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  • Title/Summary/Keyword: Anastomosis site

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The Oblique Extended Reverse First Dorsal Metacarpal Artery Perforator Flap for Coverage of the Radial-Volar Defect of the Proximal Interphalangeal Joint in the Index Finger: A Case Report

  • Jeeyoon Kim;Bommie Florence Seo;Junho Lee;Sung No Jung
    • Archives of Plastic Surgery
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    • v.49 no.6
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    • pp.760-763
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    • 2022
  • The dorsal metacarpal artery perforator flap is a flap that rises from the hand dorsum. Owing to its reliability and versatility, this flap is used as a workhorse for finger defect. However, to cover the radial-volar defect of the proximal interphalangeal joint (PIPJ) of the index finger, a longer flap is required than before. Here, we introduce the oblique extended reverse first dorsal metacarpal artery (FDMA) perforator flap to cover the radial-volar aspect defect of the index finger. A 45-year-old man got injured to the radial-volar defect of PIPJ of the left index finger caused by thermal press machine. The wound was 2 × 1 cm in size, and the joint and bone were exposed. We used FDMA perforator from anastomosis with palmar metacarpal artery at metacarpal neck. Since the defect was extended to the volar side, the flap was elevated by oblique extension to the fourth metacarpal base level. The fascia was included to the flap, and the flap was rotated counterclockwise. Finally, PIPJ was fully covered by the flap. Donor site was primarily closed. After 12 months of operation, the flap was stable without complication and limitation of range of motion. The oblique extended reverse FDMA perforator flap is a reliable method for covering the radial-volar defect of the PIPJ of the index finger. This flap, which also has an aesthetic advantage, will be a good choice for hand surgeons who want to cover the PIPJ defect of the index finger using a nonmicrosurgical option.

Bronchoesophageal fistula in a patient with Crohn's disease receiving anti-tumor necrosis factor therapy

  • Kyunghwan Oh;Kee Don Choi;Hyeong Ryul Kim;Tae Sun Shim;Byong Duk Ye;Suk-Kyun Yang;Sang Hyoung Park
    • Clinical Endoscopy
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    • v.56 no.2
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    • pp.239-244
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    • 2023
  • Tuberculosis is an adverse event in patients with Crohn's disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn's disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient's condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed.

Musculocutaneus Island Flap Based on the Distal Vascular Pedicle of Gracilis Muscle (박근의 원위혈관경을 이용한 도서형 근피판술)

  • Chung, Duke-Whan;Lee, Yong-Wook;Cho, Chang-Hyun
    • Archives of Reconstructive Microsurgery
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    • v.6 no.1
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    • pp.96-102
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    • 1997
  • The gracilis that is frequently used as a donor of free muscle trasfer is appropriate in the muscular shape and vascular position. This muscle is belonged to the second type of muscle group by the classification of the pattern of muscular nutrient vessel. The adductor branch or first perforating branch of deep femoral artery which supplies the proximal 1/3 of this muscle is a dominant one and this is used for the microscopic anastomosis of muscle or musculocutaneous flap. The minor vascular pedicles which enter the distal 1/3 of this of this muscle are branches of the superficial femoral artery and it is 0.5mm in diameter, 2cm in length with two venae comitantes. These minor pedicles supplies distal half of the gracilis muscle. This island musculocutaneous flap using distal vascular pedicle can be used to cover the defect of soft tissue around the distal femoral supra-condylar area, knee joint and proximal tibial condyle area which cause limitation of motion of knee joint, or in the cases that usual skin graft is impossible. The important operative procedure is as follows; The dissection is carried proximally and distally and the entire gracilis muscle including proximal and distal pedicle is completely dissected. After temporary blocking of the proximal vascular pedicle, the adequate muscle perfusion by the distal pedicle is identified and it is rotated to the recipient site around knee joint. The advantages of this procedure are simple, no need of microscopic vascular anastomoses and no significant functional loss of donor site. Especially in the cases of poor condition of the recipient vessel, this procedure can be used effectively. From 1991 to 1996, we performed 4 cases; complete survival of flap in 3 cases and partial survival of flap with partial necrosis in 1 case. This procedure is though to be useful in the small sized soft tissue defect of distal femoral supra-condylar area, knee joint and proximal tibial condylar area, especially in the defect of anterior aspect which expected to cause limitation of motion of knee joint due to scar contracture. But the problems of this procedure are the diameter of distal vascular pedicle is small and the location of distal vascular pedicle is not constant. To reduce the failure rate, identify the muscular perfusion of distal vascular pedicle after blocking the proximal pedicle, or strategic delay will be helpful.

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Findings of Digital Subtraction Angiography after Vascularized Fibular Grafting for Osteonecrosis of Femoral Head (대퇴골두 무혈성 괴사에 대한 혈관부착 비골 이식술 후 디지털 감산 혈관조영술 소견)

  • Lee, Kee-Haeng;Kim, Youn-Soo;Lee, Hae-Giu;Ok, Ji-Hoon;Kim, Bae-Kyun;Kim, Hyoung-Min
    • Archives of Reconstructive Microsurgery
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    • v.13 no.2
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    • pp.130-135
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    • 2004
  • Purpose : To observe the patency of anastomosis site and the findings of circulation of grafted fibula in osteonecrosis of femoral head treated with vascularized fibular graft by use of digital subtraction angiography. Materials and Methods : 17 cases of 11 patients who underwent vascularized fibula graft for osteonecrosis of femoral head. We performed digital subtraction angiography(DSA) for them at second week postoperatively in 12 cases, at sixth week in 1 case, at sixth month in 2 cases, at twelfth month in 1 case, and eighteenth month in 1 case which had been got DSA at second week before. We observe the patency of pedicle, and the circulation of grafted fibula such as periosteal and intraosseous vessels with time. Results : All cases except one which were thought failure of selective angiogram showed good passage of blood flow through anstomosed pedicle on DSA. We found the differences in appearance of circulation of grafted fibula with time. DSA at 2nd and 6th week postoperatively revealed both of periosteal and intraosseous vessels along the fibula and blood pooling at the tip of fibula. DSA at 6th month showed maintenance of periosteal and intraosseous vessels along the fibula but did not clearly reveal blood pooling at the tip of fibula. The findings of DSA at 12th and 18th month were similar each other. The periosteal vessels were not seen as the grafted fibular bone were incorporated into surrounding femoral bone but intraosseous vessels were still seen. Conclusion : It was thought that DSA could be used for evaluation of the status of pedicle including anastomsed site and vessels of grafted fibula with time. The periosteal vessels of fibula were decreased with time but intraosseous vessels were still seen until 18th month after vascularized fibula graft.

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Feasibility of Off-Pump Coronary Artery Bypass Grafting Using Bilateral Skeletonized Internal Thoracic Arteries (양측 내흉동맥을 이용한 관상동맥 우회술의 임상적 분석)

  • Lee, Jun-Wan;Lee, Jae-Won;Kim, Jong-Woo;Choo, Suk-Joong;Song, Hyun;Rheu, Sang-Wan;Kim, Jong-Wook;Park, Jong-Bin;Song, Meong-Gun
    • Journal of Chest Surgery
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    • v.36 no.10
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    • pp.728-733
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    • 2003
  • Background: The aim of the current study was to assess the effects of total arterial myocardial revascularization (TAMR) with bilateral internal mammary arteries. Material and Method: 139 consecutive patients who underwent off pump coronary artery bypass surgery from January 2000 to December 2001 were included in the current retrospective study. Patients were divided into those receiving bilateral internal mammary artery, BITA (n=85) and those receiving single internal mammary artery, SITA (n=54). Result: There was only one death in each group. No significant differences were noted in the total ICU and hospital stay; 2.4±1.7 and 11.2±17.7 days, in the BITA group, respectively and 2.8±2.7 and 9.7±7.1 days in the SITA group, respectively (P>0.05). The mean number of distal anastomosis of 3.9±0.7 was slightly higher in the SITA group compared to the SITA group, which was 3.1±0.8. Myocardial infarction occurred in 7 patients (BITA group: 2, SITA group: 5) and deep sternal infection necessitating reoperation occurred in 4 patients (BITA group: 3, SITA group: 1). Coronary angiogram was performed in the immediate postoperative period in 104 patients (BITA group: 64/85, SITA group: 40/54). Of these patients, stenosis in the LAD anastomosis site occurred in 4 patients (BITA group: 2, SITA group: 2). A total of 8 anastomotic sites were stenotic in the entire series of which percutaneous intervention was performed in 3 patients and none required reoperative coronary artery bypass. Conclusion: The results of the current data did not show a significant difference in patiency rate with bilateral internal mammary artery use for CABG supporting the feasibility of its use as a viable alternative method for TAMR.

Circular Stapled Gastrojejunostomy after Radical Subtotal Gastrectomy - Anastomotic Bleeding and Prevention - (근치적 위아전절제술 후 원형문합기를 이용한 위공장문합술 - 문합부 출혈과 예방 -)

  • Ihn, Myung-Hoon;Kang, Gil-Ho;Cho, Gyu-Seok;Kim, Yong-Jin;Kim, Hyung-Soo;Han, Sun-Uk;Bae, Sang-Ho;Kim, Sung-Yong;Baek, Moo-Joon;Lee, Moon-Soo
    • Journal of Gastric Cancer
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    • v.9 no.4
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    • pp.223-230
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    • 2009
  • Purpose: Circular stapled gastrectomy has been the favored procedure with its feasibility and the shortened operative time, but anastomotic leakage, stenosis and bleeding have been reported as problems. The aim of this study was to identify what can be done to supplement the safety of this technique by examining the potential complications of performing circular stapled gastrojejunosomy after radical subtotal gastrectomy. Materials and Methods: As subjects, this study selected 1,391 patients who underwent gastrojejunostomy after radical subtotal gastrectomy because of gastric cancer at our Department of Surgery from Jan. 1998 to Dec. 2007. The patients were divided into Group I (n=479) who underwent hand-sewn gastrojejunostomy, Group II (n=48) who underwent linear stapled gastrojejunostomy and Group III (n=864) who underwent circular stapled gastrojejunostomy. Group III was re-divided into two subgroups on the basis of the point of time that a visual check was intraoperatively performed at the anastomotic site: Group III-A (n=198) before and Group III-B (n=666) after. The characteristics and complications of the patients were then compared. Results: For the comparison of the complications between Group I, Group II and Group III, anastomotic leakage was found in 7 cases (1.5%) in Group I, in 1 case (2.0%) in Group II and in 10 case (1.2%) in Group III, and anastomotic stenosis were found in 4 cases (0.8%) in Group I, 1 case (2.0%) in Group II and 5 case (0.6%) in Group III. Anastomotic bleeding was found in 32 cases (6.7%) in Group I, in 5 cases (10.4%) in Group II and in 67 cases (7.7%) in Group III. For the comparison of complications between Group III-A and Group III-B, anastomotic bleeding was found in 57 cases (28.8%) in Group III-A and 10 cases (1.5%) in Group III-B and the difference was statistically significant (P=0.037). Conclusion: Circular stapled gastrojejunostomy after radical subtotal gastrectomy is recommended because of the safety and feasibility of this technique, but bleeding at the anastomotic site may be the critical issue. In conclusion, direct inspection for bleeding at the anastomotic site during the operation will improve the safety of performing circular stapler anastomosis.

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Surgical Management of Idiopathic Tracheal Stenosis -Three case reports- (특발성 기관 협착증(Idiopathic Tracheal Stenosis)의 외과적 치험 -3예 보고-)

  • Kim, Hyung-Tae;Choi, Ho;Yoon, You-Sang
    • Journal of Chest Surgery
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    • v.36 no.6
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    • pp.439-443
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    • 2003
  • A lower laryngeal and upper tracheal stenosis that is of idiopathic origin is occasionally seen. It is called an idiopathic tracheal stenosis. These circumferential fibrous stenosis is rare and they are most often located in the subglottic larynx and extend to varying distances predominantly in young women. Because of the unknown nature of the disease process and uncertainty about its future progression, patients were approached conservatively. Recently, surgical resection and reconstruction have been increasingly performed, as favorable results were obtained. Three female patients with dyspnea were admitted. For two patients, they were diagnosed this conditions as bronchial asthma by mistake. All patients were performed computed tomography and bronchoscopy. For two patients with subglottic stenosis, subglottic resection was performed by cervical collar incision, and for the other one patient with distal tracheal stenosis, tracheal resection was performed by right posterolateral thoracotomy. A diagnosis of idipathic tracheal stenosis was confirmed by postoperatively pathologic finding. For one case, because of anastomosis site infection and restenosis, a whole tracheal exposure was performed by cervical collar incision and median sternotomy. And reoperation was peformed successfully.

Surgical Management of Large and Giant Aneurysm (대 뇌동맥류 및 거대 뇌동맥류의 수술적 가료)

  • Yim, Man-Bin;Lee, Chang-Young;Kim, Ill-Man;Son, Eun-Ik;Kim, Dong-Won
    • Journal of Korean Neurosurgical Society
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    • v.30 no.6
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    • pp.805-812
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    • 2001
  • Objectives : The goal of the surgical management of large and giant aneurysm is complete extirpation of the aneurysms with preservation or reconstruction of the parent artery. To improve the surgical management results of those aneurysms in the future, we review our experience and discuss technical maneuvers and strategies used to avoid potential complications of those aneurysm surgery. Material and Methods : During the past 12 years, thirty six cases of large and giant aneurysms(diameter>19mm) were managed by surgery. The clinical characteristics, treatment methods, surgical complications and outcome of those cases were analyzed and, based on the review of the literatures, the preventive methods of surgical complication related to the clipping of those aneurysms were discussed. Results : The locations of those aneurysms were anterior circulation in 34 cases and posterior circulation in 2 cases. The most frequent site of aneurysmal location was a paraclinoidal region of the anterior circulation. The aneurysms were managed surgically by direct clipping of aneurysmal neck in 31 cases, aneurysmal trapping followed by extracranial-intracranial bypass in 2 cases, proximal clipping of parent artery, aneurysmorrhaphy, and excision of aneurysm followed by end to end anastomosis of parent artery in each one case. Surgical complications occurred in 13 cases. A parent vessel occlusion by thrombus formation and parent vessel stenosis after clipping of aneurysm were the main complications. We obtained good outcome in 27, fair 5, poor 1 and dead in 3 case(s). Conclusion : We conclude that selection of suitable management method for each case, high quality of surgical technique and prevention of complication during operation are important key points for the successful treatment of large and giant aneurysm. The heparinization prior to application of temporary clip on parent vessels, aneurysmal decompression during dissection and clipping of aneurysm, complete closing of the aneurysmal neck and avoiding the narrowing of parent vessel after clipping of aneurysm were the main technical maneuvers used to avoid complications of those aneurysm surgery.

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A CLINICAL STUDY ON SUPERIORLY BASED PLATYSMA MYOCUTANEOUS CERVICAL FLAP FOR RECONSTRUCTION FOLLOWING INTRAORAL SOFT TISSUE CANCER SURGERY (구강내 연조직 암 절제후 상부기조 광경근 근피부 경부 피판을 이용한 구강내 재건에 관한 임상적 연구)

  • Park, Bong-Wook;Byun, June-Ho;Shin, Hee-Suk;Kim, Jong-Ryoul
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.30 no.1
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    • pp.83-91
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    • 2008
  • The goal of reconstruction following ablative therapy for intraoral cancer is the restoration of form and function to permit a return to activities of daily life. Traditional reconstruction includes split thickness skin grafts, myocutaneous flaps and, more recently, various free flaps. Free flaps provide higher level of functional recovery relative to that seen with other techniques but require the complexity of the technique and microvascular anastomosis and thus, extended surgical time and occasionally a second team for harvesting. The platysma myocutaneous cervical flap is a possible alternative for intraoral reconstruction. It is thin and pliable like the tissue provided by the radial forearm free flap. It can be harvested with enough tissue to close most head and neck ablative defects. There is virtually no donor site morbidity involved. This study evaluated 7 patients affected by intraoral squamous cell carcinoma (SCC). All patients underwent the resection of intraoral SCC with neck dissection and subsequent intraoral reconstruction with the superiorly based platysma myocutaneous cervical flap. Flap-related complications occurred in 3 patients. Adjuvant radiation therapy was performed in 3 patients. Average follow-up was 24.1 months after surgery, with a range of 8 to 42 months. All patients presented self assessment of discomfort associated with intraoral recipient sites and cervical donor sites. However, the neck function measured by two-inclinometer technique was within the normal range during relatively long term follow-up period. Our study concluded that superiorly based platysma myocutaneous cervical flap is good alternative to free flaps, especially for relatively smaller defects and for the defects appropriate for the rotation arc of the flap.

Comparision of Inclusion TechnicRue with Open Technique in Patients with Bentall Procedures (Bentall수술에서 inclusion technique 과 open technique의 비교)

  • 김정택;문준호
    • Journal of Chest Surgery
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    • v.30 no.5
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    • pp.506-511
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    • 1997
  • To understand the clinical results of aortic root replacement with either inclusion or open technique, we analysed 53 patients who underwent replacement of the aortic root with composite graft between October,1980, and May, 1995. Annuloaortic ectasia was the most common indication for operation(29 patients), follwed by aortic dissection(22 patients). Among 53 patients, 19(35%) had Marfan syndrome. Three patients died during hospitalization (Mortality: 5.5%). The follow up was possible in 48 patients(Follow-up rate; 94%,mean duration;37 months). The actuarial survival rate at 24 months was 95% in open technique group, and 87% in inclusion technique group. Late complications developed in 10 patients. Dissecting aneurysm in the remaining aorta was noted in 3 patients with inclu ion 1,schnique, and a pseudoaneurysm from coronary artery anastomosis site developed in a patient with inclusion technique. In conclusion, there was no statistical differences in survival for 24 months between inclusion technique and open technique group. But late problems in the remaining aorta or death from unknown cause occurred with moderate frequency : careful follow-up after aortic root replacement thought to be important for long term survival.

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