• Archives of Craniofacial Surgery
• /
• v.25 no.2
• /
• pp.71-76
• /
• 2024

Background: The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. Methods: A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. Results: Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. Conclusion: The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.

• Journal of Korean Neurosurgical Society
• /
• v.61 no.2
• /
• pp.167-179
• /
• 2018

The prevalence of patients with adult spinal deformity (ASD) has been reported as high as 68%. ASD often leads to significant pain and disability. Recent emphasis has been placed on sagittal plane balance and restoring normal sagittal alignment with regards to the three dimensional deformity of ASD. Optimal sagittal alignment has been known to increase spinal biomechanical efficiency, reduce energy expenditure by maintaining a stable posture with improved load absorption, influence better bony union, and help to decelerate adjacent segment deterioration. Increasingly positive sagittal imbalance has been shown to correlate with poor functional outcome and poor self-image along with poor psychological function. Compensatory mechanisms attempt to maintain sagittal balance through pelvic rotation, alterations in lumbar lordosis as well as knee and ankle flexion at the cost of increased energy expenditure. Restoring normal spinopelvic alignment is paramount to the treatment of complex spinal deformity with sagittal imbalance. Posterior osteotomies including posterior column osteotomies, pedicle subtraction osteotomies, and posterior vertebral column resection, as well anterior column support are well known to improve sagittal alignment. Understanding of whole spinal alignment and dynamics of spinopelvic alignment is essential to restore sagittal balance while minimizing the risk of developing sagittal decompensation after surgical intervention.

• Journal of Trauma and Injury
• /
• v.24 no.1
• /
• pp.7-11
• /
• 2011

Purpose: Traumatic airway injuries have high rates of mortality and morbidity. Thus, we evaluated the clinical results of trauma-related airway-injury patients. Methods: A clinical analysis was performed for patients with airway trauma who were admitted and treated at the Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital from Dec. 2002 to Dec. 2009. Results: Sixteen patients were admitted and treated. Fourteen patients were male, and the ages of the patients ranged from 16 to 75 years. Six cases were penetrating injuries, 4 were traffic-accident injuries. 3 were fall injuries, and. 3 were other blunt trauma injuries. Anato- mic injuries included 14 trachea cases (87.5%), 1 Rt. main bronchus (6.25%), and 1 Lt. main bronchus cases (6.25%). Diagnosis was made by using computed tomography and bronchoscopy. Five patients were treated with an explothoracotomy, and 7 underwent neck exploration with primary repair. Three patients simply needed conservative management, and 1 patient was treated with a closed thoracostomy. The post-operative mortality rate was 6.25 % (1 patient). Conclusion: Airway trauma is dangerous and should be treated as an emergency, so a high index of suspicion is essential for rapid diagnosis and successful surgical intervention in patients with airway injuries.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.18 no.4
• /
• pp.555-562
• /
• 1996

A competent velopharyngeal sphincter is essential for intelligible speech. If the velopharyngeal incompetence exist, the seal will not be complete during speech, with a resultant hypernasal speech quality. The patient with velopharyngeal incompetence(VPI) may develope other compensatory speech problems. There are many approaches available to correct velopharyngeal incompetence, which include speech therapy, push back palatorrhaphy, pharyngeal wall implants and pharyngoplasty. This is cases report of velopharyngeal incompetence, which were successfully treated by superiorly based pharyngeal flap, covered with splitted hinge flap of nasal lining mucosa of the soft palate, named modified Hogan method. The advantages of this method are precision in the approximation of the flap due to pentagonal shaped flap design, good blood supply due to omission of the midsagittal incision on nasal lining mucosa, and simplicity than Hogan method.

• Archives of Plastic Surgery
• /
• v.33 no.3
• /
• pp.388-391
• /
• 2006

Hemangioma is one of the most common congenital tumors in the region of the face and neck. Although histologically benign, these facial masses are clinically malignant for their deforming and inexorable growth, especially in so-called 'cavernous hemangioma'. Carvenous hemangioma is the most common primary tumor occurring in the adult orbit. This tumor has symptoms that characteristically develop over several years with slowly progressive proptosis, eyeball deviation, hyperopia, diplopia and optic nerve compression. Today, hemangiomas are being treated by various methods; steroids, electrocoagulation, injection of sclerosing agent, cryotherapy, radiation therapy, laser therapy, and surgical treatment, etc. In principle, surgical approaches to the orbit must provide maximum safety and optimal visualization. We have experienced a case of large cavernous hemangioma in the orbit inferolaterally. The surgical treatment of tumor was achieved by the bicoronal approach combined with inferomedial and inferolateral orbitotomy. This surgical approach allows better visualization of the tumor and greater protection of essential anatomic structures. We obtained satisfactory results in terms of aesthetic and functional consideration. We present our case with a brief review of the literature related to orbital cavernous hemangioma.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.30 no.2
• /
• pp.191-193
• /
• 2008

Impacted third molars of the mandible are generally found at or close to the second molar. If the third molar is impacted far distant from its original site, it may be affected by cysts or tumors. Ectopic impaction of third molar in the condyle area is very rare. Furthermore, impaction without cystic lesion is even less common. The etiology of migration of the mandibular third molar without cystic lesion is unknown. So periodical X-ray taking is essential.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.36 no.3
• /
• pp.211-213
• /
• 2010

Glandular odontogenic cyst (GOC) is an intraoral cyst originated from serre remnants which has incidence of rare frequency. Only 111 cases have been reported since Gardener first introduced it in 1987. The clinical features are the following components: cortical bone thinning, locally aggressive root resorption, non-painful swelling. The following recurrences rate are 64.3% in conservative treatment, and 0% in wide excision for instance, segmental or marginal mandibulectomy. So, its prognosis is similar to that of odontogenic keratocyst and ameloblastoma. Therefore, periodic recall follow ups are essential to detect disease recurrence. Here, we will report the first case of GOC diagnosed in our department considering with references. And we share this treatment experience because these aggessive lesions may be misjudged for simple dental cyst.

• Journal of the Korean Academy of Clinical Electrophysiology
• /
• v.11 no.1
• /
• pp.39-44
• /
• 2013

Purpose : The purpose of present study is to evaluate the joint angles of legs in the standing posture for six patients with unilateral knee osteoarthritis. Methods : The participants underwent unilateral total knee replacement. A motion analysis was used to measure the joint angles of the hip, knee, and ankle. The measurements were taken before the surgery, one week and two weeks after the surgery. Both sides of the legs were evaluated. Results : This result showed that after a certain healing period, both hip joint angles showed a significant difference while there was no significant difference in the knee and ankle joint angles. After surgery, the angle of ankle dorsiflexion was smaller on the operated side than the opposite side compared to the pre-surgery measurements. Conclusion : After surgery, the asymmetry in a standing position left unchanged due to contracture of the knee joint and tightness in the hamstring muscle. Therefore, when physiotherapists plan an initial exercise programs for TKR patients, it is essential to apply adequate exercises which consider the contracture of the leg joints.

• Korean Journal of Bronchoesophagology
• /
• v.6 no.1
• /
• pp.90-95
• /
• 2000

Isolated(H-type) tracheoesophageal fistula without esophageal atresia occurs in approximately 4% of esophageal anomalies, and represents the least form of abnormal laryngotracheo-esophageal communication. Its symptoms such as coughing and choking The during the feeding, abdominal distension and recurrent pneumonitis usually start from birth. Diagnosis is made between 4 days to 4 years using the contrast esophagography and/or tracheoscopy. In case of diagnostic delay the postoperative mortality is not negligible and the most common cause of mortality is respitatory problems(infection, respiratory distress). So early diagnosis is essential in the newborn period with high index of suspicion. We report a case of H-type TEF in which operative repair was successful with references to recent literature.

• Journal of Chest Surgery
• /
• v.18 no.4
• /
• pp.771-779
• /
• 1985

It has been recognized that the proper matching of ventilation and perfusion within the lung is essential for the efficient exchange of gases following open heart surgery. Physiologic shunt reflects the amount of blood going to lung units with inadequate ventilation and these are also areas of the lung with adequate ventilation but inadequate blood flow. This can be quantified by measuring physiological dead space. From January to August 1985, The physiologic dead space and shunt during postoperative course had been taken in 30 patients of open heart surgery in Soonchunhyang University Hospital. Twenty cases had congenital heart disease and acquired valvular heart disease were noticed in 10 cases. The physiological dead space and shunt during postoperative periods were calculated and we made 5 items of conclusion: 1. There is high probability of ventilation-perfusion mismatch in the acquired heart disease group compared to the congenital group. 2. Duration of the CPB can exert significant influences in the physiological dead space but less in the shunt fraction. 3. There is positive relationship between Qs/Qt and Vd/Vt in the group B [CPB>90 min.] but less reliable in correlation. 4. Perfusion impairment is more significant in the diminished pulmonic blood flow group compared to the increased pulmonic blood flow [Qp/Qs>2.0] group. 5. There is no significant ventilation-perfusion mismatch within the lung during all postoperative courses.