• Archives of Plastic Surgery
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• 제34권3호
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• pp.377-382
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• 2007

Purpose: Hook nail deformity is caused by inadequately supported nail bed due to loss of distal phalanx or lack of soft tissue, resulting in a claw-like nail form. A composite graft from the foot bencath the nail bed gives adequate restoration of tip pulp. Methods: From September of 1999 to March of 2004, six patients were treated for hook nail deformity and monitored for long term follow up. Donor sites were the lateral side of the big toe or instep area of the foot. We examined cosmetic appearance and nail hooking and sensory test. The curved nail was measured by the picture of before and after surgery. Results: In all cases, composite grafts were well taken, and hook nail deformities were corrected. The curved nail of the 4 patients after surgery were improved to average $28.7^{\circ}$ from average $55.2^{\circ}$ before surgery. The static two point discrimination average was 6.5mm and the moving two point discrimination average was 5.8mm in the sensory test. Conclusion: Composite graft taken from foot supports the nail bed with the tissue closely resembling the fingertip tissue, making it possible for anatomical and histological rebuilding of fingertip.

• Journal of Periodontal and Implant Science
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• 제28권1호
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• pp.145-160
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• 1998

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue which has been lost due to destructive periodontal disease, and numerous kinds of materials and techniques have been developed to achieve this goal. Bone grafts include autografts, allografts, xenografts and synthetic grafts. Among the synthetic grafts, bioactive glass has been used in dentistry for more than ten years and Fetner reported improved new bone formation and more amount of new attachment after grafting PerioGlas, a kind of bioactive glass, in 2-wall defects of monkeys in 1994. It Is well known that 1-wall defects have less osteogenic potential and more epithelial migration, so we need to study the erect of bioactive glass in 1-wall dejects in dogs. The present study evaluates the effect of bioactive glass on the epithelial migration, alveolar bone regeneration, cementum formation and gingival connective tissue attachment in intrabony detects of dogs. Four millimeter deep and four millimeter wide 1-wall defects were surgically cheated in the mesial aspects of premolars. The test group received bioactive glass with a flap procedure and the control underwent flap procedure only. Histologic analysis after 8 weeks of healing revealed the following results: 1. The height of gingival margin was 1.30{\pm}0.73mm$ above CEJ in the control and $1.40{\pm}0.78mm$ in the test group. There was no statistically significant difference between the two group. 2. The length of epithelial growth (the distance from CEJ to the apical end of JE) was $1.74{\pm}0.47mm$ in the control and $1.12{\pm}0.36mm$ in the test group. These was a statistically significant difference between the two groups (P<0.01). 3. The length of new cementum was $2.06{\pm}0.73mm$ in the control and $2.62{\pm}0.37mm$ in the test group. There was no statistically significant difference between the two groups. 4. The length of new bone was $1.83{\pm}0.74mm$ in the control and $2.39{\pm}0.59mm$ in the test group. There was no statistically significant difference between the two groups. These results suggest that the use of bioactive glass 1-wall intrabony defects has significant effect on the prevention of junctional epithelium migration, but doesn't have any significant effect on new bone and new cementum formation.

• Archives of Plastic Surgery
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• 제42권4호
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• pp.461-468
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• 2015

Background Functional restoration of the facial expression is necessary after facial nerve resection to treat head and neck tumors. This study was conducted to evaluate the functional outcomes of patients who underwent facial nerve cable grafting immediately after tumor resection. Methods Patients who underwent cable grafting from April 2007 to August 2011 were reviewed, in which a harvested branch of the sural nerve was grafted onto each facial nerve division. Twelve patients underwent facial nerve cable grafting after radical parotidectomy, total parotidectomy, or schwannoma resection, and the functional facial expression of each patient was evaluated using the Facial Nerve Grading Scale 2.0. The results were analyzed according to patient age, follow-up duration, and the use of postoperative radiation therapy. Results Among the 12 patients who were evaluated, the mean follow-up duration was 21.8 months, the mean age at the time of surgery was 42.8 years, and the mean facial expression score was 14.6 points, indicating moderate dysfunction. Facial expression scores were not influenced by age at the time of surgery, follow-up duration, or the use of postoperative radiation therapy. Conclusions The results of this study indicate that facial nerve cable grafting using the sural nerve can restore facial expression. Although patients were provided with appropriate treatment, the survival rate for salivary gland cancer was poor. We conclude that immediate facial nerve reconstruction is a worthwhile procedure that improves quality of life by allowing the recovery of facial expression, even in patients who are older or may require radiation therapy.

• Journal of Periodontal and Implant Science
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• 제28권2호
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• pp.263-273
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• 1998

For histologic observation of the regenerated bone following guided tissue regeneration (GTR) using ePTFE membranes with calcium carbonate implant and autogenous bone graft, biopsies were collected from 2 patients during 5-year-postoperative surgical reentry. In both combined cases with guided tissue regeneration in conjunction with calcium carbonate implant and autogenous bone graft, significant bone fill and gain in probing attachment level was observed. In histologic examination, specimen in GTR case with calcium carbonate grafting was composed of a dense bone containing vascular channel with lamellar structure and viable bone cells in lacunae, however considerable calcium carbonate particles remained unresorbed and isolated from regenerated bone by the dense cellular and fibrous connective tissue. No formative cells could be seen in contact with remained calcium carbonate particles. In GTR case with autogenous bone grafting, specimen show was composed of a dense lamellar bone containing vascular channel, which showed normal alveolar bone architectures. The present observation indicate that guided tissue regeneration in conjunction with grafting, especially autogenous bone graft, has highly osteogenic potential, however resorbable calcium carbonate granules were not completely resorbed at 5 year postimplantation.

• Journal of Periodontal and Implant Science
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• 제52권6호
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• pp.466-478
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• 2022

Purpose: Coronally advanced split-or full-thickness (CAST or CAFT) flaps in combination with subepithelial connective tissue grafts (SCTGs) are commonly used in root-coverage procedures despite postoperative pain and bleeding from the graft donor site. Therefore, the modified vestibular incision subperiosteal tunnel access procedure (VISTAX) uses a novel collagen matrix (VCMX) instead of autogenous tissue to address the limitations associated with autogenous tissue grafting. This retrospective study compared the clinical outcomes of VISTAX to the results obtained after using a CAST or CAFT flap in combination with SCTG for root coverage. Methods: Patients with single or multiple adjacent recession I/II defects were included, with 10 subjects each in the VISTAX, CAFT, and CAST groups. Defect coverage, keratinized tissue width, esthetic scores, and patients' perceived pain and dentinal hypersensitivity (visual analogue scale [VAS]) were assessed at baseline, 3 months, and 6 months. Results: All surgical techniques significantly reduced gingival recession (P<0.0001). Defect coverage, esthetic appearance, and the reduction in dentinal hypersensitivity were comparable. However, the VAS scores for pain were significantly lower in the VISTAX group than in the CAFT and CAST groups, which had similar scores (P<0.05). Furthermore, the clinical results of VISTAX and CAFT/CAST generally remained stable at 6 months. Conclusions: The clinical outcomes of VISTAX, CAFT, and CAST were comparable. However, patients perceived significantly less pain after VISTAX, indicating a potentially higher patient acceptance of the procedure. A prospective trial with a longer follow-up period and a larger sample size should therefore evaluate VISTAX further.

• 대한수의학회지
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• 제40권3호
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• pp.497-504
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• 2000

To document that effects of hyperbaric oxygen(HBO) and ${\alpha}-tocopherol$ on full-thickness skin grafts in rat, we performed full-thickness skin grafts bilaterally on each rats. The HBO-treated rats were received HBO twice daily for 90 minutes at 2 ATA. Surgical control rats were not treated with HBO. ${\alpha}-tocopherol$ treated rats were received the agent via oral gastric tube daily for 3 days preoperative and a fourth dose 1 to 2 hours postoperative. HBO plus ${\alpha}-tocopherol$ treated rats were received HBO and ${\alpha}-tocopherol$ as mentioned above. Biopsy specimens were taken from each rat at the time of grafting and on days 2, 4, 7, 10, 14, 21, and 28, then were processed for tissue-concentration of total glutathione(GSHt), oxidized/reduced glutathione level, and thiobarbituric acid-reactive substance(TBARS) levels. The percentage of viable graft on day 10 ranged from 67 to 93%, and was not significantly different among the each other groups. The percentage of viable graft were, however, higher in HBO plus ${\alpha}-tocopherol$ treated rats(78.6%) than in HBO alone treated rats(59.1%), ${\alpha}-tocopherol$ alone treated rats(66.7%) and surgical control rats(58.2%). TBARS concentration had a significant increase from preoperative concentration at day 2, and peak concentration at day 4(p<0.01). Concentration then decreased to preoperative concentration at day 28. GSHt concentration of free skin graft had a similar patteren of change in four groups and decreased significantly from preoperative concentration at day 2, returning to preoperative concentration by day 7(surgical control, HBO-treated, and ${\alpha}-tocopherol-treated$, alone) and 28(HBO plus ${\alpha}-tocopherol-treated$). Percentage of the concentration of reduced glutathione decreased in surgical control, HBO-treated and, ${\alpha}-tocopherol-treated$(p<0.05), and HBO plus ${\alpha}-tocopherol-treared$(p<0.01) on day 7 after surgery, whereas the concentration of oxidized increased significantly in HBO-treated(p<0.05), ${\alpha}-tocopherol-treated$(p<0.05), and HBO plus ${\alpha}-tocopherol-treated$(p<0.01).

• Archives of Plastic Surgery
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• 제46권6호
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• pp.544-549
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• 2019

Background As the indications for postmastectomy radiotherapy expand, innovative solutions are required to reduce operative complications and reconstructive failure after prosthetic breast reconstruction. In this study, we investigated the effectiveness of acellular dermal matrix (ADM) inlay grafts in preventing postoperative wound dehiscence of irradiated breasts in the context of prosthetic breast reconstruction. Methods A retrospective analysis was conducted of 45 patients who received two-stage prosthetic reconstruction and radiotherapy following mastectomy. An ADM graft was placed beneath the incisional site during the second-stage operation in 19 patients using marionette sutures, whereas the control group did not receive the ADM reinforcement. Patient demographics and complications such as wound dehiscence, capsular contracture, peri-prosthetic infection, cellulitis, and seroma were compared between the two groups. Results During an average follow-up period of 37.1 months, wound dehiscence occurred significantly less often in the ADM-reinforced closure group (0%) than in the non-ADM group (23.1%) (P=0.032). There was no significant difference between the two groups in relation to other complications, such as capsular contracture, postoperative infection, or seroma. Conclusions The ADM inlay graft is a simple and easily reproducible technique for preventing incisional dehiscence in the setting of radiotherapy after prosthetic breast reconstruction. The ADM graft serves as a buttress to offload tension during healing and provides a mechanical barrier against pathogens. Application of this technique may serve to reduce complications in prosthetic breast reconstruction after radiotherapy.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.70-79
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• 1996

From January 1980 to May 1995, ninety-six patients had been treated by free-flap transfer for the soft tissue defects of the extremities. Ninety-eight cases of free-tissue transfer were reviewed to evaluate the clinical reliability in terms of survival and quality of long-time function after reconstructive surgery. Among these 98 cases(27 cases in latissimus dorsi myocutaneous flap, 25 in dorsalis pedis flap, 20 in forearm fasciocutaneous flap, 9 in groin flap, 7 in gracilis myocutaneous flap, 6 in 1st web space flap of foot and 4 cases in tensor fascia lata flap), 92 cases of then were survived. 7 cases were performed with vein grafts. We ananalyzed the reconstruction of the extremities on 98 cases with the soft tissue defects which had been reconstructed free-flap transfer and followed for minimum 1 year period at Korea University Hospital. 1. 92 cases(93.9%) of the total 98 cases were successful and can be obtained the excellent results in soft tissue free-flap transfer. 2. While there were no clinically significant differences in survival rate of flaps transferred from different potential flap donor sites,3 cases of 9 groin flaps were showed higher failure rate due to the complications such as arterial thrombosis, infection and anatomical variation of vessels. 3. Postoperative thrombectomy was performed in 30 cases to be occured in the arterial and venous thrombosis. The revision was failed in 2 cases due to persistent arterial thrombosis and infection, then treated with skin graft. 4. Vein graft was frequently required in severely compromised-soft tissue defects resulted from high-energy trauma. The vein graft was not stitistically significant on the frequency of flap failure rate(P<0.04). 5. Meticulous monitoring, careful planning, early revision and technical considerations will provide for a high clinical success of the free-flap transfer.

• Journal of Chest Surgery
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• 제36권2호
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• pp.63-72
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• 2003

최근 증가 추세에 있는 동맥 경화성 혈관 질환에 대한 가장 중요한 외과적 치료 도구로서 생체 적합성이 우수한 인조 혈관의 필요성이 더욱 강조되고 있는 실정이다. 새로운 항혈전성 중합체 혈액 접촉 표면으로서 폴리비닐알코올-폴리우레탄 융합체와 폴리우레탄-흑연 융합체를 개발하여 실험견의 대퇴동맥에 장단기 삽입 실험을 시행함으로써 그 혈액 적합성 및 조직 적합성을 분석, 연구하는데 본 연구의 목적이 있다. 대상 및 방법 : 폴리비닐알코올-폴리우레탄 융합체로 제작된 소구경 인조 혈관 및 폴리우레탄-흑연 융합체로 제작된 봉합편과 폴리우레탄만으로 제작된 소구경 인조 혈관 및 봉합편을 6마리의 실험견에 삽입 실험(1, 2, 4, 6, 8, 16주)을 시행하였고, 4마리의 실험견에 폴리우레탄-흑연 융합체 봉합편 및 폴리우레탄 봉합편 삽입실험(1, 2, 4, 6주)을 시행하여 혈액 적합성 및 조직 적합성을 비교, 분석하였다. 결과 : 폴리비닐알코올-폴리우레탄 융합체 인조 혈관 및 폴리우레탄 인조 혈관 삽입 실험에서 1, 4, 6, 8주 실험견에서는 실험군 및 대조군 모두에서 개방성이 관찰되지 않고 혈전으로 폐쇄되어 있었고, 2주 실험견에서는 모두 개방성이 관찰되었다. 그러나 16주 실험견에서는 폴리비닐알코올-폴리우레탄 융합체 인조 혈관만이 개방성을 유지하고 있는 것이 관찰되었는데 혈액 접촉 표면은 혈전 부착이 거의 없는 깨끗한 상태를 유지하고 있었고 병리 조직 검사에서 인조 혈관의 유공성 사이로 주위 조직의 침투가 관찰되었다. 반면 폴리우레탄 인조 혈관에서는 문합부를 중심으로 혈전 형성으로 인한 폐쇄가 관찰되었다. 폴리우레탄-흑연 융합체 봉합편 및 폴리우레탄 봉합편 삽입 실험에서 2주 실험견을 제외하고는 실험군 및 대조군 모두에서 개방성을 유지하고 있는 것이 관찰되었다. 개방성을 유지하였던 봉합편에서는 봉합편 내면 위로 혈전 형성은 관찰되지 않았으며 4, 6주 실험견에서는 봉합편 내면 위로 신내막이 형성되어 있는 것이 관찰되었다. 주사형 전자 현미경 관찰 결과 폴리우레탄-흑연 봉합편의 경우 1주 실험견에서는 봉합편 내면에 섬유소가 피복되어 있었으며 간헐적으로 세포가 혼합되어 있는 것이 관찰되었다. 이와 대조적으로 4주 실험견에서는 뚜렷한 초기 형태의 내피세포가 섬유소층을 덮어서 자라고 있는 것이 관찰되었다. 이 시기에 관찰한 내피세포의 확대 사진에는 내피세포의 활성을 나타내는 미세융모가 잘 관찰되었다. 그리고 6주 실험견에서는 내피세포가 보다 성숙하여 내피세포간 단층으로 밀접한 연결을 이루면서 상대적으로 납작한 모양을 보여 마치 자갈 모양의 전형적 형태를 취하고 있었다. 폴리우레탄 봉합편의 경우 전체적으로는 폴리우레탄-흑연 봉합편과 유사한 소견을 보였지만 4, 6주 실험견에서 상대적으로 내피세포 피복 정도가 적은 것이 관찰되었다. 그러나 전자 현미경 분석의 제한상 두 군간에 내피세포 피복 정도를 정량화하기는 어려웠다. 이상의 결과로 폴리비닐알코올-폴리우레탄 융합체와 폴리우레탄-흑연 융합체는 대조군인 폴리우레탄 인조 혈관 및 봉합편에 비해 일부 우수한 양상을 보였지만 본 실험의 범위내에서는 통계적 정량적 차이를 제시할 수는 없었다. 향후 보다 광범위한 동물 실험이 필요할 것으로 사료된다.

• Journal of Chest Surgery
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• 제41권2호
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• pp.149-159
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• 2008

배경: 최근 관상동맥우회술 및 말초 혈관 수술의 증가로 동종 이식편 혹은 합성 도관의 필요성이 제기되고 있으나, 만족스럽지 못한 장기 개존율로 널리 사용되지 못하고 있다. 최근 냉동보존된 동종 판막의 생육성 유지의 잠재력이 밝혀지면서, 냉장보존 및 냉동보존된 동종 동맥 혹은 정맥이식편의 실험적인 연구와 임상 적용이 시도되고 있다. 대상 및 방법 : $4^{\circ}C$ 냉장보존과 $-170^{\circ}C$ 냉동보존된 한국산 잡견의 대퇴 동맥 및 대복재 정맥을 수여견의 대퇴 동맥에 이식하여, 냉장보존 및 냉동보존된 동맥과 정맥의 개존율의 차이와 생육성에 따른 내피세포의 기능을 시간대별로 관찰하였다. 결과: RPMI-1640을 배양액으로 하는 3일간의 $4^{\circ}C$냉장보존법과 10% DMSO${\cdot}$RPMI-1640 을 배양액으로 하는 2주간의 $-170^{\circ}C$의 냉동보존법은 혈류량(개존율)(p=0.264), 혈전의 발생 정도(p=0.264)와 내피의 존재 정도(p=0.587), 트롬보모듈린(thrombomodulin) 면역조직화학 염색에도 차이가 없었다(p=0.657). 동맥 이식편과 정맥 이식편은 보존방법에 관계없이 동맥 이식편이 정맥 이식편보다 혈류가 좋았고(p=0.030), 혈전의 발생 정도가 낮았다(p=0.030). 혈전의 정도 및 내피의 존재 유무와 트롬보모듈린의 면역조직화학적 염색의 상관관계를 보았을 때, 혈전의 정도와 면역조직화학적 염색 정도와의 상관관계 계수는 0.654였으며(p=0.006), 내피의 존재와 면역조직화학적 염색 정도와의 상관관계 계수는 0.520 이었다.(p=0.0049). 이식편을 수여견에 이식 후 적출한 이식편을 기간별로 내피의 존재 여부와 면역조직화학적 염색 정도와의 상관관계를 살펴보면 2주일 전에는 상관관계가 없었으나(p=0.306), 1개윌 후에는 상관관계 계수가 0.931 이었다(p=0.0008). 결론: RPMI를 배양액으로 하는 3 일간의 $4^{\circ}C$냉장보존과 10% DMSO${\cdot}$RPMI-1640을 배양액으로 하는 2주간의 $-170^{\circ}C$의 냉동보존은 최소한 같은 정도의 생육성이 유지된 혈관 보존을 할 수 있었다. 보존방법에 관계없이 동맥 이식편은 정맥 이식편 보다 혈전의 발생률이 적었으며, 혈류량으로 평가한 개존율이 우수하였다. 트롬보모율련의 역할을 고려할 때, 이식 후 2주일 전에 적출된 이식편에는 내피가 존재하더라도 광학현미경상의 형태만 갖고 있고, 항응고 기능은 없었으나, 이식 후 1개월 이후에 적출된 이식편에서는 내피가 존재하는 경우 항응고 기능이 있는 것을 알 수 있었다.