• Journal of Chest Surgery
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• 제38권9호
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• pp.633-636
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• 2005

출생 직후 Carpentier-Edward D형의 Ebstein 기형을 진단 받은 신생아가 심한 저산소증 및 심부전의 증상을 보여 생후 16일째 응급수술을 시행하였다. 수술 소견 상 거대한 우심방 및 심방화 우심실, 작은 기증적 우심실, 삼천 판막의 중격엽 및 후엽의 심한 하향 전위 및 전엽의 우심실 전벽 유착 등이 관찰되었고, 전형적인 협착성 엡스타인 기형으로 양심실 교정이 북가능한 상태로 판단되어 변형 starnes 술식을 적용하였다. 즉 폐동맥판막 및 전위된 삼첨판막 개구창을 일차 봉합 폐쇠하고 광범위한 심방 중격 절제술 등을 시행한후 우심실 전벽과 심실 중격 사이를 우심 첨부에서부터 다중 봉합하여 막성 중격 주변으로 10mm 정도 남기고 심방화 우심실 내부를 모두 봉합 폐쇄하였다. 또한 폐혈류 유지를 위하여 4mm ringed Gore-Tex 도관을 무명동맥에서 주폐동맥까지 연결하였다. 환자는 수술 후 경과가 양호하여 술 후 17일째에 퇴원하였으며, 6개월 후 큰 문제없이 양방향성 상대정맥-폐도맥 단락술을 시행할 수 있었다. 저자 등은 심한 협착성 엡스타인 기형 환자에게 간편하면서도 안전하게 심방화 우심실을 혈역학으로부터 제외시키는 변형 Starnes 방법을 적용하여 좋은 성적을 얻었기에 보고하는 바이다.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.539-542
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• 2005

Reconstructions of soft tissue defect of the posterior ankle including Achilles the tendon should take into account not only coverage but functional outcome. Various methods of tendon transfer and tendon graft have been reported as a single-stage procedure. With advances and refinements in microsurgical techniques, several free composite flaps including tendon, fascia, or nerve have been used in single-stage reconstructions of large defects in this area minimizing further damage to the traumatized leg. However, when free flap is not feasible for some reasons, this cannot be accomplished successfully. Here we present a patient with Achilles tendon and circumferential large soft tissue defect. Because of circulatory compromise of the lower extremity, free flap reconstruction could not be applied. Instead, cross-leg composite flap of the dorsalis pedis flap including the extensor hallucis brevis musle and tendon, and tendon strips of the Second, third and fourth extensor digitorum logus were employed, Functional reconstruction of the tendon and resurfacing were obtained at the same time. The flap was detached 3 weeks postoperatively, and the transplanted flap has survived without any complications. By 3 months after surgery, full weight bearing, tip-toe standing and even walking without crutch assistance was possible. When functional reconstruction with the free flap is unattainable in the large defect of the posterior ankle including the Achilles tendon, cross-leg composite island flap of dorsalis pedis flap and tendon strips of the extensor digitorum longus tendon is a viable alternative.

• Journal of Yeungnam Medical Science
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• 제10권1호
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• pp.253-259
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• 1993

본원에서는 출산 후 지속되는 호흡곤란, 전신부종을 주소로 내원한 환자에서 임신과 관계된 De Bakey유형II의 대동맥해리를 진단하고 성공적으로 수술을 시행한 1례를 경험하였기에 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.179-183
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• 2007

Objective : Posterior arthrodesis in atlantoaxial instability has been performed using various posterior C1-2 wiring techniques. Recently, transarticular screw fixation (TASF) technique was introduced to achieve significant immediate stability of the C1-2 joint complex. The purpose of this study is to assess the clinical outcomes associated with posterior C1-2 TASF for the patient of atlantoaxial instability. Methods : We retrospectively reviewed data obtained from 17 patients who underwent C1-2 TASF and supplemented Posterior wiring technique (PWT) with graft between 1994 and 2005. There were 8 men and 9 women with a mean age of 43.5 years (range, 12-65 years). An average follow-up was 26 months (range, 15-108 months). Results : Successful fusions were achieved in 16 of 17 (94%). The pain was improved markedly (3 patients) or resolved completely (14 patients). There was no case of neurological deterioration, hypoglossal nerve injury, or vertebral artery injury. Progression of spinal deformity, screw pullout or breakage, and neurological or vascular complications did not occur. Conclusion : The C1-2 TASF with supplemental wiring provided a high fusion rate. Our result demonstrates that C1-2 TASF supplemented by PWT is a safe and effective procedure for atlantoaxial instability. Preoperative evaluation and planning is mandatory for optimal safety.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1997년도 춘계학술대회
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• pp.447-450
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• 1997

A new technique for the preparation of porous vascular prostheses was investigated. Polyurethane solution (10 to 14wt%) was injected into a mold. After freezing at low temperature $(0^{\circ}C\sim-40^{\circ}C)$, solvent was dissolved out with water at $0^{\circ}C$ to form porous tubes. The average pore size $(<10{\mu}m)$and pore occupation (10% to 51%) were easily changed by changing polyurethane concentration, freezing temperature, and freezing methods. This technique can give a proper pore size $(30\sim60{\mu}m)$ for tissue ingrowth, and suitable compliances for matching with arteries and veins. This method might give a desired compliant graft for artificial implantation with the presently valid medical polymers.

• Journal of Chest Surgery
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• 제35권9호
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• pp.688-691
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• 2002

Takayasu씨 동맥염은 원인이 잘 모르는 만성 염증성 질환의 일종이다. 이 질병은 주로 대동맥궁과 대동맥의 주분지를 잘 침범하는 것으로 알려져 있으며, 관상동맥과 신동맥을 동시에 침범하는 경우는 극히 드물다. 최근 고려대학교 흉부외과학교실에서는 관상동맥과 신동맥을 동시 에 침범한 Takayasu씨 동맥 염 환자를 성공적으로 치료하였기에 보고하는 바이다. 환자는 23세 여자로, 운동시의 흉통을 주소로 내원하였다. 혈관조영술상 좌주관상동맥, 양측의 신동맥, 좌쇄골하동맥의 협착 소견을 보였다. 치료로는 양측의 신동맥에 스텐트를 삽입하는 혈관성형술을 시행하였고, 1주일 뒤 대복재정맥을 이용한 관상동맥우회술과 인조혈관(PIFE)을 이용한 대동맥-쇄골하동맥간 우회술을 동시에 시행하였다. 환자는 수술 후 13일째 특별한 합병증 없이 퇴원하였다.

• Archives of Plastic Surgery
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• 제44권2호
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• pp.136-143
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• 2017

Background The goal of this study was to investigate the anatomy of the peroneal artery and its perforators, and to report the clinical results of reconstruction with peroneal artery perforator flaps. Methods The authors dissected 4 cadaver legs and investigated the distribution, course, origin, number, type, and length of the perforators. Peroneal artery perforator flap surgery was performed on 29 patients. Results We identified 19 perforators in 4 legs. The mean number of perforators was 4.8 per leg, and the mean length was 4.8 cm. Five perforators were found proximally, 9 medially, and 5 distally. We found 12 true septocutaneous perforators and 7 musculocutaneous perforators. Four emerged from the posterior tibia artery, and 15 were from the peroneal artery. The peroneal artery perforator flap was used in 29 patients. Retrograde island peroneal flaps were used in 8 cases, anterograde island peroneal flaps in 5 cases, and free peroneal flaps in 16 cases. The mean age was 59.9 years, and the defect size ranged from $2.0cm{\times}4.5cm$ to $8.0cm{\times}8.0cm$. All the flaps survived. Five flaps developed partial skin necrosis. In 2 cases, a split-thickness skin graft was performed, and the other 3 cases were treated without any additional procedures. Conclusions The peroneal artery perforator flap is a good alternative for the reconstruction of soft tissue defects, with a constant and reliable vascular pedicle, thin and pliable skin, and the possibility of creating a composite tissue flap.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.687-696
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• 2013

Background Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published. Methods Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed. Results The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18- hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups. Conclusions In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.

• Journal of Chest Surgery
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• 제43권2호
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• pp.194-198
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• 2010

대동맥 벽내 혈종은 대동맥 내벽의 열상 등 손상이 없으면서 대동맥의 혈관벽내의 출혈로 정의되며 고전적인 대동맥 박리로 진행할 수 있는 질환으로 대동맥 박리의 변형된 형태로 여겨지기도 한다. 대동맥 벽내 혈종은 높은 이환율과 사망률을 보이나 궁극적 치료는 아직 확실하지 않다. 하지만 상행 대동맥에 발생한 대동맥 벽내 혈종은 대동맥 파열과 심낭 압전의 위험성으로 인해 보통 수술적인 치료가 고려되고 있다. 저자들은 실신을 주소로 내원한 71세 남환에서 대동맥 벽내 혈종 1예를 수술 치험 하였다. 잘못된 진단으로 인해 응급실 내원 5시간 뒤 시행된 대동맥 단층 컴퓨터 촬영 검사 결과 상행대동맥 벽내 혈종과 심낭 압전 소견이 동반되어 있었으며 이로 인해 급성 신부전, 허혈성 장기손상의 합병증이 발생하였다. 응급 수술로 상행대동맥 및 대동맥궁 치환술을 진행하였고 환자는 수술 14일 뒤 합병증 없이 퇴원하였다.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.89-92
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• 2009

Purpose: The clinical syndrome of unilateral finger ischemia, caused by digital artery occlusions from embolization from the palmar ulnar artery associated with repetitive striking of the palm, has been called the hypothenar hammer syndrome (HHS). We report the case of a man with this unique disease probably caused by manual work. Methods: A 52 - year - old male left - hand dominant manual worker complained of pain and coldness in the left 4,5th finger. On physical examination, there was a tip necrosis and the result of Allen's test was mildly positive(sluggish filling of hand from the ulnar artery). Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch and distal digital artery. Surgical bypass with reverse autologous vein grafting was performed between ulnar artery and superficial palmar arch, common digital artery. Results: He had an uneventful postoperative course and has remained asymptomatic for 18 months since discharge. Patency has been confirmed by color doppler with resolution of cold intolerance and successful digital preservation. Conclusion: We introduce very unique pattern of vascular ischemic disease and recommend the arterial bypass with vein interpositional grafting.