• Restorative Dentistry and Endodontics
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• 제35권4호
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• pp.273-284
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• 2010

본 연구의 목적은 흰 쥐(rat)를 이용하여 미성숙 단계의 치아를 발치 후 즉시 재식 하였을 때 나타나는 치수의 치유 양상을 조직학적으로 관찰하고자 하는 것이다. 생후 4주된 암컷 Sprague-Dawley 계 흰쥐의 상악 우측 제1대구치를 발거 후 원래의 치조골와 내로 위치시켰다. 재식 후 3일째부터 국소적으로 치수 내 염증 소견이 관찰되었으나, 치근 부위에서는 이미 치수의 재혈관화 및 치유가 진행되고 있는 소견이 관찰되었다. 재식 후 5일째부터는 odontoblast-like cell이 관찰되기 시작하였다. 삼차 상아질의 형성은 재식 후 1주째부터 관찰되기 시작하였으며, 2주째부터는 확실히 관찰할 수 있었다. Odontoblast-like cell 및 삼차상아질 형성은 4주째까지도 계속 관찰되었다. 재식 후 4주째에는 bone-like tissue 및 cementum-like tissue이 형성되었음을 관찰하였다. 본 실험을 통하여 흰 쥐 치아 재식 시 석회화 과정은 초기에는 삼차상아질 침착에 의해서 진행되나, 시간이 경과하면서 점차 bone-like tissue 또는 cementum-like tissue가 차지하는 비율이 증가하는 것을 관찰하였다.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.44-49
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• 1999

From January 1990 to December 1998, 449 consecutive single-digital replantations were reviewed retrospectively in order to determine the essential number of vascular anastomoses for successful finger replantation. The correlations between the number of anastomosed vessels and survival rate were examined according to the amputated digital levels and all of the correlated results were compared with each other statistically. In zone I, The survival rate of the digits with a repaired vein was higher than that of digits treated with external bleeding method. In zone II, the equal number(s) between the arterial and venous repair was an important factor in successful replantation. And the repaired arteries more than repaired veins in number led to venous congestion and resulted in a failure of replantation, which was maybe due to the large amount of arterial input relative to small volume of amputated stump with small sized vein. In zone III, the equal number(s) between the arterial and venous repair was also an important factor in successful replantation. But unlike in zone II, venous congestion was scarcely happened if the venous drainage was sufficient with a repaired large vein alone. In zone IV, two or more arteries and veins were required for successful replantation. In conclusion, it is desirable that the repair of vessels as many as possible to increase the possibility of a good result. But digital amputations and their condition for replantation were variable, therefore, the numbers in vascular repair should to be modified and straightforward as the case may be.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.1-7
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• 2012

Purpose: This retrospective study was to determine the functional results of patients who were amputated of their fingertip between patients who were treated with replantation and patients who were treated with thenar flap. Materials and Methods: From 2004 to 2007, we identified and operated 159 patients who were diagnosed with fingertip amputations. Of 159 patients, Eighty-two patients were treated by replantation (67 in men and 14 in women) and the mean age at the operation was 41 years (range, 15-68 years). Seventy-nine patients was treated with thenar flap(54 in men and 25 in women) and the mean age at the operation was 43 years(range, 21-70 years). We compared variables between two groups including, age, gender, diagnosis, duration of hospital admission, grip strength, two-point discrimination, Semmes Weinstein monofilament test, active range of motion (ROM) of the proximal and distal interphalangeal (PIP and DIP) joint, pain (or tenderness), paresthesia, cold intolerance, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and finger for activities of daily living (ADLs). Results: The duration of admission was longer in Replantation group than in Thenar flap group(p=0.001). However, the grip strength (p=0.003) and Semmes Weinstein monofilament test (p=0.029) in the Replanation group were statistically superior to the Thenar flap group. The average DASH disability (p=0.003)/symptom score (p=0.007) and ADLs (p<0.001) in the Replantation group was statistically better. In addition, cold intoleranace test of Thenar flap group is worse than the Replantation group. Conclusion: This study demonstrate that fingertip replantation have demonstrated not only to obtain the best appearance but also to gain better functional outcome. However, it is impossible to perform replatation, the thenar flap can be limited alternative method for fingertip amputation in aspect of preservation of range of motion and hospitalization time.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.614-618
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• 2015

Background Hand strength deficit following digital replantation is usually attributed to the mechanical deficiency of the replanted digit. Zone 1 replantation, however, should not be associated with any mechanical deficit, as the joint and tendon are intact. We evaluate shortterm motor functions in patients who have undergone single-digit zone 1 replantation. Methods A single-institution retrospective review was performed for all patients who underwent zone 1 replantation. Hand and pinch strengths were evaluated using standard dynamometers. Each set of measurements was pooled according to follow-up periods (within 1 month, 1 to 2 months, 2 to 3 months, and after 3 months). The uninjured hand was used as reference for measurements. Results The review identified 53 patients who had undergone zone 1 replantation and presented for follow-up visits. Compared to the uninjured hand, dynamometer measurements revealed significantly less strength for the hand with replanted digit at one month. The relative mean grip, pulp, and key pinch strength were 31%, 46%, and 48% of the uninjured hand. These three strength measurements gradually increased, with relative strength measurements of 59%, 70%, and 78% for 4-month follow up. Conclusions Despite the lack of joint or tendon injury, strength of the injured hand was significantly lower than that of the uninjured hand during the 4 months following replantation. Improved rehabilitation strategies are needed to diminish the short-term negative impact that an isolated zone 1 replantation has on the overall hand strength.

• Archives of Plastic Surgery
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• 제32권1호
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• pp.124-130
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• 2005

In the microsurgical era, replantation with microvascular anastomosis is considered as the most superior method in aspects of texture, color, shape in case of nose amputation. There are some reported cases of replantation in nose amputation historically, but most of them are composite graft cases rather than microvascular anastomosis. Only a few cases of successful nasal replantation with microvascular anastomosis have been reported due to the reason that the size of vessels is usually very small and identifying suitable vessels for anastomosis is difficult. Microanastomosis of artery and microanastomosis of vein are ideal in replantation, but identifying suitable veins is often difficult. Without venous anastomosis, resolving the venous congestion remains to be a problem. We can carry out arteriovenous shunt if we can find two arteries in amputee. However, the smaller the size of amputee is, the more difficult it is to find two arteries. Instead of arteriovenous shunt, we can try external venous drainage(frequently swab, pin-prick, stab incision, IV or local heparin injection, dropping, apply of heparin-soaked gauze, use of medical leech). Here, we present three cases of replantation with microscopical arterial anastomosis (one angular artery, two dorsal nasal arteries) and external venous drainage (stab incision, application of medical leech and heparin-soaked gauze) even though the size of amputee may be as small as $1.5{\times}1.0cm$. In all cases, surgical outcomes were excellent in cosmetic and functional aspects. This report describes successful replantation by microvasular anastomosis in case that suitable veins are not found.

• Archives of Reconstructive Microsurgery
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• 제18권1호
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• pp.27-30
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• 2009

Purpose: Recently, replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. However the replantation of fingertip in adults is a well-established procedure, but the replantation in infant or child is still uncommon. Therefore we present one case of replantation of the fingertip of the small finger in 12-months-old patient. Methods: We experienced a 12-months-old male amputation of small finger. It had been amputated completely at the level of Zone I by Yamano classification. Replantation was performed using the arteryonly technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration. Venous drainage was provided by an external bleeding method with partial nail excision and repaired margin for approximately 7 days. Results: We were performed replantation in infant with only-arterial anastomosis successfully, result in good recovery of aesthetic and functional outcome. Conclusion: In conclusion, although fingertip injury was difficult to replantation in infant and child, we must try it. Because of its functional and cosmetic advantage.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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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.

• 대한두개안면성형외과학회지
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• 제25권2호
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• pp.95-98
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• 2024

Scalp avulsion is a devastating injury. The best possible procedure is replantation. Several successful scalp replantations with anastomoses of several vessels in large defects have been reported. In this report, we present a case of replantation of a large scalp avulsion using revascularizing with only one artery and vein. Despite the initial signs of flap congestion, we could predict the survival of the replanted scalp and terminate the procedure after detecting good perfusion and washout with indocyanine green fluorescence imaging. The procedure was successful following the patient's recovery of sensory and sweating functions without complications such as flap necrosis or infection. Several important factors for successful scalp replantation with positive esthetic and functional outcomes were considered.

• 대한치과의사협회지
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• 제54권8호
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• pp.592-603
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• 2016

Pathologic tooth migration (PTM) caused by periodontal disease is a relatively common disease with a prevalance rate of 30~55%. It is one of the reasons for periodontal treatment of patients. PTM occurs when various factors related to the position of the tooth are altered and clinical features of PTM include facial flaring, diastema, proximal tilting, rotation, and extrusion of teeth. The purpose of this study was to assess the treatment of teeth of hopeless prognosis through the practice of modified intentional replantation on pathologic migrated tooth. This study presents cases using modified intentional replantation for the treatment of pathologic tooth migration caused by severe periodontitis. Modified intentional replantation is a technique that prepares extraction socket by using an implant drill. Based on 3 cases performed with modified intentional replantation, an improvement of clinical periodontal indicators such as probing pocket depth, bleeding on probing, tooth mobility, and pathologic teeth migration was observed after surgery. Also, the patients were satisfied with the functional and esthetic improvement.

• 대한소아치과학회지
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• 제23권3호
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• pp.659-666
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• 1996

The treatment of complete avulsed teeth due to traumatic injuries is replantation procedure. The major complication of replantation are pulp necrosis, ankylosis, and root resorption. It is important to maintain the vitality of periodontal ligament to minimize the complications. The purpose of this case report is to consider the facts that affect the success rate and the prognosis of complete avulsed teeth after replantation. All of these cases had different conditions and transport media. The following results were observed: 1. The successive treatment of complete ayulsed teeth requires the maintainance of vitality of periodontal ligament. 2. The complication of replantation are inflammatory root resorption and ankylosis and in such case, proper endodontic treatment using calcium hydroxide medications and periodic observations are needed. 3. In case of delayed replantation, the use of fluoride and root planning procedure can help to achieve better result. 4. It is more esthetic and functional to maintain the avulsed tooth in mouth.