• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.122-128
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• 2016

Objective : To illustrate the technique of single-stage posterior subtotal corpectomy and circumferential reconstruction for the treatment of unstable thoracolumbar burst fractures and to evaluate the radiographical and clinical outcomes of patients treated using this technique. Methods : 16 consecutive patients with unstable thoracolumbar burst fractures were treated with single-stage posterior subtotal corpectomy and circumferential reconstruction. The mean patient age was 54.8 years. The mean follower up period was 25 months. Five patients suffered from T12 fractures, 10 from L1, 1 from L2. The segmental kyphosis, neurologic status, visual analogue scale for back pain was evaluated before surgery and at follow up. Results : The segmental kyphotic angle improved from 18.5 degrees before surgery to -9.2 degrees at the last follow up. The mean correction angle was 28.9 degrees. The mean surgical time was 255 minutes, and a mean intraoperative blood loss was 1073 mL. Intraoperative complications included two dural tears, and a superficial wound infection. There were no other severe complications. The mean visual analog scale of back pain decreased from a mean value of 6.6 to 2 at the last follow up. Conclusion : The single-stage posterior subtotal corpectomy and circumferential reconstruction achieved satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and complications. It is a safe and reliable surgical treatment option for unstable thoracolumbar burst fractures.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.155-161
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• 2006

Purpose: To compare the clinical and radiological results between the modified Weaver-Dunn method and modified Phemister method in the acute acromioclavicular joint dislocation. Materials and Methods: We reviewed 19 patients who were treated for the acute acromioclavicular joint dislocation from 2001 to 2002. 10 patients were operated with the modified Weaver-Dunn method (group A) and the others with modified Phemister method (group B). The classification of preoperative injury was analyzed by using the Rockwood system, the clinical assessment of preoperative and postoperative by the modified UCLA rating scale and the radiological assessment by simple x-ray. Results: With the modified UCLA rating scale, group A showed 5 cases(50%) of excellent and 5 cases(50%) of good, group B showed 4 cases(44.4%) of excellent and 5 cases(55.6%) of good. In the radiologic findings of the coracoclavicular distances, group A was 16.2 mm at preoperative, 8.8 mm at postoperative, 9.7 mm at last follow-up and group B was 12.9 mm, 6.7 mm and 7.9 mm respectively. Postoperatively there were no complications such as surgical wound infection and failure of Kirschner wires. Conclusion: Both the modified Weaver-Dunn and modified Phemister methods have shown satisfied clinical and radiologic results, and there was no difference in these result between two groups (p>0.05).

• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.335-341
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• 2010

Objective : Anterior cervical corpectomy with fusion (ACF) or laminoplasty may be associated with substantial number of complications for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with significant cord compression. For more safe decompression and stabilization in multilevel cervical OPLL with prominent cord compression, we propose circumferential cervical surgery (selective ACF and laminoplasty) based on our favorable experience. Methods : Twelve patients with cervical myelopathy underwent circumferential cervical surgery and all patients showed multilevel OPLL with Signal change of the spinal cord on magnetic resonance imaging (MRI). A retrospective review of clinical, radiological. and surgical data was conducted. Results : There were 9 men and 3 women with mean age of 56.7 years and a mean follow up period of 15.6 months. The average corpectomy level was 1.16 and laminoplasty level was 4.58. The average Japanese Orthopedic Association score for recovery was 5.1 points and good clinical results were obtained in 11 patients (92%) (p < 0.05). The average space available for the cord improved from 58.2% to 87.9% and the average Cobb's angle changed from 7.63 to 12.27 at 6 months after operation without failure of fusion (p < 0.05). Average operation time was 8.36 hours, with an estimated blood loss of 760 mL and duration of bed rest of 2.0 days. There were no incidences of significant surgical complications, including wound infection. Conclusion : Although the current study examined a small sample with relatively short-term follow-up periods, our study results demonstrate that circumferential cervical surgery is considered favorable for safety and effectiveness in multilevel OPLL with prominent cord compression.

• Journal of Chest Surgery
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• v.33 no.7
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• pp.565-569
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• 2000

Background; Post-intubation injury is known to be the most common cause of tracheal stenosis. Treatment strategy for tracheal stenosis varies accoring to the extent of pathologic lesion. Focal mucosal lesion can be treated with laser photoablation, but full thickness tracheal lesion should be treated with resection and anastomosis. Material and Method; From Aptil 1998 to May 1999, twelve patients suffering from tracheal stenosis as a complication of endotracheal intubation were managed by resection and end-to-end anastomosis in the Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital. Result; There was no operative mortality. Five temporary vocal cord paralysis and one wound infection occurred as early complications. During 18 months of follow-up, re-stenosis was not found. Conclusion; Tracheal resection and anastomosis can be considered as an excellent surgical treatment for tracheal stenosis which developed as a complication of endotracheal intubation.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.383-387
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• 2007

Purpose: A necrotizing fasciitis is a rare, but insidiously advancing fatal soft tissue infection characterized by extensive fascial necrosis. Diagnosis & treatment of this disease are difficult. Necrotizing fasciitis tend to begin with constitutional symptoms of fever and chills. Quite a many lab studies and imaging studies such as standard radiography, computerized tomography can be used, but nothing can confine the extent of affected tissue. Aggressive surgical interventions are often required because of large skin and soft tissue deformity. However, many patients with necrotizing fasciitis are not healthy enough to overcome aggressive surgical intervention. Methods: Since 2000, we treated 10 patients with necrotizing fasciitis. In 4 patients, we used magnetic resonance imaging(MRI) as a tool for diagnosis as soon as necrotizing fascitiis was doubted. We treated patients with delayed coverage with Alloderm$^{(R)}$ & split thickness skin graft or delayed wound closure in as many cases as possible. Results: In 4 patients using preoperative MRI, diagnosis could be made in earlier stage of the disease compared to other patients. Our treatment modality was debridement and coverage with Alloderm$^{(R)}$ & split thickness skin graft. We could reconstruct deformities without significant limitation of movement in 7 cases. Conclusion: We diagnosed and treated 10 necrotizing fasciitis with MRI and Alloderm$^{(R)}$ graft, and results were good.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.989-994
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• 1994

Between January 1986 and August 1993, 11 patients underwent surgical repair of ventricular septal defect [VSD] complicated with myocardial infarction. The ages of patients were ranged from 22 years to 83 years with a mean of 64 years. There were 8 male and 3 female patients. The preoperative cineangiograms of all patients were reviewed to measure both ventricular function and to evaluate coronary artery disease. The mean time interval between occurance of VSD and operation was 13 days. The operations were performed as soon as possible if there were hemodynamic derangement. Postmyocardial infarction VSD were repaired simultaneuously with coronary artery bypass graft in 3 patients, repaired with left ventricular aneurysmectomy in 6 patients, with left ventricular thrombectomy in 1 patient and with mitral valve chordae repair in 1 patient. There was no early death [within 30 days]. There were 6 postoperative complications; one with perioperative myocardial infarction, two with recurred VSD on postoperative 1 and 6 days respectively, two with lower leg embolism associated with intraaortic balloon pump insertion, one with wound infection. Of the complicated patients, 1 patient with lower leg embolism performed left above ankle amputation. Among two patients with recurred ventricular septal defect, one patient is doing well without problem. On follow up echocardiogram, the residual VSD was occluded completely. However another patient was with recurred VSD died 3 months after the operation because of congestive heart failure. Of the long term survivors, all patients are in NEW YORK Heart Association functional Class I or II. Although number of patients were small, our results of surgical closure of postmyocardial infarction VSD were favored to the others. Moreover, seven patients with preoperative cardiogenic shock among 11 were performed early operation after diagnosis of ventricular septal rupture. All of the patients were survived and doing well during the follow up period. Therefore early diagnosis with aggressive preoperative care with intraaortic balloon pumping and early operation seems to be very important for prevention of deterioration of vital organ.

• Journal of Gastric Cancer
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• v.10 no.4
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• pp.241-246
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• 2010

Purpose: Laparoscopy-assisted gastrectomy (LAG) has become a technically feasible and safe procedure for early gastric cancer treatment. LAG is being increasingly performed in many centers; however, there have been few reports regarding LAG at low-volume centers. The aim of this study was to report our early experience with LAG in patients with gastric cancer at a low-volume center. Materials and Methods: The clinicopathologic data and surgical outcomes of 39 patients who underwent LAG for gastric cancer between April 2007 and March 2010 were retrospectively reviewed. Results: The mean age was 68.3 years. Thirty-one patients had medical co-morbidities. The mean patient ASA score was 2.0. Among the 39 patients, 4 patients underwent total gastrectomy and 35 patients underwent distal gastrectomy. The mean blood loss was 145.4 ml and the mean operative time was 259.4 minutes. The mean time-to-first flatus, first oral intake, and the postoperative hospital stay was 2.8, 3.1, and 9.3 days, respectively. The 30-day mortality rate was 0%. Postoperative complications developed in 9 patients, as follows: anastomotic leakage, 1; wound infection, 1; gastric stasis, 2; postoperative ileus, 1; pneumonia, 1; cerebral infarction, 1; chronic renal failure, 1; and postoperative psychosis, 1. Conclusions: LAG is technically feasible and can be performed safely at a low-volume center, but an experienced surgical team and careful patient selection are necessary. Furthermore, for early mastery of the learning curve for LAG, surgeons need education and training in addition to an accumulation of cases.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.53-62
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• 2011

Purpose: Even though Augmentation rhinoplasty is very popular surgical procedure, it is not easy to obtain ideal materials for augmentation. Many different synthetic materials are used but frequent complications are seen such as infection, extrusion, deform, and dislocation. Autologous tissues were used for augmentation rhinoplasty. We used dermofat graft and fat injection in augmentation rhinoplasty minimizing these problems. Methods: From 2006 to 2009, we used autologous tissues in augmentation rhinoplasty in 40 patients, 20 patients with dermofat graft and other 20 patients were treated with fat injection only. Dermofats were harvested from sacral area. gluteal fold, groin and preexisting scar tissue. Dermofats were inserted with small stab wound and fat tissues were injected as Coleman's technique. The patients were followed up 6 months to 5 years. Results: Most of the patients were satisfied in shape and height the nose. Early complications such as hematoma, infection and seroma were not found. Secondary fat injection was performed in 3 patients (15%) of dermofat graft group instead of 7 patients (35%) of fat injection only group. Conclusion: We obtained satisfactory results in augmentation rhinoplasty with dermofat graft and fat injection. Secondary fat injections were more often in fat injection group than dermofat graft group. Dermofat graft and fat injection could be another alternative technique for augmentation rhinoplasty and fat injection could be a secondary adjunctive treatment for undercorrection due to absorption.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.124-135
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• 2017

Background In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. Methods A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. Results A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. Conclusions Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.446-449
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• 2008

Purpose: Pilonidal sinus is a frequent disease that occurs mostly in hairy young men, defined as chronic inflammation and infection of the postsacral sinuses. Wide excision of the affected area is the treatment of choice. Many techniques have been described to cover the defect. However none appears to be the ideal procedure to prevent infection, recurrence, and delayed wound healing. We present the results of an alternative technique that we performed by using partial deepithelized gluteal transposition flap for reconstruction of the defect following wide excision. Methods: From October 2004 to September 2007, we performed the partial deepithelized gluteal transposition flap method on 6 patients. We modified the transposition flap techniques by deepithelialising the medial parts of the flap and burying them under the opposing edge of the flap. The results were compared with previous studies and evaluated regarding duration of surgery, size of defect, hospitalization periods, and complications. Results: All the flaps were healed well with no partial or complete loss of the flap. Hospitalization and immobilization periods were acceptably shortened. Recurrence was not seen. The aesthetic outcome was also satisfactory and all patients were satisfied with the results. Conclusion: The main advantage of our techniques is using healthy tissues to obliterate the dead space, to provide an extra-cushion, and to prevent deep dehiscence. We believe that the partial deepithelized gluteal transposition flap is a good alternative method for treatment of pilonidal sinus.