• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.106-111
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• 1996

Purpose : Propose a surgical technique in donor harvesting method in free vascularized proximal fibular epiphysis. Methodology : Concerned about growth potentials of the transplanted epiphysis in our long term results of the epiphyseal transplanted 13 cases more than 4 years follow-up, anterior tibial artery which contains anterior tibial recurrent artery is most reliable vessel to proximal fibular epiphysis which is the best donor of the free vascularized epiphyseal transplantation. In vascular anatomical aspect proximal fibular epiphysis norished by latearl inferior genicular artery from popliteal, posterior tibial recurrent artery and anterior tibial recurrent artery from anterior tibial artery and peroneal artery through metaphysis. The lateral inferior genicular artery is very small and difficult to isolate, peroneal artery from metaphysis through epiphyseal plate can not give enough blood supply to epiphysis itself. The anterior tibial artery which include anterior tibial recurrent and posterior tibial recurrent artery is the best choice in this procedure. But anterior tibial recurrent artery merge from within one inch from bifucating point of the anterior and posterior tibial arteries from popliteal artery. So it is very difficult to get enough vascular pedicle length to anastomose in recipient vessel without vein graft even harvested from bifucating point from popliteal artery. Authors took recipient artery from distal direction of anterior tibial artery after ligation of the proximal popliteal side vessel, which can get unlimited pedicle length and safer dissection of the harvesting proximal fibular epiphysis. Results : This harvesting procedure can performed supine position, direct anterolateral approach to proximal tibiofibular joint. Dissect and isolate the biceps muscle insertion from fibular head, micro-dissection is needed to identify the anterior tibial recurrent arteries to proximal epiphysis, soft tissue release down to distal and deeper plane to find main anterior tibial artery which overlying on interosseous membrane. Special care is needed to protect peroneal nerve damage which across the surgical field. Conclusions : Proximal fibular epiphyseal transplantation with distally directed anterior tibial artery harvesting technique is effective and easier dissect and versatile application with much longer arterial pedicle.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.306-310
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• 2009

Purpose: Owing to improvement of microscope, microsurgery implements, and microsuture, finger replantation has shown much development. With high success rate of microsurgery in children, positive results have been reported ever from distal amputation. Here, we report the patients demographics, methods, and results of the microsurgery performed in children in our hospital for the last 8 years. Methods: From the medical records of 21 patients who had given the treatment in our hospital from January 2000 to December 2007, we analyzed patients' sex, age, operative method, and complication retrospectively. Results: The number of male patients was twice as many as female, where most patients belong to the ages of five to ten years. Operative methods performed in this study included end - to - end anastomosis of artery and vein, vein graft, and epineurial suture. As a result, 19 out of 21 cases were successfully accomplished, and four of them went through the debridement of necrotic tissue due to the partial necrosis of the lesion. A one - year follow - up observation was done after surgery and most of them were almost fully recovered like in their previous state. Conclusion: The success rate of finger replantaion in children is continuously improving despite the difficulty of vessel anastomotic procedure, rehabilitation treatment and management after surgery. We report the satisfactory results of pediatric finger replantation technically and aesthetically.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.533-538
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• 2005

Due to its safety and softness, autologous fat transplantation has been commonly performed for soft tissue correction. However, the injected fat is absorbed resulting in the reduction of volume of the graft by 40-60% within a few months. Thus, there was an attempt to use adipocytes differentiated from preadipocytes in vitro for transplantation. Differentiated adipocytes were biocompatible and matured with gradual volume increase at transplantation site in clinical study(unpublished data). In addition, they did not induce immune rejection in response to nonself lymphocytes in a mixed lymphocyte reaction(MLR)(unpublished data). The purpose of this study is to differentiate mouse preadipocytes following labeling into adipocytes to establish an animal model for allogenic transplantation. Preadipocytes isolated from inguinal and retroperitoneal fat pad of C57BL/6 mice were proliferated with growth medium by passage 3 and differentiated into adipocytes with different culture conditions after labeled with BrdU. At most suitable conditions, above 90% of preadipocytes were differentiated and BrdU labeling did not affect differentiation rate and function of differentiated adipocytes. These results demonstrate that BrdU-labeled adipocytes resulting from this in vitro differentiation protocol are useful for allogenic transplantation study.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.581-588
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• 2008

Purpose: It is generally accepted that anatomical structures of the soft tissue in Asian faces are quite different from those in Caucasian. It is presumed that these differences are due to collagen rich thick dermis and durable superficial musculo-apponeurotic system (SMAS) in Asian. We classified the aging lower eyelids and reviewed the operative procedures according to the types of aging lower eyelids in Asian. Methods: We compared preoperative and postoperative photos of 117 patients over 30 years of age, who underwent lower blepharoplasty at the Kyunghee Medical Center from January 2001 to April 2006. We classified the patients based on the degree of skin laxity, presence of nasojugal groove and malar bag, the extent of aging process. We also reviewed the operative procedures according to each type of classification. Results: We classified our patients into four types as following. Type I patients showed minimal skin-muscle excess confined to lower eyelids regardless of the facial line. For these patients, we performed only transcutaneous or transconjunctival blepharoplasty. In type II patients, nasojugal grooves were shown and skin- muscle laxity was limited to the medial side of imaginary vertical line at lateral margin of pupil. In these cases, we performed free fat graft or fat repositioning on nasojugal groove or fat removal and septal duplication confined to medial side. Type III patients displayed more advanced medial bulging and remarkable laxity over the lateral side, the same operation methods as those of type II were applied at the lateral side of the line. Type IV patients demonstrated extensive midfacial aging changes including malar bags and underwent superficial subciliary cheek lift. Conclusion: The lower eyelid aging of Asian is different from those of Caucasian. We think that our classification is useful in selection of appropriate operative procedure to address specific problems for Asian patients.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.279-281
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• 2009

A 38-year old man was admitted to our hospital due to a $5{\times}6cm$ sized pulsating mass in the right neck. He suffered from intermittent neck pain and hoarseness for two months due to the rapidly growing mass. The radiological examinations revealed an aneurysm of the right common carotid artery near the bifurcation, and it was compressing the internal and external carotid arteries. Endarterectomy of the right internal carotid artery, aneurysmectomy of the right common carotid artery and graft interposition were done, while the cerebral circulation was maintained by an internal shunt. Intraoperative injury to the nerve tissue around the aneurysm was avoided. He was discharged on the postoperative 7th day without any complications.

• Proceedings of the KSAR Conference
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• 2003.06a
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• pp.77-77
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• 2003

Chimeric animals are referred to as an organism composed of tissues derived from more than one species. In order to examine if a pluripotency of embryonic stem cells can cross the limitation of a species, we tried to establish human-mouse chimeric animals. Human embryonic stem cells were genetically modified to express eGFP using eukaryonic expression vector pcDNA 3.1 (In Vitrogene) for an easy identification. After selection with neomycin, approximately 15 cells were implanted into mouse blastocoele cavity. Ten chimeric blastocysts were transferred to one of the uterine horn of 2.5 days pesudopregnent ICR female. Out of 272 blastocysts transferred to pseudopregnant recipients 20 live newborn were obtained after 20 days. When newborn were obtained, pups were quickly removed immersed into 4% PFA. By histological examination using fluorescent microscope, green fluorescence was observed from the liver, heart, and spleen in newborn mice. Three weeks after born, presence of eGFP sequence within mouse genome (tail and kidney) was reconfirmed by PCR. eGFP sequence was amplified from the progenies of the animal suggesting a genetic transmission of the transgene. These chimeric mice having human cells at the beginning of development, are expected to recognize human cells as “self”, therefore, human cells or tissues will be able to escape the immunological surveillance of the host if grafted into the animal. These animals will serve as a good model system for studying the graft rejection in tissue transplantation and the potential of the cells to work well in many human disease.

• Journal of Biomedical Engineering Research
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• v.14 no.1
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• pp.51-62
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• 1993

An experimental study was performed for the preparation of living skin-equivalent by the using collagen gel contraction with human fibroblasts as neodermls and cultured human keratinocytes as neoderm is . The results were as follows ; 1) The rate of collagen gel contraction was dependent on the number of fibroblasts into the lattice and collagen contraction was progressed according to the increment of the number of the cells. 2) The rate of collagen gel contraction was progressed according to the decrement of the contraction of the collagen. 3) The rate of gel contraction was progressed according to the increment of serum concentration in the fixed concentration of the fibroblasts and collagen. 4) The lattice contraction was decreased according to the increment of the population doublings of the fibroblasts. 5) Macroscopically, the artificial dermis was gray white in color and tissue-like consistency and elas- ticity. 6) Microscopically, three dimensionally contracted artificial dermis showed more dense fibroblasts and its newly formed collagen fibrils in the matrix than one dimensionally contracted one. 7) Finally prepared skin-equivalent showed good attachment of living stratified keratinocytes to the dermal equivalent microscopically. It has been proposed that newly formed skin-equivalent is suitable for the graft of extensively and deeply burned patients. Shortening of the manufacturing period of skin-equivalent and development of conservation technique as a readily usable state are to be solved for our ongoing works.

• Proceedings of the KOSOMBE Conference
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• v.1997 no.05
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• pp.447-450
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• 1997

A new technique for the preparation of porous vascular prostheses was investigated. Polyurethane solution (10 to 14wt%) was injected into a mold. After freezing at low temperature $(0^{\circ}C\sim-40^{\circ}C)$, solvent was dissolved out with water at $0^{\circ}C$ to form porous tubes. The average pore size $(<10{\mu}m)$and pore occupation (10% to 51%) were easily changed by changing polyurethane concentration, freezing temperature, and freezing methods. This technique can give a proper pore size $(30\sim60{\mu}m)$ for tissue ingrowth, and suitable compliances for matching with arteries and veins. This method might give a desired compliant graft for artificial implantation with the presently valid medical polymers.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.308-315
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• 2004

Aim: The aim of this study was to investigate the mechanism of promoted skin wound healing in skin defects with primary cultured oral mucosal keratinocytes. Materials and methods: Thirty adult female nude mice weighing $20{\pm}2g$ were used for the experiment. Primary cultured and suspended oral mucosal keratinocytes, labeled with BrdU, were scattered onto $1.5cm{\times}1.5cm$ sized full thickness skin defects in the experimental group(N=15), and no grafts were placed the control group(N=15). They were sacrificed at 3 days, 1 week and 2 weeks after the treatment respectively. Histological examination of each wounds were performed to review the healing progress on measuring the length from the wound margin to regenerating epithelial front. The role of keratinocytes were assessed by double immunohistochemical staining with Anti-BrdU and Anti-cytokeratin AE1/3. Results: In the experimental group the wound was completely covered with regenerating epithelia in 2 weeks, but partially regenerated in the control group. The immunohistochemical studies unexpectedly reveal that most of regenerating epithelial cells were induced from marginal epithelium of the margin, not from the scattered keratinocytes. Conclusion: We could successfully confirm that graft of primary cultured oral mucosal keratinocytes promotes the regeneration of skin defects.

• Archives of Craniofacial Surgery
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• v.17 no.3
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• pp.140-145
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• 2016

Background: The nasal septal cartilage is often used as a donor graft in rhinoplasty operations but can vary widely in size across the patient population. As such, preoperative estimation of the cartilaginous area is important for patient counseling as well as operating planning. We aim to estimate septal cartilage area by using facial computed tomography (CT) studies. Methods: The study was performed using facial CT images taken from 200 patients between January 2012 to July 2015. Using the mid-sagittal image, the boundary of cartilaginous septum was delineated from soft tissue using the mean difference in signal intensity (or brightness). The area within this boundary was calculated. The calculated area for septal cartilage was then compared across age groups and sexes. Results: Overall, the mean area of nasal septal cartilage was $8.18cm^2$ with the maximum of $12.42cm^2$ and the minimum of $4.89cm^2$. The cartilage areas were measured to be larger in men than in women (p<0.05). The area decreased with advancing age (p<0.05). Conclusion: Measuring the size of septal cartilage using brightness difference is more precise and reliable than previously reported methods. This method can be utilized as the standard for prevention of postoperative complication.