• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.1
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• pp.99-103
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• 2024

Pancreatic resections, depending on the location of the tumor, usually require division of the vasculature of either the distal or proximal part of the stomach. In certain situations, such as total pancreatectomy and/or with splenic vein occlusion, viability of the stomach may be threatened due to inadequate venous drainage. We discuss three cases of complex pancreatic surgeries performed for carcinoma of the pancreas at a tertiary care center in India, wherein the stomach was salvaged by reimplanting the veins in two patients and preserving the only draining collateral in one case after the gastric venous drainage was compromised. The perioperative and postoperative course in these patients and the complications were analyzed. None of these 3 patients developed any complication related to gastric venous congestion, and additional gastrectomy was avoided in all these patients. Re-establishment of the Gastric venous outflow after extensive pancreatic resections helps to avoid additional gastric resection secondary to venous congestive changes.

• The Journal of Korean Academy of Prosthodontics
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• v.36 no.3
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• pp.483-495
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• 1998

The purpose of this study was to evaluate the human pulpal response to Dentin Bonding Desensitizer. Class V cavities were prepared on the buccal surfaces of the first premolars and Dentin Bonding Desensitizer(ALL-BOND Desensitizer, Bisco, Inc. U.S.A.) was applicated in ten experimental teeth, or ZOE(PROPAC, GC Co. TOKYO, JAPAN) cement in eight control teeth and cavities were filled with light curing glass ionomer(Fuji II LC, GC Co., TOKYO, JAPAN). At 3-day and 25-day postoperative interval. pulpal response was observed and evaluated histologically with light microscope. The results were as follows. ; 1. At 3-day postoperative interval, the control teeth were grade 1 inflammatory cell response and grade 1 connective tissue response. 2. At 25-day postoperative interval, all control teeth were grade 1 inflammatory cell response and in three control teeth grade 1 connective tissue response were observed, and one teeth showed grade 2 connective tissue response. 3. At 3-day postoperative interval, the experimental teeth were grade 1 inflammatory cell response and grade 1 connective tissue response. Below the cavity, a few inflammatory cell(PMNs) in odontoblastic layer, increased blood vessels and pulpal cells were seen and this pulpal response was similar to control teeth. 4. At 25-day postoperative interval, in four experimental teeth grade 1 inflammatory cell response and grade 1 connective tissue response were observed, and one experimental teeth showed mild inflammatory response. 5. At 3-day and 25-day postoperative interval, no reparative dentin deposition was seen. 6. Both experimental and control group, pulpal response showed difference between 3 and 25-day of postoperative interval. In control teeth, increased predentin and pulpal cells were seen and in experimental teeth, congestion of blood vessels and increased pulpal cells were seen. In conclusion, the pulpal irritation due to this Dentin Bonding Desensitizer was not severe, and it was considered that the agent was not harmful to the human pulp.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.10-14
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• 1999

Ear reconstruction is very difficult to perform and often results in a devastating deformity. The use of microsurgical replantation techniques has allowed very favorable anesthetic results. We report a case of a partial ear replantation without venous repair with the use of medicinal leeches to decompress the acute venous congestion during the postoperative care. The medicinal leech therapy can be very useful in a partial ear replantation in cases with no venous repair.

• Journal of Chest Surgery
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• v.16 no.4
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• pp.526-532
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• 1983

This is a report of one case of Loffler`s eosinophilic endocarditis associated with mitral insufficiency and LV thrombi treated surgically at the department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital. This patient was a 42 year old female and she has complains of dyspnea, palpitation, orthopnea and generalized edema. Above symptoms has been going for 4 months and NYHA classification was IV. On examination, blood eosinophil was 45 to 50% [WBC-9800 ]. MI and LV thrombi were confirmed by LV ventriculography and echocardiography. Pulmonary congestion and congestive cardiac failure were diagnosis by X-Ray examination, EKG finding and clinical feature and others there were no organic functional disturbance. Mitral valve replacement was performed with Ionescu-Shiley pericardial valve [29mm] replacement. Adjust thumb sized grayish brown colored two thrombi were excluded, lodged in the apex and septal endocardium of LV. Endocardial fibrosis was reliably confirmed under the gross pathology in the heart. The patient had smooth postoperative course and there were no operative complication.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.644-649
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• 2010

Purpose: As the mean life expectancy of people has been prolonged, and the elderly people who participate in the production activities has been increasing, it is expected that the demand on the replantation of amputated digits in elderly patients would increase. But, there are few studies about the replantation of amputated digits in elderly patients. Therefore, we report treatment outcomes of replantation of amputated digits in elderly patients. Methods: From 1998 to 2008, the replantation was performed in 51 completely amputated digits of 33 patients aged 60 years or older. We performed the replantation in the usual manner. Under the brachial plexus block, the surgical procedures carried out in the following sequence: internal fixation using Kirschner wire, tenorrhaphy, arteriorrhaphy, neurorrhaphy and venorrhaphy. If the arterial ends could not be approximated without tension, a vein graft was performed. Results: Of a total of 51 digits, 46 digits (90%) survived. 13 patients (40%) had underlying medical problem preoperatively. But, in all the patients, there were no postoperative medical complications. As the postoperative surgical complications, excluding five cases of the total necrosis of digit, there were three cases of venous congestion, two cases of arterial insufficiency, seven cases of infection and 16 cases of partial necrosis. Conclusion: Age alone does not affect the survival of replanted digits. Type of injury is the most important factor that affects the survival of replanted digits.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.51-56
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• 2011

During below knee amputation, the amputation stump must be covered with well-vascularized and sensate soft tissue. Many flaps can be used for this purpose, but available reconstructive options are limited. We performed reverse flow ALT flap elevation on two patients with below knee amputations to reconstruct defects in the stumps. The sizes of the defects in the stumps were $4{\times}16$ cm and $5{\times}5$ cm, respectively. The most distal portion of the defects were located 20 cm and 16 cm lateral to the knee joint in a curve, respectively. The size of the elevated flap was $5{\times}18$ cm for case 1 and $18{\times}10$ cm for case 2. The respective pivot points of the pedicles were 7 cm and 6 cm above the patella and the respective lengths of the pedicles were 17 cm and 16 cm. In both cases, venous congestion occurred on the second postoperative day and the flap distal to 10 cm or more from below the knee joint was necrotized at the second postoperative week. Surgeons should be cautious when using a reverse ALT flap to reconstruct a soft tissue defect located 10 cm or more distal from below the knee joint. Since a pedicle longer than 15 cm may develop partial necrosis of the flap, simultaneous application of antegrade venous drainage is recommended.

• Archives of Plastic Surgery
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• v.32 no.5
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• pp.567-572
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• 2005

An electrical burn used to result in the damage of the skin and underlying deep soft tissue injury. Thus, in order to preserve devitalizing tissues and promote the structural survival free flaps with ample blood supply are frequently employed. However, early unpredictable vascular injury and progressive tissue necrosis may cause the free flaps full of hazards. We applied 50 free flaps upon 41 acute electrical burn cases between 1998 and 2004. Injured areas, timing of operation and causes of flap loss were studied. The victim's ages ranged from 13 to 60 years. (an average 37.8 years) Thirteen out of 50 free flaps were lost totally: three cases were due to arterial insufficiency and ten venous congestion. Total loss of flaps were observed in 5 of 12 cases in the postoperative 3 weeks, 6 of 20 cases between 3 and 6 weeks and 2 of 18 cases after 6 weeks. In three of 12 cases the free flap was lost partially in the postoperative 3 weeks, 4 of 20 cases between 3 and 6 weeks and 1 of 18 cases after 6 weeks. The result was statistically significant by a T-test (p<0.05). This study showed that timing of the operation is accountable for the loss of free flap. It is most important to conduct the free flap procedure on an electrical injury at the time when the recipient vessel is definitely discernible and intact so as to minimize the loss of flap and spare the structures.

• Archives of Plastic Surgery
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• v.45 no.1
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• pp.58-61
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• 2018

Background Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. Methods A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1), a single vein (group 2), and 2 or more veins (group 3). Survival rates and external bleeding rates were analyzed across the groups. Results The review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143). Failures were due equally to venous complications (n=4, 50%) and to arterial complications (n=4, 50%). Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689). However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017). Conclusions The number of venous anastomoses was not correlated with the survival rate. However, a greater number of venous anastomoses was associated with a decreased need for external bleeding, corresponding to a significant decrease in the need for postoperative monitoring and leech therapy.

• Archives of Plastic Surgery
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• v.49 no.2
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• pp.227-239
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• 2022

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

• Journal of Digestive Cancer Research
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• v.5 no.1
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• pp.23-27
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• 2017

Although laparoscopic pancreaticoduodenectomy (LPD) is considered as minimally invasive surgery, an advanced level of laparoscopic skill is still required. LPD comprises various procedures including reconstruction. Therefore, establishment of a safe approach at each step is needed. Prevention of intraoperative bleeding is the most important factor in safe completion of LPD. The establishment of effective retraction methods is also important at each site to prevent vascular injury. I also recommend the "uncinate process first" approach during initial cases of LPD, in which the branches of the inferior pancreaticoduodenal artery are dissected first, at points where they enter the uncinate process. This approach is performed at the left side of the superior mesenteric artery (SMA) before isolating the pancreatic head from the right aspect of the SMA, which allows safe dissection without bleeding. Safe and reliable reconstruction is also important to prevent postoperative complications. Laparoscopic pancreatojejunostomy requires highly skilled suturing technique. Pancreatojejunostomy through a small abdominal incision, as in hybrid-LPD, facilitates reconstruction. In LPD, the surgical view is limited. Therefore, we must carefully verify the position of the pancreaticobiliary limb. A twisted mesentery may cause severe congestion of the pancreaticobiliary limb following reconstruction, resulting in severe complications. We must secure the appropriate position of the pancreaticobiliary limb before starting reconstruction. We describe the incidence of intraoperative and postoperative complications and appropriate technique for safe performance of LPD.