• Title/Summary/Keyword: composite graft.

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Surgical correction in annuloaortic ectasia associated with ascending aortic aneurysm: one case report (거대상행핵대동맥루를 동반한 대동맥륜확장증 수술 치험: Cabrol씨 수술 1례 보)

  • 곽문섭
    • Journal of Chest Surgery
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    • v.17 no.4
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    • pp.753-761
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    • 1984
  • Most patients having annuloaortic ectasia are associated with marked dilatation of the sinuses of Valsalva and the aortic annulus as well as the huge aneurysm of the ascending aorta. A 19 year old male patient complaining of tightness on left posterior chest wall underwent cardiac angiography in which demonstrated annuloaortic ectasia with ascending aortic aneurysm and aortic insufficiency. The patient had corrective operation replacing the ascending aorta and aortic valve with a composite graft[Dacron prosthesis containing a Bjork-Shiley aortic valve] within the aneurysmal sac. The coronary orifices were anastomosed to the tubular Dacron prosthesis [30 mm in diameter] by means of a second smaller Gore-Tex tube [8mm in diameter]. The aneurysmal sac was trimmed by removing the redundant wall and then wrapped outer wall of the Dacron prosthesis. Postoperatively, mediastinal bleeding was temporarily observed in the operative day and satisfactory blood pressure was maintained with small dose of dopamine. One week later, large amount of serous effusion was drained out of the retrosternal space making partial disruption of the skin which was healed well by daily local dressing. The patient discharged in good condition on postoperative 29th day with no residual complications and is doing very well on the 4 months follow-up.

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Left Carotid-to-Subclavian Artery Bypass Grafting for Recurrent Angina Caused by Coronary-Subclavian Steal Syndrome

  • Kim, Min-Seok;Paeng, Jin Chul;Kim, Ki-Bong;Hwang, Ho Young
    • Journal of Chest Surgery
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    • v.46 no.1
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    • pp.84-87
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    • 2013
  • A 60-year-old man visited the outpatient clinic due to one month of recurrent exertional chest pain. Eleven years earlier he had undergone off-pump coronary artery bypass grafting using bilateral internal thoracic artery (ITA) Y-composite grafts based on the left ITA. Preoperative coronary angiography showed patent distal graft anastomoses and visualized the left ITA retrogradely. The arch aortography revealed near-total occlusion of the left subclavian artery at the level of the ostium. The patient underwent left carotid-to-subclavian artery bypass grafting using a 6 mm vascular conduit. Postoperative computed tomographic angiography revealed a patent bypass conduit between the left common carotid artery and left subclavian artery. The patient was discharged on postoperative day 4 with no symptoms or signs of myocardial ischemia.

Reattachment of amputated auricle using postauricular subcutaneous pocket (귓바퀴 뒤 포켓을 이용한 절단된 외이의 재접합)

  • Jang, Ju Yun;Kang, Dong Hee;Lee, Chi Ho;Oh, Sang Ah
    • Archives of Plastic Surgery
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    • v.36 no.5
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    • pp.660-662
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    • 2009
  • Purpose: There are several modalities to reattach the amputated auricle. Microvascular replantation can achieve the best outcome, but technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. Methods: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket (Fig. 1, Below, left). Results: The ear was reepithelialized spontaneously in 7 days. At 3 months, the reattached ear has satisfactory appearance without contour deformity(Fig. 1, Below, right). Conclusion: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.

Replantation of Amputated Ear (완전 절단된 외이의 재접합)

  • Chung, Sung-Mo;Bae, Chung-Sang;Lee, Nae-Ho;Yang, Kyung-Moo
    • Archives of Reconstructive Microsurgery
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    • v.14 no.2
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    • pp.112-116
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    • 2005
  • The auricle is easy to be amputated in the face due to its protruding position. When facial parts are amputated, the mechanism of injury usually involves some form of avulsion, which damages these fragile vessels over a distance and renders them unsuitable for anastomosis. Replantation of the ear remains a challenging problem because of the tiny vessels and the paucity of adequate veins for anastomosis. Reattachment as a composite graft of the total or subtotal amputated ear is unreliable. Microsurgical replantation can be performed in a minority of cases because of technical difficulties and long operation time. In this article, the authors report two case of a successful ear replantation of completely amputated auricle. Only one artery and one vein were anastomosed in first case. In the other case one artery was anastomosed without vein. Instead of venous repair, multiple incision was done with leech application therapy. and the outcome was successful. In spite of the technical difficulties and long operation time, microsurgical replantation of amputated ear is better than other reconstructive method or reattachment without microsurgery.

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Effect of Matrigel for Bone Graft using Hydroxyapatite/Poly $\varepsilon$-caprolactone Scaffold in a Rat Calvarial Defect Model (랫드의 두개골결손부 모델에서 HA/PCL 지지체를 사용한 골이식 시 Matrigel의 효과)

  • Kim, Se-Eun; Shim, Kyung-Mi;Kim, Seung-Eon;Choi, Seok-Hwa;Bae, Chun-Sik;Han, Ho-Jae;Kang, Seong-Soo
    • Journal of Veterinary Clinics
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    • v.27 no.4
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    • pp.325-329
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    • 2010
  • The osteogenic potential of hydroxyapatite/poly $\varepsilon$-caprolactone composite (HA/PCL) scaffolds with matrigel was evaluated in a rat calvarial defect model. Calvarial defect formation was surgically created in Sprague Dawley rats (n = 18). HA/PCL scaffold was grafted with matrigel (M-HA/PCL group, n = 6) or without matrigel (HA/PCL group, n = 6). A critical defect group (CD group, n = 6) did not received a graft. Four weeks after surgery, bone formation was evaluated with radiography, micro computed tomography (micro CT) scanning, and histologically. No bone tissue formation was radiographically evident in the CD group. Bone tissue was radiographically evident in the HA/PCL and M-HA/PCL groups, however, there was more bone-similar opacity in the M-HA/PCL group. Micro CT analysis revealed that the bone volume of the M-HA/PCL group was higher than the HA/PCL group, however, no significant difference was found between the HA/PCL and M-HA/PCL groups. Bone mineral density in the M-HA/ PCL group was significantly higher than in the HA/PCL group (p < 0.05). Histologically, new bone was formed only from existing bone in the CD group, showing concavity without bone formation in the defect. In the HA/PCL group, new bone formation was only derived from existing bone, while in the M-HA/PCL group the largest bone formation was observed, with new bone tissue forming at the periphery of existing bone and around the HA/PCL scaffold with matrigel. The results indicate that the combination of HA/PCL scaffold with matrigel may be an effective means of enhancing bone formation in critical-sized bone defects.

In-situ TiO2 Formation and Performance on Ceramic Membranes in Photocatalytic Membrane Reactor (광촉매 반응기용 세라믹 막에의 TiO2 층 형성과 성능평가)

  • Ahmad, Rizwan;Kim, Jin Kyu;Kim, Jong Hak;Kim, Jeonghwan
    • Membrane Journal
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    • v.27 no.4
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    • pp.328-335
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    • 2017
  • Fabricating photocatalytic composite membrane with a mesoporous and tailored morphological structure would have significant implication for environmental remediation. In this study, we reported hybrid $TiO_2$ immobilized photocatalytic membrane and its application for the treatment of dye solution. Photocatalytic film with high porosity and homogeneity was fabricated by graft copolymer as polymer template. Hybridization of membrane filtration with photocatalysis was successfully achieved by photocatalytic membrane reactor developed. Result showed that membrane permeability was significantly reduced after immobilizing the $TiO_2$ film on bare $Al_2O_3$ support. The membrane characterization indicated that well organized $TiO_2$ film was successfully formed on $Al_2O_3$ support. Benefiting from the controlled morphology of $TiO_2$ film, the composite membrane exhibited almost complete degradation of organic dye within 5 h of filtration under UV illumination. Langmuir-Hinshelwood model explained degradation of organic dye. First-order rate constant was approximately six times with $TiO_2$ immobilized composite ceramic membrane, higher than the one with the bare $Al_2O_3$ support (0.0081 vs. $0.0013min^{-1}$).

Propylene/Nitrogen Separation Membranes Based on Amphiphilic Copolymer Grafted from Poly(1-trimethylsilyl-1-propyne) (양친성 고분자가 그래프팅된 Poly(1-trimethylsilyl-1-propyne) 기반의 프로필렌/질소 분리막)

  • Park, Cheol Hun;Lee, Jae Hun;Park, Min Su;Kim, Jong Hak
    • Membrane Journal
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    • v.29 no.2
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    • pp.88-95
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    • 2019
  • Hydrocarbons containing carbon double bonds are generally called olefins and it is extensively used in petro-chemical industry as essential base material. Especially, olefins are essential in polymer synthesis and thus the effective separation and purification of olefins from gas mixture are very important and it gives significant positive effect on the future industrial development. In this study, we fabricated polymeric composite membrane based on poly(1-trimethylsilyl-1-propyne) (PTMSP) for propylene/nitrogen separation and enhancement of its separation performance by grafting amphiphilic copolymer. Furthermore, to accelerate facilitated transport for propylene molecules, Ag salt ($AgBF_4$) and ionic liquid ($EMIM-BF_4$) was incorporated to polymer composite membranes. The neat PTMSP membrane exhibited extremely high gas permeance and low gas selectivity due to its high free volume. To address this issue, PTMSP was grafted with poly(oxyethylene glycol methacrylate) (POEM) and poly(ethylene glycol) behenyl ether methacrylate (PEGBEM). Additionally, the additives such as $AgBF_4$ and $EMIM-BF_4$ further increased the propylene permeance, resulting in increment of propylene/nitrogen selectivity.

The Results of using the Cabrol Technique for Aortic Root Replacement (대동맥 근부치환술에 대한 Cabrol 술식의 성적)

  • Kim, Jeong-Won;Lee, Jong-Tae;Cho, Joon-Yong;Kim, Kyu-Tae;Kim, Gun-Jik
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.573-579
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    • 2008
  • Background: Composite valve graft replacement is currently the treatment of choice for a wide variety of the lesions of aortic root disease. The purpose of this study was to explore the results of aortic root replacement after using the Cabrol technique over a 13-year period at our institution, and we analyzed the results to help surgeons make better decisions when repairing aortic root disease. Material and Method: Between January 1994 and December 2006, twenty-five patients underwent a Cabrol technique operation at our institution. The mean patient age was $43.7{\pm}14.1$ years old (range: $6{\sim}65$ years) and the male and female ratio was 21:4 (84% : 16%). The patients' follow-up was 100% complete, and the mean follow-up period was $60.7{\pm}50.4$ (range:$1{\sim}162$) months. Annuloaortic ectasia (n=18) was the most frequent cause of aortic disease in this series, followed by aortic dissection (n=7). The mean cardiopulmonary bypass time was $177.2{\pm}44.9$ minutes and the mean aortic cross clamping time was $123.4{\pm}34.1$ minutes. Nine patients were checked with MDCT (Multidetector computed tomography) for evaluating a well functioning secondary graft and the coronary anastomosis site. Result: The early mortality rate was 4% (1 of 25 patients). A significant stenosis, kinking or occlusion of the secondary graft was detected by MDCT in 4 patients. The overall survival rate was 88%. Conclusion: The Cabrol technique demonstrated a significant incidence of long-term complications such as secondary graft stenosis or obstruction. It could be used when the modified Bentall technique is not feasible.

Reconstruction of the Extremities with the Dorsalis Pedis Free Flap (족 배 유리 피부판을 이용한 사지 재건술)

  • Lee, Jun-Mo;Kim, Moon-Kyu
    • Archives of Reconstructive Microsurgery
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    • v.8 no.1
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    • pp.77-83
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    • 1999
  • The skin on the dorsum of the foot is a source of the reliable thin and sensory cutaneous free tissue transplantation with or without tendon, bone and joint. A composite flap with attached vascularized tendon grafts for the combined loss of skin and tendon on the dorsum of the hand and foot offers an immediate one stage solution to this problem. The flap provides a very durable innervated tissue cover for the heel of the foot and the dorsum of the hand and an osteocutaneous transfer combined with the second metatarsal. The major dorsalis pedis artery is constant in size, but the first dorsal metatarsal artery is variable in size and location. The dorsal surface of the foot receives sensory innervation through the superficial peroneal nerve and the first web through the deep peroneal nerve. Authors had performed 5 dorsalis pedis free flap transplantation in the foot and hand at Department of Orthopedic Surgery, Chonbuk National University Hospital from August 1993 through August 1997 and followed up for the period of between 19 and 67 months until March 1999. The results were as follows 1. 5 cases dorsalis pedis free flap transfer to the foot(4 cases) and the hand(1 case) were performed and the recipient was foot dorsum and heel 2 cases each and hand dorsum 1 case. 2 All of 5 cases(100%) were survived from free flap transfer and recipient artery was dorsalis pedis artery(2 cases), anterior tibial artery(1 case), posterior tibial artery(1 case) and ulnar artery(1 case) and recipient veins were 2 in number except in the hand. 3. Long term follow up of the exterior and maceration was good and sensory recovery was poor 4. Donor site was covered with full thickness skin graft obtained from one or both inguinal areas at postoperative 3rd week and skin graft was taken good and no morbidity was showed.

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Ruptured Sinus of a Valsalva Aneurysm into the Left Ventricle with the Rupture Site Communicating with the Left Coronary Sinus and the Left Noncoronary Sinus (좌관상동맥동과 비관상동맥동이 좌심실로 파열된 발살바동 동맥류)

  • Lee, Hongkyu;Kim, Gun-Jik;Lee, Jong-Tae
    • Journal of Chest Surgery
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    • v.42 no.1
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    • pp.96-99
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    • 2009
  • We report here on a case of a ruptured sinus of a valsalva aneurysm into the left ventricle with the rupture site communicating with both the left coronary sinus and the noncoronary sinus in a 37-year-old male who presented with symptoms of congestive heart failure. Echocardiography showed a sac-like structure around the sinus of valsalva, an enlarged left ventricle (LV) and severe aortic regurgitation, which all suggested a ruptured sinus of a valsalva aneurysm or an aortic-left ventricular tunnel. The operative findings revealed that both the left coronary sinus and the noncoronary sinus had an opening into the left ventricle. The proximal opening into the LV was closed with bovine pericardium and the aortic root was replaced with a composite graft (a 21 mm St. Jude Epic Supra tissue valve and a 24 mm Hemashild graft) by the modified Bentall procedure. The patient was discharged on the 15th postoperative day, and he was regularly followed up for 2 months. We report on this case due to its rarity and to describe the surgical repair techniques.