저자들은 우수 및 좌수의 제 2수지 결손을 주소로 고려대학병원 정형외과로 내원한 8명의 환자에 대하여 7례에서는 제 2족지, 1례에서는 반대편 제 4수지를 이용한 수지 재건술을 시행하여 다음과 같은 결과를 얻었다. 1. 대부분의 경우 수상원인은 기계적 손상에 의한 것이 8례중 7례를 차지하였다. 2. 수상후 수술까지의 기간은 평균 8년 3개월이었다. 3. 평균 수술시간은 5시간 58분이었으며, 이식족지의 평균 허혈시간은 1시간 52분이었다. 4. 피부편은 7례에서 생존하였으며, 술후 1년때 시행한 기능 평가에서 6례에서 양호이상의 결과를 보였다. 외상으로 인한 수지결손 환자에 있어서 족지를 이용한 수지 재건술은 한번의 수술로 미용 및 기능상으로 결손 수지의 기능을 회복할 수 있는 유용한 수술방법의 하나로 생각된다.

Although the etiology of $Kienb\"{o}ck's$ disease is clearly related to avascular changes in the lunate, but the actual cause leading to this vascular impairment has remained elusive. Therefore, a great many different surgical procedures have been proposed for the correction of the multiple factors leading to lunate collapse or for the treatment of the lunatomalacia. The treatment modalities includes lunate excision, intercarpal arthrodesis, lunate implant resection arthroplasty, joint levelling operation(e.g ulnar lengthening & radial shortening), pronater quadratus pedicle graft and vascular loop graft. In the period from Jan. 1981 to Dec. 1992, we performed operative treatment in 19 cases of $Kienb\"{o}ck's$ disease. Among them, 6 cases were treated with vascular loop graft. We analysed all patients who were treated with vascular loop graft after followed up of 4 year 6 months, on an average(range from 1 year to 8 year 10 months). The results analysed are as follows, 1. All cases were stage III according to Lichtman's classification. 2. Ulnar variance was -1.5(range$-2{\sim}0$), on an average. 3. The average age of patients were 37.7years old(range 31-41). 4. Postoperatively, there were considerable restoration of range of motion and complete relief of pain in all cases, but continued decrease of grip power in one case. 5. Decreased sclerosis, loss of fragmentation and new bone formation were appeared in the last follow up film, in all cases. The vascular loop graft considered as a useful method for the treatment of the $Kienb\"{o}ck's$ disease.

From 1981 to 1991, twenty one vascularized bone grafts had been performed for the treatment of large bone defects of the extremities, with average follow-up of 65.4 months. Fibulae were used in 15 patients Including two cases of osteocutaneous flap, iliums in 5 including two of osteocutaneous flap, and osteocutneous rib in one. Ten of these patients were treated for segmental defects derived from trauma or infection sequelae of long bones, while eight for locally aggressive benign or malignant bone tumors ; and three for congenital pseudarthrosis of tibia. The location of the lesions were 8 cases in tibia; 7 in humerus ; 3 in forearm bone ; 2 in foot ; and 1 in femur. The length of bone defects were averaged as 10 cm, ranging from 3 to 17.5. In eighteen patients(85.7%), the operation was successful. The duration from operation to bony union was average 5.1 months on successful cases, and three of them needed additional procedures, such as bone graft and electrical stimulation to promote bony union. Local recurrence was found in one case of chondrosarcoma, resulting in AK amputation. Wound infections were noted each one case on donor or recipient site. In five cases, the fracture of grafted bone, which united with cast immobilization in four, occurred average 16.7 months after operation.

고려대학교 의과대학 정형외과학 교실에서 광범위한 연부조직결손을 동반한 감염된 경골결손 34례에 대하여 생비골 및 생피부편이식을 시행하고 얻은 결과는 다음과 같다. 1. 국소염증이 완전히 조절되지 않은 상태에서도 생비골 및 생피부편 이식이 가능하였다. 2. 생비골 및 생피부편 이식술을 동시에 시행함으로써, 생피부편의 임상상태로 생비골 이식의 성공여부를 간접적으로 알 수 있었다. 3. 추시기간동안 이식된 비골은 비후되었으며, 이식골의 흡수는 없었다. 4. 경골을 부분절제한 경우에는 이식비골의 골절은 발생되지 않았다. 5. 이식된 비골의 비후는 수술부위의 국소염증 상태에 영향을 받는 것으로 사료되었다.

Although various methods had been reported for reanimination of facial nerve palsy, interposition nerve graft remains superior to other methods if there is a wide gap to be bridged. Dott described a excllent facial nerve reconstruction by sural nerve graft bypassing petrous bone. But his method needs two surgical fields and is performed in two stages. Authors desribe a traumatic facial nerve palsy treated by one stage facial nerve reconstruction that is performed in one surgical field by using a great auricular nerve interposition graft and bypass the petous bone.

Soft-tissue deficits over the plantar forefoot, plantar heel, Achilles tendon, and distal parts of lower leg are often troublesome to cover with a simple graft or local flap due to limited mobility of surrounding skin and poor circulation in these area. Soft-tissue reconstruction in these regions should provide tissue components similar to the original lost tissue, supply durability and minimal protective pressure sensation and result in a donor site that is well tolerated and treated. We analysed 7 cases that were treated with the Instep flap due to soft-tissue defects over these regions from July of 1990 to July of 1993. All flaps were viable and successful at follow-up. 1. The age ranged from 9 years to 60 years, and 6 cases were male and 1 case female. 2. The sites of soft-tissue loss were the plantar forefoot(1 case), plantar heel(3 cases), Achilles tendon(2 cases), and distal parts of lower leg(1 case). 3. The causes of soft-tissue loss were simple soft-tissue crushing injury(1 case), crushing injury of the 1st toe(1 case) and posttraumatic infection and necrosis(5 cases). 4. The associated injury were open distal tibio-fibula, fracture(2 cases), medial malleolar fracture of the ankle(1 case), Achilles tendon rupture(2 case) and 1st metatarso-phalangeal disarticulation(1 case). 5. The size of flap was from $3{\times}4cm$ to $5{\times}10cm$(average $4{\times}5.6cm)$. 6. In 7 cases, we were not to find post-operative necrosis and infection, non-viability, limitation of ankle joint, and gait disturbance caused by the Instep flap surgery. 7. This study demonstrates that the Instep flap should be considered as another valuable technique in reconstruction of these regions.

High level, major limb amputation above the wrist and ankle joint has some characteristic problems because of the large muscle mass and poor potential for nerve regeneration. As an adjunct method to reduce warm ischemic time prior to bony stabilization, temporary vascular shunting by simple catheterization has been performed, which has not been associated with any significant complication and has improved on success rate in replantation surgery. The authors have experienced 198 cases replantation of amputated limbs and digits from September, 1983 at the Korea medical center, Guro hospital, of which, 13 cases of successful replantation of amputated limbs by avulsion injury above the wrist and ankle joint level, which is generally considered as contraindication, were followed up for average 4.5 years(minimum 1.5 to maximum 8.4 years) on terms of survival rate, function and appearance. The clinical analysis upon these cases is to be presented with review of references.

Recently, conservative and bloodless operative procedures have been focused, so that endoscopic laser have been used. However application of endoscopic laser surgery for laryngeal lesion is capable for followings: (1)capability of delivery through an operating microscope, (2) vaporization of ultraspot. $CO_2$ laser which has been used, has limitations for voice improvement because of 700 micron beam spot. KTP-532 laser which is capable of delivery through an operating microscope vapore 200 micron ultraspot has developed and applied to microlaryngeal surgery. We have experienced 60 cases who were contracted with hoarseness(53 cases of benign lesions vocal nodule 13, vocal polyp 13, bilateral diffuse polyposis of vocal cords 11, intracordal cyst 8, vocal papilloma 5, laryngocele 1, laryngeal stenosis 2 and 7 cases of malignant lesions : laryngeal carcinoma stage I and II) since 1991. We operated them with KTP-532 Laserscope(3 Watt/0.05 sec., pulsed or continuous. San Jose, Calif, USA). Forty eigh cases(90.6%) of 53 bengin laryngeal lesions and 4 cases(57.1%) of malignant lesions were significantly improved in their voices. There were a few complications and technical problems, but laser surgery alone had a limitation to eradicate the disease.

The authors analyzed the clinical results of the reconstructive surgery for injured hands and feet due to frostbites and electrical burn with microsurgery in 7 patients, 12 cases at the department of orthopaedic surgery, school of medicine, Kyung Hee university from Jan. 1989 to Jul. 1992, and the results were as foollowings. 1. The age at the time of injury was av 24.6 yrs ranging from 4 to 35 yrs, and all cases were male. 2. The follow up period was av. 24.4 Mo ranging from 12 Mo. to 56 Mo. 3. The causes of injury were frostbite in 9 cases, electrical burn in 2 cases. 4. Initial operative treatment was performed av. 69.3 days ranging from 2 to 210 days. 5. For the reconstructive procedure, scapular free flap was applied in 6 cases, radial forearm flap in 4, dorsalis pedis 1ffap in 1, neurovascular island flap in 1. 6. Among total 12 cases, there were 5 cases(41.7%) of wound infection and 3 cases (25.0%) of partial necrosis of donor flap. 7. In 11 cases(90.1%), the end result was satisfactory. In the analysis of above results the reconstruction with microsurgery is effective procedure for reconstruction of Injured hand and foot due to frostbite and electrical burn.

Free tissue transplantation is commonly performed with the brilliant achievement in microsurgery and anticoagulants and antithrombotic agents have been prescribed in the procedures. However, there is no clean-cut indication as to which agents would be more effective in every steps and final consequences. Low molecular weight heparins inhibiting coagulation in plateletrich plasma and acting on the vascular endothelium have antithrombotic and fibrinolysis action. The experiment with rat groin free flap transplantation after 6-hour ischemia and injection of the low molecular weight heparin was performed and the results between the injection and non-injection group were analysed as follows, 1. Both of the 24-hour groups, vessel patency was not proportional to color change of the groin flap. 2. On the second day after anastomois, heparin-injection group showed intact intima, patent lumen without thrombus, and mild granulomatous inflammation around the suture material and control group with doubtful patency revealed intimal loss and thrombus formation. 3. On the 5th, 7th, and 9th postoperative day, heparin group was patent in anastomosis and showed acute inflammatory cells. 4. The 7th-week period, heparin-injection group showed intact flap color, patent lumen with intact intima and persistent foreign body granuloma.

A comparative study was undertaken to evaluate the contact Neo-dymium : yttrium aluminum garnet(Nd:YAG) laser system for vascular anastomosis of small caliber blood vessels(diameter 0.5-1.2 mm) in the animal model. In this study 40 femoral arteries and 40 femoral veins of Sprague-Dawley rats were anastomosed by contact laser assisted microvascular anastomosis(LAMA) utilizing 3 stay sutures which were placed 120 degrees apart and the intervals welded with contact Nd:YAG laser unit, conventionally sutured anastomosis(CSA) served as controls. The time needed for vascular anastomosis, patency rate(immediate postoperative, postoperative 2nd day, postoperative 1 week, postoperative 4 weeks), gross and microscopic evaluations were compared to conventional microsurgical suture technique. The results are as follows: 1. Postoperative patency rate was 82.5% for femoral artery and 75% for femoral vein by contact LAMA technique compared to 90% and 75% by CSA technique at postoperative 4 weeks. 2. Less time-consumed for arterial anastomosis by 6 minutes 23 seconds and venous anastomosis by 8 minutes 55 seconds with contact LAMA technique compared to CSA technique. 3. Grossly almost complete healing had taken place by postoperative 1 week by contact LAMA technique. 4. Aneurysm formation was 5% for femoral artery and 15% for femoral vein by contact LAMA technique compared to 5% and 10% respectively by CSA technique. 5. Microscopically, re-endothelization was complete by postoperative 7th day by contact LAMA technique. There was less medial hypertrophy and hyperplasia and also less inflammatory response compared to CSA.