• Archives of Plastic Surgery
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• v.47 no.2
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• pp.165-170
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• 2020

Background Perforator mapping has been well described in the literature. Once the suprafascial plane is reached, the course of perforators is considered constant. However, the surgeon must be aware of whether an anastomosis exists between perforators superficially to the fascia, in order to choose the best vessel upon which to base the reconstruction. Our retrospective in vivo anatomical study of lower leg perforator flaps presents the first description of variations in the suprafascial path of perforators, which may influence preoperative flap design. Methods An anatomical study of lower limb perforators was performed on 46 nonconsecutive patients who were referred to our department from June 2012 to October 2018. Reconstruction with perforator-based propeller flaps was planned for each of the patients. In total, 72 perforators were preoperatively identified and surgically isolated. The suprafascial course of each perforator was reported. Results During suprafascial surgical exploration, branching patterns were observed in four perforators. These perforators had been classified as single vessels in the preoperative ultrasonographic analysis. However, after surgical dissection, distal converging branches were noted in two of them. Conclusions Our study is the first description in the literature of suprafascial converging perforators, which might constitute an obstacle to planned reconstruction procedures. Despite the accuracy of preoperative evaluations, anatomical variations were present. Knowledge of suprafascial perforator variations may help surgeons to choose the correct perforator upon which to base a planned flap.

• Korean Journal of Bronchoesophagology
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• v.17 no.1
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• pp.53-56
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• 2011

Vocal cord paralysis (VCP) is a common complication after thyroidectomy despite the continuity of the recurrent laryngeal nerve (RLN) is preserved. Much efforts have been made into preventing VCP, but few of them focuses on the treatment strategies and prognosis after VCP take place. In this case, patient visited the clinic for papillary thyroid cancer in Rt. thyroid gland without VCP. She underwent total thyroidectomy with central neck dissection. During dissection, Rt main mass was encircling Rt. RLN. To make matters worse, Lt. RLN was severed due to tight attachment with Berry's ligament. After that, intratumoural dissection of Rt. RLN and end to end anastomosis of Lt. RLN were performed with microscopy to preserve the functions of RLNs as much as possible, otherwise permanent bilateral VCPs were inevitable. We report this case, since both vocal cords recovered from VCPs with symmetric, synchronous movements at postoperative follow up.

• Radiation Oncology Journal
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• v.37 no.1
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• pp.43-50
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• 2019

Purpose: The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed. Materials and Methods: A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients. Results: No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV₇₀) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm. Conclusion: The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.2
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• pp.140-147
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• 2012

Microvascular reconstruction, in the oral and maxillofacial regions, is a widely accepted as the best way to overcome the complex oral cavity defects. Many patients requiring composite reconstructions have been treated previously with radiation therapy, chemotherapy, selective and/or functional neck dissection or any of these combinations. In many cases of these patients, inadequate neck vessels for the microanastomosis of free flap are available, due to a lack of recipient vessels in the neck, poor vessel quality or vessel caliber mismatch. To achieve a tension-free anastomosis, vein grafting must be considered to span the vessel gap between the free flap pedicle and the recipient neck vessels. Although most microsurgeons believed that interpositional grafts are to be avoided due to vessel thrombosis and increased number of necessary microanastomosis, we, authors have some confidence of equivalency between reconstruction with and without interpositional saphenous vein graft. The great saphenous vein, also known as the long saphenous vein, is the large subcutaneous superficial vein of the leg and thigh. It joins with the femoral vein in the region of femoral triangle at the saphenofemoral junction, and coursed medially to lie on the anterior surface of the thigh before entering an opening in the fascia lata, called the saphenous opening. For a better understanding of the great saphenous vein graft for the interpositional vessel graft in the oral cavity reconstructions, and an avoidance of any uneventful complications during these procedures, the related surgical anatomies with their harvesting tips are summarized in this review article in the Korean language.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.3
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• pp.186-190
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• 2017

A surgical approach involving the retromolar trigone, posterolateral maxilla, and pterygoid region is the most challenging in the field of maxillofacial surgery. The upper cheek flap (Weber-Ferguson incision) with subciliary extension and the maxillary swing approach have been considered as alternatives; however, neither approach provides sufficient exposure of the pterygoid region and the anterior portion of the mandibular ramus. In this report, we describe two cases in which a lower cheek flap approach was used for complete tumor resection in the retromolar trigone and the anterior mandibular ramus. This approach allows full exposure of the posterolateral maxilla and the pterygoid region as well as the retromolar trigone without causing major sensory disturbances to the lower lip. A mental nerve anastomosis after tumor resection was performed in one patient and resulted in approximately 90% sensory recovery in the lower lip. The lower cheek flap approach provides adequate exposure of the posterolateral maxilla, including the pterygoid, retromolar trigone, and mandibular ramus areas. If the mental nerve can be anastomosed during flap approximation, postoperative sensory disturbances to the lower lip can be minimized.

• Journal of Gastric Cancer
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• v.4 no.2
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• pp.75-81
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• 2004

Recently detection of early gastric cancer (EGC) has been increasing and the treatment strategies for gastric cancer have been changing. The purpose of this study was to compare clinical outcomes between laparoscopically assisted (LADG) and hand-assisted laparoscopic gastrectomy (HALDG) and open distal gastrectomy for early gastric cancer. This review is directed toward providing gastric surgeons with recent advances in the treatment of EGC. We investigated the English language literature for the past 12 years through computer searches which focused on : 1) Patient demographics, 2) Operation time, 3) Intra-operative blood loss, 4) Depth of invasion, 5) CBC, 6)Weight loss, 7) Analgesic requirement, 8)Time NPO, 9) Length of hospital stay, 10) Tumor stage, 11) Lymph node (LN) dissection, 12) Position of LN resected, 13) Complications. Improved operative techniques and surgical instrumentation have facilitated the development of minimally invasive gastric cancer surgery. The short-term benefits of laparoscopic gastrectomy included less surgical trauma, less pain, rapid return of gastrointestinal function, and shorter hospital stay, with no change in operative outcome. Laparoscopic gastrectomy was better accepted by the patients as a good procedure and promptly brought the patients back to their previous lifestyle and activities of daily living. But the advantages of HALDG for gastric cancer, extended lymph node dissection and intracorporeal anastomosis are feasible and easier with the presence of the internal hand. The hand-assisted laparoscopic (HALDG) method reported the best results in lymph node dissection.This method is an alternative to total laparoscopic radical gastrectomy. LADG and HALDG, when compared with conventional open gastrectomy, have several advantages. When performed by a skilled surgeon, LADG and HALDG are safe and useful techniques for patients with early-stage gastric cancer. Their appropriateness for gastric cancer surgery require further study.

• Journal of Gastric Cancer
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• v.17 no.3
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• pp.267-276
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• 2017

Purpose: Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique. Materials and Methods: This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ. Results: We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36-87) years. The average operative time was $337{\pm}71minutes$ and intraoperative bleeding was $160{\pm}107mL$. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6-29) days. Conclusions: Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.

• Journal of Gastric Cancer
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• v.17 no.2
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• pp.99-109
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• 2017

Purpose: In this study, we aimed to evaluate the rarely reported long-term nutritional results of patients with gastric cancer after curative gastrectomy. Materials and Methods: We retrospectively reviewed the prospectively collected medical records of 658 patients who underwent radical gastrectomy with curative intent for gastric cancer from January 2008 to December 2009 and had no recurrences. All patients were followed for 5 years. Nutritional statuses were assessed using measurements of body weight, serum hemoglobin, total lymphocyte count (TLC), protein, albumin, cholesterol, and nutritional risk index (NRI). Results: Patients who underwent total gastrectomy had lower body weights, hemoglobin, protein, albumin, and cholesterol levels. TLC and NRI values after the first postoperative year (P<0.05), and lower hemoglobin and NRI values during the fifth postoperative year than patients who underwent distal gastrectomy (P<0.05). Patients who received adjuvant chemotherapy after gastrectomy had lower hemoglobin, protein, albumin, and cholesterol levels. TLC and NRI values during the first postoperative year, than those who underwent gastrectomy only (P<0.05). Regarding post-distal gastrectomy reconstruction, those who underwent Roux-en-Y had lower cholesterol levels than did those who underwent Billroth-I and Billroth-II reconstruction at the first and fifth years after gastrectomy, respectively (P<0.05). Conclusions: Patients undergoing total or distal gastrectomy with Roux-en-Y anastomosis or adjuvant chemotherapy after surgery should be monitored carefully for malnutrition during the first postoperative year, and patients undergoing total gastrectomy should be monitored for malnutrition and anemia for 5 years.

• Archives of Craniofacial Surgery
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• v.18 no.3
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• pp.162-165
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• 2017

Background: It is controversial issue that heparin decreases thrombosis for microsurgical anastomosis, and its effective role is under discussion. This study is for proving whether low-dose heparin is preventing thrombosis in free flap reconstruction. Methods: Through chart reviews of 134 patients, using low-dose heparin for free tissue transfer from 2011 to 2016, retrospective analysis was performed. 33 patients received low-dose heparin therapy after surgery. And 101 patients received no-heparin therapy. Complications included flap necrosis, hematoma formation, dehiscence and infection. Results: In no-heparin therapy group, comparing the flap necrosis revealed 16 cases (15.84%). And, flap necrosis was 6 cases (18.18%) in low-dose heparin therapy group. The statistical analysis of flap necrosis rate showed no significant difference (p=0.75). The results showed that there was no significant difference of flap necrosis rate between two groups. Conclusion: In this study, patients in the low-dose heparin group had no significantly lower rates of flap failure compared with no-heparin group. This suggests that low-dose heparin may not prevent thrombosis and subsequent flap failure to a significant extent.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.4
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• pp.353-358
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• 2008

Purpose: The purpose of this clinical retrospective study was to evaluate our experience of radial forearm free flap for reconstruction of the oral cavity. Material and methods: From 1997 to 2006, 50 radial forearm free flaps were employed for head and neck reconstruction in 50 patients at department of oral and maxillofacial surgery, Yonsei University, Korea. Data were obtained from chart review, and clinical follow-up. Results: Patients' age ranged from 26 to 82 years (mean 53.2). There were 39 men and 11 women. 43 of the 50(86%) patients had squamous cell carcinoma. The total flap survival were 47(94%), complication rate were revealed for 15(30%). Conclusion: In the reconstruction of soft tissue within the oral cavity, several free flaps have been used. Because of its constant anatomy, long pedicle allows a hypothetic vascular anastomosis in the contralateral neck, contourability for various type of oral defects, pliability and can be used simultaneous reconstruction in intraoral and extra oral defects, the radial forearm free flap constitutes one of the best choice of intraoral soft tissue reconstruction.