• Archives of Plastic Surgery
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• v.38 no.5
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• pp.621-626
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• 2011

Purpose: Implant-based breast reconstruction has multiple advantages such as decreased morbidity, shorter operative time and faster recovery. However, postoperative infection with tissue expander increases medical cost and causes a delay in concurrent antineoplastic treatment. To reduce tissue expander infection, it is important to identify related risk factors and minimize them when possible. Methods: A retrospective review of patient records in a single breast cancer center was performed. Eighty-six tissue expanders were placed in 80 women for postmastectomy breast reconstruction. Variables including patients'age, body mass index (BMI), preoperative breast volume, operation time, drain indwelling time, postoperative seroma/hematoma formation, chemotherapy, and radiation therapy were evaluated. Infection was defined as the status that shows any symptom of local inflammation and identification of pathogens. Representative values were compared through Student's t-test and univariate and multivariate analyses. Results: We examined 86 postmastectomy tissueexpanders which were placed between June 2004 and April 2010. Seven cases of tissue expander infection (8.1%) were identified. The infected tissue expander was removed in three of the cases. The relationship between BMI, and preoperative breast volume and that between infection and non-infection groups were significant ($p$ <0.05). Univariate analysis showed significant association between BMI ($p$=0.023) and preoperative breast volume ($p$=0.037). Multivariate analysis revealed that BMI and preoperative breast volume were independent variables regarding tissue expander infection. Conclusion: Certain characteristics of implant-based breast reconstruction patients increase infection rate of tissue expander. These risk factors should be monitored and evaluated before surgeries for more successful outcome.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.469-472
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• 2010

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.611-616
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• 2009

Purpose: The rate of fistulas occuring followed by resection of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancer are reported to be 9 ~ 23% according to various documents. Neglected treatment of the fistula can result in a setback in proper treatment with restrictions in oral intake leading to delayed return to daily life. Furthurmore, in severe cases, it may injure important vessels and adjacent structures of the neck area. The author reviewed previously reported cases of treatment methods for fistulas recurring after diverse head and neck operations and with sharing the treatment experiments of our patients, we tried to present a treatment algorism for different fistula types. Methods: Our study was based on retrograde analysis of 64 patients who were clinically diagnosed with fistula after operation for cancer of the head and neck from 1997 to 2008 at Severance Hospital. Their primary sites of cancer were 8 oral cavity, 22 oropharynx, 25 hypopharynx, and 9 larynx. The patients were aged 45 to 75 years and the male to female ratio was 11 to 1. The patient's operation records and progress notes were evaluated for determination of degree of fistula and treatment methods. Results: Most fistulas were clinically suspected after postoperative 5 days and symptoms noted for detection of the fistula were erythema, purulent discharge, edema, tenderness, and fluctuation. The fistula was definitely diagnosed at postoperative 2 weeks with barium test and treatment method ranging from conservative management to operative procedure were applied to each patients. Total 21 patients were managed with conservative protocol. In 15 cases, direct repair of the fistula was done and more stable repair of the fistula was possible with using of TachoComb$^{(R)}$. Pharyngostoma was performed in 14 patients. Among them, 4 patients healed spontaneously, 5 patients were taken direct closure, 4 patients were taken pectoralis major musculocutaneous flap, and one patient was taken esophageal transfer. The other 14 patients were taken 11 pectoralis major musculocutaneous flaps and 3 free flaps without pharyngostoma formation. Conclusion: Fistula is a troublesome complication resulting after resection of head and neck cancer. Early detection and adequate treatment according to the period and condition of the fistula may prevent further complications and reduce the pain of the patient.

• The Journal of the Korean dental association
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• v.23 no.12 s.199
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• pp.1031-1037
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• 1985

The purpose of this study was to evaluate the marginal sealing ability of 'vivadent.' Using freshly extracted human teeth and 2% aqueous methylene blue, the marginal leakage of dye in restorative materials such as vivadent with acid etching technique, Durafill with acid etching technique, silar with acid etching technique, Adaptic, and Amalgam were investigated at 37℃ and under temperature cycling in range of 4℃-60℃. The results were as follows; 1. All filling materials showed some degree of marginal penetration by 2% methylene blue dye. 2. Vivadent with acid etching technique revealed effective marginal sealing ability, but under temperature cycling it showed increased marginal leakage. 3. All resins showed greater marginal leakage than amalgam restoration. 4. Vivadent had the most effective marginal sealing ability in experimented resins.

• Restorative Dentistry and Endodontics
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• v.8 no.1
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• pp.167-172
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• 1982

The purpose of this study was to evaluate the marginal sealing ability of "Silar". Using freshly extracted human teeth and 2% acquous methylene blue, the marginal leakage of dye in restorative materials such as Silar, Silar with acid etching technique, Hi-Pol, Hi-Pol Enamel Bond system, Adaptic and Amalgam were investigated at $37^{\circ}C$ and under temperature cycling in range of $4^{\circ}C-60^{\circ}C$. The results as follows; 1. All filling materials showed some degree of marginal penetration by 2% methylene blue dye. 2. Silar with acid etching technique revealed effective marginal sealing ability, but under temperature cycling it showed increased marginal leakage. 3. All composite resins showed greater marginal leakage than amalgam restoration. 4. Silar had the most effective marginal sealing ability in experimented composite resins.

• Journal of Chest Surgery
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• v.25 no.1
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• pp.105-111
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• 1992

Total atherosclerotic obstruction of the juxtarenal abdominal aorta is a relatively rarely encountered form of atherosclerotic vascsular disease, accounting for less than 5% of all arterial obstrutive disease. We have encountered two patients with such lesions, both of whom were admitted for intermittent claudication of the lower extremities and symptoms of vascular ischemia. Digital subtraction angiography[DSA] was performed on both patients, the results of which revealed total obstruction of the aorta just inferior to the renal arteries without involving the latter. Operative technique involved the use of the sup-raceliac aorta as the site of proximal anastomosis of aortofemoral bypass followed by a fem-orofemoral bypass graft with Smm sized Woven Dacron[Vascutek] through a subcutaneous tunnel within the retroperitoneal space. Both patients experienced restoration of blood flow distal to the obstruction postoperatively without any complications, and OPD follow-up one month postoperatively and postoperative DSA showed evidence of continued graft patency with persistent symptomatic improvement.

• The Journal of the Korean dental association
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• v.11 no.5
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• pp.317-320
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• 1973

Two cases of rampant dental caries patients, 5 year old and 3 year old male, were treated; and got following results: 1) Early treatment of rampant dentral caries is emphasized to obtain favorable treatment results. 2) Premedication prior to treatment is an important factor due to the long operative procedures which may elicit the child's phychological trauma. 3) The full cast gold crown restoration for rampant dental caries in primary dentition indicated because of its precise work for maintaining normal occlusion and gingiva.

• Restorative Dentistry and Endodontics
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• v.11 no.1
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• pp.77-88
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• 1985

The purpose of this study was to examine the thermal diffusion through bases and restorations. The three principle types of base and two restorative materials were included in this study. They were representive brands of a zinc phosphate cement, a zinc oxide-eugenol cement, a calcium hydroxide paste, an amalgam and a composite resin (table 1). The specimens were prepared by placing the bases or restorative materials in laminated plastic molds. 5-mm diameter holes were prepared in the center of square of plastics which were 0.5, 1.0, 2.0, and 3.0mm thick respectively (fig. 1). All materials were manipulated in accordance with manufacturer's recommended proportions. All experimental procedures were carried out dividing them into eight different groups (table 2). Thermal diffusion was measured by means of digital thermometer (DP-100, RKC. instrument Inc. JAPAN) with the surface thermocouple placed on bottom surface of the specimen applying a constant source of heat and cold to the top surface of the each specimen. The thermal stimulus temperature applied on the each specimen surface was in the range of $60^{\circ}C$, $0^{\circ}C$ and $-50^{\circ}C$ respectively. The thermal change were recorded automatically on the multi-Pen recorder (R-16, Rikadenki, Co. JAPAN) connected with thermocouple tips which were centered on the bottom of the specimen. The following results were as follows, 1. Temperature diffusion was highest through amalgam and slowest through the composite resin. 2. As the thickness of restorations increased, the temperature change was decreased. 3. Thermal diffusion was slowest in the presence of zinc oxide-eugenol bases, followed by calcium hydroxide and zinc phosphate cement. 4. The efficiency of the cement bases in providing thermal insulation was dependent on their thickness beneath the restorations. 5. Thermal change was great in the range of $60^{\circ}C$ and $-50^{\circ}C$, but little in the range of $0^{\circ}C$.

• Restorative Dentistry and Endodontics
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• v.13 no.2
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• pp.337-348
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• 1988

The purpose of this study was to examine the fracture strength and characteristics of teeth with MOD cavity preparation. Freshly extracted sound maxillary premolars were cleaned and stored in normal saline solution $37^{\circ}C$ for 72 hours before experiments. The roots of teeth were embedded in a self-curing resin, and the exposed crown were maintained in a vertical position by a modelling wax in a brass ring. The MOD cavities were prepared with No. 57 carbide bur under high speed to a depth of 2.0mm and a width of 2.0mm(Fig.1). All the prepared teeth specimens were divided into 7 groups according to the mode of cavity form and restorative materials (Table 1, 2): Group I, unpreapred, intact teeth as control Group II, prepared cavity without restoration Group III, prepared teeth restored with amalgam Group IV, prepared teeth restored with composite resin (P-10) Group V, prepared teeth with beveled enamel margins restored with composite resin (P-10) Group VI, prepared teeth restored with light-cured composite resin (P-30) Group VII, prepard teeth with beveled enamel margins restored with light-cured composite resin (P-30) After placement of restorations, all of the specimens were stored in water at $37^{\circ}C$ for 72 hours before testing. All of the specimens were tested on the Instron Universal Testing machine (No. 6025) in order to evaluate the strength of fracture. One metal ball 5.0mm in diameter contacting the specimens parallel to the occlusal surface was used to in this study (Fig. 1). The fracture characteristics of the specimens were examined with naked eye and in the scanning electron microscope (JSM-20). The results obtained from this study were as follows: 1. The mean fracture strength was the highest in group VI and that in group II was the lowest. 2. The progress of crack of teeth propagated into the pulp cavity. 3. In case of the group of the restored teeth, the crack occurred to be accompanied with cuspal fracture. 4. The crack of restored teeth was initiated along the pulpo-axial line angle of the cavity.

• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.816-824
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• 2022

Objective : Emergency superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis in patients with large vessel occlusion who fails mechanical thrombectomy or does not become an indication due to over the time window can be done as an alternative for blood flow restoration. The authors planned this study to quantitatively measure the degree of improvement in cerebral perfusion flow using perfusion magnetic resonance imaging (MRI) after bypass surgery and to find out what factors are related to the outcome of the bypass surgery. Methods : For a total of 107 patients who underwent emergent STA-MCA bypass surgery with large vessel occlusion, the National Institute of Health stroke scale (NIHSS), modified Rankin score (mRS), infarction volume, and hypoperfusion area volume was calculated, the duration between symptom onset and reperfusion time, occlusion site and infarction type were analyzed. After emergency STA-MCA bypass, hypoperfusion area volume at post-operative 7 days was calculated and analyzed compared with pre-operative hypoperfusion area volume. The factors affecting the improvement of mRS were analyzed. The clinical status of patients who underwent emergency bypass was investigated by mRS and NIHSS before and after surgery, and changes in infarct volume, extent, degree of collateral circulation, and hypoperfusion area volume were measured using MRI and digital subtraction angiography (DSA). Results : The preoperative infarction volume was median 10 mL and the hypoperfusion area volume was median 101 mL. NIHSS was a median of 8 points, and the last normal to operation time was a median of 60.7 hours. STA patency was fair in 97.1% of patients at 6 months follow-up DSA and recanalization of the occluded vessel was confirmed at 26.5% of patients. Infarction volume significantly influenced the improvement of mRS (p=0.010) but preoperative hypoperfusion volume was not significantly influenced (p=0.192), and the infarction type showed marginal significance (p=0.0508). Preoperative NIHSS, initial mRS, occlusion vessel type, and last normal to operation time did not influence the improvement of mRS (p=0.272, 0.941, 0.354, and 0.391). Conclusion : In a patient who had an acute cerebral infarction due to large vessel occlusion with large ischemic penumbra but was unable to perform mechanical thrombectomy, STA-MCA bypass could be performed. By using time-to-peak images of perfusion MRI, it is possible to quickly and easily confirm that the brain tissue at risk is preserved and that the ischemic penumbra is recovered to a normal blood flow state.