• Archives of Plastic Surgery
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• v.42 no.6
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• pp.783-787
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• 2015

This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.333-339
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• 2020

Background The purpose of this study was to compare the anatomical features of the internal mammary vessels (IMVs) at the second and third intercostal spaces (ICSs) with regard to their use as recipient vessels in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods A total of 38 consecutive DIEP breast reconstructions in 36 patients were performed using IMVs as recipient vessels between March 2017 and August 2018. The intraoperative findings and postoperative complications were analyzed. Anatomical analyses were performed using intraoperative measurements and computed tomography (CT) angiographic images. Results CT angiographic analysis revealed the mean diameter of the deep inferior epigastric artery to be 2.42±0.27 mm, while that of the deep inferior epigastric vein was 2.91±0.30 mm. A larger mean vessel diameter was observed at the second than at the third ICS for both the internal mammary artery (2.26±0.32 mm vs. 1.99±0.33 mm, respectively; P=0.001) and the internal mammary vein (IMv) (2.52±0.46 mm vs. 2.05±0.42 mm, respectively; P<0.001). Similarly, the second ICS was wider than the third (18.08±3.72 mm vs. 12.32±2.96 mm, respectively; P<0.001) and the distance from the medial sternal border to the medial IMv was greater (9.49±2.28 mm vs. 7.18±2.13 mm, respectively; P<0.001). Bifurcations of the IMv were found in 18.4% of cases at the second ICS and in 63.2% of cases at the third ICS. Conclusions The IMVs at the second ICS had more favorable anatomic features for use as recipient vessels in DIEP flap breast reconstruction than those at the third ICS.

• Journal of Haehwa Medicine
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• v.10 no.1
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• pp.67-78
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• 2001

From the study of acupuncture and external diseases on mammary diseases, the following conclusions are obtained. 1. Point Shanzhong, Shaoze and Rugen are often used for galactostasis in acupuncture. 2. Often used vessels for galactostasis in acupuncture are Stomach Meridian, Conception Vessel, Small Intestine Meridian, Bladder Meridian, Liver Meridian and Large Intestine Meridian in order. 3. The direct stimulations are used in external treatment for galactostasis, often accompanied by internal medical treatment, to promote the circulation of Qi and Blood. 4. Point Zuimup, Guangming of Gall bladder Meridian and Zusanli of Stomach Meridian is used for lactation pain in acupuncture. 5. Point Jianjing, Zusanli and Shanzhong are most often used for acuremastitis and breast cancer in acupuncture. 6. Often used vessels for acuremastitis and breast cancer in acupuncture are Stomach Meridian, Gall bladder Meridian, Conception Vessel, Small Intestine Meridian, Bladder Meridian, Pericardium Meridian in order. 7. The external treatment used for acuremastitis and breast cancer can be classed into its pathological period. When lactation is interrupted, Kumhwang Powder, Okro Powder, Robongbang, Allii Radix, Pinelliae Rhizoma, garlic moxibustion and Arusaenatus Rgizoma powder are used. When pus is piled up, Chunghwa Extracts, Dioscoreae Rhizoma, Leonuri Herba, Typa Latifolia, Taraxacum platycarpum, Phaseolus angularis, Manchong, Crvi Cornus latex, and Aucklandiae Radix are used. When pus flows down, Salviae Miltiorrhizae Radix Extract, nine-one pellet, Yongboo extract, eight-dampness extract, Tissue-regeneration Powder, Toad-net treatment, Kitten-hair, Hongseung pellet are used. 8. Stomach Meridian, Conception Vessel, Small Intestine Meridian, Gall Bladder Meridian, Bladder Meridian are most often used vessels for mammary diseases. From the conclusions above, It appears that the medical effect could be maximized by further studying and developing of the acupuncture and external treatment for mammary diseases according to the its nature, while accompanying internal medicine appropriately at the same time.

• Anatomy and Cell Biology
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• v.56 no.1
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• pp.155-159
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• 2023

Studies describing the vascular systems and their variations in Situs inversus totalis (SIT) from a whole-body computed tomographic (CT) angiography perspective are lacking. We report a case of SIT in which postmortem CT angiography (PMCTA) was performed as a part of the forensic death investigation and incidentally detected several vascular variations in it. The PMCTA procedure was performed using the multiphase PMCTA protocol. Almost all major vessels were visualized, indeed in a completely reversed pattern. Contrast mixture flow interruptions were noted in the right coronary arterial branches suggesting possible blockage, upon which autopsy revealed >90% vessel occlusions at several locations. As such the cause of death was due to ischemic heart disease. Anomalous origins of the right internal mammary artery; abnormal left thyrocervical trunk and variations in the drainage of testicular veins were noted. Our findings might be helpful to clinicians and add to the body of literature on SIT.

• Journal of Chest Surgery
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• v.28 no.7
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• pp.671-677
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• 1995

Skeletonization of the internal mammary artery [IMA during myocardial revascularization procedures may provide some advantages, compared with the pedicle graft of the artery. In 17 patients undergoing IMA grafting by skeletonization technique, flow through the artery was measured on mean arterial pressure of 50-55 mmHg immediately after cardiopulmonary bypass started [first flow and just before its anastomosis to left anterior descending artery [second flow . In 16 patients except 1 patient whose graft was injured during mobilization, the first flow of IMA graft was 32.3 $\pm$ 7.4 ml/min and the second flow increased to 59.6$\pm$25.9 ml/min without any treatment and the site for anastomosis of the IMA graft was more than 1.0 cm above the bifurcation. On the basis of previous clinical studies, the flow of the skeletonized IMA was greater than that of the pedicle graft [59.6 $\pm$ 25.9 ml/min versus 37.7$\pm$ 14.1 ml/min, p < 0.05 . In comparison between the skeletonized IMA and the IMA graft intraluminally dilated with papaverine solution, there was no significant difference between two flows[59.6 $\pm$25.7 ml/min versus 74.7 $\pm$31.4 ml/min, not significant , but the former showed longer graft and anastomosis of more proximal portion of the graft to left anterior descending artery. In conclusion, the technique of internal mammary artery skeletonization has consistently produced a satifactory conduit for myocardial revascularization procedures. We have adopted IMA skeletonization not only because of the flow, diameter, and vessel length obtained but also because of limited perivascular tissue disruption that occurs during the dissection.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.994-1000
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• 1995

Thirty patients with ischemic heart disease underwent coronary artery bypass grafting [CABG from 1985 through 1994. There were 16 males and 14 females whose age ranged from 41 to 72 years old. Preoperative diagnoses were unstable angina in 13 of patients, stable angina in 8, postmyocardial infarction state in 7, and state of failed percutaneous transluminal coronary angioplasty [ PTCA in 2. The patterns of disease were single vessel involvement [ 17cases , double vessel involvement [ 7 cases , triple vessel involvement [ 3 cases , Lt main lesion including Lt. ostial lesion [ 3 cases . Saphenous vein grafts were used in 27/30 patients [ 90% , and internal mammary artery grafts were used in 6/30 patients [ 20% . The hospital mortality was 13.3% and all survivors were asymptomatic and improved over their preoperative status.

• Journal of Chest Surgery
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• v.26 no.5
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• pp.349-354
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• 1993

From July 1992 through January 1993, 11 patients with unstable angina received aorto-coronary bypass surgery at Dong-A University Hospital. There were 5 males and 6 females whose age ranged from 36 to 76 years old. Of the 11 patients, 3 were Functional class IL 5 were Functional class 111.3 were Functional class IV. Preoperative coronary angiography showed a significant stenosis of the left anterior descending artery in 9 cases, of its diagonal branch in I case, of the circumfiex artery in 3 cases, and of its obtuse marginal branch in 2 cases, of the right coronary artery in 4 cases, and of left main coronary artery in 3 cases. There were 4 cases of single vessel disease, 1 double vessel disease, 3 triple vessel disease and 3 left main disease. A single graft was placed in 1 patient, a double graft in 5, a triple graft in 2, and a quadriple graft in 3 patients. Left internal mammary artery plus saphenous vein graft were used in 4 patients. Postoperative complications were mediastinitis in 1, sternal instability in 2, pneumonia in 1, arrythmia in I case.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.271-275
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• 1993

In this country, the number of patients with coronary artery disease is progressively increasing with the change of life style and improvement of the diagnostic procedures. In addition, the medically invasive procedure for treating ischemic heart disease was rapidly developed and the surgical patients have more complex and multiple lesions and more surgical risks. Fifty three patients with ischemic heart disease underwent coronary bypass grafting [CABG] for recent 24 months. Twenty patients had three-vessel disease, 17 patients two-vessel disease, and 2 patients single-vessel disease. The average number of distal anastomoses was 3.3 per patient with the range of I to 6 grafts. Forty-one patients [77.4 %] had preoperative left ventricular ejection fraction of 50 % or more and 14 patients[26.4%] had a significant left main coronary lesion. Saphenous vein grafts were employed in 52/53 patients [98.1%] and internal mammary grafts, which were anastomosed to left anterior descending artery, in 38/53 patients[71.7%]. Two patients, whom percutaneous transluminal coronary angioplasty failed for, underwent emergency CABG with only saphenous vein grafts and both patients survived.The hospital mortality was 1.9 % and there was no late death. Perioperative myocardial infarction occurred in 1.9%. All survivors were asymptomatic[in 83% of the patients] and/or improved over their preoperative status. Twenty-nine patients were included in blood conservation group and 21 patients [72.4 %] underwent CABG without any homologous blood transfusion. Our early result of coronary bypass grafting was comparable to that which was reported in other coronary surgery units.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1369-1375
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• 1992

During a 17-month period 32 consecutive patients underwent coronary artery bypass graft. The mean age of these patients was 45.3 years [range 39 to 71 years]. There were 18 men and 14 women. Preoperatively 11 patients had stable angina pectoris and 12 patients of unstable angina pectoris. 28% [9 patients] had of myocardial infarction history. The patterns of disease were single vessel involvement [4 casis], double vessel involvement [11 cases], triple vessel involvement [12 caese] and 5 cases of left main coronary artery disease. Thirty-seven percent [12/32] were in New York Heart Association class IV. Myocardial revascularization was performed under emergency conditions in 3 patients. We performed 13 case of double anastomosis, 12 case of triple anastomosis and 4 case of 4 anstomosis [mean 2.59 anastomosis per patient]. The left internal mammary artery was used in 68.7%. 90% of the patients receieved two or more grafts. Complications occurred in 8 patients [25%]. All patients were followed up for a mean of 8.6 months [2 to 17 months]. There was no hospital and late death. Postoperatively 87% were in New York Heart Association class I or II and 96% of the patient were free from angina.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1263-1266
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• 1996

We have experienced a case of coronary artery bypass surgery without extracorporeal circulation through limited anterior thoracotomy. The lesion was a single vessel disease involving the take off of the left anterior descending artery(LAD) which showed tubular lesion with irregular contour and eccentric stenosis of more than 95% luminal narrowing. Percutaneous transluminal coronary angioplasty(PTCA) seemed to have moderate success rate and moderate complication rate. A segment of left internal mammary artery(LIMA) from the second rib down to the sixth rib was harvested through the bed of resected fourth costal cartilage. Anastomosis between LIMA and LAD was performed under beating condition. The patient was extubated in the operation room and showed excellent postoperative course without complications. The coronary angiography on the postoperative 7th day revealed good patency at the anastomosis site.