• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.122-128
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• 2016

Objective : To illustrate the technique of single-stage posterior subtotal corpectomy and circumferential reconstruction for the treatment of unstable thoracolumbar burst fractures and to evaluate the radiographical and clinical outcomes of patients treated using this technique. Methods : 16 consecutive patients with unstable thoracolumbar burst fractures were treated with single-stage posterior subtotal corpectomy and circumferential reconstruction. The mean patient age was 54.8 years. The mean follower up period was 25 months. Five patients suffered from T12 fractures, 10 from L1, 1 from L2. The segmental kyphosis, neurologic status, visual analogue scale for back pain was evaluated before surgery and at follow up. Results : The segmental kyphotic angle improved from 18.5 degrees before surgery to -9.2 degrees at the last follow up. The mean correction angle was 28.9 degrees. The mean surgical time was 255 minutes, and a mean intraoperative blood loss was 1073 mL. Intraoperative complications included two dural tears, and a superficial wound infection. There were no other severe complications. The mean visual analog scale of back pain decreased from a mean value of 6.6 to 2 at the last follow up. Conclusion : The single-stage posterior subtotal corpectomy and circumferential reconstruction achieved satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and complications. It is a safe and reliable surgical treatment option for unstable thoracolumbar burst fractures.

• 대한정형외과학회지
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• 제56권3호
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• pp.245-252
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• 2021

목적: 이번 연구 목적은 쇄골 간부 복합 골절에서 21G 환 강선으로 골편 고정 후 재건 금속판을 이용한 내고정술 시 영상학적 및 임상적 결과를 분석하고자 하였다. 대상 및 방법: 2005년에서 2019년 사이에 발생한 쇄골 간부 골절 환자 51명 중 최소한의 연부조직 박리를 통한 21G 환 강선으로 골편 고정 후 재건 금속판을 이용한 내고정술을 시행한 환자 32명과 강선을 사용하지 않고 수술한 환자 19명에 대한 후향적 코호트 연구를 시행하였다. 방사선 검사를 통해 정복 및 골유합을 확인하였고, University of California at Los Angeles (UCLA) 점수와 visual analogue scale (VAS) 통증 점수를 통해 두 군 간의 임상적 결과와 방사선적 결과를 비교하였다. 이를 바탕으로 환 강선을 사용하지 않고 수술한 환자를 대조군으로 설정하여 두 군 간의 골유합의 차이를 비교 분석하였다. 결과: 32명의 환자를 대상으로 평균 65주간의 추시관찰을 하였고, 대조군의 경우 19명의 환자를 대상으로 평균 56주간의 추시 관찰을 하였다. 방사선 검사상 32명 환자 모두에서 해부학적 정복 및 골유합을 확인하였다. UCLA 점수는 평균 32.38점, 대조군 33.11점(p=0.395), VAS 점수는 평균 1.00점, 대조군 0.84점으로(p=0.668) 통계적으로 의미 있는 차이가 없었다. 대조군과 비교하였을 때 골유합 시기의 차이에 통계적 유의성이 있었으나(p=0.015) 다른 변수를 통제하였을 때는 통계적으로 유의성이 없음을 알 수 있었다(p=0.107). 결론: 전위성 쇄골 간부 복합 골절에 대해 21G 강선 및 재건 금속판을 이용한 내고정술은 정확한 해부학적 정복과 견고한 내고정을 유지할 수 있었고, 환 강선을 통해 작은 골편도 고정할 수 있었다. 방사선 및 임상 결과에서 만족스러운 결과를 얻었기에 재건 금속판 및 21G 강선을 이용한 내고정술이 수술적 치료의 좋은 선택이 될 수 있다고 생각된다.

• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.296-300
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• 2018

음경 둘레 연조직 결손은 다양한 공여부를 이용하여 재건할 수 있으며, 유리피판술 및 국소피판술을 응용할 수 있다. 유리피판술의 경우 성공적인 결과를 위해 수술 과정 및 술 후 관리에 기술적인 어려움이 있으며, 기존 국소피판술은 결손 부위의 크기나 모양에 제약이 따르게 된다. 이에 양측 천외음부동맥 천공지피판을 이용한 음경둘레 연조직 결손 재건의 성공적인 사례를 발표하고자 한다. 음경 둘레 연조직 결손은 음낭근막까지 관찰되었으며, 변연절제술 시행 이후 심부근막과 해면체는 보존하였다. 이후 양측 천외음부동맥 천공지 피판을 이용하여 음경 전체 둘레연조직 결손 부위를 재건하였다. 27개월의 추적 관찰 기간 동안 음경의 형태와 기능은 보존되었으며, 창상치유와 연관된 문제는 관찰되지 않았다.

• 대한기관식도과학회지
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• 제7권2호
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• pp.128-139
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• 2001

The purpose of this study was to review the literatures of experimental tracheal reconstruction. Although there have been significant advancements in the surgical treatment of the long circumferential tracheal injuries, there still has been a difficult problem with high morbidity and mortality. The method for tracheal reconstruction after circumferential resection is preferred end-to-end anastomosis for defects up to 6 cm in length, but larger tracheal defects require the use of tracheal allograft, various artificial prosthesis or autogenous organs. The tracheal allotransplantation has been widely used as there was significantly improved the method of surgical technique, preservation and immunosuppression. But it has been limited by a number of factors such as few donor, limited use of immunosuppressant, delayed revascularization and re-epitheliazation. Experimental studies on the tracheal prosthesis have a long history and they tried to use silicone, polytetrafluoroethylene, polypropylene mesh, Dacron, Marlex mesh, external or internal stents. Other experimental studies were reported the use of autogenous tissues that were cartilage. jejunum, aorta, skin, muscle, periostium or esophagus. But a great variety of these protheses have been resulted unsatisfactory in a significant Proportion of cases. Alternatively, the tissue-engineering technique has showed a new approach to reconstruct trachea and much progress in tissue-engineering bas been made recently. In conclusion, although the tracheal allotransplantation and the use of prosthesis and allograft have been reported a lot of limitation to overcome, we could sooner expect good result of ideal tracheal prosthesis.

• Journal of Chest Surgery
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• 제10권1호
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• pp.17-24
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• 1977

The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tube has produced, apparently with increasing frequency, three lesions which have serious ceminical manifestations such as tracheal stenosis, tracheomalasia, and localized tracheal erosion. Extensive resection and reconstruction of the trachea must be necessary because conservative treatment has generally failed in the fully developed stenotic lesion. of the mediastinal trachea following extensive resection is best accomplished by direct anastomosis of the patient`s own tracheobronchial tissue. Any replacement of the mediastinal trachea must be air tight and laterally rigid, and must heal dependably. A variety of materials has been used for substitution following circumferential excision of tracheal segments within the mediastinum. These attempts have often failed because of early leak or late stenosis. We have successfully performed circumferential resection and primary end-to-end anastomosis of the trachea for 4 cases of post-intubation tracheal stenosis located a few centimeter below the tracheostomy stoma in the period of 3 years between 1974 and 1976. The lesion in one patient was found in the upper trachea which was approached anteriorly through a cervicomediastinal incision with division of the upper sternum. Other three located in the lower half of the trachea were operated through a high transthoracic incision with appropriate hilar mobilization in addition to cervical flexion for the development of the cervical trachea into the mediastinum. There were no hospital death, but suture line granulations occurred in two patients were managed by bronchoscopic removal of granulations without difficulties.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.564-566
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• 2017

• Archives of Plastic Surgery
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• 제44권2호
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• pp.117-123
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• 2017

Background Upper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity. Methods A literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available). Results In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation. Conclusions With the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.

• Journal of Chest Surgery
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• 제23권5호
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• pp.1021-1026
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• 1990

The patients with tracheal stenosis have become more increasing in recent due to the increased use of tracheostomy and assisted ventilation Anesthetic management during tracheal reconstruction is a concern to the anesthetist and the surgeon, who must share the airway as a operation field and at the same time provide good gas exchange. Multiple technique such as the tube ventilation system or C \ulcornerP bypass method have been recommended to achieve this goals. However, these methods have disadvantages of poor surgical exposure and hemorrhagic complication from using C \ulcornerP bypass The technique for HFJV was first described for bronchoscopy, and it involves positive-pressure breathing with high flow[40 \ulcorner60L/min] of oxygen This flow is directed to a semirigid catheter inserted in the endotracheal tube and the tracheal reconstruction can be done without interruption. From Dec. 1986 to July 1990 we have experienced 6 patients of tracheal stenosis necessitating circumferential resection and end to end anastomosis; 5 patients with tracheal stenosis following cuffed tracheostomy or intubation, a patient with tracheal stenosis due to invasive thyroid cancer. The specific advantages during tracheal reconstruction are unobstructed field during surgical reconstruction and good gas exchange through the procedure.

• 대한기관식도과학회지
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• 제8권1호
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• pp.50-56
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• 2002

Advanced or recurrent thyroid cancer, and metastatic paratracheal lymph nodes may directly invade the trachea and lead to tracheal stenosis. In these cases the stenosis is not circumferential and it would be possible to reconstruct the trachea after partial resection of the stenotic trachea. We experienced five cases of tracheal reconstruction after partial resection of the tracheal wall in four Patients of advanced thyroid cancer, and in one Patient of malignant paratracheal lymphadenopathy.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.290-294
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• 2023

Generally, patients with severe burst fractures, instability, or neurological deficits require surgical treatment. In most cases, circumferential reconstruction is performed. Surgical methods for three-column reconstruction include anterior, lateral, and posterior approaches. In cases involving an anterior or lateral approach, collaboration with general or thoracic surgeons may be necessary because the adjacent anatomical structures are unfamiliar to spinal surgeons. Risks include vascular or lumbar plexus injuries and cage displacement, and in most cases, additional posterior fusion surgery is required. However, the posterior approach is the most common and anatomically familiar approach for surgeons performing spinal surgery. We present a case in which three-column reconstruction was performed using only the posterior approach to treat a patient with a severe lumbar burst fracture.