• Journal of Chest Surgery
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• 제42권2호
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• pp.252-255
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• 2009

58세 남자 환자가 좌쇄골하동맥협착이 동반된 관상동맥 질환으로 하이브리드술식을 시행받았다. 쇄골하동맥에 대한 스텐트 삽입과 좌내흉동맥의 좌전하행지 문합을 포함한 심폐 바이패스 없이 관상동맥 우회술을 시행하였다. 수술 후 시행한 관상동맥 조영술과 컴퓨터 단층촬영(CT)상에서 이식편의 개방성은 양호하였고 스텐트의 삽입부위는 적절한 것으로 보였고 개방성도 양호하였다. 술 후 8일째 퇴원하였고, 현재 6개월째 외래 경과관찰 중이다.

• Journal of Chest Surgery
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• 제41권1호
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• pp.133-136
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• 2008

흉부둔상에 의한 내유동맥의 손상은 매우 드문 경우이다. 또한, 그로 인한 흉막외혈종과 종격동혈종의 발생도 매우 드물며 빠른 진단과 적극적인 치료가 요구된다. 교통사고에 의한 흉부둔상으로 앞가슴통증을 주소로 내원한 59세 남자에서 발생한 내유동맥의 손상으로 인한 흉막외혈종과 종격동혈종 1예를 진단하여 수술치험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1190-1196
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• 1997

1994년 7월부터 1995년 8월까지 서울대학교병원 흉부외과에서 시행한 관상동맥 우회술 78례 중 49례 (62,8%)에서 수술 1년 후 관상동맥 조영술을 시행하여 이식 혈관의 개존성을 조사하였으며, 수술 전,후 및 수술과 관련된 여러 위험 요소들이 개존성에 미치는 영향에 대하여 분석하였다. 관상동맥 우회술 후 평균 13.4$\pm$2.1개월 째에 관상동맥 조영술을 시행하였다. 내유동맥으로 문함을 시행한 60개소 중 3개소에서 string sign을 보였으나, 폐쇄 없이 전례에서 개존성이 유지되었으며, 요골동맥으로 문합을 시행한 4개소는 모두 개존성이 유지되었다. 복제정맥으로 문합을 시행한 81개소 중 69개소(85.2%)에서 개존성이 유지되었으며, 12개 소(14.8%)에서 폐쇄되었다. 개존성에 미치는 위험요소로 수술 전,수술 중 그리고 합병증 등의 수술 후 요소로 나누어 일원적 및 다원적으로 분석하였으며, 내유동맥의 협착 과 복재정맥의 개존성, 폐쇄에 미치는 요소들을 분석하였다. 내유동맥은 환자의 연령(60세 이상),수술 후 대동맥 내 풍선펌프의 삽입,수술 후 출혈, 및 급성신부전 등 합병증이 이식 혈관의 협착과 관련된 위험 인자였으며, 복제정맥은 우회술을 시\ulcorner 받은 관상동맥의 직경이 1.5mm 이하인 경우가 이식 혈관의 폐쇄 위험성과 관련된 위험 인자로 분석되었다(p<0.05). 관상동맥 우회술 1년 후 이식 혈관의 개존성은 내유동맥이 복재정맥보다 우수함을 보였으며 환자 연령 수술 후 대동맥 내 풍선펌프의 삽입여부, 출혈, 급성 신부전 등의 합병증 및 문합된 관상 동맥의 직경 등이 개존에 관련된 요소로 분석되었다. 이러한 결과를 토대로 수술 후 이식혈관의 폐쇄 여부에 대한 11측과 수술 방법이나 수술 후 환자의 추적 관찰에 도움을 줄 수 있으리라 생각된다.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.750-754
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• 2009

Purpose: The thoracodorsal vessels have been the standard recipient vessels for the majority of surgeons performing free abdominal flap breast reconstructions. Recently, the internal mammary vessels have been recommended as the first - choice recipient vessels for microvascular breast reconstruction. To approach the internal mammary vessel, 3rd or 4th rib cartilage excision is needed, but this method has some demerits - vessel injury, post operative pain and post operative chest hollowness. So, authors propose the approach method to the internal mammary vessel through intercostal space without rib cartilage resection. Methods: From November, 2008 to May, 2009, 13 patients underwent free abdominal flap breast reconstruction with approach to the internal mammary vessel through intercostal space without rib cartilage resection. Results: The mean patient age was 41.8 years, and the mean height was 159.3 cm. 11 patients underwent immediate breast reconstruction. Free DIEP flap reconstruction was performed in 7 patients, Free TRAM flap was performed in 5 patients, and Free SIEA flap was performed in 1 patient. Except 1 case, approach to the internal mammary vessel was took through 3rd intercostal space, and all width of intercostal space exceeded 1 cm. Conclusion: In the authors' experience, use of approach to the internal mammary vessels without rib cartilage resection method is safe and reliable to overcome demerits of rib cartilage resection method.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.569-573
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• 2007

Purpose: The selection of the recipient vessels in breast reconstruction has a great influence on the surgical result and the shape of the reconstructed breast. We would like to introduce the criteria for the selection of recipient vessels in delayed reconstruction of the breast. Methods: We studied 56 patients with delayed breast reconstruction using free TRAM flaps from April 1994 to December 2006. The thoracodorsal and the ipsilateral internal mammary vessels were used as recipients in 25 patients each, the opposite internal mammary vessels in 3 patients, the thoracoacromial vessels in 2 patients, and the transverse cervical artery with the cephalic vein in 1 patient. The survival rate of the flaps, the vessel diameter, the length of the pedicles, and the convenience of vessel dissection were studied. Results: The diameter of the recipient vessel did not influence the anastomosis. The operation time, the survival rate of flap, the postoperative complications showed no significant difference according to the recipient vessel. Dissection of the thoracodorsal vessels was tedious due to scar formation from the prior operation. Dissection of the internal mammary vessels proved to be relatively easy, and the required length of the pedicle was shorter than any other site, but the need for removal of rib cartilage makes this procedure inconvenient. Conclusion: The first choice of the recipient vessel in immediate breast reconstruction is the thoracodorsal vessels, but in cases of delayed reconstruction the internal mammary vessels are favored as the first choice, because the thoracodorsal vessels have a high unusability rate. If the ipsilateral internal mammary vessels prove to be useless, the contralateral vessels can be used. The thoracoacromial vessels are useful, when the mastectomy scar is located in the upper portion. The transverse cervical artery and the cephalic vein can serve as the last resort, if all other vessels are unreliable.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.502-508
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• 2017

Background Breast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation. Methods To date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study. Results We applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site. Conclusions In our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.

• Journal of Chest Surgery
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• 제36권10호
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• pp.728-733
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• 2003

동맥편만을 이용한 관상동맥 우회술을 위한 한 방법으로 양측성 내흉동맥을 이용한 관상동맥우회술의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2001년 12월까지 서울아산병원 흉부외과에서 심폐바이패스를 사용하지 않는 관상동맥 우회술을 시행받은 139명의 환자를 대상으로 의무기록을 이용한 후향적 분석을 시행하였다. 전체환자를 양측성 내흉동맥을 사용한 환자군을 양측 내흉동맥군(bilateral internal thoracic artery; BITA group, n=85), 단일 내흉동맥을 사용한 환자군을 단일 내흉동맥군(single internal thoracic artery; SITA group, n=54)으로 나누었고 수술결과를 비교하였다. 결과: 수술에 따른 사망은 양 군에서 각각 1예씩 발생하였다. 중환자실 재원일 및 퇴원기간은 양 군 간에 차이를 보이지 않았다(BITA군: 2.4$\pm$1.7일, 11.2$\pm$17.7일, SITA군 2.8$\pm$2.7일, 9.7$\pm$7.1일, p>0.05). 문합혈관수는 BITA군이 3.9$\pm$0.7개, SITA군이 3.1$\pm$0.8개로 BITA군이 더 많았다. 술 후 심근경색은 7예(BITA군 2예, SITA군 5예)에서 발생하였고 심부 흉골감염이 4예(BITA군 3예, SITA군 1예)발생하여 재수술이 시행되었다. 수술 직후 104명의 환자에서(BITA군 64/85, SITA군 40/54명) 관상동맥 조영술이 시행되었고 좌전하행지로의 문합부위 협착이 4예(BITA군: 2예, SITA군: 2예)에서 관찰되었다. 전체 관찰기간 동안의 문합부위 협착 발생은 총 8예였고 이 중 3명의 환자에서 경피적 관상동맥 성형술이 시행되었으며 관상동맥 우회술을 재시행한 경우는 얼었다. 걸론: 관상동맥 우회술 시행시 양측 내흉동맥의 사용은 수술 전후 이환율에서 큰 차이 없이 만족할 만한 개통률을 얻으면서 동맥편만을 이용한 관상동맥 우회술을 가능케 하는 유용한 대안이 될 수 있으리라 생각한다.

• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.28-33
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• 2001

The numbers of breast cancer are increasing in Korea and the needs for breast reconstruction are also parallel with cancer frequency. The purpose of the study is to define the different state and condition between the delayed reconstruction and the immediate reconstruction of breasts and to suggest how to get more satisfactory outcome. The study included 22 patients who underwent delayed breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) free flap from December, 1990 to January, 2001. Their ages ranged from 28 years to 58 years. We have used internal mammary artery and vein as a recipient vessel in 13 patients because of fibrosis and severe scarring in the axillary region and thoracodorsal artery and vein in 9 patients. When we used internal mammary artery with recipient vessel, we would use contralateral deep inferior epigastric artery with donor vessel. We obtained satisfactory result without any flap loss, and most patients satisfied with shape and volume of reconstructed breast. We found that delayed breast reconstruction have some differences compared with immediate breast reconstruction. First, we remove fibrotic and scar tissue as much as possible to achieve satisfactory shape of breast. Second, we plan preoperative design in standing position to obtain symmetrical recreation of inframammary fold. Third, we use internal mammary vessel in many cases with recipient vessel for microvascular anastomosis. Fourth, patients with delayed breast reconstruction feel more satisfaction than patients with immediate breast reconstruction do. Finally, economic burden is much higher in the delayed case than in the immediate case because of no coverage with insurance.

• 한국응급구조학회지
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• 제9권1호
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• pp.89-93
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• 2005

Penetrating chest trauma by stab injury may result in massive hemothorax from damage to single or multiple intrathoracic organs such as heart, aorta, internal mammary artery, intercostal artery or pulmonary parenchyme. Prognosis of massive hemothorax necessitating emergency thoracotomy is fatal especially so if there exists concomitant underlying compromise of cardiopulmonary function. A 56 year old man with destroyed left lung due to old pulmonary tuberculosis was stabbed in right parasternal lesion through third intercostal space. Intubation with cardiopulmonary resuscitation and closed thoracostomy were performed to resuscitate from cardiac asystole from hemorrhagic shock and acute respiratory distress. Midsternotomy was made to expose active bleeding foci in right mammary artery, subclavian vein, intercostal artery and anterior segment of right upper lung showing severe bullous change and pleural adhesion. Postoperative care included ventilator support, inotropic instillation and cautious, balance fluid therapy ; successful extubation was done on third postoperative day and patient was discharged on tenth postoperative day without any complication.

• Journal of Chest Surgery
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• 제47권5호
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• pp.465-467
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• 2014

We present a patient who developed recurrent angina after coronary artery bypass grafting (CABG). Myocardial single-photon emission computed tomography (SPECT) demonstrated deterioration in the myocardial perfusion, and coronary angiography revealed an overgrown side branch of the grafted left internal thoracic artery (ITA); otherwise, there were no significant changes compared with previous imaging studies obtained after the CABG. After percutaneous embolization of the grafted left ITA side branch, the angina was resolved and myocardial SPECT showed improved perfusion.