• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.4
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• pp.340-349
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• 2007

Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. In this study, vascular patency and thrombus formation in experimental micro-venous anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-venous anastomosis with heparin irrigation, all of 12 anastomosis site were good vascular patency. 2. In thrombus formation in 2 weeks group(Experimental I), 2 site of 6 cases were observed thrombus, and in 4 weeks group(Experimental II), 1 site of 6 cases were observed thrombus. 3. In histologic examination, normal vein(Control Group) showed continued internal elastic lamina, well formed thick smooth muscle layer and connective tissue. The group of 2 weeks after microvenous anastomosis(Experimental I) showd locally recovered internal lamina, discontinued internal lamina, disorganized smooth muscle cells and granulation tissue around suture silk. In the group of 4 weeks after micro-venous anastomosis(Experimental II), anastomosis site showed almostly continued internal lamina, disorganized smooth muscle cells and cicartrized tissue around suture silk. 4. In scanning electron microscope examination in 2 weeks(Experimental I) after micro-venous anastomosis, mesh fibrin formation showed near to endothelial cells, and in 4 weeks after micro-venous anastomosis(EXperimental II), numerous blood cells and fibrin mesh formation was seen associated with irregular endothelial cell arrangement. 5. In transmission electron microscope examination in 2 weeks after micro-venous anastomosis(Experimental I), irregular arrangement of smooth muscle cells was seen adjacent to collagenized tissue around suture silk. In 4 weeks after micro-venous anastomosis(Experimental II), denuded venous wall composed of relatively well arranged smooth muscle cells was covered by endothelial cells, but fibroblast cells and foreign body giant cells near to suture silk was remained. From the results obtained in this study, results of good vascular patiency and anti-thrombotic effect of heparin were obtained as a local irrigation solution, and repair of venous endothelial cell was observed in 2 weeks after micro-venous anastomosis.

• Journal of Veterinary Clinics
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• v.20 no.3
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• pp.294-301
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• 2003

This study was performed to compare the effects of hydrocolloid(Duoderm$\circledR$, HC in this study) and hydrogel (Nu-Gel$\circledR$, HG in this study) occlusive dressing materials on degree of exudate, wound contraction, epithelialization, and healing of full-thickness skin wound in dogs. Three wounds measuring 2${\times}$2 cm in size were created bilaterally(6 wounds/dog) on the dorsolateral aspect of the trunk of 12 dogs. In each dog, the wounds were treated with HC, HG, and normal saline, respectively. For a 4 week period, the wounds were evaluated gross aspects and histopathological aspects. There were no statistically significant differences between treatment groups in percentage of wound contraction, percentage of epithelialization, and percentage of wound total healing during the first week. Significant differences were first detected on day 14. On day l4(P < 0.01) and 21 (P < 0.05), mean percentage of epithelialization of HG-treated wound was significantly greater than those in HC- and normal saline-treated wound. Mean percentage of wound contraction of HG-treated wound was significantly greater than that in HC- and control wounds on day 21(P< 0.05). On day 21, mean percentage of wound healing of HG-treated wound was significantly greater than that in HC- and control wounds(P < 0.02). On day 1, 4, and 7 after wound creation, although severe infiltration of PMN (polymorphonuclear leukocyte) cells in HC- and control wounds were observed in the subcutis and moderate infiltration of PMN cells in HG-treated wound were observed in the subcutis, we did not detect significant differences. On day 14 after wounding creation, in the wounds treated with HG dressing, epithelial cells were found over the surface, and edema further decreased in the tissue under the wounds, and the granulation tissue was replaced with collagen fibers. On day 21 after wound creation, in HG-treated wound compared with other experimental material-treated wounds, regenerated epidermis covered most of the wound surface, and the granulation tissue was more replaced with collagen fibers than that on day 14. Overall results indicated that the use of hydrogel dressing materials(Nu-Gel$\circledR$) as hydrocolloid dressing (Duoderm$\circledR$) materials and normal saline treatment on full-thickness skin wounds in dogs increased the rate of healing at repair stage.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.3
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• pp.257-265
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• 1999

To investigate the sequential changes in microvascular architecture and osseous regeneration during the bony healing after an application of the guided tissue regeneration method, we made artificial defects measuring $0.7cm{\times}0.3cm$ in size on femoral bones of rats measuring about 200gm and applied non-absorbable TEFE membrane at experimental sites but not at control sites. Then we observed the sequential changes and correlations between new vacuolation and bony regeneration using microvascular corrosion cast method and routine light microscopic observation at 1, 2 and 3 weeks after operation, respectively. The results showed that there were close relationships between regeneration of microvasculature and bone. In early phase, the invasion of granulation tissue at control sites delayed bony regeneration, however, in later phase, there was no remarkable differences in bony regeneration between control and experimental sites. The placement of barrier also affected in revascularization of regenerating bony defects. This is, the experimental sites showed parallel arranged nutritional vessels along long axis with well developed retiform plexus whereas the control revealed vertical invasion of microvasculature from outside of marrow space through bony defects which was also rearrange with time into parallel pattern with a vertical plexus but lesser organized than that of experimental sites. These findings suggest that the reconstruction of regenerating vasculature within the marrow cavity only may be sufficient and/or more be efficient in regeneration of bony defects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.5
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• pp.406-414
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• 2011

Thermally induced bone necrosis during implant surgery is a rare phenomenon and a potential contributing factor to implant failure. The frictional heat generated at the time of surgery causes a certain degree of necrosis of the surrounding differentiated and undifferentiated cells. The bone necrosis occurred in the mandible in all three cases, leading to a soft tissue lesion and pain. In each case, radiolucent areas appeared in the middle and apical portions of the implant 4 weeks after surgery. Thermally induced bone necrosis did not improve following systemic antibiotic medication, necessitating surgical treatment. The nonintegrated implants were removed, and meticulous debridement of dead bone and granulation tissue was performed. Then, new implants were implanted along with the placement of autogenous and xenogenic bone covered with a collagen membrane. No further complications occurred after re-operation. The radiolucencies around the new implants gradually resolved entirely, and the soft tissue lesions healed successfully. At 4-5 months after reoperation, implant loading was initiated and the implant-supported restorations have been functioning. The aim of this case report is to present the successful clinical treatment of three cases suspected to be caused by thermally induced bone necrosis after implant drilling.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.139-145
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• 2006

Ranula is a mucocele which occurs at the mouth floor and is mostly related to sublingual gland. In other words ranula is definded as a pseudocyst which occurs as the secretion duct of sublingual gland is destructed there as the saliva from the secretion duct flows out and retention in the soft tissue. The cause of ranula is destruction or obstruction of the duct. The clinical findings of ranula is a painless, unilateral bluish transparent swelling around the frenum and shows fluctuation when palpated. Histological finding represent a formation of cavity inside the connective tissue, but a pseudo-cyst can be seen which the wall of the cyst is composed of granulation tissue rather than epithelial cells. The first treatment of ranula can be considered as marsupialization. which induces the inner wall of the Ranula to be a part of oral mucosa. This case report shows a treatment of marsupialization with gauze packing in a young patient representing a clinical finding of characteristic ranula.

• Korean Journal of Bronchoesophagology
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• v.10 no.2
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• pp.17-21
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• 2004

Background Insertion of tracheal stent in the treatment of benign tracheal & bronchial disease has increased since the introduction of expandable metallic stent. Material & Methods : Between Jan, 1995 and Feb. 2004, eight patients who had benign tracheo-bronchial disease underwent insertion of expandable metallic tracheal stent. We retrospectively analyzed stent insertion indications, complications, and following the result. Results : Surgical indications were post-intubation tracheal stenosis (1 case), tracheal stenosis following tracheal surgery (2 cases), tracheo-esophageal fistula (2 cases), broncho-pleural fistula(1 case), left main bronchus stenosis following bronchoplasty (1 case), and left main bronchus stenosis due to mediastinal repositioning (1 case). Expandable metallic tracheal stent was inserted in five patients to resolve dyspnea caused by airway obstruction, and to prevent recurrent pneumonia in three patients. The complication developed in 6 patients $75\%$; 3 cases of distal stenosis due to growth of granulation tissue, and one case each of tearing of posterior membrane, aggravation of tracheo-esophageal fistula, and airway partial obstruction due to stent migration. The stent was removed in 5 patients and tracheal surgery (tracheal resection and end to end anastomosis with primary repair of esophagus, pericardial patch tracheo-bronchoplasty, tracheal repair and omental wrapping) was performed in 3 patients. Conclusion Insertion of self expandable metallic stent in benign tracheo-bronchial disease is an effective means of relieving dyspnea for only a short period, and it did not increase the long term survival. Better means of treatment of benign tracheo-bronchial stenosis in necessary.

• Korean Journal of Bronchoesophagology
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• v.13 no.2
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• pp.77-81
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• 2007

Foreign body aspiration is a cause of the accidental death at home. Therefore, early intervention and proper management is important. A bronchoscopy is indicated whenever there is a suggestive history and medical opinion. Occasionally, foreign body removal with bronchoscopy may be fail. But, on the situation, there is no definite recommended standard management. We experienced two cases of bronchial foreign body could not be removed with bronchoscopy at first intervention. The one was diagnosed too late. Endobronchial granulation tissue and edema made it impossible to find the foreign body at first bronchoscopy. After steroid and antibiotic therapy, foreign body could be removed with secondary bronchoscopy. Another was bronchial foreign body jammed tightly bronchus intermedius. Even after medical therapy, patient got aggravated. So foreign body was removed with bronchotomy.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1320-1323
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• 2001

SAPHO syndrome is an acronym for an increasingly recognized syndrome of synovitis, acne, pustulosis, hyperostosis, and osteitis. Most of the previously reported case are from Japan and Europe. The authors report a case of SAPHO syndrome in Korean female who presented with extrasternal neurologic symptoms. A 60-year-old female with thoracic and right chest wall pain presented with the sternocostoclavicular hyperostosis, and recurrent aseptic osteitis. Previously, she had hystrectomy and thyroidectomy due to uterine malignancy 25 years ago. Also, she started to take medications for palm and sole pustulosis 7 days prior to admission. Through evaluation of clinical, radiological, serological studies, studies was done along with bone needle biopsy for the biological reassessment. The hyperostosis was found in the pedicles of thoracic 8, 9, 10 vertebrae and sternoclavicular joint. Radio-isotope bone scan showed an accumulation of tracer in thoracic vertebra. The bone biopsy from these site showed increased osseous turnover, thickening of trabeculae accompanied by mild acculuation of granulation tissue and round cell infiltration, compatible with mild chronic inflammation with marrow fibrosis. The patient showed good response to conservative management. The authors report a case of SAPHO syndrome with thoracic radiculopathy. It is considered that SAPHO syndrome is related to spondyloarthropathy, and appears to have benign disease process with good prognosis.

• Archives of Craniofacial Surgery
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• v.14 no.2
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• pp.119-123
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• 2013

Except for special situations, it is generally agreed that best results in the treatment of facial fractures is expected if reduction is done within the first 2 or 3 weeks after injury. We reduced facial bone fractures at 4 to 7 weeks after trauma. A 44-year-old female patient underwent open reduction for her right zygomaticomaxillary complex fracture at 7 weeks after injury. A 59-year-old female patient underwent surgery for the right mandible body and left parasymphysis fractures at 4 weeks after injury. Using traditional approaches, granulation tissue and callus were removed from the fracture sites, and malunited fracture lines were separated by a small osteotome. We reduced the displaced fractured zygoma and mandible to their normal anatomical positions and fixed them using titanium plates. No complications such as asymmetry, malunion, malocclusion, or trismus were seen. Unfavorable asymmetric facial contours were corrected, and we obtained good occlusion with favorable bony alignment. The functional and aesthetic outcomes were satisfactory. Through removal the callus and limited osteotomy, a successful approach to the previously fractured line was possible, and an exact correction with symmetry was obtained. This method can be a good option for obtaining good mobility and clinical results in treating delayed facial bone fractures.

• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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• pp.68-71
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• 2014

Purpose: The purpose of this study is to report the results of culture test at the time of removal of metal devices used for management of ankle fractures and for analysis of contributing factors. Materials and Methods: We reviewed medical records of 132 patients with lower tibia and ankle fracture who had their metal devices removed during the period from January 2010 to February 2014. Patients with clinical signs of infection were excluded. Culture test was performed by taking the granulation tissue around the metal device at the time of removal. We divided the subjects into two groups, culture positive and negative. We then performed a retrospective review of each medical record of multiple factors that might contribute to the culture results, including laboratory results, medical history, material and size of metal device, indwelling period, and whether or not it was open injury. Results: Among 132 cases, six were culture positive. Enterococcus was detected in two cases and the others were Staphylococcus. No significant difference in medical history of patients and laboratory results, including C-reactive protein level, was observed between the culture positive and negative group. Culture positive rate was 5.4% in titanium and 3.9% in stainless steel. In terms of metal size, culture positive rate was 5.1% in small plates, 6.7% in large plates, and culture negative in intramedullary nails. The average indwelling period of metal device was 61.5 weeks in the culture positive group, and 68.6 weeks in the negative group. Nine cases were open fractures and all were in the culture negative group. Conclusion: Whether or not the culture result was positive, there were no meaningful contributing factors. Presence of bacterium on the metal device could not be screened by any laboratory results or other factors.