• Archives of Reconstructive Microsurgery
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• 제23권1호
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• pp.1-7
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• 2014

Purpose: Recent studies have reported on application of fibrin glue composed of fibrinogen and thrombin to nerve anastomosis, which can be another candidate for vessel anastomosis. However, no research regarding the risk and effectiveness of thrombin in microvascular free tissue transfer has been reported. Therefore, the aim of study is to determine the risk and effectiveness of thrombin on microvascular free tissue transfer through clinical cases. Materials and Methods: Twenty-five patients underwent free flap reconstruction for soft tissue defect or bone exposure in our institute from March 2011 to February 2014. In the group using thrombin, dissolved powder thrombin (5,000 IU/amp) was mixed with 10 mL normal saline. Saline mixed with thrombin was applied on the flap, recipient, and around vessel anastomosis. In the control group, free flap was performed using the same method, except using thrombin. We analyzed the results between the two groups. Results: All flaps survived. The group using thrombin included 14 patients and the control group included 11 patients. Hematoma was found in two cases, respectively, in each group. The group using thrombin showed lower incidence of hematoma than the control group. No difference in survival rate of the flap was observed between the thrombin group and the control group. Conclusion: Results of this study showed that use of saline mixed with thrombin in free tissue transfer may be safe and effective for prevention of hematoma formation in the recipient site.

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1994년도 제14차 학술대회
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• pp.103-103
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• 1994

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.112-120
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• 1996

We peformed tendon transfer with a microvascular free flap for recovery of handicapped function and reconstruction for the skin and soft tissue loss. We review the clinical data of 11 children who underwent these operation due to injured foot by pedestrian accident from January, 1986 to June, 1994. The mean age of patients was 5.6 years old(3-8). Five cases underwent tendon transfer and microvascular free flap simultaneously. Another 6 cases underwent operations separately. The time interval between tendon trasnfer and microvascular free flap was average 5.6 months(2-15 months). The duration between initial trauma and tendon transfer was average 9.6 months(2-21 months). The anterior tibial tendon was used in 6 cases. Among these, the technique of splitting the anterior tibial tendon was used in 5 cases. The posterior tibial tendon was used in 3 cases and the extenosr digitorum longus tendon of the foot in 2 cases. Insertion sites of tendon transfer were the cuboid bone in 3 cases, the 3rd cuneiform bone in 3 cases, the 2nd cuneiform bone in 1 case, the base of 4th metatarsal bone in 1 case, and the remnant of the extensor hallucis longus in 3 cases. The duration of follow-up was average 29.9 months(12-102 months). The clinical results were analysed by Srinivian criteria. Nine cases were excellent and 2 cases were good. The postoperative complications were loosening of the tranferred tendon in 2 cases, plantar flexion contracture in 1 case, mild flat foot deformity in 1 case and hypertrophic scar in 2 cases. So we recommend the tendon transfer with a microvascular free flap in the case of injured foot of children combined with nerve injury and extensive loss of skin, soft tissue and tendon.

• Archives of Reconstructive Microsurgery
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• 제4권1호
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• pp.52-57
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• 1995

The authors have reviewed 19 patients of brachial plexus injury who treated by operative methods at Department of Orthopedic Surgery, Korea University Hospital during the period from January 1989 to February 1994. All of these patients were followed up more than one year and following results were obtained. 1. The whole arm type injury was most common(7 of 19 patient) and supraclavicular lesion(15 of 19 patient) was more dominant than infraclavicular lesion(4 of 19 patients). 2. The neurorrhaphy, nurolysis, nerve grafting, and neurotization were performed for the primary neural surgery and secondary reconstructive procedure consist of musculotendinous transfer and free muscle transfer with neurotization. 3. The followed up period was from one year to four years and six months, average being two years and five months. 4. We have obtained satisfactory results in 12 patients among 19 patients.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.282-286
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• 2021

Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.

• Journal of Nutrition and Health
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• 제10권2호
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• pp.5-11
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• 1977

The mature human braun contains over 10 billion nerve cells (neurons), whose functions are directly related to the acquisition, transfer, processing, analysis, and utilization of all the information. There are also billions of glial cells, which serve primarily to support and to maintain the integrity of the neuron network and to synthesize an essential fatty strucfure, myelin. In the human brain DNA content therefore cell number rises rapidly until birth and then more slowly until $5{\sim}6$ months of age, when it reaches a maximum. While glial cells may be replaced, the more important nerve cell neurons can never be replaced once they are formed. Humans are born with their full complement of neurons and every neuron is as old as each individual. Thus prenatal malnutrition can seriously affect a person's entire life by severely inhibiting the production of neurons before birth.It has been demonstrated that in humans severe malnutrition during the fetal period and in infancy is associated with intellectual impairment. Severely malnourished children have brains smaller than average size and have been found to have $15{\sim}20%$ fewer brain cells than wellnourished childen. There is growing body of literature pointing to malnutrition as a cause of abnormal behavior as evidence that suggests these abnormalities may produce chromosomal damage that may persist forever. Although cognitive development in children is affected by multiple environmental factors, nutrition certainly deaerves more attention than it has received.

• 한국군사과학기술학회지
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• 제2권1호
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• pp.73-81
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• 1999

Four bis-iodosobenzoic acid derivatives have been synthesizd in 5 steps following literature methods from 5-hydroxyantranilic acid; 1) diazotization and iodination, 2) acid protection, 3) tosylate substitution, 4) acid deprotection, 5) oxidation of iodo-substituent to iodoso group. Catalytic effects of new 5,5'-tri-, tetra-, deca-, polyethyleneglycoxy- bis(2-iodosobenzoic acid) on hydrolysis reactions of PNPDPP(p-nitrophenyl diphenyl phosphate), sarin and soman have been measured to determine the role of ethyleneglycoxy substituents as phase transfer catalysts. At $25{\pm}0.2^{\circ}C$, pH 8.0, and cetyltrimethyl ammonium chloride(CTACl) micelle solution condition, bis-IBA derivatives hydrolyzes PNPDPP with maximum pseudo-first order rate constant($K_{obsd}^{max}$) of 0.32035 ~ 0.13659 $sec^{-1}$, which corresponds to 2~18 times rate increase than those of unsubstituted o-IBA[iodosobenzoate($K_{obsd}^{max}=0.0645sec^{-1}$), iodoxybenzoate ($K_{obsd}^{max}$ = $0.0178 sec^{-1}$)]. At the similar condition for PNPDPP hydrolysis, bis-IBA derivatives also act as efficient catalysts for hydrolytic cleavage of nerve agents such as sarin and soman. Hydrolysis rate constant with 5,5'-polyethyleneglycoxy- bis(2-iodosobenzoic acid) shows 7 times increase than that of simple 5-hydroxy-2-iodosobenzoic acid.

• Restorative Dentistry and Endodontics
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• 제45권3호
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• pp.27.1-27.9
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• 2020

Apical surgery for a mandibular molar is still challenging for many reasons. This report describes the applications of computer-guided cortical 'bone-window technique' using piezoelectric saws that prevented any nerve damage in performing endodontic microsurgery of a mandibular molar. A 49-year-old woman presented with gumboil on tooth #36 (previously endodontically treated tooth) and was diagnosed with chronic apical abscess. Periapical lesions were confirmed using cone-beam computed tomography (CBCT). Endodontic microsurgery for the mesial and distal roots of tooth #36 was planned. Following the transfer of data of the CBCT images and the scanned cast to an implant surgical planning program, data from both devices were merged. A surgical stent was designed, on the superimposed three-dimensional model, to guide the preparation of a cortical window on the buccal side of tooth #36. Endodontic microsurgery was performed with a printed surgical template. Minimal osteotomy was required and preservation of the buccal cortical plate rendered this endodontic surgery less traumatic. No postoperative complications such as mental nerve damage were reported. Window technique guided by a computer-aided design/computer-aided manufacture based surgical template can be considerably useful in endodontic microsurgery in complicated cases.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.10-14
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• 1998

When covering a skin defect of the finger with a local flap is difficult, a vascular island flap is often used. For a palmar skin defect, it is desirable to add a sensory supply to the flap. This report describes a neurovascular island flap that was used to repair a palmar skin defect, the donor skin coming from the dorsal region of the middle phalanx. This flap is elevated with a vascular pedicle of the palmar digital artery and its dorsal skin branch, including the dorsal digital veins, palmar digital nerve and its cutaneous branches. The advantage of this flap are that it can be transferred with ease and without any tension. No special manipulation is required under a microscope and operation can be performed under a simple nerve-block. There if little possibility that the flap itself undergoes ischemic change or congestion. The disadvantage of this flap are that a skin graft is required at the donor skin site and one palmar digital aretery is lost. We think that this neurovascular island flap is one of the useful methods for skin defects that are difficult to cover with a local flap.

• Archives of Plastic Surgery
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• 제39권6호
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• pp.637-642
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• 2012

Background Fingertip injuries involving subtotal or total loss of the digital pulp are common types of hand injuries and require reconstruction that is able to provide stable padding and sensory recovery. There are various techniques used for reconstruction of fingertip injuries, but the most effective method is functionally and aesthetically controversial. Despite some disadvantages, cross-finger pulp flap is a relatively simple procedure without significant complications or requiring special techniques. Methods This study included 90 patients with fingertip defects who underwent cross-finger pulp flap between September 1998 and March 2010. In 69 cases, neurorrhaphy was performed between the pulp branch from the proper digital nerve and the recipient's sensory nerve for good sensibility of the injured fingertip. In order to evaluate the outcome of our surgical method, we observed two-point discrimination in the early (3 months) and late (12 to 40 months) postoperative periods. Results Most of the cases had cosmetically and functionally acceptable outcomes. The average defect size was $1.7{\times}1.5$ cm. Sensory return began 3 months after flap application. The two-point discrimination was measured at 4.6 mm (range, 3 to 6 mm) in our method and 7.2 mm (range, 4 to 9 mm) in non-innervated cross-finger pulp flaps. Conclusions The innervated cross-finger pulp flap is a safe and reliable procedure for lateral oblique, volar oblique, and transverse fingertip amputations. Our procedure is simple to perform under local anesthesia, and is able to provide both mechanical stability and sensory recovery. We recommend this method for reconstruction of fingertip injuries.