• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.203-216
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• 1991

Nerve allografts as a bridge of regeneration is useful in the repair of peripheral nerve defect resulting from trauma, and leprosy. But immunological rejection and complicated scar formation is an unavoidable problem in the application of allogeneic nerves. This article is intended to study of the regeneration of allogeneic nerve grafts in rats with histopathologically, scanning electron microscopically. 24 adult male Sprague-Dawley rats were used as the experimental animals. A 2cm skin incision was made on the lateral aspects of limb, parallel to femur. Segments of sciatic nerve trunk taken from rats, 10mm was resected at the middle of the thigh, nerve graft was inserted between the ends of gaps with perineural and epineural suture method with 10-0 prolene. Obsrevation was made simultaneously at 3 day, 1, 2, 3, 4, 5, 6, 8 weeks after surgery. The results were as follows. 1. In light and electronic microscopic studies, marked degenerative change of the graft nerves were observed at 2 weeks after surgery. 2. After surgery, blood clot fromation was observed at 3 day, granualtion tissue formation was observed at 2 week, and fibrous tissue proliferation was observed at 3 week. 3. In change of nerve fiber, there were Wallerian degeneration at early stage, decrease in degeneration at 4 week but degeneration of myeline was continuded at 8 week. 4. At 4 week, schwann cells proliferate at its cut ends to join with the distal and proximal stump of the damaged nerve. 5. Fibrous scar tissues are formed at 2 weeks and increased progressively in 8 weeks, which was interrupted the regeneration of grafted nerve.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.89-92
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• 2000

Acute gastric volvulus is uncommon but surgically emergent. Normally, the stomach is held in position by four ligaments: gastrophrenic, gastrohepatic, gastrosplenic, and gastrocolic. In addition, relative fixation of the pylorus and esophagus provides further anchorage. A normal diaphragm also helps to prevent abnormal displacement of abdominal viscera and development of gastric volvulus. Volvulus may be organoaxial, mesenteroaxial, or a combination of both. Organoaxial volvulus is the rotation of the stomach around an axis extending from the hiatus of the diaphragm to the pylorus. Mesenteroaxial volvulus is the rotation of the stomach around an axis transecting the lesser and greater curvatures of the stomach. The symptoms of gastric volvulus depend on its type, the extent and degree of rotation and obstruction, and associated defects. Classic clinical features of acute gastric volvulus, as by Borchardt in 1904, include unproductive retching, acute, localized epigastric distention, and the inability to pass a NG tube. The presence and severity of these features depend on the degree of gastric obstruction of both the gastroesophageal junction and pyloric outlet. It may be suspected on plain abdominal radiographs and usually confirmed by upper gastrointestinal series. Acute volvulus requires immediate surgical repair, fixation to avoid recurrence, and correction of any underlying anatomic abnormality. Any associate defect should be repaired and the stomach must be fixed. The authors report a case of an 3-year-old girl who had a mesenterioaxial gastric volvulus.

• Journal of Chest Surgery
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• v.47 no.2
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• pp.94-99
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• 2014

Background: Surgical repair of a partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava (SVC) may be complicated by sinus node dysfunction or SVC obstruction. We modified the Warden procedure by using a right atrial auricular flap to decrease the occurrence of these complications. Methods: Between February 2005 and July 2012, 10 consecutive patients underwent a modified Warden procedure to correct PAPVC. The median patient age was 5.7 years. Eight patients (80%) had an atrial septal defect. To surgically correct the PAPVC, we made a U-shaped incision on the right atrial appendage and sutured the flap to the posterior wall of the SVC. The anterior wall was reconstructed with various patch materials. Results: No early or late deaths occurred, nor did any patient require early or late reoperation for SVC or pulmonary venous obstruction. No new arrhythmias appeared during follow-up, which was complete in all patients (mean, 29.5 months). Conclusion: Our modification of the Warden procedure seems to be effective and safe. This technique may lower the risk of SVC obstruction, pulmonary venous obstruction, and sinus dysfunction.

• Journal of Korean Dental Science
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• v.7 no.1
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• pp.38-42
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• 2014

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as exposed necrotic bone without evidence of healing for at least 8 weeks in the maxillofacial area in a patient with history of bisphosphonate use. Obtaining complete coverage of the hard tissue by soft tissue in BRONJ patients is especially important. Therefore, managing the mucosa is one of the key factors in a successful outcome, but this is especially hard to achieve in BRONJ patients. Various applications of buccal fat pad in oral reconstruction-including the closure of surgical defects following tumor excision, repair of surgical defects following the excision of leukoplakia and submucous fibrosis, closure of primary and secondary palatal clefts, coverage of maxillary and mandibular bone grafts, and lining of sinus surface of maxillary sinus bone graft in sinus lift procedures for maxillary augmentation-have been studied. Eliminating all potential sites of infection and post-operative infection control is crucial in BRONJ. We present a case using the buccal fat pad pedicle for a stage 3 BRONJ defect. Uneventful total epithelialization of the buccal fat pad regardless of size was noted. In summary, the buccal fat pad has versatile application and various recipient sites for surgical utilization. It is an easy technique, with promising overall success rates. With careful selection and handling, buccal fat graft can resolve problems with soft tissue coverage in stage 2 or 3 BRONJ patients.

• Journal of Chest Surgery
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• v.38 no.7 s.252
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• pp.507-509
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• 2005

Open heart surgery via right thoracotomy can be accomplished in atrial septal defects, and mitral valve diseases. Recently, thoracoscopic atrial septal defect closure, mitral valve repair, Maze operation, and minimal invasive direct coronary artery bypass (MIDCAB) are accomplished with AESOP 3000. However, there is no report of thoracoscopic aortic valve replacement in Korea. We report a successful thoracospic aortic valve replacement assisted with AESOP 3000 in a 31-year-old female patient.

• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.44-48
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• 2009

Purpose: The treatment of arteriovenous malformation (AVM) of the face remains a difficult challenge in plastic surgery. Incomplete resection resulting in uncontrolled bleeding, postoperative enlargement of the remaining malformation, and a poor functional and cosmetic result could be the problems confronted by the surgeons. Methods: A 37 year-old male with large arteriovenous malformation in face treated with preoperative superselective transarterial embolization and free flap transfer. The size of the defect was $13{\times}9cm$. Sclerotheraphy without resection were performed several times but the results were unsatisfactory. Resection was performed the next day of embolization. We were able to repair with the thoracodorsal artery perforator free flap. And facial muscle reconstruction performed by simultaneous muscle and nerve transfer. Results: During the follow-up period 8 months the patient regained an acceptable cosmetic appearance. And he has shown no reexpansion of the malformation. Conclusion: The thoracodorsal artery perforator free flap could be a good choice for the reconstruction for massive defects of the face. A huge arteriovenous malformation could be safely removed and successfully reconstructed by the complete embolization, wide excision and coverage with a well vascularized tissue.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.235-240
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• 2011

Purpose: Management of pressure sores has been improved, along with development of musculocutaneous flaps and perforator flaps. Nowadays, the treatment of pressure sore with perforator flaps has shown several advantages, including minimal donor site morbidity, relatively versatile flap design not only in primary cases but also in recurred cases and minimized anatomical rearrangement of regional muscle position. In this study, we report our clinical experience of gluteal perforator flap used in the treatment of a greater trochanteric pressure sore. Methods: A clinical study was performed on 7 patients who underwent total 10 operations. 1 superior gluteal artery perforator flap and 9 inferior gluteal artery perforator flaps were used to reconstruct the defect, followed by the mean observation duration of 22 months. Results: There were no total flap loss. We treated 2 cases of partial flap loss with debridement and primary repair. 2 recurred cases were successfully treated using the same method. Donor sites were all primarily repaired. Conclusion: The gluteal perforator flap could be considered as a safe and favorable alternative in the treatment of soft tissue defects in the greater trochanteric area. The advantages of the flap include low donor site morbidity and the possibility of versatile flap design not only in primary cases but also in recurred cases.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.151-156
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• 2013

Purpose: Traumatic cervical SCI is frequently accompanied by dural tear and the resulting cerebrospinal fluid (CSF) leak after surgery can be troublesome and delay rehabilitation with increasing morbidity. This study evaluated the incidence of intraoperative CSF leaks in patients with traumatic cervical spinal cord injury (SCI) who underwent anterior cervical surgery and described the reliable management of CSF leaks during the perioperative period. Methods: A retrospective study of medical records and radiological images was done on patients with CSF leaks after cervical spine trauma. Results: Seven patients(13.2%) were identified with CSF leaks during the intraoperative period. All patients were severely injured and showed structural abnormalities on the initial magnetic resonance image (MRI) of the cervical spine. Intraoperatively, no primary repair of dural tear was attempted because of a wide, rough defect size. Therefore, fibrin glue was applied to the operated site in all cases. Although a wound drainage was inserted, it was stopped within the first 24 hours after the operation. No lumbar drainage was performed. Postoperatively, the patients should kept their heads in an elevated position and early ambulation and rehabilitation were encouraged. None of the patients developed complications related to CSF leaks during admission. Conclusion: The incidence of CSF leaks after surgery for cervical spinal trauma is relatively higher than that of cervical spinal stenosis. Therefore, one should expect the possibility of a dural tear and have a simple and effective management protocol for CSF leaks in trauma cases established.

• Journal of Veterinary Clinics
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• v.19 no.1
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• pp.66-72
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• 2002

Korean safflower seed has been known to have healing effects on both bone fracture and osteoporosis. On the base of such a notice, this experiment was carried out to explore the effects of safflower seed on bone formation and bone repair. The toxicity test and the effect of Korean safflower seed were evaluated with 60 rats, 3-month old. Forty Sprague-Dawley rats composed of 20 male and 20 female were underwent unilateral tibial defect and then fastened with unilateral fixators. The operated rats were divided into two groups depending on the composition of diet, such as positive control group fed normal diet(C-OP group) and safflower seed group fed 30% of safflower seed diet and 70% of normal diet(S-OP group). Another 20 rats without operation were maintained, each 10 rats were fed either normal diet or 30% of safflower seed diet and 70% of normal diet, and observed the toxicity of safflower seed by measuring weight and urine parameters. Postoperative radiography were taken once in 2 weeks to evaluate callus formation for operated groups and blood collection via heart puncture were carried out once in 3 weeks for 3 groups. The concentration of Ca and Pi in serum were measured using both auto Kit and $^{31}$ P Nuclear Magnetic Resonance(NMR). At present study, no toxic effect was observed from both weight increment and urine index after feeding the safflower seed diet. The comparison of the radiography between C-OP and S-OP group were showed that the safflower seed diet appeared to stimulate the formation of callus in the rat. The ratio of Ca/P in serum was low in S-OP group compared to C-OP group with the auto Kit, but there were no significant differences between two groups (p < 0.05). In addition, the variations of Pi values in NMR examination were also confirmed based on the result of auto Kit. In conclusion, this study implied that safflower seed might influence to bone formation and shorten the periods of remedy by stimulating the calcification of bone

• Journal of the Korean Medical Association
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• v.61 no.12
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• pp.724-731
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• 2018

Our faces can express a remarkable range of subtle emotions and silent messages. Because the face is so essential for complex social interactions that are part of our everyday lives, aesthetic repair and restoration of function are an important tasks that we must not take lightly. Soft-tissue defects occur in trauma patients and require thorough evaluation, planning, and surgical treatment to achieve optimal functional and aesthetic outcomes, while minimizing the risk of complications. Recognizing the full nature of the injury and developing a logical treatment plan help determine whether there will be future aesthetic or functional deformities. Proper classification of the wound enables appropriate treatment, and helps predict the postoperative appearance and function. Comprehensive care of trauma patients requires a diverse breadth of skills, beginning with an initial evaluation, followed by resuscitation. Traditionally, facial defects have been managed with closure or grafting, and prosthetic obturators. Sometimes, however, large defects cannot be closed using simple methods. Such cases, which involve exposure of critical structures, bone, joint spaces, and neurovascular structures, requires more complex treatment. We reviewed and classified causes of significant trauma resulting in facial injuries that were reconstructed by microsurgical techniques without simple sutures or coverage with partial flaps. A local flap is a good choice for reconstruction, but large defects are hard to cover with a local flap alone. Early microsurgical reconstruction of a large facial defect is an excellent choice for aesthetic and functional outcomes.