• Archives of Plastic Surgery
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• 제47권5호
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• pp.460-466
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• 2020

Background Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction. Methods A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed. Results Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were male. The average body mass index (BMI) was 30.0±8.8 kg/㎡. The most common infection etiologies were intravenous drug use and bacteremia (both 25%). Fourteen patients (43.8%) underwent one-stage reconstruction and 18 (56.2%) underwent delayed two-staged reconstruction. Both single and delayed-stage groups had comparable rates of reinfection (7.1% vs. 11.1%, respectively), surgical site complications (21.4% vs. 27.8%), readmissions (7.1% vs. 16.6%), and reoperations (7.1% vs. 5.6%; all P>0.05). The single-stage reconstruction group had a significantly lower BMI (26.2±5.7 kg/㎡ vs. 32.9±9.1 kg/㎡; P<0.05) and trended towards shorter hospital length of stay (11.3 days vs. 17.9 days; P=0.01). Conclusions Both single and delayed-stage approaches are appropriate methods with comparable outcomes for reconstruction for SCJ osteomyelitis. When clinically indicated, a single-stage reconstruction approach may be preferable in order to avoid a second operation as associated with the delayed phase, and possibly shortening total hospital length of stay.

• Journal of Chest Surgery
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• 제55권1호
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• pp.37-43
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• 2022

Background: The surgical strategy for single-stage resection of primary colorectal cancer (CRC) and synchronous pulmonary metastases remains a matter of debate. Methods: Perioperative data of patients who underwent single-stage resection of primary CRC and synchronous pulmonary metastases were compared to those of patients who underwent 2-stage resections. The demographic data, number of metastases, type of pulmonary and colorectal resections, operation time, blood loss, postoperative complications, morbidities, mortality, medical costs, and length of hospital stay were analyzed. Results: Twenty-two patients underwent single-stage resection of primary CRC and pulmonary metastases, while 27 patients underwent 2-stage resection. Tumor size and the number of pulmonary metastases were not significantly different between the 2 groups. The extent of pulmonary metastasectomy and abdominal procedures were similar in both groups, as was the thoracic surgical approach (video-assisted thoracic surgery vs. thoracotomy). However, open laparotomy was performed more frequently in the 2-stage group than in the single-stage group (p=0.045), which also had a longer total anesthetic time (p=0.013). The operation time, medical costs, estimated blood loss, complication rates, and severity were similar in both groups, but the length of hospital stay was shorter in the single-stage group (p<0.001). Conclusion: Single-stage colorectal and pulmonary resection shortened the overall hospital stay, with no significant changes in operation time, medical costs, hospital mortality, and morbidity. Therefore, single-stage resection could be a good surgical strategy in selected patients.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.32-36
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• 2017

In unresectable stage IV colorectal cancer, the role of palliative surgery is not defined clearly. The palliative surgery can be categorized into two surgeries; first, palliative primary tumor resection; second, palliative metastatectomy. Several retrospective studies reported initial palliative systemic chemotherapy in unresectable stage IV colorectal cancer did not increase primary tumor related complications such as obstruction, perforation and hemorrhage, so they insisted that primary tumor resection in asymptomatic stage IV colorectal cancer should be preserved. However, in terms of overall survival and cancer-specific or progression-free survival, several retrospective studies, especially using population-based big data, reported favored survivals in palliative primary tumor resection group. And also several studies reported that palliative metastatectomy such as liver resection without resection of lung metastasis showed better overall survivals. But those results from those studies came from retrospective studies and are likely to be affected by selection bias. Prospective randomized studies are needed to define the benefit of palliative primary tumor resection and metastatectomy in unresectable stage IV colorectal cancer. However, based on the updated evidences, the dogma that palliative primary tumor resection should be preserved in asymptomatic unresectable stage IV colorectal cancer should be questioned.

• Journal of Chest Surgery
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• 제32권11호
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• pp.1009-1016
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• 1999

Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.214-219
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• 2013

Background We established the Microvascular Research Center Training Program (MRCP) to help trainee surgeons acquire and develop microsurgical skills. Medical students were recruited to undergo the MRCP to assess the effectiveness of the MRCP for trainee surgeons. Methods Twenty-two medical students with no prior microsurgical experience, who completed the course from 2005 to 2012, were included. The MRCP comprises 5 stages of training, each with specific passing requirements. Stages 1 and 2 involve anastomosing silicone tubes and blood vessels of chicken carcasses, respectively, within 20 minutes. Stage 3 involves anastomosing the femoral artery and vein of live rats with a 1-day patency rate of >80%. Stage 4 requires replantation of free superficial inferior epigastric artery flaps in rats with a 7-day success rate of >80%. Stage 5 involves successful completion of one case of rat replantation/transplantation. We calculated the passing rate for each stage and recorded the number of anastomoses required to pass stages 3 and 4. Results The passing rates were 100% (22/22) for stages 1 and 2, 86.4% (19/22) for stage 3, 59.1% (13/22) for stage 4, and 55.0% (11/20) for stage 5. The number of anastomoses performed was $17.2{\pm}12.2$ in stage 3 and $11.3{\pm}8.1$ in stage 4. Conclusions Majority of the medical students who undertook the MRCP acquired basic microsurgical skills. Thus, we conclude that the MRCP is an effective microsurgery training program for trainee surgeons.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.99-105
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• 1999

We investigated the effectiveness of arthroscopic decompression in stage Ⅱ subacromial impingement after long term follow up. Arthroscopic subacromial decompression was done in 104 consecutive patients who had stage Ⅱ sub­acromial impingement. After average of 8.4 years follow up, the final results were as following; 57 shoulders(55%) in excellent, 25(24%) in good, 16(15%) in fair and 6(6%) in poor. All parameters-pain, function, muscle strength and motion-were improved significantly(p<0.00l). Rotator cuff tear was developed in 10 shoulders after decompression. Among them, 8 shoulders had unfavorable results including two poor. In 6 failures, two had rotator cuff tear, three had recurrence of impingement with degenerative change and reflex sympathetic dystrophy was developed in one. Reoperations were done in 4 shoulders. Improvement of impingement symptoms was maintained in the most of patients(79%) after long term follow up. Arthroscopic decompression surgery was very effective means for stage Ⅱ impingement syndrome.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.140-145
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• 2020

Background Capsular contracture is a common complication of two-stage expander/implant breast reconstruction. To minimize the risk of this complication, capsulectomy is performed using monopolar cautery or ultrasonic surgical instrumentation, the latter of which can be conducted with a Harmonic scalpel. To date, there is disagreement regarding which of the two methods is superior. The purpose of this study was to compare postoperative outcomes between a group of patients who underwent surgery using a Harmonic scalpel and another group treated with monopolar cautery. Methods A retrospective chart review was conducted of patients who underwent capsulectomy as part of two-stage breast reconstruction between January 2018 and February 2019 and who received at least 1 month of follow-up after surgery. Operative time and postoperative outcomes, including drainage duration, were analyzed. Results In total, 36 female patients underwent capsulectomy. The monopolar group consisted of 18 patients and 22 breasts, while the Harmonic scalpel group consisted of 18 patients and 21 breasts. There was no statistically significant difference in demographics between the two groups. The Harmonic scalpel group had a significantly shorter mean drainage duration (6.65 days vs. 7.36 days) and a smaller mean total drainage volume (334.69 mL vs. 433.54 mL) than the monopolar cautery group (P<0.05). No statistically significant difference was observed with regard to seroma or hematoma formation. Conclusions The Harmonic scalpel approach for capsulectomy reduced the total drainage volume and drainage duration compared to the monopolar cautery approach. Therefore, this approach could serve as a good alternative to electrocautery.

• Radiation Oncology Journal
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• 제2권2호
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• pp.229-235
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• 1984

Surgery remains the mainstay in the management of carcinoma of the rectum. However, local recurrence and systemic metastasis remain the challenge. It appears that post operative radiotherapy has a very definite role in the reduction of local recurrence. Minty two patients of carcinoma of the rectum after curative surgery received post operative radiotherapy $5,000rad/5\~6weeks$ to whole pelvis at the Department of Therapeutic Radiology, Seoul National University Hospital between March 1979 and December 1982. Fifty three percent of patients show modified Astler-Coiler stage C2. Actuarial disease free survival rate of rectal cancer was : stage B1, 2 $75\%$, stage C1 $81\%$ stage C2 $39\%$, and stage C3 $20\%$, Twelve percent shows local recurrence and distant metastasis occurred in $28\%$. Prognostic significance of nodal metastasis is also analysed. Incidence of small bewel obstruction, requiring surgery, is $8\%$, occurring between 5th month to 12 th month after operation. It is suggested that post operative radiotherapy of the rectal cancer following curative surgery has a significant role in the reduction of local recurrence.

• Journal of Korean Dental Science
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• 제13권2호
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• pp.67-72
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• 2020

Purpose: This clinical study presented the effectiveness of 2-stage posterior maxillary segmental osteotomy (PMSO) under local anesthesia in gaining interarch space to restore the posterior mandibular segment with dental implants. Materials and Methods: Nine patients who received two-stage PMSO for mandibular implant placement from 2003 to 2011 were included in the study. Of the 9 patients, 7 were female and 2 were male. Ages ranged form 28 to 72 (mean 46.6). Potential complications were investigated such as sinus infection, survival of bone segment, inflammatory root resorption of adjacent teeth, relapse of bone segment and timing of implant placement, delivery of implant prosthesis and stability of bone segment. Result: None of the patients showed relapse or complication. Bone segments were stabilized by opposed implant prosthesis. Conclusion: Office-based 2-stage PMSO under local anesthesia can be considered a stable and predictable procedure. Also pedicle damage can be avoided by allowing favor of blood supply to the bone segments. From these advantages, it can be concluded that this surgical procedure can decrease post-operative complications.

• Archives of Plastic Surgery
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• 제43권2호
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• pp.197-203
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• 2016

Background The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant. Methods We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant. Results The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry. Conclusions This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.