• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.2
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• pp.141-147
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• 2011

The aim of this study was to evaluate histomorphometrically and compare the efficiency of various bone graft material and autogenous tooth bone graft material which were used in sinus bone graft procedure. Subjects were the 24 patients who had treated with sinus bone graft using lateral approach from October 2007 to September 2009 at SNUBH. The average age was $52.51{\pm}11.86$ years. All cases was taken after 4month of procedure and divided into 3 groups according to bone graft material. Group 1: autogenous tooth bone graft material, Group 2: OrthoblastII(integra lifescience corp. Irvine, US)+Biocera(Osscotec, seoul, korea), group 3: DBX(Synthes, USA)+BioOss(Geistlich Pharm AG, Wolhusen, Switzerland). Total 37 implant placement area were included and evaluated(7 in group 1, 10 in group 2, 20 in group 3). Evaluation of new bone formation, ratio of woven bone to lamellar bone, ratio of new bone to graft material were performed on each tissue section. Kruskal-Wallis test was used for statistical analysis(SPSS Ver. 12.0, USA). New bone formation were $52.5{\pm}10.7%$ in group 1, $52.0{\pm}23.4%$ in group 2, $51.0{\pm}18.3%$ in group 3. There were no statistical significant differences between each groups. Ratio of woven bone to lamella bone were $82.8{\pm}15.3%$ in group 1, $36.7{\pm}59.3%$ in group 2, $31.0{\pm} 51.2%$ in group 3. Ratio of new bone to graft material were $81.3{\pm}10.4%$ in group 1, $72.5{\pm}28.8%$ in group 2, $80.3{\pm}24.0%$ in group 3. After 4 month of healing period, all group showed favorable new bone formation and around graft material and implant. Within limitation of our study, it is suggested that autogenous tooth bone graft material might be used as novel bone graft material for sinus bone graft.

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.46-52
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• 1993

Soft-tissue deficits over the plantar forefoot, plantar heel, Achilles tendon, and distal parts of lower leg are often troublesome to cover with a simple graft or local flap due to limited mobility of surrounding skin and poor circulation in these area. Soft-tissue reconstruction in these regions should provide tissue components similar to the original lost tissue, supply durability and minimal protective pressure sensation and result in a donor site that is well tolerated and treated. We analysed 7 cases that were treated with the Instep flap due to soft-tissue defects over these regions from July of 1990 to July of 1993. All flaps were viable and successful at follow-up. 1. The age ranged from 9 years to 60 years, and 6 cases were male and 1 case female. 2. The sites of soft-tissue loss were the plantar forefoot(1 case), plantar heel(3 cases), Achilles tendon(2 cases), and distal parts of lower leg(1 case). 3. The causes of soft-tissue loss were simple soft-tissue crushing injury(1 case), crushing injury of the 1st toe(1 case) and posttraumatic infection and necrosis(5 cases). 4. The associated injury were open distal tibio-fibula, fracture(2 cases), medial malleolar fracture of the ankle(1 case), Achilles tendon rupture(2 case) and 1st metatarso-phalangeal disarticulation(1 case). 5. The size of flap was from $3{\times}4cm$ to $5{\times}10cm$(average $4{\times}5.6cm)$. 6. In 7 cases, we were not to find post-operative necrosis and infection, non-viability, limitation of ankle joint, and gait disturbance caused by the Instep flap surgery. 7. This study demonstrates that the Instep flap should be considered as another valuable technique in reconstruction of these regions.

• Journal of Dental Rehabilitation and Applied Science
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• v.29 no.4
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• pp.407-417
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• 2013

The one of peri-implant soft tissue problems seen during the maintenance phase of implant therapy is an inadequate zone of keratinized tissue. Keratinized tissue plays a major role around teeth and dental implants, helping in maintaining and facilitating oral hygiene. A free gingival graft (FGG) is chosen to correct the soft tissue defects and provide optimal peri-implant health in order to increase the long-term prognosis of the implant reconstruction. However, the patient treated with FGG has pain and discomfort on donor site such as palate. It is also technically demanding, time consuming, and the color match of the tissue is often less than ideal. An apically positioned flap (APF) is selected for increasing the keratinized tissue simply while or after the second stage implant surgery. This case report shows successfully increasing the width of peri-implant kenratinized tissue through APF procedure on small site of dental implant instead of FGG.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.261-268
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• 2006

Background: Current vascular prostheses are still inadequate for reconstruction of small-diameter vessels. Autologous pericardium can be a good alternative for this purpose as it already possesses good blood compatibility and shows a mechanical behavior similar to that of natural arteries. However, the clinical use of autologous pericardial tissue as a small-diameter vascular graft has limitations due to mixed outcomes from uncertain biological behavior and difficulty to gain reliable patency results in animal experiments. To study this issue, we implanted fresh and glutaraldehyde-treated autologous pericardium as small-diameter arterial grafts in dogs, and compared their time-related changes histologically. Material and Method: As a form of 5mm-diameter arterial graft, one pair of autologous pericardial tissue was used for comparison between the glutaraldehyde-treated and the glutaraldehyde-untreated grafts in the bilateral carotid arteries in the same dog. The patency of the grafts were evaluated at regular intervals with Doppler ultrasonography. After the predetermined periods of 3 days, 2 weeks, 1 month, 3 months and 6 months, the grafts in each animal were explanted. The retrieved grafts were processed for light and electron microscopic analyses following gross observation. Result: Of 7 animals, 2 were excluded from the study because one died postoperatively due to bleeding and the other was documented as one side of the grafts being obstructed. All 10 grafts in the remaining 5 dogs were patent. Grossly, a variable degree of thromboses were observed in the luminal surfaces of the grafts at 3 days and 2 weeks, despite good patency. Pseudointimal smooth blood-contacting surfaces were developed in the grafts at f month and later. By light microscopy, mesothelial cell layers of the pericardial tissue were absent in all explanted grafts. Newly formed endothelial cell layers on the blood-contacting surface were observed in both the glutaraldehyde-treated and fresh grafts at 3 months and later. The collagen fibers became degraded by fragmentation in the fresh graft at 1 month and In the glutaraldehyde-treated graft at 3 months. At 6 months, the collagen layers were no longer visible in either the glutaraldehyde-treated or fresh grafts. By electron microscopy, a greater amount of coarse fibrin fibers were observed in the fresh grafts than in the glutaraldehyde-treated grafts and, more compact and well-arrayed layers were observed in the glutaraldehyde-treated grafts than in the fresh grafts. Conclusion: The glutaraldehyde-treated small-diameter pericardial arterial grafts showed a better endothelialization of the blood-contacting surface and a slower fragmentation of the collagen layers than the fresh grafts, although it has yet to be proven whether these differences are so significant as to affect the patency results between the groups.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.70-76
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• 2006

This study investigated the clinical application of anterolateral thigh (ALT) perforator flap in reconstruction of soft tissue defect of lower extremity. There were twenty-one patients who had been taken soft tissue reconstruction with anterolateral thigh perforator flap. There were 19 males and 2 females between 3 and 65 years (mean, 36 years). This study included 4 cases of pedatric case of under 10-year-old. All cases were a cutaneous flap. Flap size averaged $160\;cm^2\;(20{\sim}450\;cm^2)$. 19 cases were musculocutaneous perforator flaps and 2 were septocutaneous perforator. T-shaped pedicle were used to reconstruct and to preserve major artery of lower extremity in 2 cases. 19 cases flaps survived completely and 2 cases flap were marginal necrosis partially. There was venous congestion in one case of type of reverse island flap but that was improved after salvage procedure with leech. While the donor sites were closed directly in 5cases, 16 cases underwent skin graft. ALT flap is suitable for coverage of defects in lower extremity where have various condition and reliable in children as in adult.

• Archives of Reconstructive Microsurgery
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• v.23 no.1
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• pp.18-20
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• 2014

Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.222-226
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• 2014

Four patients with soft tissue defects around the ankle joint were covered with peroneal artery perforator-based propeller flaps. Using color Doppler sonography, the flap was designed by considering the location of the perforator and soft tissue defects. The procedure was then performed by rotating the flap by $180^{\circ}$. Additional skin graft was required in a patient due to partial necrosis, and delayed wound repair was performed in another patient with poor blood circulation at the distal part of the flap. The remaining patients did not have any complications and results were considered excellent. Good outcomes were eventually obtained for all patients.

• Archives of Craniofacial Surgery
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• v.22 no.6
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• pp.337-340
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• 2021

Full-thickness nasal tip reconstruction is a challenging process that requires provision of ample skin and soft tissue, and intricate cartilage structure that maintains its architecture in the long term. In this report, we describe reconstruction of a full-thickness nasal tip and ala defect using a posterior auricular artery perforator based chondrocutaneous free flap. The flap consisted of two lay ers of skin covering conchal cartilage, and was based on a perforating branch of the posterior auricular artery. A superficial vein was secured at the posterior margin. The donor perforator was anastomosed to a perforating branch of the lateral nasal artery. The superficial vein was connected to a superficial vein of the surrounding soft tissue. The donor healed well after primary closure. The flap survived without complications, and the contour of the nasal rim was sustained at follow-up 6 months later. As opposed to combined composite reconstructions using a free cartilage graft together with a small free flap or pedicled nasolabial flap, the posterior auricular artery perforator free flap encompasses all required tissue types, and is similar in contour to the alar area. This flap is a useful option in single-stage reconstruction of nasal composite defects.

• Archives of Plastic Surgery
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• v.51 no.3
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• pp.332-336
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• 2024

Reconstructive surgeons face challenges when considering limb salvage methods for the treatment of diabetic foot ulcers (DFUs). In this article, we present our experience with autologous fat grafting as a viable alternative in cases where flap reconstruction is difficult. We encountered a 78-year-old female patient with a nonhealing DFU who had multiple comorbidities, including renal failure and severe peripheral arterial disease. During the initial multidisciplinary meeting, due to extensive necrosis and osteomyelitis, amputation was recommended. However, the patient expressed a strong preference for a salvage procedure and refused amputation. After careful consideration, we opted to reconstruct the patient's foot using three-dimensional bioprinted autologous minimally manipulated homologous adipose tissue. The AMHAT was engrafted well without complications such as autolysis, graft failure, or infection. After the operation, the large defect with partial bone exposure was covered with healthy granulation tissue. The size of the wound decreased to less than half its original size after 6 weeks of surgery, and it decreased to less than 25% after 12 weeks of surgery. The AMHAT may be an appealing treatment option for diabetic foot patients who are unsuitable for flap reconstruction due to comorbidities.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.6
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• pp.520-530
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• 2006

Undifferentiated mesencymal stem cells(UMSCs) have been thought to be multipotent cells that can replicate as undifferentiated cells and that have the potential to differentiate into lineages of mesenchymal tissue including the bone, cartilage, fat, tendon, muscle, and marrow stroma. It can be used to sinus lifting, Guided bone regeneration, other bone graft in dental part. The purpose of this study is to evaluate the effect of mesencymal stem cells on sinus augmentation with autogenous bone, fibrin glue mixture in a rabbit model. 8 New Zealand white rabbits were divided randomly into 4 groups based on their time of sacrifice(1, 2, 4 and 8 weeks). First, undifferentiated mesenchymal stem cells were isolated from iliac crest marrow of rabbits and expanded in vitro. cell culture was performed in accordance with the technique described by Tsutsumi et al. In the present study, The animals were sacrificed at 1, 2, 4 and 8 weeks after transplantation, and the bone formation ability of each sides was evaluated clinically, radiologically, histologically and histomorphologically. According to the histological observations, Stem cell group showed integrated graft bone with host bone from sinus wall. At 2 and 4weeks, It showed active newly formed bone and neovascularization. At 8 weeks, lamella bone was observed in sinus graft material area. Radiologically, autobone with stem cell showed more radiopaque than autobone without stemcell. there were significant differences in bone volume between 2 and 4 weeks (p<0.05). In summary, the autobone with stem cells had well-formed, newly formed bone and neovasculization, compared with the autobone without stem cells (esp. 2 weeks and 4 weeks) The findings of this experimental study indicate that the use of a mixture of mesenchymal stem cell yielded good results in osteogenesis and bone volume comparable with that achieved by autogenous bone. Therefore, this application of this promising new sinus floor elevation method for implants with tissue engineering technology deserves further study.