• 한국간담췌외과학회지
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• 제27권3호
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• pp.313-316
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• 2023

Attenuated portal vein (PV) flow is challenging in pediatric liver transplantation (LT) because it is unsuitable for classic end-to-end jump graft reconstruction from a small superior mesenteric vein (SMV). We thus introduce a novel technique of an end-to-side jump graft from SMV during pediatric LT using an adult partial liver graft. We successfully performed two cases of end-to-side retropancreatic jump graft using an iliac vein graft for PV reconstruction. One patient was a 2-year-old boy with hepatoblastoma and a Yerdel grade 3 PV thrombosis who underwent split LT. Another patient was an 8-month-old girl who had biliary atresia and PV hypoplasia with stenosis on the confluence level of the SMV; she underwent retransplantation because of graft failure related to PV thrombosis. After native PV was resected at the SMV confluence level, an end-to-side reconstruction was done from the proximal SMV to an interposition iliac vein. The interposition vein graft through posterior to the pancreas was obliquely anastomosed to the graft PV. There was no PV related complication during the follow-up period. Using a jump vascular graft in an end-to-side manner to connect the small native SMV and the large graft PV is a feasible treatment option in pediatric recipients with inadequate portal flow due to thrombosis or hypoplasia of the PV.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.444-450
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• 2020

Background Fingertip injuries are the most common type of traumatic injury treated at emergency departments and require prompt and adequate interventions for favorable wound survival outcomes. Hyperbaric oxygen (HBO₂) therapy is well known for its many positive effects on wound healing. We hypothesized that treatment with HBO₂ would improve the graft survival outcomes of amputated fingertip injuries treated with composite grafts. Methods This retrospective observational study included fingertip amputations that were treated between January 2013 and December 2017. A conventional group and an HBO₂ therapy group were statistically compared to evaluate the effect of HBO₂ treatment. Graft survival was categorized as either success or failure. Results Among 55 cases (digits), 34 digits were conventionally treated, while 21 digits were treated with HBO₂. No statistically significant differences were observed between the groups with regard to general characteristics. Among patients with guillotine-type injuries, the composite graft success rate was statistically significantly higher in the group that received HBO₂ therapy than in the conventional group (P=0.0337). Overall, the HBO₂ group also demonstrated a statistically significantly shorter healing time than the conventional group (P=0.0075). As such, HBO₂ treatment facilitates composite graft survival in cases of fingertip injury. Conclusions HBO₂ treatment was associated with an increased composite graft survival rate in guillotine-type fingertip injuries and reduced the time required for grafts to heal.

• 대한골관절종양학회지
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• 제4권2호
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• pp.81-87
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• 1998

Although autoclaved autogenous bone reconstruction is one of the established procedures, it may have some problems in bone regeneration and mechanical property. The purpose of this study is to evaluate the efficacy of more biologic and anatomical reconstruction where allograft is not readily available. From Aug.1991 to Feb. 1996 the authors analyzed 32 cases of reconstruction with autogenous low heat treated bone. Autogenous graft sites were humerus 4, tibia 4, pelvis 9, and 15 femur. Average follow-up period was 23(range;12-51) months. There were 49 graft-host junctional sites. Diaphysis was 22, metaphysis 10, and flat bone 17. Average duration of healing for the 38 united sites was 7 months. Average union time for each anatomical area 8 months in 19 diaphysis, 12 months in 7 metaphysis, and 12.7 months in 12 flat bone(pelvis). Eleven nonunion sites consisted of 3 diaphysis(3/22), 3 metaphysis(3/10), and 5 flat bone(5/17). Complications other than nonunion were local recurrence(4), bone resorption(3), graft fracture(2), osteomyelitis(1), metal failure(2), and wound infection(1). Initial bone quality and stable fixation technique was important for union rate. Plate and screw is a good method for diaphyseal lesion. Metaphyseal and flat bone are weak area for rigid fixation and one stage augmentation with iliac bone graft can be a salvage procedure.

• Journal of Chest Surgery
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• 제44권1호
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• pp.25-31
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• 2011

Background: Mature autogenous arteriovenous fistulas have better long term patency and require fewer secondary interventions compared to arteriovenous prosthetic graft. Our Study evaluated vascular patency rates and incidence of interventions in autogenous arteriovenous fistulas and grafts. Material and Methods: A total of 166 vascular access operations were performed in 153 patients between December 2002 and November 2009. Thirty seven caeses were excluded due to primary access failure and loss of follow-up. One group of 92 autogenous arterioveous fistulas and the other group of 37 arteriovenous prosthetic grafts were evaluated retrospectively. Primary and secondary patency rates were estimated using the Kaplan-Meier method. Results: The primary patency rate (84%, 67%, 51% vs. 51%, 22%, 9% at 1, 3, 5 year; p=0.0000) and secondary patency rate (96%, 88%, 68% vs. 88%, 65%, 16% at 1, 3, 5 year; p=0.0009) were better in autogenous fistula group than prosthetic graft group. Interventions to maintain secondary patency were required in 23% of the autogenous fistula group (average 0.06 procedures/patient/year) and 65% of prosthetic graft group (average 0.21 procedures/patient/year). So the autogenous fistula group had fewer intervention rate than prosthetic graft group (p=0.01) The risk factor of primary patency was diabetus combined with ischemic heart disease and the secondary patency's risk factor was age. Conclusion: Autogenous arteriovenous fistulas showed better performance compared to prosthetic grafts in terms of primary & secondary patency and incidence of interventions.

• 대한정형외과학회지
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• 제56권1호
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• pp.14-25
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• 2021

성공적인 전방십자인대 재건술을 얻기 위해 수술 전 계획, 수술수기, 수술 후 재활 등 여러 가지 요소가 관여한다. 그리고 좋은 결과를 얻기 위해서 수술 중 이식건의 선택, 고정, 처리 방법, 성숙, 본체골에 병합, 장력 등을 고려해야 한다. 이식건을 선택할 때 이식건의 강도, 이식건의 고정방법, 고정부위 치유, 공유 부위 이환, 이식건의 표면적 크기 등을 고려해야 한다. 이식건에는 자가건과 동종건의 두 가지가 있다. 자가 슬개건, 슬괵건, 대퇴사두건 등 사용할 수 있는 자가건은 여러 가지가 있으며 각각의 장·단점을 가지고 있다. 최근 국내에서 동종건의 사용빈도가 높아지고 있는데 공여부의 이환이 없고, 수술 시간이 짧고, 수술 후 통증이 적고, 재료가 다양한 장점이 있다. 하지만 동종건이 자가건보다 장기간 추적 결과가 더 좋다는 보고는 없다. 동종건은 골과의 합병이 오래 걸리고, 불완전하며, 인대 재형성이 늦고, 생역학적으로 자가건보다 강도가 낮으며, 면역반응의 위험성이 높고, 질병 전파의 가능성 등 원초적인 제한점을 가지고 있다. 그래서 장기간 결과에서 실패율이 높고 이식건의 성숙도가 자가건보다 좋지 않다. 그러므로 동종건은 자가건의 대용이 될 수 있지만 자가건을 사용할 수 없을 때, 여러 가지 인대 재건술이 필요한 경우를 제외하고 자가건을 사용하도록 하는 것이 좋다. 만약 적절한 크기와 굵기의 자가건을 얻을 수 있다면 자가건을 사용한 적절한 고정방법을 선택하고 수술 후 재활을 하면 동종건을 사용한 결과보다 우수한 결과를 얻을 것으로 생각된다.

• 대한두경부종양학회지
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• 제17권2호
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• pp.216-220
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• 2001

There are many approaches in surgery of posterior hypopharyngeal wall cancer according to location, extent, and invasion depth of primary cancer. And many reconstruction methods have been used in reconstruction of surgical defect remaining after wide resection of primary cancer. Posterior hypopharyngeal wall cancer is relatively rare, so its surgical experiences are fewer than those of pyriform sinus cancer and there have been few reports of surgical approaches and reconstruction methods of posterior hypopharyngeal wall cancer. Recently, we experienced a case of posterior hypopharyngeal wall cancer reconstructed with longus colli flap and skin graft after failure of radial forearm free flap in a 72-year -old man and report it with the review of the literatures.

• Clinical and Experimental Pediatrics
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• 제49권12호
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• pp.1329-1339
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• 2006

목 적 : 조혈모세포이식은 혈액암뿐만 아니라, 유전 질환, 면역질환에서 완치의 방법으로 널리 사용되고 있다. 그러나 생착 실패나 재발로 인해 조혈모세포이식이 실패하는 경우가 종종 있고, 이때는 장기 생존이 거의 불가능한 것으로 알려져 있으며, 치료방법도 정립되지 않았다. 이에 본 저자들은 1차 이식이 실패한 경우 치료법으로써 2차 이식의 의의에 대해 알아보고자 하였다. 방 법 : 1991년 5월부터 2004년 12월까지 전남대학교병원 소아과에서 조혈모세포이식을 시행한 115례 중에서 생착 실패나 재발로 2차 이식을 시행한 비혈액암 8례(재생불량성빈혈 7례, 부신백질이영양증 1례)와 혈액암 7례(급성골수성백혈병 3례, 급성림프구성백혈병 2례, 만성골수성백혈병 1례, 골수이형성증후군 1례), 총 15례의 의무기록지를 바탕으로 치료 방법, 합병증, 치료성과 등에 대해 분석 하였다. 결 과 : 비혈액암의 경우 2례는 일차성 생착 실패, 5례는 후기 이식편 거부, 1례는 Fanconi 빈혈로 1차 이식 후 급성골수성백혈병으로 전환되어 2차 이식을 시행하였다. 1차 이식 후 이식편기능 부전까지 기간은 중앙값 130.5일(범위, 59-279일)이었고, 1차와 2차 이식 사이의 간격은 중앙값 348일(범위, 86-1,875일)이었다. 전처치는 7례에서 cyclophosphamide를 기본으로 하였고, fludarabine을 3례에서, 방사선 조사를 2례에서 사용하였다. 이식원은 6례에서 조직형 일치 형제간 말초조혈모세포를, 1례에서 조직형 일치 형제간 골수를, 1례에서 제대혈을 사용하였고, 제대혈을 사용한 1례를 제외한 7례는 2차 이식의 공여자가 1차 이식 시와 동일하였다. 급성 이식대숙주병은 1례에서 Grade IV로 발생하였다. 총 8례 중 2례가 사망하였고, 1례는 생착 실패하였으나 생존하여, 5년 Kaplan-Meier(K-M)전체생존율은 75.0%, 무병생존율은 62.5%이었다. 혈액암의 경우 모두 재발로 인해 2차 이식을 시행하였다. 1차 이식 후 재발까지 기간은 중앙값 174일(범위, 90-1,474일)이었고, 1차 이식과 2차 이식 사이의 간격은 중앙값 319일(범위, 178-1,715일)이었다. 전처치는 5례에서 fludarabine, busulfan, antithymocyte globulin 병합요법을, 1례는 busulfan, ara-C, idarubicine 병합요법을, 나머지 1례는 melphalan, busulfan 병합요법을 사용하였다. 이식원은 5례는 1차 이식과 동일한 공여자의 말초조혈모세포였고, 나머지 2례는 제대혈을 사용하였다. grade II 이상의 급성 이식대숙주병은 2례에서 발생하였다. 사망한 5례 중 4례는 재발로, 나머지 1례는 이식관련 합병증으로 사망하였다. 2년 K-M 전체생존율과 무병생존율은 각각 28.6%이었다. 결 론 : 조혈모세포이식을 시행하고 이식편 거부나 재발이 된 경우 2차 이식은 일부 환자에서 장기 생존을 가능하게 하는 방법이 될 수 있다. 비혈액암 질환, 특히 재생불량성빈혈에서 생착 실패를 보이는 경우 2차 이식을 시행하는 것을 추천할 수 있지만, 적절한 전처치와 이식원에 관한 연구가 더 필요하겠고, 혈액암 질환에서 재발한 경우에는 소수에서만 장기 생존이 가능하므로 더욱 효과적인 항백혈병 치료가 필요할 것으로 사료되었다.

• Childhood Kidney Diseases
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• 제10권2호
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• pp.219-227
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• 2006

Purpose : We aim to identify the clinical and demographic characteristics in children who underwent renal transplantation(RTx) and to evaluate the influence on growth of RTx in children. Methods : We reviewed 17 medical records of chronic renal failure patients who underwent RTx from April 1992 and June 2004 at Busan Paik Hospital. Age and sex distribution, cause of disease, donor analysis, patient and graft survival rate, and the status of growth after RTx were analysed by retrospective study. Results : Eighteen RTx were performed in 17 patients(8 boys, 9 girls). The mean age at the time of RTx was $15.8{\pm}3.5$ years and the mean duration of dialysis therapy before RTx was $22.4{\pm}18.0$ months. The 1 year and 5 year patient survival rate were each 100%, and the 1 year and 5 year graft survival rate were 88%, 36% respectively. The most common cause of graft failure was chronic rejection. The mean final height of male patients was $162.8{\pm}10.0$ cm(143.0-172.5 cm) and of female patients was $154.5{\pm}12.1$ cm(135.8-160.0 cm). The mean height standard deviation score(Ht SDS) increased after RTx from -1.95 to -1.53 but the increment rate was not statistically significant. Similar changes were noted in individual patient analysis. Also there was no significant difference between the living-related donors and cadaveric donors. Conclusion : Our data shows that even successful RTx rarely results in full growth rehabilitation. To overcome retarded growth in children with chronic renal failure, appropriate combined management of metabolic and nutritional problems, correction of anemia, proper use of recombinant growth hormone therapy, early renal transplantation and shortening of the duration of dialysis would be necessary.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권4호
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• pp.359-362
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• 2011

Purpose: This study evaluated the clinical applications of implant placement and guided bone regeneration using a mineralized bone allograft and a barrier membrane derived from ox pericardium Methods: From January 2007 to June 2009, among the patients who received an implant at Chosun University Dental Hospital, patients were selected if they were treated with guided bone regeneration (GBR) with simultaneous implant placement or GBR prior to implant placement. The selected patients were sorted according to the materials and membranes used in GBR, and the implant survival rate was recorded by clinical examination and reviewing the medical records and the radiographs. Each study list was analyzed by SPSS (version 12.0, SPSS Inc., USA) software and the survival rate was verified by Chi-square tests. $P$ values less than 0.05% were deemed significant. Results: 278 implants were placed on a total of 101 patients and 8 implants resulted in failure. Three implants failed among 15 implants with only a mineralized bone allograft. No failure was shown among the 74 implants placed with mineralized bone allograft and a barrier membrane derived from ox pericardium. One group of 4 implant placements showed failure among the 102 implants placed with a mineralized bone allograft and another bone graft material. The group that had a barrier membrane derived from ox pericardium with a mineralized bone allograft or other bone materials showed no implant failure. Three failures were shown among the 21 implants placed with only bone graft and not using a membrane. The group with membranes other than a barrier membrane derived from ox pericardium showed 5 failures among 170 implants. Conclusion: The implant survival rate of the group with GBR using a mineralized bone allograft was 96.3%, which meant there was little difference compared to the groups of another bone graft materials (98.9%). The implant survival rate of the group without a membrane-was 85.7% and it showed a significant difference compared to the group using a barrier membrane derived from ox pericardium (100%) and the group using another membrane (97.1%).

• 구강회복응용과학지
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• 제28권1호
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• pp.1-13
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• 2012

짧은 임플란트는 상악동이나 하치조신경 등의 해부학적 구조물이 있거나 심한 치조골 흡수로 인해 제한적인 치조제 높이를 가지는 부위에서 사용되고 있다. 본 연구는 길이 10 mm 이하의 임플란트에서 임플란트의 길이, 직경, 식립 부위, 골이식술 유무, 보철물의 연결고정 유무가 임플란트의 생존율과 변연골 흡수에 미치는 영향을 알아보고자 하였다. 원광대학교 치과병원 임플란트센터에서 길이 10 mm 이하의 임플란트를 식립한 137명의 환자, 227개 임플란트를 대상으로 진료 기록부를 통해 임플란트의 길이, 직경, 식립 위치, 골이식 유무, 보철물의 연결고정 유무를 조사하였다. 변연골 흡수량은 Emago advanced v5.6(Oral diagnostic systems, Amsterdam, The Netherlands) 프로그램을 이용하여 측정하였다. 총 227개의 임플란트 중 8개가 실패하여, 전체 짧은 임플란트의 생존율은 96.5 %로 나타났다. 골이식 부위와 상악에 식립된 경우 더 높은 실패율을 보이는 경향이 있었으며, 임플란트의 길이와 직경은 변연골 흡수량에 영향을 미치지 않았다. 실패 요인을 조사하였을 때, 상악의 불량한 골질과 골이식 유무가 임플란트의 더 높은 실패율에 영향을 미쳤다. 10 mm 이하 임플란트에서 길이, 직경, 식립 부위, 골이식술과 보철물의 연결 고정은 임플란트 생존율과 변연골 흡수량에 영향을 끼치지 않았다.