• Archives of Plastic Surgery
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• 제43권5호
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• pp.438-445
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• 2016

Background The goal of reconstruction is to provide coverage of exposed vital structures with well-vascularized tissue for optimal restoration of form and function. Here, we present our clinical experience with the use of the scapular fascial free flap to correct facial asymmetry and to reconstruct soft tissue defects of the extremities. Methods We used a scapular fascial free flap in 12 cases for soft tissue coverage of the extremities or facial soft tissue augmentation. Results The flaps ranged in size from $3{\times}12$ to $13{\times}23$ cm. No cases of total loss of the flap occurred. Partial loss of the flap occurred in 1 patient, who was treated with a turnover flap using the adjacent scapular fascial flap and a skin graft. Partial loss of the skin graft occurred in 4 patients due to infection or hematoma beneath the graft, and these patients underwent another skin graft. Four cases of seroma at the donor site occurred, and these cases were treated with conservative management or capsulectomy and quilting sutures. Conclusions The scapular fascial free flap has many advantages, including a durable surface for restoration of form and contours, a large size with a constant pedicle, adequate surface for tendon gliding, and minimal donor-site scarring. We conclude that despite the occurrence of a small number of complications, the scapular fascial free flap should be considered to be a viable option for soft tissue coverage of the extremities and facial soft tissue augmentation.

• 대한장애인치과학회지
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• 제7권1호
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• pp.38-43
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• 2011

Treatment of the mandibular fracture consists of reduction and fixation. Primary wire & Arch bar are perhaps the ideal method for intermaxillary fixation. But, daily feeding, swallowing, speech, and in some instances, respiration is difficult to maintain during the period of intermaxillary fixation, owing to muscle weakness, emotional disorder and poor oral hygiene in a position of the long-term bed disabled patient with multiple injuries. Therefore, Intermaxillary fixation is not applied in the disabled bed patient, the alternative methods must be obtained. In the case of the mandibular fracture, because of the absence of weight bearing, osseous union may eventually occur even without immobilization if the patient is maintained without wound infection on a controlled soft diet. For the purpose of the prevention of the wound infection, the establishment of an drainage on the oral lacerated wound is necessary for the removal of the hematoma & seroma in the fracture site. This is the report of a case that was managed conservatively without the intermaxillary fixation in the long-term disabled bed patient with a mandibular compound fracture.

• Advances in pediatric surgery
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• 제17권1호
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• pp.35-44
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• 2011

Thyroglossal duct cysts (TGDC) are the most common type of congenital developmental anomaly encountered in the anterior midline of the neck in childhood. The aim of the study was to evaluate the clinical characteristics of TGDC and identify any factors that could be related to recurrence after surgery. This study consisted of a retrospective chart review of 45 patients treated at Kyungpook National University Hospital for TGDC between 1990 and 2008. All records were reviewed for age and sex, length of history, presentation, diagnostic methods, sizes and locations of cyst, surgical management, histopathology of the lesion and recurrences. The statistical analysis of risk factors for recurrence was made using the Fisher's exact test with a significance level of p (0.05. The male to female ratio was 2.2:1 with a male preponderance. The mean age at operation was 5 years and 2 months (4 months - 17 years). The most common presenting symptom was a nontender cervical mass (78 %). Most TGDC were found in the midline position. Twenty four were infrahyold, 17 were hyoid, and 4 were suprahyoid level. Forty one (91 %) patients received the Sistrunk operation, and 4(9 %) patients received Cyst excision. Postoperative a seroma developed in six patients in the early postoperative days. There were a total of 3(6.6 %) recurrences, 2 in patients who had excision only and in one patient who had the Sistrunk operation. Univariate analysis for risk factors with recurrence showed that there was no statistical relationship between the presence of preoperative infection and the development of recurrence. The removal of hyoid bone along with TGDC was a statistically significant risk factor for recurrent disease. This study suggests that the Sistrunk operation Is the treatment of choice for TGDC in order to reduce recurrence.

• Journal of Korean Neurosurgical Society
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• 제63권4호
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• pp.487-494
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• 2020

Objective : To analyze the incidence and characteristics of delayed postoperative fever in posterior cervical fusion using cervical pedicle screws (CPS). Methods : This study analyzed 119 patients who underwent posterior cervical fusion surgery using CPS. Delayed fever was defined as no fever for the first 3 postoperative days, followed by an ear temperature ≥38℃ on postoperative day 4 and subsequent days. Patient age, sex, diagnosis, laminectomy, surgical level, revision status, body mass index, underlying medical disease, surgical duration, and transfusion status were retrospectively reviewed. Results : Of 119 patients, seven were excluded due to surgical site infection, spondylitis, pneumonia, or surgical level that included the thoracic spine. Of the 112 included patients, 28 (25%) were febrile and 84 (75%) were afebrile. Multivariate logistic regression analysis showed that laminectomy was a statistically significant risk factor for postoperative non-pathological fever (odds ratio, 10.251; p=0.000). In contrast, trauma or tumor surgery and underlying medical disease were not significant risk factors for fever. Conclusion : Patients who develop delayed fever 4 days after posterior cervical fusion surgery using CPS are more likely to have non-pathologic fever than surgical site infection. Laminectomy is a significant risk factor for non-pathologic fever.

• Archives of Plastic Surgery
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• 제35권2호
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• pp.169-173
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• 2008

Purpose: Sacrococcygeal pilonidal sinus is a chronic inflammatory disease that mostly affects young people, which warrants surgical intervention. Although many surgical methods have been suggested, an optimal surgical method remains controversial because of high recurrence rates and postoperative complications. The objective of this study is to evaluate the results of wide excision and coverage with fasciocutaneous advancement flap for the treatment of sacrococcygeal pilonidal sinus, and to assess the usefulness of this method Methods: From May 1995 to October 2006, the authors treated 19 patients with the use of coverage with fasciocutaneous flap after wide excision. The results were evaluated regarding recurrence rates, complications, and the change in sensitivity of the gluteal region after surgery. The follow-up period was 7 to 142 months (mean, 76 months). All patients were male. Results: Postoperative complications were wound infection at the suction drain insertion site and skin necrosis around the suture margin in one case, respectively. During the follow up period, only one recurrence (5.3%) was seen in fifth postoperative month, which was successfully treated by the same operative procedure. There was no other complications such as seroma, hematoma, wound dehiscence and flap loss. Extensive scarring and anatomic distortion did not occur in the reconstructed area. In addition, sensitivity of the gluteal region did not diminish. The aesthetic results were satisfactory for all patients as well. Conclusion: The authors advocate that fasciocutaneous flap closure be a good alternative method to cover defects after the excision of sacrococcygeal pilonidal sinus.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.26-30
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• 2010

Purpose: Common complications of immediate breast reconstruction with implant are capsular contracture, malposition of implant, hematoma and seroma. Especially, the most severe complication is implant exposure caused by inflammation or necrosis of skin flap margin of mastectomy site. This article reports the experience of cases of salvage in such an exposure of implant. Methods: From July, 2002 to Feb., 2009, sixty-five patients who underwent immediate breast reconstruction with implant were retrospectively analyzed. Exposure of implant was happened in 5 of 65 patients and they were treated at out patient district. Two of five patients were reconstructed with saline implnt and all of them underwent the enveloping of the implant with AlloDerm$^{(R)}$ and Serratus muscle flap. Remaning three patients were reconstructed with silicone implant and all of them underwent the enveloping of the implant with AlloDerm$^{(R)}$. Results: In the group of patients who underwent reconstruction with saline implant, implant exposure was found in one patient due to partial necrosis of the margin of skin flap and debridement and primary repair were done. In the other one patient, dressing with antibiotic ointment were done. And debridement and primary repair were proceeded. In the group of patients who underwent reconstruction with silicone implant, implant exposure was found in one patient. After removal of the implant, tissue expansion was done and a new silicone implant was inserted. Implant exposure were found in the other two patients, antibiotics ointment application and primarily repaired. Conclusion: It was the common knowledge that the exposed implant should be removed. But salvage of the exposed implants may be possible with proper treatment. Four of five patients (80%) with exposed breast implant were salvaged with conservative management.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.393-396
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• 2009

Purpose: Low - molecular - weight dextran is one of the most frequently used antithrombotic agents in microvascular surgery, but there is controversy if it has the real benefit in the clinical aspects. The purpose of this study was to evaluate the effect associated with postoperative use of low - molecular - weight dextran in breast reconstruction by free TRAM flap patients. Methods: From January 2002 to October 2008, we reconstructed 88 cases of postmastectomy deformity using the free TRAM flap. The 88 cases were divided into two groups : a group with no use of dextran(66 patients, control group, Group A) and a postoperative low - molecular weight dextran loaded group(22 patients, Group B). We assessed number of flap survival, rate of complication like hematoma or seroma, total amount of drainage from operative wound, duration of drainage, and amount of transfusion in each group. Results: There was no total flap loss and every flap was survived. Total amount of drainage for post - operative 5 days were 857 ml in group A and 1101 ml in group B. Drain was kept for average of 7.3 days in group A and 8.7 days in group B. Packed red cell transfusions were made in average of 3.3 units for group A and 3.0 units for group B. Group B showed significantly higher values in former 2 comparative parameters than group A. Conclusion: There was no definitive advantage of anticoagulants in elective free - flap surgery in terms of success rate. However, groups with using anticoagulants had the increased bleeding tendency in immediate postoperative period. The routine use of anticoagulants in elective free - flap surgery should be reconsidered with postoperatively less bleeding and early recovery.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.397-405
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• 2009

Purpose: Soft tissue defect of anterior chest wall is caused by trauma, infection, tumors and irradiation. To reconstruct damaged anterior chest wall does require to consider the patient's body condition, the cause, the location, the depth and the size of deletion, the circulation of surrounding tissue and minimization of functional and cosmetic disability. In this report, we suggest the algorithm of configuration for reconstruction methods. Methods: A retrospective study of 20 patients who underwent anterior chest wall reconstruction with pedicled musculocutaneous flap and fasciocutaneous flap was conducted. We collected the information of the patient's body condition, the cause, the size, the depth and the location of deletion, implemented flap and complication. We observed and evaluated flap compatibility, functional and cosmetic results. Patients completed survey about the extent to their satisfaction. Result: Follow up period after surgery was from 6 to 26 months, survival of flap were confirmed in all of patients' case. Two cases of local necrosis, one case of wound disruption were reported, but all these were cured by the debridement and primary closure. One hematoma and one seroma formation were observed in donor site. Longer surgery time, more bleeding amount and more transfusion volume were reported in the group of musculocutenous flap. Conclusion: Long term follow up result showed the successful reconstruction in all patients without recurrence and with minimal donor site morbidity. In addition, the patients' satisfaction for cosmetic and functional results were scaled relatively higher. This confirmed the importance of reconstruction algorithm for the chest wall reconstruction.

• Archives of Plastic Surgery
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• 제33권1호
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• pp.131-134
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• 2006

The closed suction drain is commonly inserted after various surgical procedures. It has an important role to prevent possible hematoma or seroma that can cause postoperative wound problems. But there is still no consensus on managing the insertion site of suction drain after operation. Suture-tie fixation of drain to skin and classical Y shape gauze dressing is a usually accepted method, but it has many limitations. We introduce a new approach to the care for the insertion site of suction drain by using occlusive transparent film dressing, $IV3000^{(R)}$(Smith & Nephew, London, UK). By using transparent film, insertion site of drain can be easily checked without removal of dressing. Because it can reduce the tension of suture-tie fixation, it helps to prevent skin injury. Furthermore, occlusive film dressing can block air leakage from insertion site of drain, and the water-proof character of film allows patients to take a shower without dressing change. This new method is more convenient, more efficient, and less harmful to skin than classic one.

• Journal of Chest Surgery
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• 제27권12호
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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.