• Archives of Plastic Surgery
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• v.34 no.2
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• pp.229-236
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• 2007

Purpose: Breast reconstruction with deep inferior epigastric perforator(DIEP) free flap is known to be the most advanced method of utilizing autologous tissue. The DIEP free flap method saves most of the rectus abdominis muscle as well as anterior rectus sheath. Therefore, the morbidity of the donor site is minimized and the risk of hernia is markedly decreased. Methods: We chose the internal mammary artery and its venae comitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels. The number and location of the perforators derived from medial or lateral branch of deep inferior epigastric artery(DIEA) in 23 DIEP flaps were identified. Ten patients underwent evaluation of their abdominal wall function preoperatively and 6 months postoperatively by using Lacote's muscle grading system. Results: Of the 23 patients, a patient with one perforator from lateral branch of DIEA experienced partial necrosis of flap. Total flap loss occurred in one patient. Mild abdominal bulging was reported in one patient 4 months postoperatively probably because of early vigorous rehabilitational therapy for her frozen shoulder. Postoperative abdominal wall function tests in 10 patients showed almost complete recovery of muscle function upto their preoperative level of upper and lower rectus abdominis and external oblique muscle function at 6 months postoperatively. All patients have been able to resume their daily activities. Conclusion: The breast reconstruction with DIEP free flap is reliable and valuable method which provide ample soft tissue from abdomen without compromising the integrity of abdominal wall. Selection of reliable perforators is important and including more than two perforators may decrease fat necrosis and partial necrosis of flap.

• Neurospine
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• v.15 no.4
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• pp.362-367
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• 2018

Objective: To assess the efficacy of cervical open-door laminoplasty by hydroxyapatite implant insertion between the lamina and the lateral mass without suturing. Methods: All patients who underwent cervical open-door laminoplasty with C2/C7 undermining and insertion of hydroxyapatite implants from C3 to C6 were retrospectively evaluated for surgical time and neurological outcomes according to the Japanese Orthopaedic Association (JOA) score. To assess the alignment of the cervical spine and postoperative cervical pain, the C2-7 angle and a visual analogue scale score were used, respectively. Results: The population consisted of 102 women and 222 men ranging in age from 32 to 90 years. The average surgical time was 86 minutes. Fourteen of 1,296 hydroxyapatite implants were kept in place with sutures due to a weak restoration force of the hinge during surgery. No hydroxyapatite implant dislocation was detected on cervical computed tomography at 1 year after surgery. The average JOA score was $10.2{\pm}2.5$ before surgery and $14.6{\pm}2.8$ at 1 year after surgery. The average recovery rate was 61.8%. The average C2-7 angle at the neutral position was $7.1^{\circ}{\pm}6.2^{\circ}$ before surgery and $6.5^{\circ}{\pm}6.3^{\circ}$ at 1 year after surgery. Conclusion: This method enabled us to achieve minimal exposure of the lateral mass, prevention of lateral mass injury and dural injury, and a shorter surgical time while maintaining acceptable surgical outcomes. The idea that firm suture fixation is needed to prevent spacer deviation during cervical open-door laminoplasty may need to be revisited.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.61-70
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• 2019

Objective : Corpectomy of the first lumbar vertebra (L1) for the management of different L1 pathologies can be performed using either an anterior or posterior approach. The aim of this study was to evaluate the usefulness of a retroperitoneal extrapleural approach through the twelfth rib for performing L1 corpectomy. Methods : Thirty consecutive patients underwent L1 corpectomy between 2010 and 2016. The retroperitoneal extrapleural approach through the 12th rib was used in all cases to perform single-stage anterior L1 corpectomy, reconstruction and anterior instrumentation, except for in two recurrent cases in which posterior fixation was added. Visual analogue scale (VAS) was used for pain intensity measurement and ASIA impairment scale for neurological assessment. The mean follow-up period was 14.5 months. Results : The sample included 18 males and 12 females, and the mean age was 40.3 years. Twenty patients (67%) had sensory or motor deficits before the surgery. The pathologies encountered included traumatic fracture in 12 cases, osteoporotic fracture in four cases, tumor in eight cases and spinal infection in the remaining six cases. The surgeries were performed from the left side, except in two cases. There was significant improvement of back pain and radicular pain as recorded by VAS. One patient exhibited postoperative neurological deterioration due to bone graft dislodgement. All patients with deficits at least partially improved after the surgery. During the follow-up, no hardware failures or losses of correction were detected. Conclusion : The retroperitoneal extrapleural approach through the 12th rib is a feasible approach for L1 corpectomy that can combine adequate decompression of the dural sac with effective biomechanical restoration of the compromised anterior loadbearing column. It is associated with less pulmonary complication, no need for chest tube, no abdominal distention and rapid recovery compared with other approaches.

• PNF and Movement
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• v.20 no.1
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• pp.91-101
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• 2022

Purpose: The purpose of this study was to examine the effect of cycle ergometer exercise inducing movement of the affected side on knee joint function after total knee arthroplasty (TKA). Methods: The primary experiment was conducted on 19 members of the cycle ergometer exercise group to measure the muscle activity of the rectus femoris, hamstring, tibialis anterior, and gastrocnemius muscles during cycle ergometer exercise that induced the affected side's movement. In the second experiment, after receiving physiotherapeutic intervention for 30 min, the general bicycle exercise group and cycle ergometer exercise group performed the corresponding exercise for 15 min, 5 times per week, for 2 weeks. The ROM, muscle strength, pain, and balance were then measured and compared between the two groups. Results: In the results of the primary experiment, cycle ergometer exercise inducing movement of the affected side showed a significantly larger increase in the activity of leg muscles (rectusfemoris, hamstring, tibialis anterior, gastrocnemius) on the affected side than the general bicycle exercise (p <0.05). In the second experiment, the cycle ergometer exercise group showed a significantly larger increase in range of movement of affected side knee flexion and muscle strength of affected side knee flexion, knee extension, and plantarflexion than the general bicycle exercise (p <0.05). No significant between-group difference was observed in pain and balance before or after the intervention (p >0.05). Conclusion: Cycle ergometer exercise inducing movement of the affected side increases use of the muscles around the affected side knee joint after TKA more than general bicycle exercise and produces better effects for enhancing muscle strength. The application of cycle ergometer exercise inducing movement of the affected side is expected to reduce the patients' unbalanced use during the early postoperative period and help them to quickly return to normal daily life through rapid muscle strength recovery.

• Journal of Trauma and Injury
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• v.34 no.4
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• pp.248-256
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• 2021

Purpose: Laparoscopy has various advantages over laparotomy in terms of postoperative recovery. The number of surgeons using laparoscopy as a diagnostic and therapeutic tool in abdominal trauma patients is increasing, whereas open conversion is becoming less common. This report summarizes a single surgeon's experience of laparoscopy at a level I trauma center and evaluates the feasibility of laparoscopy as a diagnostic and therapeutic tool for abdominal trauma patients. Methods: In total, 30 abdominal trauma patients underwent laparoscopy by a single surgeon from October 2014 to May 2020. The purpose of laparoscopy was categorized as diagnostic or therapeutic. Patients were classified into three groups by type of surgery: total laparoscopic surgery (TLS), laparoscopy-assisted surgery (LAS), or open conversion (OC). Univariate analysis was performed to determine the advantages and disadvantages. Results: The mechanism of injury was blunt in 19 (63.3%) and penetrating in 11 patients (36.7%). Eleven (36.7%) and 19 patients (63.3%) underwent diagnostic and therapeutic laparoscopy, respectively. The hospital stay was shorter for patients who underwent diagnostic laparoscopy than for those who underwent therapeutic laparoscopy (5.0 days vs. 13.0 days), but no other surgical outcomes differed between the groups. TLS, LAS, and OC were performed in 12 (52.2%), eight (34.8%), and three patients (13.0%), respectively. There was no significant difference in morbidity and mortality among the three groups. Conclusions: Laparoscopic surgery for selected cases of abdominal trauma may be feasible and safe as a diagnostic and therapeutic tool in hemodynamically stable patients due to the low OC rate and the absence of fatal morbidity and mortality.

• Journal of Yeungnam Medical Science
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• v.39 no.3
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• pp.235-243
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• 2022

Background: Intrahepatic cholangiocarcinoma (ICC) of the left liver often shows left-sided lymph node (LN) metastasis. If gastric lesser curvature is extensively dissected, it can induce an iatrogenic injury to the extragastric vagus nerve branches that control motility of the pyloric sphincter and lead to gastric stasis. To cope with such LN dissection-associated gastric stasis, we performed pyloroplasty preemptively. The objective of this study was to analyze our 20-year experience of preemptive pyloroplasty performed in 10 patients. Methods: We investigated clinical sequences of 10 patients with ICC who underwent preemptive pyloroplasty following left hepatectomy and extended left-sided LN dissection. Incidence of gastric stasis and oncological survival outcomes were analyzed. Results: All 10 patients were classified as stage IIIB due to T1-3N1M0 stage according to the 8th edition of American Joint Committee on Cancer staging system. The overall patient survival rate was 51.9% at 1 year, 25.9% at 2 years, and 0% at 3 years. Seven patients showed uneventful postoperative recovery after surgery. Two patients suffered from gastric stasis, which was successfully managed with supportive care. One patient suffered from overt gastric paresis, which was successfully managed with azithromycin administration for 1 month. Conclusion: We believe that preemptive pyloroplasty is an effective surgical option to prevent gastric stasis in patients undergoing extensive left-sided LN dissection. Azithromycin appears to be a potent prokinetic agent in gastroparesis.

• Journal of the Korean Orthopaedic Association
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• v.55 no.4
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• pp.354-358
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• 2020

Lipoma arborescens (LA) is a rare lesion that causes joint effusion and pain. LA usually presents as a unilateral knee lesion, and bilateral lesions are extremely rare. LA among adolescent patients is also extremely rare with the disorder having a much higher incidence among adults. This paper reports a 14-year-old boy who was treated for bilateral knee LA. X-rays revealed the characteristic features of LA in both knees, and arthroscopic synovectomy was performed to resect the lesions. Postoperative recovery progressed smoothly, and the patient was eventually relieved of pain and swelling. LA should be considered when adolescent patients present with bilateral pain and swelling, even though this condition is rare in this age group. Furthermore, surgical synovectomy for a complete resection is an appropriate treatment option.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.17 no.2
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• pp.63-72
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• 2022

Objectives This case study aimed to investigate the effect of complex Korean medicine treatment including Chuna manual therapy on sacroiliac joint (SIJ) pain status post SIJ fusion with sacroiliac screw fixation. Methods Complex Korean medicine treatments including Chuna manual therapy were provided to patients with SIJ widening due to a traffic accident trauma. Measurement of range of motion and manual muscle test to evaluate functional activities of daily living was conducted before and after treatment. Moreover, outcome estimates were performed using the numeric rating scale, pain disability index, and EuroQol 5-dimension five-level questionnaire. Results After complex treatment, functional activities of daily living improved. Sacroiliac joint pain decreased and the quality-of-life score improved. Conclusions This study suggests that treatment with complex Korean medicine treatment including Chuna manual therapy may improve traumatic SIJ widening status post SIJ fusion. A postoperative rehabilitation protocol based on accumulated research results considering a multidisciplinary approach should be prepared to ensure holistic treatment.

• Korean Journal of Transplantation
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• v.28 no.3
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• pp.165-168
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• 2014

The recipient candidate was a 51-year-old male with end-stage renal disease owing to diabetes mellitus. The initial immunosuppressive regimen included basiliximab for induction and tacrolimus, mycophenolate mofetil, and steroids. Urine output was 413 mL/day on the operative day and 100 mL/day on the postoperative day (POD) 1. There was no definite stenosis of the ureter or vessels. He had anuria on POD 2~4 and he had undergone hemodialysis. His serum creatinine level did not decrease. Therefore, a graft biopsy was performed on POD 4. The pathologic finding was consistent with acute calcineurin inhibitor (CNI) toxicity. There was no evidence of rejection or acute tubular necrosis. Anuria continued on POD 6; therefore, we started sirolimus instead of a CNI based regimen. Graft function was gradually recovered 1 day after reduction of CNI dose and hemodialysis was stopped. The serum creatinine level was normalized on POD 10. He was discharged on POD 21.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.1
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• pp.21-29
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• 2023

Objectives: Dental or maxillofacial emergencies are uncommon during pregnancy, but if they occur, they are challenging to treat due to potential risks. The mother should not be denied necessary medical or dental care because of pregnancy. The aim of the study is to observe outcomes of pregnancy in patients requiring emergency minor oral surgical procedures during gestation and to determine the safety of the pregnant woman undergoing the procedure and the fetus. Materials and Methods: The study was conducted on 52 pregnant women requiring emergency oral surgical procedures. A standard treatment protocol for treatment of specific entities was followed. Close monitoring and observation were the primary goal of treatment. All patients were followed postoperatively until complete recovery from the surgical procedures and then until birth of the baby. A control group of 52 healthy pregnant patients who did not require oral surgical procedures was considered for statistical analysis. The measurements to calculate observation were fetal loss (spontaneous abortion), preterm birth, low-birth weight, or incidence of any congenital anomalies in the baby and its association with surgical procedures. Results: No fetal loss occurred in any of the cases. However, four patients experienced preterm birth and seven neonates exhibited low birth weights. No congenital abnormalities were discovered. In one instance, a patient who underwent surgery for a mandibular symphysis fracture under general anesthesia in the 31st week of pregnancy experienced labor pain on the fourth postoperative day, requiring an emergency Caesarean section. Conclusion: The results of our study demonstrate that, compared to the control group, minor emergency surgeries performed during pregnancy have no discernible negative effects on the fetus. These procedures can safely be performed by adhering to our described protocols.