• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.156-162
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• 2008

Purpose: Open fractures of the foot and ankle require prompt repair of the wound due to the complexity of anatomy, insufficiency of soft tissues and inadequate blood supply. Early flaps and skin grafts are used for this purpose yet general condition of the patient as well as local wound environment often precludes such treatment options. Vacuum- Assisted Closure (VAC) is recently being used in such cases. This study was done to validate the use of VAC together with silver antimicrobial dressing materials in contaminated open fracture wounds. Materials and Methods: We have selected 10 patients with Gustillo-Anderson type III open fractures of the foot & ankle treated with VAC and silver antimicrobial dressing materials from March 2007 to January 2008. The relationship between duration of treatment with wound size, contamination, and degree of soft tissue damage was analyzed. Results: The average age of patients was 36.6 years. The average amount of VAC application time was 23.4 days. Silver dressing materials were used for 16.8 days. Average wound healing time was 51.9 days. Statistically significant relationship was found between wound size, VAC application time and silver dressing material application time. No complications such as osteomyelitis were found after treatment. Conclusion: VAC technique is recently being used in open fractures with wide skin and soft tissue defects, producing good results. A wide array of dressing materials such as silver dressing is in development. We have incorporated the VAC technique together with silver dressing materials in the treatment of open fractures and achieved complication free results.

• Composites Research
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• v.17 no.4
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• pp.68-73
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• 2004

An analytical study was conducted to characterize the fatigue crack growth behavior of pre-cracked aluminum plates repaired with asymmetric bonded composite patch. For single-sided repairs, due to the asymmetry and the presence of out-of$.$plane bending, crack front shape would become skewed curvilinear started from a uniform through-crack profile, as observed from Previous studies. Therefore, for the accurate investigation of fatigue behavior, it is necessary to predict the actual crack front evolution and take it into consideration in the analysis. In this study, the fatigue analysis of single-sided repairs considering crack front shape development was conducted by implementing three-dimensional successive finite element method coupled with linear elastic fracture mechanics (LEFM) concept, which enables the growing crack front to be directly traced and modeled in a step by step way. Through conducting present analysis technique, crack path of the patched plate as well as the fatigue life was evaluated with sufficient accuracy. The analytical predictions of both the crack front shape evolution and the fatigue life were in good agreement with the experimental observations.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.159-166
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• 2008

Articular cartilage is a unique tissue with no vascular, nerve, or lymphatic supply. This uniqueness may be one of the reasons why chondral injuries will hardly heal and may progress to osteoarthritis over time. Currently, there are several surgical options for the treatment of articular cartilage lesions. Although there is some discrepancy as to which procedures work best in certain patients. The spectrum of treatment alternatives for articular cartilage defects can range from simple lavage and debridement, drilling, micro-fracturing, and abrasion to osteochondral grafting and autologous chondrocyte implantation. In 1984, for the first time, results of autologous chondrocyte implantation in a rabbit model were presented, showing hyaline cartilage repair. Clinical study using autologous cultured chondrocyte implantation in chondral defects of the human knee has been reported in 23 patients in 1994. In 14 out of 16 patients treated for chondral injuries on the femoral condyles, the results were good to excellent. It is important for the surgeon to understand the autologous chondrocyte implantation technique and to be aware on the postoperative management. Attention to surgical technique and selection of appropriate patient for the autologous chondrocyte implantation will provide with the best results.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.619-625
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• 2012

Background After skin tumor excision on the face, extremities, or trunk, the choice of treatment for a skin defect is highly variable. Many surgeons prefer to use a local flap rather than a skin graft or free flap for small- or moderately-sized circular defects. We have used unilateral or bilateral V-Y advancement flaps, especially on the face. Here we evaluated the functional and aesthetic results of this technique. Methods All of the patients were pathologically diagnosed with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), or malignant melanoma or premalignant lesion (Bowen's disease). Thirty-two patients underwent V-Y advancement flap repair (11 unilateral and 21 bilateral) from January 2007 to June 2011. We analyzed the patients' age and satisfaction, and location and size of defect. The patients were followed up for 6 months or more. Results There were 22 women and 10 men. The ages ranged from 47 to 93 years with a mean age of 66 years. The causes were SCC in 15 cases, BCC in 13 cases, malignant melanoma in 1 case, Bowen's disease in 2 cases, and another cause in 1 case. The tumor locations were the face in 28 patients, and the scalp, upper limb, and flank each in one patient. All of the flaps survived and the aesthetic results were good. Postoperative recovery was usually rapid, and no complication or tumor recurrence was observed. Conclusions The V-Y advancement flap is often used not only for facial circular defects but also for defects of the trunk and extremities. Its advantages are less scarring and superior aesthetic results as compared with other local flap methods, because of less scarification of adjacent tissue and because it is an easy surgical technique.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.156-161
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• 1995

Although there are many kinds of method in treatment of tracheal stenosis, tracheal resection and primary anastomosis can be performed for management of various kinds of tracheal stenosis because it is considered the most anatomical ideal therapeutic modality. During a 10-year period we performed 18 tracheal resection on 18 patients with no operative mortality and some morbidity. 13 patients had tracheal stenosis caused by endotracheal intubation [eight patients or tracheostomy [five patients ; and five patients caused by a variety of neoplastic lesions [four primary and one secondary . The length of tracheal stenosis were various from 1.5cm to 5.5cm and site of tracheal stenosis were cervical[17patients and thoracic [one patient . Operative techniques were tracheal resection and primary anastomosis[18 patients and additional procedures were cricoid cartilage reconstruction with costal cartilage [one patient , primary repair of esophagus[one patient and suprahyoid laryngeal release technique[eight patients without any complications. We have eight complications; tracheal restenosis were developed in five patients[growth of grannulation tissue at anastomotic site in three patients, delayed restenosis in two patients , anastomotic disruption in one patient, hoarseness and pneumonia in each of two patients. We managed tracheal complications with T-tube insertion in two patients, permanent tracheostomy in three patients and insertion of Gianturco tracheal stent in one patient, but tracheal stent did not reveal good result because it caused persistent production of sputum. We concluded that it is necessary to access full length of normal trachea including suprahyoid laryngeal release technique to avoid anastomotic tension in tracheal surgery and develope new ideal techniques to manage postoperative tracheal complications, because we suppose tracheal complications are developed due to anastomotic tension.

• Journal of Chest Surgery
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• v.24 no.1
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• pp.15-25
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• 1991

From February 1988 to December 1990, 42 patients underwent so called REV operation for pulmonary stenosis or atresia with or without anomalies of ventriculoarterial connection and truncus arteriosus. The principles of operative technique are mobilization of pulmonary arterial tree beyond the pericardial reflection, transection of pulmonary trunk between the pulmonary ventricle and pulmonary artery, suture of distal pulmonary arterial stump to the upper margin of Pulmonary ventriculotomy site with absorbable suture, and anterior patch with 0.625% glutaraldehyde fixed autologous pericardium with monocusp inside it. Age at operation ranged 3-156months [mean 41.8 month] with twelve of whom infants. Operative indications were pulmonary atresia, with ventricular septal defect[16], and pulmonary stenosis with double outlet right ventricle[8], with ventricular septal defect[16], with double outlet right ventricle[8], with complete transposition of the great arteries[8], with corrected transposition of the great arteries[6], with Fallot`s tetralogy[3], and truncus arteriosus[1]. There were six hospital deaths[14%] and no late death. Twenty-four of 36 survivals were followed up more than 12 months with good clinical results. Postoperative angiocardiogram was performed in fifteen patients. Hemodynamically, two patents had residual pressure gradients along the pulmonary outflow tract, one patient showed severe pulmonary regurgitation; morphologically, there were six significant stenosis of left pulmonary arterial tree, two of whom showed significant pressure gradients. Our present experience with REV operation suggests that this technique make it possible to perform anatomic repair in a wide variety of congenital anomalies of abnormal ventriculoarterial connection associated with pulmonary outflow tract obstruction without using the prosthetic material, even in infants, with relatively low mortality and morbidity.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.178-182
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• 2011

Background: We analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method. Materials and Methods: From May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation. Results: The indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation. Conclusion: Thoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.

• Archives of Reconstructive Microsurgery
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• v.18 no.1
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• pp.27-30
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• 2009

Purpose: Recently, replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. However the replantation of fingertip in adults is a well-established procedure, but the replantation in infant or child is still uncommon. Therefore we present one case of replantation of the fingertip of the small finger in 12-months-old patient. Methods: We experienced a 12-months-old male amputation of small finger. It had been amputated completely at the level of Zone I by Yamano classification. Replantation was performed using the arteryonly technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration. Venous drainage was provided by an external bleeding method with partial nail excision and repaired margin for approximately 7 days. Results: We were performed replantation in infant with only-arterial anastomosis successfully, result in good recovery of aesthetic and functional outcome. Conclusion: In conclusion, although fingertip injury was difficult to replantation in infant and child, we must try it. Because of its functional and cosmetic advantage.

• Journal of the korean academy of Pediatric Dentistry
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• v.24 no.4
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• pp.805-812
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• 1997

Despite dentistry's attempts to improve the dental health of the public and to minimize the effects of caries, many children still present with extensive destruction of primary anterior teeth. One of dentistry's most challenging tasks is to repair these teeth with restoration which are durable, retentive, and esthetic. Esthetic restoration can often be achieved with polycarbonate crowns, strip crowns, conventional S-S crowns, open-faced S-S crowns, commercially veneered S-S crowns. But, all of these have limitation. Advances in restorative materials and metal-bonding procedures have made possible new restorative techniques that combine the advantages of S-S crowns with the cosmetics of composite restoration methods. The described technique of bonding composite to trimmed and fitted S-S crowns offers many advantages over other techniques currently used to restore primary anterior teeth. 1. If S-S crowns are accurate trimmed and contoured, good retention of crowns is achieved. 2. The patient time required is similar to that of conventional S-S crowns. 3. Good esthetics and high bond strengths are achieved. 4. It is possible to use this veneering technique intraorally on crowns that have fractured veneers.

• Journal of the Korean Society of Safety
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• v.27 no.3
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• pp.131-140
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• 2012

Though there might exist not a few differences between cyclic works and atypical works, many researchers have applied the same assessment techniques that used for repetitive works, which may result introduce bias in their conclusions. This research aimed to verify whether there exist non-negligible work characteristics and/or dissimilarity among works with different work nature and whether one of the most prevalent assessment techniques for assessing ergonomic hazards of musculoskeletal disorders, REBA, can be applied to atypical works. For a general hospital, an automobile repair shop, and two auto-part assembly plants which manufactures quite different parts, a questionnaire survey and field investigation and ergonomic assessment were carried out and analyzed statistically with reference to the 3rd Quantification technique. The results showed that there exist remarkable difference between physical factors in cyclic works and atypical non-cyclic works. As for repetitive work, body posture was significant factors affecting on musculoskeletal disorders while atypical works seemed to have none which implied that the necessity of taking psychosocial factors into account for assessment of hazards. Complain rate in repetitive works was highest shoulder, back, and neck or wrist in sequence. However, there existed no consistent trend in complain rate in atypical works. And, though weight of manufacturing objects was a common factor that can partly explain musculoskeletal complain, time duration was significant in atypical work whereas repeatability and body posture were significant in repetitive works. As being the results, to summarize, it could be said that application of conventional ergonomic assessment techniques regardless of repetitiveness would be fruitless, and that the necessity of a unique methodology focused on atypical non-cyclic works should not be neglected.