• Archives of Plastic Surgery
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• 제48권1호
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• pp.133-143
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• 2021

Background Extensive research has been conducted on islet transplantation as a possible cure for diabetes. Islet transplantation in the liver via the portal vein has shown remarkable results, but numerous other recipient sites are currently being investigated. We aimed to show the effectiveness of using a muscle flap as a recipient site for islet transplantation. Methods Islet cells were harvested from 12 isogenic Lewis rats, and then diabetes was induced in another 12 isogenic Lewis rats by streptozotocin injection. In six rats, 3,000 islets were transplanted into gastrocnemius muscle flaps, and in the other six rats, the same number of islets were transplanted into the gastrocnemius muscle. The transplanted islet cell function between the two groups was compared by means of blood glucose tests, glucose tolerance tests, immunohistochemistry, and real-time reverse transcription polymerase chain reaction. Results In the muscle flap group, blood glucose levels significantly decreased after islet transplantation. Blood glucose levels were significantly different between the two groups at 3 weeks after transplantation. The muscle flap group showed nearly normoglycemic results upon the glucose tolerance test, whereas the muscle group was hyperglycemic. Immunohistochemical evaluation showed positive results against insulin and glucagon in biopsies of both groups, and the islet cell density was higher in the muscle flap group. There were no statistically significant differences between the two groups in real-time reverse transcription polymerase chain reaction results. Conclusions Our results suggest that muscle flaps are promising candidates for islet cell transplantation.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.249-255
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• 2008

Objective : In Moyamoya disease, the primary goal of treatment is to improve collateral circulation through angiogenesis. In the present study, we obtained and sub-cultured bone marrow stromal cells (BMSCs) from rats without a cell-mediated immune response. Then, we injected the labeled BMSCs directly into adjacent temporal muscle during encephalomyosynangiosis (EMS). Three weeks after BMSC transplantation, we examined the survival of the cells and the extent of neovascularization. Methods : We divided 20 rats into a BMSC transplantation group (n=12) and a control group (n=8). Seven days after the induction of chronic cerebral ischemia, an EMS operation was performed, and labeled BMSCs ($1{\times}106^6/100\;{\mu}L$) were injected in the temporal muscle for the transplantation group, while an equivalent amount of culture solution was injected for the control group. Three weeks after the transplantation, temporal muscle and brain tissue were collected for histological examination and western blot analysis. Results : The capillary/muscle ratio in the temporal muscle was increased in the BMSC transplantation group compared to the control group, showing a greater increase of angiogenesis (p<0.05). In the brain tissue, angiogenesis was not significantly different between the two groups. The injected BMSCs in the temporal muscle were vascular endothelial growth factor (VEGF)-positive by immunofluorescence staining. In both temporal muscle and brain tissue, the expression of VEGF by western blot analysis was not much different between the two groups. Conclusion : During EMS in a chronic cerebral ischemia rat model, the injection of BMSCs resulted in accelerated angiogenesis in the temporal muscle compared to the control group.

• Archives of Reconstructive Microsurgery
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• 제20권2호
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• pp.108-112
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• 2011

Purpose: Gracilis muscle free flap transplantation is chosen in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity. We set a study to search for gracilis free flaps to know whether symptoms were cured or recurred in patients that have passed over 10 years from flap transplantation. Materials and Methods: From August 1995 through September 2010, we have performed 28 cases of gracilis muscle free flap in the lower extremities. Ever since no case visited to demand any discomfort, breakdown or recurrence in the flap site on outpatient basis. We made a telephone call to patients or relatives documented in the medical record and only 2 cases visited outpatient department and 9 cases postponed the visit who satisfied with the final result but 17 cases had wrong telephone numbers. Causes, area of lower extremity, recipient vessels in the lower extremity, condition of the donor thigh and overall satisfaction of the flap transplantation in activities of daily living were investigated and written down in the medical record. Results: 11 cases were reviewed after average postoperative 13.7 years. Gracilis muscle flaps were not break down at the recipient site in all cases. The wound of donor thigh wound healed good and overall activities of daily living was satisfied in all cases. Conclusion: Gracilis muscle flaps which had performed and followed up average 13.7 years revealed confident in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity.

• 성인간호학회지
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• 제13권1호
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• pp.5-14
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• 2001

The purpose of this study was to explore the change of muscle strength, muscle endurance, flexibility and activities of daily living to develop a rehabilitational program. The subjects were selected randomly among the patients who underwent kidney transplantations at one major transplantation hospital in Seoul, Korea. This study was carried out between November 23, 1999 and February 15, 2000. The subjects in this study consisted of 16 patients who had kidney transplantations between 1 month and 12 months ago prior to this study. They were all on steroids and did not take any physical exercise regularly. The muscle strength, muscle endurance, flexibility and activities of daily living were evaluated at 1st week and after 12 weeks. The data were analyzed with numbers, percentiles, mean, standard deviation and t-test. The results were as follows: 1. After 12 weeks, the grip strength was significantly decreased than 1st week (p=.0002). 2. After 12 weeks, the back lift strength was significantly decreased than 1st week (p=.0002). 3. After 12 weeks, the muscle endurance was increased than 1st week, but it was not significant(p=.5487). 4. After 12 weeks, the flexibility was significantly decreased than 1st week (p=.0002). 5. After 12 weeks, the activities of daily living was significantly decreased than 1st week (p=.0006). Like the above result, the kidney transplant receipients' muscle strength, flexibility and activities of daily living were reduced. In order to solve this problem, the writer has found that program development to prevent the defects should be extremely required. Since now on the number of patients should expand. After the kidney transplantation, the periods of 4, 8, 12 and 16 weeks are extended. The writer proposes to examine the different phase of change in each periods.

• Korean Journal of Radiology
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• 제22권2호
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• pp.189-197
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• 2021

Objective: Muscle depletion in patients undergoing liver transplantation affects the recipients' prognosis and therefore cannot be overlooked. We aimed to evaluate whether changes in muscle and fat mass during the preoperative period are associated with prognosis after deceased donor liver transplantation (DDLT). Materials and Methods: This study included 72 patients who underwent DDLT and serial computed tomography (CT) scans. Skeletal muscle index (SMI) and fat mass index (FMI) were calculated using the muscle and fat area in CT performed 1 year prior to surgery (1 yr Pre-LT), just before surgery (Pre-LT), and after transplantation (Post-LT). Simple aspects of serial changes in muscle and fat mass were analyzed during three measurement time points. The rate of preoperative changes in body composition parameters were calculated (preoperative ΔSMI [%] = [SMI at Pre-LT - SMI at 1 yr Pre-LT] / SMI at Pre-LT x 100; preoperative ΔFMI [%] = [FMI at Pre-LT - FMI at 1 yr Pre-LT] / FMI at Pre-LT x 100) and assessed for correlation with patient survival. Results: SMI significantly decreased during the preoperative period (mean preoperative ΔSMI, -13.04%, p < 0.001). In the multivariable analysis, preoperative ΔSMI (p = 0.016) and model for end-stage liver disease score (p = 0.011) were independent prognostic factors for overall survival. The mean survival time for patients with a threshold decrease in the preoperative ΔSMI (≤ -30%) was significantly shorter than for other patients (p = 0.007). Preoperative ΔFMI was not a prognostic factor but FMI increased during the postoperative period (p = 0.009) in all patients. Conclusion: A large reduction in preoperative SMI was significantly associated with reduced survival after DDLT. Therefore, changes in muscle mass during the preoperative period can be considered as a prognostic factor for survival after DDLT.

• Journal of Chest Surgery
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• 제35권5호
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• pp.336-342
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• 2002

배경: 최근 들어 심부전증을 가진 심장에 세포이식을 이용하여 심장기능을 개선시키고자 하는 연구가 활발히 진행되고 있다. 이 연구는 확장성 심근증을 가진 햄스터 심장에 배양한 평활근 세포와 심근세포를 이식한 후 심장기능의 변화를 관찰하였다. 대상 및 방법: 심근세포와 평활근세포는 BIO 53.58 햄스터의 심장과 옃션 deferens에서 분리하여 배양하였다. 실험군은 각각 10마리로서 심근세포 (1군)와 평활근세포 (2군) 및 배양액 (3군)을 17주된 BIO 53.58 햄스터의 좌심실에 이식하였고 Cyclosporine (5mg/Kg)을 1군에 한하여 수술 직후부터 매일 피하주사하였다. sham군 (4군) 은 세포나 배양액의 이식 없이 단순 흉부수술만을 시행하였다. 세포나 배양액의 이식 4주 후에 Langendorff 체외순환 모델을 이용하여 좌심실기능을 측정하였다. 결과: 조직학적 검사상 모든 군에서 심한 심근괴사가 있었고, 1군과 2군에서는 수여심장의 심근 내에서 새로운 근육조직이 형성되었다. 좌심실기능의 평가에서 1군과 2군은 3군과 4군에 비해 통계적으로 유의하게 우수하였고 (p<0.01), 2군은 1군에 비해 수축기 좌심실압과 발생기압이 통계적으로 유의하게 우수하였다 (p<0.05). 그러나 3군과 4군 사이에는 통계적인 유의성이 없었다. 절론 확장성 심근증을 가진 햄스터 심장에 배양한 평활근 세포와 심근세포를 이식한 결과 수여심장의 심근 내에서 근육조직을 형성하고 좌심실기능을 개선시켰으며, 이 중 평활근세포를 이식한 심장이 수축기 좌심실압과 발생기압이 더 우수한 좌심실기능 개선효과를 보여주었다.

• Archives of Reconstructive Microsurgery
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• 제8권2호
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• pp.176-183
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• 1999

전북대학교병원 정형외과에서 1993년 12월부터 1998년 9월까지 하지의 만성 골수염 7례에 대하여 유리 근 피판 이식술을 시행하고 최소 1년 2개월부터 최장 5년 3개월까지 추시하여 다음과 같은 임상적 결과를 얻었다. 1. 만성 골수염의 발생 부위는 경골이 4례, 종골 2례 그리고 대퇴골이 1례였다. 2. 만성 골수염의 지속 기간은 평균 31.6년이었다. 3. 전체 7례 중 1례에서 편평 상피암이 발병되었다. 4. 만성 골수염은 4례에서 혈행성 감염으로 초래되었고, 3례는 외상력이 있었는데 2례는 교통사고 그리고 1례는 경미한 외상이었다. 5. 치료는 부골 제거술과 유리 근 이식술을 시행하였던 예가 2례, 부골 제거술없이 유리 근 이식술을 시행한 예가 5례였다. 6. 전체 7례 중 6례에서 유리 근 이식술을 시행하였고 1례에서 유리 근피판 이식술을 시행하였는데 복직 근이 4례였고, 광배 피판, 광배 근피판 그리고 박근이 각각 1례씩이었으며 7례 중 6례(85.7%)에서 생존하였다. 7. 대퇴부에 시행하였던 광배 근피판 1례는 정맥이식술을 통한 단측 문합술을 시행하였으나 술 후 2일째부터 허혈성 변화를 일으켜 실패하였으며, 외상으로 인한 종골 1례에서는 복직근 이식술이 성공하였으나, 술 후 심한 외상성 족관절염으로 인한 극심한 통증으로 슬관절 하부 절단술이 시행되었다.

• Archives of Reconstructive Microsurgery
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• 제1권1호
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• pp.9-16
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• 1992

Volkmann's ischemic contracture is the end result of an untreated, delayed or Inadequately decompressed compartment syndrome in which muscle ischemia and necrosis have occurred. Once the muscle necrosis have happened, the involved muscle undergo permanent change into fibrous tissue. So secondary shortening and distal joint contracture will be a final outcome, which results in marked functional impairment of hand and forearm. Even though several procedures, such as muscle sliding operation has been attempted, overall results were far from satisfaction, compare to healthy opposite hand. The management of these unfavorable condition of the forearm and hand was regarded as one of challenging area in orthopedics. Recently new approach, using microsurgical technique which transfers functioning muscle unit, has been developed and its result was much better than any other methods in the aspect of an active motion. Among these musculocutaneous free flaps, gracilis has obtained special reputation due to its easiness to handle such as elevation of flap and reliable neurovascular pedicle. Other advantages are flexibility of flap size to adjust variable size of the defect in the forearm and minor morbidity of the donor site. Authors have performed 7 cases of functioning gracilis musulocutaneous free flap transplantation for the functional loss of forearm and hand due to Volkmann's ischemic contracture or muscle and skin defect due to severe trauma since November, 1981 till May, 1991. The results in most cases were satisfactory and acceptable.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.88-94
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• 1998

Free vascularized fibular transplantation is one of the most useful living bone reconstructive procedure in microsurgical field. Concerning about donor site morbidity, the donor has minor problems of ankle stability and muscle power weakness and transient peroneal nerve symptoms. That problems can be minimized with longitudinal splitted osteotomy on the donor fibula if the bone defect in recipient site is not so large. Half splitted fibula with peroneal arterial pedicle which contains nutrient artery and periosteal vessels, grafted bone can survive with those vascular supplies. Authors underwent five cases of half splitted free vascularized fibular transplantation from 1985. There were no evidence of devascularization in all cases, we can minimized donor morbidity with leaving half fibula intact on donor site. The problem of that technique is technically demanding in longitudinal splitting of bone without damage to peroneal nutrient vessels and periosteal soft tissues which attached to the bone. Authors can propose longitudinal half fibular transplantation is one of modification in free vascularized bone transplantation that minimize donor defect.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.129-134
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• 1998

The ability for tissue transfer based on microvascular anastomosis has created a revolution in microsurgical free tissue transplantation. The advantages of cutaneous flaps are that they are soft, durable and provide a good cosmetic reconstruction and muscle flaps have a more vigorous blood supply and a longer, larger vascular pedicle than cutaneous flaps. From June 1992 through May 1997, 68 patients had received reconstructive microsurgery in the lower extremity at Department of Orthopedic Surgery, Chonbuk National University Hospital. The results were as follows. 1. The age distribution was from 15 years of age to 67 and male were 59 cases and female 9 cases. 2. The most common cause was traffic accident(54 cases, 79.4%) and followed chronic osteomyelitis(9 cases, 13.2%), industrial accident(3 cases, 4.4%), burn(1 case, 1.5%) and farm injury(1 case, 1.5%). 3. Latissimus dorsi myocutaneous flap were 25 cases(36.8%), rectus abdominis muscle flap 21 cases(30.9%), gracilis muscle flap 10 cases(14.7%), dorsalis pedis flap 9 cases(13.2%), groin 2(2.9%) and vascularized iliac osteocutaneous flap 1(1.5%). 4. 61 cases(89.7%) of 68 cases were survived and the exposed vital tissues and bones were covered and revealed good cosmetic results.