• Journal of Chest Surgery
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• 제29권1호
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• pp.107-111
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• 1996

지속적인 기관지-늑막루는 여전히 치료하기 어려운 질환이며 일반적인 치료가 실패했을 때는 적극적인 치료가 필요하다. 50세 남자 환자로 1981년 10월에 중증 페결핵으로 우측전폐 절제술을 받았으나 술후 1개 월만에 기관지-늑막루 및 농흥이 발생하여 기관지-늑막루 페쇄 및 Clagett술식을 받았으나 실패하였고 술후 1년째 자연성 개방창이 형성되었다. 기관지-늑막루의 크기가 점차 커져서, 술후 13년째인 1994년 7월에 대흥근피 판을 이용한 기관지-늑막루 폐쇄 및 사강 소멸을 시도하였다. 술후 43일째 기관지-늑막루 폐쇄로 및 호흡부전 증상이 호전되어서 퇴원하였다. 근피판술을 이용한 방법이 기관지-늑막루의 폐쇄에 효과적인 것으로 생각하고 수술수기 및 치험 1례를 보고하는 바이다.

• Archives of Plastic Surgery
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• 제45권4호
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• pp.375-378
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• 2018

In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasound-guided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권3호
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• pp.163-168
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• 2023

An oroantral fistula (OAF) or oroantral communication (OAC) is an opening between the oral cavity and the maxillary sinus. If left untreated, these openings may cause chronic maxillary sinusitis. Although small defects (diameter <5 mm) may close spontaneously, larger communications require surgical intervention. Various studies have been conducted on OAC closure using a platelet-rich fibrin (PRF) membrane; most of these prior studies have involved simple direct application of PRF clots. This study introduces a new "double-barrier technique" using PRF for closure of an OAF involving sinus mucosal lifting and closure. The PRF material is inserted into the prepared maxillary sinus space, and the buccal advancement flap covers the oral side. This technique was successfully used to treat two patients with chronic OAF in the posterior maxillary region after implant removal or tooth extraction. The use of a PRF membrane in a double-barrier technique may have advantages in soft-tissue healing and could enable easy closure of chronic OAF with minimal trauma.

• 대한구순구개열학회지
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• 제12권1호
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• pp.1-6
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• 2009

Oronasal fistula are a well-known complication of surgical treatment of cleft palate, occurring most frequently in the alveolus and hard palate. Previous reports have demonstrated that oronasal fistulas, particularly if greater than l cm in diameter, had an adverse effect on speech. The aim of this study was to demonstrate the relationship between the size of the fistula and the influence on velopharyngeal function. The site and size of the fistula were indicated on graph paper with calipers and measured in $mm^2$. Speech assessment was carried out using a Nasometer, VPI articulation differential test, spectrography. Patient whose fistulas affected their speech had significantly larger fistulas than those whose fistulas did not. The study shows that the larger the fistula, the greater the risk of hypernasality and nasal emission, but even small fistulas can cause speech problems. If obstruction of the nasal passage is eliminated in a patient with a previously asymptomatic fistula, it may result in a fistula becoming symptomatic, resulting in hypernasality and nasal emission. In conclusion, even small fistulas can influence speech production and should be considered before any treatment is planned. The study lends support to early closure of oronasal fistulas, particularly before pharyngeal flap surgery is contemplated.

• Journal of Chest Surgery
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• 제39권2호
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• pp.150-153
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• 2006

심방 중격 결손에 대한 경피적 카테타 폐쇄술은 적절한 환자에서 치료적 대안으로 이용되며, 미용적으로 우수하고, 덜 침습적이며, 재원 기간이 짧으나, 응급 수술이 요구되는 치명적인 합병증이 발생할 수 있다. 저자들은 Amplatzer septal occluder에 의한 심방 중격 결손의 경피적 카테터 폐쇄술 시행 후 발생한 대동맥-우심방루를 경험하였다. 시술 2개월 후에 호흡곤란, 심계항진과 용혈에 의한 황달로 발견되어, 대동맥의 무관상동맥동과 우심방 사이의 누공을 일차 봉합하고, 심방 중격 결손은 팻취로 봉합하는 응급수술을 시행하였다. 이 합병증은 우심방 원반(disk)이 대동맥으로 침식(erosion)하여 발생하였다.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.75-79
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• 2021

Bardach described a closure of the cleft utilizing the arch of the palate, which provides the length needed for closure and is most effective only in narrow clefts. Herein, we describe a case where we utilized Bardach's two-flap technique with a vital and easy modification, done to allow closure of a wide cleft palate and to prevent oronasal fistula formation at the junction of the hard and soft palate, which are otherwise difficult to manage with conventional flaps. The closed palate showed healthy healing, palatal lengthening, and no oronasal regurgitation. We advise using this modification to achieve the goals of palatal repair in difficult cases where tension-free closure would otherwise be achieved with more complex flap surgical techniques, such as free microvascular tissue transfer.

• 대한두경부종양학회지
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• 제30권2호
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• pp.39-42
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• 2014

Background and Objectives : Pharyngocutaneous fistula is the most common complication after total laryngectomy. The objective of this study was to determine the incidence of pharyngocutaneous fistula after total laryngectomy in patients operated on in our department and to establish whether specific factors predispose to fistula formation. Materials and Methods : For 10 years(2003-2014), 49 cases of patients who were diagnosed with laryngeal cancer and underwent total laryngectomy in our department. Patients who underwent radiotherapy before the surgery was 24 cases(48.9%) of all total laryngectomy patients. And those who were needed flap reconstruction because of extensive tumor involvement to hypopharynx were also 24 cases(48.9%), whereas primary closure were performed in 25 cases(51%). Results : The postoperative pharyngocutaneous fistula was found in 12 of the 49 patients(24.5%). The radiotherapy before surgery was a statistically significant factor that increase the incidence of postoperative fistulas(p=0.037). Large extent of surgery including flap reconstruction was almost statistically significant factor of raising postoperative fistula rates(p=0.051). Conclusion : According to this study, the presence of postoperative fistula seems to be influenced by previous radiotherapy and the extent of surgery. These could be the risk factors of pharyngocutaneous fistula after total laryngectomy.

• 대한구순구개열학회지
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• 제8권1호
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• pp.31-37
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• 2005

In alveolar deformity of cleft patient, the flap design is very important to make the functional and esthetic outcome. Especially in bilateral cleft alveolus with wide defect, deficiency of covering tissue is a greatest problem. Wound dehiscence may develop oronasal fistula of palatal and labial region and loss of the bone graft. We report 2 cases with bilateral cleft alveolus. In both case, bilateral buccal mucosal flap was used for closure of bilateral cleft alveolus with wide defect. The one was operated with iliac bone graft according to secondary grafting method, the other was closed without bone grafting. The patient was 3 years old. So, secondary alveolar bone graft will be required some years later for the establishment of bony continuity and esthetic advantage. In both cases, we found the entire soft tissue closure without the lack of covering flap. In these case, the closure of alveolus defect was accomplished successfully by the use of bilateral buccal mucosal flap. There was no complication, secondary fistula. The most important thing is the tension-free closure of the bilateral buccal mucosal flap. So, we report these cases with literatures.

• Journal of Chest Surgery
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• 제25권6호
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• pp.581-587
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• 1992

Tracheoesophageal fistula[TEF] is a rare but life-threatening lesion that may occur from ventilation with a cuffed tube. It occurs most frequently when an inlying esophageal tube is also being used-usually for feeding purposes. The mechanism of injury appears to be pressure experted on the tracheal wall by the cuff, which then compresses the "party wall" of the trachea and esophagus against the foreign body that lies in the esophagus. The patient was 32 years old female who had been receiving a treatment of respiratory failure induced by postoperative sepsis with assist ventilator and nasogastric tubal feeding. Sudden attack of abdominal gas distention and massive drainage of gas through N-G tube were developed during assist ventilation in that patient, so we diagnosed as tracheal stenosis with a tracheoesophageal fistula induced by prolonged endotracheal intubation We performed tracheal reconstruction and primary closure of perforated esophagus after weaning ventilator. The postoperative course was uneventiful.eventiful.

• 대한기관식도과학회지
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• 제18권2호
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• pp.41-44
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• 2012

Acquired tracheoesophageal fistula (TEF) can occur rarely from various causes. Recently, cuff-related tracheal injury after endotracheal intubation with the orotracheal tube and tracheostomy cannula is the most common etiology of nonmalignant TEF. Since cuff-related TEF is usually preventable with proper selection of the cuffed tube and close monitoring of cuff pressure. Although most patients present increased secretions, recurrent pneumonia, or coughing after swallowing, a high index of suspicion is required in patients at risk for developing a TEF. Surgical correction for the defectis required. In most cases, primary closure of the esophageal defect and tracheal resection and end-to-end anastomosis give the best results.