• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.3
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• pp.184-194
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• 2011

The dorsalis pedis artery (DPA) was renamed from the anterior tibialis artery after it passed under the extensor retinaculum, and DPA travels between the extensor hallucis longus and extensor digitorum longus muscle along the dorsum of the foot. After giving off the proximal and distal tarsal, arcuate and medial tarsal branches, DPA enters the proximal first intermetatarsal space via the first dorsal metatarsal artery (FDMA), which courses over the first dorsal interosseous muscle (FDIM). For detailed knowledge of the neurovascular anatomy of a dorsalis pedis artery flap (DPAF) as a routine reconstructive procedure after the resection of oral malignant tumors, the precise neurovascular anatomy of DPAF must be studied along the DPA courses as above. In this first review article in the Korean language, the anatomical basis of DPAF is summarized and discussed after a delicate investigation of more than 35 recent articles and atlas textbooks. Many advantages of DPAF, such as a consistent flap vascular anatomy, acceptable donor site morbidity, and the ability to perform simultaneous flap harvest using oral cancer ablation procedures, and additional important risks with the pitfalls of DPAF were emphasized. This article will be helpful, particularly for young doctors during the special curriculum periods for the Korean National Board of Specialists in the field of oral and maxillofacial surgery, plastic surgery, otolaryngology, orthopedic surgery, etc.

• Journal of Gastric Cancer
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• v.11 no.4
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• pp.219-224
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• 2011

Purpose: The Roux en Y method has rarely been performed due to longer operation time and high risk of complication, despite several merits including prevention of bile reflux. We conducted a retrospective review of the result of Roux en Y reconstruction using two circular staplers after subtotal gastrectomy. Materials and Methods: From December 2008 to May 2009, a total of 26 patients underwent Roux en Y reconstruction using two circular staplers after subtotal gastrectomy, and seventy-two patients underwent Billroth-I reconstruction. Roux en Y anastomosis was performed using two circular staplers without hand sewing anastomosis. We compared clinicopathologic features and surgical outcomes between the two groups. All patients underwent gastrofiberscopy between six and twelve months after surgery to compare the bile reflux. Results: No significant differences in clinicopathologic findings were observed between the two groups, except for the rate of minimal invasive surgery (P=0.004) and cancer stage (P=0.002). No differences in the rate of morbidity (P=0.353) and admission duration (P=0.391) were observed between the two groups. Gastrofiberscopic findings showed a significant reduction of bile reflux in the remnant stomach in the Roux en Y group (P=0.019). Conclusions: When compared with Billroth-I reconstruction, Roux en Y reconstruction using the double stapler technique was found to reduce bile reflux in the remnant stomach without increasing postoperative morbidity. Based on these results, we planned to begin a randomized controlled clinical trial for comparison of Roux en Y reconstruction using this method with Billroth-I anastomosis.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.461-465
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• 2007

Purpose: Nasal bone fracture may be the most common fracture among facial trauma. However, diagnosis and treatment tend to be overlooked while the reduction and maintenance of fragments remain complicated. Thus, the results are plagued with high rate of nasal deformity which leads cosmetic and functional discomfort. We took advantage of the fact that the nasal bone is one of the thinnest facial bone while at the same time being located close to the skin and utilized ultrasound in performing reduction of nasal bone. Methods:This method was performed on 25 patients with nasal bone fracture. The CL 15-7 linear array transducer (10-15MHz) ultrasound which provides a total of 7 views (3 axial views and 4 transverse views) of the elevator under the bony fragments was enough for the surgeon to accurately perform the reduction. Results: In our class, an accurate and precise reduction has been made possible by real time images before, during, and after the procedure with the help of ultrasound while reducing the exposure to radiation. Conclusion: Compared to previous methods, satisfaction of patients has increased in the nasal tip, minimal fracture of the side wall and secondary reduction cases. Therefore, the incorporation of ultrasound in the closed reduction of nasal bone may prove to be a useful method.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.108-115
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• 1986

During 12 years period from 1974 to 1985, 76 valve replacement procedures were performed at Seoul National University Hospital in 67 pediatric patients aging up to 15 years [mean 12.3 years] and it was 7.3% of total valve replacement procedures in same period. Sixty seven patients were composed of 44 males and 23 females. Of the 67 patients, 43 patients had acquired valve lesions and 24 patients congenital valve lesions. Sixty cases received single valve replacement, 7 cases double or triple valve replacement and 9 cases redo-valve replacement. Sixty seven patients received 84 valves [65 bioprosthetic valves and 19 prosthetic valves by] 76 operations, Sixty three of 65 bioprosthetic valves had been replaced before 1983 and 15 of 19 prosthetic valves in recent 2 years. Eleven patients [14.6%] died within one month post-operatively and 8 patients [10.5%] during the follow-up period with the overall mortality rate of 25.1%. There were early post-operative complication of 23 cases [30.3%] and late post-operative complication of 27 cases [35.3%] with the total complication rate of 65.8%. In 58 patients received bioprosthetic valves, there were 14 cases of restenosis of replaced valves. Of the 14 cases of bioprosthetic valve restenosis, 8 cases received redo-valve replacement procedures without mortality in 1 5/12-5 years after initial operation but 4 cases died without reoperation and 2 cases lost during follow-up. The overall mortality and complication rate were still high but they markedly decreased during recent 2 years. So, in spite of its containing many problems, valve replacement in children is becoming safe and useful procedure in whom valve reconstructive procedures are impossible.

• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.152-156
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• 2005

Purpose: We reconstructed the thumb with groin flap combined with secondary heterodigital neurovascular island flap and report our 6 cases. Materials and Methods: Between March 2003 and August 2004, 6 degloving thumbs or amputation of thumbs were reconstructed with groin flap combined with secondary heterodigital neurovascular island flap. There ware 4 men and 2 women, and mean age was 42.2 years. The following parameters were evaluated. Results: Recipient thumb was no limitation of apposition. but flexion contracture of interphalangeal joint was about 10 degree in two cases. Average grip power were 80% and average pinch power were 70% that of the normal thumb. The two point discrimination was average 10.5 mm and double sensibility in 2 cases. 2 patients have cold intolerance. Neuroma formation was not made. Cosmetic results as judged by patients were that 4 cases are good and 2 cases are fair. Conclusion: If massive skin defect after degloving thumb or amputation of thumb are present, we consider the numerous methods for reconstruction of thumb. This surgical procedure is good methods because of it's pliability, sensation, satisfactory functional results but major disadvantage are the staged operation and cosmetic effect of the absence of thumb nail.

• Korean Journal of Head & Neck Oncology
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• v.21 no.1
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• pp.35-41
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• 2005

Wide vertical hemilaryngopharyngectomy with immediate glottic and pharyngeal reconstruction using a radial forearm free flap is reported in 1991 by Chantrain et al. This procedure was designed for the preservation of healthy hemilarynx and resection of pharynx with safe oncological margin in especially piriform sinus cancer or supraglottic cancer invading the hypopharynx. In the original paper, they used palmaris longus tendon for reconstruction of neoglottis. In other groups, they used rib cartilage instead of palmaris longus tendon. In this paper, we report two cases of piriform sinus cancer patients who treated with wide vertical hemilaryngectomy with radial forearm free flap reconstruction. In one case, the operation was performed as Chantrain et al described. But in another case, the ipsilateral forearm was impossible due to the positive Allen's test. So the contralateral forearm flap and rib cartilage graft was done. This reconstructive technique make large resection possible. As the dissection of thyroid cartilage and lateral displacement makes direct visualization and manipulation of piriform sinus lesions, sufficient resection margin in lateral and inferior pharyngeal wall cab be obtained.

• Journal of Korean Neurosurgical Society
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• v.61 no.6
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• pp.737-746
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• 2018

Objective : The purpose of this study was to compare the cosmetic outcome and complications after cranioplasty (CP) due to three different implant materials, and analyze the mean implant survival and cumulative survival rate based on these results. Methods : We reviewed 108 patients retrospectively who underwent CP between January 2014 and November 2016. Autologous bone (AB; 45 patients) and synthetic materials with porous polyethylene (PP; 32 patients) and custom-made 3-dimensional printed titanium mesh (CT; 31 patients) were used as implants. Results : Regardless of implanted materials, more than 89.8% of the CP patients were satisfied with the cosmetic outcome. No statistically significant difference was observed among the three groups. The overall postoperative complication rates of each group were 31.1% in the AB group, 15.6% in the PP group and 3.2% in the CT group. The CT group showed lower complication rates compared with AB and PP groups (${\chi}^2$-test : AB vs. PP, p=0.34; AB vs. CT, p=0.00; PP vs. CT, p=0.03). The AB and PP groups demonstrated a higher post-CP infection rate (11.1% and 6.3%) than the CT group (3.2%). However, no significant difference in the incidence of post-CP infection was observed among the three groups. The PP and CT groups demonstrated a higher mean implant survival time and cumulative survival rate than the AB group at the last follow-up (p<0.05). Conclusion : In comparison with AB and PP, cranioplasty with CT shows benefits in terms of lower post-CP complication, less intraoperative bleeding loss, shorter operation time and in-hospital stay. The PP and CT groups showed higher implant survival time and cumulative survival rate compared with the AB group.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.24-30
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• 2019

Background: Closed reduction of the fracture under general or local anesthesia with elevators or forceps is widely used to treat nasal bone fractures. However, operating under general anesthesia increases the risk of morbidity and raises the cost of management. Furthermore, using forceps or elevators may cause undercorrection, new fractures, mucosal damage, and nasal hemorrhage. We therefore performed manual reduction under local anesthesia, using the little finger, to minimize the demerits of treatment under general anesthesia with forceps or elevators and aimed to assess functional and aesthetic outcomes, and patient satisfaction. Methods: Patients who visited the plastic and reconstructive surgery department between November 2016 and November 2017 with nasal bone fractures and treated by a single surgeon were prospectively followed up. Patients with simple unilateral or bilateral nasal bone fractures were treated with bedside finger reduction under local anesthesia and patients with comminuted nasal bone or septal fractures were scheduled for closed reduction under general anesthesia. Results: Of 84 patients, 28 met the inclusion criterion and underwent bedside finger reduction under local anesthesia. Twenty-seven patients (96.4%) were successfully contacted via telephone for survey. Twenty-three (85.2%) showed good and three (11.1%) showed fair results. All 27 patients (100%) were satisfied with their postoperative function and 25 (92.6%) were satisfied with their postoperative aesthetic result. Twenty-five patients (92.6%) preferred the finger reduction method under local anesthesia over closed reduction under general anesthesia. Conclusion: Finger reduction under local anesthesia in patients with mild unilateral or bilateral nasal bone fractures is an easy and efficient procedure with high patient satisfaction and favorable postoperative functional and aesthetic outcomes.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.296-303
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• 2022

Background In recent years thread lift has become widespread; however, existing methods need to improve their long-term outcome, which requires considering topographic anatomy of face and neck, especially the ligamentous apparatus. This study aims to assess the effectiveness and safety of an innovative method of one-time three-step thread facelift, which provides an additional support to the ligamentous structures of the upper, middle, and lower thirds of the face and neck. Methods The study included 357 patients aged 32 to 67 years with various morphotypes of aging. The original method of thread lift was applied, and its effectiveness was followed up for to 2 years. The Wrinkle Severity Rating Score (WSRS) and Global Aesthetic Improvement Scale (GAIS) scores were used for assessment by investigators, independent observers, and patients. Statistical significance was determined using paired t-test and chi-square test. Results The mean WSRS score was 3.88 ± 0.88 before the thread lift, 1.93 ± 0.81 one month after the procedure, and 2.36 ± 0.85 after 2 years of follow-up. The mean GAIS was 4.80 ± 0.04 one month after thread lift, and 4.01 ± 0.04 after 2 years, while in the patients' assessment Global Satisfaction Scale was 4.86 ± 0.02 and 4.10 ± 0.02, respectively. There were no clinically significant complications throughout the observation period. Conclusion The new method of one-time three-step thread fixation of the soft tissues of the face and neck demonstrated a high degree of satisfaction by both experts and patients after 2 years of follow-up. It showed high efficacy and safety, including in the group of patients with pronounced age-related changes of the skin of face and neck.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.614-621
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• 2021

Background Reconstruction of congenital microtia remains challenging, particularly in patients with a history of ear canaloplasty due to insufficient regional soft tissue. The insertion of a tissue expander prior to implantation of the cartilage framework has traditionally been employed. However, this procedure could induce additional morbidity. Herein, we present a method using V-Y advancement of a temporal triangular flap to gain additional soft tissue in these challenging cases. Methods Congenital microtia patients with a history of ear canaloplasty who underwent auricular reconstruction using the Nagata technique between 2016 and 2020 were reviewed. To obtain additional soft tissue, V-Y advancement of a temporal triangular flap was performed concurrently with implantation of the costal cartilage framework, without prior insertion of a tissue expander. The outcomes of these patients with respect to postoperative complications and esthetics were evaluated. Results Eight patients with bilateral lesions were included. No specific complications developed after the first-stage surgery. However, one patient experienced complications after the second stage (auricular elevation). An analysis of the esthetic results showed most patients had excellent outcomes, achieving a satisfactory convolution. The median number of operations needed to complete reconstruction was 2, which was fewer than required using the conventional method with prior insertion of a tissue expander. Conclusions In patients with a history of previous canaloplasty, V-Y advancement of a temporal triangular flap could serve as an alternative to tissue expansion for microtia reconstruction. This technique provided reliable and satisfactory results with a reduced number of surgical stages.