• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.128-136
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• 1996

Radial nerve injury is caused by variety of etiologies, mainly traumatic. It is primarily a motor nerve and loss of it's function leads to a significant disability. Surgical treatments of radial nerve comprise of neurolysis(internal or external), neurorrhaphy(eineural, perineural or epi-perineural), nerve graft and tendon transfer. However, there is still controversies in treatment methods and time of operation. Authors experienced 23 cases of radial nerve injuries who were treated by operative methods and followed up over 1 year's duration. The male to female ratio was 18 to 5 and mean age was 30.7 years old. The causes were 13 cases in fractures, 5 cases in crushing injury, 3 cases in laceration, 1 case in CO poisoning and 1 case in unknown cause. The summary of the study were as follows ; 1. Excellent or good results were obtained in overall 16 cases among 23 cases; 5 of 9 cases in neurolysis, 3 of 3 cases in neurorrhaphy, 2 of 3 cases in nerve graft and 6 of 8 cases in tendon transfer. 2. In cases of neurorrhaphy and nerve graft, primary or delayed repair showed excellent or good results and neurolysis performed before 6 months leads to better results. But there was no correlations between the time of injury and operation in tendon transfer. 3. The radial nerve injury associated with extensive soft tissue defect or any conditions that leads to nerve ischemia results poor prognosis. 4. The patients aged under 40 years showed better prognosis in clinical results according to the age of surgical treatment. 5. If the surgeon decide the method and the time of operation through the exact evaluation of the factors which influencing the end result such as age of the patient, level and type of injury, extent of nerve lesion and the associated tissue injury, good result could be expected.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.6
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• pp.590-594
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• 2006

Dental implant has become one of the important option for completely or partially edentulous patients, But it is challenging to reconstruct the severely atrophic ridge. Insufficient bone volume could restrict to place the wide and long implant and because of excessive interocclusal clearance, improper prosthetics could be produced. In this case bone augmentation for implant dentistry is necessary procedure to improve the insufficient bone volume. Therefore, bone augmentation or GBR is the most important procedure for successful implant placement and for ideal crown- root ratio. There are various bone augmentation techniques have been introduced recently; like block bone graft, distraction osteogenesis, inlay graft, onlay graft, etc.... In severe bucco-lingual resorption area, ridge splitting is the first choice of the treatment, because it provides a place for implantation and also has compaction effect. This technique may be indicated for sharp mandible and maxillary ridges in patients whose bone quantity is inadequate for primary stabilization. We report that the clinical experience of bone augmentation using ridge splitting technique in bucco-lingual bone resorption area.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.521-528
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• 2005

The purpose of this research is to find out the degree of cartilage regeneration by inserting the atelo-collagen scaffold obtained from dermis of a calf on cartilage defect site. Dissection underneath the perichondrium by the periosteal elevator on both side of ears of six New Zealand white rabbits were made to expose the cartilage, leaving pairs of circular holes 3, 6, 9 mm width with punches. One hole was left for a control, and on the other hole atelo-collagen scaffold of the same size was transplanted. In postoperative 1, 2, 4 weeks, the tissues were dyed. The length of long axis of neocartilage was measured through an optical microscope with a 0.1 mm graduation at original magnification, ${\times}40$. In the first and second week, both group showed no sign of cartilage regeneration. In the fourth week, regeneration on marginal portions was observed on all groups and the average values of length of long axis of neocartilage according to defect size were as follows: In the cases with 3mm defect, it was $0.85{\pm}0.30mm$ in the control group, and $1.85{\pm}0.38mm$ in the graft group; in the cases with 6 mm defect, $1.33{\pm}0.58mm$ in the control group, and $2.25{\pm}0.46mm$ in the graft group; and in the cases with 9 mm defect, $2.33{\pm}0.77mm$ in the control group, and $4.47{\pm}1.39mm$ in the graft group. This means that the collagen scaffold has an influence on the regeneration of neocartilage. But the relative ratio of the length of neocartilage to cartilage defect size was not significant in the statistics.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.218-228
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• 2000

Background : Among 'structure', 'process' and 'outcome' approaches, outcome evaluation is considered as the most direct and best approach to assess the quality of health care providers. Risk-adjustment is an essential method to compare outcome across providers. This study has aims to judge performance of hospitals by severity adjusted mortality rates of coronary artery bypass graft (CABG) surgery. Methods : Medical records of 584 patients who got the CABG surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups was used to quantify severity of patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex. For evaluation of hospital performance, we calculated ratio of observed number to expected number of deaths and z score [(observed number of deaths - expected number of deaths)/square root of the variance in the number of deaths], and compared observed mortality rate with confidence interval of adjusted mortality rate for each hospital. Results : The overall in-hospital mortality was 7.0%, ranged from 2.7% to 15.7% by hospital. After severity adjustment the mortality by hospital was from 2.7% to 10.7%. One hospital with poor performance was distinctly divided from others with good performance. Conclusion : In conclusion, severity-adjusted mortality rate of CABG surgery might be applied as an indicator for hospital performance evaluation in Korea. But more pilot studies and improvement of methodologies has to be done to use it as quality indicator.

• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.94-101
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• 2018

Background: Atrophy of muscle and fat often contributes to temporal hollowing after pterional craniotomy. However, the main cause is from the bony defect. Several methods to prevent temporal hollowing have been introduced, all with specific limitations. Autologous bone grafts are most ideal for cranial defect reconstruction. The authors investigated the effectiveness of bony defect coverage and temporal augmentation using pterional craniotomy bone flap. Methods: This study was conducted in 100 patients who underwent brain tumor excision through pterional approach from 2015 to 2016. Group 1 underwent pterional craniotomy with temporal augmentation and group 2 without temporal augmentation. In group 1, after splitting the calvarial bone at the diploic space, the inner table was used for covering the bone defect and as an onlay graft for temporal augmentation. The outcome is evaluated by computed tomography at 1-year follow-up. Results: The mean operative time for temporal augmentation was 45 minutes. The mean follow-up was 12 months. The ratio of temporal thickness of operated side to non-operated side was 0.99 in group 1 and 0.44 in group 2, which was statistically different. The mean visual analogue scale score was 1.77 in group 1 and 6.85 in group 2. Conclusion: This study demonstrated a surgical technique using autologous bone graft for successfully preventing the temporal hollowing and improved patient satisfaction.

• Archives of Plastic Surgery
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• v.40 no.4
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• pp.403-408
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• 2013

Background For patients with neuropathy, vasculopathy, and impairment of wound healing, treatment of a diabetic foot ulcer poses many challenges. A large number of dermal analogues have been invented in an effort to overcome these challenges. Matriderm, a dermal analogue, is made from bovine collagen and elastin. This study was conducted in order to evaluate the effectiveness of Matriderm for treatment of diabetic foot ulcers, in comparison with skin grafting. Methods Sixty patients with diabetic foot ulcer were included in this prospective study. The average age of the patients, who had type II diabetes mellitus, was 58 years old. The patients were allocated to an experimental or control group with their consents. The patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a Matriderm appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft. Results A shorter hospitalization period (7.52 weeks) was observed in the experimental group than in the control group (9.22 weeks), and a shorter period of time (8.61 weeks) was required for complete healing, compared with the control group (12.94 weeks), with statistical significance (P<0.05). A higher elasticity ratio of the affected side to the non-affected side was observed in the experimental group, compared with the control group (P<0.01). Conclusions Matriderm enables effective healing and improves elasticity in treatment of patients with diabetic foot ulcer.

• The Journal of the Korean dental association
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• v.48 no.1
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• pp.45-55
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• 2010

Purpose: The aim of this study was to evaluate 1 year cumulative survival rate of implants placed on augmented sinus using Osteon$^{(R)}$, bone graft material and to assess height of the grafted material radiographically. Material and Methods: 10 maxillary sinuses were augmented in 10 patients and 25 implant fixtures were installed simultaneously or after 6 months healing period. The height of the sinus graft material was measured using panoramic images immediately after augmentation and up to 19 months subsequently. Changes in the height of the sinus graft material were calculated with respect to implant length and original sinus wall height. Results: The cumulative survival rate was 100% in all 25 implants. Additionally, normal healing process without any complication was observed in all patients. The mean crown/Implant ratio was 1.25. The mean marginal bone loss was 0.95mm and the mean resorption rate of Osteon$^{(R)}$ was 0.05mm/month. The fastest resorption site of Osteon$^{(R)}$ is the first molar area. The grafted material was well maintained in sinus and decreased slightly over 1 year. Conclusion: In conclusion, It can be suggested that Osteon$^{(R)}$ may have predictable result when it was used as a grafting material for sinus floor augmentation.

• Macromolecular Research
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• v.16 no.2
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• pp.139-148
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• 2008

Biodegradable and elastic poly(L-lactide-co-$\varepsilon$-caprolactone) (PLCL) was electrospun to prepare nanofibers, and N-isopropylacrylamide (NIPAAm) was then grafted onto their surfaces under aqueous conditions using $^{60}Co-{\gamma}$ irradiation. The graft yield increased with increasing irradiation dose from 5 to 10 kGy and the nanofibers showed a greater graft yield compared with the firms. SEM confirmed that the PLCL nanofibers maintained an interconnected pore structure after grafting with NIPAAm. However, overdoses of irradiation led to the excessive formation of homopolymer gels on the surface of thc PLCL nanofibers. The equilibrium swelling and deswelling ratio of the PNIPAAm-g-PLCL nanofibers (prepared with 10 kGy) was the highest among the samples, which was consistent with the graft yield results. The phase-separation characteristics of PNIPAAm in aqueous conditions conferred a unique temperature-responsive swelling behavior of PNIPAAm-g-PLCL nanofibers, showing the ability to absorb a large amount of water at < $32^{\circ}C$, and abrupt collapse when the temperature was increased to $40^{\circ}C$. In accordance with the temperature-dependent changes in swelling behavior, the release rate of indomethacin and FITC-BSA loaded in PNIPAAm-g-PLCL nanofibers by a diffusion-mediated process was regulated by the change in temperature. Both model drugs demonstrated greater release rate at $40^{\circ}C$ relative to that at $25^{\circ}C$. This approach of the temperature-controlled release of drugs from PNIPAAm-g-PLCL nanofibers using gamma-ray irradiation may be used to design drugs and protein delivery carriers in various biomedical applications.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.117-126
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• 2021

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.500-508
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• 2021

Background: The major limitation of arteriovenous graft access is the high incidence of thrombotic occlusion. This study investigated the outcomes of our salvage strategy for thrombosed hemodialysis arteriovenous grafts (including surgical thrombectomy with balloon angioplasty) and evaluated the efficacy of intragraft curettage. Methods: Salvage operations were performed for 290 thrombotic occluded arteriovenous grafts with clinical stenotic lesions from 2010 to 2018. Of these, 117 grafts received surgical thrombectomy and balloon angioplasty from 2010 to 2012 (group A), and 173 grafts received surgical thrombectomy and balloon angioplasty, with an additional salvage procedure using a curette and a graft thrombectomy catheter, from 2013 to 2018 (group B). Outcomes were described in terms of post-intervention primary patency and secondary patency rates. Results: The post-intervention primary patency rates in groups A and B were 44.2% and 66.1% at 6 months and 23.0% and 38.3% at 12 months, respectively (p=0.003). The post-intervention secondary patency rates were 87.6% and 92.6% at 6 months and 79.7% and 85.0% at 12 months, respectively (p=0.623). Multivariate Cox regression analysis demonstrated that intragraft curettage was a positive predictor of post-intervention primary patency (hazard ratio, 0.700; 95% confidence interval, 0.519-0.943; p=0.019). Conclusion: Surgical thrombectomy and balloon angioplasty showed acceptable outcomes concerning post-intervention primary and secondary patency rates. Additionally, intragraft curettage may offer better patency to salvage thrombotic occluded arteriovenous grafts with intragraft stenosis.