• Archives of Plastic Surgery
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• 제35권2호
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• pp.169-173
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• 2008

Purpose: Sacrococcygeal pilonidal sinus is a chronic inflammatory disease that mostly affects young people, which warrants surgical intervention. Although many surgical methods have been suggested, an optimal surgical method remains controversial because of high recurrence rates and postoperative complications. The objective of this study is to evaluate the results of wide excision and coverage with fasciocutaneous advancement flap for the treatment of sacrococcygeal pilonidal sinus, and to assess the usefulness of this method Methods: From May 1995 to October 2006, the authors treated 19 patients with the use of coverage with fasciocutaneous flap after wide excision. The results were evaluated regarding recurrence rates, complications, and the change in sensitivity of the gluteal region after surgery. The follow-up period was 7 to 142 months (mean, 76 months). All patients were male. Results: Postoperative complications were wound infection at the suction drain insertion site and skin necrosis around the suture margin in one case, respectively. During the follow up period, only one recurrence (5.3%) was seen in fifth postoperative month, which was successfully treated by the same operative procedure. There was no other complications such as seroma, hematoma, wound dehiscence and flap loss. Extensive scarring and anatomic distortion did not occur in the reconstructed area. In addition, sensitivity of the gluteal region did not diminish. The aesthetic results were satisfactory for all patients as well. Conclusion: The authors advocate that fasciocutaneous flap closure be a good alternative method to cover defects after the excision of sacrococcygeal pilonidal sinus.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.393-396
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• 2009

Purpose: Low - molecular - weight dextran is one of the most frequently used antithrombotic agents in microvascular surgery, but there is controversy if it has the real benefit in the clinical aspects. The purpose of this study was to evaluate the effect associated with postoperative use of low - molecular - weight dextran in breast reconstruction by free TRAM flap patients. Methods: From January 2002 to October 2008, we reconstructed 88 cases of postmastectomy deformity using the free TRAM flap. The 88 cases were divided into two groups : a group with no use of dextran(66 patients, control group, Group A) and a postoperative low - molecular weight dextran loaded group(22 patients, Group B). We assessed number of flap survival, rate of complication like hematoma or seroma, total amount of drainage from operative wound, duration of drainage, and amount of transfusion in each group. Results: There was no total flap loss and every flap was survived. Total amount of drainage for post - operative 5 days were 857 ml in group A and 1101 ml in group B. Drain was kept for average of 7.3 days in group A and 8.7 days in group B. Packed red cell transfusions were made in average of 3.3 units for group A and 3.0 units for group B. Group B showed significantly higher values in former 2 comparative parameters than group A. Conclusion: There was no definitive advantage of anticoagulants in elective free - flap surgery in terms of success rate. However, groups with using anticoagulants had the increased bleeding tendency in immediate postoperative period. The routine use of anticoagulants in elective free - flap surgery should be reconsidered with postoperatively less bleeding and early recovery.

• 대한두개안면성형외과학회지
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• 제13권1호
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• pp.22-28
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• 2012

Purpose: In accordance to an increased interest in facial appearance and the popularization of computed tomography scanning, the number of diagnosis and treatment of blowout fractures has been increased. The purpose of this article is to review pure blowout fracture surgery through transconjunctival incision focusing on complications and their management. Methods: In this retrospective study, 583 patients, who had been treated for pure blowout fracture through transconjunctival incision from 2000 to 2009, were evaluated. Their hospital records were reviewed according to their sex, age, fracture site, preoperative presentations, time interval between trauma and surgery, and postoperative complications. Results: According to postoperative follow-up results, there were early complications that included wound dehiscence and infection (0.2%), hematoma (insomuch as extraocular movement is limited) (0.7%), lacriminal duct injury (0.5%), and periorbital nerve injury (0.7%). In addition, there were late complications that lasted more than 6 months, that included persistent diplopia (1.7%), extraocular movement limitation (0.9%), enophthalmos (1.0%), periorbital sensation abnormalities (1.0%), and entropion (0.5%). Conclusion: We propose the following guidelines for prevention of postoperative complications: layer by layer closure; bleeding control with the epinephrine gauzes, Tachocomb, and Tisseel; conjunctival incision 2 to 3 mm away from punctum; avoidance of excessive traction; performing surgical decompression and high dose corticosteroid therapy upon confirmation of nerve injury; atraumatic dissection and insertion of Medpor Barrier implant after securing a clear view of posterior ledge; using Medpor block stacking technique and BioSorb FX screw fixation; performing a complete resection of the anterior ethmoidal nerve during medial wall dissection; and making an incision 2 to 3 mm below the tarsal plate.

• Journal of Chest Surgery
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• 제22권5호
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• pp.839-844
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• 1989

There appears to be significant problems remained in the treatment of tuberculous empyema with BPF in spite of several surgical methods: decortication, thoracoplasty, and pleuropneumonectomy. We presented one case of tuberculous empyema with BPF. The patient was 42-year-old male and his chief complaint was hemoptysis. In past history, he was treated with left closed thoracostomy and antituberculous medication for two months, 16 years ago. Chest X-ray, tomogram and C. T, revealed a huge mass with central necrosis in the lower 2/3 of left thoracic cavity and shifting of the mediastinal structure to the right. Needle aspiration cytology was undifferentiated large cell carcinoma. Left thoracotomy was made under the impression of lung cancer and pleuropneumonectomy was done. Operative findings; thick walled empyema sac filled with hematoma and BPF, the mediastinum was fixated due to fibrosis and calcification of the pleura and the mediastinum. Postoperative biopsy was consistent with tuberculosis. In the postoperative course, there was massive hemorrhage and so reoperation was done. But there was no active bleeding focuses in the thoracic cavity at the time of reoperation. Massive transfusion, coagulant therapy and intermittent clamping and declamping of the chest tube were carried out. Especially, serum calcium level was chronically decreased and so large amount of calcium gluconate was infused for the calcium level to be normal. Total transfused blood; whole blood was 33 pints, packed cell was 63 pints and fresh frozen plasma was 70 pints. At the postoperative[reop] 45th day, intrathoracic hemorrhage was stopped and the chest tube was removed. In conclusion, this suggest that uncontrollable bleeding after pleuropneumonectomy of the tuberculous empyema with BPF could be treated without reoperation in case of the mediastinal fixation due to fibrosis and calcification of the pleura and the mediastinum.

• Journal of Chest Surgery
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• 제28권7호
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• pp.678-683
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• 1995

Arterial bypass for the chronic ischemia of the lower extremities underlying atherosclerotic obliterans has been performed with a number of alternative conduits from 1941 by Kunlin. It is indicated for the limb salvage of patients with threatened limb loss despite of several controversies in surgical treatment of atherosclerotic obliterans. From March 1991 to January 1995, 26 arterial bypasses were performed in 23 patients with the chronic ischemia of the lower extremities in our hospital. Their mean follow up period is 18.9 months ranging from 4 months to 44 months. Mean age is 60.9 years ranging 47 years to 76 years and the most prevalent incidence is the 6th decade. 21 patients are male and 2 patients are female. 19 of 23 patients are smokers. Clinical classifications by Fontaine are class II[21.7% , class III[34.8% and class IV[43.5% .Diabetes mellitus[47.8% , hypertension[43.5% , hyperlipid-emia[26% , tuberculosis[21.7% , cerebrovascular accident[13.0% and cardiac diseases[8.7% are associated. Aorto-single femoral bypass in 4 cases, aorto-bifemoral bypass in 5 cases, aortofemoral & femoropopliteal bypass in 2 cases, femoropopliteal bypass in 10 cases, popliteotibial bypass in 3 cases, femoropedal bypass[composite graft bypass in 2 cases were surgically approached. There are complicated early thrombosis in 4 cases those are required immediately reoperation, wound infection in 3 cases, hematoma in 3 cases, and so on. Postoperative complication rate is 53.8%.Postoperative patency rates are 84.6% at 6 months, 75.0% at 1 year, 70.0% at 2 years and 66.7% at 3 years. We usually used 6 mm & 8 mm graft for bypass, and the rate of thrombosis formation is 28.6%[2/7 in 6 mm graft and 12.5%[2/16 in 8 mm separately. In according to the graft materials, the rate of thrombosis formation is higher in the group using artificial graft than in that using autologous saphenous vein[16.6% vs 12.5% . Limb salvage rate is 76.9%. Postoperative mortality rate is zero %.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.729-739
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• 2022

Cranioplasties are common procedures in plastic surgery. The use of tissue expansion (TE) in staged cranioplasties is less common. We present two cases of cranioplasties with TE and systematically review literature describing the use of TE in staged cranioplasties and postoperative outcomes. A systematic review was performed by querying multiple databases. Eligible articles include published case series, retrospective reviews, and systematic reviews that described use of TE for staged bony cranioplasty. Data regarding study size, patient demographics, preoperative characteristics, staged procedure characteristics, and postoperative outcomes were collected. Of 755 identified publications, 26 met inclusion criteria. 85 patients underwent a staged cranioplasty with TE. Average defect size was 122 cm², and 30.9% of patients received a previous reconstruction. Average expansion period was 14.2 weeks. The most common soft tissue closures were performed with skin expansion only (75.3%), free/pedicled flap (20.1%), and skin graft (4.7%). The mean postoperative follow-up time was 23.9 months. Overall infection and local complication rates were 3.53 and 9.41%, respectively. The most common complications were cerebrospinal fluid leak (7.1%), hematoma (7.1%), implant exposure (3.5%), and infection (3.5%). Factors associated with higher complication rates include the following: use of alloplastic calvarial implants and defects of congenital etiology (p = 0.023 and 0.035, respectively). This is the first comprehensive review to describe current practices and outcomes in staged cranioplasty with TE. Adequate soft tissue coverage contributes to successful cranioplasties and TE can play a safe and effective role in selected cases.

• Journal of Korean Neurosurgical Society
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• 제46권5호
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• pp.501-504
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• 2009

Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.

• The Korean Journal of Pain
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• 제14권2호
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• pp.253-256
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• 2001

One of the most serious complications of regional anesthesia is a neurological deficit. Although such a problem is very rare, obstetric patients may develop paresthesia and motor dysfuntion during the postoperative period in association with number of other factors, including direct nerve trauma, equipment problems, adhesive arachnoiditis, anterior spinal artery syndrome, epidural hematoma or abscess and adverse drug effect. We experienced a case of unilateral paraparesis following epidural anesthesia with 20 ml of 0.75% ropivacaine and $25{\mu}g$ of fentanyl in an obstetric patient.

• The Korean Journal of Pain
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• 제3권1호
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• pp.59-62
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• 1990

Epidural block is used for surgical analgesia, postoperative pain management, obstetric relief and management of chronic pain. Long-term pain control for chronic pain is achieved by development of epidural catheter placement technic. But long term placement of epidural catheteter has several problems, epidural hematoma, epidural absess and neural damage. We had successfully managed long-term placement of epidural catheter in patient with diabetic neuropathy who was susceptable to infection. The duration of epidural catheter placement was 416 days and specific complication was not occurred.

• Journal of Trauma and Injury
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• 제29권2호
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• pp.51-55
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• 2016

Isolated injury to the pancreas after abdominal trauma is uncommon, and a delay in diagnosis and treatment can increase the morbidity and mortality. Therapeutic decisions with respect to pancreatic trauma are usually made based on the site of injury and the status of the pancreatic ductal system. In this report, we describe the surgical management of pancreatic head transection as an isolated injury following blunt abdominal trauma. A 55-year-old man presented with epigastric pain that radiated to the back. Abdominal computed tomography revealed a hematoma in the pancreatic head and upstream dilatation of the main pancreatic duct. Endoscopic retrograde cholangiopancreatography showed complete disruption of and contrast leakage from the main pancreatic duct in the pancreatic head region with a nonenhanced upstream duct. Emergency pancreaticoduodenectomy was successfully performed, and the patient was discharged on postoperative day 9 without any complications.