• Archives of Plastic Surgery
• /
• v.37 no.4
• /
• pp.396-399
• /
• 2010

Purpose: In hand injury, pedicle is usually damaged by avulsion injury or crushing injury. Because of postoperative pedicle obliteration, it is often hard to save the injured hand and fingers, even after successful replantation. The author introduces three cases of extensive hand injury, and successful results after applicatoin of multiple venous grafts to these patients. Methods: In all cases there was no circulation in any finger. In the first case, some vessels were extracted, so venous graft was applied to two sites of severely damaged venous sites. In the second case, venous grafts were applied to all four digital arteries of all fingers except thumb which got severely crushed, and two sites of dorsal veins. In the third case, venous graft was applied to all four digital arteries of all five fingers, and two sites of dorsal veins and palmar veins each. Results: In all cases, survival of hands and fingers was successful. In the second case, however, amputation in thumb and little finger at DIP joint level was inevitable, because of its severe damage, and the large dorsal defect on index finger was filled with DIEP free flap. Thumb was reconstructed with toe-to-thumb free flap, and additional debulking procedures and contracture release is furtherly needed. In the first case, additional surgery was done, as FDP tendon got re-ruptured, but in long term follow-up, satisfactory range of motion was attained. In the third case, FTSG on dorsal skin region was planned. as flap on dorsal area got partial necrosis. Conclusion: In hand injury, there are many structures to be repaired, but sometimes venous graft is avoided for its long operating time. Even though the length of damaged vessel is enough for anastomosis, the endothelium is often damaged (zone of injury). In extensive hand injury, successful reconstruction would be possible with active venous graft to all vessels suspicious for damage.

• Archives of Plastic Surgery
• /
• v.37 no.4
• /
• pp.469-472
• /
• 2010

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

• Archives of Plastic Surgery
• /
• v.36 no.5
• /
• pp.565-570
• /
• 2009

Purpose: Numerous techniques have been introduced to reconstruct the perineal area in order to preserve function of both the recipient and the donor site while satisfying aesthetic results. There are several advantages of using the pudendal aretery perforator based flap in that it provides thin coverage of defect area and a relatively excellent circulation through perforators. The perineal region can be divided into two areas : the urogenital triangle and the anal triangle. Since each area differs in structure and function so does its reconstructive plan. The authors of this article report clinical results obtained from pudendal artery perforator based reconstructed cases according to each differrent triangles. Methods: A total of 15 patients who underwent perineal reconstruction were enrolled in our study between the year 2002 and 2006. There were 4 cases of vaginal cancer, 4 cases of extramammary Paget's disease, 1 case of rectovaginal fistula in females and 2 cases of Paget's disease and 4 cases of Fournier's gangrene in male cases. The follow up period was on average 6 month. In female, superfical pudendal artery perforator based local flap were used to reconstruct the urogenital triangle defects, while internal pudendal artery perfoator based local flaps were used to reconstruct the anal traingle defects. In males the gracilis myocutaneous flap and internal pudendal artery perforator based local flaps were used in reconstruction of the scrotum and perineal defect. Result: In females, there was 1 case of partial flap necorsis that employed the superficial pudendal artery perforator but secondary repair through the internal pudendal artery perforator based local flap was done. In addition, there were 4 wound dehiscence cases in females and 2 cases in males. Conclusion: We believe that a better aesthetic and functional outcome can be achieved in perineal reconstruction if discrete surgical planning is carried out systematically categorizing the choice of flap employed acccording to distinct anatomical regions : the urogenital and the anal triangle.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.43 no.1
• /
• pp.46-48
• /
• 2017

A patient, who underwent partial masseter muscle resection and mandibular angle reduction at a plastic surgery clinic, visited this hospital with major complaints of trismus and dysesthesia. A secondary angle formation due to a wrong surgical method was observed via clinical and radiological examinations, and the patient complained of trismus due to the postoperative scars and muscular atrophy caused by the masseter muscle resection. The need for a masseter muscle resection in square jaw patients must be approached with caution. In addition, surgical techniques must be carefully selected in order to prevent complications, and obtain effective and satisfactory surgery results.

• International Journal of Highway Engineering
• /
• v.14 no.4
• /
• pp.37-49
• /
• 2012

PURPOSES : This study is to investigate the fundamental properties of limestone added cement concrete for application of pavement. METHODS : As the production of Portland cement causes environmental problems, engineers have sought more environment-friendly concrete construction materials. Limestone powder can be used for concrete as a partial replacement of Portland cement. One of the great applications of limestone powder added cement concrete might be a cement concrete pavement since the concrete pavement consumes massive quantity of Portland cement. Experimental variables were different replacement level of limestone powder by 0% to 25% with 5% increment. Before hardening of fresh concrete, setting time and plastic shrinkage characteristics were investigated in addition to other basic properties. Properties of hardened concrete included compressive, tensile and flexural strength as well as drying shrinkage. RESULTS : The addition of limestone powder did not significantly affect the properties of fresh concrete. Strength deceased as the replacement ratio increased and when the replacement ratio was greater than 10% decrease rate increased. CONCLUSIONS : It was found that the partial replacement of the limestone powder to cement in pavement materials can be positively considered as its mechanical properties show comparable performance to those normal concrete.

• The Academic Congress of Korean Shoulder and Elbow Society
• /
• 2009.03a
• /
• pp.222-222
• /
• 2009

Primary malignant bone tumors of the scapula are very rare, and little literature is available regarding their characteristics and outcome. We studied the clinical characteristics, and outcome of patients with primary malignant bone tumors of the scapula. From 1979 to 2008, we treated 7 patients at our institute (4 men and 3 women; chondrosarcoma 3, Ewing's sarcomas 3, Osteosarcoma 1). The mean age was 45 years (range, 5~65 years). The follow-up period was 2 - 180 months. Six patients were performed operations: total scapulectomy 3, partial scapulectomy 1, forequarter resection 1, total resection of the shoulder girdle (Tikhoff-Linberg procedure) 1. No-operative treatment was chosen for one patient with a limited life expectancy. Local recurrence occurred in one patient. Distant metastasis occurred in 3 patients. Of the 7 patients, 4 patients are died because of propagation of the disease. Three patients were alive and apparently disease-free, and these patients were evaluated for functional results with the functional evaluation system of the International Society of Limb Salvage (ISOLAS). Functional result of partial scapulectomy was excellent, however, the function after total scapulectomy or Tikhoff-Linberg procedure is severely impaired. Our study indicates reconstruction procedure needs to be reconsidered following total scapulectomy or Tikhoff-Linberg procedure.

• Korean Journal of Bronchoesophagology
• /
• v.4 no.1
• /
• pp.101-104
• /
• 1998

Partial splitting of the upper sternum provides an excellent surgical view in reconstruction of the intrathoracic trachea. However, when deep-seated mediastinitis develops postoperatively, it is difficult to manage especially when combined with sternal osteomyelitis. It also needs an additional consideration compared to the usual treatment modality applied to mediastinitis following a standard median stemotomy because the lower part of the stemum remains intact. We treated a 50 year old female patient with deep-seated mediastinitis and sternal osteomyelitis following resection and end-to-end anastomosis of the trachea through an upper midline sternotomy. The patient underwent extensive stemectomy, omental free grafting, and pectoral myocutaneous flap. Postoperative viability of the free-grafted omentum was evaluated by angiography and CT scan.

• International journal of steel structures
• /
• v.18 no.5
• /
• pp.1684-1698
• /
• 2018

Fragility functions are determined for braced steel moment frames (SMFs) with plans such as square-, T-, L-, U-, trapezoidal-, and semicircular-shaped, subjected to blast. The frames are designed for gravity and seismic loads, but not necessarily for the blast loads. The blast load is computed for a wide range of scenarios involving different parameters, viz. charge weight, standoff distance, and blast location relative to plan of the structure followed by nonlinear dynamic analysis of the frames. The members failing in rotation lead to partial collapse due to plastic mechanism formation. The probabilities of partial collapse of the SMFs, with and without bracing system, due to the blast loading are computed to plot fragility curves. The charge weight and standoff distance are taken as Gaussian random input variables. The extent of propagation of the uncertainties in the input parameters onto the response quantities and fragility of the SMFs is assessed by computing Sobol sensitivity indices. The probabilistic analysis is conducted using Monte Carlo simulations. The frames have least failure probability for blasts occurring in front of their corners or convex face. Further, the unbraced frames are observed to have higher fragility as compared to counterpart braced frames for far-off detonations.

• Geomechanics and Engineering
• /
• v.10 no.4
• /
• pp.423-436
• /
• 2016

Currently, there is a great interest in the coupling between multiphase fluid flow and geomechanical effects in hydrocarbon reservoirs and surrounding rocks. The ideal solution for this coupled problem is to introduce the geomechanical effects through the stress analysis solution and implement an algorithm, which assures that the equations governing the flow and stress analyses are obeyed in each time step. This paper deals with the implementation of a program (FORTRAN90 interface code), which was developed to couple conventional reservoir (ECLIPSE) and geomechanical (ABAQUS) simulators, using a partial coupling algorithm. The explicit coupled hydro-mechanical behavior of Iranian field during depletion and $CO_2$ injection is studied using the soils consolidation procedure available in ABAQUS. Time dependent reservoir pressure fields obtained from three dimensional compositional reservoir models were transferred into finite element reservoir geomechanical models in ABAQUS as multi-phase flow in deforming reservoirs cannot be performed within ABAQUS. The FEM analysis of the reservoir showed no sign of plastic strain under production and $CO_2$ injection scenarios in any part of the reservoir and the stress paths do not show a critical behavior.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.16 no.1
• /
• pp.1-11
• /
• 1994

The functional deformity following removal of the maxilla is considerable, especially following maxilla cancer excision. Rehabilitation of oral and maxillofacial region used to be very difficult with prosthesis or traditional flaps. Temporal muscle and fascia flaps have been described for immediate reconstruction following hemi-maxillectomy, but not total maxillectomy. The muscle and superficial fascia of the temporal area differ in their physical characteristics, vascular supply and clinical applications. Both can be employed independently or simultaneously as regional flaps in the reconstruction of a variety of complex craniofacial defects. Four case is presented in which 3 case maxilla cancer, one case non-union after maxilla fracture, and all case showed successful use of this flap. Only one patient developed partial necrosis of the flap ; significant necrosis did not occur in any other patient. This present paper reviews the anatomy, surgical technique and utilisation of temporal muscle and fascia flaps.