• 제목/요약/키워드: Primary closure

검색결과 309건 처리시간 0.023초

대동맥류의 수술요법 (Surgical treatment of the aortic aneurysm)

  • 박표원;노준량
    • Journal of Chest Surgery
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    • 제16권3호
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    • pp.301-309
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    • 1983
  • Twenty-three patients with aneurysm were operated between Jan. 1956 to July 1983 at the Department of Thoracic surgery, Seoul National University Hospital. There were 18 males and 5 females in this series. The age ranged from 14 to 68 years with the mean age of 41 years. The etiology of aortic aneurysms was atherosclerosis in 10, trauma in 2, annuloaortic ectasia in 4, syphilis in 1, and unknown etiology in six cases. Among the 4 patients with ascending aortic aneurysm, aortic valve replacement with aneurysmorrhaphy in three patients and Bentall operation in one patient were performed successfully. One patient with entire aortic arch aneurysm was received Dacron graft replacement with anastomosis of brachiocephalic arteries separately under cardiopulmonary bypass. There was no complication. Among 6 patients involving the descending thoracic aorta, three patients were managed by prosthetic bypass graft and aneurysm resection, and another three patients were also managed by prosthetic graft replacement. There were three hospital deaths. There were two thoracoabdominal aortic aneurysm. One patient in shock state due to preoperative rupture died from cardiac arrest during operative procedure. In another patient who had extensive involvement from the midportion of descending thoracic aorta to the terminal abdominal aorta, the aneurysm was successfully repaired with Dacron graft. In this instance celiac axis, superior and inferior mesenteric arteries and right renal artery were anastomosed separately. Eight of the 10 abdominal aortic aneurysms was replaced with prosthetic graft. One saccular aneurysm was treated by resection and primary closure. In another patient, cardiac arrest occurred during operation before definitive procedure. There was one another hospital death in the patient with preoperative rupture.

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개심술 치험 보고: 12예 (Clinical experience of open heart surgery: 12 cases)

  • 최영호
    • Journal of Chest Surgery
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    • 제16권3호
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    • pp.289-294
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    • 1983
  • The report is concerned to our experience of 12 cases of open heart surgery under the extracorporeal circulation at the Department of Thoracic and Cardiovascular Surgery, Chosun University Hospital during the period between Nov, 1979 and April, 1983. 1. There were 4 cases of congenital anomaly and 8 cases of acquired heart disease. 2. There were 6 male and 6 female patients with a mean age of 20 years. [range 9 to 33 years]. 3. The cases induced 2 ventricular septal defect, 2 atrial septal defects and 8 acquired valvular heart diseases. 4. The surgical managements were 2 primary repair for atrial septal defect and 2 patch closure for ventricular septal defect, 1 triple valve replacement [AVR MVR TVR], 1 aortic valve replacement, 4 double valve replacement [AVR MVR] and 2 open mitral commissurotomy for pure mitral stenosis. 5. The average cardiopulmonary bypass time was 61.5 minutes for congenital heart disease and 201.4 minutes for acquired valvular heart disease and the average aortic cross clamping time was 36.75 minutes for the former and 165.6 minutes for the latter. 6. Postoperatively, there were 1 Alopecia, 1 Electric burn and 1 wound infection as complication. 7. Overall operative mortality was 8.3%. 7. All patients received valve replacement were recommended anticoagulation with persantin.

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다형샘종 제거 후 발생한 연구개 점막 결손의 무세포 동종 진피기질을 이용한 재건 1례 (Use of Acellular Allogenic Dermal Matrix in Soft Palate Reconstruction after Excision the Pleomorphic Adenoma)

  • 이재성;임길채;김정홍;강재경;신명수;윤병민
    • 대한두경부종양학회지
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    • 제35권1호
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    • pp.21-23
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    • 2019
  • Recent studies have reported on the reconstruction of oral mucosal defects using acellular dermal matrix (ADM). This case report describes the reconstruction of a soft-palate mucosal defect using ADM. A 43-year-old man developed a $2.5cm{\times}3cm$ soft-palate mucosal defect after the removal of a lump on the soft palate andreconstructed the defect using ADM without further complications. Reconstruction of the soft palate with ADM could be more convenient than traditional methods including primary closure, skin graft, and local or free flap without complications.

Fatigue reliability analysis of steel bridge welding member by fracture mechanics method

  • Park, Yeon-Soo;Han, Suk-Yeol;Suh, Byoung-Chul
    • Structural Engineering and Mechanics
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    • 제19권3호
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    • pp.347-359
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    • 2005
  • This paper attempts to develop the analytical model of estimating the fatigue damage using a linear elastic fracture mechanics method. The stress history on a welding member, when a truck passed over a bridge, was defined as a block loading and the crack closure theory was used. These theories explain the influence of a load on a structure. This study undertook an analysis of the stress range frequency considering both dead load stress and crack opening stress. A probability method applied to stress range frequency distribution and the probability distribution parameters of it was obtained by Maximum likelihood Method and Determinant. Monte Carlo Simulation which generates a probability variants (stress range) output failure block loadings. The probability distribution of failure block loadings was acquired by Maximum likelihood Method and Determinant. This can calculate the fatigue reliability preventing the fatigue failure of a welding member. The failure block loading divided by the average daily truck traffic is a predictive remaining life by a day. Fatigue reliability analysis was carried out for the welding member of the bottom flange of a cross beam and the vertical stiffener of a steel box bridge by the proposed model. Results showed that the primary factor effecting failure time was crack opening stress. It was important to decide the crack opening stress for using the proposed model. Also according to the 50% reliability and 90%, 99.9% failure times were indicated.

안면 외상에서 연부조직 치료에 있어 미용적 재건 (Aesthetic soft tissue management in facial trauma)

  • 정규진;김태곤;이진호
    • 대한의사협회지
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    • 제61권12호
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    • pp.715-723
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    • 2018
  • Facial soft tissue injury due to trauma is common. Severe damage of soft tissue causes functional and cosmetic problems. In the initial evaluation of patients with facial trauma, airway maintenance and respiratory maintenance are the most important. The principles of treatment include adequate irrigation and debridement, primary closure, or secondary wound healing. Postoperative care such as taping, silicone gel sheeting, and sun screening is important to prevent scarring. The scalp and forehead are abundant in blood and can cause severe bleeding. The eyelid is very thin and has a multi-layered structure, requiring accurate suturing and reconstruction of the layers. It is advisable to determine the presence of hematoma in the ear and treat it. When the cheek area is damaged, it is necessary to identify and treat the damage of the parotid gland and the facial nerve branch. The lips should be sewn with the white roll of lip and vermillion.

Complete Transection of the Cystic Duct and Artery after Blunt Trauma: A Case Report

  • Cho, Sung Hoon;Lim, Kyoung Hoon
    • Journal of Trauma and Injury
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    • 제34권4호
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    • pp.294-298
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    • 2021
  • Extrahepatic biliary tract and gallbladder injuries following blunt abdominal trauma are uncommon. Traumatic cystic duct transection is even rarer, which has frequently caused missed diagnosis and delayed treatment. An 18-year-old female patient with no past medical history was transferred to the Trauma Center of Kyungpook National University Hospital after falling from a height of approximately 20 meters. She became hemodynamically stable after initial resuscitation, and initial contrast-enhanced abdominal computed tomography (CT) showed right kidney traumatic infarction and multiple intrahepatic contusions with minimal fluid collection but no extravasation of the contrast. She was admitted to the intensive care unit. On the second day of hospitalization, her abdomen became distended, with follow-up CT showing a large collection of intra-abdominal fluid. Laparoscopic exploration was then performed, which revealed devascularization of the gallbladder with complete transection of the cystic duct and artery. Laparoscopic cholecystectomy was performed, as well as primary closure of the cystic duct orifice on the common bile duct using a 4-0 Prolene suture. After surgery, no clinical evidence of biliary leakage or common bile duct stricture was observed.

Chondrocutaneous posterior auricular artery perforator free flap for single-stage reconstruction of the nasal tip: a case report

  • Lee, Jun Yong;Seo, Jeong Hwa;Jung, Sung-No;Seo, Bommie Florence
    • 대한두개안면성형외과학회지
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    • 제22권6호
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    • pp.337-340
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    • 2021
  • Full-thickness nasal tip reconstruction is a challenging process that requires provision of ample skin and soft tissue, and intricate cartilage structure that maintains its architecture in the long term. In this report, we describe reconstruction of a full-thickness nasal tip and ala defect using a posterior auricular artery perforator based chondrocutaneous free flap. The flap consisted of two lay ers of skin covering conchal cartilage, and was based on a perforating branch of the posterior auricular artery. A superficial vein was secured at the posterior margin. The donor perforator was anastomosed to a perforating branch of the lateral nasal artery. The superficial vein was connected to a superficial vein of the surrounding soft tissue. The donor healed well after primary closure. The flap survived without complications, and the contour of the nasal rim was sustained at follow-up 6 months later. As opposed to combined composite reconstructions using a free cartilage graft together with a small free flap or pedicled nasolabial flap, the posterior auricular artery perforator free flap encompasses all required tissue types, and is similar in contour to the alar area. This flap is a useful option in single-stage reconstruction of nasal composite defects.

Verrucous carcinoma arising from actinic keratosis: a case report

  • Jung, Ji Hyuk;Jeon, Yeo Reum;Kim, Hyo In;Lee, Mi Kyung;Chung, Seum
    • 대한두개안면성형외과학회지
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    • 제22권6호
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    • pp.333-336
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    • 2021
  • Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma that commonly occurs in the oral cavity. However, VC of the facial skin is relatively rare. We report a case of a 91-year-old woman with VC of the facial skin in the left zygoma area. She was diagnosed with actinic keratosis (4×3 cm) of the same site approximately 12 years previously, but declined further treatment. The mass was excised with a minimum of 0.4 cm from gross margins with the result of free from tumor of all margins by frozen section, allowing for primary closure after skin undermining. Basal resection was performed in the preplatysmal plane. The diagnosis of VC was confirmed by histopathological examination. Postoperatively, the wound healed without incident and with no signs of facial nerve injury. To our knowledge, this is the first reported case of VC of facial skin arising from actinic keratosis.

Open healing of contained and non-contained extraction sockets covered with a ribose cross-linked collagen membrane: a pilot study

  • Friedmann, Anton;Meskeleviciene, Viktorija;Yildiz, Mehmet Selim;Gotz, Werner;Park, Jung-Chul;Fischer, Kai R.
    • Journal of Periodontal and Implant Science
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    • 제50권6호
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    • pp.406-417
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    • 2020
  • Purpose: This study investigated whether the placement of ribose cross-linked collagen (RCLC) membranes without primary soft tissue closure predictably resulted in sufficient alveolar ridge preservation in contained and non-contained extraction sockets. Methods: Membranes were positioned across extraction sockets, undermining full-thickness flaps, and the gingival margins were fixed by double-interrupted sutures without crossed horizontal mattress sutures for 1 week. In non-contained sockets, a bone substitute was used to support the membrane within the bony envelope. Radiographs and clinical images obtained 4 months later were analyzed by ImageJ software using non-parametric tests. Results: In 18 patients, 20 extraction sockets healed uneventfully and all sites received standard-diameter implants (4.1, 4.8, or 5.0 mm) without additional bone augmentation. Soft tissues and the muco-gingival border were well maintained. A retrospective analysis of X-rays and clinical photographs showed non-significant shrinkage in the vertical and horizontal dimensions (P=0.575 and P=0.444, respectively). The new bone contained vital bone cells embedded in mineralized tissues. Conclusions: Within the limitations of this pilot study, open healing of RCLC membranes may result in sufficient bone volume for implant placement without additional bone augmentation in contained and non-contained extraction sockets.

뜸치료에 의한 화상으로 발생한 당뇨족 및 연부조직 괴사 (Diabetic Foot and Soft Tissue Necrosis Caused by Moxibustion Burn Injury)

  • 한송현;조동인;김철근;김순흠
    • 대한화상학회지
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    • 제23권2호
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    • pp.60-63
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    • 2020
  • A 72-year-old man with diabetes, who underwent moxibustion, developed a foot wound but did not receive proper treatment. Examination showed a soft tissue defect (6×6 cm) on the dorsal aspect of the right foot with involvement of the first and second toes along with some phalangeal bone loss. The wound was treated with a skin graft and healed without complications. The right calf showed a raw surface (4×3 cm), which underwent epithelialization after conservative treatment. We observed four focal necrotic lesions (1.5×1.5 cm) on the right lower leg and anterior chest, which served as indicators of moxibustion, and debridement and primary closure were performed. Moxibustion is increasingly used as a therapeutic option; however, statistical data describing its adverse effects are limited. Moxibustion significantly increases skin temperature and can cause burn injuries. It is important to prevent moxibustion-induced adverse effects and avoid severe complications, particularly in patients with diabetes.