevant factors that determine cancer surgery at a medium-sized general hospital where patients are diagnosed with cancer. Methodology: The study subjects were 1,530 patients diagnosed with cancer between November 2013 and October 2019 at a 400-bed general hospital located in the metropolitan area. Multiple logistic regression analysis was performed to identify the patient characteristics, cancer types, and characteristics of treatment experience of the study subjects, in addition to the determinants of cancer surgery in the hospital. Findings: Among 1,530 cases diagnosed with cancer, 353 cases (23.1%) were operated at the hospital where the cancer diagnosis was made. As determinants of surgery after a fist-time diagnosis at a general hospital, the likelihood of having surgery at the hospital, for colorectal cancer patients compared to stomach cancer patients (Odds Ratio=2.38), bladder and kidney cancer patients (Odds Ratio=1.79). According to the results of an additional survey conducted, it was found that important determinants of decisions on a hospital to receive cancer surgery were the kindness of the staff including doctors and nurses, and the trust in the medical skills and technique of the doctor. Practical Implication: The management of general hospitals should take note of the fact that it is important to establish proactive strategies for hospital management including strengthening the rapport between patients and medical institutions based on the kindness of medical staff (doctors and nurses) and staff, in addition to promoting cancer adequacy evaluation results and introducing one-stop systems.

• The Korean Journal of Physiology and Pharmacology
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• v.26 no.5
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• pp.347-355
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• 2022

Abdominal aortic aneurysm (AAA) is a life-threatening disorder worldwide. Fibroblast growth factor 21 (FGF21) was shown to display a high level in the plasma of patients with AAA; however, its detailed functions underlying AAA pathogenesis are unclear. An in vitro AAA model was established in human aortic vascular smooth muscle cells (HASMCs) by angiotensin II (Ang-II) stimulation. Cell counting kit-8, wound healing, and Transwell assays were utilized for measuring cell proliferation and migration. RT-qPCR was used for detecting mRNA expression of FGF21 and activating transcription factor 4 (ATF4). Western blotting was utilized for assessing protein levels of FGF21, ATF4, and markers for the contractile phenotype of HASMCs. ChIP and luciferase reporter assays were implemented for identifying the binding relation between AFT4 and FGF21 promoters. FGF21 and ATF4 were both upregulated in Ang-II-treated HASMCs. Knocking down FGF21 attenuated Ang-II-induced proliferation, migration, and phenotype switch of HASMCs. ATF4 activated FGF21 transcription by binding to its promoter. FGF21 overexpression reversed AFT4 silencing-mediated inhibition of cell proliferation, migration, and phenotype switch. ATF4 transcriptionally upregulates FGF21 to promote the proliferation, migration, and phenotype switch of Ang-II-treated HASMCs.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.87-93
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• 2024

This study aimed to analyze cases of anterolateral thigh (ALT) free flap used for hand reconstruction with terminal perforator-to-digital artery anastomosis. Patients who underwent ALT free flap placement with terminal perforator-to-digital artery anastomosis for hand reconstruction between January 2011 and August 2021 were included. The number, length, and diameter of the perforators and veins, flap size, and operative time were investigated through a retrospective review of charts and photographs. The occurrences of arterial thrombosis, venous thrombosis, arterial spasm, and flap necrosis were analyzed. In total, 50 patients were included in this study. The mean diameter and length of the perforators were 0.68 mm and 3.25 cm, respectively, and the mean number of veins anastomosed was 1.88, with a mean diameter of 0.54 mm. Complications included four cases of arterial thrombosis, one case of venous thrombosis, seven cases of partial necrosis, and one case of total flap failure. Regression analysis showed that a longer perforator was associated with arterial thrombosis whereas larger flap size and number of anastomosed veins were associated with partial necrosis (p < 0.05). The terminal perforator-to-digital artery anastomosis offers advantages in using compact free flaps with short pedicle lengths to cover small hand defects.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.535-540
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• 2023

Background Abdominoplasty with abdominal plication increases intra-abdominal pressure (IAP) and has been previously associated with limited diaphragmatic excursion and respiratory dysfunctions. Many factors found in abdominoplasties and among postbariatric patients predispose them to a higher occurrence. This study aims to evaluate the impact of abdominal plication among postbariatric patients, assess whether the plication increases their IAP, and analyze how these IAP correlate to their postoperative outcome. Methods This prospective study was performed on all patients who underwent circumferential Fleur-De-Lis abdominoplasty. For this intended study, the IAP was measured by an intravesical minimally invasive approach in three stages: after the initiation of general anesthesia, after a 10-cm abdominal wall plication and skin closure, and 24 hours after the procedure. Results We included 46 patients, of which 41 were female and 5 were male. Before the bariatric procedure, these patients had an average maximum weight of 121.4 kg and an average maximum body mass index of 45.78 kg/m²; 7 were grade I obese patients, 10 were grade II, and 29 were grade III. Only three patients were operated on with a gastric sleeve and 43 with gastric bypass. We presented six patients with transitory intra-abdominal hypertension in the first 24 hours, all of them from the grade I obesity group, the highest presented was 14.3 mm Hg. We presented 15% (7/46) of complication rates, which were only four seroma and five dehiscence; two patients presented both seroma and wound dehiscence. Conclusion Performing a 10-cm abdominal wall plication or greater represents a higher risk for intra-abdominal hypertension, slower general recovery, and possibly higher complication rate in patients who presented a lower degree of obesity (grade I) at the moment of the bariatric surgery.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4843-4846
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• 2013

Background: The infusion rate is considered to affect incidence and severity of infusion reactions (IRs) caused by protein formulations. Trastuzumab (TRS) is approved for 90-minute infusion as the initial dose followed by 30-minute infusion with 250 ml saline. In the study, we evaluated the safety of TRS intravenously administered over 30 minutes with 100 ml saline to reduce burden of patients, safety of infusion with 250 ml saline already being established. Materials and Methods: Women with HER2 positive breast cancer, ${\geq}18$ years and ${\geq}55%$ left ventricular ejection fraction (LVEF), were registered in the study. Patients received 8mg/kg of TRS 250 ml over 90 minutes followed by 6mg/kg of TRS 100ml over 30 minutes in a three-week cycle. Results: A total of 31 patients were recruited, 24 for adjuvant therapy and seven with metastases. The median age was 59 years (range 39 to 82). The total number of TRS doses ranged from 5 to 17 with the median of 15. Mild IR occurred in two patients at the first dose. However, no IR was observed after reducing to 100 ml saline. No decrease of LVEF, increase of serum brain natriuretic peptide or any other adverse events were reported. Conclusions: Intravenous infusion of TRS with 100 ml saline over 30 minutes in breast cancer patients can be considered safe based on results from the study. It can be given on an outpatient basis as with the currently recommended dilution in 250 ml saline.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.2049-2053
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• 2016

Background: The LigaSure vessel sealing system has been proposed to save operation time and reduce intraoperative blood loss for various surgeries. However, its usage for gastric cancer is still controversial. The aim of the present meta-analysis was to compare the effectiveness of LigaSure with conventional surgery in gastrectomy. Materials and Methods: Sources were retrieved from the Cochrane Library, MEDLINE, EMBASE, SCOPUS and Google Scholar until February, 2015. All randomized controlled trials comparing LigaSure with conventional surgery in curative gastric cancer resection were selected. After data extraction, statistics were performed by Review Manager 5.1 software. Results: Three eligible randomized controlled trials were evaluated, with a total of 335 patients. The quality of the included trials was good, yet some methodological and clinical heterogeneity existed. There were no significant differences between the LigaSure and conventional groups in operative time (weighted mean difference [WMD], -22.95 minutes; 95% confidence interval [CI], [-59.75, 13.85]; P = 0.22), blood loss (WMD, -45.8 ml; 95% CI, [-134.5, 42.90]; P = 0.31), nor the incidence of surgical complications (odds ratio, 1.18; 95% CI, [0.68, 2.05]; P = 0.54). But there was a longer duration of hospital stay in LigaSure group (WMD, 1.41 days; 95% CI, [0.14, 2.68]; P = 0.03). Conclusions: All available randomized evidence has been summarized. LigaSure does not confer significant advantage over conventional surgery for curative gastric cancer resection. The usefulness of the device may be limited in gastrectomy. But, more trials are needed for further assessment of the LigaSure system for gastric cancer.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.510-513
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• 2003

Annuloaortic ectasia, aortic regurgitation(AR), and ventricular septal defect(VSD) in patients with right ventricular hypoplasia is a very rare condition. We report a patient who underwent aortic root replacement with a composite graft for annuloaortic ectasia associated with VSD and AR in right ventricular hypoplasia. The patient was a 19 year-old male. Transthoraic echocardiogram and cardiac catheterization revealed a perimembranous VSD (2 cm in diameter), severe AR, annuloaortic ectasia, bipartite right ventricle with hapoplasia, and hypoplastic tricuspid valve. Operative findings showed that free margins of the right and noncoronary cusps were markedly elongated, thickened, and retracted, and commissure between the right coronary cusp and the noncoronary cusp was fused and calcified. VSD was closed with an autologous pericardial patch and composite graft aortic root replacement using direct coronary button reimplantation was performed, and the hypertrophic muscle of the right ventricular outflow tract was resected. The patient had transient weaning failure of cardiopulmonary bypass and was discharged at the postoperative 14 days without any problems.