• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.229-236
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• 2015

Background: Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed by split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Methods: Twenty-five patients showed positive results upon long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range, 12-120 months). Four patients had non-traumatic etiologies and 22 patients had traumatic etiologies. On follow-up assessment for functional improvement, a Constant-Murley score was used. Twenty-one patients were completely evaluated, while five patients who had less than 12 months of follow-up were excluded. Results: Pain relief was achieved in 19 of the 21 patients, with 20 patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from $108^{\circ}$ (range, $20^{\circ}-165^{\circ}$) preoperatively to $151^{\circ}$ (range, $125^{\circ}-170^{\circ}$) postoperatively. The mean Constant-Murley score improved from 57.7 (range, 21-86) preoperatively to 86.9 (range, 42-98) postoperatively. A recurrence developed in one patient. Of the 21 patients, ten had excellent results, six had good results, four had fair results, and one had poor results. Conclusions: Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2009년도 제17차 학술대회
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• pp.208-208
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• 2009

Eleven shoulders (9 patients) with refractory scapulothoracic dysfunction were treated with scapulothoracic arthrodesis between 2000 and 2006. Refractory shoulder dysfunction included facioscapulohumeral muscular dystrophy in five shoulders (3 patients), refractory scapular winging with long thoracic nerve palsy in one shoulder, scapular winging caused by serratus anterior palsy with trapezius dysfunction in one shoulder, post-surgical thoracic outlet syndrome due to medial clavicle resection in two shoulders, refractory scapular winging with spinal accessory nerve injury in one shoulder, and chronic trapezius rupture caused by cervical spine surgery in one shoulder. The mean active flexion was improved from 82 degrees preoperatively to 112 degrees postoperatively. The mean Constant score was improved from 27.2 points to 68.0 points. Two shoulders (1 patient) that had facioscapulohumeral muscular dystrophy had broken wires due to nonunion, and one patient had a reactive pulmonary effusion. In ten of the eleven shoulders, the patients were satisfied with their results. The scapulothoracic arthrodesis can cause significant pain relief and functional improvement in refractory scapulothoracic and/or shoulder dysfunction. By selecting patients that present with appropriate indications, and using experienced surgical technique through complete preoperative evaluation, we can diminish the complication rate and make good clinical outcomes.

• Archives of Plastic Surgery
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• 제42권1호
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• pp.73-77
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• 2015

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

• Journal of Chest Surgery
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• 제28권8호
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• pp.772-777
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• 1995

Bronchoplastic procedure has been considered as an appropriate surgery for traumatic bronchial disruption and occasionaly for primary bronchial tumors or tuberculosis because it can bring preservation of pulmonary tissue for patients without compromising the chance for cure. Nowadays bronchoplastic procedure is also applicable for the selected cases of bronchogenic carcinomas with favorable long term survival, when compared to standard pneumonectomy.Eighteen bronchoplastic procedures were performed with or without pulmonary resection at Department of Thoracic and Cardiovascular Surgery, Catholic University Medical College, between 1990 and 1994. The patients were 11 men and 7 wemen with average age of 57 years [range, 19 to 71 years . Tumor comprised 56% of the lesions, including 6 squamous cell carcinoma [33% , 2 bronchial adenoma [11% , 1 leiomyoma and 1 metastatic osteogenic sarcoma. Cicatrical stenosis secondary to endobronchial tuberculosis and traumatic disruption occurred in 6 [33% and 1 patient respectively.Applied bronchoplastic procedures were as follows ; sleeve lobectomy, 8 cases [right upper : 6, left upper : 1, right middle : 1 : bronchial segmental resection without pulmonary resection, 2 cases : sleeve bi-lobectomy, 1 cases :patch dilating bronchoplasty with or without concomitant lobectomy in 7. There was no perioperative mortality. Morbidity in 4 patients included 1 transient recurrent laryngeal nerve palsy, 1 unstability of bronchial patch resulting atelectasis of afftected lung and 2 bronchial stenosis of anastomotic site.Throughout our experiences, we feel strongly that bronchoplastic procedure is a safe and effective surgical method preserving normal pulmonary tissue below affected bronchus for the wide range of various bronchial lesion including selected cases of bronchogenic carcinoma with acceptable complication and mortality.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1118-1122
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• 1996

1990년 1월부터 1995년 12월가지 43명의 환아가 다양한 심혈관수술로 인해 유발된 횡격막 마비로횡 격막 습벽형성술을 시행 받았다. 환아의 평균연령은 11.1개월이었고, 남녀 비율은 31:12였다. 횡격막 마비의 원인이 된 수술로는 변형 Blalock-Taussig단락술 및 활로씨 4징증의 전교정술이 각각 7례로 가장 많았고, 기타 동맥 전환술 6례, 심실중격결손을 동반한 폐동맥 폐쇄증에서의 unifocalization 및 변형 Fontan수술, 심실중격결손 교정 등이 각각 3례씩이었다. 마비된 부위는 우측이 17례, 좌측이 23례, 양측성이 3례였으며, 원인은 대부분 과도한 심낭 절제 및 심낭 절개면 부위의 전기소작으로 추정되었다. 원인이 된 수술후 횡격막 습벽형성술까지의 기간은 수술 당일로부터 98일까지로 대부분 2주이내에 습 벽형성술이 이루어졌다 수술방법은 2례를 제외하고 모두 횡격막 신경분지를 피해서 횡격막을 접어주는 central pleating technique 이 적용되었다. 10명의 환아가 습벽형성술후 사망했으며(조기: 7, 만기: 3), 사망원인은 전례 에서 습벽 형성술과는 무관한 것으로 사료되 었다. 36명의 조기생존자들은 습벽 형성술후 1일에서 24일 사이에 양압호\ulcorner으로 부터 벗어날 수 있었다(평균 4.5일). 6명의 환아가 습벽 형성술후 8개 월에서 52개월 사이에 fluoroscopy를 시행하였으며, 대부분 횡격막의 위치 및 운동성이 양호하였다. 결 론적으로 불가역적인 횡격막 신경 손상이 없다면 횡격막 습벽형성술은 단기적으로는 환아의 양압호흡 의존기 간을 단축시키고 장기적으로는 횡격막 기능의 완전회복을 유도할 수 있다.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2008년도 제16차 학술대회
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• pp.53-53
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• 2008

Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed with split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Twenty-five patients had positive results for long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range 12~120 months). Four patients had non-traumatic etiologies and twenty-two patients had traumatic etiologies. At the final follow-up assessment for functional improvement, a Constant-Murley score was used. 21 patients were completely evaluated, while 5 patients who had less than 12 months follow-up were excluded. Pain relief was achieved in 19 of the 21 patients, with twenty patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from $108^{\circ}$ (range $20^{\circ}\sim165^{\circ}$) preoperatively to $151^{\circ}$ (range $125^{\circ}\sim170^{\circ}$) postoperatively. The mean Constant-Murley score improved from 57.7 (range 21~86) preoperatively to 86.9 (range 42~98) postoperatively. A recurrence developed in one patient. Of the twenty-one patients, eight had excellent results, nine had good results, three had fair results, and one had poor results. Most patients with severe symptomatic scapular winging had functional improvement and pain relief with resolution of scapular winging.

• Journal of Chest Surgery
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• 제32권5호
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• pp.471-479
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• 1999

배경: 폐동맥폐쇄와 주대동맥폐동맥혈관부행지를 동반한 활로씨사징증 환아들은 여러가지 이질적인 외과적인 원칙하에 치료되어 왔다. 본 연구에서는 상기 질환으로 본원에서 치료를 받은 환아들을 대상으로 그동안 시도하였던 5 가지 서로 다른 외과적인 치료전략을 중심으로 그 장단점을 비교하고자 하였다. 대상 및 방법: 1986년 1월부터 1998년 6월까지 본 질환을 가진 50명의 환아를 대상으로 최초 수술방법에 따라 일단계단일화술군(A-1, n=9), 단계적단일화술군(A-2, n=11), 우심실-폐동맥 연결술군(B-1, n=11), 우심실-폐동맥연결/단일화술 동시 시행군(B-2, n=11), 일단계 완전교정술군(C, n=8) 등 5군으로 분류하고 군별 형태학적 특성, 수술결과, 완전교정 가능성, 추적결과 등을 비교 분석하였다. 50명 환아들의 제 1차 수술당시 평균연령은 39$\pm$31 (1-177) 개월이었다. 결과: 각 군의 최초 수술 당시 평균 연령은 각각 57$\pm$18(A-1), 42$\pm$48(A-2), 18$\pm$14(B-1), 52$\pm$55(B-2), 32$\pm$34(C) 개월이었다 (p<0.05). 주대동맥폐동맥혁관부행지의 평균 숫자는 일단계 완전교정술 시행 군에서 가장 적었다 (A-1=4.3$\pm$1.0, A-2=4.5$\pm$1.3, B-1=4.1$\pm$1.9, B-2=4.1$\pm$1.6, C=3.4$\pm$1.8 : p<0.05). 직접 및 간접 주대동맥폐동맥혁관부행지 숫자의 비는 군간에 차이가 없었다 (A-1=91%/9%), A-2=78%/22%, B-1=80%/20%, B-2=80%/20%, C=81%/19% : p>0.05). 19명의 환아는 1개 이상의 의존성 주대동맥폐동맥혈관부행지를 가지고 있었다. 13명의 환아는 진폐동맥이 존재하지 않았으며 29명의 환아의 진폐동맥은 좌우폐동맥 연결이 있었다. 수술은 50명의 환아에 대하여 총 101 (1-4)회 시행되었으며 각 군의 최초 수술에 따른 수술사망율은 각각 33%(3/9, A-1), 18%(2/11, A-2), 0%(0/11, B-1), 36%(5/11, B-2), 13%(1/8, C)였다 (p<0.05). 군별 심실중격결손의 완전폐쇄까지를 포함한 완전교정술을 완료한 환아의 백분율은 각각 22%(2/9, A-1), 18%(2/11, A-2). 45%(5/11,B-1), 27%(4/11,B-2), 100%(8/8,C)(p<0.05)였다 (p<0.05). 사망원인은 저산소성 호흡부전 및 심부전(6), 뇌손상(2), 패혈증(4) 등이었고 술후 합병증으로 횡격막신경마비가 5례에서 발생하였다. 6례의 추적실패를 제외한 생존환자 31례는 평균 74$\pm$42 (3-145) 개월 외래추적되었으며 1년 및 5년 생존율이 각각 73%, 73%였다. 결론: 연구자등은 본 연구를 통하여, 본 질환에 대하여 제 1단계로 시행한 시술로 우심실-폐동맥 연결술이 가장 안전하고도 완전교정술 도달 확률이 높은 치료전략이라는 사실을 입증하였으며 주대동맥폐동맥혈관부행지의 크기나 숫자가 단일화하기 쉬운 형태학적 특징을 지닌 경우에는 조기에 일단계완전교정술을 시행하여 양호한 결과를 얻을 수 있다는 사실을 발견하였다. 반면 본 환아군 중 단일화술을 먼저 시도한 군에서는 비록 단계적인 단일화를 시도한 군에서 단일화술과 관계된 수술사망율이 약간 낮기는 하였으나 완전교정술까지 완료될 가능성에는 차이가 없었다. 그러나 이 경우 보다 정련된 적응 환자의 선택을 통한 단일화 우선전략의 시도와 장기 추적결과의 관찰이 요구된다.