• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제39권1호
• /
• pp.21-26
• /
• 2013

Objectives: Full thickness skin grafts (FTSG) offer several advantages; they are esthetically superb, have less postoperative shrinkage, and offer minimal postoperative pain and scar formation at the donor site. As a donor site of FTSG, the groin offers a relatively large area of skin with high elasticity. The aim of this study was to evaluate FTSG from the groin for reconstruction in oral and maxillofacial surgery. Materials and Methods: In a retrospective study, 50 patients (27 males, 23 females) who received FTSG from the groin were evaluated for their operation records, clinical photography, and medical records. Results: The width of skin from the groin was distributed from 2-8 cm (mean: 5.1 cm) at the donor site, while the long axis length was distributed from 3-13 cm (mean: 7.4 cm). A high number of patients, 47 patients (94%) out of 50, showed good healing at the donor site. Wound impairment was seen in 3 patients (6%), minor wound dehiscence in 2 patients, and severe wound dehiscence in 1 patient. In the recipient site, delayed healing was observed in 2 patients (4%). Conclusion: FTSG from the groin to repair soft tissue defects in reconstruction surgery is a good method due to the relatively big size of the graft, decreasing morbidity at the donor site, and higher graft survival rates.

• Archives of Plastic Surgery
• /
• 제41권4호
• /
• pp.330-336
• /
• 2014

Background For patients with full thickness skin defects, autologous Split-thickness skin grafts (STSG) are generally regarded as the mainstay of treatment. However, skin grafts have some limitations, including undesirable outcomes resulting from scars, poor elasticity, and limitations in joint movement due to contractures. In this study, we present outcomes of Matriderm grafts used for various skin tissue defects whether it improves on these drawbacks. Methods From January 2010 to March 2012, a retrospective review of patients who had undergone autologous STSG with Matriderm was performed. We assessed graft survival to evaluate the effectiveness of Matriderm. We also evaluated skin quality using a Cutometer, Corneometer, Tewameter, or Mexameter, approximately 12 months after surgery. Results A total of 31 patients underwent STSG with Matriderm during the study period. The success rate of skin grafting was 96.7%. The elasticity value of the portion on which Matriderm was applied was 0.765 (range, 0.635-0.800), the value of the trans-epidermal water loss (TEWL) was 10.0 (range, 8.15-11.00)$g/hr/m^2$, and the humidification value was 24.0 (range, 15.5-30.0). The levels of erythema and melanin were 352.0 arbitrary unit (AU) (range, 299.25-402.75 AU) and 211.0 AU (range, 158.25-297.00 AU), respectively. When comparing the values of elasticity and TEWL of the skin treated with Matriderm to the values of the surrounding skin, there was no statistically significant difference between the groups. Conclusions The results of this study demonstrate that a dermal substitute (Matriderm) with STSG was adopted stably and with minimal complications. Furthermore, comparing Matriderm grafted skin to normal skin using Cutometer, Matriderm proved valuable in restoring skin elasticity and the skin barrier.

• Journal of Periodontal and Implant Science
• /
• 제38권3호
• /
• pp.535-542
• /
• 2008

Purpose: The aim of this retrospective study is to evaluate survival rate of implant and bone formation, to analyze failure contribution factor. Material and Methods: A total of 52 consecutive patients(35 male, 17 female, mean age 49 years) with 104 osseous defects were treated during the period from October 2004 to June 2007 with a simultaneous or staged GBR approach using non-resorbable or resorbable membranes combined with autogenous bone grafts or xenograft(Bio-Oss, Bio-cera, BBP). Result: A total of 32(30,8%) of 104 GBR-treated sites failed the bone formation and a total of 5(5.6%) of 89 implants were removed. Early exposure of the membrane has significantly affected bone formation(p<0.05). Non-resorbable membrane showed more exposure of the membrane and low success rate of bone formation than resorbable membrane(p<0.05). There were no difference between success rate of bone formation and using autogenous bone or graft materials. There were no statistically significant difference between success rate of bone formation and smoking or using PRP. Mandible showed more success rate of bone formation than maxilla(p<0.05). Conclusion: Early exposure of the membrane, membrane type and maxilla/mandible type have influence on success rate of bone formation during GBR.

• Journal of Chest Surgery
• /
• 제53권2호
• /
• pp.64-72
• /
• 2020

Background: It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization. Methods: Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospectively to investigate technical details, clinical outcomes, and graft patency. Results: Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30-day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011). Conclusion: LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA- based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.

• 대한골관절종양학회지
• /
• 제18권1호
• /
• pp.7-13
• /
• 2012

목적: 편평상피 세포암 환자의 치료 결과를 분석하여, 전반적인 생존율과 예상 가능한 예후인자들에 따른 생존율을 비교하고 분석하는데 있다. 대상 및 방법: 1999년 3월부터 2011년 2월까지 본원에서 병리학적으로 진단된 사지와 체부에 발생한 편평상피 세포암은 151예였고 수술적 치료를 시행한 환자는 51예였다. 연구는 이 중 12개월 이상 외래추적이 가능하였던 41예를 대상으로 하였다. 평균 연령은 64.4세였고, 남자와 여자는 각각 31명, 10명이었다. 수술은 광범위 절제 및 재건술(29예)과 절제연을 얻기 힘든 사지 말단부나 신경, 혈관계를 침범한 경우에 절단술(12예)을 시행하였다. 수술적 치료만 시행한 환자는 33예이고, 절제 후 항암화학치료 또는 방사선 치료를 시행한 환자는 8예가 있었다. 병기는 AJCC 분류에 따라 나누었으며 생존율은 Kaplan-Meier 법으로 계산하였고 군간의 생존율 비교는 Log-rank test를 이용하였다. 생존율과 관련된 예후 인자들로 원발 병소의 위치, 병인, 조직학적 분류, 병기, 수술방법, 추가 항암요법 여부를 조사하여 각각 생존율을 비교하였다. 결과: 평균 외래 추적은 평균 65.2개월(12-132개월)이었고 최종 추시 상 생존은 30예(73.1%)이었고 Kaplan-Meier에 의한 5년 생존율은 77%이었다. 전체 환자에서 총 3예(7.3%)의 국소 재발과 7예(17.0%)의 전이가 있었다. 국소재발 3예에서 재발시기는 평균 27개월(18-43개월)이었다. 원발 병소의 위치, 병인, 조직학적 분류, AJCC 분류에 따른 병기, 추가 항암요법에서 생존율은 통계적으로 유의한 차이가 없었으나 절단술을 시행한 환자는 광범위 절제술을 시행한 환자보다 생존율이 낮았다. 결론: 41예의 편평상피 세포암의 치료결과를 분석한 결과 5년 생존율이 77%이었고 예후에 영향을 미칠 수 있는 여러 인자 중에 수술 방법만이 통계적으로 유의하였다.

• Journal of Periodontal and Implant Science
• /
• 제46권2호
• /
• pp.72-83
• /
• 2016

Purpose: The goal of this study was to evaluate the long-term success of horizontal alveolar crest augmentation of the retromolar region of the mandible with particulated bone, as well as factors affecting subsequent peri-implant bone loss. Methods: A total of 109 patients (68 female, 41 male) suffering from alveolar ridge deficiencies of the maxilla and mandible were included in this study. All patients were treated with particulated retromolar bone grafts from the mandible prior to the insertion of endosseous dental implants. Mesial and distal peri-implant crestal bone changes were assessed at six time points. Several parameters, including implant survival and the influence of age, gender, localisation of the implant, diameter, covering procedures, and time points of implant placement, were analysed to identify associations with bone level changes using the Mann-Whitney U-test, the Kruskal-Wallis test, and Spearman's rank-order correlation coefficient. Results: A total of 164 dental implants were placed in the maxilla (n=97) and in the mandible (n=67). The mean observation period was $105.26{\pm}21.58$ months after implantation. The overall survival rate was 97.6% after 10 years. Overall, peri-implant bone loss was highest during the first year, but decreased over time. The mean amount of bone loss after 10 years was 2.47 mm mesially and 2.50 mm distally. Bone loss was significantly influenced by implant type and primary stability. Conclusions: The use of particulated autologous retromolar bone grafts is a reliable technique for the horizontal reconstruction of local alveolar ridge deficiencies. Our results demonstrate that implants placed in augmented bone demonstrated similar bone level changes compared to implants inserted in non-augmented regions.

• Journal of Chest Surgery
• /
• 제42권4호
• /
• pp.456-463
• /
• 2009

배경: 동맥도관이 정맥도관에 비해 개통률이 우수하다고 알려져 있으나, 재관상동맥 우회술시 동맥도관의 이용은 제한적으로 보고되고 있다. 또한 일차 관상동맥 우회술에 비해 재관상동맥 우회술은 수술 위험도가 높은 것으로 알려져 있어 본 연구는 동맥도관을 이용한 재관상동맥 우회술의 안전성과 효용성을 평가하고자 하였다. 대상 및 방법: 2001년 3월에서 2008년 7월까지 본원에서 동맥도관을 이용하여 시행한 33예의 재관상동맥 우회술에 대해 후향적으로 분석하였다. 수술 시 환자의 평균 연령은 62.6$\pm$9.0세(41$\sim$75)였고 25명(75.8%)은 남자였다. 첫 수술로부터 재수술까지의 평균 기간은 100.1$\pm$67.3개월이었고 수술 당시 평균 좌심실 구출률은 52$\pm$12.5%였다. 수술은 인공심폐기 보조하에서 24예(심정지액을 사용한 경우가 17예, 심박동하 7예)를 시행하였고 인공심폐기의 보조없이 심박동하에 시행한 관상동맥우회술은 7예, 최소침습적 관상동맥우회술은 2예였다. 사용된 도관은 내흉동맥(34예: 우측내흉동맥 28예, 좌측내흉동맥 6예), 요골동맥(14예), 우위대망동맥(14예), 복재정맥(4예) 등이었고, 목표 원위부는 좌전하행지가 23예, 사선분지가 10예, 둔각분지가 25예, 원위 우관상동맥이 4예, 후하행지가 16예, 후측분지가 8예, 중간지(ramus intermedius)가 5예였다. 26명의 환자에서 동맥 복합도관을 이용하여 수술하였고 이들 중 5예에서는 원위치 이식 도관(in situ)으로 좌측 내흉동맥을 혈액공급원으로 다른 동맥과 복합도관을 만들어 사용하였고 10예에서는 일차 관상동맥 우회술 시 사용되어진 좌측내흉동맥을 재이용하였다. 또한 5명에서는 원위치 이식 도관으로서 우측내흉동맥을 혈액공급원으로, 6명에서는 다양한 동맥 유리 도관(arterial free graft)으로 대동맥을 혈액공급원으로 하여 복합도관을 만들어 사용하였다. 평균 원위 문합수는 2.8$\pm$0.9였다. 결과: 수술 사망 및 주요 상처감염은 없었다. 평균 추적관찰 기간은 31.1$\pm$22.7개월이었고 4명은 추적관찰 중 사망하였다. 수술 후 합병증으로는 수술 후 심근 경색이 2예(6%), 대동맥내 풍선 펌프 삽입을 한 환자가 1예(3%), 심방세동이 5예(15.1%), 신경학적 합병증이 3예(9.1%) 있었다. 수술 후 3년 및 5년 누적 생존율(cumulative survival rate)은 각각 87.04%였다. 결론: 현재 심근 보호법과 수술 수기의 발달 및 경험 축적 등으로 인해 다양한 동맥도관을 이용한 재관상동맥 우회술은 비교적 안전하게 시행될 수 있을 것으로 생각된다.

• Journal of Chest Surgery
• /
• 제23권3호
• /
• pp.438-451
• /
• 1990

Pneumatic total artificial heart[TAH] has been clinically applied for the purpose of permanent or temporary use followed by cardiac transplantation in the patients with end stage heart diseases. In spite of the good durability of the pneumatic TAH, thrombus formation, bleeding and infection resulted in death. The Tomasu heart, which is a type of pneumatic TAH, was used in this study. This model is a modified Jarvik heart and consists of atrial cuffs, outflow vascular grafts and thin-layer seamless diaphragm type of ventricles. Cardiac outputs of the left artificial heart were measured by Donovan`s mock circulation under variable conditions of driving parameters, and an experimental artificial heart implantation was performed in 4 calves to observe the changes of hemodynamic parameters in early postoperative period and hematologic and bio-chemical changes in a long-term survival case. In the mock circulation test, cardiac output of the heart was increased with the increase of the left atrial pressure and left driving pressure. Maximum cardiac output was obtained at the heart rate of 120 to 130/min and percent systole of 40 to 45Zo under the condition of a constant left driving pressure of 180mmHg and left atrial pressure of 10mmHg. During the first 24 hours of TAH pumping, driving pressure ranged from 178$\pm$5mmHg to 187$\pm$8mmHg for the left heart and from 58$\pm$6mmHg to 78$\pm$28mmHg for the right heart. The Mean arterial pressure significantly increased between 2 and 8 hours after the start of pumping. The survival time ranged from 27 hours to 46 days. The causes of death were respiratory failure in 2 cases, mechanical valve failure in one, and left ventricular outflow obstruction due to thrombus in a 46-day survival case. This study demonstrated that Tomasu artificial heart operated effectively during the first 24 hours of artificial heart pumping, but thrombus formation around the valve holding area was the main problem in long-term survival case.

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

• 대한치과의사협회지
• /
• 제48권3호
• /
• pp.205-217
• /
• 2010

Purpose The aim of this study is to evaluate the survival rates and analyze the stability of lateral approach and trans-crestal approach for maxillary sinus floor elevation of simultaneous implant placement. Materials and method 407 patients who have been treated in LivingWell dental hospital between 2003 to 2009 were selected. Lateral window technique, osteotome technique and sinus drill technique were used for sinus floor elevation procedure. A total of 714 implants-MP-1 HA coated implant(Tapered Screw $Vent^{TM}$, $Spline^{TM}$, Zimmer, USA), FBR surfaced implant(Pitt-$Easy^{TM}$, Oraltronics, Germany)-were placed in grafted maxillary sinus simultaneously. The autogenous bone or a combination with the allograft or alloplast was grafted into sinus. Sinus floor elevation was combined with vertical/horizontal onlay bone grafts to reconstruct the defect of alveolar ridge. Results The average preoperative height of the maxillary alveolar bone was 5.78mm(range: 0.4mm~12.5mm). 14 implants failed during the healing period(lateral approach: 4, trans-crestal approach: 10) and 3 implant failed after prosthetic loading(lateral approach: 2, trans-crestal approach: 1). The cumulative survival rate of implants after 6 years was 97.6%. Trans-crestal approach(97.4%) and lateral approach(97.9%) had similar survival rates. Conclusion The results indicate that the trans-crestal approach and lateral approach for maxillary sinus elevation is a acceptable method at atrophic maxillary posterior area.