• Archives of Plastic Surgery
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• 제46권3호
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• pp.214-220
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• 2019

Background Microvascular anastomosis patency is adversely affected by local and systemic factors. Impaired intimal recovery and endothelial mechanisms promoting thrombus formation at the anastomotic site are common etiological factors of reduced anastomosis patency. Epigallocatechin gallate (EGCG) is a catechin derivative belonging to the flavonoid subgroup and is present in green tea (Camellia sinensis). This study investigated the effects of EGCG on the structure of vessel tips used in microvascular anastomoses and evaluated its effects on thrombus formation at an anastomotic site. Methods Thirty-six adult male Wistar albino rats were used in the study. The right femoral artery was cut and reanastomosed. The rats were divided into two groups (18 per group) and were systemically administered either EGCG or saline. Each group were then subdivided into three groups, each with six rats. Axial histological sections were taken from segments 1 cm proximal and 1 cm distal to the microvascular anastomosis site on days 5, 10, and 14. Results Thrombus formation was significantly different between the EGCG and control groups on day 5 (P=0.015) but not on days 10 or 14. The mean luminal diameter was significantly greater in the EGCG group on days 5 (P=0.002), 10 (P=0.026), and 14 (P=0.002). Intimal thickening was significantly higher on days 5 (P=0.041) and 10 (P=0.02). Conclusions EGCG showed vasodilatory effects and led to reduced early thrombus formation after microvascular repair. Similar studies on venous anastomoses and random or axial pedunculated skin flaps would also contribute valuable findings relevant to this topic.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권1호
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• pp.93-101
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• 2011

Reconstruction following a resection of malignant oral cavity tumors is one of the most difficult problems in recent oral oncology. The radial forearm free flap (RFFF) is a thin, pliable soft tissue flap with large-caliber vessels for microvascular anastomosis. Its additional advantages include consistent flap vascular anatomy, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with a tumor resection. For a better understanding of RFFF as a routine reconstructive procedure in oral and maxillofacial surgery, the constant anatomical findings must be learned and memorized by young doctors during the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article discusses the anatomical basis of RFFF in the Korean language.

• 한국간담췌외과학회지
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• 제27권4호
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• pp.428-432
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• 2023

Minimally invasive pancreatoduodenectomy (MIS PD) is a well reported technique with several advantages over conventional open pancreatoduodenectomy. In comparison to distal pancreatectomy, the adoption of MIS PD has been slow due to the technical challenges involved, particularly in the reconstruction phase of the pancreatojejunostomy (PJ) anastomosis. Hence, we introduce a lowcost model for PJ anastomosis simulation in MIS PD. We fashioned a model of a cut pancreas and limb of jejunum using economical and easily accessible materials comprising felt fabric and the modelling compound, Play-Doh. Surgeons can practice MIS PJ suturing using this model to help mount their individual learning curve for PJ creation. Our video demonstrates that this model can be utilized in simulation practice mimicking steps during live surgery. Our model is a cost-effective and easily replicable tool for surgeons looking to simulate MIS PJ creation in preparation for MIS PD.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1299-1304
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• 1992

We experienced 5 cases of tracheal stenosis and 7 cases bronchial stenosis treated surgically at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Hanyang University during 5 years. The causes of tracheal stenosis were prolonged endotracheal intubation 1 case, tracheostomy 1 case, the sequela of endobronchial tuberculosis 2 cases and tracheomalacia 1 case. The causes of bronchial stenosis were all endobronchial tuberculosis. The managements of tracheal stenosis were tracheal resection and end to end anastomosis. The resected lengths of trachea were 1.5cm, 3cm and 7.5cm. One case of suglottic stenosis was underwent the resection of trachea, 8cm in length, and the laryngotracheal anastomosis was done, but the re-stenosis of trachea was developed after 4 weeks post-operatively. One case of tracheomalacia was done permanent tracheostomy only, because the entire trachea was adhered to the surrounding tissue. The managements of bronchial stenosis were resection of involved lobe or one lung, in the 5 case. One case with Lt. main bronchial stenosis and atelectasis of Lt. upper lobe was done the lobectomy of Lt. upper lobe only and then, the Lt. pneumonectomy was done re-operatively because the atelectasis of Lt. lower lobe had continued. The other one case with stenosis of Rt. main bronchus, failed the insertion of metalic stent, was underwent the Rt. upper lobe lobectomy, sleeve resection and side to end anastomosis

• Journal of Chest Surgery
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• 제25권11호
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• pp.1369-1375
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• 1992

During a 17-month period 32 consecutive patients underwent coronary artery bypass graft. The mean age of these patients was 45.3 years [range 39 to 71 years]. There were 18 men and 14 women. Preoperatively 11 patients had stable angina pectoris and 12 patients of unstable angina pectoris. 28% [9 patients] had of myocardial infarction history. The patterns of disease were single vessel involvement [4 casis], double vessel involvement [11 cases], triple vessel involvement [12 caese] and 5 cases of left main coronary artery disease. Thirty-seven percent [12/32] were in New York Heart Association class IV. Myocardial revascularization was performed under emergency conditions in 3 patients. We performed 13 case of double anastomosis, 12 case of triple anastomosis and 4 case of 4 anstomosis [mean 2.59 anastomosis per patient]. The left internal mammary artery was used in 68.7%. 90% of the patients receieved two or more grafts. Complications occurred in 8 patients [25%]. All patients were followed up for a mean of 8.6 months [2 to 17 months]. There was no hospital and late death. Postoperatively 87% were in New York Heart Association class I or II and 96% of the patient were free from angina.

• Journal of Chest Surgery
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• 제23권3호
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• pp.550-555
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• 1990

Since Steichen and Ravich`s pioneer work in 1972 proved that staples reduced anastomotic leaks and operative time, the use of EEA stapler`s in esophagogastrostomy have gained acceptance and popularity. But overriding these benefits are the high stricture rate, which leads to the reappearance of dysphagia. The mechanism for the development of stricture in stapled anastomosis is likely to be due to the lack of mucosa to mucosa apposition and presence of necrotic tissue between the luminal edge and the rows of the stapler. All strictures were easily dilated. Recently, we encountered a patient who suffered from an esophageal stricture that slowly developed 10 months after an esophagogastric anastomosis with a EEA 425 was performed due to severe muscular hypertrophy of esophagus. Because the stricture failed to respond to the Bougienage, we reoperated using a EEA 28 this time. We feel that this case review helps to show that despite the very low leakage rate in small size EEA stapler, there is also a very high risk of stricture.

• Journal of Gastric Cancer
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• 제22권3호
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• pp.248-259
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• 2022

Purpose: To overcome the technical difficulties of single-incision laparoscopic distal gastrectomy (SILDG), needle grasper (Endo Relief^TM)-assisted SILDG (NASILDG) was developed. Here, we compared the operative convenience and postoperative outcomes between SILDG and NASILDG. Materials and Methods: A needle grasper was inserted into the right upper abdomen and used in the NASILDG. We retrospectively reviewed patients who underwent D1 + dissection and delta-shaped Billroth I anastomosis with SILDG or NASILDG performed by a single surgeon between September 2015 and August 2018. Results: The SILDG (male, 50.0%) and NASILDG (male, 60.0%) groups included 10 and 15 patients, respectively. The operative time without combined operation and anastomosis was significantly shorter in the NASILDG group. Early complications and scar characteristics were not significantly different between the two groups. Conclusions: By adding a needle grasper, SILDG became more convenient without decreasing cosmetic results. NASILDG could be a recommended method to reduce the technical difficulty of SILDG.

• Journal of Korean Neurosurgical Society
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• 제67권4호
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• pp.442-450
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• 2024

Objective : Cerebral hyperperfusion syndrome (CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow (CBF), afflicting nearly 30% of patients who have undergone superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. Methods : A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 hours after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Results : Out of a total of 162 patients, 24 individuals (comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but nine of them showed no significant findings. Among the patients, 10 displayed elevations in both CBF and cerebral blood volume (CBV), three only showed elevation in CBF, and two only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. Conclusion : The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.

• Journal of Chest Surgery
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• 제42권5호
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• pp.645-648
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• 2009

저자들은 우리나라에서는 처음으로 복강경을 이용한 수기보조 방법으로 복부 대동맥류 치환술을 시행하였다. 환자는 67세 남자였으며, 복부 대동맥류의 직경은 약 5.8 cm였다. 첫 단계로 상복부에 6 cm 절개선을 내고, 복강경하에서 집도의의 왼손을 이용하여 대동맥류 주위를 박리하였다. 근위부 문합은 절개창을 통하여 직접 하였으며, 인조혈관의 양쪽 다리를 후복막을 통하여 양족 서혜부에서 총대퇴동맥과 단측문합하였다. 환자는 술 후 6시간 후 경구 식이를 시작하였으며, 술 후 4일째 퇴원하였다.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.454-457
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• 2006

Purpose: The anastomosis of hepatic artery to recipient vessel has a major role in a liver transplantation, so its occlusion is the most important cause of failure of liver transplantations. We made the study to reveal the peculiarities in pediatric liver transplantations compared with adult cases. Methods: From January 1999 to September 2005, we performed 99 cases of pediatric liver transplantation. The mean age at operation was 4.17 years of age. The hepatic vein and portal vein are anastomosed by the general surgeons and then the hepatic artery is anastomosed by the plastic surgeons. The Doppler ultrasonography and computed tomography were used for postoperative checkup for hepatic artery patency. Results: There were no immediate complications, but hepatic arterial occlusion was developed in 3 cases (2.8%). In pediatric patients, the anastomosis of hepatic artery is more difficult than adults because of the rapid respiratory and pulse rate, the small vascular diameter, and the large gap of diameter difference between the recipient and the donor vessels. Conclusion: We could confirm that pediatric liver transplantations are relatively safe but long learning curve was needed.