• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.46-49
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• 2002

Background: Free flaps have become a very important role in the ablative head and neck surgery with functional preservation of defect sites. The forearm free flap has many advantage of lack of bulk, ease of dissection, vascularity, and malleability. Patients and Methods: A review of 51 radial forearm free flaps performed between may 1990 and feburary 2001 at the Korea University was undertaken to determine outcome. Patient age ranged 27 to 72 years (mean 56). There were 44 men and 7 women. The most prevalent neoplasm was squamous cell carcinoma. Results: The tans verse cervical artery and the external jugular vein were the most frequent receipient sites for microvascular anastomosis. Total flap loss occurred in 2 cases (4%) and other complications were seen in 42%. Fifteen patients received preoperative irradiation and the complication was higher than non-irradiation patients, but statistically not significant. Conclusion: The radial forearm free flap offers a variety of reconstructive options for head and neck. Its low flap loss and complication rates offer the best choice for reconstruction of defect of head and neck malignancy.

• Archives of Reconstructive Microsurgery
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• v.1 no.1
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• pp.51-55
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• 1992

Problems of composite tissue transfer commonly arise when a single indispensable recipient vessel receives the graft vssel, and the graft vessel must be sutured in end-to-side fashion so as not todisturb the vascularity of the recipient vessel. The triangular flap in the recipient vessel wall gives an intact endothelial surface when the flow of blood stream is presented and may reduce the chance of anastomosis. We selected mature Wistar rats weighing over 450 grams to compare the conventional longitudinal slit from the triangular flap in the recipient carotid artery over bloood pressure and blood flow when the donor carotid artery was anastomosed in end-to-side fashion. In 30 minutes after anastomosis, maximum blood pressure measured in the donor carotid arterial side when the recipient arterial wall was fasioned with the longitudinal slit was recorded 114 mmHg and with the triangular flap 100mmHg. Minimum blood pressure with the longitudinal slit was 98mmHg and with the triangular flap 88mmHg. The amount of blood collected for 30 seconds in the conventional longitudinal slit was 1.18mg and in the triangular flap 0.78mg. Histology study in 30 minutes, the conventional longitudinal slit demonstrated the more hemorrhagic features around the suture material compared to that of the triangular. flap and, in the 7th day, the conventional longitudinal slit demonstrated the more prominent granulomatous reactions and vascular proliferations around the suture material compared to that of the triangular flap.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.181-186
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• 2006

Myocutaneous flaps have improved the management of soft tissue defects on buttocks and lower extremity. However, there are several inherent disadvantages of muscle flaps such as functional deficits of the donor sites and the bulkiness at the recipient site. To overcome these disadvantages, we have used perforator-based fasciocutaneous rotation flaps for reconstruction of the buttock and lower extremity defects. From March 2003 to February 2005, we have treated 14 patients using perforator-based fasciocutaneous rotation flaps. 10 flaps were based on perforators of the gluteus maximus muscle, and 4 flaps were nourished by perforators from the tibialis anterior and posterior system. The mean postoperative follow-up period was about 1 year. The technique involves localization of the flap perforators preoperatively with a Doppler. The flaps were elevated superficial to the fascia with preservation of one to three perforators. The donor site is then closed primarily. All flaps completely survived and there was no perioperative complications. There was no functional disability of the donor area with esthetically pleasing results. Perforator-based fasciocutaneous rotation flaps for the reconstruction of buttock and lower extremity defects are excellent alternatives to musculocutaeous flaps. The vascularity of the flaps is robust and dissection is technically easy. Perforator flaps do not require sacrificing muscles, but provide sufficient volume and are durable Furthermore, these flaps result in less scar formation and allow more liberal dissection with safety. We conclude that perforator-based fasciocutaneous rotation flaps are very useful for reconstruction of the buttock and lower extremity.

• Archives of Plastic Surgery
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• v.33 no.3
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• pp.341-346
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• 2006

The two major concerns in skin grafting are poor color match in the recipient site and the donor site morbidity. A new skin graft(dermis graft; deepithelialized split thickness skin graft), was used to minimize these problems. The important aspects of this method involve immediate return of epidermis to the donor site and restoration of the recipient site's epidermis by inducing epithelialization from adjacent skin. From April of 2001 to March of 2004, dermis graft and a conventional split thickness skin graft(STSG) were performed in 53 and 33 patients, respectively. The healing time, the scar condition, and the patients' satisfaction were compared. Regarding the recipient sites, the wounds of the dermis graft(n=53) and STSG(n=33) had reepithelialized after $15.5{\pm}1.9$ and $11.8{\pm}1.6$ days, respectively. The scarring were less severe on the dermis graft in terms of pigmentation, height, and vascularity(p<0.05). No significant difference in pliability was detected. The patients' satisfaction with the dermis graft was also better. Concerning the donor sites, the wounds healed within $7.5{\pm}0.8$ and $12.8{\pm}1.1$ days, respectively. In terms of scar quality and patients' satisfaction, the dermis graft(n=26) showed better results. The dermis graft is superior to conventional STSG both aesthetically and functionally in both the recipient and donor sites.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.329-332
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• 2011

Purpose: In developed countries, vesicovaginal fistula occur from various pelvic operations including total hysterectomy, leading to urinary leakage and incontinence. Although various methods have been proposed for adequate tissue coverage in fistula repair, the surgical treatment of is not simple and still controversial. We report a case of neobladder-vaginal fistula repair using modified Martius fat pad flap. Methods: A 62-year-old female patient underwent radical cystectomy with total abdominal hysterectomy and neobladder formation due to invasive bladder tumor 5 years ago. For 3 years following the operation, urine leakage was observed. Exploration demonstrated neobladder-vaginal fistula and primary repair including fistulectomy and direct closure was performed. Urinary incontinence relapsed 2 years after primary repair, and after demonstrating the recurrence of fistula on urography, repair of recurrent fistula was performed. After dissection of vagina and neobladder and closure of fistula by urologic surgeon, fibroadipose flap was elevated, rotated and advanced through the tunnel at vaginal sidewall, and interpositioned to the fistula site between neobladder and vagina. Results: There was no acute complication after the surgery and urethral catheter was extracted on the 8th day after the operation. During six month follow-up period after the operation, there is no clinical evidence of fistula recurrence. Conclusion: From our clinical experience and literature review, we think Martius fat pad flap is a useful technique in management of neobladder-vaginal fistula, for it provides enough vascularity, major epithelization surface and better lymphatic drainage, and also prevents overlapping of vesical, vaginal suture lines at the same time.

• Archives of Plastic Surgery
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• v.41 no.3
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• pp.241-247
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• 2014

Background Autologous fat grafts have been widely used for cosmetic purposes and for soft tissue contour reconstruction. Because diabetes mellitus is one of the major chronic diseases in nearly every country, the requirement for fat grafts in diabetes patients is expected to increase continuously. However, the circulation complications of diabetes are serious and have been shown to involve microvascular problems, impairing ischemia-driven neovascularization in particular. After injection, revascularization is vital to the survival of the grafted fat. In this study, the authors attempted to determine whether the diabetic condition inhibits the survival of injected fat due to impaired neovascularization. Methods The rat scalp was used for testing fat graft survival. Forty-four seven-week-old male Sprague-Dawley rats were allocated to a diabetic group or a control group. 1.0 mL of processed fat was injected subcutaneously into the scalp of each rat. The effect of diabetes was evaluated by calculating the volume and the weight of the grafted fat and by histologically analyzing the fat sections. Results The surviving fat graft volume and weight were considerably smaller in the diabetic group than in the control group (P<0.05), and histological evaluations showed less vascularity, and more cysts, vacuoles, and fibrosis in the diabetic group (P<0.05). Cellular integrity and inflammation were not considerably different in the two groups. Conclusions As the final outcome, we found that the presence of diabetes might impair the survival and the quality of fat grafts, as evidenced by lower fat graft weights and volumes and poor histologic graft quality.

• Archives of Plastic Surgery
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• v.43 no.5
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• pp.418-423
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• 2016

Background Skin grafting is a relatively simple and thus widely used procedure. However, the elastic and structural quality of grafted skin is poor. Recently, various dermal substitutes have been developed to overcome this disadvantage of split-thickness skin grafts. The present study aims to determine the feasibility of RapiGraft as a new dermal substitute. Methods This prospective study included 20 patients with partial- or full-thickness skin defects; the patients were enrolled between January 2013 and March 2014. After skin defect debridement, the wound was divided into two parts by an imaginary line. Split-thickness skin grafting alone was performed on one side (group A), and RapiGraft and split-thickness skin grafting were used on the other side (group B). All patients were evaluated using photographs and self-questionnaires. The Manchester scar scale (MSS), a chromameter, and a durometer were used for the scar evaluation. The average follow-up period was 6 months. Results The skin graft take rates were 93% in group A and 89% in group B, a non-significant difference (P=0.082). Statistically, group B had significantly lower MSS, vascularity, and pigmentation results than group A (P<0.05 for all). However, the groups did not differ significantly in pliability (P=0.155). Conclusions The present study indicates that a simultaneous application of RapiGraft and a split-thickness skin graft is safe and yields improved results. Therefore, we conclude that the use of RapiGraft along with skin grafting will be beneficial for patients requiring reconstructive surgery.

• Korean Journal of Veterinary Research
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• v.28 no.2
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• pp.261-270
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• 1988

This study was performed to investigate the effect of gestation on the histological and histochemical changes of the uterine cervix of the native Korean cattle. A total of 110 cows obtained from the Chonhuk abattoir were divided into six groups. The 1st group was of 9 non-pregnant cows and 101 singleton pregnant cows were grouped into 5 groups from pregnant I to pregnant V according to gestation periods by means of crown rump length measures. For light microscopy the tissues were fixed in 10% neutral formalin and processed routinely for paraffin sections The $6{\mu}m$ sections were taken and stained with H-E, Alcian blue pH 1.0, Alcian blue pH 2.5, Alcian blue pH 2.5/PAS, PAS reaction, toluidin blue, and trichrome. The results obtained were as follows: 1. The cervical lengths and widths were increased in relation to advancing gestation. 2. The cervical folds of the pregnant groups were increased and complicated with many branches, and the cervical muscosal epithelia were increased in according to advancing gestation. 3. As advancing gestation, the tunics muscularis of cervix was increased following moderate distribution of fibroblast and vascularity, meanwhile decreased mast cells were found. 4. The cervical mucosubstance was composed of mixed mucopolysaccharides; the acid mucus was increased from the early pregnant state but the neutral mucus was found after pregnant IV, and the mucus was stained deeply in each staining in the fold cavity in according to gestation state.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.136-142
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• 1995

A clinical study was performed on 69 cases of isolated PDA surgically treated at the Department of Thoracic and Cardiovascular surgery of Kyung-Hee University Hospital from Mar. 1986 to Feb. 1994. Retrospective clinical analysis of these patients were as follows: 1.23 males and 46 females ranged in age from 16 days to 49 years. [mean 8.69yrs.,sex ratio M:F=1:2 2. Chief complaints were frequent URI in 44%, dyspnea on exertion in 16%,palpitation in 8%, easy fatigability in 6%, and no subjective symptoms in 26%. 3. On auscultation, typical continuous machinery murmur heard in 84%, and systolic murmur in 16% on Lt 2nd or 3rd intercostal space. 4. Simple chest x- ray showed increased pulmonary vascularity in 67%, cardiomegaly in 61%,and within normal limit in 16%. 5. EKG findings were LVH in 42%, biventricular hypertrophy in 17%, RVH in 3%, and within normal limit in 38%. 6. Echocardiogram was performed from all patient, and direct visualization of ductus in 93% 7. Cardiac catheterization was performed in 39 patients. The mean value of the results were;Differance SaO2[MPA-RV =11.03$\pm$ 5.26%,Qp/Qs=2.44$\pm$1.35,systolic pulmonary arterial pressure=40.69 $\pm$ 17.69mmHg. 8. 66 patients were operated through the left posterolateral thoracoctomy ; closure of ductus by double ligation in 43 cases, triple ligation in 23 cases.3 patients were operated by simple closure under cardiopulmonary bypass. 9. There was no death associated with the operation. The operative complications were atelectasis in 8 cases, pneumonia in 4 cases recannalization in 2 cases, and hoarseness in one case. 10. Systemic diastolic pressure was increased 8.12$\pm$ 0.13mmHg, and pulse pressure was decreased about 9.52 $\pm$ 1.87mmHg.

• Journal of Periodontal and Implant Science
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• v.45 no.4
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• pp.128-135
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• 2015

Purpose: The aim of this study was to determine the effect of overlaying titanium mesh (TM) with an adjunctive collagen membrane (CM) for preserving the buccal bone when used in association with immediate implant placement in dogs. Methods: Immediate implant placements were performed in the mesial sockets of the third premolars of five dogs. At one site the TM was attached to the fixture with the aid of its own stabilizers and then covered by a CM (CM group), while the contralateral site received only TM (TM group). Biopsy specimens were retrieved for histologic and histomorphometric analyses after 16 weeks. Results: All samples exhibited pronounced buccal bone resorption, and a high rate of TM exposure was noted (in three and four cases of the five samples in each of the TM and CM groups, respectively). A dense fibrous tissue with little vascularity or cellularity had infiltrated through the pores of the TM irrespective of the presence of a CM. The distances between the fixture platform and the first bone-implant contact and the bone crest did not differ significantly between the TM and CM groups. Conclusions: Our study suggests that the additional use of a CM over TM does not offer added benefit for mucosal healing and buccal bone preservation.