• 대한두개안면성형외과학회지
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• 제21권6호
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• pp.376-379
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• 2020

Supraclavicular lymph node (SCLN) flap is a common donor site for vascularized lymph node transfer for the treatment of lymphedema. Chyle leakage is a rare but serious complication after harvesting SCLN flap in the neck. We report a case of chyle leakage at the SCLN donor site and its successful management. A 52-year-old woman underwent SCLN transfer for treatment of lower extremity lymphedema. After starting a regular diet and wheelchair ambulation on the 3rd postoperative day, the amount of drainage at the donor site increased (8-62 mL/day) with the color becoming milky, which suggested a chyle leak. Despite starting a low-fat diet on the 4th postoperative day, the chyle leakage persisted (70 mL/day). The patient was started on fat-free diet on the 5th postoperative day. The amount of drainage started to decrease and the drain color became more clear within 24 hours. The drainage amount remained less than 10 mL/day from the 8th postoperative day, and we removed the drain on the 12th postoperative day. There was no seroma or other wound complications at follow-up 4 weeks after the operation. The current case demonstrates that a fat-free diet can be a first-line treatment for low output chyle leakage after a SCLN flap.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.350-354
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• 2014

Background The authors sought to compare the use of the nonabsorbable polyvinyl alcohol sponge (PVA, Merocel) and absorbable synthetic polyurethane foam (SPF, Nasopore Forte plus) as intranasal splints after closed reduction of fractured nasal bones during the hospitalization period. Methods The medical records of 111 patients who underwent closed reduction for nasal bone fracture at Sanggye Paik Hospital, Inje University College of Medicine, from 2012 to 2013 were reviewed retrospectively. PVA (group A) or SPF (group B) was packed as an internal splint after closed reduction. The efficacy of the materials was compared and statistically analyzed. Results PVA was used in 82 patients, and SPF was used in 29 patients. The patients in group B complained significantly more of nasal pain on the first day after operation than the patients in group A. Headaches on the operation day were significantly more painful in group B than in group A. Bleeding on the fourth postoperative day was significantly reduced in group B as compared to group A. The patients in group B exhibited significantly more intensive nasal obstruction on the operation day and the following day than the patients in group A. However, on the third and fourth postoperative days, the nasal obstruction in group B was less than that in group A. The pain and bleeding related to the packing material was significantly reduced in group B as compared to group A. Conclusions The use of SPF as an absorbable packing material is a reasonable substitute for the traditional nonabsorbable material.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권5호
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• pp.422-430
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• 2010

Purpose: The aim of this study is that we evaluate the change of the White Blood Cell(WBC) count, Absolute Neutrophil Count (ANC), Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) values, and try to make standardization for postoperative sequels before and after the oral cancer resection and reconstructive surgery. Materials and Methods: The study was comprised of 34 patients (male 15, female 19) who were diagnosed as an oral cancer and had performed ablation and reconstructive surgery at Dankook university dental hos-pital. Each blood specimen was collected from patients and estimated WBC count, Neutrophil count, ESR, CRP on first, third, fifth, seventh day efore and after surgery and analyzing inter relationship between each value. Classifying Group I (resection with reconstructive surgery patients) and Group II (resection without reconstructive surgery patients). Also classifying group A (below 4 hours of operation time), Group B (4 to 8 hours of operation time), Group C (above 8 hours of operation time), each group was analyzed and compared. The Following results were induced. Results: (1) In coefficient of correlation, the CRP and WBC has highest value except WBC count and Neutrophil count. (2) There was no significant difference any lapse in the progress between Group I and II of WBC count, Neutrophil count, but the CRP shows statistically higher level in group I than group II at immediate postoperative day, and 1 to 5 days after surgery. (3) There is no significant difference any lapse in the progress between Group A, B, C of WBC count, Neutrophil count, but CRP shows statistically significant difference in 1 day, 3 days after surgery Conclusion: It should be suggested that, determination of CRP is most valuable parameter for postopera-tive management and determination of postoperative clinical changes than other parameter such as WBC count, neutrophil count, and ESR values in oral cancer patient after resection and reconstructive surgery, based on the results of this study.

• Journal of Chest Surgery
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• 제19권2호
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• pp.181-187
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• 1986

The changes of serum creatine phosphokinase [CPK], serum lactic dehydrogenase [LDH], serum glutamic oxaloacetic transaminase [GOT] and serum glutamic pyruvic transaminase [GPT] were studied in a total of 82 cases who underwent open heart operation under the cardiopulmonary bypass at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. The results were as follows 1. The average values of CPK and COT after the operation were reached to the maximal values on the first postoperative day, which were returned to the normal range until the fifth postoperative day. The average values of LDH and CPT after the operation were reached to the maximal values on the first and second postoperative day respectively, which were significantly increased until the seventh postoperative day. 2. In the relationship of the serum enzymes and duration of the extracorporeal circulation, the values on the group over 90 minute of the extracorporeal circulation were more increased than on the group below 90 minute of the extracorporeal circulation. 3. In the relationship of the changes of the serum enzymes and congenital heart diseases and acquired heart diseases, there were no significantly differences in the values between the two groups.

• Journal of Chest Surgery
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• 제13권1호
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• pp.41-47
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• 1980

Fifty one consecutive patients undergoing open heart surgery, twenty eight congenital and twenty three acquired heart disease, were studied between May and August 1979 in Dept. of Thoracic and Cardiovascular Surgery SNUH. During the same time 10 patients of PDA were included in this study as control group. Four out of fifty one OHS patients, two ASD and two pulmonic stenosis patients, were operated without aortic cross-clamp. In all patients, serial determination of total level of creatine phosphokinase [CPK], lactic dehydrogenase [LDH], glutamic oxaloacetic transaminase [SGOT] were made preoperatively, operative day [immediate post-op], and post-operative days up to 7th day. Electrocardiograms were also evaluated serially. Open heart surgery patients were divided into two groups; Group A was aorta clamp time beyond SO minutes, and Group B was below 50 minutes. The peak level of each enzyme was compared, and electrocardiographic changes were also compared between groups. Although the electrocardiographic changes were more frequent in Group A [50%] than Group B [24%], the peak levels of each enzymes were almost same in Group A and Group B.

• Advances in pediatric surgery
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• 제2권1호
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• pp.68-71
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• 1996

Esophageal atresia(EA) with a double tracheoesophageal fistula(TEF) is rare. It accounts for only 0.7% of all cases of EA and TEF. A male newborn weighing 2860g was born by normal vaginal delivery at 41 weeks' gestation to a 27-year-old mother who had a normal pregnancy. But immediately developed recurrent choking and respiratory distress. Feeding tube was inserted and chest X ray showed the feeding tube coiled in the proximal pouch(T-2 level). With a preoperative diagnosis of EA and distal TEF, the thoracotomy was performed on the third day of life. At thoracotomy, TEF was proved to be a double fistula. Both fistulas were divided and an esophageal anastomosis was performed. The postoperative course was uncomplicated until the eighth postoperative day when a minor anastomotic leak. The patient was discharged at 103 days of age.

• Journal of Chest Surgery
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• 제38권3호
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• pp.258-262
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• 2005

환자는 18세 여자로 6년 전부터 연하곤란 및 식사 후 빈번하게 구토가 발생하였으며, 최근 6개월 동안 15 kg의 체중 감소가 있었다. 식도 계측검사에서 식도이완불능증으로 진단되었다. 약물치료를 하였으나 증상이 호전되지 않아 복강경을 이용한 수술을 결정하였다. 복부에 5개의 트로카용 소절개를 시행하였고, 복강경을 이용하여 근절개술과 전방위저부주름술을 시행하였다. 수술 후 1일째 식도조영술을 시행하였다. 조영제가 누출 없이 원활하게 통과되었다. 수술 후 2일째 식이를 시행하였으며, 술 후 9일째 특별한 문제없이 퇴원하였다.

• 대한치과의사협회지
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• 제15권2호
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• pp.153-158
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• 1977

To assure that cyclophosphamide has been considered something that must be effective to retard wound healing, the Author has studied clinically and histopathologically. All rabbits were incised on the mucogingival junction of anterior teeth in mandible about 1 Cm. in length with mucosa and periosteum layer. The 21 rabbits within 6 months old, weighing about 1.5-1.8 kg were divided into a experimental group and a control group. 1) Group 1 (Experimental group)-After 14 rabbits dieted as the control group were injected with Endoxan (=Cyclophosphamide) in dosage of 30mg per 1kg-body weight intramuscularly, the surgery was performed. 2) Group 2 (Control group)-the surgery in this group was performed without Endoxan. The rabbits were sacrificed on the 1st, 3rd, 5th, 7th, 10the, 14th day after surgery and microscopic slides were made with H-E stain. The results might be summarized as follows; 1) Cyclophosphamide effected to retard healing process on the incised wound of oral mucosa and connective tissue. 2) Control wounds were healed by the 7th day after surgery. 3) Comparison between control and experimental wound did not show significant differences 14th day after surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권3호
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• pp.205-217
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• 2005

Distraction osteogenesis is a technique of lengthening bone including soft tissue by gradual separation of surgically divided bone surfaces. Although the biomechanical, histological, and ultrastructural changes associated with distraction osteogenesis have been widely described, the molecular mechanisms governing the formation of new bone in distracted bone segments remain largely unclear. However, such information has significant clinical implications because it may enable targeted therapeutic manipulations designed to accelerate osseous regeneration. The purpose of this study was to evaluate the expression of TGF-$\beta$1, IGF-I and bFGF in distraction osteogenesis according to different distraction rates in a rabbit's mandible. When twenty-four adult rabbits underwent open osteotomy between the premolar and mental foramen, an external bilateral distraction device was applied. Latency was allowed for five days before distraction. Three different distraction rates were 0.7 mm/day (A, n=8), 1.4 mm/day (B, n=8) and 2.4 mm/day (C, n=8). The distraction device was activated with the same distraction rhythms of twice a day until 4.9 mm (A & B group) and 8.4 mm (C group) length gains was achieved. The animals were sacrificed at postoperative 3, 7, 14 and 28 days. The bony specimens were stained with H&E for histologic examination, and RT-PCR analysis was done for the identification of the expression of TGF-$\beta$1, IGF-I and bFGF. The results obtained from this study were as follows : The 0.7 mm/day and 1.4 mm/day distraction rate groups were shown to improve regenerative bone formation on radiographic and histologic examination. Also, TGF-$\beta$1, IGF-I and bFGF expression increased in the 0.7 mm/day and 1.4 mm/day distraction rate groups. But the 2.4 mm/day distraction rate group specimen was different with adjacent normal bone and hardly expressed of growth factors. These findings suggest that improved new bone formation in the 0.7 mm/day and 1.4 mm/day distraction rates is associated with enhanced expression of TGF-$\beta$1, IGF-I and bFGF by mechanical tension stress. Additionally, the 0.7 mm/day and 1.4 mm/day distraction rate groups were significantly different from the 2.4 mm/day distraction rate group in the expression of growth factors. According to the above results, it seems possible to apply a distraction rate of up to 1.4 mm/day a day in rabbit's mandible. And further studies are needed to evaluate growth factors of TGF-$\beta$1 and IGF-I, which are excellent in expression.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.755-758
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• 2008

Purpose: In order to determine the amount of wound healing, objective sequential assessments of changes in wound size and depth are essential. Although a variety of measurements for wound healing have been proposed, a gold standard for quantifying day-to-day changes in healing has not been established. We present here a simple and non-invasive wound measurement method that quantitatively and accurately documents changes of the size of a raw surface and the volume of a soft tissue defect using a stereoimage optical topometer(SOT) system. Methods: Using a 5mm diameter biopsy punch, four circular wounds were created on abdominal area of a diabetic mouse. Photographs were taken using SOT system at baseline, 5th day and 10th postoperative day. The wound margin was traced on a digitalized photo and evaluated the area and the volume of the wound by SOT system. Results: The SOT system calculated a mean wound surface of $15.93{\pm}0.29mm^2$ and volume of $827.50{\pm}88.86$ intensity/pixel${\times}$area(I/PA) immediately after wounding. On the 5th day after the operation wound surface declined by $10.73mm^2$ and on the 10th day declined by $5.95mm^2$. The wound volume also declined from 827.50 I/PA to 161.75 I/PA and 30.50 I/PA on 0, 5th and 10th day, respectively. Conclusion: The SOT system described in this study represents a reliable, simple, practical, and non-invasive technique to accurately monitor and evaluate wound healing.