• Journal of Korean Neurosurgical Society
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• 제30권10호
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• pp.1187-1192
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• 2001

Objective : The lateral extracavitary approach(LECA) to the thoracolumbar spine is known as one of procedure which allows not only direct vision of pathologic lesion, but also ventral decompression, and dorsal fixation of the spine through the same incision. However, some drawbacks of LECA, including the technically- demanding, time-consuming, unfamiliar surgical anatomy and excessive blood loss, make surgeons to hesitate to use this approach. This study is to provide the surgical anatomy of LECA using cadavers, for detailed informations when LECA is considered for the surgery. Methods : We performed the 10 cadaveric studies, 7 male and 3 female, and careful dissection was carried out on right side of thoracolumbar region, except one for thoracic region. The photographs with micro-lens were taken to depict the close-up findings and for demonstrating detailed anatomy. Results : The photographs and hand-drawings demonstrated the relationships among the musculature, segmental vessels and nerve roots seen during each dissection plane. The lateral branches of dorsal rami of spinal nerve and the transverse process were confirmed to be the most important landmark of this approach. Conclusion : We concluded that detailed anatomical findings for LECA through this step-by-step dissection would be useful during operative intervention to reduce the intraoperative complications in LECA.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1612-1619
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• 2000

Objective : To retrospectively analyse the surgical outcome and efficacy of the lumbar spinal surgery in sixty to older patients who failed to conservative treatments. Methods : Between July 1990 and November 1996, the authors retrospectively investigated the medical records of 46 patients who over 60 years of age at the time of surgery. The clinical severity was assessed with Prolo's grade(economic and functional). Questionnaire was sent to each patient regarding long-term effect, satisfaction, and side effects. Results : In 46 patients, 2 patients(1 case died of lung cancer, 1 case lost in follow-up) were lost. Among 44 patients (28 men, 16 women ; mean age 64 years), 22 patients underwent partial or total laminectomy, 17 spinal fusion with instruments, 2 chemonucleolysis, 2 adhesiolysis for failed back surgery syndrome, and 1 automated percutaneous lumbar discectomy. Although postoperative complications were observed in 5 patients, they were successfully managed. No deaths were documented in the perioperative periods. The average Prolo's economic and functional grade improved from 2.98 to 3.48 and 2.81 to 3.75, respectively. Conclusion : In overall, the favorable surgical outcome was obtained. This results indicated that with appropriate preoperative selections and indications, careful intraoperative monitoring, and attentive postoperative care, the surgical treatment of eldery patients for the lumbar spinal disorders, significant improvement with acceptable levels of morbidity and mortality can be achived.

• Journal of Korean Neurosurgical Society
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• 제44권1호
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• pp.52-56
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• 2008

Objective : The purpose of this study was to introduce our surgical experiences of scoliosis and to evaluate the effectiveness of anterior correction and fusion in adolescent idiopathic scoliosis (AIS). Methods : Between August 2004 and August 2007, four patients with AIS were treated with anterior segmental fusion and fixation at our hospital. Mean follow-up period was 9 (6-12) months. The average age was 14.0 (13-15) years. According to Lenke classification, three patients showed Lenke 1 curve and one patient with Lenke 5 curve. Single rod instrumentation was performed in one patient, dual rod instrumentation in one patient and combined rod instrumentation in two patients. Coronal Cobb measurements were performed on all curves in thoracic, thoracolumbar and, lumbar spine and the angle of hump was measured by a scoliometer pre- and postoperatively. Results : The average operative time was 394 minutes (255-525) with an average intraoperative blood loss of 1,225 ml (1,000-1,700). The mean period of hospital stay was 19.3 days and there was no complication related to the surgery. The mean Cobb angle was reduced from $43.3^{\circ}$ to $14.8^{\circ}$ (65.8% correction) postoperatively and the rib hump corrected less than $5^{\circ}$. All patients and their parents were satisfied with the deformity correction. Conclusion : Anterior spinal correction and fusion of AIS with Lenke 1 and 5 curve showed excellent deformity correction without any complications. In particular, we recommend anterior dual rod instrumentation because of mechanical stability, better control of kyphosis, and a higher fusion rate.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.251-255
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• 2013

We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

• Archives of Plastic Surgery
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• 제47권4호
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• pp.365-370
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• 2020

The ability to directly harvest thin and superthin perforator flaps without jeopardizing their vascularity depends on knowledge of the microsurgical vascular anatomy of each perforator within the subcutaneous tissue up to the dermis. In this paper, we report our experience with ultrahigh-frequency ultrasound (UHF-US) in the preoperative planning of thin and superthin flaps. Between May 2017 and September 2018, perforators of seven patients were preoperatively evaluated by both ultrasound (using an 18-MHz linear probe) and UHF-US (using 48- and 70-MHz linear probes). Thin flaps (two cases) and superthin flaps (five cases) were elevated for the reconstruction of head and neck oncologic defects and lower limb traumatic defects. The mean flap size was 6.5×15 cm (range, 5×8 to 7.5×23 cm). No complications occurred, and all flaps survived completely. In all cases, we found 100% agreement between the preoperative UHF-US results and the intraoperative findings. The final reconstructive outcomes were considered satisfactory by both the surgeon and the patients. In conclusion, UHF-US was found to be very useful in the preoperative planning of thin and superthin free flaps, as it allows precise anticipation of very superficial microvascular anatomy. UHF-US may represent the next frontier in thin, superthin, and pure skin perforator flap design.

• Archives of Plastic Surgery
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• 제32권1호
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• pp.43-48
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• 2005

Septal deviations interfere with the nasal airflow and contribute to the deformities in the external appearance of the nose. An aesthetically and functionally satisfactory correction of severe septal deformities often requires temporary intraoperative removal of the septal cartilage for appropriate remodeling. This article describes septoplasty through dorsal approach for the correction of septal deviation. From March 2001 to April 2004, the author performed septoplasty through dorsal approach for the correction of septal deviations on 45 patients, of whom 22 of whom had nasal obstruction. Open rhinoplasty was used for dorsal approach in all patients and operation was performed under the general anesthesia or local anesthesia. The follow-up period of the patients ranged from 3 to 15 months with a mean of 10 months, and postoperative results were quite satisfactory. There was neither incidences of patients' complaints, nor any complications such as hematoma, septal perforation, supratip deformity, or recurrence. And there was some improvement of nasal obstruction in 15 patients. In conclusion, Septoplasty through dorsal approach is an effective method for the correction of septal deviation and improvement of the nasal airway obstruction.

• The Korean Journal of Pain
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• 제10권2호
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• pp.166-169
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• 1997

Background: We have noted a high incidence of vasovagal episodes associated with use of interscalene block(ISB) for shoulder arthroscopy in the sitting position. The purpose of this retrospective study is to alert the possibility of potentially dangerous vasovagal events, describe the characteristics of this problem, and propose therapeutic devices. Methods: Results 62 patients who underwent shoulder arthroscopy in the sitting position with ISB were retrospectively analyzed. Group 1, 10 patients experienced vasovagal events characterized by sudden hypotension and bradycardia. Remaining 52 patients, Group 2, did not experience these symptoms. All patient charts were reviewed for age, sex, side of surgery, premedication, preoperative fluid and intraoperative medications. Perioperative hemodynamic changes were also compared between the two groups. Results: Vasovagal events experienced in 16% of patients(10/62) and occurred $39{\pm}18$ min after sitting position and $22{\pm}18$ min after start of operation. Number of patients who receiving anticholinergics for premedication were significantly lower in Group 1 than Group 2(2/10 vs. 28/52, p<0.05). Conclusions: Bezold-parish reflex is a potential mechanism for sudden hypotension and bradycardia which can occur during shoulder arthroscopy in sitting position. Therefore anticholinergic pretreatment and meticulous monitoring during operation are recommended to prevent B-J reflex.

• 대한두경부종양학회지
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• 제34권1호
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• pp.15-19
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• 2018

Background and Objectives: Thunderbeat (TB) and Harmonic scalpel (HS) have been applied to variable head and neck surgery, which are useful for both coagulation and cutting of tissues. However, there have been no comparative studies covering the usefulness of these energy devices in surgery for major salivary gland. In this study, we analyzed the surgical outcomes of two devices in surgery for parotidectomy and submandibular gland (SMG) resection. Materials and Methods: A retrospective chart review of 90 patients including two groups (HS group, n=45 versus TB group, n=45) of patients matched for their patient factors was conducted. Clinicopathologic factors of the patients and surgical outcomes such as the operation time, intraoperative bleeding, amount and duration of drain, hospital stay and complications were compared between two groups. Results: There were no significant difference between two groups regarding the clinicopathologic factors and short-term surgical outcomes. Conclusion: Thunderbeat and HS are both effective and safe for parotidectomy and SMG resection in variable benign disease of major salivary gland.

• 대한기관식도과학회지
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• 제17권1호
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• pp.35-39
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• 2011

Objectives The high sensitivity of ultrasound and thyroglobulin determination for follow-up of differentiated thyroid cancer allows early detection of nonpalpable recurrences. Intraoperative localization of these small foci in previously dissected necks is a surgical challenge. We assessed the safety and effectiveness of ultrasound-guided tattooing (US-tattoo) with a charcoal suspension for localizing nonpalpable cervical recurrences after thyroidectomy for thyroid cancer. Subjects and Methods Between March 2009 and December 2010, we retrospectively reviewed 19 patients who underwent US-tattoo with injection of a charcoal suspension for recurrent thyroid papillary cancer on central neck compartment after thyroidectomy. All patients underwent the surgical dissection after US-tattoo. The complications and effectiveness of US-tattoo were evaluated. Results The technical success rate of US-tattoo for suspicious lesions was 100%. There was no complication with regard to US-tattoo. During surgery, all but one tattooed lesions were detected by surgeons. On final pathologic reports, all recurrence lesions but two cases were successfully removed. Conclusion Preoperative US-tattoo is a safe and effective method for successful reoperation of central neck compartment recurrences after thyroidectomy.

• Journal of Periodontal and Implant Science
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• 제50권4호
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• pp.209-225
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• 2020

Purpose: Marginal bone loss (MBL) is an important clinical issue in implant therapy. One feature that has been cited as a contributing factor to this bone loss is peri-implant mucosal thickness. Therefore, in this report, we conducted a systematic review of the literature comparing bone remodeling around implants placed in areas with thick (≥2-mm) vs. thin (<2-mm) mucosa. Methods: A PICO question was defined. Manual and electronic searches were performed of the MEDLINE/PubMed and Cochrane Oral Health Group databases. The inclusion criteria were prospective studies that documented soft tissue thickness with direct intraoperative measurements and that included at least 1 year of follow-up. When possible, a meta-analysis was performed for both the overall and subgroup analyses. Results: Thirteen papers fulfilled the inclusion criteria. A meta-analysis of 7 randomized clinical trials was conducted. Significantly less bone loss was found around implants with thick mucosa than around those with thin mucosa (difference, -0.53 mm; P<0.0001). Subgroups were analyzed regarding the apico-coronal positioning, the use of platform-matched vs. platform-switched (PS) connections, and the use of cement-retained vs. screw-retained prostheses. In these analyses, thick mucosa was found to be associated with significantly less MBL than thin mucosa (P<0.0001). Among non-matching (PS) connections and screw-retained prostheses, bone levels were not affected by mucosal thickness. Conclusions: Soft tissue thickness was found to be correlated with MBL except in cases of PS connections used on implants with thin tissues and screw-retained prostheses. Mucosal thickness did not affect implant survival or the occurrence of biological or aesthetic complications.