• Archives of Reconstructive Microsurgery
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• v.15 no.1
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• pp.10-16
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• 2006

We retrospectively evaluated our results of replantations of distal digital amputations and analyzed the factors deterrent to the survival of replanted digits. From January 2004 to 2005 June, we performed 101 cases of replantations following complete amputations at or distal to interphalangeal joint level. The study included 98 patients with a mean age of 35.6 years (range 1 to 63 years). Amputation level correlated to zone I (distal to the lunula)in 47 cases and zone II (lunula to distal interphalangeal joint) in 54 cases according to Yamano's classification. According to the mechanism of amputation, 24 cases (22.9%) suffered from guillotine type injury, 27 cases (27.1 %) from avulsion type injury and 50 cases (50%) from crush type injury. In all cases, a single arterial anastomosis was performed. Venous anastomosis on either volar or dorsal side was performed in 12 cases of amputation in zone II. Salvage procedure for venous drainage was performed in 98 cases. The mean duration of salvage procedures was 5.9 days (ranging from 4 to 14 days). Successful replantation was achieved in 96 cases (95.1%), which included 93.7% cases in zone I amputations and 96.3% cases in zone II amputations. A single venous anastomosis was performed in 12 cases of amputation in zone II. All of them survived completely. Among the 5 cases that failed to survive, 3 cases were related with avulsion injury in zone I. Initial mechanism of injury determines the survival rate of amputated parts as it is directly related with the status of vessels and soft tissues. Meticulous precaution during the salvage procedure may affect the overall survival rate of distal digital replantations.

• Archives of Plastic Surgery
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• v.40 no.6
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• pp.742-747
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• 2013

Background The medial canthus is an important area in determining the impression of a person's facial appearance. It is composed of various structures, including canthal tendons, lacrimal canaliculi, conjunctiva, the tarsal plate, and skin tissues. Due to its complexity, medial canthal defect reconstruction has been a challenging procedure to perform. The contralateral paramedian forehead flap is usually used for large defects; however, the bulkiness of the glabella and splitting at the distal end of the flap are factors that can reduce the rate of flap survival. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. Methods This study included 10 patients who underwent medial canthal reconstruction using ipsilateral paramedian forehead flaps between 2010 and 2012. To avoid an acute curve of the pedicle, which can cause venous congestion, we attempted to make the arc of the pedicle rounder. Additionally, the pedicle was skeletonized from the nasal root to the glabella to reduce the bulkiness. Results All patients had basal cell carcinoma, and 3 of them had recurrent basal cell carcinoma. All of the flaps were successful without total or partial flap loss. Two patients developed venous congestion of the flap, which was healed using medicinal leeches. Four patients developed epiphora, and 2 patients developed telecanthus. Conclusions Large defects of the medial canthus can be successfully reconstructed using ipsilateral paramedian forehead flaps. In addition, any accompanying venous congestion can be healed using medicinal leeches.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.534-537
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• 2010

A twenty six year old man was admitted to our clinic for bleeding from a venous ulcer of the left leg. His left femoral vein had been ligated for bleeding control after a traffic accident that happened when he was 5 years old. He had a varicose vein, stasis dermatitis, and a venous ulcer on his left leg. To shunt left femoral venous return to the right femoral vein, we did a crossover bypass with arteriovenous fistula using the right greater saphenous vein. To get good patency of the arteriovenous fistula, the bypass graft was closed 6 weeks after the initial operation. He maintained his left leg circumference relatively well for 6 months after the operation. We report the case of a patient who had a vein crossover bypass for a chronic femoral vein ligation.

• The Korean Journal of Physiology
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• v.3 no.2
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• pp.25-31
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• 1969

Effects of graded increase of positive lung inflation upon heart rates and arterial blood pressure were observed in the anesthetized dogs to analyze the mechanical and neural regulatory factor in response to the positive inflation of the lung. The results obtained were summarized as followings: 1) When the low grade of positive lung inflation was employed under the mild to moderate anesthesia, central venous pressure was linearly increased while heart rate was decreased. After bilateral vagotomy, central venous pressure was obviously increased while heart rate was constant. 2) When the high degree of positive lung inflation was employed, changes of central venous pressure and heart rate were not significant. 3) The low grade of intrapulmonary pressure increase caused reflex tachycardia in phase 2 and overshooting in phase 4 in response to the systemic arterial blood pressure change. 4) On the other hand, the high degree of intrapulmonary pressure increase caused paradoxical bradycardia in phase 2 and lack of overshooting in phase 4 in response to the systemic arterial blood pressure change. 5) It may be noted that the experimental model employed in the present study is a useful tool to evaluate and analyze the neural and mechanical regulatory factor in response to the graded increase of the positive lung inflation.

• Clinical and Experimental Pediatrics
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• v.51 no.12
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• pp.1359-1362
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• 2008

The most effective treatment strategy for patients with hemophilia is replacement therapy with FVIII or FIX concentrates, which usually requires long-term, uncomplicated venous access. However, central venous access device (CVADs, ports) insertion requires inpatient admission and general anesthesia, and presents some problems regarding health insurance coverage. Peripherally inserted central catheters (PICCs) were inserted in two severe hemophilia patients aged 7 and 11 years with high titers of inhibitors. They experienced frequent bleeding episodes and required replacement therapy, which eventually resulted in difficulty in acquiring venous line access. Factor VIII activity was below 1%, and inhibitor titers were 160 and 26.3 BU/ml. In an outpatient setting, PICC lines are easily placed by radiological guidance and require local anesthesia alone. PICC has been feasible, in particular, for hemophilia patients with frequent bleeding episodes.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.74-80
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• 2013

Purpose: There are no detailed reports on the incidence of venous thromboembolism (VTE) in pelvic and acetabular fractures in the Asian population. The purpose of this study was to investigate the incidence of VTE in pelvic and acetabular fractures in the Korean population. Methods: The cases of 67 Korean patients with pelvic and acetabular fractures treated at our hospital from January 2009 to February 2012 were analyzed retrospectively. Until May 2010, VTE screening was performed by contrast-enhanced computed tomography (CT) or ultrasonography (US) when the D-dimer value did not decline predictably, still exceeded $20{\mu}g/ml$ at 5 days after trauma and surgery, or increased to greater than $20{\mu}g/ml$ after a period of decline. After May 2010, contrast-enhanced CT and US were performed routinely irrespective of the D-dimer value. Physical prophylaxis was performed on all patients. The effects of the presence of a pelvic and/or acetabular fracture, and the effects of fracture type, accompanying injuries, and screening strategies on the incidences of VTE were investigated. Results: Overall, 26 patients(38.8%) were diagnosed with VTE and PTE in 14(20.9%). All were asymptomatic. Significantly higher incidences of VTE and PTE were observed in trauma patients with pelvic and acetabular fractures than in trauma patients without pelvic and acetabula fractures treated during the same period. No significant differences were observed in the incidences of VTE and PTE between patients with pelvic fractures, and patients with acetabular fractures or between patients with and without accompanying injuries. Compared with the previous screening strategy, the detection rates for VTE and PTE were higher for the newer screening strategy; however, the difference did not reach statistical significance. Conclusion: In the Korean population, we should be vigilant for a high incidence of VTE, especially PTE, in patients with pelvic and acetabular fractures.

• Clinics in Shoulder and Elbow
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• v.20 no.1
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• pp.18-23
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• 2017

Background: To assess the incidence of venous thromboembolism (VTE) following shoulder surgery and to evaluate the role of postoperative duplex ultrasonography. Methods: The study comprised a total of 224 patients who underwent shoulder surgery, including 180 shoulder arthroscopic surgeries, 28 shoulder arthroplasties, and 16 plate fixations for proximal humerus fracture between January 2014 and December 2014. The mean age of patients was 59.0 years, and there were 81 men and 143 women. Clinical data, including body mass index, blood tests, metabolic work-up for liver and renal function, previous, and present medical history, were evaluated. Duplex ultrasonography in the operative arm was performed on 2 to 4 days after surgery. Results: The overall incidence of VTE following shoulder surgery was 0.45% (1/224). One patient with open reduction and plate fixation for proximal humerus fracture had asymptomatic deep vein thrombosis that showed complete remission after anticoagulant medication during a 2-month period. Four patients had asymptomatic superficial cephalic vein thrombosis and complete remission without any treatment. There was no case of pulmonary embolism. Conclusions: The incidence of VTE following shoulder surgery was extremely low in Asians. Duplex ultrasonography may be not considered a routine follow-up of shoulder surgery and can be selectively performed in high-risk or symptomatic patients for VTE.

• Korean Journal of Head & Neck Oncology
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• v.29 no.2
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• pp.48-50
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• 2013

Angiomyoma is a rare, benign smooth muscle cell tumor. These tumors may be found anywhere in the body. They frequently occur in the lower extremities except venous type. Angiomyoma in the head and neck area is very rare, and only a few cases have been reported. A 63 year-old male patient visited to outpatient clinic due to size-growing nodule-like lesion in the Lt. alar area. Excisional biopsy was done for diagnosis. The lesion was totally excised with 2 mm safety margin. Frozen biopsy of the lesion was requested, and all resection margins were proved negative. To cover the raw surface, full thickness skin grafting was performed. The graft was harvested from Rt. posterior auricular area. Tie over dressing was applyed on Lt. alar area. The graft was well taken and healed without any complication in both short term and long term follow up periods of 2 weeks, 1 month, 2 months, and 6 months. Donor site completed healed without any complications. The leiomyoma is benign tumor originated from smooth muscle, and it can be classified into solid leiomyoma, angiomyoma, and epithelioid leiomyoma. Especially, the angiomyoma consists of smooth muscle cell and blood vessel, and it is originated from the tunica media of blood vessel. Angiomyoma alone frequently occurs in the lower extremities as solitary painless subcutaneous tumor. Venous type of angiomyoma in the oral cavity was reported in other references, but on the facial surface it may be the first case reported as paper. So this report can be very meaningful.

• Bulletin of the Korean Chemical Society
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• v.29 no.2
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• pp.422-426
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• 2008

Hemodialysis graft coated with paclitaxel prevents stenosis; however, large initial burst release of paclitaxel causes many negative effects such as drug toxicity and inefficient drug loss. Therefore we developed and tested a novel coating method, double dipping, to provide controlled and sustained release of paclitaxel locally. Expanded polytetrafluoroethylene (ePTFE) grafts were dipped twice into a solution of several different paclitaxel concentrations. In vitro release tests of the double dipping method showed that early burst release could be somewhat retarded and followed by sustained release for a long time. We observed the effect of paclitaxel coating by double dipping in porcine model of arterio-venous (AV) grafts between the common carotid artery and the external jugular vein. 12 weeks after constructing AV grafts, cross sections of the graft venous anastomosis were obtained and analyzed. Paclitaxel coated ePTFE grafts by double dipping were observed to prevent neointimal hyperplasia and therefore reduced stenosis of the arteriovenous hemodialysis grafts, especially at the graft venous anastomosis sites. Our results demonstrate that second dipping of ePTFE graft, which was already coated once with paclitaxel, washes off the drug on a surface of the graft and affects the ratio of paclitaxel on the surface to that of the inner space, possibly by diffusion: thus the early burst of drug can be somewhat reduced.

• Vascular Specialist International
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• v.34 no.4
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• pp.103-108
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• 2018

Purpose: Surgery is the most common risk factor for pulmonary embolism (PE) in patients with a recent venous thromboembolism (VTE). This study reviewed clinical outcomes of preoperative inferior vena cava filter (IVCF) use in patients with acute VTE during abdominal-pelvic cancer or lower extremity orthopedic surgeries. Materials and Methods: We retrospectively analyzed 122 patients with a recent VTE who underwent IVCF replacement prior to abdominal-pelvic cancer or lower extremity orthopedic surgery conducted between January 2010 and December 2016. Demographics, clinical characteristics, postoperative IVCF status, risk factors for a captured thrombus, and clinical outcomes were collected for these subjects. Results: Among the 122 study patients who were diagnosed with acute VTE in the prior 3 months and underwent preoperative IVCF replacement, 70 patients (57.4%) received abdominal-pelvic cancer surgery and 52 (42.6%) underwent lower extremity orthopedic surgery. There were no perioperative complications associated with IVCF in the study population and no cases of symptomatic PE postoperatively. A captured thrombus in the filter was identified postoperatively in 16 patients (13.1%). Logistic regression analysis indicated that postoperative anticoagulation within 48 hours significantly reduced the risk of a captured thrombus (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.08-0.94; P=0.032). Conclusion: A captured thrombus in preoperative IVCF was identified postoperatively in 16 patients (13.1%). Postoperative anticoagulation within 48 hours reduces the risk of captured thrombus in these cases.