• Title/Summary/Keyword: Early reconstruction

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A step-by-step intraoperative strategy during one-stage reconstruction of an acute electrical burn injury in the neck for superior surgical outcome in India: a case report

  • Mainak Mallik;Sanjay Kumar Giri;M. Vishnu Swaroop Reddy;Kallol Kumar Das Poddar
    • Journal of Trauma and Injury
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    • v.37 no.2
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    • pp.151-157
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    • 2024
  • Electrical burn injuries can cause more damage than clinical evaluations initially suggest. The energy waves penetrate from the surface to the deepest layers of tissue, causing extensive harm at every level. The neck is a critical area, both functionally and aesthetically. We present a case involving a young male patient with a severe fourth-degree electrical burn on the neck, who underwent a single-stage debridement and reconstructive surgery. The pectoralis major myocutaneous flap is a versatile option for various head and neck reconstructions. However, if the donor site cannot be closed primarily and requires split-thickness skin grafting, it can result in unsightly scars and deformities. For large flap paddles, it is ideal to reconstruct the secondary defect with locoregional flaps. In this case, we successfully reconstructed the donor site's secondary defect using a contralateral internal mammary artery perforator flap, without resorting to any skin grafts. The early postoperative results demonstrated satisfactory cosmesis, patient satisfaction, and functional outcomes.

Ideal Right Ventricular Outflow Tract Size in Tetralogy of Fallot Total Correction (팔로네징후 완전교정술 시 이상적인 우심실 유출로 크기에 관한 분석)

  • Kim Jin-Sun;Choi Jin-Ho;Yang Ji-Hyuk;Park Pyo-Won;Youm Wook;Jun Tae-Gook
    • Journal of Chest Surgery
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    • v.39 no.8 s.265
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    • pp.588-597
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    • 2006
  • Background: The surgical repair of a tetralogy of Fallot (TOF) has been performed successfully with a favorable early and late outcome. However, the later development of pulmonary regurgitation and stenosis remains a problem. The development of pulmonary regurgitation and stenosis may be changed by the size of right ventricular outflow tract (RVOT) reconstruction at the initial total correction. Hence, it is necessary to investigate the ideal size of RVOT reconstruction. Material and Method: This prospective study was carried out to determine how a surgical strategy and the RVOT size affect the occurrence of pulmonary regurgitation and stenosis. From January 2002 to December 2004, 62 patients underwent the TOF total correction. The RVOT size (diameter of pulmonary valve annulus) of each case was measured after the RVOT reconstruction and converted to a Z value. A pre-scheduled follow up (at discharge, 6 months, 1 year, 2 years and 3 years) was carried out by echocardiography to evaluate the level of pulmonary regurgitation and stenosis. Result: The patients were divided to two groups (transannular group n=12, nontransannular group n=50) according to the method of a RVOT reconstruction. The Z value of RVOT=iameter of pulmonary valve annulus) (transannular group -1, $range\;-3.6{\sim}-0.8;$ nontransannular group -2.1, $range\;-5.2{\sim}-1.5)$ and the average pRV/LV after surgery ${(transannular group 0.44{\pm}0.09,\;nontransannular group\;0.42{\pm}0.09)}$ did not show any significant difference between two groups. The occurrence of pulmonary regurgitation above a moderate degree was more frequent in the transannular group (p<0.01). In nontransannular group, the development of pulmonary regurgitation more than moderate degree occurred to the patients with larger RVOT size (Z value>0, p<0.02) and the progressing pulmonary stenosis more than mild to moderate degree developed in the patients with smaller RVOT size (Z value<-1.5, p<0.05). A moderate degree of pulmonary stenosis developed for 4 nontransannular patients. Three underwent additional surgery and one underwent a balloon valvuloplasty. Their Z value of RVOT were -3.8, -3.8 -2.9, -1.8, respectively. Conclusion: When carring out a TOF total correction, transannular RVOT reconstruction group has significantly more pulmonary regurgitation. In the nontransannular RVOT reconstruction. the size of the RVOT should be maintained from Z value -1.5 to 0. If the Z value is less than -1.5, we should follow up carefully for the possibility of pulmonary stenosis.

Evaluation of Image Quality Based on Time of Flight in PET/CT (PET/CT에서 재구성 프로그램의 성능 평가)

  • Lim, Jung Jin;Yoon, Seok Hwan;Kim, Jong Pil;Nam Koong, Sik;Shin, Seong Hwa;Yoon, Sang Hyeok;Kim, Yeong Seok;Lee, Hyeong Jin;Lee, Hong Jae;Kim, Jin Eui;Woo, Jae Ryong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.16 no.2
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    • pp.110-114
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    • 2012
  • Purpose : PET/CT is widely used for early checking up of cancer and following up of pre and post operation. Image reconstruction method is advanced with mechanical function. We want to evaluate image quality of each reconstruction program based on time of flight (TOF). Materials and Methods : After acquiring phantom images during 2 minutes with Gemini TF (Philips, USA), Biograph mCT (Siemens, USA) and Discovery 690 (GE, USA), we reconstructed image applied to Astonish TF (Philips, USA), ultraHD PET (Siemens, USA), Sharp IR (GE, USA) and not applied. inside of Flangeless Esser PET phantom (Data Spectrum corp., USA) was filled with $^{18}F$-FDG 1.11 kBq/ml (30 Ci/ml) and 4 hot inserts (8. 12. 16. 25 mm) were filled with 8.88 kBq/ml (240 ${\mu}Ci/ml$) the ratio of background activity and hot inserts activity was 1 : 8. Inside of triple line phantom (Data Spectrum corp., USA) was filled with $^{18}F$-FDG 37 MBq/ml (1 mCi). Three of lines were filled with 0.37 MBq (100 ${\mu}Ci$). Contrast ratio and background variability were acquired from reconstruction image used Flangeless Esser PET phantom and resolution was acquired from reconstruction image used triple line phantom. Results : The contrast ratio of image which was not applied to Astonish TF was 8.69, 12.28, 19.31, 25.80% in phantom lid of which size was 8, 12, 16, 25 mm and it which was applied to Astonish TF was 6.24, 13.24, 19.55, 27.60%. It which was not applied to ultraHD PET was 4.94, 12.68, 22.09, 30.14%, it which was applied to ultraHD PET was 4.76, 13.23, 23.72, 31.65%. It which was not applied to SharpIR was 13.18, 17.44, 28.76, 34.67%, it which was applied to SharpIR was 13.15, 18.32, 30.33, 35.73%. The background variability of image which was not applied to Astonish TF was 5.51, 5.42, 7.13, 6.28%. it which was applied to Astonish TF was 7.81, 7.94, 6.40 6.28%. It which was not applied to ultraHD PET was 6.46, 6.63, 5.33, 5.21%, it which was applied to ultraHD PET was 6.08, 6.08, 4.45, 4.58%. It which was not applied to SharpIR was 5.93, 4.82, 4.45, 5.09%, it which was applied to SharpIR was 4.80, 3.92, 3.63, 4.50%. The resolution of phantom line of which location was upper, center, right, which was not applied to Astonish TF was 10.77, 11.54, 9.34 mm it which was applied to Astonish TF was 9.54, 8.90, 8.88 mm. It which was not applied to ultraHD PET was 7.84, 6.95, 8.32 mm, it which was applied to ultraHD PET was 7.51, 6.66, 8.27 mm. It which was not applied to SharpIR was 9.35, 8.69, 8.99, it which was applied to SharpIR was 9.88, 9.18, 9.00 mm. Conclusion : Image quality was advanced generally while reconstruction program which is based on time of flight was used. Futhermore difference of result compared each manufacture reconstruction program showed up, however this is caused by specification of instrument of each manufacture and difference of reconstruction algorithm. Therefore we need further examination to find out appropriate reconstruction condition while using reconstruction program used for advance of image quality.

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Quantitative Study of Annular Single-Crystal Brain SPECT (원형단일결정을 이용한 SPECT의 정량화 연구)

  • 김희중;김한명;소수길;봉정균;이종두
    • Progress in Medical Physics
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    • v.9 no.3
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    • pp.163-173
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    • 1998
  • Nuclear medicine emission computed tomography(ECT) can be very useful to diagnose early stage of neuronal diseases and to measure theraputic results objectively, if we can quantitate energy metabolism, blood flow, biochemical processes, or dopamine receptor and transporter using ECT. However, physical factors including attenuation, scatter, partial volume effect, noise, and reconstruction algorithm make it very difficult to quantitate independent of type of SPECT. In this study, we quantitated the effects of attenuation and scatter using brain SPECT and three-dimensional brain phantom with and without applying their correction methods. Dual energy window method was applied for scatter correction. The photopeak energy window and scatter energy window were set to 140ke${\pm}$10% and 119ke${\pm}$6% and 100% of scatter window data were subtracted from the photopeak window prior to reconstruction. The projection data were reconstructed using Butterworth filter with cutoff frequency of 0.95cycles/cm and order of 10. Attenuation correction was done by Chang's method with attenuation coefficients of 0.12/cm and 0.15/cm for the reconstruction data without scatter correction and with scatter correction, respectively. For quantitation, regions of interest (ROIs) were drawn on the three slices selected at the level of the basal ganglia. Without scatter correction, the ratios of ROI average values between basal ganglia and background with attenuation correction and without attenuation correction were 2.2 and 2.1, respectively. However, the ratios between basal ganglia and background were very similar for with and without attenuation correction. With scatter correction, the ratios of ROI average values between basal ganglia and background with attenuation correction and without attenuation correction were 2.69 and 2.64, respectively. These results indicate that the attenuation correction is necessary for the quantitation. When true ratios between basal ganglia and background were 6.58, 4.68, 1.86, the measured ratios with scatter and attenuation correction were 76%, 80%, 82% of their true ratios, respectively. The approximate 20% underestimation could be partially due to the effect of partial volume and reconstruction algorithm which we have not investigated in this study, and partially due to imperfect scatter and attenuation correction methods that we have applied in consideration of clinical applications.

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Operative Treatment of Mitral Valve Regurgitation Due to Chordal Rupture and/or Papillary Muscle Rupture (건삭 파열 및 유두근 파열로 인한 승모판 판막 폐쇄부전의 외과적 치험)

  • 김시호;방정희;우종수
    • Journal of Chest Surgery
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    • v.37 no.5
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    • pp.401-409
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    • 2004
  • Background: As the rupture of chordae and/or papillary muscle became the main cause of mitral valve regurgitation, mitral reconstructive surgery has a very important role. In this regard, we analyzed the clinical result and postoperative early result of operative treatment performed in our hospital, Material and Method: For this analysis, forty nine patients (male 26, female 23, mean age 49.0$\pm$16.5) who underwent mitral valve operation caused by the rupture of chordae and/or papillary muscle from August 1991 to April 2002 were reviewed. Among forty nine patients, twenty two (44.9%) received mital valve reconstruction and twenty seven (59.2%) received mitral valve replacement. Result: As to the pathological etiology of rupture of mitral and papillary muscle, twenty five cases (51.0%) were nonspecific degeneration, eleven cases (22.4%) were myxomatous degeneration, seven cases (14.3%) were subacute bacterial endocarditis. Three patients suffered mortality after operation (6.1%) and valve replacement was performed again on one patient because of remnant mitral insufficiency after valve reconstruction. The 5-year survival rate after operation for the entire mitral valve regurgitation patients was 81 .4%. We have also compared and analyzed the operation results of a group of patients who underwent valve reconstruction and the other group of patients who underwent valve replacement from thirty six patients who had suffered from mitral valve regurgitation caused by degenerative disease. The mortalities were 0% and 14.3%, respectively and the 5-year survival rates were 90.2% and 64.3%, respectively, but there were no statistical significance. Conclusion: The most common pathological etiology of mitral valve regurgitation caused by rupture of chordae and/or papillary muscle was nonspecific degeneration, In case of degenerative disease is the cause of mitral valve regurgitation, valve reconstruction showed better long-term effects in many respects and better operation results compared to valve replacement.

Reproducing Racial Globality: W.E.B. Du Bois and the Sexual Politics of Black Internationalism

  • Weinbaum, Alys-Eve
    • Lingua Humanitatis
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    • v.2 no.2
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    • pp.223-265
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    • 2002
  • In United States black mothers have consistently been treated as national outsiders, as women whose children, although ostensibly entitled to full citizenship, are in practice rarely provided with equal protection within the nation′s borders or under its laws. From the time he began writing in the aftermath of the failures of national Reconstruction, the African American public intellectual and political activist W. E. B. Du Bois realized that a truly effective anti-racist politics would also have to contend with the particular ways in which U.S. racism targeted black mothers. In short, he understood that an effective anti-racism would necessarily have to be a form of anti-sexism. This article examines the myriad ways in which Du Bois attempted to reconstruct the relationship between race and reproduction in the interest of producing anti-racist, anti-nationalist, as well as internationalist thinking. In so doing it treats the various representations of black maternity and child birth that Du Bois created, and elaborates on the rhetorical and political function of these representations in combating the racialization of national belonging on the one hand, and in articulating universal black citizenship, or what this article theorizes as racial globality on the other. The article begins by considering Du Bois′s attempts to transcend ideas about the racialized reproductive body as a source of national belonging within the United States, particularly his efforts to contest the idea of the reconstructing nation as a white nation reproduced exclusively by white women. Through analysis of Du Bois′s depiction of the birth and death of his son in his monumental work The Souls of Black Folk (1903) it demonstrates his reluctance to build an anti-racist politics founded on the idea that belonging within the nation is something that can be bestowed by one′s mother. The article proceeds by turning to Du Bois less well-known romantic novel, Dark Princess (1928) in which, by contrast, he depicts the birth of a "golden chi1d" who belongs not only within the United States, but within the world. This child, the son of an African American man and an Indian Princess, is cast as a messenger and messiah of a utopian alliance between pan-Asia and pan-Africa. In exploring the relationship between these two reproductive portraits, the article moves from a discussion of Du Bois′s critique of the ideological construction of the U.S. as a white nation reproduced by white progenitors, to an examination the literary figuration of a b1aek mother out of whose womb a black diasporic anti-imperialist alliance springs. In contrast to previous scholarship, which has tended to focus on the critique of U.S. racial nationalism that Du Bois expressed in his early work, or on the internationalism that he later embraced, this article pays close attention to how Du Bois′s anti-nationalist and internationalist politics together subtended by subtle, but constitutive, sexual politics.

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Clinical Results of Treatment of Distal Biceps Rupture (이두박근 원위부 파열의 임상적 치료 결과)

  • Chung, Duke-Whan;Hwang, Jung-Chul
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.8 no.1
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    • pp.13-18
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    • 2009
  • Purpose: To report the clinical results of patients treated for a rupture of the distal tendon of biceps brachii Materials and Methods: Between February 1987 and March 2004, we treated 16 patients with a rupture of the distal tendon of biceps brachii. 9 of 16 patients underwent surgical treatment. All cases were male, median age was 26.3(range, 16-48) years. The mean interval between injury and surgery was 4.7 days (range, 1~36 days). Operative correction was performed anatomically, using the two-incision technique(3 cases) or one-incision technique(6 cases). Clinical outcomes were evaluated one year after operation by assessing the review about the physical examination finding and radiologic findings with surgical findings, range of motion, muscle strength, subjective satisfaction, activity and return to previous occupation. and via telephone interview in cases of conservative treatment. Results: In cases of surgical treatment, 85.8%, 86.3% of flexion-extension and supination-pronation motion than healthy side were measured respectively. 75% of flexion power than healthy side was measured. Eight of nine(89%) were very satisfied. Eightl of nine returned to original job. In cases of conservative treatment, 65% of flexion power than pre-injury state was reported. Four of seven were satisfied, two were dissatisfied, one was very dissatisfied. Three of seven returned to original job. Conclusion: Early anatomic reconstruction can restore more strength and endurance for supination and flexion range and power. Conservative management may be considered for partial injuries, but operative repair must be considered in complete rupture, athletes, patient with high activity.

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Three-dimensional Imaging with an Endoscopic Optical Coherence Tomography System for Detection of Airway Stenosis (기도협착 측정을 위한 내시경 광 결맞음 단층촬영법을 이용한 3차원 이미징)

  • Kwon, Daa young;Oak, Chulho;Ahn, Yeh-Chan
    • Korean Journal of Optics and Photonics
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    • v.30 no.6
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    • pp.243-248
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    • 2019
  • The respiratory tract is an essential part of the respiratory system involved in the process of respiration. However, if stenosis occurs, it interferes with breathing and can even lead to death. Asthma is a typical example of a reversible cause of airway narrowing, and the number of patients suffering from acute exacerbation is steadily increasing. Therefore, it is important to detect airway narrowing early and prevent the patient's condition from worsening. Optical coherence tomography (OCT), which has high resolution, is suitable for observing the microstructure of tissues. In this study we developed an endoscopic OCT system. We combined a 1300-nm OCT system with a servo motor, which can rotate at a high speed. A catheter was pulled back using a linear stage while imaging with 360° rotation by the motor. The motor was selected considering various requirements, such as torque, rotational speed, and gear ratio of pulleys. An ex vivo rabbit tracheal model was used as a sample, and the sample and catheter were immobilized by acrylic structures. The OCT images provided information about the structures of the mucosa and submucosa. The difference between normal and stenosed parts in the trachea was confirmed by OCT. Furthermore, through a three-dimensional (3-D) reconstruction process, it was possible to identify and diagnose the stenosis in the 3-D image of the airway, as well as the cross-sectional image. This study would be useful not only for diagnosing airway stenosis, but also for realizing 3-D imaging.

Do the Rotating Hinge-Flexible Intramedullary Nail Composites Alleviate Junctional Osteolysis in Megaprothesis Reconstruction for Bone Tumor? (탄력성 있는 골수강 내고정물과 회전경첩형 슬관절 전치환물을 조합한 종양인공관절로 자가골의 골 용해를 감소시킬 수 있는가?)

  • Song, Won-Seok;Cho, Wan-Hyeong;Cho, Sang-Hyun;Jeon, Dae-Geun
    • The Journal of the Korean bone and joint tumor society
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    • v.13 no.2
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    • pp.96-104
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    • 2007
  • Purpose: The authors investigated whether 35 flexible nail-rotating hinge composite reconstructions around knee joint minimize junctional osteolysis of host bone. Material and Method: The reconstructive technique was as follows: 1) en bloc tumor resection, 2) filling of the host bone marrow cavity with multiple Ender nails, 3) assembling the Ender nails and an Endo-Link type total knee component with wire and bone cement. Result: Mean follow-up was 53 months (ranged 30~79). At final follow-up, 29 patients retained a mobile joint. Resection of more than 40% of bone showed a positive relationship with junctional hypertrophy (p=0.028). Eight patients showed nail breakage and eight prostheses were removed due to early or late infection. The cumulative prosthetic survival rate was 33% at 6 year. Average functional score according to the MSTS criteria was 26.8. Conclusion: Mid-term evaluations showed that results were fair. The revision process was straightforward. Junctional hypertrophy observed appears to give some clues as to how to minimize osteolysis at the prosthesis-host junction after modular prosthesis fixation.

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Ligament Reconstruction for Subluxation of the Trapeziometacarpal Joint of the Thumb (무지의 대능형중수간 관절의 아탈구에 대한 인대 재건술)

  • Park Jin Soo;Chung Yung Khee;Yoo Jung Han;Na Kyong Soo
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.3 no.2
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    • pp.134-140
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    • 2004
  • Purpose: The reconstructive surgery of the anterior oblique ligament has been recommended for patients with unstable carpometacarpal joints. We reviewed retrospectively the functional results of two patients who had been treated by6 using a harvested portion of the tendon of flexor carpi radialis as a substitute for the anterior oblique ligament. Materials and Methods: In two patients with a instability of the trapeziometacarpal joint because of a rupture of the anterior oblique ligament, reconstruction was carried out using a slip of the tendon of flexor carpi radialis and the patients had been followed up for two years. Results: The results after a follow-up of two years that both of them had significant relief from pain and symptoms. The mean grip strength recovered to 90$\%$ of the controlateral side. patients felt that they had subjective improvement and would have undergone the operation again. Conclusion: Increased awareness of this lesion can lead to an early and clear diagnosis, so that the patient may be advised adequately.

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