• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.22-27
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• 1999

While the conventional end-to-end anastomotic technique is accepted as 'the golden standard' for microvascular anastomosis, it is time-consuming and tedious. In an effort to offer faster and safer ways of performing microvascular anastomoses, numerous anastomotic techniques have been proposed, but further refinements in microvascular techniques are still necessary. A 'continuous suture with interrupted knot' technique was devised for faster and safer anastomosis. It has been successfully used in microanastomoses of both artery and vein for free tissue transfer. It is a combination of the interrupted suturing technique and the continuous suturing technique. First, a continuous suture is made with the size of loop decreasing in order, and then the sutures are tied individually from the first loop to the last one as in the conventional interrupted suturing technique. It was applied clinically to fourteen patients over the past ten months and found to be a highly efficient technique that satisfied our needs. This 'continuous suture with interrupted knot' technique has several advantages over other techniques : The operative time is reduced comparing conventional interrupted suture technique. By delaying the tie and with the vessel walls kept separated, the risk of through-stitch can be reduced. Tying all the sutures at one time not only speed up the procedures, but also reduced the surgeon's fatigue. In addition, it has no problem of anastomotic stenosis which is a disadvantage of continuous suture technique. This technique proved to be faster and safer, and has patency equal to that of the conventional end-to-end anastomosis. It is of great help to the surgeon in reducing operative time, especially in clinical situations when many anastomoses are required, or lengthy grafting procedures are undertaken.

• Journal of Trauma and Injury
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• 제34권4호
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• pp.305-308
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• 2021

Comminuted fractures of the patella mostly occur at the inferior pole and require appropriate reduction and fixation to restore the extensor mechanism. Conventional methods such as tension-band wiring are not enough to gain proper fixation strength. Numerous methods have been reported, including circumferential cerclage wiring, osteosynthesis, and suture anchors depending on the fracture pattern. Herein, the author reports a relatively rare case of a comminuted fracture of the upper pole of the patella, for which we used augmented Krackow sutures in the quadriceps and fixation with tying of the suture limbs through patellar bone tunnels. Satisfactory results were obtained in terms of reduction and extensor mechanism recovery.

• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.49-54
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• 2001

Sutures support wound healing during the initial phase. As the tensile strength of a wound increases, the need for the presence of sutures becomes less important. For this reason, absorbable suture materials have been sought. Nowadays, commonly used suture materials are Chromic Catgut, Coated Vicryl, and PDS. Among these materials, Coated Vicryl is the most popular. Studies were conducted to compare the handling properties, reliability of knots, wound healing, and tissue reactivity(Inflammation, Fibroblast proliferation, Collagen deposition, Giant cell reaction, Absorption) between AILEE vicryl and ETHICON vicryl. We used twelve purebred New Zealand white rabbits, and biopsied the tissue at three, seven, fourteen, and thirty days post implantation. The results showed that both were supple and easy to handle and tie, and gross and histologic differences were not apparent.

• Clinics in Shoulder and Elbow
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• 제17권4호
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• pp.175-180
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• 2014

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder ($8.2{\pm}7.9mm$ versus $7.3{\pm}3.4mm$, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. Conclusions: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.

• 대한관절경학회지
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• 제3권2호
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• pp.109-114
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• 1999

목 적 : 내측 반월상 연골후각의 후방 경골 부착부위의 절단 파열은 흔하지 않고 기존의 수기로는 봉합이 어렵다. 이에 저자들은 내측 반월상 연골의 후방 경골 부착부위의 절단 파열의 임상 양상 및 pullout suture를 통한 새로운 봉합술을 소개하고자 한다. 대상 및 방법 : 년 9월부터 1999년 7월까지 9명의 환자에서 후방 경골 부착부위의 절단 파열을 경험 하였다. 평균 나이는 59.3세로 38세에서 70세까지의 분포였다. 전예에서 자기공명영상과 임상양상으로 진단하였고, 슬관절경을 통해서 확진과 치료를 하였다. 1예에서 2차적 관절경을 시행하여 봉합 된 반월상 연골의 치유여부를 확인하였다. 임상 양상 : 대개 중년이후의 나이에서 호발하며, 특별한 외상의 과거력이 없다. 슬관절 후면의 통증을 호소하였으나, 그 위치가 불명확한 특징이 있었다. 경도내지 중등도의 슬관절의 종창을 호소하였으며, 특징적으로 슬관절을 굴곡 시킬수록 심해지는 술관절 후면의 통증으로 완전한 굴곡의 장애가 있었다. 단순 방사선 사진에서 퇴행성 변화는 없거나, 나이에 비해서 미미한 양상이었다. 술 전 자기 공명영상이 진단에 있어서 매우 중요한 역할을 하며, 특히 관상면에서 반월상 연골의 후각이 후방 경골 부착부위에서 분리되어 있는 형태를 보인다. 수술 수기 : 4개의 표준 portal 로 도달하여 후각부의 절단파열을 확인하고, 변연절제술로 시야를 확보하고 후각의 후방 부착부위의 연골하골을 노출 시킨다. 전내측 또는 후내측 도달법으로 절단단율 PDS 로 봉합한다. PDS 봉합사를 전내측 도달법으로 밖으로 꺼내 놓는다. 경골 내측 근위부에 종절개를 가한 후에 ACL tibla guide를 이용하여 경골 내측 근위부에서 후각의 후방 경골부착부위까지 골 터널을 만든다. 강선 루프를 경골 터널을 통하여 삽입하여서 전내측 도달법으로 빼내고, PDS 봉합사를 사이에 끼워서 다시 경골 터널을 통해 아래쪽으로 당겨서 끌어낸다. PDS 봉합사를 경골 내측 근위부에 post-tie 방법으로 고정한다. 결 론 : 내측 반월상연골 후각의 후방 경골부착부위의 절단피열은 임상적으로 흔하지 않고 보고도 드물다. 임상 양상과 자기공명영상이 진단에 있어서 중요한 역할을 한다. 관절경적 pullout 봉합이 이런 형태의 파열에 대한 치료로서 유용할 수 있을 것으로 사료된다.

• 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.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.711-714
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• 2013

Background The most common cause of skin graft failure is the collection of blood or serous fluid underneath the graft. In our study, we describe the use of silicone tube for tie-over dressing to secure the skin graft margins with the aim of decreasing loss of the skin graft, particularly in grafting of deep wounds. Methods Between March 2008 and July 2011, we used this technique in 17 patients with skin defects with depths ranging from 3.5 to 8 mm (mean, 5.5 mm). First, the skin graft was sutured with 3/0 silk suture material from its corners. Then, a silicone round drain tube was sutured with 3/0 absorbable polyglactin 910 over the margins of the graft. Finally, long silk threads were tied over the bolus dressing, and the tie-over dressing was completed in the usual fashion. Results The mean follow-up was 7 months (range, 2-10 months) in the outpatient clinic. Graft loss on the graft margins due to hematoma or seroma was not developed. The results of adhesion between the graft and wound bed peripherally was excellent. Conclusions In our study, we suggest that use of a silicone tube for additional pressure on the edges of skin grafts in case of reconstruction of deep skin defects.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권6호
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• pp.239-246
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• 2014

Many kinds of membrane have been used for the guided bone regeneration (GBR) technique. However, most membranes do not fulfill all requirements for the ideal membrane for the GBR technique. Among them, collagen membrane has been most widely used. However, its high price and weak tensile strength in wet condition are limitations for wide clinical application. Synthetic polymers have also been used for the GBR technique. Recently, silk based membrane has been considered as a membrane for the GBR technique. Despite many promising preclinical data for use of a silk membrane, clinical data regarding the silk membrane has been limited. However, silk based material has been used clinically as vessel-tie material and an electrospun silk membrane was applied successfully to patients. No adverse effect related to the silk suture has been reported. Considering that silk membrane can be provided to patients at a cheap price, its clinical application should be encouraged.