• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.80-91
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• 1996

A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.101-106
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• 2015

Objective : The aim of this study was to explore the immunity in rats transplanted with adipose-derived mesenchymal stem cells (ADSCs) and acellular nerve (ACN) for repairing sciatic nerve defects. Methods : ADSCs were isolated from the adipose tissues of Wistar rats. Sprague-Dawley rats were used to establish a sciatic nerve defect model and then divided into four groups, according to the following methods : Group A, allogenic nerve graft; Group B, allograft with ACN; Group C, allograft ADSCs+ACN, and Group D, nerve autograft. Results : At the day before transplantation and 3, 7, 14, and 28 days after transplantation, orbital venous blood of the Sprague-Dawley rats in each group was collected to detect the proportion of $CD3^+$, $CD4^+$, and $CD8^+$ subsets using flow cytometry and to determine the serum concentration of interleukin-2 (IL-2), tumor necrosis $factor-{\alpha}$ ($TNF-{\alpha}$) and $interferon-{\gamma}$ ($IFN-{\gamma}$) using enzyme-linked immunosorbent assay (ELISA). At each postoperative time point, the proportion of $CD3^+$, $CD4^+$, and $CD8^+$ subsets and the serum concentration of IL-2, $TNF-{\alpha}$, and $IFN-{\gamma}$ in group C were all near to those in group B and group D, in which no statistically significant difference was observed. As compared with group A, the proportion of $CD3^+$, $CD4^+$, and $CD8^+$ subsets and the serum concentration of IL-2, $TNF-{\alpha}$, and $IFN-{\gamma}$ were significantly reduced in group C (p<0.05). Conclusion : The artificial nerve established with ADSCs and ACN has no obvious allograft rejection for repairing rat nerve defects.

• 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.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.75-81
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• 2007

Introduction: Microsurgical replantation of amputated digit have become common procedure in recent years. However replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. So, fingertip amputation was covered by volar V-Y flap, composite graft, cross finger flap and groin flap. But patients who have been treated by these methods experience shortening of digit, nail deformity, excessive tenderness and persistent pain. Replantation could solve most of these problems. Material & Methods: In our department, from March 2004 to August 2007, 36 digits in 32 patients with complete amputation at distal to nail base were replanted using a microsurgical technique. Results: The overall survival rate of the replanted finger was 75%. Venous anastomosis was possible in 8 cases and impossible in 28 cases. In latter cases external bleeding technique was applied with medical leech. Conclusion: After replantation, a few patient complained decreased sensibility, nail deformity and cold intolerance. But most of patients were satisfied with the functional and cosmetic appearance of the viable replanted digits. We believe the replantation should be the first choice in fingertip amputation.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.119-124
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• 2007

Purpose: We reconstructed the skin defect of lower legs exposing muscles, tendons and bone with fasciocutaneous sural artery flap and report our cases. Materials and Methods: Between March 2005 and September 2006, 8 cases of skin defect were reconstructed with fasciocutaneous sural artery flap. Defect site were 4 case of ankle and foot and 4 cases of lower leg. The average defect size was $4{\times}4\;cm^2$. There were 5 men and 3 women and mean age was 52.2 years. We evaluated the viability of flap, postoperative complication, healing time, patient's satisfaction. Results: There was no flap failure in 8 cases. But recurrent discharge in 2 cases was healed through several times adequate debridement and delayed suture without complication. Flap edema may be due to venous congestion was healed through leg elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence in follow up period. Cosmetic results as judged by patients were that 5 cases are good and 3 cases are fair. Conclusion: Sural artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Sural artery flap is useful method for the skin defect of lower legs because it is simple procedure, has constant blood supply and relatively good cosmetic effect.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.115-119
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• 2008

Purpose: We reconstructed the skin defect of hands exposing tendons and/or bone with distally based ulnar artery flap and report our cases. Materials and Methods: Between March 2005 and September 2007, 6 cases of skin defect were reconstructed with distally based ulnar artery flap. Defect site were 5 cases of hand dorsal side and 1 case of hand volar side. The average defect size was $3{\times}3\;cm^2$. There were 4 men and 2 women and mean age was 55.5 years. We evaluated the viability of flap, postoperaive complication, healing time, patient's satisfaction. Results: There was no flap failure in 6 cases. But 1 case with recurrent discharge was healed with several times adequate debridement and delayed suture. 1 case with flap edema which might be due to venous congestion was healed with hand elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence was found in follow up period. Cosmetic results as judged by patients were that 3 cases are good and 3 cases are fair. Conclusion: Distally based ulnar artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Distally based ulnar artery flap is useful method for the skin defect of hands because it is simple procedure, has constant blood supply and relatively good cosmetic effect.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.68-74
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• 2008

Segmental defects of the tibia after open fractures, sepsis and a tumor surgery are among the most difficult and challenging clinical problems. Tibia defects in these situations are complicated with infection and are resistant to conventional bone grafting techniques. The aim of this study is to report the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of tibia defects. Ten patients had free flap followed by IVFT in the period 1989~2007. Mean age was 25.3 years. The patients were followed for an average of 3.4 years. All flaps were survived including 1 case with venous thrombosis requiring additional surgery. The average time to union of proximal and distal end was 5.2 months, 8.2 months, each other. All transposed fibula were viable at last follow-up. IVFT offers the advantages of a vascularized graft. In patients with large bone and soft tissue defects combined with infection, free flap followed by IVFT is an useful and reliable method without microvascular anastomosis.

• 대한약침학회지
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• 제19권3호
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• pp.246-252
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• 2016

Objectives: The purpose of this study was to obtain a natural antibiotic from Phenol-rich compounds; for the dressing and the treatment of chronic wounds. Methods: The Phenol-rich compound sweet gel was prepared by blending four natural herbal extracts, Acacia catechu (L.F.), Momia (Shilajit), Castanea sativa, and Ephedra sinica stapf, with combination of a sweet gel medium, including honey, maple saps, Phoenix dactylifera L. (date), pomegranate extract and Azadirachta indica gum as a stabilizer. The combinations were screened by using a well-diffusion assay with cloxacillin as a control. Pseudomonas spp. was tested with our novel antimicrobial compound. The zones of inhibition in agar culture were measured for each individual component and for the compound, and the results were compared with those of the control group which had been treated with cloxacillin. Data were expressed as means ${\pm}$ standard deviations. Quantitative analyses were performed using the paired t-test. Results: The antibiotic effect of the Phenol-rich compound sweet gel was statistically shown to be more significant than that of cloxacillin against Pseudomonas aeruginosa (P < 0.05). Conclusion: Our novel approach to fighting the antibiotic resistance of Pseudomonas proved to be successful. The Phenol-rich compound sweet gel was found to be suitable for use as an alternative medicine and bioactive dressing material, for the treatment of patients with various types of wounds, including burns, venous leg ulcers, ulcers of various etiologies, leg ulcers on the feet of diabetic, unhealed graft sampling sites, abscesses, boils, surgical wounds, necrotic process, post-operative and neonatal wound infection, and should be considered as an alternative to the usual methods of cure.

• 대한영상의학회지
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• 제84권3호
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• pp.713-718
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• 2023

뇌사자 간이식은 말기 간질환 환자에서 최우선치료로 시행되고 있다. 간이식 후 가성동맥류 형성, 동맥 혈전증 및 협착, 정맥의 협착 및 폐색 등 다양한 초기 또는 후기 혈관 합병증이 발생할 수 있으며, 이는 이식 실패를 야기할 수 있다. 이러한 합병증을 빨리 발견하고 적절한 치료를 하는 것이 이식 성공을 달성하고 재이식을 방지하기 위해 중요하다. 이 증례 보고에서는 컴퓨터단층촬영 및 디지털감산 혈관조영술 영상 소견과 협착 부위 전후의 압력차 측정을 통해 뇌사자 간이식 후 발생한 하대정맥 협착 환자에서 즉각적인 인터벤션이 필요한 감별점을 제시하고자 한다.

• Journal of Chest Surgery
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• 제36권4호
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• pp.229-241
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• 2003

관상동맥 우회술이나 말초 혈관 우회술 시 가장 많이 쓰이는 대체 혈관은 자가 복재정맥이나, 이러한 정맥을 사용할 수 없는 경우 동종 복재정맥이 이용되어 왔다. 1900년대 초부터 시작된 동종 정맥의 이식은 아직도 그 이용에 대하여 논란이 있으며 보존 방법에 따른 혈관 내피세포나 평활근의 생활성 평가에 있어도 큰 편차가 있다. 특히 혈관 내피세포의 항응고 기능이나 nitric oxide에 대한 연구가 이루어지면서 동종 정맥 이식에 있어도 이들의 생활성 및 항원성 여부에 관심이 모아지고 있다. 대상 및 방법: 본 연구는 사람의 복재정맥을 보존하였을 때 보존 방법 및 기간에 따른 혈관 내피세포의 생활성의 평가를 목적으로 하였다. 신선 복재정맥을 대조군으로 하였으며, 실험군 복재정맥은 RPMI (Roswell park memorial institute) 1640에 10% 우태혈청이 포함된 $4^{\circ}C$ 조직 배양액에 넣어 각각 1일(24시간), 3일, 5일, 7일, 14일간 냉장 보존(cold storage)하였다. 기간별 냉장 보존이 끝나면 반으로 나누어 이 상태의 정맥을 I군(I-1, I-3, I-5, I-7, I-14)으로 정하고 냉장 상태에서 실험하였으며, 나머지는 10% 우태혈청과 10% DMSO가 포함된 RPMI 1640용액에 넣고 $-196^{\circ}C$의 액화 질소 탱크에서 2주간 냉동 보존 후(cryopreservation), $37^{\circ}C$에서 급속 해동하여 냉장 보존된 기간에 따라 II군(II-1, II-3, II-5, II-7, II-14)으로 정하여 실험하였다. 각 군의 생활성을 알아보기 위하여 전자현미경을 이용한 내피세포의 관찰, 트롬보모듈린(thrombomodulin) 면역조직화학검사를 이용한 혈관 내피세포의 항응고기능, 효소 소화에 의한 정맥에서의 혈관 내피세포 분리 후 트리판 블루(trypan blue)를 이용한 세포 생존율 검사 등을 시행하였다. 결과: 전자현미경을 통한 세포의 형태학적 검사에서 Groups I-7, I-14, II-5, II-7, 그리고 II-14정맥군들이 Gundry score의 의미 있는 증가(p <0.05)를 보이는 형태학적 변화가 나타났다. 트롬보모듈린을 이용한 면역조직화학검사와 트리판 블루를 이용한 세포 생존율 검사에서는 냉장군은 7일째 생활성 저하를 나타냈으나 냉동 보존군에서는 보존 기간에 상관없이 모두 생활성이 저하된 것으로 관찰되었다. 결론: 사람의 복재정맥을 우태혈청이 포함된 $4^{\circ}C$의 RPMI 1640에 냉장 보존하였을 경우 냉장 7일째부터 형태학적, 기능적 생활성 저하를 관찰할 수 있었으나, $-196^{\circ}C$에 냉동 보존한 경우에는 냉장 5일 후 냉동 보존한 정맥에서도 형태학적인 생활성 저하를 관찰할 수 있었으며 혈관 내피의 항응고 기능을 나타내는 트롬보모듈린 면역조직화학검사에서는 냉동 보존한 대부분 정맥에서 기능적 생활성이 저하된 것으로 관찰되었다. 그러나 이러한 생활성 및 항응고 기능의 저하가 일시적인 현상인지의 여부와 이러한 기능 저하가 이식 혈관의 장기 개통률에 미치는 영향에 대하여 지속적 연구가 필요하다.