• Journal of Oral Medicine and Pain
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• v.26 no.4
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• pp.377-393
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• 2001

In order to study the closure stage of cranial sutures and its correlations with age, the ectocranial closure stage of coronal suture, sagittal suture, and lambdoidal suture of 67 skulls was measured. Among the skulls kept at the department of anatomy, college of medicine, Yonsei University, the ones with ages identified were used for this study. These measurements of suture closure were conducted by 4 examiners independently. The sutures were further divided by Frederic's method into 16 suture parts. The closure stages were classified by five stages of Broca-Ribbe. The following results were obtained: 1. The inter-observer reliability among 4 examiners showed high intraclass correlation coefficient of over 0.75(mean : 0.856) in all suture parts. Therefore, the determination of closure stage wasn't influenced by the subjective view of each examiner. 2. In all suture parts, the closure stage increased proportionally with age.(p<0.01) In terms of each suture part, the S2 part of sagittal suture showed the highest correlation(68.1%) while the L1-R part of lambdoidal suture showed the lowest correlation(51.3%). In addition, in terms of suture types, the correlation with age decreased in the order of sagittal suture(60.0%), coronal suture(57.7%), and lambdoidal suture (55.7%). In general, the average value of suture closure stages had 57.8% correlation with age(p<0.01). 3. The most frequent suture closure stage according to age group was '0' for ages below 30, '0' and '1' for ages within the 30's, '1' and '2' for ages within the 40's, and '2' for ages within the 50's. With older age groups, the frequency of '3' and '4' increased, and the suture closure stage increased proportionally with age. 4. The mean age by closure stage of each suture were within the 40's for the closure stage of '1', within the 50's for the closure stage of '2', and from 50's through 60's for the closure stage of '3'. The standard deviation was over 10 for all closure stages. In addition, at the same suture closure stage, the mean age according to the coronal suture was higher than the ages according to the sagittal suture or lambdoidal suture. Especially, C1-R, C1-L, C2-R, and C2-L parts showed the highest age when at the same suture closure stage. 5. The values appropriate for age estimations using suture closure stages of 16 suture parts were calculated, and a calculator for age estimation ($R^2=0.6944$, p<0.01) by ectocranial suture closure stage for Koreans is presented. From the above results, the method of using the closure stage of sutures of the skull to estimate age can be useful in individual identification of forensic science. Further extensive and accurate research using larger samples would be worthy of study.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.22-27
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• 1999

While the conventional end-to-end anastomotic technique is accepted as 'the golden standard' for microvascular anastomosis, it is time-consuming and tedious. In an effort to offer faster and safer ways of performing microvascular anastomoses, numerous anastomotic techniques have been proposed, but further refinements in microvascular techniques are still necessary. A 'continuous suture with interrupted knot' technique was devised for faster and safer anastomosis. It has been successfully used in microanastomoses of both artery and vein for free tissue transfer. It is a combination of the interrupted suturing technique and the continuous suturing technique. First, a continuous suture is made with the size of loop decreasing in order, and then the sutures are tied individually from the first loop to the last one as in the conventional interrupted suturing technique. It was applied clinically to fourteen patients over the past ten months and found to be a highly efficient technique that satisfied our needs. This 'continuous suture with interrupted knot' technique has several advantages over other techniques : The operative time is reduced comparing conventional interrupted suture technique. By delaying the tie and with the vessel walls kept separated, the risk of through-stitch can be reduced. Tying all the sutures at one time not only speed up the procedures, but also reduced the surgeon's fatigue. In addition, it has no problem of anastomotic stenosis which is a disadvantage of continuous suture technique. This technique proved to be faster and safer, and has patency equal to that of the conventional end-to-end anastomosis. It is of great help to the surgeon in reducing operative time, especially in clinical situations when many anastomoses are required, or lengthy grafting procedures are undertaken.

• Archives of Plastic Surgery
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• v.32 no.2
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• pp.262-266
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• 2005

In some blepharochalasis patients, upper blepharoplasty alone is not satisfactory because of narrow distance between eyebrow and eyelash. On that occasion, eyebrow lift is advisable. There are many methods of classical eyebrow lift, such as direct excision, transblepharoplasty approach, anterior hairline technique, and so on. But they are not so effective, have a tendency to recur and also give rise to side effects; unacceptable scar, facial nerve palsy, sensory loss and hematoma, etc. Some patients who have prominent nasolabial folds, are reluctant to perform face lift procedure due to psychologic or economic burden. The authors performed the eyebrow lift procedure separately or simultaneously with face lift or forehead lift. After making 2 or 3 slit incisions, we passed absorbable suture material, 3-0 vicryl, through suborbicularis oculi fat layer. Then it was passed through subperiosteal plane and fixated to the temporalis fascia. When patients complain prominent nasolabial folds, malar fat pad was elevated also in the same manner. This methods is effective and has minimal complication such as facial nerve palsy, scar, sensory loss. Recurrent tendency was rarely observed during follow-up. Dimples were observed at slit incision sites but they disappeared within 2 or 3 weeks. Eyebrow lift and malar fat lift by absorbable suture elevation with subperiosteal dissection is a simple and less morbid. Because of its effectiveness and little side effect or complication, this procedure can be a useful method.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.4
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• pp.381-390
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• 1991

The purpose of this study was to select the absorbable suture material with the lowest level of foreign body reaction in the extraoral field. The absorbable sutures tested were polyglactin 910(Vicryl), polyglycolic acid(Dexon), and chromic gut. Black silk served as to control suture. Eighteen domestic rabbits served as the animal model for testing purposes. After shaving the fur, A six centimeter incision was made in the hind quarter of all eighteen animals. Each wound was then closed wit two Vicryl, two Dexon, and two chromic gut sutures. All wounds were closed in the same manner. A similar wound was made on the oppsite side and closed with black silk suture. Three rabbits were then sacrificed on postoperative day one, three, seven fourteen, twenty-one, and twenty-eight. The surgical sites were then examined histologically. 1. On days one, three, and seven all suture materials as a similar severe level of inflammatory response. On the fourteenth day the inflammatory reaction of Vicryl was minimal, chromic gut was moderate, and Dexon was severe, Black silk control groups demosnstrated the most severe levels of inflammation of all sutures tested from day fourteen to twenty-eight. 2. On the fourteenth day all absorbable suture materials demonstrated similar minimal levels of resorption. At twenty-eight days Vicryl demonstrated a greater amount of resorption than Dexon or cromic gut suture. There was no resorption noted in the black silk control groups through day twenty-eight. 3. Due to its decreased level of inflammatory response in the animal model, Vicryl might be expected to as a decreased level of response in humans. It is felt that Vicryl is preferred to Dexon or chromic gut for extraoral suturing.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.711-717
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• 1998

Background: Although various anastomotic techniques and suture materials have been used in esophageal anastomosis, anastomotic leakage and stenosis are still somewhat frequent and serious complications when compared to other intestinal anastomoses. We have used interrupted single-layer suture technique using monofilament polypropylene suture in various esophageal anastomoses, including repair of the esophageal atresia, since 1990. Methods and method: We retrospectively evaluated the efficacy of this technique on postoperative leakage and stenosis in several esophageal reconstructions. The esophageal reconstructions using this technique were performed in 90 patients at Dong-A University Hospital from April 1990 through December 1996. Results: Anastomotic leakage occurred in 5 patients(5.6%) with one operative death. Stenosis at the anastomotic site occurred in 15 patients(n=86, 17.4%), which was most common in esophagogastrostomy(22%) and least common in esophagocolostomy (5%). This result was comparable to other methods including the autosuture technique. Conclusions: We concluded that this suture technique in esophageal anastomosis can be used with reasonable results in various esophageal reconstructions including correction of the esophageal atresia.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.179-182
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• 2009

Purpose: Point fixation at the margin of the glenoid is a limitation of conventional arthroscopic stabilization using suture anchors, and does not afford sufficient footprint healing, especially in glenoid bone deficiency. So, we introduce an arthroscopic suture bridge transosseous-equivalent technique for bony Bankart lesions to avoid the technical disadvantage of point contact with anchor fixation and to improve mechanical stability through cross compression of the labrum. Surgical approach: The technique was adapted from the transosseous-equivalent rotator cuff repair technique using suture bridges, which improved the pressurized contact area and mean pressure between the tendon and footprint. After preparation of the glenoid bed by removal, reshaping, or mobilization of the bony lesion, two anchors (3.0 mm Biofastak, $Arthrex^{(R)}$, Naples, FL) were inserted into the superior and inferior portion of the bony Bankart lesion. Using a suture hook, medial mattress sutures were applied around the capsulolabral portion of the IGHL complex to obtain sufficient depth of glenoid coverage. A 3.5 mm pushloc anchor ($Arthrex^{(R)}$, Naples, FL) hole was made in the articular edge of the anterior glenoid rim. distal, suture bridge was applied, and proximal was inserted to mobilize the labrum in the proximal direction. This avoided the technical disadvantage of point contact with anchor fixation and decreased the level of gap formation through cross-compression of the labrum.

• Journal of Chest Surgery
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• v.12 no.2
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• pp.105-109
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• 1979

Since 1973, 40 patients with Patent Ductus Arteriosus were operated in The Department of Thoracic and Cardiovascular Surgery, Korea University Medical College. Clinical analysis of these cases: 1. Age ranged from 8 months old to 28 years old Sex ratio was 22 females to 18 males. 2. Pulse pressure widening above 50 mmHg was appeared in 27 patients. In 31 patients, continuous machinery murmur was heard on left second and third intercostal space, but 9 patients has holosystolic murmur on left sternal border. 3. Retrograde Aortography was performed in 11 patients and right heart catheterization, 17 patients, In 8 patients, pulmonary hypertension [above 30 mmHg in` systole] was noted. 3 out of 8 patients was combined with Ventricular Septal Defect. Severe pulmonary hypertension [above 80mmHg in systole] was presented in 3 patients. 4. In 38 patients, operative method was performed with multiple suture ligation of PDA, and in 2 patients, suture closure through pulmonary arteriotomy under cardiopulmonary bypass. 5. One operative death occurred in a patient in this group. Cause of death was right heart failure after multiple suture ligation of PDA and pulmonary artery bandings.

• Journal of Chest Surgery
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• v.24 no.4
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• pp.390-396
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• 1991

From July 1984 to September 1990, 316 patients of congenital heart diseases were operated and 15 patients died. Hospital mortality was 4.75%. Five patients of 73 PDA had residual shunt after operation: 4 were ligated under support of Dacron patch, 1 was closed through the pulmonary arteriotomy under CPB. 3 patients were reoperated. No patient had residual shunt or reopening among the patients of simple ligation or division and suture. During the ligation of PDA, Dacron patch for protection from tearing may disturb the complete interruption of shunt. If the tissue around the ductus arteriosus looks weak or fragile, division and suture may be more reliable other than ligation with supporting patch. If the septal leaflet of tricuspid valve is adherent around the VSD, remained opening of VSD may be closed with simple suture directly. In these cases, the incidence of postoperative residual shunt is as high as the incidence of more large VSD closed with patch [10.9%: 9.6%]. During the direct closure of remained opening of VSD, another leaking route should be looked for carefully beneath the septal leaflet of tricuspid valve.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.2
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• pp.211-216
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• 2023

It has been shown that external pancreatic ductal stenting (EPDS) can reduce the incidence of clinically relevant postoperative pancreatic fistula. Although studies have described EPDS in open pancreaticoduodenectomy (PD), EPDS in minimally invasive PD has not been reported yet. Thus, the objective of this study was to describe the technique of EPDS in minimally invasive PD. The procedure was performed either laparoscopically or using a robot. Once PD was completed, key steps included triple enterotomy, threading of silk-suture through all enterotomies and exteriorization, completing posterior layer of pancreaticojejunostomy (PJ), railroading stent through preplaced silk-suture, intubation of stent into the pancreatic duct, completion of PJ, followed by hepaticojejunostomy and parietalization of jejunum at the stent exit site. EPDS in PD through a minimally invasive approach can be performed safely in selected cases with either a small-sized pancreatic duct or a soft pancreas.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.72-78
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• 2010

Purpose: Too develop a flexible drill device that can be inserted into the shoulder joint so that arthroscopic transosseous suture repair for Bankart lesion is possible. Materials and Methods: We created a device composed of a flexible drill unit and a guide pipe unit. The flexible drill unit was made of flexible multifilament wires (1.2 mm in diameter) that was twisted into one cord so that it can flex in any direction and a drill bit (1.2 mm in diameter) that is attached onto one end of the flexible wire. The guide pipe unit was a 150 mm long metal pipe (2.0 mm in inner diameter and 3.0 mm in outer diameter), with one end bent to 30 degrees. The flexible drill set was inserted into the shoulder joint through the posterior portal of the joint. The guide pipe component was placed onto the medial wall of the glenoid so that the pipe was placed 5 mm posterior to the margin of the anterior glenoid rim. The flexible drill was driven through the glenoid by the power drill so that holes were made in the glenoid. A non- absorbable suture was passed through the hole. Tying of a sliding knot tying was accomplished over the capsule and labrum after making a stitch through the capsule and labrum with a suture hook loaded with suture passer. The same procedures were done at the 2 and 4 O'Clock positions of the glenoid. Results: Five cases with Bankart lesion received arthroscopic transosseous repair with our flexible drill device. There were no intraoperative problems. Neither redislocation nor subluxation was reported at final follow-up. Conclusion: Arthroscopic transosseous suture repair without suture anchors and easy tying of a sliding knot are possible with a flexible drill set.