• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.23-27
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• 2001

Penile amputation results primarily from attempts at self-emasculation in the psychotic individual or from felonious assault. Because of the complex nature of patients whom perform self-emasculation and low incidence of felonious assault, large series of these individuals do not exist, and experience with amputation injuries of the genitals is confined to individual case reports. Fortunately, complete amputation of penis is quite rare but potentially devastating occurrence. The repels of the treatment of penile amputation by coporal reapproximation that have been published since 1977 indicate that microreplantation techniques are propably superior to the technically simpler nonmicroscopic coporal reapproximation techniques. As microsurgical techniques have been demonstrated to superior, the preferred method of replantation involves this routine whenever possible. We have experience of a case of successful replantation of completely amputated penis by using microneurovascular repair, with the good result of cosmetic and functional concern. Herein, we report this case with the review of the literatures.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.1-15
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• 1996

From Fabuary 1982 to May 1995, 396 patients had undergone reconstructive surgery of the upper and lower limb with microsurgical technique at department of orthopaedic surgery, Yonsei University of Medicine. The results were as follows; 1. Average age at the time of operation was 23.4years(2-64 years), and there were 277 male and 119 female patients. 2. Among 324 patients of soft tissue flap(87 inguinal flap, 132 scapular flap, 38 latissimus dorsi flap, 11 latissimus dorsi and scapular combind flap, 6 gracilis flap, 12 deltoid flap, 3 tensor facia lata flap, 11 dorsalis pedis flap, 6 lateral thigh flap, 12 wrap around flap, 1 lateral arm flap, 5 musculocutaneous flap), 274 cases(85.5%) were succeed. 3. Among 37 patients of vascularized bone graft(18 fibular bone graft, 11 iliac bone graft, 7 toe to finger transplantation,1 vascular pedicle rib graft), 30 cases(80.1%) were succeed. 4. In 26 cases of segmental resection and rotationplasty at lower extremity, 23 cases were succeed. 5. In 7 cases of Tikhoff-Linberg procedure and in 2 case of segmental resection and replantation, all case was succeed. Overall success rate of microscopic reconstructive surgery was 85.6%. In conclusion, microsurgical technigue is valuable for reconstruction of tissue defect or function loss of the limb.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.660-662
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• 2009

Purpose: There are several modalities to reattach the amputated auricle. Microvascular replantation can achieve the best outcome, but technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. Methods: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket (Fig. 1, Below, left). Results: The ear was reepithelialized spontaneously in 7 days. At 3 months, the reattached ear has satisfactory appearance without contour deformity(Fig. 1, Below, right). Conclusion: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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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.

• 대한미세수술학회:학술대회논문집
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• 1992.11a
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• pp.80-81
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• 1992

• Journal of Yeungnam Medical Science
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• v.5 no.1
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• pp.23-32
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• 1988

Finger injuries are becoming more common with the increasing use of mechanical industrial and household appliances. Among the hand injuries, amputation is the serious disaster to the patient. Recently, application of microsurgical technique to the reattachment of ampuatated digits has been common clinical procedures. We performed microsurgical replantation to the 75 patients with 102 digits from march in 1986 to february in 1988. The following results were obtained. 1. The most common age distribution was third decade and male to female ratio was about 5:1. 2. The ratio of right to left hand was about 1:1 but the dominant to non-dominant hand was about 2:1. 3. The index finger was most commonly injured and the next was middle finger. 4. The most common type of the injuries was the crushing injury and the most common vector was a kind of pressor. 5. The anesthesia was performed in equal ratio between the general and regional anesthesia. 6. The survival rate of microreplantation to the injuries of the zone II was 77.8% and zone III was 80%. 7. The functional result after replantation at zone II was better than zone III. 8. Microreplantation was performed in any case of the type of the injury, the severity of crushing and the ischemic time, and the patients requirement was an important factor.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.4
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• pp.397-418
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• 1994

Microvascular surgery has been widely used in the clinical field of replantation and reconstructive surgery. Since the last 20 years, microsurgical techniques and instruments have been rapidly developed and the success rate is remarkably increased. But thrombotic occlusion of vessels remains the major reason for clinical failure. The change of vessel wall is the most important factor in thrombus formation. If we can reduce the traumatic changes in the vessel walls during surgery, the success rate can be markedly increased. For this study, femoral arteries and veins of 36 Sprague-Dawley rats with average weights of 300gm were used. The author observed the histological changes and healing process in the anastomostic site after 1 hour, 24 hours, 1, 2, 3 and 4 weeks under light microscopy and scanning electron microscopy. The results were as follows : 1. The patency rate was 100% in femoral arteries and 85% in femoral vein. 2. At the early stages after microvascular anastomosis, the loss of endothelial cell in the vessel walls was observed in the wide area including anastomotic site. In scanning electron microscopic finding the anastomotic site was covered with much fibrin, many red blood cells and some platelets. 3. At 1st week, new endothelial cells were formed toward anastomotic site and at 3rd week, the anastomotic site was completely covered by new endothelial cells. At 4th week, the complete endothelialization over the threads was observed. 4. The media extended from the anastomotic site toward the end of the specimen. At later stages, the extent of media necrosis was markedly decreased. But the media necrosis of anastomotic site was not regenerated till 4th week. 5. Intimal hyperplasia appeared at 1st week and increased till 4th week. The layer consisted of endothelialization the most luminal layers and smooth muscle in the deeper layers. But in veins, the response was less pronounced than in arteries. 6. Foreign body granuloma remained during 4 weeks and aneurysm was observed at 3rd week in artery. In aneurismal wall, media necrosis, loss of elastic lamina and intimal hyperplasia were seen.