• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권5호
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• pp.302-309
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• 2013

Purpose: This study evaluated the prognosis of conservative and surgical treatment according to the staging of bisphosphonate-related osteonecrosis of jaw (BRONJ) by American Association of Oral and Maxillofacial Surgeons and American Society for Bone and Mineral Research. Methods: We evaluated 53 patients of BRONJ who visited Department of Dentistry, Ajou University School of Medicine from May 2007 to February 2013. Twenty eight patients in stage 2, were divided into surgical and conservative groups with cessation of bisphosphonate therapy. Fifteen patients belonged to the conservative treatment group, in which mouth rinsing and antibiotics medication were done. Thirteen patients were treated with debridement or sequestrectomy, in the surgical treatment group. Each study list was analyzed by SPSS ver. 14.0 (SPSS Inc., USA) software and the favorable rate was verified by the Fisher exact test. P-values less than 0.05% were deemed significant. Results: Clinical outcome was evaluated on the basis of both clinical and radiographic findings. Of all the 28 patients of stage 2, 15 patients underwent conservative treatment and 13 patients received surgical treatment. In the surgical group, 9 of 13 (69.2%) showed good prognosis, 4 of 13 (30.7%) showed recurrence. In the conservative group, 13 of 15 (86.6%) showed no change duting the follow-up period. Two of 15 patients even showed a bad prognosis, such as pain and pus discharge, which are criteria for stage 3. P-value was 0.067 (>0.05). Conclusion: The results of the present study suggests that surgical intervention is good choice against the conservative treatment, after proper drug holidays period, while further investigation is needed for a definite solution to BRONJ.

• Journal of Periodontal and Implant Science
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• 제30권2호
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• pp.241-257
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• 2000

자가골막은 골결손부에서 골형성을 자극할 수 있는 능력과 조직유도재생술의 이상적인 차폐막이 갖추어야 할 여러 조건들을 만족하고 있다. 치주조직의 재생 술식에 적용시 임상적으로 다른 차폐막을 사용한 정도의 치주낭 감소와 임상적인 부착증진을 얻었다고 보고되고 있으나 이러한 임상적인 긍정적인 결과가 치주조직의 재생을 반드시 의미하는 것이 아니므로 조직학적 평가가 필요하다. 이에 본 실험은 성견의 하악 소구치에 2급 분지부 골결손을 형성하고 상악 견치의 협측 변연치은 정상 3 mm 하방에서 채취한 자가골막을 이식한 경우와 자가골막에 Calcium carbonate 이식을 병용하였을 때 치주조직의 재생에 미치는 영향을 평가하고자 하였다. 실험은 잡종 성 견 6마리를 이용하였다. 실험군은 모두 3개 군으로 나누었다. 대조군은 골결손부의 외과적 처치 후 치주판막으로 봉합한 군, 실험 I군은 골결손부에 외과적 처치 후 자가골막만 이식한 군, 실험 II군은 골결손부에 자가골막과 Calcium carbonate 이식을 병용한 군으로 하였다. 희생은 각각 술후 2, 4, 12주에 시행하였고 광학 현미경적 관찰을 시행하여 다음과 같은 결론을 얻었다. 임상적으로 잘 치유된 소견을 보였다. 광학현미경적으로 관찰시 2주째에 대조군은 상피의 근단이동이 심하였고 홈하방 부위에서만 골조직의 개조현상이 관찰되었으나 자가골막을 이식한 실험 I, II군에서는 상피의 하방이동은 미약하였고 홈상방으로 많은 골양조직이 관찰되었다. 조직계측학적으로 상피대는 실험군과 대조군 모두 4주와 1 2주째에 큰 변화가 없었다. 치주조직의 신부착 양은 실험군 대조군 모두 1 2주에 4주보다 더 증가하였으며 실험 I, II군이 대조군에 비하여 많은 경향을 보였으나 실험 I, II군간의 차이는 없었다. 이식된 자가골막은 시간이 경과함에 따라 골막이 주위조직과 생착되어 4주이후에는 관찰되지 않았다. 이상의 결과로 보아 이식된 자가골막에 의한 치주조직 재생은 비교적 양호하였으며 상피의 하방증식을 억제할 수 있어 흡수성 차폐막으로 이용할 수 있을 것으로 사료된다.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.75-78
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• 2015

High-pressure (HP) injection injury to the upper extremity often causes a very serious clinical problem, leading to poor outcomes, including amputation, so that a true surgical emergency is required. The outcomes can be improved with emergent wide surgical debridement. However the diagnosis of these injuries is often delayed due to underestimated evaluation at first appearance and lack of common knowledge of the seriousness of this injury. The type and pressure of the infecting material is an important factor in prognosis and organic solvents infected pressure injury can cause poor outcome and increased amputation rate. In this case, we report on reconstruction of HP oil-based paint injection injuries of the finger using T-shaped pedicles and multiple venous anastomoses. In this concept, arterial flow can be maintained by the reverse flow of distal anastomosis when there is difficulty with the proximal anastomosis. And venous flow can be preserved by deep and superficial vein anastomosis. This concept has various advantages including preserving patency of the pedicle in chronic vasculopathy or trauma cases and maintaining the arterial flow by the reverse flow of distal anastomosis and can improve the free flap survival by a two vascular anastomosis system.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.759-767
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• 2014

Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권5호
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• pp.458-463
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• 2006

방사선골괴사증은 발병율이 낮아지고는 있으나 발병시 여전히 치료가 힘든 합병증이다. 방사선골괴사증의 병인 및 치료에 대해서는 논쟁이 계속되고 있으나 그 과정에서 새로운 시도와 개발이 진행되고 있어 고무적이라 할 수 있다. 방사선골괴사증은 치유기전의 문제이며 임의적으로 발병할 수 있어 완전한 예방은 불가능하다. 그러나 앞서 언급한 위험요소들을 주의깊게 인지하고 방사선 치료 전 예방적인 치과치료, 조심스런 발치 및 발치 후 충분한 치유기간, 구강 위생 교육, 예방적 항생제의 사용 등을 철저히 함으로써 발병 위험을 줄일 수 있다. 이 질환은 발병시 자발적으로 치유되지 않으며 보존적 치료로 개선이 되지 않을 시에는 적절한 외과적 개입이 필수적이다. 외과적 개입시에는 방사선골괴사 병소뿐 아니라 환자의 나이, 건강상태 및 환자의 바램, 암종의 예후등도 함께 고려해야 한다. 본 교실에서는 2명의 방사선골괴사증 환자에 대해 비록 장기간의 치료가 시행되었지만 비교적 양호한 치유결과를 얻을 수 있었기에 문헌고찰과 함께 보고하는 바이다.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.461-466
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• 2005

Despite the major advances in the microvascular surgery with success rates of up to 98%, failure and vascular complications still remain even in the experienced hands. Failure of blood to flow across an anastomosis is usually caused by three factors: (1) Technical errors; (2) Undetected damage more proximally or via vasospasm; or (3) A clot or a thrombus. The success of a microvascular surgery depends on the severity of the vascular injury and, proper debridement of an injured vessel, and the failure rate of microvascular anastomosis in cases of trauma is higher as the thrombogenic possibility is increased by the endothelial damage. From January to November in 2003, 460 patients were underwent microvascular surgery(270 replantations and 190 free flap transfers) and re-operations were performed in 15 cases. Cases were reviewed by clinical and operative records. In these cases, causes of post-operative circulation insufficiency were identified as 9 vascular spasms and 6 thromboses at the previous anastomotic site. The average of re-operative success rate was 73%(60% in replantations and 100% in free flaps). In conclusion, through precise postoperative monitoring and assessment, immediate surgical re-exploration could be performed when a vascular complication is suspicious, the success rate of microvascular surgery would be increased more.

• Archives of Plastic Surgery
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• 제35권5호
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• pp.615-618
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• 2008

Purpose: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge. The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. Methods: A 27-year-old male patient was referred to our institution with a $7{\times}8cm$ sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. Results: Split-thickness skin grafting with 1 : 1.5 mesh was successfully taken. Conclusion: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.

• 대한족부족관절학회지
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• 제24권1호
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• pp.25-30
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• 2020

Purpose: Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages. Materials and Methods: From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo-Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation. Results: The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%). Conclusion: Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.

• Advances in pediatric surgery
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• 제19권2호
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• pp.98-107
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• 2013

Debates exist about the appropriate treatment for pancreatic trauma in children. We intended to examine the safety of the operation of pancreatic trauma in children. This is a retrospective study of 13 patients, younger than 15, who underwent surgery for pancreatic trauma, between 1993 and 2011 in Seoul National University Children's Hospital. Medical records were reviewed for mechanism of trauma, clinical characteristics, radiological findings, operation and outcomes. Organ injury scaling from the AAST (American Association for Surgery of Trauma) was used. All injuries were caused by blunt trauma. Patients with grade III, IV, and those who were difficult to distinguish grade II from IV, underwent surgery due to severe peritonitis. Three patients with grade II were operated for reasons of mesenteric bleeding, tumor rupture of the pancreas, and progression of peritonitis. Distal pancreatectomy was performed in 10 patients and subtotal pancreatectomy and pylorus preserving pancreaticoduodenectomy in 1 patient each. The remaining one underwent surgical debridement because of severe adhesions. The location of injury, before and after operation, coincided in 83.3%. The degree of injury, before and after the operation, was identical in all the patients except for those who were difficult to tell apart grade II from grade IV, and those cannot be graded due to severe adhesion. Postoperative complications occurred in 23.1%, which improved with conservative treatment. Patients were discharged at mean postoperative 12(range 8~42) days. Even though patients with complications took longer in time from diagnosis to operation, time of trauma to operation and hospital stay, this difference was not significant. In conclusion, When pancreatic duct injury is present, or patient shows deterioration of clinical manifestation without evidence of definite duct injury, or trauma is accompanied by other organ injury or tumor rupture, operative management is advisable, and we believe it is a safe and feasible method of treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권2호
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• pp.150-154
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• 2020

We present a case of osteoradionecrosis treated with leukocyte- and platelet-rich fibrin (LPRF) and surgery and followed up with clinical and tomographic investigations. A 65-year-old woman presented with pain in the posterior region of the right palate. Her medical history included cardiovascular disease and squamous cell carcinoma in the anterior region of the floor of the mouth that had been treated with intensity-modulated radiation therapy. Measurements of isodose curves showed a full dosage of 6,462.6 cGy in the anterior mandibular region, whereas that in the posterior region on the right side of the maxilla reached 5,708.1 cGy. Osteotomy was performed using rotary instruments, and debridement and placement of two LPRF membranes were also carried out. New gum tissue with no bone exposure was noted 14 days postoperatively. Tissue repair was complete, and the patient had no further complaints. During a 39-month follow-up period, the oral mucosa remained intact, and the patient was rehabilitated with a new upper denture. Since there is no consensus regarding the best protocol to treat osteoradionecrosis, LPRF might be an interesting adjuvant to a surgical approach. The use of LPRF is simple and reduces operational costs, time of handling, probability of technical failure, and associated morbidities for patients with osteoradionecrosis.