• Journal of Korean Neurosurgical Society
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• 제58권6호
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• pp.504-507
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• 2015

Objective : Our aim was to evaluate the histopathological effects of tissue adhesives on peripheral nerve regeneration after experimental sciatic nerve transection in rats and to search whether these tissue adhesives may possess a therapeutic potential in peripheral nerve injuries. Methods : This experimental study was performed using 42 female Wistar-Albino rats distributed in 6 groups subsequent to transection of right sciatic nerves. Group I underwent external circumferential neurolysis; Group II received suture repair; Group III had local polymeric hydrogel based tissue adhesive administration; Group IV received suture repair and polymeric hydrogel based tissue adhesive application together; Group V had gelatin based tissue adhesive application and Group VI had suture repair and gelatin based tissue adhesive together. After a 6-week follow-up period, biopsies were obtained from site of neural injury and groups were compared with respect to histopathological scoring based on inflammatory, degenerative, necrotic and fibrotic changes. Results : There were remarkable differences between control group and study groups with respect to inflammation (p=0.001), degeneration (p=0.002), necrosis (p=0.007), fibrosis (p<0.001) and vascularity (p=0.001). Histopathological scores were similar between study groups and the only noteworthy difference was that Group V displayed a lower score for necrosis and higher score in terms of vascularization. Conclusion : Our results imply that tissue adhesives can be useful in repair of peripheral nerve injuries by decreasing the surgical trauma and shortening the duration of intervention. Results with gelatin based tissue adhesive are especially promising since more intense vascularity was observed in tissue after application. However, trials on larger series with longer durations of follow-up are essential for reaching more reliable conclusions.

• Journal of Chest Surgery
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• 제33권1호
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• pp.7-19
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• 2000

Background :To assess the accuracy of Electron-Beam Tomography(EBT) in following evaluation of the pulmonary vascular system after a shunt operation in the cyanotic con-genital heart disease with pulmonary stenosis or pulmonary atresia. Material and Method : Sixteen patients(M:F=11:5) who received Blalock-Taussig(n=8) bidirectional cavo-pulmonary shunt(n=10) and unifocalization (n=2) were ncluded in the study. We evaluated the patency of the shunt the morphology of intrapericardial and hilar pulmonary arteries(PA) peripheral pulmonary vascularity by background lung attenuation and the abundance of arterial & venous collateral. Angiography(n=12) and echocardiography(n=20) were used as the gold standard for the comparison of EBT results. Result: EBT was consistent with angiogram/ echo in 100% of the evaluation for the patency of the shunt and in 12(by angiogram 100%) and 19(by echo 95%) for the detection the hypoplasia stenosis or interruption of central PA In measuring of PA EBT and angiogram corrlated(r=0.91) better than EBT-echo(r=0.88) or echo-angiogram(r=0.72) Abundant systemic arterial collateral were noted in 4 and venous collateral in 3 cases. In evaluating the peripheral pulmonary vascularity the homogenous and normal-ranged lung attenuation(m=6) decreased but homo-genous attenuation(n=1) segment-by-sgment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) segment-by-segment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) and venous congestion(n=2) were observed nd 12 of them were compatible with the blood flow pattern revealed by cardiac catheterization. Conclusion: EBT was accurate in the integrated evaluation of the pulmonary vascular system after the shunt including the patency of the shunt operaion the morphology and dimension of the central and hilar PAs and the loco-regional pulmonary flow in the lung parenchyma. It suggests the useful information about the need of secondary shunt operation the proper timing time for total repair and the need of interventional procedure prior to total repair.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.345-351
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• 2012

Background Cranial base defects are challenging to reconstruct without serious complications. Although free tissue transfer has been used widely and efficiently, it still has the limitation of requiring a long operation time along with the burden of microanastomosis and donor site morbidity. We propose using a reverse temporalis muscle flap and calvarial bone graft as an alternative option to a free flap for anterior cranial base reconstruction. Methods Between April 2009 and February 2012, cranial base reconstructions using an autologous calvarial split bone graft combined with a reverse temporalis muscle flap were performed in five patients. Medical records were retrospectively analyzed and postoperative computed tomography scans, magnetic resonance imaging, and angiography findings were examined to evaluate graft survival and flap viability. Results The mean follow-up period was 11.8 months and the mean operation time for reconstruction was $8.4{\pm}3.36$ hours. The defects involved the anterior cranial base, including the orbital roof and the frontal and ethmoidal sinus. All reconstructions were successful. Viable flap vascularity and bone survival were observed. There were no serious complications except for acceptable donor site depressions, which were easily corrected with minor procedures. Conclusions The reverse temporalis muscle flap could provide sufficient bulkiness to fill dead space and sufficient vascularity to endure infection. The calvarial bone graft provides a rigid framework, which is critical for maintaining the cranial base structure. Combined anterior cranial base reconstruction with a reverse temporalis muscle flap and calvarial bone graft could be a viable alternative to free tissue transfer.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.720-726
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• 2009

Purpose: Fasciocutaneous flap with random pattern flap has limitation in mobility and length - width ratio. This characteristic is more pronounced in lower extremity which has relatively poor vascularity. Perforator based flap in lower extremity reconstruction has various advantages as a axial flap, allowing abundant blood supply and widening of mobility range. So if it is not a case of wide defect, free flap can be replaced by perforator based flap. Methods: From April 2007 to March 2009, 18 cases of perforator flap were performed. 8 had defect in upper 1/3 of calf, 6 in middle 1/3, and 4 in lower 1/3. In 10 cases island flap were used, 3 case had transposition flap, 2 cases used advancement flap, 2 case had propeller flap and 1 case had rotation flap. Results: 17 cases survived without flap necrosis. Partial flap necrosis occurred in 1 case, so secondary split thickness skin graft was done. Chronic wound with pseudomonas infection occurred in 1 case, but it was completely cured with conservative treatment. Conclusion: Perforator based flap is useful in lower extremity reconstruction because of relative freedom in changing the size and thickness of the flap depending on the recipient site, good mobility, and abundant vascularity. And donor site morbidity can be minimized. Lower extremity reconstruction using perforator based flap is a good method because it can minimize the complication and obtain effective result.

• 대한두경부종양학회지
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• 제39권2호
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• pp.31-34
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• 2023

Pilomatricoma is characterized by a semi-transparent epidermis, especially pigmented pilomatricoma, containing melanocytes in basaloid cells, which are dark and purple, resembling vessel-derived skin masses. If the vascularity at doppler ultrasound is high before surgery, it may be misdiagnosed. A 10-year-old female patient visited our clinic because of a mass in the right ear triangular fossa. Ultrasonography was performed, and a vascular-origin tumor was suspected because of the high vascularity. The excised mass was diagnosed as pigmented pilomatricoma by a pathologist. Pilomatricoma is mistaken for other masses owing to its various phenotypes. A misdiagnosis can lead to misdirected strategies which can cause delayed treatment and can result in an increase in the size of the pilomatricoma, making the sequalae of surgery more complicated. For proper treatment, careful examination and evaluation are required before surgery.

• Archives of Reconstructive Microsurgery
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• 제20권2호
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• pp.96-101
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• 2011

Reconstruction of soft tissue defect of knee joint area has been remained a challenging task for plastic surgeons. The earlier the normal tissue saved and the necrotic tissue removed, the less the patients had complications and functional disability. But such defects are difficult to manage for its poor vascularity, rigid tissue distensibility, easy infectability and a relatively long healing period. The goal of flap coverage in the knee joint should not only be satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. We have treated five cases using the anterolateral thigh perforator flaps for reconstruction successfully. In conclusion, we believe that in cases of knee joint area soft tissue defects, flaps like anterolateral thigh perforator flap should be considered as the first line of treatment.

• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.292-294
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• 2015

Vestibular schwannoma (VS) usually present the widening of internal auditory canal (IAC), and these bony changes are typically limited to IAC, not extend to temporal bone. Temporal bone invasion by VS is extremely rare. We report 51-year-old man who revealed temporal bone destruction beyond IAC by unilateral VS. The bony destruction extended anteriorly to the carotid canal and inferiorly to the jugular foramen. On histopathologic examination, the tumor showed typical benign schwannoma and did not show any unusual vascularity or malignant feature. Facial nerve was severely compressed and distorted by tumor, which unevenly eroded temporal bone in surgical field. Vestibular schwannoma with atypical invasion of temporal bone can be successfully treated with combined translabyrinthine and lateral suboccipiral approach without facial nerve dysfunction. Early detection and careful dissection of facial nerve with intraoperative monitoring should be considered during operation due to severe adhesion and distortion of facial nerve by tumor and eroded temporal bone.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.76-80
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• 2012

Various soft tissue defects can be occurred in the hand. In determining the most suitable means of reconstruction a defect, the benefit of the reconstruction has to outweigh the risk of donor morbidity. Flap selection will be based on the size of the defect, the requirements for sensibility, the surgeon's comfort level, and the patient profile such as gender, age, or systemic disease. The hand is the most important tactile sensory organ, hence sensory restoration is critical. Neurosensory free flaps can provide sensibility, vascularity, and soft tissue coverage to an injured hand. This paper will discuss free flaps which can be used for soft tissue reconstruction of the hand.

• Advances in pediatric surgery
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• 제10권1호
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• pp.60-62
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• 2004

Leveling colostomy with a frozen-section biopsy in a Hirschsprung's disease is an important factor for a successful procedure. Two neonatal cases of Hirschsprung's disease in the descending colon are reported. In both cases, loop ileostomy was established because of the unavailability of frozen-section biopsy on an emergency basis. At the time of definitive procedure of the first case, transition zone at the splenic flexure was noted and was compatible with the frozen section biopsy. In the second case, an unexpected longer resection at a higher level than transition zone was required because of the poor vascularity after dissection. In conclusion, a leveling colostomy should be selected as a choice in long-segment Hirschsprung's disease. Confirming preservation of the marginal artery of Drummond is particularly important in case of Hirschsprung's disease in the descending colon.

• Journal of Korean Neurosurgical Society
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• 제37권3호
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• pp.232-234
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• 2005

We report a rare case of a patient with meningeal solitary fibrous tumor. A 60-year-old woman presented with right leg monoparesis. Brain magnetic resonance imaging demonstrates a well enhancing huge mass, located in left parietal lobe. Cerebral angiography demonstrating increased vascularity in area of the tumor, which had feeder vessels extending from the internal carotid artery and external carotid artery. A presumptive diagnosis of meningioma or hemangiopericytoma was considered. At surgery, the consistency was firm and had destroyed the dura and skull. A gross total resection was performed. Immunohistochemically, tumor was strongly, and widely, positive for CD34 and vimentin. There was no staining for epithelial membrane antigen(EMA), S-100 protein, cytokeratin, and glial fibrillary acidic protein (GFAP). Differential diagnosis of intracranial solitary fibrous tumor includes fibroblastic meningioma, meningeal hemangiopericytoma, neurofibroma, and schwannoma.