• Journal of Minimally Invasive Surgery
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• v.21 no.4
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• pp.160-167
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• 2018

Purpose: The aim of our study was to present an abdominal wall closure technique using barbed suture $V-Loc^{TM}$ 90 after single incision laparoscopic appendectomy (SILA) and to compare perioperative outcomes with conventional layer by layer abdominal wall closure after SILA. Methods: From March 2014 to July 2016, a retrospective case-control study was conducted for a total of 269 consecutive patients who underwent SILA. According to abdominal wall closure methods, 129 patients were classified into the V-Loc closure group and 140 patients were assigned into the conventional layer by layer closure group. In the V-Loc group, abdominal wall closure was performed from the fascia to the skin with a single thread of unidirectional absorbable barbed suture $V-Loc^{TM}$ 90 2-0 using continuous running suture and reverse overlapping reinforced running technique. Subcutaneous closure and subcuticular suture were performed with the remaining portion of V-Loc. Results: The V-Loc closure group showed shorter total operation time ($40.0{\pm}15.4min$ vs. $44.9{\pm}16.3min$, p=0.013) and abdominal wall cusing continuous running suture and reverse overlapping reinforced running technique. Subcutaneous closure and subcuticular suture were performed with the remaining portion of V-Loc. Results: The V-Loc closure group showed shorter total operation time losure time ($5.5{\pm}0.9min$ vs. $6.5{\pm}0.8min$, p<0.001). Postoperative incision length was significantly shorter in the V-Loc closure group ($1.1{\pm}0.3cm$ vs. $1.8{\pm}0.4cm$, p<0.001). Postoperative wound pain, time to resume diet, postoperative hospital stay, complications including surgical site infection, or mean patient satisfaction score at one month after hospital discharge was not significantly different between the two groups. Conclusion: In conclusion, unidirectional knotless barbed suture is a safe alternative method for abdominal wall closure after SILA. It can save time while providing comparable cosmesis.

• Journal of Veterinary Clinics
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• v.30 no.1
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• pp.80-85
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• 2013

Twenty one cows in Goyang and Paju cities were referred due to displacement of the abomasum and foreign body in the rumen. Omentopexy and rumenotomy through a right flank celiotomy were performed for treatment of abomasal displacement and the foreign body removal in the rumen. The right paralumbar fossa is clipped and prepared surgically. Local anesthesia is instituted by performing inverted L block. The abdomen was entered through 25 to 30 cm vertical incision in the right paralumbar fossa starting 4 to 5 cm ventral to the transverse processes of the lumbar vertebrae. A 14-gauge needle with rubber tubing attached is inserted to relieve the gaseous pressure and to facilitate further exploration and manipulation. The rumen was gently pulled out of the abdominal cavity and incision was made at the omentum. Rumenotomy was done and retrieved the foreign body. After the rumen was rinsed with sterile saline, the rumen wall was closed by a Lembert suture technique. The omentum was closed by a simple continuous suture. Right flank omentopexy was performed for the surgical correction of abomasal displacement. Recovery results among 21 cows included 9 excellent, 5 good, 2 fair and 5 bad. It was considered that operation of abomasal displacement and foreign body removal in the rumen through right flank celiotomy was a good surgical technique to reduce expenses, surgical pain, and surgery time.

• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.223-228
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• 2016

Background: The aim of study was to confirm the clinical effectiveness and results of wide and single anterior approach for fractures occurring along length of humerus. Methods: A total of 23 patients with humeral fracture were enrolled into our study who were able to participate in at least one year of follow-up. Seven patients had segmental comminuted humeral fractures and 16 patients had distal humeral fractures. We made various tractions of the muscles to expose the proximal and the middle third humerus between the biceps and brachialis and the distal humerus by partial splitting of lateral side of biceps through a single incision. Postoperatively, we measured the Mayo elbow performance index (MEPI). Results: we achieved bone union in all 23 patients. Solid union of the bone was achieved at an average 13.9 weeks. Postoperatively, two complications were observed screw loosening and nonunion. Revision surgery was performed in both patients. The patient with bone nonunion was treated using bone grafts. No postoperative infections or peripheral neuropathies were observed. At the final follow-up (average 20 months), we found that the average MEPI functional score of the patients was 91.7 points regardless of the fracture site. Conclusions: Our whole humerus with a single incision was effective for the treatment of segmental comminuted and distal fractures. we believe it is a useful alternative to preexisting methods of fracture fixation.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.41-46
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• 1998

Background: Preoperative analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and therefore may preempt postoperative pain. Although preemptive analgesia has shown to decrease postinjury pain in animals, studies in human are not consistent. We studied whether epidural morphine injection before surgical incision could affect postoperative pain and analgesic demands, compared with injection after removal of specimen. Methods: Forty patients scheduled for radical subtotal gastrectomy were randomly assigned to one of two groups for prospective study in a double-blind manner. Group 1 received an epidural injection of 3 mg of morphine in 8 ml of 0.9% saline before surgical incision, and Group 2 after removal of specimen. Postoperative pain relief was provided with I.V. patient controlled analgesia (PCA) system. Numerical rating scales for pain and mood, Prince Henry Hospital scores for pain, cumulative PCA analgesic consumptions, and incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. Results: Cumulative PCA analgesic consumption in group 1 was significantly less than in group 2 at 2, 6 hours after surgery. Pain scores and the incidence of side effects were similar in both groups. Conclusions: Preoperative analgesia with epidural morphine showed little difference in patient controlled analgesic consumption after upper abdominal surgery compaired to intraoperative morphine.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.382-387
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• 2007

Objective : Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity. Although many different operative techniques have been introduced, none of them have been proven superior to others. Simple cubital tunnel decompression has numerous advantages, including simplicity and safety. We present our experience of treating cubital tunnel syndrome with simple decompression in 15 patients. Methods : According to Dellon's criteria, one patient was classified as grade 1, eight as grade 2, and six as grade 3. Preoperative electrodiagnostic studies were performed in all patients and 7 of them were rechecked postoperatively. Five patients of 15 underwent simple decompression using a small skin incision (2 cm or less). Results : Preoperative mean value of motor conduction velocity (MCV) within the segment (above the elbow-below the elbow) was $41.8{\pm}15.2\;m/s$ and this result showed a decrease compared to the result of MCV in the below the elbow-wrist segment ($57.8{\pm}6.9\;m/s$) with statistical significance (p<0.05). Postoperative mean values of MCV were improved in 6 of 7 patients from $39.8{\pm}12.1\;m/s$ to $47.8{\pm}12.1\;m/s$ (p<0.05). After an average follow-up of $4.8{\pm}5.3$ months, 14 patients of 15 (93%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. Five patients who had been treated using a small skin incision achieved good or excellent outcomes. There were no complications, recurrences, or subluxation of the ulnar nerve. Conclusion : Simple decompression of the ulnar nerve is an effective and successful minimally invasive technique for patients with cubital tunnel syndrome.

• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.71-75
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• 2002

Background and Objectives: The tracheotomy is one of the most essential surgical procedures performed in the intensive care unit (ICU). The tracheal stenosis, as a complication following endotracheal intubation or tracheotomy, has been the subject of considerable recent investigation. Many different methods have been developed to avoid the tracheal stenosis but there is still controversy about the tracheal incisions. We had performed tracheotomy using a vertical elliptical tracheal incision in the ICU to evaluate its efficiency and safety. Materials and Methods: 191 patients who underwent the tracheotomy in the ICU between 1995 and 2000 were reviewed retrospectively by chart records and interviews. Results: The complications were reported such as bleeding, infection, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula and tracheal stenosis. The total numbers of complications were 35 cases (18.3%) and the tracheal stenosis was developed in 4 patients. The characteristics of tracheal stenosis are as follows. Conclusion: The vertical elliptical tracheal incision is the safe and reliable methods in ICU patients compared with other methods, but other factors are also important in preventing the complications.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.124-130
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• 2005

In the microsurgical era, replantation with microvascular anastomosis is considered as the most superior method in aspects of texture, color, shape in case of nose amputation. There are some reported cases of replantation in nose amputation historically, but most of them are composite graft cases rather than microvascular anastomosis. Only a few cases of successful nasal replantation with microvascular anastomosis have been reported due to the reason that the size of vessels is usually very small and identifying suitable vessels for anastomosis is difficult. Microanastomosis of artery and microanastomosis of vein are ideal in replantation, but identifying suitable veins is often difficult. Without venous anastomosis, resolving the venous congestion remains to be a problem. We can carry out arteriovenous shunt if we can find two arteries in amputee. However, the smaller the size of amputee is, the more difficult it is to find two arteries. Instead of arteriovenous shunt, we can try external venous drainage(frequently swab, pin-prick, stab incision, IV or local heparin injection, dropping, apply of heparin-soaked gauze, use of medical leech). Here, we present three cases of replantation with microscopical arterial anastomosis (one angular artery, two dorsal nasal arteries) and external venous drainage (stab incision, application of medical leech and heparin-soaked gauze) even though the size of amputee may be as small as $1.5{\times}1.0cm$. In all cases, surgical outcomes were excellent in cosmetic and functional aspects. This report describes successful replantation by microvasular anastomosis in case that suitable veins are not found.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.1008-1014
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• 1994

Increased interest in alternative approach to thoractomy has developed because of the considerable morbidity associated with the standard posterolateral thoracotomy[ST]. Muscle sparing thoracotomy is appeared as excellent alternative because of less postoperative pain and morbidity than standard posterolateral one. Vertical axillary muscle sparing thoracotomy[VM] is the newly revised modified muscle sparing thoracotomy that overcomes the disadvantages of previous lateral muscle sparing thoracotomy such as seroma, cosmetic problems, and need of subcutaneous drains. We conducted a prospective study of 45 consecutive patients to compare postoperative pain, muscle strength of serratus anterior and latissimus dorsi, and range of motion of the shoulder girdle between ST and VM group. There were no difference in preoperative status, surgical procedure, morbidity, mortality and hospital stay between two groups. But there were significant less postoperative narcotics requirements, more preserved latissimus dorsi and serratus anterior muscle strength, nd larger range of motion of shoulder girdle [ especially flexion and internal rotation in VM group. The opening time was prolonged[p<0.01] but closing time was less in VM group [p<0.01]. The sum of opening and closing time was not different in two group. The length of incision line was shorter in VM group. The vertical skin incision was concealed by the upper arm.In conclusion vertical axillary muscle sparing thoracotomy is good alternative for various intrathoracic procedures with less postoperative pain, well preserved muscle strength,increased range of motion of the shoulder girdle and impressive cosmetic outcome.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.161-165
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• 2002

Descending necrotizing mediastinitis is a life-threatening infection originating in the head or the neck and descends into the mediastinum. Even in the era of antibiotics, mortality rate has been reported to be 25 ∼ 40%. Prompt diagnosis and treatment is mandatory for delayed diagnosis and inappropriate drainage of the mediastinum are the main causes of high mortality Surgical management ranges from cervical drainage to routin thoracotomy:however, the optimal management still needs to be defined particularly in respect to effective mediastinal drainage. Although posterolateral thoracotomy incision has been considered as a standard approach, potential disadvantages including postoperative pain, risk of wound complication and delayed recovery remain to be concerned. Thoracoscopic approach is an attractive treatment modality as it can provide an excellent exposure with minimal incision and can complete drainage from the mediastinum and the neck in one-staged manner We describe here two cases of descending necrotizing mediastinitis successfully managed by thoracoscopic drainage.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.244-247
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• 1996

Multiple symmetric lipomatosis is a rare disease characterized by progressive growth of subcutaneous fat masses which are located symmetrically at neck, shoulders, chest, abdomen and groin. Recent surveys revealed a high incidence of combined somatic and autonomic neuropathy. The exact cause of the disease is not known. We have experienced one case of multiple symmetric lipomatosis with mediastinal involvement with symptomatic compression of trachea. The patient was a 55-year-male, complaining of dyspnea and slowly enlarging multiple symmetric masses at the neck, shoulders, chest, abdomen, flank and groin over a period of 10 years. He had a habit of excessive alcohol intake for many years. The fatty masses in the neck and the upper mediastinum including peritracheal region were excised through transverse cervical incision. But, because of the incomplete excision of peritracheal fatty tissue, we performed reoperation for the relief of residual tracheal compression at the 15th postoperative day. Two days later emergent tracheostomy was performed due to postoperative pneumomediastinum and subcutaneous emphysema. He could discharge with permanant tracheostomy.