• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권5호
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• pp.349-357
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• 2003

Several microvascular anastomotic techniques have been described with methodical effectiveness, patency rates, healing state of microscopic findings. This experimental study presents the comparison of three types of arterial microvascular anastomotic techniques: end-to-end(ETE) anastomosis, end-in-end(EIE) anastomosis, and continuous technique. Sixty male Sprague-Dawley rats, 60 femoral arteries were used for this study. Twenty rats per each technique were used and sacrificed at post-operation 1 day, 3 days, a week, 2 weeks for scanning electromicroscopic findings. The patency was monitored by miniDoppler throughout total experimental periods. The anastomotic time on each method was measured to compare the technical effectiveness. The final results were as follows: 1. The anastomotic time for the end-in-end technique was significantly shorter than another techniques. The average time for each technique was measured as 15 minutes on EIE technique, 20 minutes on continuous technique and 25 minutes on ETE technique. 2. The patency rate for the end-in-end technique at 2 weeks also was superior to another techniques. The patency rate for each technique was demonstrated as 90 % on EIE technique, 85 % on ETE technique and 80 % on continuous technique. 3. The scanning electromicroscopic findings on healing condition of vessel endothelium during the observation period showed that the end results of EIE technique, ETE technique and continuous technique in sequence were good. The end-in-end technique proved to be the superior with regard to anastomotic time and patency rate when compared to end-to-end technuqe, so EIE techniqe might be well available for the case of large discrepancy of vessel size. The patency rate, microscopic healing findings in continuous technique were seen as the lowest level among the three anastomotic techniques, therefore the application of continuous technique was recommended only on the inevitable case.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권1호
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• pp.16-29
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• 1991

미세혈관봉합술에서의 가장 큰 문제점은 봉합부에서의 내피손상과 혈전형성이라고 볼 수 있다. 이 연구의 목적은 봉합시 일어날 수 있는 내피손상부에서의 치유과정을 관찰코져 각각 다른 문합술인 혈관함입문합술과 혈관단단문합술을 백서 대퇴부동맥에 적용하여 개존율및 전자현미경적 관찰을 통하여 비교하였고 아울러 임상에의 적용 가능성을 검토코져 하였다. 저자는 미세현미경시야에서 혈관함입문합술 20례와 단단문합술 20례를 시행한후 1일, 3일, 1주, 2주, 3주에 각각 4마리씩 희생후 문합혈관부를 육안관찰후 주사전자현미경으로 조직변화를 관찰하여 다음의 결과를 얻었다. 1. 혈관 함입문합술 시술시 문합후 개존율은 90%였고 혈관 단단문합술은 85%였다. 2. 혈관 함입문합시 술후 3일째는 문합부에서의 혈소판 응집물이 기질화되었으며 함입으로 좁아져 있던 혈관내경이 약 1주째 혈관 합입부의 중막 위축현상으로 다소 넓어졌다. 3. 혈관 내피재생과정을 혈관 함입문합술에서는 7일에서 14일경에, 혈관 단단문합술에서는 14일에서 21일째 완성되었다.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.53-56
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• 2007

Purpose: Microsurgical exercise has been performed with rat femoral vessels. But, it needs animal laboratory, anesthesia and its keeping facilities. Materials and Methods: Ten human placentas were studied for suitability in a microvascular exercise. The size and useful length of vessels were measured, and various microvascular anastomoses were performed. Result: The human placenta has many vessels traversing its fetal surface. A variety of sizes are available down to vessels of diameter 1 mm and up to vessels of diameter 6.5 mm (1.0

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1996년도 제16차 학술대회
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• pp.157.2-158
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• 1996

• Archives of Reconstructive Microsurgery
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• 제20권2호
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• pp.126-131
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• 2011

Purpose: The subcutaneous pocket graft of the thumb tip amputation across or proximal to the lunula is chosen in case of impossible microvascular anastomosis and in patient who strongly desired to preserve the thumb tip after failed replantation. Materials and Methods: Two patients who underwent a subcutaneous pocket graft for a thumb tip reconstruction between August 2008 and November 2009 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 48 years and had sustained complete thumb tip amputations across or proximal to the lunula. In one case, the microsurgical replantation was not feasible and the other one revealed arterial insufficiency at the 7th day after microsurgical replantation. Results: Authors had experienced 2 cases of flaps which survived completely. The results of sensibility was good, the range of motion at interphalangeal joint and tip to tip pinch was acceptable and color mismatch and loss of thumb finger nail was unacceptable after more than 1 year follow up with conventional successful thumb tip replantation. Conclusion: The subcutaneous pocket graft could be chosen in thumb tip amputation in case of impossible microvascular anastomosis as well as who strongly desires to preserve thumb tip after failed replantation.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권1호
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• pp.93-101
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• 2011

Reconstruction following a resection of malignant oral cavity tumors is one of the most difficult problems in recent oral oncology. The radial forearm free flap (RFFF) is a thin, pliable soft tissue flap with large-caliber vessels for microvascular anastomosis. Its additional advantages include consistent flap vascular anatomy, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with a tumor resection. For a better understanding of RFFF as a routine reconstructive procedure in oral and maxillofacial surgery, the constant anatomical findings must be learned and memorized by young doctors during the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article discusses the anatomical basis of RFFF in the Korean language.

• Archives of Plastic Surgery
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• 제49권4호
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• pp.543-548
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• 2022

Microvascular reconstruction frequently requires anastomosis outside of the zone of injury for successful reconstruction. Multiple options exist for pedicle lengthening including vein grafts, arteriovenous loops, and arteriovenous bundle interposition grafts. The authors performed a systematic review of arteriovenous bundle interposition grafts to elucidate indications and outcomes of arteriovenous grafts in microvascular reconstruction. A systematic review of the literature was performed using targeted keywords. Data extraction was performed by two independent authors, and descriptive statistics were used to analyze pooled data. Forty-four patients underwent pedicle lengthening with an arteriovenous graft from the descending branch of the lateral circumflex femoral artery. Most common indications for flap reconstruction were malignancy (n = 12), trauma (n = 7), and diabetic ulceration (n = 4). The most commonly used free flap was the anterolateral thigh flap (n = 18). There were five complications, with one resulting in flap loss. Arteriovenous bundle interposition grafts are a viable option for pedicle lengthening when free flap distant anastomosis is required. The descending branch of the lateral circumflex femoral artery may be used for a variety of defects and can be used in conjunction with fasciocutaneous, osteocutaneous, muscle, and chimeric free flaps.

• 대한치과의사협회지
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• 제49권9호
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• pp.527-534
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• 2011

Microvascular reconstruction of maxillary composite defect after oncologic resection has improved both esthetic and functional aspect of quality of life of the cancer patients. However, a lot of patients had prior surgery with radiation and/or chemotherapy as a part of comprehensive cancer treatment. Sometimes it is nearly impossible to find out adequate recipient vessel for maxillary reconstruction with microvascular anastomosis. Therefore long pedicle of the flap is needed to use distant neck vessels located far from the reconstruction site such as ipsilateral transverse cervical artery or a branch of contralateral external carotid artery. For this reason, although we know the treatment of the choice is osteocutaneous flap, it is difficult to use this flap when we need long pedicle with complex three dimensional osseous defect. Vascular option for these vessel-depleted neck patients can be managed by a soft tissue reconstruction with long vascular pedicle and additional free non-vascularized flap that is rigidly fixed to remaining skeletal structures. For this reason, maxillofacial reconstruction by vascularized soft tissue flap with or without the secondary restoration of maxillary bone with non-vascularized iliac bone can be regarded as one of options for reconstruction of profound maxillofacial composite defect resulted from previous oncological resection with chemo-radiotherapy.

• Archives of Plastic Surgery
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• 제44권4호
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• pp.293-300
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• 2017

Background Simulation training is becoming an increasingly important component of skills acquisition in surgical specialties, including Plastic Surgery. Non-living simulation models have an established place in Plastic Surgical microsurgery training, and support the principles of replacement, reduction and refinement of animal use. A more sophisticated version of the basic chicken thigh microsurgery model has been developed to include dissection of a type 1-muscle flap and is described and validated here. Methods A step-by-step dissection guide on how to perform the chicken thigh adductor profundus free muscle flap is demonstrated. Forty trainees performed the novel simulation muscle flap on the last day of a 5-day microsurgery course. Pre- and post-course microvascular anastomosis assessment, along with micro dissection and end product (anastomosis lapse index) assessment, demonstrated skills acquisition. Results The average time to dissect the flap by novice trainees was $82{\pm}24$ minutes, by core trainees $90{\pm}24$ minutes, and by higher trainees $64{\pm}21$ minutes (P=0.013). There was a statistically significant difference in the time to complete the anastomosis between the three levels of training (P=0.001) and there was a significant decrease in the time taken to perform the anastomosis following course completion (P<0.001). Anastomosis lapse index scores improved for all cohorts with post-test average anastomosis lapse index score of $3{\pm}1.4$ (P<0.001). Conclusions The novel chicken thigh adductor profundus free muscle flap model demonstrates face and construct validity for the introduction of the principles of free tissue transfer. The low cost, constant, and reproducible anatomy makes this simulation model a recommended addition to any microsurgical training curriculum.

• Journal of Korean Neurosurgical Society
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• 제67권2호
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• pp.158-165
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• 2024

Objective : Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is conducted for flow augmentation. In this study, we measured the STA cut flow of a Korean population and evaluated the relationship between STA cut flow and long-term patency of the bypass. Methods : A retrospective study was conducted. Intraoperative measurement of STA flow was conducted using a microvascular flow meter on patients who underwent STA-MCA. After cutting the distal end, the STA flow rate was measured with no resistance and recorded. After finishing anastomosis, STA flow was measured and recorded. The cut flow index was calculated by dividing post anastomosis flow by cut flow in intracranial atherosclerotic stenosis patients. Results : The median STA cut flow was 35.0 mL/min and the post anastomosis flow was 24.0 mL/min. The cut flow of STA decreased with aging (p=0.027) and increased with diameter (p=0.004). The cut flow showed no correlation with history of hypertension or diabetes mellitus (p=0.713 and p=0.786), but did correlate a positively with history of hyperlipidemia (p=0.004). There were no statistical differences in cut flow, STA diameter, and post anastomosis flow between the frontal and parietal branches (p=0.081, p=0.853, and p=0.990, respectively). Conclusion : The median STA cut flow of a Korean population was 35 mL/min. Upon reviewing previous articles, it appears that there are differences in the STA cut flow between Western and Asian patients.