• Journal of Chest Surgery
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• 제46권5호
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• pp.340-345
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• 2013

Background: This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods: Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of $16.5{\pm}9.7$. Group II comprised 14 female and 3 male patients with an average age of $18.5{\pm}9.8$ showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was $1.8{\pm}0.2$. The average pulmonary artery pressure was $35{\pm}10$ mmHg. Following the diagnosis, performing elective surgery was planned. Results: No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion: To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권4호
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• pp.300-305
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• 2005

Purpose: For the reconstruction of maxillofacial defect created by trauma, infection, or tumor etc, the role of microvascular anastomosis or vessel graft has been increased. Many methods has been tried to increase the success rate of microvascular anastomosis. Various anticoagulants and thrombolytic agents have been used to reduce the failure rate of microvascular anastomosis and avoid re-operation. Many drugs, however, have been used in the limited cases because most of these drugs may cause complications, such as allergy, fever or systemic bleeding. This study was performed to evaluate the influence of the Argatroban on patency and thrombosis in microvascular anastomosis when it is used for local irrigation or general administration. Materials & methods: Eight mature rabbits, weighing 2kg, were used. After exposing both femoral veins, the artificial thrombotic model was made by crushing injury using a smooth needle holder, and the transverse incision were made on femoral vein. The animals were divided into 4 groups according to Argatroban administration methods; control group (n=4), topical irrigation of lumen with saline solution; experimental group 1 (n=4), topical irrigation of lumen with Argatroban saline solution; experimental group 2 (n=4), topical irrigation of lumen with heparin followed by intravenous injection of Argatroban; experimental group 3 (n=4), topical irrigation of lumen with Argatroban followed by IV of Argatroban. Microvascular anastomosis was done with 10-0 Ethilon. The patency was evaluated by empty-and-refill test 30 minutes and 3 days after microanastomosis. The thrombus formation was examined 3 days after microanastomosis by surgical microscope. The histologic findings were also examined. Results: 1. Thirty minutes after microvascular anastomosis, the patency of all experimental groups was better than that of control group, but there was no significant difference among groups. 2. Three days after microvascular anastomosis, the patency of all experimental groups was more improved than that of control group (p<0.05). There was no significant difference among experimental groups. 3. Three days after microvascular anastomosis, the amount of thrombus in all experimental groups was less than that of control group (p<0.05). There was no significant difference among experimental groups. 4. Histologically, a lot of luminal thrombus was observed around sutured area in control group. Few luminal thrombus was observed in all experimental groups. The necrotic changes were observed on the sutured vein wall in all specimens. Conclusion: These results indicate that topical irrigation and/or intravenous administration of Argatroban is effective in improving patency and preventing thrombus formation after microvascular anastomosis.

• 대한두개안면성형외과학회지
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• 제20권2호
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• pp.101-108
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• 2019

Background: To date, a variety of surgical approaches have been used to reconstruct the medial orbital wall fracture. Still however, there is still a controversy as to their applicability because of postoperative scars, injury of anatomical structures and limited visual fields. The purpose of this study was to introduce a useful additional medial subbrow approach for better reduction and securement more accurate implant pocket of medial orbital wall fracture with the subciliary technique. Methods: We had performed our technique for a total of 14 patients with medial orbital wall fracture at our medical institution between January 2016 and July 2017. All fractures were operated through subciliary technique combined with the additional medial subbrow approach. They underwent subciliary approach accompanied by medial wall dissection using a Louisville elevator through the slit incision of the medial subbrow procedure. This facilitated visualization of the medial wall fracture site and helped to ensure a more accurate pocket for implant insertion. Results: Postoperative outcomes showed sufficient coverage without displacement. Twelve cases of preoperative diplopia improved to two cases of postoperative diplopia. More than 2 mm enophthalmos was 14 cases preoperatively, improving to 0 case postoperatively. Without damage such as major vessels or extraocular muscles, enophthalmos was corrected and there was no restriction of eyeball motion. Conclusion: Our ancillary procedure was useful in dissecting the medial wall, and it was a safe method as to cause no significant complications in our clinical series. Also, there is an only nonvisible postoperative scar. Therefore, it is a recommendable surgical modality for medial orbital wall fracture.

• Journal of Chest Surgery
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• 제32권6호
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• pp.556-560
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• 1999

자연기흉에 대한 정확한 원인은 아직 밝혀지지 않았으나 기포의 파열에 의한 흉곽내로의 공기가 누출되면서 발생한다. 이들 재발성 기흉의 수술적 방법에는 비디오 흉강경을 이용하거나 액와개흉술등의 여러 가지 수술방법으로 치료할수 있으나 기포절제술후에도 수술방법에 따라 0.3%~20%까지의 재발과 재수술이 보고되고 있다. 연세대학교 영동세브란스병원 흉부외과에서 1992년 11월부터 1997년 6월까지 737례의 기흉환자에서 기포절제 수술을 받은 446례의 자연기흉환자중 다시 기흉이 재발한 16례(3.5%)에서 재수술을 하였다. 남녀의 비는 15:1 이었고 처음 자연기흉이 발생한 평균나이는 20.2세(범위 15~50세) 였으며 평균 재원일수는 6.3일(범위 1~20일), 평균 흉관 보유기간은 4.2일(범위 1~10일)이었다. 평균추적기간은 46개월(범위 10-66개월)이었다. 처음수술은 비디오 흉강경, 액와 개흉술, 그리고 제한적인 측방개흉술등 3가지의 방법으로 시행하으며 비디오흉강경을 이용한 281례중 14례에서 재발하였으며 액와 개흉술 159례중 2례에서 재발하였고 제한적인 측방 개흉술을 시행한 6례에서는 재발이 없었다. 재수술방법은 다시 비디오흉강경을 이용하였던 예가 6례,액와 개흉술을 시행하였던 예가 9례, 제한적인 측방 개흉술이 필요하였던 예가 1례에서 있었다. 재수술한 경우 수술소견은 9례의 overlooking type과 new growing typ 7례였으며 재발과 처음수술간의 기간은 overlooking type 1개월, new growing typ 18개월이었다. 재발율이 높은 자연기흉은 기흉의 발생횟수, 다발성 기 汰\ulcorner존재, subpleural fibrosis와 폐실질의 emphysematous한 변화 등이었으며 비디오 흉강경을 이용한 기포절제술은 액와개흉술에 비해 높은 재발율을 보였다(4.9% vs 1.2%). 이와 같은 결과로 비디오 흉강경을 이용한 기포절제술의 경우 재발을 방지하기 위하여 over-looking type은 적절한 수술 전 검사와 수술 중 굴절이 가능하며 영상이 선명한 비디오 흉강경의 사용으로 보다 세밀한 기포의 관찰을 함으로써 over-looking type 의 재발을 줄일 수 있으며 기포 절제 시 좀더 세심한 기구의 조작과 완전한 기포절제와 정상조직을 포함한 봉합이나 stapling으로 병소 부위가 남아 있지 않도록 주의하면서 봉합과 stapling 주위의 공기 누츨이나 부적합한 기구 사용 등의 세심한 관찰과 보강 봉합수술 및 조직 접합제 도포 등으로 new growing type을 줄일 수 있을 것으로 사료되며 그 외로 수술 후 약물이나 전기 소작기에 의한 적절한 늑막유착술등의 재발을 줄이기 위한 대책이 도움이 될 것으로 사료된다.