• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.34-40
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• 2012

Prevention of acute rejection in composite tissue allotransplantation without continuous immunosuppression lacks reports in worldwide literature. Recently dendritic cells (DC) gained considerble attention as antigen presenting cells that are also capable of immunologic tolerance induction. This study assesses the effect of alloantigen-pulsed dendritic cells in induction of survival in a rat hindlimb allograft. We performed hindlimb allotransplantation between donor Sprague-Dawley and recipient Fischer344 rats. Recipient derived dendritic cells were harvested from rat whole blood and cultured with anti-inflammatory cytokine IL-10. Then donor-specific alloantigen pulsed dendritic cells were reinjected into subcutaneous tissue before limb transplantation. Groups: I) untreated (n=6), II) DC injected (n=6), III) Immunosuppressant (FK-506, 2 mg/Kg) injected (n=6), IV) DC and immunouppressant injected (n=6). Graft appearance challenges were assessed postoperatively. Observation of graft appearance, H-E staning, immunohistochemical (IHC) study, and confocal immunofluoreiscece were performed postoperatively. Donor antigen pulsed host dendritic cell combined with short-term immunosuppression showed minimal mononuclear cell infiltration, regulator T cell presence, and could prolong limb allograft survival.

• Journal of Chest Surgery
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• 제38권11호
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• pp.791-794
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• 2005

식도절제술 후 재건술에서 위장은 가장 흔한 식도 대체물로 사용된다 그러나, 인두 이상의 위치까지 위장을 끌어 올려 연결하는 경우 위장만으로는 길이가 모자라는 경우가 많이 있다. 후두암과 식도암을 동반한 환자에서 후두전절제술과 식도전절제술을 시행하였고 유리공장이식편을 이용하여 경부에서 인두공장위장문합을 시행하였다. 유리공장을 이용하여 문합에 충분한 길이를 확보함으로써 문합부 긴장을 줄이고, 혈액공급을 확보할 수 있었다.

• Journal of Chest Surgery
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• 제24권1호
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• pp.36-40
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• 1991

Between November, 1981 and July, 1989, 4 patients, 3 male and 1 female patients ranging in age from 36 to 45 years, were operated on for aortic insufficiency associated with uncomplicated annuloaortic ectasia. All patients were in New York Heart Association class III. Two patients had clinical stigmata of the Marfan syndrome. The surgical treatment consisted of. supracoronary replacement of ascending aorta with vascular graft and replacement of the aortic valve in our first case. and composite graft replacement of the ascending aorta and aortic valve with reimplantation of the coronary arteries in subsequent 3 cases. Our first patient developed aneurysm of proximal aorta and pseudoaneurysm of distal aortic anastomosis 5 years postoperatively. One patient among the three patients with Ben-tall operation, died of ventricular fibrillation and myocardial failure during immediate postoperative period. Remaining 2 patients were in NYHA class I with follow-up of 16 months and 20 months respectively.

• 대한골관절종양학회지
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• 제13권2호
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• pp.113-118
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• 2007

골반 골에 생기는 종양은 복잡한 해부학적 구조와 체부 깊숙이 위치하는 특성으로 인하여, 상당히 커진 후에야 발견되는 경우가 많아서 진단이 늦어지고, 수술이 어려워지는 경우가 많이 있다. 특히 비구 주위에 발생한 종양은 종양의 제거 후에 고관절의 기능을 유지 할 수 있는 재건술의 방법이 극히 제한되어 있고, 수술도 어려우며, 재건술의 예후 또한 예측하기 어렵다. 저자는 신장암이 골반 골 비구 주위로 단독 전이 된 환자의 광범위 종양절제 후 저온 가열 처리한 자가골 과 인공고관절로 재건 한 증례를 보고한다.

• Journal of Chest Surgery
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• 제55권3호
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• pp.243-245
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• 2022

True aneurysms of the coronary artery after aortic root replacement in Marfan syndrome patients are very rare. An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva adds complexity during aortic root surgery. We present a case of a 37-year-old male patient with Marfan syndrome who had an RCA anomaly and a 4.5-cm true aneurysm of the common coronary button 14 years after a previous Bentall procedure. A redo Bentall operation and hemi-arch replacement were successfully performed. The anomalous origin of the RCA from the left sinus of Valsalva was safely divided and anastomosed as separate coronary buttons to the prosthetic composite valve graft. To prevent coronary button aneurysms after aortic root surgery in Marfan patients, the coronary buttons and the corresponding side holes on the prosthetic graft must be reduced to the maximum possible extent.

• Journal of Korean Dental Science
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• 제17권2호
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• pp.84-91
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• 2024

Achieving both esthetic and functional implant rehabilitation is crucial for the successful treatment of the anterior maxilla. Adequate peri-implant alveolar bone and soft tissue are essential for optimal rehabilitation of the esthetic area, and there is a direct association between the implant position and prosthetic outcomes. Immediate provisionalization may also be advantageous when combined with augmentation. This case report described the implant placement in a 25-year-old female patient who had lost her right maxillary lateral incisor (#12) due to trauma-induced avulsion. The treatment involved simultaneous grafting and collagenated, deproteinized bovine bone mineral, along with subepithelial connective tissue taken from the right maxillary tuberosity. A polyetheretherketone abutment and non-functional immediate provisionalization were performed by removing both the proximal and occlusal contacts on the composite resin crown. Clinical and radiographic evaluations revealed maintenance of stable ridge contour aspects for six months following surgical treatment. In summary, implant rehabilitation in the esthetic zone can be successful using simultaneous soft and hard tissue grafts. Moreover, soft tissue stabilization post-subepithelial connective tissue grafting can be achieved through early or immediate visualization, along with immediate implant placement.

• Journal of Periodontal and Implant Science
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• 제32권2호
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• pp.325-338
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• 2002

Bone graft using growth factors and guided tissue regeneration have been used for the regeneration of infrabony defects which caused by periodontal disease. Calcium sulfate which is one of the resorbable barrier materials used for guided tissue regeneration. Platelet rich plasma which is a easy method to obtain the growth factors had many common points but, platelet rich plasma was still studying. This study was the comparative study between bone graft using platelet rich plasma and guided tissue regeneration using calcium sulfate barrier material in clinical view. For the study, 28 sites(2 or 3 wall infrabony defects) were treated. 14 infrabony defects were received surgical implantation of BBP-calcium sulfate composite with a calcium sulfate barrier and the others received BBP mixed with platelet rich plasma. Clinical outcome was accessed 3 and 6 months of postsurgery. 1. There was no statistical difference between CS group and PRP group in pocket depth, gingival recession, clinical attachment level, and probing bone level at baseline. 2. There was statistically significant reduction in probing depth, clinical attachment level, and probing bone level at 3 and 6 months postsurgery(p<0.05). 3. In the probing depth and clincial attachment level PPR group had less improvement than CS group, but there was no statistically difference at 3 and 6 months postsurgery. 4. In the recession PPR group had less recession than CS group, but there was no statistically difference at 3 and 6 months postsurgery. 5. In the probing bone level PPR group had less improvement than CS group, but there was no statistically difference at 6 months postsurgery. In conclusion bone graft using platelet rich plasma and guided tissue regeneration using calcium sulfate barrier showed similar clinical improvement for the treatment of 2 or 3 wall infrabony defects.

• 대한두경부종양학회지
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• 제1권1호
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• pp.35-61
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• 1985

The surgical treatment of advanced carcinomas and some benign tumors having clinically malignant behaviors of the head and neck region often require extensive resection, necessitating large flaps for reconstruction. Since the original upper arm flap was described by Tagliacozzi in 1597, a variety of technique such as random pattern local flap, axial flap, distant flap, scalping flap, myocutaneous flap, free flap etc. have been proposed for reconstruction of head, face and neck defects. Reconstruction of the facial defects usually require the use of distant tissue. Traditionally, nasal reconstruction has been carried out with a variety of forehead flaps. In recent years, there has been more acceptance of immediate repairs following the removal of these tumors. As a result, patients are more willing to undergo these extensive resections to improve their chances of cure, with the reasonable expectation that an immediate reconstruction will provide an adequate cosmetic result. Authors experienced 13 cases of head and neck tumor during last three and half years that required wide excision and immediate reconstruction with various flaps, not with primary closure or simple skin graft. We present our experience with varied flaps for reconstruction after wide resection of head and neck tumors 3 cases of defect of dorsum of nose or medial canthus with island forehead flaps, lower eyelid defect with cheek flap, cheek defect with Limberg flap, orbital floor defect with Temporalis muscle flap, lateral neck defects with Pectoralis major myocutaneous flap or Latissimus dorsi myocutaneous free flap, subtotal nose defect with scalping flap, wide forehead defect with Dorsalis pedis free flap and 3 cases of mandibular defect or mandibular defect combined with lower lip defect were reconstructed with free vascularized iliac bone graft or free vascularized iliac bone graft concomitantly combined with free groin flap pedicled on deep circumflex iliac vessels We obtained satisfactory results coincided wi th goal of treatment of head and neck tumors, MAXIMAL CURE RATE with MINIMAL MORBIDITY, OPTIMAL FUNCTION, and an APPEARANCE as close to normal as possible.

• 대한두개안면성형외과학회지
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• 제11권1호
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• pp.13-18
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• 2010

Purpose: Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps. Methods: From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor (18 cases), trauma (11 cases), inflammation from foreign body reaction (5 cases) and congenital malformation (2 cases). The sites of the defects were ala (22 cases), nasal tip (8 cases) and dorsum (6 cases). The thickness of the defects was skin only (5 cases), dermis and cartilagenous layer (7 cases) and full-thickness (24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below $0.25 cm^2$ were covered with composite graft or full-thickness skin graft. Results: The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match. Conclusion: The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.

• Archives of Plastic Surgery
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• 제33권5호
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• pp.541-545
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• 2006

Purpose: There are many methods for the reconstruction of the facial defect after an excision of a skin cancer; such as skin graft, local flap, free flap, etc... Skin graft has its' limitations; it could remain in different color with in regards of the recipient to donor, with an unfavorable scar. Free flap can lead to big donor site morbidity with long operation time and uncontrolled scar as a disadvantage factor. Compared to the prior, local flap offers several merits; sufficient blood supply, good tissue quality and short operation time. We revised 'V-Y-S flap' for the facial defect, which proved to have favorable outcomes. Methods: Total 7 V-Y-S flaps were performed to patients with skin cancers(six squamous cell carcinoma and one basal cell carcinoma). Two of these flaps were combined with composite grafts, one with full thickness skin graft. Six patients were female and one male. The average diameter of defects after excision was 2.3 cm. The follow-up period was 18 months maximally. Results: We treated seven facial skin cancers with 'V-Y-S flap'. There were no flap necrosis, cancer recurrence and scar contracture as a result. Furthermore, this method also offers a favorable central scar line that is parallel to the nasolabial fold and the nasojugal groove, especially in the nasolabial area and superomedial side of the cheek. With this method, we could cover a maximum diameter of 4cm facial defect. Conclusion: In conclusion, it is suggested that V-Y-S flap is a useful method to cover facial defects after the excision of a skin cancer.