• Journal of Chest Surgery
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• v.27 no.10
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• pp.888-892
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• 1994

Acquired, traumatic tracheoesophageal fistula [TEF] is rare and difficult problem to manage. This 55 years old man met with a roller accident of a tractor. During accident, he received a penetrating injury on the left upper sternal border. At local clinic, he received closed thoracotomy drainage [CTD]for relief of pneumothorax[left]. Three days after CTD, he complained abdominal pain and hematemesis. The endoscopy revealed large ulcer at the stomach, so he received subtotal gastrectomy. On 10th day post subtotal gastrectomy, he developed aspiration and coughing from a TEF. The esophagogram showed large TEF at the mid-trachea level. So he transfered to our hospital for operation. This patient was operated on for late TEF three weeks after injury. We have used absorble 4-0 Vicryl sutures to repair trachea. We repair all esophageal injuries with two layers of nonabsorbable silk suture. Where suture line on the esophagus, the strap muscle was interposed for reinforcement. And for feeding, the feeding jejunostomy was performed. Postoperatively the osteomyelitis of the manubrium site was developed, so on the 30th postoperative day, an ostectomy of manubrium, both clavicle and fight 1st, 2nd ribs, and the pectoralis major musculo-cutaneous flap coverage were performed.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.812-815
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• 2010

Myxofibrosarcoma is one of the most common soft tissue tumors in elderly patients, mostly arising in the extremities, and rarely arising in the chest wall. A 53-year-old women presented with a painful chest wall mass in the manubrium. We excised the mass. The mass was located subdermally, but had infiltrated the underlying muscle layer, and was histologically diagnosed as an intermediate grade myxofibrosarcoma showing myxoid changes and hypercellularity. Here we report a rare case of chest wall myxofibrosarcoma and present a review of the literature.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.89-91
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• 1998

Tuberculosis infection is wide spread disease and makes troublesome complications in some cases. A 50 - year old male visited Andong Hospital with coughing and sputum, dyspnea on exertion, bulging left anterior chest wall mass. Chest X-ray showed right pleural effusion, both side streaky infiltraion, and pleural thickness in apex. Chest CT scan showed bone destruction of left clavicle head, manubrium and large abscess pocket in pectoralis muscle. In May 1996 he underwent en bloc resection of left upper anterior chest wall including pectoralis major and minor muscle, left clavicle head, manubrium and covering infected skin, then contralateral pectoralis major muscle flap and skin graft was done. Patient shows no evidence of recurrence during follow up.

• Animal Systematics, Evolution and Diversity
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• v.19 no.1
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• pp.111-117
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• 2003

Some hydromedusae were collected from Shiwhaho (Kyonsgi-do), Korea Strait and Yeosu, Korea during years 2000-2002. They were identified into Sorsia tubulosa (M. Sars, 1835) of the order Anthomedusae, and Liriope tetraphylla (Chamisso and Eysenhardt, 1821) of the order Trachymedusae respectively. They are new to the Korean fauna. The order Trachymedusae is first recorded in Korea. The long tube-like manubrium and four marginal tentacles are characteristics of S. tubuloso. In L. tetraphylla, the four triangle-shaped gonads and their positions upon half of surface of subumbrella, the seven blind centripetal canals in a quadrant and the long fat manubrium are its distinct characteristics. Resulting from this work, the Korean hydromedusae identified so far consist of 13 species of 11 families in five orders.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.33-39
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• 2015

Background: This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG) surgery using bilateral internal thoracic arteries. Methods: This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA) from 2006 through 2009. Postoperative computed tomography (CT) angiography was performed on all patients at monthly intervals for three to six months after surgery. In 108 patients, an additional CT study was performed 24 to 48 months after surgery. The axial CT images were used to score sternal fusion at the manubrium, the upper sternum, and the lower sternum. These scores were added to evaluate overall healing: a score of 0 to 1 reflected poor healing, a score of 2 to 4 was defined as fair healing, and a score of 5 to 6 indicated complete healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results: Three to six months after surgery, the average total score of sternal healing was $2.07{\pm}1.52$ and 68 patients (34.5%) showed poor healing. Poor healing was most frequently found in the manubrium, which was scored as zero in 72.6% of patients. In multivariate analysis, the factors associated with poor early healing were shorter post-surgery time, older age, diabetes mellitus, and postoperative renal dysfunction. In later CT images, the average sternal healing score improved to $5.88{\pm}0.38$ and complete healing was observed in 98.2% of patients. Conclusion: Complete sternal healing takes more than three months after a median sternotomy for CABG using sBITA. Healing is most delayed in the manubrium.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.325-330
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• 1986

Eosinophilic granuloma is one of the histiocytosis X. It may occur in any bone and tissues, but the one originated from the sternum was rarely reported. Recently, we experienced an eosinophilic granuloma at the manubrium sterni, associated with diabetes insipidus, which was surgically resected. Although intranasal spray of DDAVP has been used for the control of diabetes insipidus, the bony lesion was remitted. With the brief review of the literatures, we report the case.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.143-147
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• 1976

A case of congenital funnel chest which was observed in 6 year old male was reported. The patient represented clinical status of depression of lower sternum, recurrent upper respiratory tract infection, and slight exertional dyspnea. The treatment was carried out by "turnover" method, and it was easy to do viable on sternum, costal cartilage, and intercostal muscles. And it is fit to reimplantation by free autograft when repair was indicated. The plane of the manubrium, an acute hump on the sternum, and asymmetry constitute limiting factors in the cosmetic results.

• Journal of Korean Neurosurgical Society
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• v.58 no.3
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• pp.236-241
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• 2015

Objective : We report on the technical feasibility and limitations of the transmanubrial approach for cervicothoracic junction (CTJ) lesions and emphasize the advantage of bisecting the upper part of the manubrium in an inverted Y-shape. Methods : Thirteen patients who underwent the fourteen transmanubrial approach for various CTJ lesions were enrolled during 2005-2014. For the evaluation of the accessibility for the CTJ lesion, we analyzed the two parallel line defined as a straight line parallel to the inferior and superior plateau of the upper and lower healthy vertebrae, the angle of the two parallel lines and the distance from the sternal notch to lines at the sternum on preoperative magnetic resonance images. Surgical limitations and perspectives, as well as postoperative clinical outcomes were evaluated retrospectively. Results : The CTJ lesions were six metastases, three primary bone tumors, two herniated discs, and one each of a traumatic dislocation with syrinx formation and tuberculous spondylitis and ossification of the posterior longitudinal ligament. If two parallel lines pass below the sternal notch, the manubriotomy should be inevitably performed. The mean preoperative Visual analogue scale score was 8 (range, 5-10), which improved to 4 (range, 0-6) postoperatively. Seven cases showed an increase in Frankel score postoperatively. Conclusion : The spatial relationship between the sternal notch and the two parallel lines to the lesion was rational to determine the feasibility of manubriotomy. The transmanubrial approach for CTJ lesions can achieve favorable clinical outcomes by providing direct decompression of lesion and effective reconstruction.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.643-648
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• 2012

Background Aggressive treatment of sternoclavicular joint (SCJ) infection involves systemic antibiotics, surgical drainage and resection if indicated. The purpose of this paper is to describe a classification of post resectional SCJ defects and highlight our reconstructive algorithm. Defects were classified into A, where closure was possible often with the aid of topical negative pressure dressing; B, where parts of the manubrium, calvicular head, and first rib were excised; and C, where both clavicular, first ribs and most of the manubrium were resected. Methods Twelve patients (age range, 42 to 72 years) over the last 8 years underwent reconstruction after SCJ infection. There was 1 case of a type A defect, 10 type B defects, and 1 type C defect. Reconstruction was performed using the pectoralis major flap in 6 cases (50%), the latissimus dorsi flap in 4 cases (33%), secondary closure in 1 case and; the latissimus and the rectus flap in 1 case. Results All wounds healed uneventfully with no flap failure. Nine patients had good shoulder motion. Three patients with extensive clavicular resection had restricted shoulder abduction and were unable to abduct their arm past $90^{\circ}$. Internal and external rotation were not affected. Conclusions We highlight our reconstructive algorithm which is summarised as follows: for an isolated type B SCJ defect we recommend the ipsilateral pectoralis major muscle for closure. For a type C bilateral defect, we suggest the latissimum dorsi flap. In cases of extensive infection where the thoracoacromial and internal mammary vessels are thrombosed, the pectoralis major and rectus abdominus cannot be used; and the latissimus dorsi flap is chosen.

• Journal of Chest Surgery
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• v.50 no.4
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• pp.295-297
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• 2017

A 27-year-old man was admitted with a penetrating injury at the mid-manubrium. Computed tomographic (CT) angiography showed a f illing def ect in the aortic arch. This was evaluated as a sign of injury and the patient underwent an emergency operation. No active bleeding or clot was f ound in the mediastinum during the operation. The laceration point was between the innominate and the left carotid artery posteriorly. The injury was approached using hypothermic circulatory arrest. Aortotomy and exploration showed a 2-cm-long full-thickness aortic injury with an overlying clot. A filling defect on angiography as a sign of a penetrating arch injury has never been reported previously, but was the main pathological finding on CT angiography in our case. The aorta is a high-pressure system and injuries to it should be treated aggressively.