• Archives of Plastic Surgery
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• v.38 no.5
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• pp.642-648
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• 2011

Purpose: The recent advances in microsurgical techniques and their refinement over the past decade have greatly expanded the indications for digital replantations and have enabled us to salvage severed fingers more often. Many studies have reported greater than 80% viability rates in replantation surgery with functional results. However, replantation of multi-level amputations still remain a challenging problem and the decision of whether or not to replant an amputated part is difficult even for an experienced reconstructive surgeon because the ultimate functional result is unpredictable. Methods: Between January of 2002 and May of 2008, we treated 10 multi-level amputated digits of 7 patients. After brachial plexus block, meticulous replantation procedure was performed under microscopic magnification. Postoperatively, hand elevation, heat lamp, drug therapy and hyperbaric oxygen therapy were applied with careful observation of digital circulation. Early rehabilitation protocol was performed for functional improvement. Results: Among the 19 amputated segments of 10 digits, 16 segments survived completely without any complications. Overall survival rate was 84%. Complete necrosis of one finger tip segment and partial necrosis of two distal amputated segments developed and subsequent surgical interventions such as groin flap, local advancement flap and skin graft were performed. The overall result was functionally and aesthetically satisfactory. Conclusion: We experienced successful replantations of multi-level amputated digits. When we encounter a multi-level amputation, the key question is whether or not it is a contraindication to replantation. Despite the demand for skillful microsurgical technique and longer operative time, the authors' results prove it is worth attempting replantations in multi-level amputation because of the superiority in aesthetic and functional results.

• Archives of Plastic Surgery
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• v.45 no.1
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• pp.58-61
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• 2018

Background Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. Methods A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1), a single vein (group 2), and 2 or more veins (group 3). Survival rates and external bleeding rates were analyzed across the groups. Results The review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143). Failures were due equally to venous complications (n=4, 50%) and to arterial complications (n=4, 50%). Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689). However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017). Conclusions The number of venous anastomoses was not correlated with the survival rate. However, a greater number of venous anastomoses was associated with a decreased need for external bleeding, corresponding to a significant decrease in the need for postoperative monitoring and leech therapy.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.54-61
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• 2020

Background Conventional methods of external bleeding for congested fingertip replants exhibit notable problems, including uncontrollable bleeding and unpredictable survival of the replant. We have added a local injection of heparin calcium to the routine use of systemic heparinization for inducing external bleeding. We retrospectively examined patients who underwent external bleeding using our method. Methods Local subcutaneous injections of heparin calcium were made in 15 congested replants in addition to systemic heparinization. Each injection ranged from 500 to 5,000 U. The average duration of the injections was 4.1 days. Surgical outcomes were analyzed and compared with a control group of patients who underwent external bleeding without heparin calcium. Results The overall survival rate was 93.3%, which was higher than that of the control group (83.3%), but the difference was not statistically significant (P=0.569). The survival rate for subzones I and II by the Ishikawa subzone classification was 100%, whereas it was 87.5% in subzones III and IV. No statistically significant difference was observed. The rate of partial necrosis was 0% in subzones I and II, whereas it was significantly higher (66.7%) in subzones III and IV (P=0.015). The mean total blood loss via external bleeding was 588 g in 10 fingers. No patients required blood transfusion. Conclusions Congestion of a replanted fingertip can be successfully managed without blood transfusion by our method. Although complete relief from congestion in replants in subzones I and II is achievable, there is a higher risk of partial necrosis in subzones III and IV.

• Journal of Ginseng Research
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• v.43 no.1
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• pp.1-9
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• 2019

Background: Korean ginseng is an important cash crop in Asian countries. However, plant yield is reduced by pathogens. Among the Ilyonectria radicicola-species complex, I. mors-panacis is responsible for root-rot and replant failure of ginseng in Asia. The development of new methods to reveal the existence of the pathogen before cultivation is started is essential. Therefore, a quantitative real-time polymerase chain reaction method was developed to detect and quantify the pathogen in ginseng soils. Methods: In this study, a species-specific histone H3 primer set was developed for the quantification of I. mors-panacis. The primer set was used on DNA from other microbes to evaluate its sensitivity and selectivity for I. mors-panacis DNA. Sterilized soil samples artificially infected with the pathogen at different concentrations were used to evaluate the ability of the primer set to detect the pathogen population in the soil DNA. Finally, the pathogen was quantified in many natural soil samples. Results: The designed primer set was found to be sensitive and selective for I. mors-panacis DNA. In artificially infected sterilized soil samples, using quantitative real-time polymerase chain reaction the estimated amount of template was positively correlated with the pathogen concentration in soil samples ($R^2=0.95$), disease severity index ($R^2=0.99$), and colony-forming units ($R^2=0.87$). In natural soils, the pathogen was recorded in most fields producing bad yields at a range of $5.82{\pm}2.35pg/g$ to $892.34{\pm}103.70pg/g$ of soil. Conclusion: According to these results, the proposed primer set is applicable for estimating soil quality before ginseng cultivation. This will contribute to disease management and crop protection in the future.

• Korean Journal of Medicinal Crop Science
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• v.24 no.4
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• pp.294-302
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• 2016

Background: Crop rotation plays an important role in improving soil chemical properties, minimizing the presence of disease pathogens, and assists in neutralizing autotoxic effects associated with allelochemicals. Methods and Results: Five rotation crops of sudan grass, soybean, peanut, sweet potato, and perilla were cultivated for one year with an aim to reduce yield losses caused by repeated cropping of ginseng. In 2-year-old ginseng grown in the same soil as a previous ginseng crop, stem length and leaf area were reduced by 30%, and root weight per plant was reduced by 56%. Crop rotation resulted in a significant decrease in electrical conductivity, $NO_3$, and $P_2O_5$ content of the soil, whereas organic matter, Ca, Mg, Fe, Cu, and Zn content remained-unchanged. Soil K content was increased following crop rotation with sudan grass and peanut only. Rotation with all alternate crops increased subsequent ginseng aerial plant biomass, whereas root weight per plant significantly increased following crop rotation with perilla only. A significant positive correlation was observed between root rot ration and soil K content, and a significant negative correlation was observed between ginseng root yield and the abundance of actinomycetes. Crop rotation affected the soil microbial community by increasing gram negative microbes, the ratio of aerobic microbes, and total microbial biomass whereas decreases were observed in actinomycetes and the ration of saturated fatty acids. Conclusions: In soil exhibiting crop failure following replanting, crop rotation for one year promoted both soil microbial activity and subsequent ginseng aerial plant biomass, but did not ameliorate the occurrence of root rot disease.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.3
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• pp.303-311
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• 2020

The aim of this study was to assess the awareness of caregivers, emergency medical technicians, and emergency medical doctors by investigating the storage media for avulsed teeth at the trauma site. This study was performed by reviewing medical records of 183 patients with the age under 17 years old, who visited Ajou University Hospital for dental trauma. Based on their medical records, storage media for avulsed permanent teeth were investigated by classifying them as dry, milk, saline, saliva and tap water. The storage media chosen by caregivers at the trauma site were classified as cases by parents and school nurse teachers. Storage media chosen by emergency medical technicians and emergency medical doctors were also investigated using the same classification criteria. The results show that both parents and school nurse teachers used milk the most as a storage medium for avulsed teeth. Dry storage was the second most chosen medium by parents, and saline by nurse teacher. As a storage media emergency medical technicians used saline the most, while emergency medical doctors used only saline when they failed to replant avulsed teeth. There is a need to improve the knowledge of caregivers, emergency medical technicians, and emergency medical doctors regarding the storage media for avulsed teeth.

• Archives of Reconstructive Microsurgery
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• v.19 no.1
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• pp.12-20
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• 2010

Purpose: Industrial punch accidents involving fingers cause segmental injuries to tendons and neurovascular bundles. Although multiple-level segmental amputations are not replanted to regain function, most patients with an amputated finger want to undergo replantation for cosmetic as much as functional reason. The authors describe four cases of digital amputation by an industrial punch that involved the reinstatement of the amputated finger involving a joint and neurovascular bundle. Amputated segments were replanted to restore amputated surfaces and distal segments. Methods: A single institution retrospective review was performed. Inclusion criteria of punch injuries requiring replantation were applied to patients of all demographic background. Injury extent (size, tissue involvement), operative intervention, pre- and postoperative hand function were recorded. Result: Four cases of amputations were treated at our institute from 2004 to 2008 from industrial punch machine injury. Average patient age was 32.5 years (25~39 years) and there were three males and one female. Sizes of amputated segments ranged from $1.0{\times}1.0{\times}1.2\;cm^3$ to $3{\times}1.5{\times}1.6\;cm^3$. Tenorrhaphy was conducted after fixing fractured bone of the amputated segments with K-wire. Proximal and distal arteries and veins were repaired using the through & through method. The average follow-up period was thirteen months (2~26 months), and all replanted cases survived. Osteomyelitis occurred in one case, skin grafting after debridement was performed in two cases. Because joints were damaged in all four cases, active ranges of motion were much limited. However, a secondary tendon graft enhanced digit function in two cases. The two-point discrimination test showed normal values for both static and dynamic tests for three cases and 9 mm and 15 mm by dynamic and static testing, respectively, in one case. Conclusion: Though amputations from industrial punch machines are technically challenging to replant, our experience has shown it to be a valid therapy. In cases involving punch machine injury, if an amputated segment is available, the authors recommend that replantation be considered for preservation of finger length, joint mobility, and overall functional recovery of the hand.

• Korean Journal of Medicinal Crop Science
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• v.23 no.3
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• pp.223-230
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• 2015

To study the effect of crop rotation on the control of ginseng root rot, growth characteristics and root rot ratio of 2-year-old ginseng was investigated after the crops of 18 species were cultured for one year in soil contaminated by the pathogen of root rot. Fusarium solani and Cylindrocarpon destructans were detected by 53.2% and 37.7%, respectively, from infected root of 4-year-old ginseng cultivated in soil occurring the injury by continuous cropping. Content of $NO_3$, Na, and $P_2O_5$ were distinctly changed, while content of pH, Ca, and Mg were slightly changed when whole plant of crops cultured for one year were buried in the ground. All of EC, $NO_3$, $P_2O_5$, and K were distinctly increased in soil cultured sudangrass, peanut, soybean, sunnhemp, and pepper. All of EC, $NO_3$, $P_2O_5$, and K among inorganic component showed negative effect on the growth of ginseng when they were excessively applied on soil. The growth of ginseng was promoted in soil cultivated perilla, sweet potato, sudangrass, and welsh onion, while suppressed in Hwanggi (Astragalus mongholicus), Deodeok (Codonopsis lanceolata) Doraji (Platycodon grandiflorum), Gamcho (Glycyrrhiza uralensis), Soybean. All of chicory, lettuce, radish, sunnhemp, and welsh onion had effective on the inhibition of ginseng root rot, while legume such as soybean, Hwanggi, Gamcho, peanut promoted the incidence of root rot. Though there were no significant correlation, $NO_3$ showed positive correlation, and Na showed negative correlation with the incidence of root rot.

• Korean Journal of Medicinal Crop Science
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• v.24 no.2
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• pp.136-142
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• 2016

Background: Root diseases caused by Cylindrocarpon destructans and Fusarium solani decrease the yield and quality of ginseng. Cylindrocarpon root rot is a major disease caused by replant failure in ginseng fields. Methods and Results: Solarization of infested greenhouse soil was carried out during the summer season after applying green manure (Sudan grass) and Calcium Cyanamide (CC) on the soil. Mycelium and conidia of C. destructans died at $40^{\circ}C$ after 15 h, but they did not die at $35^{\circ}C$ after 15 h. They also died after keeping the soil at $40^{\circ}C$ for 2 h daily for 9 days, and at $45^{\circ}C$ for 8 days, but they did not die at $38^{\circ}C$ for 9 days. Maximum soil temperature was $55.4^{\circ}C$ at 5 cm depth, $48.7^{\circ}C$ at 10 cm, $44.7^{\circ}C$ at 15 cm, $42.5^{\circ}C$ at 20 cm, and $31.9^{\circ}C$ at 30 cm by incorporating green manure into the soil and using solarization. Solarization using green manure mixed with CC was the most effective in decreasing soil-borne pathogens of 2-year-old ginseng. However, the addition of CC decreased the root weight due to the increase in EC and $NO_3-N$. Conclusions: Soil disinfection using green manure and solarization in a greenhouse environment was effective in inhibiting root rot, however, it did not completely kill the soil-borne pathogens.

• Restorative Dentistry and Endodontics
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• v.25 no.2
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• pp.170-179
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• 2000

The rh-BMP-4 is a subgroup of TGF-${\beta}$ superfamily. The application of rh-BMP in alveolar bony defect was reported to new alveolar bone and new cementum formation. For minimized complications following tooth replantation, a operator must replant a tooth fast at the pertinent position. This study was to evaluate the effect of rh-BMP-4 on periodontal regeneration and root resorption following tooth replantation in rats. The 50 Sprague-Dawley rats weighting about 130gm were used in this study. The animals were divided into three groups. Group 1 ; immediate replantation after extraction : Group 2 ; replantation stored teeth extraction of first molar, the removal of periodontal ligament with collagenase, and etching with citric acid : Group 3 ; replantation stored teeth with treated rh-BMP-4 in mesial root. Experimental animals were sacrificed 3, 7, 14 days after replantation by heart infusion. The maxillae were removed, fixed, demineralized, dehydrated, infiltrated and embedded with JB-4 mixture. For light microscopic observation, 5 micron sections were cut and stained with toluidine blue. The results of this study were as follows : 1. After experimental 3 days, all groups were observed dead space between periodontum and root. 2. After experimental 7 days, group 1 and group 3 were observed filling periodontal fibers between alveolar bone and root but group 2 were not. 3. After experimental 7 days, group 3 were observed appearance of attached cementoblast like cell on root surface. Group 1 were observed regular arrangement of fibroblasts and collagen fibers at ${\times}400$ observation. 4. After experimental 14 days, all group were observed filling periodontal fibers between alveolar bone and root. Group 1 were observed normal arrangement of periodontal fibers. Group 3 were observed less abnormal arrangement of periodontal fibers. Group 2 were not observed functional normal arrangement of periodontal fibers. 5. After experimental 14 days, group 2 and 3 were observed several root resorption and irregular root surface but group 1 were not. These results suggest that the rh-BMP-4 can stimulate cementogenesis and enhance to attach collagen fibers.