• Archives of Plastic Surgery
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• v.37 no.1
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• pp.22-25
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• 2010

Purpose: As patients who take immediate breast reconstructions with TRAM flap have increased, concomitant or delayed other elective intra-abdominal operations in these patients also have increased. There are few reports of concomitant or delayed intra-abdominal operation in TRAM flap patients. We report our experiences and outcomes of these operations which is safe and feasible. Methods: We reviewed the charts and postoperative follow-up results of 11 patients among 471 consecutive patients who took immediate breast reconstruction with TRAM flap from December of 2002 to September of 2006. Four patients took concomitant intra-abdominal operation and 7 patients took delayed intra-abdominal operation between 1 to 52 months after TRAM flap Results: There were no significant postoperative abdominal and systemic complications. One patient who took concomitant intra-abdominal operation presented partial skin necrosis of abdomen, but recovered completely with conservative treatments. Two patients took transfusion in peri-operative periods. Conclusion: Concomitant or delayed intra-abdominal operation in immediate breast reconstruction with TRAM flap could be performed safely and feasibly when it is necessary. Furthermore, it could be helpful to patients and surgeons.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.7-12
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• 2010

Purpose: 'White-eye blowout' fracture is often occur in young patients and defined as blow out fracture with little or no clinical sign of soft tissue trauma such as edema, ecchymosis, but with marked motility restrictions in vertical gaze. In this conditions, immediate operation is essential. We reported the clinical investigation study of these cases about clinical symptoms and radiologic findings and introduce our experiences about immediate operations in 'white-eye blowout' fractures. Methods: From January 2008 to December 2009, nine pediatric patients who were diagnosed as pure white-eye blowout fractures were involved this study. Patients with other facial bone fractures or with poor general medical condition were excluded. In all cases, we performed immediate operation within 48 hours. Results: All patients had diplopia, vertical gaze restriction or systemic symptoms. Six patients had nausea, vomiting and syncope caused by oculocardiac reflex. In all patients, preoperative symptoms were improved after immediate operation. There were no postoperative complications such as infection, hematoma or wound dehiscence. Conclusion: When we meet the young patients with history of periocular trauma, with little or no soft tissue trauma signs, but with marked vertical gaze restriction or general symptoms caused by oculocardiac reflex, we should immediately examine by facial bone computed tomography and refer the patient to ophthalmologist for ophthalmic evaluations. If patient is diagnosed as orbital floor fracture with entrapped muscle or soft tissue, the earlier surgical reduction get better clinical outcomes.

• Journal of Korean Foot and Ankle Society
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• v.24 no.1
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• pp.25-30
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• 2020

Purpose: Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages. Materials and Methods: From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo-Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation. Results: The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%). Conclusion: Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.5
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• pp.265-271
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• 2003

Skeletal relapse is known as a complication following orthognathic surgery of mandibular prognathism and occurring during intermaxillary fixation period. Therefore relapse of teeth and skeleton during intermaxillary fixation period is considered as a important problem of orthognathic surgery. In this study, cephalolateral radiographs taken at pre-operation, immediate post-operation and after release of intermaxillary fixation were measured for evaluation of dental and skeletal relapse in 30 cases. The cases were classified as screw fixation group and plate fixation group, then we compared magnitude of dental and skeletal changes of each group. The results were as follows 1. The $\underline{1}$ SN angle increased at immediate post-operation with a mean value of $0.12^{\circ}$ and at intermaxillary fixation period with a mean value of $0.43^{\circ}$ (p>0.05). 2. The $\overline{1}$ MP angle decreased with a mean value of $0.14^{\circ} at immediate post-operation and with a mean value of $1.28^{\circ} during intermaxillary fixation period but there were not significant difference(p>0.05). 3. There were not significant difference in magnitude of dental position changes between screw fixation group and plate fixation group(p>0.05). 4. Gonial angle increased with a mean value of $0.62^{\circ} during intermaxillary fixation period. Each group showed changes of gonial angle during intermaxillary fixation period but there were not significant difference(p>0.05).

• Archives of Plastic Surgery
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• v.45 no.4
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• pp.340-344
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• 2018

Background In performing extended latissimus dorsi (ELD) flap procedures, a skin paddle design on the bra line helps reduce visible scarring. This improves the patient's satisfaction with the outcome. However, such a design leads to a longer operation time and increased fatigue of the surgeon due to the narrow operative field. In this study, the authors propose a method that elongates the axillary incision line posteriorly by 1.5 cm from the lateral border of the latissimus dorsi muscle. We examined whether this method could shorten the operation time and compared the incidence of complications between patients who underwent this novel procedure and patients who underwent the traditional procedure. Methods In this study of patients who underwent ELD flap procedures for immediate breast reconstruction, 89 underwent surgery with the elongated axillary incision and 45 underwent surgery without the elongated incision. The total operation time and complications were retrospectively examined based on the patients' medical records, and we examined whether there was any statistically significant difference in the total operation time. Results In the experimental group with the elongated axillary incision, the operation time ranged from 125 to 255 minutes (median, 175 minutes). In contrast, in the control group without the elongated axillary incision, the operation time ranged from 142 and 340 minutes (median, 205 minutes). The operation time was statistically significantly different between the two groups, and no significant complications were observed in the experimental group. Conclusions Elongation of the axillary incision alone may shorten the operation time of the ELD flap procedure without causing additional complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.6
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• pp.536-539
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• 2004

The apicoectomy is an operation in which the root apex is removed and the adjacent periapical pathologic tissue is curetted. In this operation, there are several factors that may lead to the surgical wound infection, such as, local, systemic, environmental, endogenous and surgical factor. The systemic medical and surgical factor that may compromise patients defense are more important cause of the wound infection. The postoperative infection is likely to occur owing to poor systemic condition(especially geriatric cancer patient with operation, radiotherapy and chemotherapy), postoperative accumulation of hematoma & seroma and other contaminated factors. So, the authors established the immediate rubber drainage into the sutured wound of dental apicoectomy for the prevention of postoperative infection. The results are more favorable without the wound infection in total 31 cases of the dentistry of Dong San Medical Center & Wonju Christian Hospital.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.5
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• pp.507-513
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• 2000

Objective : The purpose of this study is to evaluate the vitality of the teeth in and adjacent to the mandibular fracture line according to variable conditions of fracture and to establish the protocol of treatment of fracture line teeth. Materials and Methods : The vitality of 97 teeth in fracture line and 104 teeth adjacent to fracture line of 52 patients were invested preoperatively. Of these, 66 teeth in fracture line and 72 teeth adjacent to fracture line were monitored at least 6 months after operation. An electric pulp tester was used to measure pulpal response. The relationships between the vitality of teeth in variable time(preoperation, immediate post-operation; within 1 week after operation, and 6 months after operation) and variable conditions of fracture(horizontal, vertical gap of fracture line, the number of fracture line)were evaluated statistically. Result : The vitality of fracture line teeth in the 6 months after operation statistically differed by the vertical gap of fracture line and the number of fracture line. The vitality of fracture line adjacent teeth in the immediate post-operation only statistically differed by the vertical gap of fracture line. There were statistically differences between preoperative EPT value and vitality of fracture line teeth on 6 months after operation. There were 5 cases of complications including periapical and periodontal abscess. Of these, only one tooth was extracted and the others were well treated with endodontic treatment and subgingival curettage. Conclusion : It is recommended to retain teeth and to monitor the vitality of teeth in and adjacent to fracture line, unless there is an absolute indication for extraction.

• Journal of Chest Surgery
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• v.2 no.1
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• pp.25-40
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• 1969

Lung homotransplantation was performed in 15 pairs of dog. Methotrexate and R.E.S. blocking were used to prolong the survival time. Details of handling the transplant, operative technique and management of the recipient were discussed and following results were obtained: 1]. 7 dogs out of 15 dogs of homotransplantation of lung were survived beyond 3 days. In the group of dogs treated with methotrexate, the average survival was 8.5 days, and in the group of dogs treated with R.E.S. blocking, the average survial was 9.7 days with longest survival of 17 days. 2]. The causes of immediate postoperative death in homotransplantation of dogs were lung edema and disruption of bronchial anastomosis. 3]. The main causes of death in successful homotransplantation dogs which were survived beyond 3 days were infection of lung parenchyma and bronchial necrosis rather than the occurence of graft rejection. 4]. Graft rejection was not revealed even after 7 days of operation in the group treated with methotrexate as well as in the group treated with R. E.S. blocking. This finding made it suggest that the R. E.S. blocking may be effective to control the rejection reaction. 5]. Even though the pulmonary function of transplanted lung was revealed the evidence of severe impairment immediate after operation by bronchospirometry, it was increased gradually and 10 days after operation the minute ventilation and oxygen uptake were decreased 8%, 13% respectively less than pre-operative one.

• Journal of Chest Surgery
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• v.27 no.4
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• pp.328-330
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• 1994

Brachial plexus injury developing after axillary thoracotomy is an uncommon complication. But if it occurs, it may cause annoying events. We recently experienced 2 patients who developed brachial plexus injury after wedge resection by axillary thoracotomy . The first patient was a 22 year-old man with right spontaneous pneumothorax . After wedge resection of the right upper lung by axillary thoracotomy, he complained total paralysis of the right arm. An electromyogram was obtained at 7 days after operation, with the confirmation of brachial plexus injury. He was discharged at 22days after operation and brachial plexus injury was completely recovered 4 months after discharge. The second patient was a 17 year-old man with recurrent right pneumothorax. He underwent wedge resection of the right upper lung by axillary thoracotomy. Electromyogram confirmed the diagnosis of brachial plexus injury in the immediate postoperative period. He was discharged at 15 days after operation and brachial plexus injury was recovered 2months after discharge.Brachial plexus injury after axillary thoracotomy is caused by stretching around the clavicle and tendon of pectoralis minor by fixation of the abducted arm to the frame. Thus, when we perform wedge resection by axillary thoracotomy, we must avoid over-stretching of the brachial plexus in positioning. If brachial plexus injury develops, immediate attention and management with close rapport are important to avoid possible medicolegal problems.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.32-45
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• 1995

This study was intended to evaluate condyle position and the relationship of condyle position change and post surgical relapse following the sagittal split ramus osteotomy for mandible setback in 25 patients by paired t-test and multiple regression analysis. We used oblique transcranial and cephalometric radiographs taken before operation, immediate after operation, and at least 6 months post operatively. 1. In oblique transcranial view, posterior joint space was decreased immediate after operation and increased 6 months after operation. To compare the measurement before and 6 months after operation, there was no statistically significant change in over all joint spaces(P>0.05). 2. The joint spaces changed under the 0.2mm were 30%, 0.2mm to 1.0mm were 60.7%, above 1.0mm were 9.3%. This result reveals that condyle position was relatively reproduced to pre-operative state. 3. Statistically, the amount of mandible set back didn't influence the post operative relapse(P>0.05). 4. Statistically, the amount of mandible set back didn't influence the condylar displacement(P>0.05), and the amount of joint space change didn't influence the post operative relapse.(P>0.05) The changes in joint space is in the standard tracing error or within the adaptive capacity of the individual, it was too small to influence the stability of surgery.