• Restorative Dentistry and Endodontics
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• v.25 no.2
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• pp.170-179
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• 2000

The rh-BMP-4 is a subgroup of TGF-${\beta}$ superfamily. The application of rh-BMP in alveolar bony defect was reported to new alveolar bone and new cementum formation. For minimized complications following tooth replantation, a operator must replant a tooth fast at the pertinent position. This study was to evaluate the effect of rh-BMP-4 on periodontal regeneration and root resorption following tooth replantation in rats. The 50 Sprague-Dawley rats weighting about 130gm were used in this study. The animals were divided into three groups. Group 1 ; immediate replantation after extraction : Group 2 ; replantation stored teeth extraction of first molar, the removal of periodontal ligament with collagenase, and etching with citric acid : Group 3 ; replantation stored teeth with treated rh-BMP-4 in mesial root. Experimental animals were sacrificed 3, 7, 14 days after replantation by heart infusion. The maxillae were removed, fixed, demineralized, dehydrated, infiltrated and embedded with JB-4 mixture. For light microscopic observation, 5 micron sections were cut and stained with toluidine blue. The results of this study were as follows : 1. After experimental 3 days, all groups were observed dead space between periodontum and root. 2. After experimental 7 days, group 1 and group 3 were observed filling periodontal fibers between alveolar bone and root but group 2 were not. 3. After experimental 7 days, group 3 were observed appearance of attached cementoblast like cell on root surface. Group 1 were observed regular arrangement of fibroblasts and collagen fibers at ${\times}400$ observation. 4. After experimental 14 days, all group were observed filling periodontal fibers between alveolar bone and root. Group 1 were observed normal arrangement of periodontal fibers. Group 3 were observed less abnormal arrangement of periodontal fibers. Group 2 were not observed functional normal arrangement of periodontal fibers. 5. After experimental 14 days, group 2 and 3 were observed several root resorption and irregular root surface but group 1 were not. These results suggest that the rh-BMP-4 can stimulate cementogenesis and enhance to attach collagen fibers.

• The Journal of the Korean dental association
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• v.48 no.7
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• pp.531-537
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• 2010

Intentional replantation is useful for failed cases of conventional dental treatment - including root canal treatment - to restore the tooth in question. Based on a recent study, it is relatively very successful; prognosis is good for a long period. On the other hand, a tooth that becomes an indication of intentional replantation is often severely weakened throughout several treatments. Moreover, with multi-rooted teeth, extracting without root fracture is difficult. Safe extraction that is free of coronal or root fracture is important, but little information is known as to a concrete, safe way of extraction. There are a few considerations for safe extraction. First, a tooth with orthodontic extrusion force is easier for extraction due to its increased mobility; it increases the amount of the periodontal ligament, which is essential for re-attachment. As a safe way of extraction, the use of physics forceps has been introduced recently; it minimizes damage to the gingiva and alveolar hone. This paper reports the good result of using atraumatic safe extraction via both orthodontic extrusion and physics forceps$^{(R)}$.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.23-27
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• 2001

Penile amputation results primarily from attempts at self-emasculation in the psychotic individual or from felonious assault. Because of the complex nature of patients whom perform self-emasculation and low incidence of felonious assault, large series of these individuals do not exist, and experience with amputation injuries of the genitals is confined to individual case reports. Fortunately, complete amputation of penis is quite rare but potentially devastating occurrence. The repels of the treatment of penile amputation by coporal reapproximation that have been published since 1977 indicate that microreplantation techniques are propably superior to the technically simpler nonmicroscopic coporal reapproximation techniques. As microsurgical techniques have been demonstrated to superior, the preferred method of replantation involves this routine whenever possible. We have experience of a case of successful replantation of completely amputated penis by using microneurovascular repair, with the good result of cosmetic and functional concern. Herein, we report this case with the review of the literatures.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.158-163
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• 2000

Over the past several years, countless patients have benefitted from the use of leeches in microsurgery. As we know, leeches are used to overcome the problem of venous congestion by creating prolonged localized bleeding uniquely characteristics of leech bite. Venous congestion, a common complication of digital replantation, often has been treated through surgical repair like arteriovenous anastomosis. The leech produces a number of important substances which contribute to the special property of the bite, including an anticoagulant, a local vasodilator and local anesthetics. The bite usually bleeds for 1 to 2 hours and under special circumstances may bleed for up to 24 hours. So venous congestion is relieved. However, leeches increase the possibility of infection through their gut content. Infection associated medical leech application is significant risk. Other risk include allergic reaction, adverse psychologic reaction and blood loss requiring transfusion. The 65 cases of medical leech application were performed between August, 1997 and May, 2000 according to an established protocol. The complication were 18 cases ; infection (13 cases), hemorrhage (2 cases), allergic reaction (1 case), psychologic problem (1 case) and hypochromic anemia (1 case). Then our study was performed on the base of indication. As a result, Aeromonas hydrophilia was cultured from gut of medical leech and Klebsiella, Staphylococcus and Pseudomonas were cultured from media. We present the clinical risk-benefit of the medical leech therapy through several cases following digital replantation.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.63-68
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• 2013

Purpose: In case of the failed replantation, if the patients want to preserve the length of amputated stump, toe transfer is the ideal choice. However, reconstruction of these amputated stump with a free flap can be a useful method when the patients refuse sacrificing their toe. Our purpose of this study is to evaluate availability of functional results and patient satisfaction after this procedure. Materials and Methods: From March 2008 to February 2012, we reconstructed the amputated stump with free flap by patients demand. Eleven patients were included, medial plantar artery perforator flap in seven cases and great toe pulp flap in five cases. Follow-up range 12 to 24 months and we evaluate patient satisfaction by using a visual analogue scale (VAS; 1=unsatisfied, 5=excellent) and functional recovery by measuring the range of motion of remaining joint at 12 months after operation. Results: During follow-up period, all transferred free flaps survived and no major complications were noted. Range of motion of remaining joint appeared satisfactory result ($15^{\circ}$ to $100^{\circ}$). The VAS patient satisfaction score for aesthetic were five in six patients, four in four patients, and three in one patient. Conclusion: In case of the failed digital replantation, if patient refuse toe transfer, it could be useful method to reconstruction with the free flap to preserving maximal length of amputated stump.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.1
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• pp.73-79
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• 2000

A material of 48 patients with 60 avulsed and replanted permanent teeth were followed retrospectively in the period of 1996. 1 to 1998. 12 (mean observation period=1year 7months). The age of the patients at the time of replantation ranged from 9 to 63 years (mean=24 years). Clinical records of patients were reviewed to obtain valid data concerning the extent of injury and treatment provided. Pulpal and periodontal healing states were examined with periapical x-rays and clinical examination procedures (i.e. percussion test and mobility test) at their recall visit. Root ankylosis was found in fifty-two teeth(87%) and root resorption in twenty-four(40%). Only two of the replanted teeth(3%) showed partial regeneration of the periodontal ligament. Six teeth(10%) resulted in tooth loss, but the remaining fifty-four were clinically well functioning. Most of teeth have mild marginal bone loss accompanied by gingival retraction without pathological periodontal pockets. The incidence of root resorption was much higher in younger age group. However, it was not affected by the interval between avulsion and replantation, the condition of supporting tissues, the degree of root formation and the type of splinting, indicating that multiple factors involved in determining the prognosis of replanted teeth. Based on these findings, avulsed teeth in unfavorable conditions (i.e. long extra-alveolar periods, etc.) should be preserved if possible.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.73-79
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• 1998

We carried out 107 replantations of amputated digits since last 1988. Among them, clean Gillotine amputation was 19 digits, mild crush amputation was 51 digits, severe crush amputation was 28 digits and avulsion type amputation was 9 digits. Vein grafts were used on 24 of these cases. The donor site of the vein graft was the volar aspect of the ipsilateral wrist or lower forearm. The average length of the vein graft was 1.8cm(1.0-3.0cm) and the average diameter of the vein graft was 1.5mm(1.0-2.0mm). Sixty-one of 107 digits were successfully replanted for an 57% success rate. The survival rate of the replantation using the vein graft was 66.7%. We analysed the functional results of the successfully replanted digits according to Nakamura and Tamai's criteria. The functional results of the replantated digits using vein graft were better than that of without using vein graft(more than fair results, 81.2% vs 73.3%). We conclude that the jucidious use of autogenous vein grafts in digital replantation surgery will improve the survival rate and promote the functional result.

• Journal of the Korean Society of Environmental Restoration Technology
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• v.6 no.4
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• pp.24-32
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• 2003

This study was carried out to select proper species for early stage replantation of forest road cut-slope. From one to fourteen year elapsed forest roads in Gangwon-do, sample plots were selected, and their vegetations and environmental factors were investigated. Invaded species with high frequency ordered Lespedeza cyrtobotrya, Lysimachia clethroides, Rubus crataegifolius, Patrinia villosa, Spodiopogon sibiricus, Pueraria thunbergiana, Youngia denticulata, Dactylis glomerata, Rhus chinensis, and Pinus densiflora. North cut-slope have the highest value of invaded species number and plant coverage, and so, north aspect could be best for plant invasion. According to ordination, distribution of species were influenced by elapsed year, cut-slope aspect, and cut-slope. Lespedeza bicolor, Lespedeza cyrtobotrya, Artemisia stolonifera, Miscanthus sinensis, Rubus crataegifolius, Rhus chinensis, Lindera obtusiloba, and Pinus densiflora were considered with proper species for replantation at south slope. Also, Lespedeza bicolor, Lespedeza cyrtobotrya, Arundinella hirta, Artemisia keiskeana, Astilbe chinensis var. davidii, Rubus crataegifolius, Weigela subsessilis, Stephanandra incisa, and Rhododendron mucronulatum were considered with proper species as replantation at north slope.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.38-42
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• 2011

Purpose: To evaluate the effect of intermittent bleeding method in the distal phalanx replantation. Materials and Methods: From January 2007 through June 2009, authors have replanted 117 cases of distal phalangeal amputation in adults at Soo Hospital and Chonbuk National University Hospital. Cases of zone II were 60 cases and zone III 57 according to Allen classification. Male to female ratio was 8.7:1.3. The most common cause was machinery injury in the factory, 98 cases(83.8%), next one was belt injury of the machine, 11 cases(9.4%) and others, 8(6.8%). At least one digital artery and digital nerve were anastomosed under the operating microscope, but vein was impossible to anastomosis as unable to find out in the zone II and III. After anastomosis of one or more digital arteries and nerves, heparine(6,000-10,000 units) was kept to intravenous injection for 24 hours and at the same time fish mouth incision in 2-3 millimeter diameter was made in the distal radial and ulnar margin of the replanted distal phanlanx. From the first 30 minutes to an hour after replantation, incision site was swabbed with heparinized cotton ball for 5 minutes in every 30 to 40 minutes to make sure perfusion for 24 hours, every an hour at the second day, every two hours at the postoperative third to fifth day. Results: 92 cases(78.6%) was completely survived at average postoperative third week follow-up and satisfied with preservation of the finger nail, digit length, good range of motion of the distal interphalangeal joint and acceptable sensibility at average 1.2 years follow-up. Conclusions: Intermittant bleeding method in replantation of crushed distal phalanx impossible to anastomosis of vein at zone II and III of Allen classification was regarded as one of the notable salvage procedure.

• Archives of Plastic Surgery
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• v.44 no.1
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• pp.53-58
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• 2017

Background Adequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation. Methods A single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups. Results The exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%). Conclusions In this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.