• Journal of Chest Surgery
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• v.36 no.4
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• pp.267-272
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• 2003

Background: Common treatment modalities for tracheal stenosis include conservative methods such as repeated balloon dilatation, removal of obstructive material through bronchoscopy and T-tube insertion as well as operative treatment methods. Recent advances in surgical approaches through tracheal resection and end-to-end anastomosis have been reported to give better functional and anatomical results. Material and Method: Between March 1990 and July 2002, 41 patients who received tracheal resection and end-to-end anastomosis at Asan Medical Center, University of Ulsan were studied retrospectively. Result: The causes for tracheal resection and end-to-end anastomosis included 26 cases of postintubation stenosis, 10 cases of primary tracheal tumors (3 benign, 7 malignant), 1 case of endobronchial tuberculosis, 2 cases of traumatic rupture, and 2 cases of tracheal invasion of a thyroid cancer, Of the 41 patients who received tracheal resection and reconstruction, 29 received tracheal resection and end-to-end anastomosis, and 12 received laryngotracheal anastomosis with cricoid or thyroid cartilage resection. Four of these patients received supralaryngeal release. The average length of the resected trachea was $3.6{\pm}1.0$cm. Of the 41 patients who received tracheal resection and end-to-end anastomosis, 30 (73.2%) experienced no postoperative complications, and 8 (19.5%) experienced granulation tissue growth and/or minor infections which improved after conservative management. Good or satisfactory results were therefore achieved in 92.7%. Complications included repeated granulation tissue growth in 7, wound infection in 2, anastomotic site dehiscence in 2, restenosis resulting in dyspnea on exertion in 1, and repeated postoperative aspiration requiring retracheostomy in 1. There was no early postoperative mortality. There were 3 cases of hospital death. Conclusion: In cases of proper length of tracheal lesion, excellent results were obtained after tracheal resection and end-to-end anastomosis. But, granulation tissue growth is so serious complication, it is necessary for continuous study and efforts to prevent it.

• The Journal of the Korean dental association
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• v.23 no.1 s.188
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• pp.73-81
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• 1985

In the assessment of patency of a small vessel anastomosis, micro-arteriography using dental X-ray and film was used as a method of testing the patency of arterial anastomoses in the rat. Micro-arteriography could lead to an objective evaluation of the patency in End-to-End and End-to Side anastomoses. The method used in this study is easily accessible for Oral and Maxillo-facial surgeon to practice the microvascular anastomosis, and requires materials available in every dental clinic.

• Journal of the Korean Society for Precision Engineering
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• v.21 no.8
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• pp.188-195
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• 2004

In this paper we analyzed the mechanical behavior with respect to the thickness variation of elastic foundation(fatty tissue) in end-to-end anastomosis. This study considered the preliminary deformed shape induced by suturing in the anastomosis of coronary artery and PTFE with different diameters using simplified suturing model and the fatty tissue surrounding heart and coronary artery for more accurate result using finite element method. Area compliance(CA) was used to analyze the final deformed shape of the anastomotic part with respect to the thickness variation of fatty tissue under mean blood pressure, 100mmHg(13.3㎪). And Equivalent and circumferential stresses in the anastomosis were also analyzed with respect to the change of initial diameter ratio( $R_1$) and fatty tissue thickness( $T_{F}$). The results obtained were as follows : 1 When the elastic foundation, assumed to be incompressive material, surrounded the grafts in anastomosis, the compliance mismatch of artery and PTFE was reduced by 47 -72%. 2. As the initial diameter ratio( $R_1$) became larger, the higher difference of compliance was induced in spite of elastic foundation surrounding grafts. 3. The maximum nondimensional circumferential stress is twice or three times as high as the maximum nondimensional equivalent stress in the anastomotic part.t.

• Journal of Chest Surgery
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• v.26 no.5
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• pp.409-412
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• 1993

We report a case of subglottic stenosis by blunt neck trauma. Preoperative CT showed a stenosis extending distally from just below the vocal cords for 4cm. Concomittent bilateral vocal cords paralysis and quadriplegia were present. At operation the lesion was severely adhesed and the lumen was nearly obstructed. The recurrent laryngeal nerves were embedded in fibrous tissue and were not identified at ease. The stenosed segment was resected and direct end-to-end anastomosis with preservation of the recurrent laryngeal nerves was performed. Six months latar he discharged with intermediate position of vocal cord paralysis.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.101-108
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• 1995

From 1988 to 1995, 59 patients with laryngotracheal stenosis were operated with resection of stenotic segment and end to end anastomosis in Seoul national university. Among these patients, 36 were tracheal stenosis, 17 were combined lesion of subglottis and trachea and 5 were subglottic stenosis. The success of procedure was determined by stoma closure or decannulation and an overall 89.8% success rate was achieved following 165 procedures. The success rate showed correlation with severity of stenosis and the number of procedures done was related to the site of stenosis. There was no mortality and granulation formation, unilateral vocal cord palsy were the common complication of end to end procedures.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.22-27
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• 1999

While the conventional end-to-end anastomotic technique is accepted as 'the golden standard' for microvascular anastomosis, it is time-consuming and tedious. In an effort to offer faster and safer ways of performing microvascular anastomoses, numerous anastomotic techniques have been proposed, but further refinements in microvascular techniques are still necessary. A 'continuous suture with interrupted knot' technique was devised for faster and safer anastomosis. It has been successfully used in microanastomoses of both artery and vein for free tissue transfer. It is a combination of the interrupted suturing technique and the continuous suturing technique. First, a continuous suture is made with the size of loop decreasing in order, and then the sutures are tied individually from the first loop to the last one as in the conventional interrupted suturing technique. It was applied clinically to fourteen patients over the past ten months and found to be a highly efficient technique that satisfied our needs. This 'continuous suture with interrupted knot' technique has several advantages over other techniques : The operative time is reduced comparing conventional interrupted suture technique. By delaying the tie and with the vessel walls kept separated, the risk of through-stitch can be reduced. Tying all the sutures at one time not only speed up the procedures, but also reduced the surgeon's fatigue. In addition, it has no problem of anastomotic stenosis which is a disadvantage of continuous suture technique. This technique proved to be faster and safer, and has patency equal to that of the conventional end-to-end anastomosis. It is of great help to the surgeon in reducing operative time, especially in clinical situations when many anastomoses are required, or lengthy grafting procedures are undertaken.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1508-1515
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• 1992

Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.467-470
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• 2015

A 74-year-old patient was diagnosed with a subarachnoid hemorrhage suspected from a dissecting aneurysm located at the lateral medullary segment of the posterior inferior cerebellar artery (PICA). Because perforators to the medulla arose both proximal and distal to the dissecting segment, revascularization for distal flow was essential. However, several previously reported methods for anastomosis, such as an occipital artery-PICA bypass or resection with PICA end-to-end anastomosis could not be used. Ultimately, we performed an in situ side-to-side anastomosis of the proximal loop of the PICA with distal caudal loops within a single artery, as a "closing omega," followed by trapping of the dissected segment. The aneurysm was obliterated successfully, with intact patency of the revascularized PICA.

• Journal of Biomedical Engineering Research
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• v.18 no.3
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• pp.253-259
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• 1997

Von Mises stress and compliance distribution was evaluated using a finite element analysis on the anastomosis of an artery with length of 20mm(z direction, along the horizental artery), inner diameter of 4mm, thickness fo 0.5mm and a PTFE graft with length of 5.7mm, inner diameter of 2mm, thickness of 0.2mm when anastomotic angle was $45^{\circ}$ and inner pressure of 1330 dyne/mm2 was applied inside the 2 conduits. From the analysis results were obtained as follows. (1) Artery diameter increased in both horizontal x(along the length of artery) and vertical y(perpendicular to the length of artery)directions and the magnitude of that in x direction was bigger than that in y direction. (2) The compliance was maximum on the anastomosis, especially on that with acute angle. The reduction of compliance was observed from the anastomosis area to the either right or left end. (3) The equivalent stress was maximum on top in the y direction and minimum on the nodes apart $110^{\circ}$ in circumferential direction from the top. (4) The equivalent stress was maximum in t도 vicinity of anastomosis with acute angle along the longitudinal direction of the artery. This trend was also observed along the PTFE graft.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.5
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• pp.349-357
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• 2003

Several microvascular anastomotic techniques have been described with methodical effectiveness, patency rates, healing state of microscopic findings. This experimental study presents the comparison of three types of arterial microvascular anastomotic techniques: end-to-end(ETE) anastomosis, end-in-end(EIE) anastomosis, and continuous technique. Sixty male Sprague-Dawley rats, 60 femoral arteries were used for this study. Twenty rats per each technique were used and sacrificed at post-operation 1 day, 3 days, a week, 2 weeks for scanning electromicroscopic findings. The patency was monitored by miniDoppler throughout total experimental periods. The anastomotic time on each method was measured to compare the technical effectiveness. The final results were as follows: 1. The anastomotic time for the end-in-end technique was significantly shorter than another techniques. The average time for each technique was measured as 15 minutes on EIE technique, 20 minutes on continuous technique and 25 minutes on ETE technique. 2. The patency rate for the end-in-end technique at 2 weeks also was superior to another techniques. The patency rate for each technique was demonstrated as 90 % on EIE technique, 85 % on ETE technique and 80 % on continuous technique. 3. The scanning electromicroscopic findings on healing condition of vessel endothelium during the observation period showed that the end results of EIE technique, ETE technique and continuous technique in sequence were good. The end-in-end technique proved to be the superior with regard to anastomotic time and patency rate when compared to end-to-end technuqe, so EIE techniqe might be well available for the case of large discrepancy of vessel size. The patency rate, microscopic healing findings in continuous technique were seen as the lowest level among the three anastomotic techniques, therefore the application of continuous technique was recommended only on the inevitable case.