• International Journal of Vascular Biomedical Engineering
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• 제1권1호
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• pp.41-47
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• 2003

The patency rates of small diameter vascular grafts are disappointing because of the formation of thrombus and intimal hyperplasia. Among the various factors influencing the success of graft surgery, the compliance and the size of a graft are believed to be the most important physical properties of a vascular graft. Mismatch of compliance and size between an artery and a graft alters anastomotic flow characteristics, which may affect the formation of intimal hyperplasia. Among the hemodynamic factors influencing the development of intimal hyperplasia, the wall shear stress is suspected as the most important one. The wall shear stress distributions are experimentally measured near the end-to-end anastomosis models in order to clarify the effects of compliance and diameter mismatch on the hemodynamics near the anastomosis. The effects of radial wall motion, diameter mismatch and impedance phase angle on the wall shear rate distributions near the anastomosis are considered. Compliance mismatch generates both different radial wall motion and instantaneous diameter mismatch between the arterial portion and the graft portion during a flow cycle. Mismatch in diameter seems to be affecting the wall shear rate distribution more significantly compared to radial wall motion. The impedance phase angle also affects the wall shear rate distribution.

• Journal of Gastric Cancer
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• 제2권1호
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• pp.29-32
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• 2002

A gastroduodenostomy is the most physiological reconstruction after a distal gastrectomy. However, a gastroduodenostomy with either sutures or staples has many complications. These include bleeding, leakage and stenosis. A sutureless gastroduodenostomy with a biofragmentable anastomosis ring (BAR) in was used adenocarcinoma patients to prevent these complications from 1999. A BAR is composed of polyglycolic acid and Barium sulfate to allow for X-ray visualization. Hardy in first introduced the BAR in 1985. Since then, it has been used in an anastomosis of the colon or small bowel surgery but its use in a gastroduodenostomy is the first trial in the world. A 70 year male patient, old who received a subtotal gastrectomy (Billroth I), underwent a A sutureless gastroduodenostomy with a BAR. The gastroduodenostomy with the BAR was watertight and maintained the initial burst strength in the gastrografin X-ray study performed at the postoperative 1 week. The BAR began to fragment 3 weeks after the operation and disappeared from the digestive tract completely. The diameter of the anastomosis site was sufficient for passed foods. No other secondary changes from remained foreign bodies were found in the endoscopic examination. In a second operation to treat a primary hepatoma, there was no adhesive changes around the gastroduodenostomy site. In conclusion, a sutureless gastroduodenostomy with BAR is a safe, easy and efficient reconstructive method after a distal gastrectomy.

• 대한의용생체공학회:의공학회지
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• 제13권2호
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• pp.165-174
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• 1992

Compliance mismatch across an end-to-end anastomosis was measured In the In vitro experimental setup. A 35mm camera was used and Image process was done in Gould/ DeAnza Image processor. The results showed that compliances of Penrose tubing and synthetic PTFE grafts were In good agreement with the previously reported In vivo data. PTFE grafts exhibited a nonlinear behavior with compliance decreasing with Increasing transmural pressure, whereas the compliance of the Penrose tubing remained relatively constant within the range of the pressures in which data were obtained. The lumen cross sections at the anastomosis were affected by the suture and the mismatch In compliance between the Penrose tubing and vascular grafts. The varla~lons In the lumen dtameter at the anastomosis was more pronounced with increasing transmural pressures. From the present study, it was clearly demonstrated that the compliance of prosthetic grafts Is much lower than that of the arteries. In addition to the hemodynamlc consequences, compliance mismatch across the anastomosis has been known to lead to Increased anastomotlc and suture stresses with resultant suture line dehlscence and false aneurysm formation. Thus, there are good hemodynamic reasons to suppose that Introduction of a less compliant arterial graft Into the arterial circulation wlll be damaging and that grafts should be made to match the elastic behavior of their host arteries as closely possible.

• Archives of Reconstructive Microsurgery
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• 제8권2호
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• pp.170-175
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• 1999

Objective : Extracranial-intracranial(EC-IC) microvascular anastomosis was performed in 18 patients with hemodynamic cerebral ischemia and traumatic cerebral aneurysm, the aim of this retrospective study was to assess its value in neurosurgical field. Method : Of 18 cases, 17 case were hemodynamic cerebral ischemia and one was traumatic cerebral aneurysm. There were 14 superficial temporal artery(STA)-to-middle cerebral artery(MCA) anastomosis, 3 saphenous vein graft bypass(2 external carotid artery(ECA)-to-MCA, 1main trunk of the STA-to-MCA) and 1 radial artery bypass(ECA-to-MCA). Results : Bypass patency was confirmed by postoperative angiography in all cases except for two cases, postoperative cerebral blood flow of ischemic brain showed significant increased in all cases with good patency through bypass. Conclusion : Revascularization by EC-IC microvascular anastomosis to the ischemic brain eliminated ischemia and was associated with excellent good outcome and good patency rates.

• 대한수의학회지
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• 제45권3호
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• pp.417-421
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• 2005

Adhesions are the most common postoperative complication in intestinal surgery in dogs. This study was aimed at verify to the efficacy of sodium carboxymethylcellulose (SCMC) in the adhesion prevention during healing of intestinal anastomosis. Twenty three healthy dogs were taken with average 4.17 years and weight was 5.68 kg and divided into 4 groups. The dogs of group III and IV, a pedicle of greater omentum was wrapped around the suture line. In the animals of group II and IV, 1% SCMC was infused (5 ml/kg, IP) at just before closure of the abdominal cavity. Two weeks after surgery, animals were reoperated and the adhesions were evaluated and graded. We found various degrees of intraabdominal adhesions in animals of all the groups. The significantly (P<0.05) lower adhesion score was observed in group IV than that of other groups. Nevertheless, varying intra-peritoneal adhesions, healing of anastomotic site was normal in all groups. It could be concluded that intra-peritoneal administration of SCMC solution reduces postoperative adhesions without any adverse effects on healing, and a synergistic beneficial effect can be obtained by supplementation with omental graft for intestinal anastomosis.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1995년도 춘계학술대회
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• pp.104-108
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• 1995

Von Mises stress and compliance distribution was evaluated using a finite element analysis on the anastomosis of an artery with length of 20mm, inner diameter of 4mm, thickness of 0.5mm and a PTFE graft with length of 5.7mm, Inner diameter of 2mm. thickness of 0.2mm. When anastomotic angle was taken as $45^{\circ}$ and inner pressure of $1330\;dyne/mm^2$ was applied inside the 2 conduits. From the analysis results were obtained as follows. (1)Artery diameter increased in both horizontal x and vertical y directions and the magnitude of that in x direction was bigger than in y direction. (2) The compliance was maximum on the anastomosis. especially on that with acute angle. This reduced approaching to the right or left end. (3) The equivalent stress was maximum on top in the y direction and winimum on the nodes around $110^{\circ}$ in circumferential direction from the top. (4) The equivalent stress was maximum in the vicinity of anastomosis with acute angle along the longitudinal direction of the artery. This trend was also observed along the PTFE graft.

• 한국식물병리학회지
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• 제10권1호
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• pp.7-12
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• 1994

Incidence of radish disease caused by Rhizoctonia solani ranged from 1 to 30% in fields located at Hwaseong, Naju and Yeoncheon in Korea during the growing seasons in 1989, 1990 ad 1993. A total of 133 isolates of R. solani was obtained from the diseased seedlings, leaves and roots of radish collected. The fungus was most commonly isolated from the roots. Among 133 isolates of R. solani, 56 isolates were classified as anastomosis group AG-1 by anastomosis test, 37 isolates as AG-2-1, and 40 isolates as AG-4. Among the isolates of AG-1, 26 isolates were grouped as cultural type IA, and the others as cultural type IB. Cultural types IA and IB of AG-1, were isolated from the leaves, AG-2-1 from the roots, and AG-4 from the seedlings, leaves and roots. Pathogenicity tests revealed that the AG-1(IA) isolates were highly virulent on leaves of radish, but avirulent on the seedlings, petioles and roots. The AG-1(IB) isolates were highly virulent on the leaves, but mildly virulent on the seedlings and avirulent or mildly virulent on the petioles and roots. The AG-2-1, isolates were mildly virulent on the leaves and seedlings and mildly or highly virulent on the petioles and roots. The AG-4 isolates were highly virulent on the seedlings and mildly or highly virulent on the leaves, petioles and roots.

• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.127-130
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• 2009

Purpose: In an amputated auricle, a microvascular anastomosis is the best treatment of choice. But, the neartotally amputated auricle which is connected by very narrow tissue pedicle to the head, can survive by simple attachment without a microvascular anastomosis owing to the rich vascular network through the superficial temporal artery and posterior auricular artery. In cases of venous congestion resulting from a lack of vein anastomosis, medical leeches (Hirudo medicinalis) can solve the problem. We are reporting the case of a 6-year-old boy who had a neartotally amputated auricle with successful results by simple closure and medical leech treatment without a microvascular anastomosis. Methods: A 6-year-old male patient had an left auricular injury by an escalator accident. The left auricle was neartotally amputated from the temporal head with connection only by very narrow skin and subcutaneous pedicle (about 1 cm in width) at the helical root of upper and anterior part of auricle. Marginal bleeding from the avulsed auricle was noted and the arterial blood was supplied from a branch of upper auricular branch of the superficial temporal artery. The auricle was repaired by simple closure including cartilage and skin without any vascular anastomosis. After simple closure, the auricle showed good circulation with pink color. But on the 2nd day after the operation, there was a venous congestion with severe swelling, which resulted in a purplish colored auricle. The venous congestion disappeared after using medical leeches by the 5th day after the operation. Results: The repaired auricle showed aesthetically and functionally satisfactory result with normal development at the 9 months follow-up check after the operation. Conclusion: In cases of neartotally amputated auricles of children or crushing injury in which microsurgery is difficult, we can try simple closure with the use of medical leeches in treating a of venous congestion for a successful result.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.22-27
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• 1999

While the conventional end-to-end anastomotic technique is accepted as 'the golden standard' for microvascular anastomosis, it is time-consuming and tedious. In an effort to offer faster and safer ways of performing microvascular anastomoses, numerous anastomotic techniques have been proposed, but further refinements in microvascular techniques are still necessary. A 'continuous suture with interrupted knot' technique was devised for faster and safer anastomosis. It has been successfully used in microanastomoses of both artery and vein for free tissue transfer. It is a combination of the interrupted suturing technique and the continuous suturing technique. First, a continuous suture is made with the size of loop decreasing in order, and then the sutures are tied individually from the first loop to the last one as in the conventional interrupted suturing technique. It was applied clinically to fourteen patients over the past ten months and found to be a highly efficient technique that satisfied our needs. This 'continuous suture with interrupted knot' technique has several advantages over other techniques : The operative time is reduced comparing conventional interrupted suture technique. By delaying the tie and with the vessel walls kept separated, the risk of through-stitch can be reduced. Tying all the sutures at one time not only speed up the procedures, but also reduced the surgeon's fatigue. In addition, it has no problem of anastomotic stenosis which is a disadvantage of continuous suture technique. This technique proved to be faster and safer, and has patency equal to that of the conventional end-to-end anastomosis. It is of great help to the surgeon in reducing operative time, especially in clinical situations when many anastomoses are required, or lengthy grafting procedures are undertaken.

• Journal of Chest Surgery
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• 제37권7호
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• pp.617-621
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• 2004

양성 식도협착에 대한 분절절제술 및 단단문합술은 식도-장관 문합술에 비해 수술침습도가 적고 식도 고유기능을 보존할 수 있으므로, 짧은 분절의 식도협착에서 수술방법으로 고려해야 하지만 임상 보고나 분석에 대한 연구는 매우 적은 실정이다. 본원 흉부외과에서는 수술 후 문합부 협착이 있는 13개월 여아와 부식성 식도협착이 있는 27세 여자를 대상으로 단단문합술을 적용한 임상경험을 하였기에 보고하는 바이다. 생후 2일째 식도무형성증-식도기관누공에 대한 수술 후 발생한 문합부 협착인 경우는 결과가 좋았으나, 경부 식도의 고도 부식성협착에서는 단단문합술 후 다시 협착이 재발하여 인후-대장-위 문합술을 시행하게 되었다. 양성 식도협착에 대한 단단문합술은 협착의 범위와 원인에 따라 적응증을 선택하여 사용된다면 좋은 치료 방법이라고 생각하나 더 많은 연구가 필요하리라 생각한다.