• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.82-86
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• 2008

Purpose: Soft tissue defect can occur on the posterior aspect of the elbow after trauma or fracture fixation. To cover the defect and maintain elbow functions, various flap surgeries including latissimus dorsi muscle flap, lateral arm flap and radial forearm flap can be performed. We present the clinical results of transposition lateral arm flap for coverage of the elbow defect and discuss the cause of posterior soft tissue necrosis after fracture fixation. Materials and Methods: Two patients who had posterior soft tissue defect of the elbow after open reduction of the fractures around the elbow were treated with transposition lateral arm flap. The mean size of skin defect was 20 $cm^2$. The flap was elevated with posterior radial collateral artery pedicle and transposed to the defect area. Donor defect was covered with split thickness skin graft. The elbow was immobilized for 1 week in extended position and active range of motion was permitted. Results: All two cases of transposition lateral arm flap survived without marginal necrosis. The average range of motion of the elbow was 10~115 degrees. Mayo elbow performance score was 72 and Korean DASH score was 23. Conclusion: When elbow fractures are fixed with three simultaneous plates and screws, skin necrosis can occur on the posterior aspect of the elbow around olecranon area. If the size of skin defect is relatively small, transposition lateral arm flap is very useful option for orthopaedic surgeons without microsurgical technique.

• Archives of Reconstructive Microsurgery
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• 제18권2호
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• pp.79-83
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• 2009

Purpose: Avulsion injuries of digits have been presented for a long time as complex management problems. Despite of microsurgical advances, it is difficult to achieve good functional results and their management remains somewhat controversial. However, in a finger there are three transverse digital palmar arches. The middle and distal transverse digital palmar arches are consistently large(almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. 39-year-old man presented with avulsion amputation of the ulnar three digits, was operated using only arterial anastomosis with rerouting the transverse digital palmar arches. Methods: Replantation was performed using the artery-only technique. Because the digital arteries had been damaged, we did that the transverse digital palmar arches were transposed in an inverted Y to I configuration and were lengthened with rerouting them for the purpose of direct anastomosis of the digital artery. Venous drainage was provided by an external bleeding method with partial nail excision and external heparin irrigation. Results: The authors conclude that complete avulsion amputations with only soft tissue at the distal to insertion of the flexor digitorum superficialis tendon were salvageable with acceptable functional results. All three fingers survived. Conclusion: With technical advancements, the transverse digital palmar arches play an important role for finger amputation. Three digital palmar arches give us additional treatment option for the finger amputation. In this case, replantation with only-arterial anastomosis was successful and we obtained good aesthetic and functional outcome.

• Archives of Reconstructive Microsurgery
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• 제22권1호
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• pp.29-32
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• 2013

Purpose: Reconstruction of scalp and calvarial defects should provide both aesthetic and functional aspects. The inelastic nature of the scalp and previous surgery or radiation preclude the use of primary closure or a local flap. With development of microsurgical technique, a free tissue transfer is a good option. We use the latissimus dorsi myocutaneous free flap for reconstruction. Materials and Methods: A review of all latissimus dorsi free flap reconstructions performed in nine patients from 2009 to 2012 was conducted. There were six males and three females, ranging in age from seven to 69 years, and nine different regions, including five temporal regions, two occipital regions, and two frontoparietal regions. The flaps ranged in size from $9.0{\times}10.0cm$ to $14.0{\times}15.0cm$. Recipient vessels available for microanastomosis were most often the superficial temporal vessels and two patients had anastomoses to the external carotid artery and internal jugular vein. Results: All flaps survived postoperatively. With a median follow-up period of 14 months, no major complications were noted. However, two patients developed minor wound dehiscence, and a hematoma was observed in one patient. Conclusion: We performed the latissimus dorsi myocutaneous free flap reconstruction, which is one of the most popular reconstructive methods. The latissimus dorsi myocutaneous free flap reconstruction has been proven successful in our patients with satisfactory results. During the long term follow-up period, even though depressions were observed on the defect area in some patients, they were treated successfully with cranioplasty. Therefore, we recommend the latissimus dorsi myocutaneous free flap for reconstruction of scalp and calvarial defects.

• Clinical and Experimental Reproductive Medicine
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• 제17권2호
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• pp.107-113
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• 1990

To evaluate the factors affecting the incidence of ectopic pregnancy following tubal reversal, the clinical characteristics of ectopic pregnancy group (N=28)and intrauterine pregnancy group (N=316)were compared in 344 cases of pregnancy following tubal reversal using microsurgical technique at the Department of Obstetrics and Gynecolgy from July 1980 to May 1989. We found no significant relationship between the incidence of ectopic pregnancy and the duration of sterilization. Although the incidence rate (11.2%) of ectopic pregnancy following laparoscopic cautery appeared to be the highest among tubal sterilization methods, none showed statistically significant differences. There was a fourfold difference in the incidence rate of ectopic pregnancy between post-reversal tubal length less than 7cm (12.7%)and greater than 7cm (3.5%). The mean interval from tubal reversal to conception was 15.7months in ectopic pregnancy group, and 9. 3months in intrauterine pregnancy group, the difference reaching statistical significance. While most(80%)of the pregnancies were achieved within the first 12months following tubal reversal in intrauterine pregnancy group, 50% of the pregnancies occured in the same period, and the cumulative pregnancy rate is related in a linear fashion to the duration after reversal in ectopic pregnancy group. The incidence rate of ectopic pregnancy was found to be higher after cornual-ampullary anastomosis and cornual-isthmic anastomosis.

• Journal of Korean Neurosurgical Society
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• 제30권7호
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• pp.842-848
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• 2001

Objectives : The mortality rate of subarachnoid hemorrhage(SAH) has been reduced recently due to refinement of microsurgical technique and improved perioperative management. Also, many survivors of SAH show excellent neurological recoveries. However, we found that a high proportion of the survivors do not fully regain their premorbid status in cognitive and memory function. Object of this study is to evaluate which factors might influence on cognitive and memory impairment in ruptured aneurysmal SAH patients. Methods : In this prospective study, a series of 66 patients with aneurysmal subarachnoid hemorrhage(SAH) from 1996 to 1998, most of whom had a "good" or "fair" neurological outcome, were assessed with various tests of cognition and memory function. All patients underwent clipping operation by pterional approach. Right side approach was performed in 16 case and left 21 cases. K-WAIS(Korean-Wechsler Adult Intelligence Scale) was used as method of cognition and memory function test. The time interval between SAH and assessment varied between 4 months and 8 months, averaging 6.2 months. Statistical analyses were carried out for each test score to see whether aneurysm site(A-com : non A-com), route of approach, age and sex, vasospasm, Hunt-Hess grade and Fisher CT group at admission, Glasgow Outcome Scale(GOS) at discharge affect cognitive and memory function. Results : Aneurysm site was not shown to be associated with performance on any test, and the initial grade (Hunt-Hess grade, Fisher CT group) of SAH and vasospasm had only minimal predictive values. The grade at discharge( GOS) was proved to be the best predictor of impairment of cognition and memory function within 1 year after operation. Conclusion : The authors conclude that the diffuse effects of SAH are more important than focal neuropathology in relation to cognitive impairment in this group of patients.

• Journal of Korean Neurosurgical Society
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• 제41권6호
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• pp.359-366
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• 2007

Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression [MVD] offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.29-33
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• 2022

The application of minimal invasive mastectomy has allowed surgeons to perform nipples-paring mastectomy via a shorter, inconspicuous incision under clear vision and with more precise hemostasis. However, it poses new challenges in microsurgical breast reconstruction, such as vascular anastomosis and flap insetting, which are considerably more difficult to perform through the shorter incision on the lateral breast border. We propose an innovative technique of transcutaneous medial fixation sutures to help in flap insetting and creating and maintaining the medial breast border. The sutures are placed after mastectomy and before flap transfer. Three 4-0 nylon suture loops are placed transcutaneously and into the pocket at the markings of the preferred lower medial border of the reconstructed breast. After microvascular anastomosis and temporary shaping of the flap on top of the mastectomy skin, the three corresponding points for the sutures are identified. The three nylon loops are then sutured to the dermis of the corresponding medial point of the flap. The flap is placed into the pocket by a simultaneous gentle pull on the three sutures and a combined lateral push. The stitches are then tied and buried after completion of flap inset.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권3호
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• pp.260-266
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• 2023

Objective: Microvascular anastomosis, particularly side-to-side (STS) bypass, is a complex surgical procedure. While several suture techniques exist, none of them is superior to the others. We assessed the association between various STS bypass techniques and vessel twisting using chicken wing training models. Methods: Three suture techniques were compared over an anterior wall suture procedure. The unidirectional continuous suture (UCS) group used a downward "right-to-left" continuous suture. The reverse continuous suture (RCS) group used a downward "left-to-right" continuous suture. The interrupted suture (IS) group used the standard interrupted suture. The number of samples in each of the three groups was 30 (n=90). We compared the incidence of vessel twisting and rotation angles across groups. Results: Vessel twisting occurred in 96.7%, 56.7%, and 0% of the cases in the UCS, IS, and RCS groups, respectively. The incidence of vessel twisting differed significantly in all 3 groups (p<0.001), with an apparent trend (p=0.002). The mean rotation angles were 201°±90.6°, 102°±107.6°, and 0° in the UCS, IS, and RCS groups, respectively, which were significantly different (p<0.001). On excluding cases without twisting, the rotation angles of twisted vessels in the UCS and IS groups were 207.9°±83.7° and 180°±77.9°, respectively, which yielded a significant difference between these groups (p<0.001). Conclusions: We found that the incidence and trend of vessel twisting differed significantly across suture techniques. The RCS technique may aid in preventing vessel twisting in the STS bypass procedure.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권4호
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• pp.462-467
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• 2023

Thrombectomy procedures following intra-aneurysmatic lesions are extremely rare, and few cases have been reported. This article describes a microsurgical intra-aneurysmatic thrombectomy (MIaT) for a distal anterior cerebral artery (DACA) aneurysm. We present the case of a 48-year-old female that was admitted to the emergency room, showing neurologic deterioration with focal deficits. A computed tomography angiography (CTA) scan revealed an aneurysm located in the distal segment of the left anterior cerebral artery. During the surgical procedure, after clipping, a well-formed clot was visualized through the aneurysm's wall obstructing the left DACA flow. We proceeded to open the aneurysm's dome to remove the thrombus and clip the aneurysm neck, re-establishing the flow of the left DACA. Intra-aneurysmatic thrombosis can occur as a complication during clipping, obstructing the distal flow of vital arteries and causing fatal results in the patient's postoperative status. MIaT is a good technique for restoring the flow of the affected vessel and allows a secure aneurysm clipping after thrombus removal.

• 대한후두음성언어의학회지
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• 제13권2호
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• pp.173-179
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• 2002

본 교실에서 1988년 1월부터 2002년 3월까지 시행했던 후두미세수술 2595례중 수술 후 성대낭종으로 확진된 121례를 대상으로 다음과 같은 결과를 얻었다. 1) 전체 후두미세수술 2595례 중 성대낭종이 차지하는 비율은 121례로 4.7%였다. 2) 성대낭종 121례 중 유표피낭종은 33례로 27.3%, 저류낭종은 88례로 72.7%를 차지하였다. 이전 보고들에 비해 최근 들어 저류낭종이 증가하는 경향을 보이고 있다. 3) 성별분포는 121례의 성대낭종 중 여성이 81례(66.9%), 남성이 40례(33.1%)로 여성에 호발하는 양상을 보였고 유표피낭종의 경우에는 남녀비가 11 : 22, 저류낭종의 경우 29 : 59로 나타났다. 4) 이학적 검사소견으로서 유피낭종은 보다 진단이 용이하여 술 전 이학적 검사상 33례 중 21례(63.6%)에서 낭종을 의심할 수 있었으나 저류낭종은 성대 폴립이나 결절 등으로 오인되는 경우가 88례 중 56례로 63.6%를 차지했고 수술 전 낭종을 의심할 수 있었던 경우는 32례로 36.4%에 불과했다. 5) 병리조직학적 검사상 유표피낭종 내부에 PAS 음성인 케라틴과 콜레스테롤양(cholesterol-like)물질이 중층 편평상피로 구성된 막에 둘러 싸여 있는 양상을 보였고 저류낭종은 내부에 PAS 양성인 점액분비물을 포함하고 있는 원주 또는 입방세포로 구성된 막으로 이루어져 있었다. 6) 애성 발생과 관련된 유발 요인으로는 성대과용 또는 음성남용과 관련된 경우가 121례 중 42례(34.7%), 상기도감염 후에 발생한 경우가 21례(17.4%)로 나타나 성대과용과 상기도감염이 중요한 유발인자로 생각되며 수다스러움과의 관련성에 대한 조사에서 조사대상 84례 중 약 82.1%에 해당하는 69례에서 경도 이상의 수다스러움을 보이는 것으로 나타나 관련이 있는 것으로 생각되며 특히 저류낭종의 경우 관련이 더 많을 것으로 생각된다. 7) 발병부위는 대부분 막성유리연의 중간부 및 전방부 1/3에서 발생하였고 수술 결과는 저류낭종 82례 중 25례(30.5%)에서만 낭종의 파열 없이 완전제거가 가능하였으며 유표피낭종 30례 중에서는 21례(70.0%)에서 완전제거가 가능했던 것으로 나타나 저류낭종이 유표피낭종에 비해 낭종을 파열시키지 않고 완전히 제거하는 것이 더욱 어려움을 알 수 있었다. 따라서 저류낭종의 경우 낭종의 절제가 어려운 경우 수술방법으로 조대술(marsupialization)을 시행하는 것도 의미가 있을 것으로 사료된다. 8) 수술 전 후의 음성만족도를 비교한 조사 결과 조사가 가능했던 82례 중 49례(52.0%)에서 만족할 만한 결과를 보였다고 답하여 성대 폴립수술 후의 만족도와 유사한 결과를 보였다.