• Journal of Chest Surgery
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• v.15 no.4
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• pp.422-427
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• 1982

A clinical analysis of 82 cases who were sustained the penetrating gun-shot wound in the chest by 8 bullets was done during 4~ year-period from January 1978 to August 1982 in the department of thoracic surgery, CA FGH. Among 82 cases, 61 cases [74.4%] of them were brought to the Hospital by ambulance, 21 cases [25.6%] were by Helicopter and 76 cases [92.7%] of them were admitted within 4 hours after wounding. Thirty eight [46.3%] patients were treated by closed thoracotomy only, 19 cases [23.2%]by open thoracotomy, 18 cases [22.0%] by primary closure with debridement, and 7 cases [8.5%] by vascular surgery. Causes of open thoracotomy were due to massive intrapleural bleeding in 16 cases, rupture of diaphragm in 2 Gases, and heart injury in one case. Among 25 cases of surgical complications, wound infection was most common in 16 cases [53.5%] and recurrent pneumothorax in 3 cases [10%], empyema in 3 cases [10%], and BPF in one case [3.3%]. Hospital mortality was seen in 6 cases due to hypovolemic shock and respiratory insufficiency in 4 cases, spinal shock in 2 cases due to spinal injury.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.711-714
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• 2007

Phlegmonous esophagitis is a disorder in which bacterial infection occurs in the submucosal and muscular layers of the esophagus. This malady is very rare and it is usually associated with high mortality. A 69-year-old male was admitted with chest pain and fever he'd experienced for 7 days. The chest computerized tomography scan revealed mediastinal widening, circumferential esophageal thickening, an air shadow along the esophagus and right pleural effusion. Drainage and debridement of the mediastinum and primary repair of the perforated esophageal muscular layer through a right thoracotomy was done immediately. Further surgical treatment was not performed. He had a good oral intake without dysphagia or esophageal leakage at discharge.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.775-778
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• 2010

Purpose: Reconstruction of soft tissue defects with osteomyelitis in the lower third of the leg represents a challenge to plastic surgeons. Moreover, it is more arduous in multimorbid patients. One excellent option for reconstruction of these defects is to use a delayed distally based sural flap. Methods: We successfully used delayed distally based sural flap with a two-step procedure. During the first operation, radical debridement and elevation of flap were performed. The raised flap was fixed again at the donor site. The delay period ranged from seven to ten days. Between August 2008 and July 2009, we underwent operations for five patients using this technique. The size of flap varied from $10{\times}6\;cm$ to $12{\times}14\;cm$. Results: All flaps successfully survived. Partial skin loss of the grafted site was seen in two patients but no further surgical procedure was required for wound healing. Complaints of hypoesthesia on the lateral part of the foot was observed. In a three month follow-up period, hypoesthesia was resolved spontaneously. Conclusion: Delayed procedure improves the viability of distally based sural flap in high risk, critically multimorbid patients. We recommend that, if a two-stage operative approach is required, the delayed procedure should be considered.

• Journal of Veterinary Clinics
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• v.38 no.5
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• pp.249-253
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• 2021

We describe the case of a Jindo dog that presented with a 2-month history of an abscess-like mass on the skin of the left hip. The patient was initially diagnosed with a suspected insect bite and was treated with a topical dressing. After observing no improvements, surgical debridement was done to remove the abscess. Nine days after surgery, the patient started showing severe anorexia, vomiting, lethargy, and oliguria. Azotemia was detected, and the patient was diagnosed with acute kidney injury. Ultrasonography depicted an abdominal mass (4.6 × 7.5 cm) in the right ureter, and severe hydronephrosis in the right kidney. The patient was euthanatized. Results of the necropsy, histopathologic examination, and immunohistochemistry for tumor cells, confirmed that the patient had developed hydronephrosis and disseminated histiocytic sarcoma which had metastasized to the lungs. To the best of our knowledge, this is the first report of acute renal failure produced by ureter invasion and urinary tract obstruction resulting from the abdominal mass of disseminated histiocytic sarcoma in dogs.

• Archives of Aesthetic Plastic Surgery
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• v.23 no.3
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• pp.143-145
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• 2017

Medical leech therapy is a treatment for the venous congestion of tissue flaps, grafts, and replants. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) following leech application at a congested flap after mastectomy. A 45-year-old woman had an invasive ductal carcinoma. Modified radical mastectomy was performed. The chest wall defect was reconstructed with a local rotation flap. On postoperative day (POD) 1, congestion and color change were observed, and 10 medical leeches were applied to the congested area. On POD 4, another 10 medical leeches were applied. On POD 12, wound necrosis progressed and a pus-like discharge appeared. A wound swab culture revealed MRSA. Debridement was carried out on POD 15. From POD 16, vancomycin and piperacillin/tazobactam were injected for 18 days. The wound culture on POD 18 also revealed MRSA. A split-thickness skin graft was performed on POD 28. MRSA has not been clearly identified in the literature as a leech enteric bacterium. Although MRSA may have come from another source, the present case raises the possibility of MRSA infections following leech application at congested flaps. When medical leeches are applied at the congestion site of a flap, an aseptic cradle will be helpful. Vancomycin irrigation may be needed if infection occurs.

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.231-236
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• 2021

Mucormycosis is an invasive, rapidly progressive, life-threatening fungal infection, with a propensity for diabetic, immunosuppressed, and trauma patients. The classic rhinocerebral variation is most common in diabetic patients. While the cutaneous form is usually caused by direct inoculation in immunocompetent patients. Cutaneous mucormycosis manifests in soft tissue and risks involvement of underlying structures. Tibial osteomyelitis can also occur secondary to cutaneous mucormycosis but is rare. Limb salvage is typically successful after lower extremity cutaneous mucormycosis even when the bone is involved. Herein, we report two cases of lower extremity cutaneous mucormycosis in diabetic patients that presented as acute worsening of chronic pretibial ulcers. Despite aggressive antifungal therapy and surgical debridement, both ultimately required amputation. Such aggressive presentation has not been reported in the absence of major penetrating trauma, recent surgery, or burns.

• Korean Journal of Head & Neck Oncology
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• v.38 no.1
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• pp.59-63
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• 2022

The latissimus dorsi flap has high vascularity and is helpful for the reconstruction of infected areas. Herein, we present a patient with recurrent infections and soft-tissue defects who underwent cranial reconstruction using a free latissimus dorsi flap. The patient had undergone craniectomy and reconstruction using alloplastic bone 18 years previously. A scalp defect accompanied by infection occurred five years ago, and patient underwent reconstruction using a free flap at another hospital; however, the problem persisted. After debridement and bone flap removal, the right latissimus dorsi musculocutaneous flap was elevated, and the thoracodorsal artery and vein were anastomosed end-to-end to the right superficial temporal artery and vein. Methicillin-resistant Staphylococcus aureus was eradicated, and the flap survived. Cranioplasty was performed eight months later, and one year follow-up proceeded without complications. Effective reconstruction and cranioplasty are possible using the free latissimus dorsi musculocutaneous flap, even on scalp with persistent infections and soft-tissue defects.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.3
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• pp.233-237
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• 2022

Postpolio syndrome (PPS) is widely known to manifest as muscle weakness in patients affected by poliomyelitis in early childhood. This is caused by the long-term overwork of motor nerves regenerated from surviving nerve cells. We report a characteristic delay in recovery from muscle relaxation after administering rocuronium to a patient with PPS under general anesthesia with desflurane. A 59-year-old woman was scheduled to undergo surgical debridement for jaw osteonecrosis. She had a history of poliomyelitis at the age of 2 years, and was diagnosed with PPS at the age of 51 years. General anesthesia was induced with 80 mg propofol, 50 ㎍ fentanyl, and 30 mg (0.69 mg/kg) rocuronium, and maintained with desflurane and remifentanil. The durations of train-of-four (TOF) count 0 and 1 were 96 and 37 min, respectively. Five minutes after discontinuing desflurane, the TOF count was 4. Three minutes after administering 200 mg sugammadex, the TOF ratio was 0.83, and the tracheal tube was subsequently removed. In summary, the effect of a single dose of rocuronium on twitch in TOF monitoring was significantly prolonged in a patient with PPS, which may have been exacerbated by desflurane.

• Archives of Plastic Surgery
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• v.50 no.2
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• pp.188-193
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• 2023

Vascular injury following traumatic knee injury quoted in the literature ranges from 3.3 to 65%, depending on the magnitude and pattern of the injury. Timely recognition is crucial to ensure the revascularization is done within 6 to 8 hours from the time of injury to avoid significant morbidity, amputation, and medicolegal ramifications. We present a case of an ischemic limb following delayed diagnosis of popliteal artery injury after knee dislocation. Even though we have successfully repaired the popliteal artery, the evolving ischemia over the distal limb poses a reconstruction challenge. Multiple surgical debridement procedures were performed to control the local tissue infection. Free tissue transfer with chimeric latissimus dorsi flap was done to resurface the defect. However, the forefoot became gangrenous despite a free muscle flap transfer. His limb appeared destined for amputation in the vicinity of tissue and recipient vessels, but we chose to use a cross-leg free flap as an option for limb salvage.

• Archives of Plastic Surgery
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• v.51 no.3
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• pp.317-320
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• 2024

Several strategies for the management of venous congestion of the nipple-areola complex (NAC) after reduction mammaplasty have been proposed. Among these, hirudotherapy represents an ancient but still effective method, even though the risk of infections related to leeches should be considered. We report a peculiar case of breast infection and sepsis after leech therapy in a patient who underwent a reduction mammaplasty. A prompt surgical debridement of the wounds and necrotic tissues associated with targeted antibiotic therapy led to a fast improvement of clinical conditions, and partial preservation of the NAC was obtained. Accurate knowledge of the clinical presentation of soft tissue infections related to leeching allows for an early diagnosis and would serve as a warning for surgeons who approach such breast cosmetic procedures.