• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.211-219
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• 2017

Objective : This study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM). Methods : From January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2-7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade. Results : The mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups. Conclusion : This study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.193-196
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• 2008

Purpose: TRAM flap reconstruction has settled down as a common method for breast reconstruction after mastectomy. There are a few surgical contraindication in TRAM flap surgery. Previous abdominal liposuction has been a relative contraindication in TRAM flap surgery. The authors present 2 patients of successful breast reconstruction using pedicled TRAM flaps, who previously underwent abdominal liposuction. Methods: Case 1: A 48-year-old woman with a right breast cancer visited for mastectomy and breast reconstruction. Her past surgical history was notable for abdominal liposuction 15 years ago. Skin sparing mastectomy and breast reconstruction with a pedicled TRAM flap was performed. Case 2: A 45-year-old woman with a left breast cancer visited us for mastectomy and autologous breast reconstruction. 3 years ago, she had an abdominal liposuction and augmentation mammaplasty in other hospital. Nipple sparing mastectomy and breast reconstruction was done using pedicled TRAM flap. Results: One year after the reconstruction, partial fat necrosis was developed in one case but there was no skin necrosis or donor site complication in both patients. Conclusion: As aesthetic surgery becomes more popular, increasing numbers of patients who have a prior abdominal liposuction history want for autologous tissue breast reconstruction. In these patients, TRAM flap surgery will be also used for breast reconstruction. But, the warning of fat necrosis and the use of preoperative Doppler tracing to evaluate the abdominal perforator may be beneficial to patients who had abdominal liposuction recently.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.422-427
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• 2009

Purpose: Breast cancer is second most common cancer in women. Almost of patients with breast cancer treated with mastectomy undergoes breast reconstruction. Nipple reconstruction is an important step in breast reconstruction. Many surgeons have investigated of nipple reconstruction using the flap technique after breast reconstruction with the autologous tissue. The objective of this study is to evaluate the results of nipple reconstruction using the C - V flap technique after breast reconstruction with the only breast expander. Methods: From April 2006 to May 2008, the authors treated 17 patients of nipple reconstruction using C - V flap technique, who were received breast reconstruction with the only breast expander. We have predicted decrease of the size of reconstructed nipple and designed flap a little larger than wanted nipple size. Nipple splint was applied for 4 - 6 months for minimizing decrease of the size of reconstructed nipple. The diameter and height of the reconstructed nipple were measured and patient's satisfaction score was assessed. Results: Mean follow-up duration was 12.5 months. Among the 17 patients, the average absorption rate by height of nipple was 47.0%. Partial necrosis was noted in 1 case, and treated well with conservative management. There was no other significant complications noted. Patient's satisfactory score was assessed by the height, design and location of the nipple. The average of satisfaction score was 85%, 68%, 62% and total average was 83%. Conclusion: The authors experienced 17 patients of nipple reconstruction using the C - V flap technique after breast reconstruction with the only breast expander. The absorption rate of the size of the nipple, complications and patient's satisfactory score of this study were similar to those of nipple reconstruction after breast reconstruction with the autologous tissue. It is expected that nipple reconstruction after breast reconstruction with the only breast expander is safe and reliable. It is considered that a long - term study is necessary.

• Proceedings of the KSLP Conference
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• 2003.11a
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• pp.181-181
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• 2003

Objectives : Vocal fold augmentation using injectable material is an easy and simple operation. This study is to evaluate the histology of minced and injected autologous auricular cartilage and fat graft in the augmentation of unilateral vocal fold paralysis using a canine model for two years. Study Design : A prospective study with the contralateral side of the larynx used as the control Methods : Twelve dogs were operated. At first, a piece of auricular cartilage was harvested from ear and minced into tiny chips with a scalpel and scissors. And also, a piece of fat tissue was harvested from inguinal area and minced into tiny chips with a scalpel and scissors. The minced cartilage and fat-paste (0.2ml) was injected using a pressure syringe into the paralyzed thyroarytenoid muscle under direct laryngoscopy. Two animals were sacrificed at 3 days, three at 3 weeks. two at 3 months. one at 6 months, one at 12 months, three at 24 months. Each dog underwent laryngectomy and serial coronal sections of paraffin blocks from the posterior part of the vocal fold were made. Result : There was no significant complication perioperatively and during follow-up. There was acute inflammatory findings in the graft at 3 days and 3 weeks. Only a very small proportion of the injected cartilage was absorbed due to the degenerative change and the overall volume was preserved even when the cells died out. The injected cartilage remained in the larynx until 24 months. Conclusion : The autologous cartilage implant using auricular cartilage was the ideal vocal cord augmentative material for the treatment of glottic incompetence.

• The Journal of the Korean Society for Microbiology
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• v.10 no.1
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• pp.1-8
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• 1975

Despite a number of recent studies on appendix its function appears to remain unknown. The present studies were undertaken in order to extend and confirm the previous studies concerning the role of appendix in immune response. An early hemagglutinin response of mercaptoethanol sensitive antibody(IgM antibody) in rabbit injected intravenously(i.v.) with 200mcg of bovine gamma globulin(BGG) was abolished by lethal whole body irradiation(900 r), but preserved in animals whose appendix and bone marrow were shielded during irradiation. Late formation of mercaptoethanol resistant antibody(IgG antibody) and the development of memory in bone marrow shielded animals were not affected by irradiation of the appendix. Formation of either IgM or IgG antibody to sheep red blood cells(SRBC) injected i.v. as determined by direct plaque forming cell(DPFC) technique in spleen were effectively abolished by appendectomy, thymectomy, or both followed by irradiation. When bone marrow was shielded in combination with autologous appendix reconstitution, DPFC response was about 5 times greater than the sum of two. Lysed appendix cells failed to restore the response. Lethally irradiated rabbits restored with combination of autologous appendix and thymus cells showed DPFC responses which were essentially normal. Three pools of appendix were obtained by manual separation technique and were stimulated with soluble concanavalin A(Con A), phytohemagglutinin-P(PHA) and pokeweed mitogen(PWM). Rabbit appendix cells responded to Con A, PHA and PWM. Cells of thymus dependent area(TDA) of the appendix were relatively enriched in their response to T cell mitogens compared to dome and follicle cells. The PHA/Con A responsive ratio of appenix TDA subpopulation was high, indicating that Con A responsive cells have a wider distribution among appendix. This finding showed that interfollicular area of the appendix is thymus-dependent. The present studies confirmed other evidence that the rabbit appendix cells itself are unable to form antibody and T lymphocytes in appendix TDA may be heterogenous, and that the appendix cells are synergistic with either bone marrow or thymus cells in the early hemagglutinin on splenic antibody response to BGG or SRBC.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.542-547
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• 2014

Background Abdominal wall free flaps are used most frequently in autologous breast reconstruction, and these flaps require intact and robust deep inferior epigastric perforator (DIEP) vessels. Pfannenstiel incisions are often present during preoperative visits for breast reconstruction and could potentially signal compromised blood supply to the lower abdominal wall. In this study, we compared the number of DIEP vessels between patients with and without Pfannenstiel incisions undergoing autologous breast reconstruction. Methods A retrospective review of medical records was performed for patients with (study) and without (control) Pfannelstiel incisions (n=34 for each group) between June 2010 and July 2013. In addition to patient demographics, number of caesarian sections, and outcomes of free flap reconstruction, abdominal wall vasculature was compared using the preoperative computed tomography angiographic data between the groups. For each patient, vessels measuring greater than 1 mm were counted and divided into four sections of the lower abdominal wall. Results The mean number of perforator vessels was 10.6 in the study group and 11.4 in the control group, which was not statistically different (P=0.575). Pfannenstiel incisions with history of repeat caesarian sections were not associated with decreased number of perforator vessels. Conclusions Pfannenstiel scars are associated with neither a change in the number of DIEP vessels nor decreased viability of a free transverse rectus abdominis myocutaneous and DIEP flap. Lower abdominal free flaps based on DIEP vessels appear safe even in patients who have had multiple caesarian sections through Pfannenstiel incisions.

• Archives of Plastic Surgery
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• v.40 no.5
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• pp.621-626
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• 2013

Background Ever since lipoabdominoplasty was first developed to achieve better aesthetic outcomes and less morbidity, the rate of seroma formation, especially in obese patients, has disturbed plastic surgeons. The aim of this study was to evaluate the effect of fibrin sealant in the prevention of seroma formation after lipoabdominoplasty in obese patients. Methods Sixty patients with a body mass index (BMI) between 30 and 39.9 were assigned randomly to 1 of 2 groups (30 patients each). Group A underwent lipoabdominoplasty with fibrin glue, while group B underwent traditional lipoabdominoplasty; both had closed suction drainage applied to the abdomen. The patients' demographics and postoperative complications were recorded. Seroma was detected using abdominal ultrasound examinations at two postoperative periods: between postoperative days 10 and 12 and, between postoperative days 18 and 21. Results The age range was 31 to 55 years ($38.5{\pm}9.5$ years) in group A and 25 to 58 years ($37.8{\pm}9.1$ years) in group B, while the mean BMI was 31.4 to 39.9 $kg/m^2$ (32.6 $kg/m^2$) in group A and 32.7 to 37.4 $kg/m^2$ (31.5 $kg/m^2$) in group B. In group A, the patients had a complication rate of 10% in group A versus 43% in group B (P<0.05). The incidence of seroma formation was 3% in the fibrin glue group but 37% in the lipoabdominoplasty-alone group (P<0.05). Conclusions Lipoabdominoplasty with the use of autologous fibrin sealant is a very effective method that significantly reduces the rate of postoperative seroma.

• Archives of Reconstructive Microsurgery
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• v.22 no.1
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• pp.7-12
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• 2013

Purpose: Breast reconstruction with lower abdominal tissue can produce the best outcome with acceptable rates of long-term complication. However, for cases in which sufficient abdominal tissue is not available, an superior gluteal artery perforator (SGAP) flap can be considered as the next option for autologous breast reconstruction. Materials and Methods: Among a total of 63 women who underwent breast reconstruction with free autologous tissue transfer from July 2010 to April 2011, SGAP flap was performed for four patients. In two cases, patients did not have enough abdominal tissue for sizable breast reconstruction. In another case, the patient had a long abdominal scar due to donor hepatectomy of liver transplantation. In the last case, which was a revisional case after radiation necrosis of a previous pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, a large amount of healthy skin and soft tissue was needed. SGAP flap was elevated in lateral decubitus position. The internal mammary vessels were used for recipient vessels in all cases. Results: Breast reconstruction was performed successfully in all four cases without flap loss. Donor site complication was not observed, except for one case of seroma. The shape of the reconstructed breast was satisfactory in all patients. Conclusion: SGAP flap is an excellent alternative option for the TRAM or deep inferior epigastric artery perforator flap for breast reconstruction. In terms of narrower width, harder consistency of soft tissue, and shorter pedicle, it is clear that the SGAP flap is less competent than the TRAM flap. However, in cases where abdominal tissue is not available, SGAP flap is the only way of providing a large amount of healthy tissue.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.89-93
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• 1989

We performed the autologous epidural blood patch (AEBP) for the relief of headache and other related symptoms following dural punctures of the lumbar region during 8 years from 1981 to 1988. The total of 37 patients with the patching consisted of 9 cases in 3007 of spinal anesthesia, 12 accidental dural punctures in 4283 cases of lumbar epidural anesthesia, 12 cases in 4747 of epidural analgesia for back pain control, 3 cases of myelography and a case of diagnostic lumbar puncture. The headaches were relieved completely in 35 cases following the first AEBP and the remaining two were also relieved following the second AEBP. We think that the AEBP for postdural-puncture headache is the treatment of choice.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.28 no.2
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• pp.64-73
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• 2019

Various techniques have been developed, and the development of piezo electric devices have made it possible to widen the alveolar ridge even if the residual bone is dense or if there is a lack of cancellous bone between the cortical bones. In the operation of the mandibular posterior area, the flap is easily accessible to the ramus bone, from which high quality autogenous bone can be obtained, compared to other parts. A small autologous bone block can be used with particulated bone graft material using one screw for bone regeneration instead of a large autologous bone with two screws. The tapered implant design can minimize buccal bone fracture, even in severely atrophic mandibular areas. We report a case of 4 years following implant placement with ridge splitting and small autogenous bone graft in severly atrophic mandible. This report demonstrates a case of functional and aesthetic restoration in a patient through a collaboration.