• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.1-15
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• 1996

From Fabuary 1982 to May 1995, 396 patients had undergone reconstructive surgery of the upper and lower limb with microsurgical technique at department of orthopaedic surgery, Yonsei University of Medicine. The results were as follows; 1. Average age at the time of operation was 23.4years(2-64 years), and there were 277 male and 119 female patients. 2. Among 324 patients of soft tissue flap(87 inguinal flap, 132 scapular flap, 38 latissimus dorsi flap, 11 latissimus dorsi and scapular combind flap, 6 gracilis flap, 12 deltoid flap, 3 tensor facia lata flap, 11 dorsalis pedis flap, 6 lateral thigh flap, 12 wrap around flap, 1 lateral arm flap, 5 musculocutaneous flap), 274 cases(85.5%) were succeed. 3. Among 37 patients of vascularized bone graft(18 fibular bone graft, 11 iliac bone graft, 7 toe to finger transplantation,1 vascular pedicle rib graft), 30 cases(80.1%) were succeed. 4. In 26 cases of segmental resection and rotationplasty at lower extremity, 23 cases were succeed. 5. In 7 cases of Tikhoff-Linberg procedure and in 2 case of segmental resection and replantation, all case was succeed. Overall success rate of microscopic reconstructive surgery was 85.6%. In conclusion, microsurgical technigue is valuable for reconstruction of tissue defect or function loss of the limb.

• Journal of Periodontal and Implant Science
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• v.26 no.1
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• pp.47-67
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• 1996

The purpose of this study was to observe the effect of $Biocoral^R$ graft and bioglass 45S5 graft in combination with ePTFE membrane in periodontal osseous defects for new bone formation. Nine healthy dogs were used. Under general anesthesia, 3-wall defects were created on the mesial and distal surfaces of the maxillary right canines, the mesials of the maxillary right second premolars, the distals of the mandibular right canines and the mesials of the mandibular right third premolars. To induce periodontitis, a silicone rubber, $Provil^R$ light body, was injected under pressure into the defects. Ninety days later, $Provil^R$was removed and followed by thorough root planing. The followings were then applied in the mesial and distal defects of the maxillary right canines, the mesials of the maxillary right second premolars, the distals of the mandibular right canines and the mesials of the mandibular right third premolars by random selections : 1) ePTFE membrane only application, 2) $Biocoral^R$ graft, 3) $Biocoral^R$ graft and ePTFE membrane application, 4)Bioglass 45S5 graft, 5) Bioglass 45S5 graft and ePTFE membrane application. The membranes were removed 1 month later. The dogs were sacrified at 1, 2 and 3 months following the graft, and block sections were made, demineralized, embedded, stained and examined by light microscope and transmission electron microscope. On the sections from teeth treated with ePTFE membrane only, the defect demonstrated extensive connnective tissue and alveolar bone regeneration. The $Biocoral^R$ graft group demonstrated extensive bone regeneration compared with ePTFE membrane only group. In the $Biocoral^R$ graft plus ePTFE membrane group, regeneration of new alveolus and crest occurred within the defect. As the experimental period lengthened, bone regeneration was increased and bone bridge was formed among the graft particles. The but bioglass 45S5 graft group demonstrated extensive bone regeneration but the amount of new bone was less than that of the $Biocoral^R$ graft group. For the bioglass 45S5 graft plus ePTFE membrane group, the amount of new bone was also increased. As the experimental period lengthened, bone regeneration was increased. Multinucleated giant cells, fibroblasts and macrophages were observed. As the bone formation was increased, the number of such cells was decreased. In conclusion, the $Biocoral^R$ was found better than the bioglass 45S5 for new bone formation, and the use of ePTFE membrane alone or with $Biocoral^R$/bioglass 45S5 can be supported as potential methods of promoting bone formation.

• Journal of Periodontal and Implant Science
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• v.30 no.2
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• pp.277-287
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• 2000

For the regeneration of osseous defect on the furcation area, autogeneous bone graft has been primarily used. But it has the limitation of donor site, additive surgical operation etc. Recently anorganic xenogenic bone graft materials of removing all organic components are commonly used for the regeneration of periodontal defects. This study was the comparison of the effect on the regeneration with two types xenografts($Bio-oss^{(R)}$ and Ca-P thin coated Bovine bone powder) on the furcation involvement in Beagle dogs. After surgically induced chronic periodontitis in bifurcation area of premolar, $Bio-oss^{(R)}$ and Ca-P BBP were grafted on the osseous defects. Tissue blocks including defects with soft tissues were harvested following a four-& eight-week healing interval and prepared for histologic analysis. The results of this study were as follows: 1. $Bio-oss^{(R)}$ group: there were significant differences among the $Bio-oss^{?}$ group at 4weeks and 8weeks, but the control group had various appearances : new bone formation, resorption of graft materials by multinuclear giant cells, connective tissue cells intervention in the bone graft sites etc. 2. Ca-P BBP group: lots of new bone formation were observed but the arrangement of periodontal ligament was not completed at 4weeks. New bone were replaced mature bone and the periodontal ligaments showed the functional arrangement at 8weeks. 3. By reason of undergrowing the epithelium within the osseous defects, new bone formation was not happened in the upper area of bifurcation in $Bio-oss^{(R)}$ group. 4. In Ca-P BBP group, epithelial undergrowth was not seen and generally showed much more new bone formation. 5. Ca-P BBP group showed the osteocyte-like cells at the inner portion of the graft materials 6. Both groups were similar to resorptive appearances of graft materials, but Ca-P BBP group had the better effects of osteoconduction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.3
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• pp.239-252
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• 1995

The present study was aimed to evaluate the effect of demineralized freeze-dried bone (DFDB) and resorbable hydroxyapatite (RHA) on bone formation in the extracted socket. The lower left and right 2nd and 3rd premolar were extracted in adult dogs. The one group was grafted with DFDB into the extracted socket, and the other group grafted with RHA. The extracted socket was sutured without any graft materials as control. The animals were killed on the 1st, 2nd, 4th, and 8th week after the graft for macroscopic and microscopic examination. Results obtained were as follows : 1. Macroscopically, nor infection of the graft site and dislodgement of the grafted material were noted in any animals used. 2. Young trabeculae of osteoid were formed in the socket wall in control group at 2 weeks after the graft. Osteoid tissue was formed in DFDB group at 1 week after graft, and a fine osteoid tissue was grown through the RHA particles in RHA group at 2 weeks graft. 3. The grafted groups showed more rapid bone formation than the control. Between the grafted groups, DFDB group showed more rapid formation than RHA group, DFDB group showed osteoinductive bone formation and RHA group showed osteoconductive bone formation. These results suggest that DFDB and RHA are useful to preserve the alveolar bone and to improve new bone formation by immediate grafting into the extraction sockets.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.2
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• pp.92-99
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• 2003

The prevalence of anterior cruciate ligament (ACL) injury is continuously increased due to sports activities and traffic accident. Simultaneously ACL reconstruction operations are on the increase. Several kinds of autografts and allografts are used in ACL reconstruction. Although ACL reconstruction using an autogenous bone-patellar tendon-bone graft is the good standard, it might have potential morbidity, anterior knee pain and minimal extension loss. To minimize the complications and disadvantages on each graft and to select appropriate graft for each patient, it is necessary to understand the unique characteristics of each graft for biomechanical aspect, morbidity and disadvantage. Selecting the appropriate graft depends on numerous factors including surgeon's preference and experience, patient's activity level and age, extent of ligament injury, tissue availability, and patient's selection for graft .

• Journal of Periodontal and Implant Science
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• v.34 no.2
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• pp.377-392
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• 2004

The purpose of this present study was to investigate the effect of autogenous bone with histological evaluation of regenerated bone after sinus elevation. The study involved genaral healthy 6 patients participated in this study and were treated with 2-stage sinus elevation procedures using a combination of demineralized freezed-dried bone allograft (DFDBA) and coralline calcium carbonate with or without autogenous bone. At 6months after sinus elevation, bone specimens were obtained and stained with Hematoxylin-Eosin for light microscopic evaluation. The results of this study were as follows : 1. Autogenous bone grafts present trabecular patterns at 6 months in test groups, consist of woven bone and lamellar bone, but more compact than control groups. 2. Resorption of bone graft particles, osteoblast-like cells, newly formed osteoid tissue were observed at 6 months in test groups, but seems to be more frequently than control groups. 3. New osteoid tissue was formed from the surface of graft materials and gradually expanded around them. 4. The appearance of connective tissue around graft materials was densely formed, but more prominent in test groups than control groups. 5. Bone graft particles were resorbed incompletely and slight inflammatory infiltrate, newly formed capillaries, and adipocytes were observed. From the above results, autogenous bone is effective in bone regeneration after sinus elevation, could provide favorable conditions in implant placement.

• Journal of the Korean Arthroscopy Society
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• v.2 no.2
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• pp.124-128
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• 1998

From Feb. 1996 to Feb. 1997. among sixty-four patients of anterior cruciate ligament(ACL) reconstruction using multi-stranded hamstring tendon and EndoButton fixation, twenty-five patients of volunteer, 15 men and 10 women, from 16 to 50 years of age(mean 27.6 years) underwent arthroscopic evaluation. Arthroscopic evaluation was routinely performed one year after surgery along with an examination of stability. The purpose of this study was to arthroscopically evaluate the morphological changes that occurred in hamstring tendon autograft one year after ACL reconstruction. Both of the tendon graft and the adjacent fibrous tissues were observed for gross appearance and physical properties with probing and response to passive anterior translation. Biopsy samples were taken from the surrounding fibrous tissue and the tendon graft. Grossly, we found a well-defined ligamentous structure with good tension tested with a probe. A common finding was that the reconstructed ligaments were embedded in a layer of the synovium, and blood vessels could be seen on the anterior surface of the ligament. The biopsy tissue was placed in formalin solution and subjected to histological preparation by hematoxylin and eosin staining method. The hamstring tendon graft appeared histologically normal under light microscopic finding. There were a few vessels located between existing collagen bundles, and the vessels had an orderly pattern. The surrounding fibrous tissue envelope was covered with synovium. We pleased with preliminary findings in our evaluation.

• 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.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.117-123
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• 2005

The reconstructive modalities for vaginal reconstruction include simple dilatation, skin graft, use of intestinal segments and various methods using flaps. However, skin grafting procedure is the most commonly used technique and the McIndoe procedure is a representative technique among skin grafting procedures. McIndoe procedure is easier, faster and has a lower morbidity compared to other techniques. However the conventional McIndoe procedure has several problems such as incomplete vestibule formation, excessive bleeding during dissection, possibility of recto-vaginal or urethro-vaginal fistula formation, late vaginal contracture and discomfort in wearing hard plastic mold for a long time after operation. To solve these problems, the authors modified the conventional McIndoe procedure in several perspectives. The undeveloped vestibule was incised with X-shaped mucosal incision between the urethral opening and posterior margin of the vestibule and deepened by blunt finger dissection to provide a sufficient diameter & length of the neovagina and to minimize bleeding. A sizable medium thickness split skin graft was harvested and wrapped over a roll gauze-filled condom mold. Applying multiple stab incision on the skin grafted condom mold, it was inserted into the prepared neovaginal canal. Distal margin of the skin graft was secured with tips of the mucosal flaps created by X-shaped vestibular incision to prevent accidental extrusion of the skin grafted mold. During last 15 years, we applied this modification to 20 vaginal agenesis patients and investigated results of the 12 patients who could be followed up serially including hematoma formation and skin graft survival rate, size, depth, presence of late contracture, appearance, comfortness, and hygiene of the neovagina. And they were compared with 8 patients of 20 patients who underwent conventional McIndoe procedures. The modified McIndoe procedure revealed lower complication rate, higher patient satisfaction and better functional results.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.252-264
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• 1991

The purpose of this study was to compare the response of adjacent tissue and new bone formation after implantation by different methods of subperiosteal using using Proplast I and II in rabbit mandible. Microstructure of Proplast I and II was observed by scanning electron microscope. And the implantation procedure was carried out by dividing into tow groups, A and B. a group consisted of subperiosteal graft on the cortex, and the other B group was made up onlay graft following artificial decortication in the madibular body of rabbit. The experimental animals were sacrificed on the 1st, 2nd, 4th and 8th week after grafting for macroscopic and histopathologic examination. The samples extracted at the 6th postgrafting week were also used for biometric test. The result ere as follows : 1. By scanning electron microscopic observation, pore size was $50{\sim}180{\mu}m$ in the Proplast I and $100{\sim}220{\mu}m$ in Proplast II. 2. Macroscopically, infection of the graft site, deformation and displacement of the implanted materials were not observed in all experimental groups. 3. In the tissue response, infiltration of inflammatory cells and multinucleated giant cells were observed from the 2nd to the 8th week in Proplast I. Inflammatory cells decreased in number from the 2nd week in Proplast II suggesting that Proplast II is better than Proplast I. 4. Bone formation was not observed until the 8th week in the group A, but new bone formation from the surrounding graft bed and the periostium was appeared from the 4th week in the group B. 5. The maximum mean values of shear stress mere serially $65.5gf/mm^2$ in Proplast II of group B, $32.9gf/mm^2$ in Proplast I of group B, $17.0gf/mm^2$ in Proplast II of group A, and $15.7gf/mm^2$ in Proplast I. of group A.