• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.36 no.2
• /
• pp.62-66
• /
• 2014

Osteoradionecrosis is one of the most serious complications of patients receiving radiation therapy. It is characterized by hypovascularity, hypocellularity, and hypoxia-inducing necrosis of bone and soft tissue following delayed healing. In this case, a 72-year-old man was referred to the Department of Oral and Maxillofacial Surgery complaining of trismus following extraction three months before first visit. He had a history of right tonsillectomy, radical neck dissection and radiotherapy performed due to right tonsillar cancer seven years prior. After the diagnosis of osteoradionecrosis on right mandibular body and angle, conservative antibiotic therapy was used first, but an orocutaneous fistula gradually formed, and extensive bony destruction and sequestrum were observed. Sequestrectomy, free particulated iliac bone and umbilical fat pad graft were performed via a submandibular approach under general anesthesia. Preoperative regular exams and delicate wound care led to secondary healing of the wound without vascularized free flap reconstruction.

• Archives of Plastic Surgery
• /
• v.47 no.2
• /
• pp.187-193
• /
• 2020

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.

• Membrane Journal
• /
• v.31 no.4
• /
• pp.268-274
• /
• 2021

One of the chronic problems in the issue of global warming is the emission of greenhouse gases. Carbon dioxide (CO₂), which accounts for the highest proportion of various greenhouse gases, has been continuously researched by humans to separate it. From this point of view, a poly(vinyl alcohol) (PVA)-based copolymer with acrylic acid monomer was utilized in a gas separation membrane in this study. We employed a free radical polymerization to fabricate PVA-g-PAA (VAA) graft copolymer. It was utilized in the form of a composite membrane on a polysulfone substrate. The proper amount of acrylic acid reduced the crystallinity of PVA and increased CO₂ solubility in separation membranes. In this perspective, we suggest the novel approach in CO₂ separation membrane area by grafting and solution-diffusion.

• Archives of Plastic Surgery
• /
• v.48 no.3
• /
• pp.329-332
• /
• 2021

Calcific myonecrosis is a rare condition in which hypoperfusion due to compartment syndrome causes soft tissue and muscle to become calcified. As calcific myonecrosis gradually deteriorates, secretions steadily accumulate inside the affected area, forming a cavity that is vulnerable to infection. Most such cases progress to chronic wounds that are unlikely to heal spontaneously. After removing the calcified tissue, the wound can be treated by primary closure, flap coverage, or a skin graft. In this case, a 72-year-old man had extensive calcific myonecrosis on his left lower leg, and experienced swelling and increasing tenderness. After removing the muscle calcification, we combined two anterolateral thigh free flaps, which were harvested from the patient's right and left thigh, respectively, to reconstruct the wound with a dead-space filler and skin-defect cover at the same time. The patient recovered without revision surgery or major complications.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.34 no.6
• /
• pp.398-403
• /
• 2012

Purpose: Mandible resection and discontinuity defect created lead to aesthetic and functional problems. The iliac crest bone graft exhibits relative ease for bone harvesting, possibility of two team approach, ability to close the wound primarily, large amount of corticocancellous bone and relatively few complications. Whereas the use of free vascularized flaps has donor site morbidity and worse-fitting bone contour, the use of nonvascularized iliac bone graft has advantages in the operation time and patients' recovery time. So, nonvascularized iliac bone graft could be an attractive option. Methods: Twenty-one patients (M:F=1:1.1) underwent iliac crest bone harvesting for reconstruction of mandibular discontinuity defect (mean length : $61.6{\pm}17.8$ mm), from May 2005 to October 2011 at the Department of Oral and Maxillofacial Surgery in Kyungpook National University. The average age was $44.1{\pm}16.4$ years and the mean follow up periods was $28.2{\pm}22.7$ months. Bone resorption rate, according to age, sex, primary lesion, location and distance of defect, type of fixation plate, time of graft and pre-operative radiation therapy, were measured in each patient. Results: The mean bone resorption rate was $16.1{\pm}9.0%$. Bone resorption rate was significantly increased in mandibular defect that is over 6 cm in size (P=0.015, P<0.05) and the cases treated pre-operative radiation therapy (P=0.017, P<0.05). All was successfully fixed and maintained for the long-term follow-up. There were a few donor site complications and almost all patients were shown favorable outcome without severe bone resorption in this study. Conclusion: The nonvascularized iliac bone graft seems to be a reasonably reliable treatment option for reconstruction of mandibular discontinuity defects.

• Archives of Plastic Surgery
• /
• v.36 no.5
• /
• pp.578-582
• /
• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Archives of Plastic Surgery
• /
• v.38 no.1
• /
• pp.27-34
• /
• 2011

Purpose: Anterolateral thigh (ALT) perforator free flap is commonly used because of its various benefits. The author reports important factors of preoperative and perioperative ALT perforator free flap and causes of failure. Methods: 84 patients who were treated with ALT perforator free flap from December 2004 to 2008, and February 2010 to April 2010 were studied. 61 patients were male and 23 were female. The mean age of patients was 51.1. The main cause was neoplasm and the main reconstructive areas were head and neck area. The size of flap was various from $3{\times}4$ to $12{\times}18$ cm. 6 patients received split thickness skin graft at donor site. Preoperative angiography was checked to all patients. Results: Among the 84 patients, partial necrosis of flaps occurred in 4 patients because of atherosclerosis, varicose vein, or inattention of patient, etc. And total flap necrosis in 5 patients because of abnormal vessels of recipient area or delay of operation, etc. One case of serous cyst was found as the complication of donor area. Two cases of skin graft on donor site were done because of suspected muscle compartment syndrome, 4 cases of that because of large flap. Septocutaneous perforators were found in 7 cases. The author couldn't find reliable perforator in 3 cases, ipsilateral anteromedial thigh perforator and contralateral ALT perforator and latissimus dorsi musculocutaneous free flap were done instead of ALT. There was no case which needed reoperation because of the impairment of blood supply, and 3 cases were revised by leech because of the burn injury by a lamp or venous congestion. Conclusion: Although ALT perforator free flap is widely used with its various merits, many factors such as preoperative condition of donor or recipient area, morphology of defect and operating time need to consider to prevent flap necrosis. And operators should need careful technique because septocutaneous perforator is uncommon, and musculocutaneous perforator is common but difficult to dissect.

• Journal of Chest Surgery
• /
• v.53 no.6
• /
• pp.353-360
• /
• 2020

Background: Most abdominal aortic aneurysms are degenerative atherosclerotic aneurysms. Inflammatory or infected abdominal aortic aneurysms, which show a slightly different clinical course, are rarely encountered in clinical settings. Therefore, we aimed to investigate the clinical course of these variants of abdominal aortic aneurysms. Methods: This retrospective study included 32 patients with atypical inflammatory or infected abdominal aortic aneurysms who underwent emergent graft replacement between November 1997 and December 2017. Patients were followed up at the outpatient clinic for a mean period of 4.9±6.9 years. We analyzed the patients' clinical course and compared it with that of patients with atherosclerotic abdominal aortic aneurysms. Results: There was 1 surgical mortality (3.0%) in a case complicated by aneurysmal free rupture. In 2 cases of infected abdominal aortic aneurysms, anastomotic complications developed immediately postoperatively. During the follow-up period, 10 patients (30%) developed graft complications, and 9 of them underwent reoperations; of these, 2 patients (22.2%) died of postoperative complications after the second operation, whereas 2 patients survived despite graft occlusion. Conclusion: Patients with inflammatory abdominal aneurysms frequently develop postoperative graft complications requiring secondary surgical treatment, so they require close mandatory postoperative follow-up.

• Archives of Reconstructive Microsurgery
• /
• v.1 no.1
• /
• pp.31-38
• /
• 1992

The management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In certain some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. The traditional bone grafts have high incidence in recurrence rate, delayed union, bony resorption, stress fracture despite long immobilization and stiffness of adjuscent joint. We have attemped to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle as a living bone graft. From Apr. 1984 to Nov. 1990, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 4 cases, using Vascularized Fibular Graft, which occur at the distal radius in 3 cases and at the proximal tibia in 1 case. An average follow-up was 2 years 8 months, average bone defect after wide segmental resection of lesion was 11.4cm. These all cases revealed good bony union in average 6.5months, and we got the wide range of motion of adjacent joint without recurrence and serious complications.

• Polymer(Korea)
• /
• v.36 no.2
• /
• pp.137-144
• /
• 2012

The surface of polyethylene (PE) was modified through Ar atmospheric pressure plasma treatment and subsequent grafting of glycidyl methacrylate (GMA). Optimum plasma treatment conditions were determined through analyzing the surface free energies calculated from the contact angles between PE samples and three probe liquids, which were RF-power of 200 W, plasma treatment time of 600 sec, Ar flow rate of 5 LPM, and sample-holder moving speed of 20 mm/sec. To introduce the maximum amount of GMA on PE surface treated under the conditions, graft copolymerization conditions such as GMA concentration, temperature, and time were carefully controlled. Grafting degree (GD) was obtained through weight difference analysis of PE film before and after graft copolymerization. A maximum GD was achieved at the GMA concentration of 20 vol%, the temperature of $80^{\circ}C$, and the treatment time of 4 hr.