• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.1-15
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• 1996

From Fabuary 1982 to May 1995, 396 patients had undergone reconstructive surgery of the upper and lower limb with microsurgical technique at department of orthopaedic surgery, Yonsei University of Medicine. The results were as follows; 1. Average age at the time of operation was 23.4years(2-64 years), and there were 277 male and 119 female patients. 2. Among 324 patients of soft tissue flap(87 inguinal flap, 132 scapular flap, 38 latissimus dorsi flap, 11 latissimus dorsi and scapular combind flap, 6 gracilis flap, 12 deltoid flap, 3 tensor facia lata flap, 11 dorsalis pedis flap, 6 lateral thigh flap, 12 wrap around flap, 1 lateral arm flap, 5 musculocutaneous flap), 274 cases(85.5%) were succeed. 3. Among 37 patients of vascularized bone graft(18 fibular bone graft, 11 iliac bone graft, 7 toe to finger transplantation,1 vascular pedicle rib graft), 30 cases(80.1%) were succeed. 4. In 26 cases of segmental resection and rotationplasty at lower extremity, 23 cases were succeed. 5. In 7 cases of Tikhoff-Linberg procedure and in 2 case of segmental resection and replantation, all case was succeed. Overall success rate of microscopic reconstructive surgery was 85.6%. In conclusion, microsurgical technigue is valuable for reconstruction of tissue defect or function loss of the limb.

• Journal of Korean Dental Science
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• v.4 no.2
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• pp.59-66
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• 2011

Purpose: This research sought to determine the resorption rate of bone grafted to the maxillary sinus according to the grafted material's type, patient's age, systemic disease, implant size, site of implant placement, and residual ridge height. Materials and Methods: This research targeted 24 patients who had immediate Osstem$^{(R)}$ implant (US Plus$^{(R)}$) placement after bone graft. The panorama was taken before the surgery, after the surgery, and 6 months after the surgery. Vertical height change and resorption rate of the grafted bone were measured with the same X-rays and compared. The influence of the following factors on the grafted bone material's resorption rate was evaluated: grafted material type, patient's age, systemic disease, implant size, site of implant placement, and residual ridge height. Results: Patients in their 40s had $34.0{\pm}21.1%$ resorption rate, which was significantly higher compared to the other age groups (P<0.05). There was no significant relationship between systemic disease and grafted bone resorption. There was no significant relationship between implant size (diameter, length) and grafted bone resorption. There was no significant relationship between the site of implant placement and grafted bone resorption. The ramal bone-grafted site was significantly more resorbed than the ramal bone/Bio-Oss$^{(R)}$-grafted site, maxillary tuberosity bone/Bio-Oss$^{(R)}$-grafted site, and ramal bone/maxillary tuberosity bone/Bio-Oss$^{(R)}$-grafted site (P<0.05). There was no significant difference in the grafted bone resorption rate in the sinus between more than 4 mm and less than 4 mm residual ridge heights. After an average of 6 months, a second surgery was done; given an average follow-up of 1.9 years, the success rate and survival rate of the implant were 96.9% and 98.4%, respectively. Conclusion: These results indicate that the bone resorption rate of grafted bone among patients in their 40s is higher compared to patients in their 50s and over, and that only autogenous bone (ramus) shows higher resorption rate than the mixed graft of autogenous bone and xenogenous graft (Bio-oss) after maxillary sinus graft.

• The Journal of the Korean dental association
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• v.46 no.4
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• pp.243-247
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• 2008

Purpose : Ridge expansion osteotomy (REO) has been introduced when it is necessary to expand narrow crestal ridge with simultaneous implant placement. This study has designed to evaluate the clinical availability of REO. Materials and methods : Subject were patients who had visited Seoul National University Bundang Hospital from July. 2003 to December, 2005 for implant placement using REO by one surgeon. Intraoperative and postoperative complication, failure of initial osseointegration and marginal bone resorption were estimated using electronic medical record and periapical radiography. Twenty?three patients, 8 males and 15 females, mean age 51, ranged 18 to 72, were treated for mean 26 months, ranged from 16 months to 46 months. Results : Mean diameter and length of implants placed at upper anterior, were 3.72mm and 13.32mm each other. Guided bone regeneration and ridge splitting were accompanied in this study. Five cases of cortical bone fracture, three cases of crestal bone loss more than 2mm, 2cases of gingival recession, and 2 cases of infection were noted, but there were no implants removed because of disintegration. Success rate of implant was 91.7%, even if survival rate of implant was 100%. In addition, there were no statistical significance between the success rate of REO and bone graft(p>0.05). Conclusion : Based on the results of the present study, it can be concluded that REO technique is reliable for implant placement at atrophic ridge with adequate height compared to bone graft and other osteotomies for ridge expansion, but care should be taken of esthetic problem such as gingival recession because of crestal bone resorption from trauma by osteotome.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.50.1-50.6
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• 2019

Purpose: Maxillary bone grafts and implantations have increased over recent years despite a lack of maxillary bone quality and quantity. The number of patients referred for oroantral fistula (OAF) due to implant or bone graft failure has increased, and in patients with an oroantral fistula, the pedicled buccal fat pad is viewed as a robust, reliable option. This study was conducted to document the usefulness of buccal fat pad grafts for oroantral fistula closure. Materials and methods: We retrospectively studied 25 patients with OAF treated with a buccal fat pad graft from 2015 to 2018. Sex, age, OAF location, cause, duration, presence of systemic disease, smoking, previous dental surgery, and side effects were investigated. Results: A total of 25 patients were studied. Mean patient age was 54.8 years, and the male to female ratio was 19: 6. Causes of oroantral fistula were cyst enucleation, tumor resection, implant removal, bone graft failure, and extraction. Excellent results were obtained in 23 (92%) of the 25 patients. In the other two patients that both smoked, a small fistula was observed during follow-up. No recurrence of oroantral fistula was observed after 2 months to 1 year of follow-up. Conclusions: The incidence of oroantral fistula is increasing due to implant and bone graft failures. Oroantral fistula closure using a pedicled buccal fat pad was found to have a high success rate.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.6
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• pp.332-342
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• 2019

Objectives: Socket grafting is vital to prevent bone resorption after tooth extraction. Several techniques to prevent resorption have been described, and various bone graft substitutes have been developed and used with varying success. We conducted this pilot study to evaluate the performance of nanohydroxyapatite (nHA) derived from chicken eggshells in socket preservation. Materials and Methods: This was a prospective, single center, outcome assessor-blinded evaluation of 23 sockets (11 patients) grafted with nHA and covered with platelet-rich fibrin (PRF) membrane as a barrier. Bone width and radiographic bone density were measured using digital radiographs at 1, 12, and 24 weeks post-procedure. Postoperative histomorphometric and micro-computed tomography (CT) evaluation were performed. The study protocol was approved by the Institutional Ethics Committee. Results: All patients had uneventful wound healing without graft material displacement or leaching despite partial exposure of the grafted socket. Tissue re-epithelialized with thick gingival biotype (>3 mm). Width of the bone was maintained and radiographic density increased significantly with a trabecular pattern (73.91% of sockets) within 12 weeks. Histomorphometric analysis showed 56.52% Grade 3 bone formation and micro-CT analysis revealed newly formed bone with interconnecting trabeculae. Conclusion: Use of a PRF membrane with nHA resulted in good bone regeneration in sockets. Use of a PRF membrane prevents periosteal-releasing incisions for primary closure, thereby facilitating the preservation of keratinized mucosa and gingival architecture. This technique, which uses eggshell-derived nHA and PRF membrane from the patient's own blood, is innovative and is free of disease transfer risks. nHA is a promising economic bone graft substitute for bone regeneration and reconstruction because of the abundant availability of eggshell waste as a raw material.

• Journal of Rhinology
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• v.25 no.2
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• pp.123-129
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• 2018

Background and Objectives: Endoscopic repair of cerebrospinal fluid (CSF) leak can avoid morbidity of open approaches and has shown a favorable success rate. Free mucosal graft is a good method, and multi-layered repair is more favorable. The inferior turbinate has been commonly utilized for the free mucosal graft, but we newly designed it as a bone-periosteal-mucosal composite graft for multilayered reconstruction. Subjects and Method: Four subjects with a skull base defect were treated with this method. The inferior turbinate was partially resected including the conchal bone and was trimmed according to defect size. Both bony parts and periosteum were preserved on the basolateral side of the mucosa as a composite graft. The graft was applied to the defect site using an overlay technique. Results: All cases were successfully repaired without any complications. Three of them had a defect size greater than 10-12 mm, and the graft stably repaired the CSF leakage. Conclusion: Endoscopic repair of CSF leakage using inferior turbinate composite graft is a simple and easy method and would be favorable for defect sizes greater than 10 mm.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.5.1-5.9
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• 2020

Immunomodulation is a technique for the modulation of immune responses against graft material to improve surgical success rates. The main target cell for the immunomodulation is a macrophage because it is the reaction site of the graft and controls the healing process. Macrophages can be classified into M1 and M2 types. Most immunomodulation techniques focus on the rapid differentiation of M2-type macrophage. An M2 inducer, 4-hexylresorcinol, has been recently identified and is used for bone grafts and dental implant coatings.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.578-582
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• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.4
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• pp.468-474
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• 2008

Purpose: Previous clinical investigations of sinus floor augmentation have demonstrated repneumatization of grafted sinus. The aim of this study is to evaluate and compare the height changes of sinus floor after grafting with deprotenized bovine bone mineral (DBBM) and beta tricalcium phosphate (TCP). Materials and methods: 34 sinuses in 28 patients were augmented with 100% DBBM or 100% TCP through lateral approaches. Sinusgraft height was measured before, immediately after, and 6 months after bone graft with panoramic radiography. Result: After 6 months, the decreases of graft heights were 14.53% for DBBM group and 15.15% for TCP group. There was no statistically significant difference. Discussion and Conclusion: Long-term stability of sinus-graft height represents an important factor for implant success. After the uses of DBBM and TCP for maxillary sinus floor augmentations, acceptable graft height maintenances were observed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.2
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• pp.163-168
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• 2001

Purpose : This study is conducted to evaluate the clinical success of secondary alveolar bone grafting using autogenous iliac particulate cancellous bone marrow in cleft maxilla. Materials and methods : We evaluated 107 cleft patients who had been admitted to the Dept. of Oral and Maxillofacial Surgery of Pusan National University Hospital from January 1, 1991 to January 31, 1999 and had been performed secondary alveolar bone grafting with autogenous particulated cancellous bone marrow from iliac crest. Results : 1. Men were 70 and women were 37, which shows 65.4% and 34.6% and the proportion of males to females was 1.9:1. Unilateral cases were 89(83.2%) and bilateral cases were 18(16.8%). 2. Age of bone grafting is widely distributed from 7 to 29, and the average was 13.2. 3. Success rate was 97.8% in unilateral cases, 94.4% in bilateral cases. Overall success rate was 96.7%. 4. We evaluated the bone graft contour by the percentage of bone attachment level adjacent to the alveolar cleft and the menial side showed 82.4% and the distal 87.7%. 5. The amount of notching the alveolar ridge at the grafted site through the ratio of notching length up to the most apical base to the length of proximal segment anatomic root was 0.19.