• Archives of Plastic Surgery
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• 제33권6호
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• pp.784-788
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• 2006

Purpose: For the reconstruction of the ankle joint as well as the soft tissue defect in the distal lower leg, a free flap or a local flap has been used, and because of the condition of patients, if a complex microvascular surgery under general anesthesia could not be performed, it could be reconstructed by using the distally based lateral supramalleolar fascio-cutaneous island flap using the perforating branch of the peroneal artery in the ankle area. Methods: The study subjects were 4 male patients between 53 years and 73 years of age. 2 cases were tissue defect in the medial malleolus area due to systemic diseases such as gouty arthritis accompanied traffic accident, diabetes mellitus foot, atherosclerotic obliterans, etc., 1 case was the defect in the pretibia area, and 1 case was the defect underneath the lateral malleolus, which was reconstructed by the distally based lateral supramalleolar fascio-cutaneous island flap. The donor area was the skin harvested from the groin, and the full thickness skin graft was performed. The size of the flap varied from $4{\times}3cm$ to $9{\times}6cm$. As the flap border, the medial side was to the tibialis anterior tendon, the lateral side was to the fibula crest, and the proximal area was less than the fibula size. Results: The consequence is that, in total 4 cases, the congestion in the flap began from 12 hours after the surgery, and the progression of congestion was ceased on the 5th day after the surgery, and finally epidermal bulla and sloughing, partial necrosis was developed. After the end of necrosis, the defect area was reconstructed successfully by the second full thickness skin graft. Conclusions: Although the distally based lateral supramalleolar fascio-cutaneous island flap has the shortcoming of requiring the second skin graft, it has the advantages that it does not require a long complex microsurgery, the flap itself is thin, it is similar to the color of the skin in the recipient area, and it does not leave a big scar in the donor area. Therefore, it is thought that for the cases who could not undergo a long complex surgery due to systemic diseases or the cases of patients whose condition of the recipient area is not suitable for microsurgery, the lateral supramalleolar fascio-cutaneous island flap is very useful for the reconstruction of the distal lower leg and the ankle joint area.

• Journal of Chest Surgery
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• 제47권2호
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• pp.163-166
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• 2014

A 49-year-old man with drowsy mentality was diagnosed with acute type A aortic dissection; he underwent an emergency operation. When selective antegrade cerebral perfusion was initiated, the right regional cerebral oxygen saturation ($rSO_2$) decreased as compared to the left one. Adequate blood flow was perfused through the branch of the artificial graft, after distal anastomosis, but the right $rSO_2$ did not recover. Angiography revealed another intimal tear on the right common carotid artery. A stent was then inserted. The right $rSO_2$ promptly increased to the same level as that of the left one. The patient was discharged without any neurologic complications.

• Journal of Chest Surgery
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• 제18권2호
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• pp.258-264
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• 1985

The experience with operative treatment for total correction of Fallot at the department of Thoracic and Cardiovascular Surgery, Keimyung University Dong San Medical Center from July 1980 to July 1984 was reviewed. There were 37 males and 12 females and their ages ranged from 3 years to 30 years, with the average age of 12.2 years. Sixty nine point four percent of patients were younger than 15 years of age. The most frequent type of right ventricular outflow stenosis was the combined type [pulmonary valvular and infundibular stenosis] containing 41 patients [83.7%] and there were 9 deaths in this group. The major associated lesions included Patent foramen ovale in 20 patients [40.8%], Atrial septal defect in 7 patients [14.3%], Left superior vena cava in 4 patients [8.2%], Right sided aortic arch in 2 patients [4.1%] and Patent ductus arteriosus in 11 patient [2.0%]. The pulmonary valvotomy was performed in 41 patients and patch graft reconstruction of the right ventricular outflow tract was performed in 23 patients. In 11 patients the monocusp patches were used. Thirty-five patients [71.4%] had the right bundle branch block postoperatively. There were 11 postoperative deaths with hospital mortality rate of 22.4% and the leading causes of death were low output syndrome, bleeding, and cerebral embolism.

• Journal of Chest Surgery
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• 제47권6호
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• pp.529-532
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• 2014

An eight-day-old neonate was diagnosed with dextro-transposition of the great arteries, atrial septal defect, patent ductus arteriosus, and a single sinus origin of the coronary arteries. The single coronary artery originated from the left sinus (sinus 2), had a proximal left circumflex arterial branch, and passed anteriorly to the right side of the aorta, further branching into the right coronary and left anterior descending arteries. We successfully performed an arterial switch operation and coronary transfer by tube graft reconstruction with autologous aortic tissue to treat the dextro-transposition of the great arteries and atrial septal defect with a single-sinus origin of the coronary arteries.

• 한국염색가공학회지
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• 제9권4호
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• pp.47-53
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• 1997

To improve the interfacial bonding of carbon fiber-nylon 6 composite, carbon fiber(CF) were oxidized by nitric acid treatment, and two types of graft polymer(GP) of nylon 6-g-polyacrylamide (PAAm) -water dispersable GP(WDGP) and m-cresol solu ble GP(CSGP) were treated as coupling agents. Introduction of polar groups such as -COOH, -OH, etc, on the surface of the oxidized CF was confirmed by IR spectra. The stem polymer of nylon 6 in the coupling agent (GP) could be compatible with'matrix nylon 5, and the grafted branch of PAAm on GP could react to the polar groups on the oxidized CF in composite. The interfacial strength was measured by the transverse tensile test to the fiber direction for single CF embedded nylon 6 film especially prepared and by the pull-out test method. The interfacial strength of the composite reinforced with oxidized CF is greater than that reinforced with unoxidized CF. The interfacial strength of the composite was increased by treatment of coupling agents(GPs) considerably, and the increasing tendency by the WDGP is greater than that by the CSGP. The optimum conditions of coupling agent treatment are as follows: the concentration, adsorption tlme of GP, and curing temperature are 2%, 20 minutes, and $170^{\circ}$, respectively.

• Archives of Reconstructive Microsurgery
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• 제22권1호
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• pp.38-41
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• 2013

A 31-year-old female patient presented with a skin and soft tissue defect measuring $8{\times}6cm$ in size with exposure of the extensor hallucis longus tendon and the first metatarsal bone after metatarsal lengthening for brachymetatarsia. The defect was covered with a distally based dorsalis pedis flap based on the distal communicating branch of the dorsalis pedis artery. Secondary defect was covered by a split thickness skin graft. There was congestion of the flap tip after the operation; however, it was resolved using medical leeches and anti-coagulants. No necrosis or infection was encountered and the contour of the flap was satisfactory. There was no donor site morbidity. Reverse dorsalis pedis flap has not been commonly used due to the anatomical variation and uncertainty, which is different from the reverse radial forearm flap. However, when faced with the challenge of a moderate soft tissue defect of the distal forefoot, we believe that the reverse dorsalis pedis flap offers a good option with various advantages.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.10-14
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• 1998

When covering a skin defect of the finger with a local flap is difficult, a vascular island flap is often used. For a palmar skin defect, it is desirable to add a sensory supply to the flap. This report describes a neurovascular island flap that was used to repair a palmar skin defect, the donor skin coming from the dorsal region of the middle phalanx. This flap is elevated with a vascular pedicle of the palmar digital artery and its dorsal skin branch, including the dorsal digital veins, palmar digital nerve and its cutaneous branches. The advantage of this flap are that it can be transferred with ease and without any tension. No special manipulation is required under a microscope and operation can be performed under a simple nerve-block. There if little possibility that the flap itself undergoes ischemic change or congestion. The disadvantage of this flap are that a skin graft is required at the donor skin site and one palmar digital aretery is lost. We think that this neurovascular island flap is one of the useful methods for skin defects that are difficult to cover with a local flap.

• Journal of Chest Surgery
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• 제33권1호
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• pp.38-44
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• 2000

Background: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. Material and Method : The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60$\pm$9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. Result: The mean number of grafts was 3.2$\pm$1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13$\pm$20 hours after the operation. Mean duration of stay in intensive care unit was 49$\pm$46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70$\pm$1.36 pack/patient. Conclusion: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.less cost.

• 정보처리학회논문지B
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• 제19B권2호
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• pp.123-126
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• 2012

본 논문은 생체간이식 전에 복부 MDCT(Multi-Detector Computed Tomography) 영상에서 간 이식편의 체적을 간단하고 정확하게 계산하기 위하여 좌간과 우간을 나누는 방법을 제안하였다. 본 알고리즘은 기증자와 수혜자의 안전을 보장하기 위하여 시스템과 의료진의 상호작업을 최소화 하여 의료진이 수술 전 이식편의 판단을 정확하게 처리할 수 있도록 하였다. 간이 추출된 영상에 좌간과 우간을 나눌 수 있는 2점(중간 정맥(MHV: Middle Hepatic Vein) 내부의 한 점과 좌우문맥(PV: Portal Vein) 분지부에서 한 점)을 선택한다. 선택된 중간정맥 내부의 점을 이용하여 중간정맥을 자동 인식한 후 중간정맥을 기준으로 절개선을 결정하여 문맥 분지부의 한 점을 연결하는 절개면을 형성한다. 좌간과 우간의 체적과 간 전체에 대한 좌우간의 비율을 계산한다. 계산된 체적의 정확성을 입증하기 위해 진단 방사선과 의사가 수동으로 처리하여 계산한 체적과 함께 수술 중 획득한 실측무게와 비교하였다. 실측무게와 수동으로 예측된 체적 사이의 오차에 대한 평균${\pm}$표준편차는 $162.38cm^3{\pm}124.39$이고, 실측무게와 2점을 이용하여 예측된 체적과의 오차에 대한 평균${\pm}$표준편차는 $107.69cm^3{\pm}97.24$이다. 실측무게와 수동으로 예측된 체적의 상관관계는 0.79이고, 실측무게와 2점을 이용하여 예측된 체적의 상관관계는 0.87이다. 그리고 2점을 선택한 후 좌우간을 분할하여 체적을 계산하는 시간을 측정하여 수술실에서 실시간으로 처리 가능한지의 여부를 확인하였다. 한 데이터세트($149.17pages{\pm}55.92$) 당 처리 시간의 평균${\pm}$표준편차는 $57.28sec{\pm}32.81$이다.

• Journal of Chest Surgery
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• 제30권8호
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• pp.760-769
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• 1997

본 연구는 관상동맥 우회수술중 측정한 우회도관의 혈류량을 결정하는 인자들을 분석함으로써 일반적으로 적용되고 있는 수술 전략의 의의를 검토하고자 하였다. 50명의 환자를 대상으로 관상동맥 우회수술중 transit-time ultrasound flowmeter를 이용하여 총 146개의 우회 도관의 혈류량(graft blood flow; GBF)을 측정하였다. 수혜관상동맥의 내경, 해당 심근의 면적, 우회도관의 종 류, 수술전 심근 관류 스캔 소견 등의 변수와 GBF간의 상관관계를 분석하고 수술 3개월후 시행한 심근 관류 스캔 소견과의 상관관계 여부를 분석하여 다음과 같은 결과를 얻었다. 1. 연속 문합된 목재정맥 우회도관의 GBF(평균 61.5 ml/min)가 내홉동맥(평균 42.5 ml/min)이나 단순 복재정맥 우회도관의 GBF(평균 46.9 ml/min)보다 의미있게 높았다(p<0.01). 2. GBF와 myocardial value 및 수혜동맥의 내경 간에 유의할 만한 상관관계가 있었으며 심근 스캔상 관류결손 의 유무와는 상관관계가 없었다. 3. 수혜동맥 내경이 1.5 m 미만이거나 혹은 myocardial value가 2 미만인 경우에는 CBF가 유의하게 낮았다. 4. myocardial value가 같을 경우 수혜 관상동맥의 내경과 GBF간의 상관관계가 약하였던 반면 수혜동맥의 내경이 같을지라도 myocardial value가 클수록 GBF가 증가하였다. 5. GBF 측정치가 회귀분석을 통하여 구한 기대치보다 낮았던 경우와 기대치 이상이었던 경우를 비교하면 전 자에서 수술후에 해당 심근영역에서 관류결손이 발견되는 비율이 유의하게 높았다(32.2% vs 15.1%, p< 0.05). 이상의 결과는 관상동맥우회도관의 혈류량은 해당 심근 영역과 동맥계(run-of)의 크기에 의하여 주로 결정됨을 시사하는 것으로 내경 1∼1.5 m의 작은 관상동맥일지라도 지배하는 심근의 면적이 클 경우에는 우회 도관을 조성하여 줌으로써 심근 관류를 효과적으로 개선시킬 수 있고 완전 혈류재건(complete revascularization)의 목적을 달성할 수 있음을 확인시켜주는 것이라 할 수 있다. 특히 이런 경우 연속문합술을 이용함으로써 우회도관 근위의 혈류량을 증가시켜 장기 개통율의 향상을 기대할 수 있을 것이라 판단된다.