• 대한미세수술학회:학술대회논문집
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• 1996.10a
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• pp.177-178
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• 1996

• Applied Microscopy
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• v.44 no.1
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• pp.21-29
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• 2014

Retinal glial responses to hypertensive glaucomatous injury were spatiotemporally surveyed. Retinas as a whole or vertical sections were processed for anti-glial fibrillary acidic protein (GFAP), anti-Iba1, anti-nerve growth factor (NGF), and anti-tumor necrosis factor (TNF)-${\alpha}$ immunohistochemistry for confocal microscopic analyses. The optic nerve head of paired controls was processed for electron microscopy. GFAP positive astrocytes appeared in the nerve fiber layer in the glaucomatous and control retinas, changing from fine protoplasmic to stout fibrous parallel to glaucomatous duration. Iba1 positive microglia appeared in both retinas, and enormous reaction appeared at the latest glaucomatous. M$\ddot{u}$ller reaction detected by GFAP reactivity expanded from the end feet to whole profile following to duration in the glaucomatous. NGF reactivity expended from the end feet to the proximal radial processes of the M$\ddot{u}$ller cells in both retinas according to glaucomatous duration. TNF-${\alpha}$ immunoreactivity in the nerve fiber layer was stronger in both the glaucomatous and controls than in the normal, and exceptionally at the latest glaucomatous was even lower than the normal. The astrocytes in the optic nerve head are interconnected with each other via gap junction. These results demonstrate that astrocyte reaction propagates to the contralateral via physical links, and TNF-${\alpha}$ is correlated with NGF production for neuroprotection in response to hypertensive glaucomatous injury.

• Journal of Chest Surgery
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• v.46 no.3
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• pp.165-177
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• 2013

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.120-126
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• 2000

Microsurgical reconstruction of the hand demands recovery of the sensation of the reconstructed free flap as well as microsurgeon's intelligence, technique and experience. Even with adequate soft tissue coverage and skeletal mobility, an insensate hand is prone to further injury and is unlikely to be useful to the patients. Authors have performed 8 cases of neurosensory free flaps in the hand, 4 cases of wrap around, 3 dorsalis pedis and 1 lateral arm flap, from July 1992 through June 1999 and followed up average 4 years and 4 months. Wrap around flap was performed for reconstruction of 4 cases of thumb, repairing deep peroneal nerve and superficial radial nerve by epineurial neurorrhaphy, and followed up for average 3 years and 10 months and calculated 9mm in the static 2 point discrimination test. Dorsalis pedis flap were 3 cases for reconstruction of the ray amputation, extensor tendon exposure and wrist exposure. Deep peroneal nerve and branch of the ulnar nerve was repaired by epineurial neurorrhaphy calculating 6mm and superficial peroneal nerve and superficial radial nerve averaging 18mm in the static 2 point discrimination test for follow up average 2 years and 9 months. Lateral arm flap was 1 case for reconstruction of the ray amputation in the hand repairing posterior cutaneous nerve to the arm to the superficial radial nerve calculating 20mm for follow up 6 years and 8 months.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.667-669
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• 2009

Purpose: Radial and ulnar arteries are two major arteries responsible for the blood supply of the hand. We experienced early recurrent thrombosis of ulnar artery after arteriorrhaphy in a patient with rupture of ulnar and radial arteries due to glass injury. Thus, we thought this would require reviews. Method: 41 - year - old female patient was presented for the laceration of right wrist due to glass injury. Operative findings revealed the rupture of radial artery, ulnar artery, ulnar nerve and most of the flexor tendons. We performed three consecutive operations because of the recurrent arterial thrombosis in ulnar artery. Arteriorrhaphy was performed in each operation and the interpositional vein graft was performed in the final operation. Result: Consequently, doppler ultrasonography was performed on twentieth postoperative day and fair flow in the ulnar artery was visualized. Pathologic examination of the artery revealed no histopathologic abnormalities. Conclusion: It is not a matter of ease to follow up the patients with rupture of radial or ulnar arteries. Obstruction of the repaired artery is also not easy to detect because it usually presents no definite symptoms. We could detect the obstruction of the artery following arteriorrhaphy with the doppler ultrasonography in less than a week postoperatively, and repeated operations were followed. We reviewed the causes and factors affecting the thrombosis and hereby report with literature review.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.51-57
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• 2004

Introduction: To cover the exposed tendons and bones in the foot and hand which need coverage and abundant vascular flow, lateral arm flaps were transferred. Lateral arm flap is a thin and innervated fasciocutaneous flap with a lower lateral cutaneous nerve and posterior radial collateral artery. Materials and methods: From October 1992 through September 2003, we have performed 5 lateral arm flaps for reconstruction of the exposed achilles tendons in 2 cases and the exposed forearm extensors, 2nd to 5th metacarpal bones and scaphoid each 1 case. The causes were traffic accident in 2 cases and machinary injury in 3 cases. Age range was between 31 to 74 (average 50) and all male except 1. Posterior lateral collateral artery and venae comitantes were anastomosed by end to end in 3 cases and vena comitante in 2 cases. Lower lateral cutaneous nerve was anastomosed with a branch of superficial radial nerve in 2 cases. Results: The results were evaluated by survival of the flap, sensory discrimination, cosmesis and comfort in the activities of the daily living. All flaps were survived. Sensory recovery was graded as deep cutaneous pain sensibility in 2 cases. Cosmesis was moderately satisfied and comfort was good except 1 as moderate. Postoperative defatting procedure was done in 1 case and skin abrasion was occurred in 1 case. Conclusion: Lateral arm flap was suitable for coverage of the exposed achilles tendons and exposed forearm extensors, metacarpals and scaphoid in the wrist.

• Archives of Reconstructive Microsurgery
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• v.21 no.2
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• pp.86-91
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• 2012

Purpose: Mass can compress around tissue and cause deviation of normal anatomical structures. Often, mass grows toward neurovascular pedicle and encircles depending on the nature of mature mass. Neglecting neurovascular involvement of the mass is a serious problem not to be overlooked. Authors have performed microscopic approach regarding mass involving the neurovascular pedicle in the hand. Materials and Methods: From January 2007 through February 2012, retrospective analysis for nine cases of mass involving neurovascular pedicles was done. Patients were evaluated preoperatively by ultrasonography or MRI and checked intraoperative finding. Masses were evaluated by site, preoperative evaluation, involved neurovascular pedicle, histopathologic diagnosis, complication, and recurrence. Results: The site of mass involving neurovascular pedicles was 4 cases on the wrist, 2 cases on the palm, 2 cases on the finger, 1 case on the hand dorsum. Involved neurovascular pedicles were 3 radial arteries and nerves, 3 proper digital arteries and nerves, 1 radial artery, 1 superficial branch of radial nerve, 1 common digital artery and nerve. The histopathologic diagnosis of mass were 3 ganglions, 2 giant cell tumors, 2 epidermal cysts, 1 fibroma, and 1 benign spindle tumor. There were 2 cases of recurrence and secondary excisions were performed. Conclusion: Neurovascular pedicle injury can lead to serious complication like sensory and motor disorders, distal part ischemia, and so on. In case of mass suspected neurovascular invasion, accurate preoperative evaluation such as ultrasonography or MRI is necessary. To prevent any neurovascular related complication during mass excision, delicate surgical technique using a microscope becomes essential.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.41-49
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• 2012

Purpose: To report clinical appearances and the outcomes of patients treated for wrist laceration with suicidal intent. Materials and Methods: Between March 2005 and February 2008, patients with wrist laceration were treated at our center. Among them, 14 patients with suicidal intent were reviewed retrospectively. They were 8 females and 6 males with a mean age of 33 years at the time of treatment. The side of injured wrist, injured structures, suicidal instrument, the time of injury, a suicidal motive, drug or alcohol abuse or not, indication of combined psychiatric disease, the duration of postoperative treatment, and the results of treatment were analyzed. Results: The injured wrist was the left one in 13 cases (93%), and knife wounds in 11 cases (79%) was the most frequent mechanism of injury. An average of 4.6 structures were injured including 3.5 tendons, 0.57 nerves and 0.5 arteries. The most frequently injured structures were the palmaris longus (71%), FCU (50%), FCR (43%), FDS 3 (36%), FDS 2, median nerve, and ulnar artery (each 29%). Simultaneous injury of both median and ulnar nerves occurred in 3 cases (21%), and simultaneous injury of both radial and ulnar artery occurred in 1 case (7%). The injury time was the night in 12 cases (86%), and the most frequent suicidal motive was human relations such as lover or spouse in 12 cases (86%). In 9 cases (64%), the injured were in a drunken state, 3 cases (21%) had been treated for a psychiatric disease at the time of the injury. The durations of postoperative treatment were an average of 5 days of admission and 1 day follow up. Only 1 case results could be evaluated. Conclusions: Patient's poor compliance in wrist laceration with suicidal intent should be expected and these characteristics may affect the management plan.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.93-98
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• 2001

Purpose : This describes our experience with a tenocutaneous free flap from the dorsum of the foot or radial forearm to reconstruct the dorsal skin and extensor tendons of the hand. Material and Methods : Between february 1987 and July 1998, we treated 9 patients with composite tissue loss on the dorsal hand caused by crushing injury. Nine men had an average age of 26.4 years(range, $19{\sim}47$). We treated 5 patients with the free dorsalis pedis flap including the extensor tendons and the superficial peroneal nerve and 4 patients with reverse forearm flap including the brachioradialis tendon and/or superficial radial nerve. Flap size was average 4.4(3,2cm. Evaluation of the results was based on the survived flap rate, the recovery rates for range of motion of the metacarpophalageal joints in the operated fingers. two-point discrimination. Results : All flaps were well vascularized and survived completely. Recovery rates for range of motion of the metacarpophalageal joints in operated fingers range from $78%{\sim}99%$(average, 90%). Two-point discrimination of the transferred flaps in 5 patients average $20{\pm}3.5mm$. Conclusion : The advantages of this procedure are mass action reconstruction with tendon, one-stage operation, faster healing with less adhesion formation, and early mobilization.

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.50-59
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• 2006

Purpose: The nonoperative outcome of elbow dislocations with associated radial head and coronoid fractures are often unsatisfactory because of chronic instability and stiffness from proloned immobilization, Therefore we managed these injuries with well programed surgical appproaches. Method: Ten patients with this injury were evaluated retrospectively from May 1998 to June 2004 after a minimum of 12 months. These injuries include elbow dislocation and associated fractures of both the radial head and the coronoid process. All ten patients were treated by one clinic operatively with similar scheduled surgical methods which started on the lateral side and terminated on the medial side of the elbow. Radial head and neck fractures were classified Mason types, as two and three types respectively with six and four cases and six cases were fixated. Coronoid process were fixated with screws anteroposterior directly or anchor suture in all cases, each type was classified one, two and three. where were three type one, four type two, and three type three were according to Regan and Morrey classification. Results: The outcome was three resulting in excellent, four good, two normaland and the remaining case was one poor according to the Mayo Elbow Performance score. At a terminal follow up, the range of motion of the elbow averaged flection contracture, $6^{\circ}(0{\sim}20^{\circ})$ and further flection, $129^{\circ}(115{\sim}140^{\circ})$. Two patients had complications requiring additional care. One, displaced coronoid process which was repaired with capsule and the other patient experienced, palsy of ulnar nerve and contracted elbow joint. Conclusions: Usage of early operation as the minimum injury of medial ligaments complex and the rigid fixation of fractures to prompt motion with our scheduled management for elbow dislocations with associated radial head and coracoid fractures provided excellent results.