• Journal of Periodontal and Implant Science
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• 제30권2호
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• pp.229-242
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• 2000

The purpose of this study was to evaluate the effect of fibrin tissue adhesive and porous resorbable calcium carbonate on the periodontal regeneration of the class II furcation defect in dogs. Class II furcation defect was surgically created on the second, third, and fourth premolars bilaterally in the mandibles of six mongrel dogs. The experimental sites were divided into four groups according to the treatment modalities: Control-surgical debridement only; Group I-calcium carbonate grafting; Group II-application of fibrin adhesive only; Group III-application of fibrin adhesive after calcium carbonate grafting. The animals were sacrificed at the 2, 4, and 12 weeks after periodontal surgery and the decalcified specimens were prepared for histological and histometrical examination. The results are as follows : Clinically, there were no inflammatory response in all groups after 2, 4, 12 weeks. In the Control group, junctional epithelium was grown downward to the reference notch. In Group I, graft materials were exfoliated from the defect throughout the experimenta periods andnew bone was seen in the notch area at 4 and 12 week specimens. In Group II, fibrin adhesive was absorbed at 2 week specimens, and connective tissue attachment increased than that of control group. New cementum and new bone were seen above the notch area. In Group III, the graft material was maintained in the defect throughout the experimental period and inducing the amount of periodontal tissue regeneration was higher than other groups. These results suggest that the use of fibrin tissue adhesive in conjunction with porous resorbable calcium carbonate would improves the stability of graft material and inhibit the epithelial down growth and make it be a feasible method for periodontal regeneration.

• 대한족부족관절학회지
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• 제13권1호
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• pp.23-27
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• 2009

Purpose: The purpose of this study was to evaluate the clinical outcome of neglected Achilles tendon rupture treated with reconstruction and augmentation with flexor hallucis longus (FHL) tendon using one incision technique. Materials and Methods: Between July 2006 and March 2008, eleven patients with neglected Achilles tendon rupture received surgical treatment. Through one incision technique, augmentation with auto FHL tendon transfer was performed using a Bio-Interference screw (Arthrex, Naples, FL) and followed by V-Y advancement (5 cases) or gastronemius fascial turn-down flap procedure (6 cases). After mean follow up of 20.7 months (range, 11.8-33.3 weeks), clinical outcomes were evaluated with Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, 10 repetitive double heel raise test, 10 repetitive single heel raise test and subjective satisfaction. Results: The length of the gap after debridement was $5.4{\pm}2.0$ cm. The VAS improved from $4.1{\pm}0.9$ to $1.5{\pm}0.8$ at last follow up (p<0.05). The AOFAS score increased from $38.9{\pm}12.2$ to $91.5{\pm}8.9$ at last follow up (p<0.05). Eight patients were satisfied with excellent results and three were satisfied with good results. All patients were able to perform 10 repetitive double heel raise and nine out of eleven patients were able to perform 10 repetitive single heel raise at last follow up. There were no complications including deep infection or re-rupture. Conclusion: Augmentation with FHL tendon transfer and reconstruction with V-Y advancement or turn-down flap through one incision technique appeared to be effective and safe. This technique is recommendable for the treatment of neglected Achilles tendon rupture.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.601-607
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• 2015

Background Autologous or implant-based breast reconstruction after nipple-sparing mastectomy is increasingly preferred worldwide as a breast cancer treatment option. However, postoperative nipple-areola complex (NAC) necrosis is the most significant complication of nipple-sparing mastectomy. The purpose of our study was to identify the risk factors for NAC necrosis, and to describe the use of our skin-banking technique as a solution. Methods We reviewed cases of immediate autologous breast reconstruction after nipple-sparing mastectomy at our institution between June 2005 and January 2014. The patients' data were reviewed and the risk of NAC necrosis was analyzed based on correlations between patient variables and NAC necrosis. Moreover, data pertaining to five high-risk patients who underwent the donor skin-banking procedure were included in the analysis. Results Eighty-five patients underwent immediate autologous breast reconstruction after nipple-sparing mastectomy during the study period. Partial or total NAC necrosis occurred in 36 patients (43.4%). Univariate analysis and binary regression modeling found that body mass index, smoking history, radiation therapy, and mastectomy volume were significantly associated with NAC necrosis. Of the 36 cases of NAC necrosis, 31 were resolved with dressing changes, debridement, or skin grafting. The other five high-risk patients underwent our prophylactic skin-banking technique during breast reconstruction surgery. Conclusions NAC necrosis is common in patients with multiple risk factors. The use of the skin-banking technique in immediate autologous breast reconstruction is an attractive option for high-risk patients. Banked skin can be used in such cases without requiring additional donor tissue, with good results in terms of aesthetic and reconstructive outcomes.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.71-74
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• 2010

Purpose: Nowadays spinal cord stimulator is frequently used for the patients diagnosed as complex regional pain syndrome. The lead is placed above the spinal cord and connected to the stimulation generator, which is mostly placed in the subcutaneous layer of the abdomen. When the complication occurs in the generator inserted site, such as infection or generator exposure, replacement of the new generator to another site or pocket of the abdomen would be the classical choice. The objective of our study is to present our experience of the effective replacement of the existing stimulation generator from subcutaneous layer to another layer in same site after the wound infection at inexpensive cost and avoidance of new scar formation. Methods: A 50-year-old man who was diagnosed as complex regional pain syndrome after traffic accident received spinal cord stimulator, Synergy$^{(R)}$ (Medtronic, Minneapolis, USA) insertion 1 month ago by anesthetist. The patient was referred to our department for wound infection management. The patient was presented with erythema, swelling, thick discharge and wound disruption in the left upper quadrant of the abdomen. After surgical debridement of the capsule, the existing generator replacement beneath the anterior layer of rectus sheath was performed after sterilization by alcohol. Results: Patient's postoperative course was uneventful without any complication and had no evidence of infection for 3 months follow-up period. Conclusion: Replacement of existing spinal cord stimulation generator after sterilization between the anterior layer of rectus sheath and rectus abdominis muscle in the abdomen will be an alternative treatment in wound infection of stimulator generator.

• Journal of Chest Surgery
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• 제29권2호
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• pp.239-243
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• 1996

역행성 호흡 운동을 방지 하고 종격동내의 구조물을 보호하는 흥곽의 기능을 고려해야 하기 때문에 흉벽 재건은 임상적으로 간단하지가 않다. 영남대 학교병원 흉부외과에서는 교통사고로 좌측 전흉부의 전층에 걸친 흉벽 결손을 가진 37세 남자 환자에게 흉벽 재건술을 시행하였다. 외상직후 변연 절제와 지혈을 위해 1차 응급 수술이 시행되었고, 수술후25일째 흉벽 재건을 위한 2차수술을 시행하였다. 흉벽재건에는 흉배동맥을 피판경으로한 광배근피판과 좌측 대퇴부로부터 피부이식이 이용되었다. 흉벽 재건 수술후 인공호흡기 보조없이 자가 호흡이 가능하였으며, 수술후 3개월에 시행한 폐기능 검사(FVC, FEV1.0)는 예측치의 80%로 나타났다. 광배근피판을 이용한 흉벽 재건의 수술후 경과는 생리학적, 해부학적 그리고 미학적으로도 만족할만 하였다.

• Archives of Reconstructive Microsurgery
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• 제18권1호
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• pp.35-39
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• 2009

Purpose: Various techniques have been attempted for design of the flaps. However, there are some disadvantages. They have thin, pliable, and two dimensional methods. The aim of this study is to report usefulness of polyurethane foam dressing materials for three dimensional design of the digital island flap. Methods: From June of 2007 to september of 2008, 10 patients received digital island flap surgery for soft tissue defect of the finger. After minimal debridement of the wound, size and shape of the defect were measured using polyurethane foam. We used Medifoam-$5^{(R)}$ And then, designed this inset the wound. The flap was designed on the donor site with a arterial pedicle as the central axis according to size and shape. A full thickness skin graft from the groin is applied on the flap donor defect and secured with a tieover bolster dressing. Results: Reviewing sizes of the flaps, the length and width of flaps ranged from 1.5 to 3.3 cm and 1.0 to 2.5 cm. The PACS(Picture Archiving Communication System) program allows identification of the donor depth of finger. The distance for the soft tissue ranged from 4.3 mm to 6.7 mm. Mean depth of donor site was 5.3${\pm}$0.6 mm. Also, the thickness of Medifoam-$5^{(R)}$ ranged nearly 5 mm. On flap insetting, full-thickness skin graft was necessary. We did not experience any problems in the recipient site size either, regardless of the extended flaps. Conclusion: Polyurethane foam has many advantages over the more conventional templates. Refinements in flap design and surgical technique resulted in favorable functional and cosmetic results. Especially, for beginner, Polyurethane foam dressing material is a simple and safe tool and therefore is an excellent choice for design of the island flap.

• Clinics in Shoulder and Elbow
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• 제8권2호
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• pp.63-67
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• 2005

이상의 보고에서 임상의 들은 청소년기 운동선수에서 주관절 동통이 있을 때 반드시 골연골염에 대한 주의가 필요하며 비록 치료방법 및 예후에 있어 아직도 많은 논쟁은 있으나 초기발견이 매우 중요한 예후결정의 요소가 된다는 것을 주지하여야 한다. 많은 경우에 있어 초기에 보존적 치료시 증상의 호전 및 기능의 회복 그리고 운동으로의 복귀가 가능하다. 그러나 보존적 치료로 호전이 되지 않을 때 수술적 치료를 고려해야 하는데 이 때 수술적 치료 선택에 매우 신중해야 하며 수술적 적응증 역시 반드시 숙지하여야 한다.

• 대한두경부종양학회지
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• 제29권2호
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• pp.65-67
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• 2013

Osteomyelitis is an infection of bone or bone marrow, caused by pyogenic bacteria or mycobacterium. Osteomyelitis can be acute or chronic, inflammatory process of the bone and its structures. Chronic osteomyelitis will result in variable sclerosis and deformity of the affected bone. With an infection of the bone, the subsequent inflammatory response will elevate this overlying periosteum, leading to a loss of the nourishing vasculature, vascular thrombosis, and bone necrosis, resulting occasionally in formation of sequestra. These become areas that are more resistant to systemic antibiotic therapy due to lack of the normal Havesian canals that are blocked by scar tissue. At this aspect, not only systemic antibiotic therapy, but also surgical debridement maybe required to remove the affected bone and prevent disease propagation to adjacent areas. We experienced a patient who diagnosed tongue cancer and underwent wide partial glossectomy few years before, with an ulcerative lesion around right retromolar trigon. We diagnosed cancer recurrence because PET indicated hot uptake on mandible which was nearby previous tongue tumor site. The patient received hemiglossectomy via paramedian mandibulotomy, partial mandibulectomy and fibula osteocutaneous free flap reconstruction. But final diagnosis was mandible osteomyelitis on pathology report. Here, we present the case with a review of the related literatures.

• Journal of Periodontal and Implant Science
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• 제38권3호
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• pp.429-436
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• 2008

Purpose: The goal of periodontal regenerative therapy is to replace bone, cementum, and periodontal ligament on a previously diseased root surface, which has suffered the loss of these supporting structures. To accomplish the regeneration, a number of surgical procedures have been advocated throughout the years. There seems to be a potential for some spontaneous periodontal tissue regeneration in the bottom of periodontal defect following open flap debridement alone. The aim of this study was to analyse the radiographic bone changes over 2-year after flap operation. Material and Methods: Patients attending the department of periodontics of Kyungpook National University Hospital were studied. Patients had clinical and radiographic evidence of infrabony defect(s). forty two sites of 33 patients aged 26 to 65 (mean age 45.5) were treated by flap operation with or without osseous surgery. Baseline and over 2-year follow-up radiographs were collected and evaluated for this study. Radiographic assessment includes a bone fill, bone crest change, defect resolution, and % of defect resolution. Pre- and post-treatment differences between variables (maxilla and mandible, gender, defect depth, defect angle) using the paired t-test were examined. Result: We observed 0.74 mm of bone fill, 0.66 mm of crestal resorption, 1.40 mm of defect resolution, and 27% of percentage of defect resolution. Mandible, women, deeper initial defect depth, narrower initial defect angle showed greater bone fill, defect resolution, and % of defect resolution. Conclusion: The results of this study suggest that the use of flap operation did enhance the outcome in terms of radiographically detectable bone fill. Both treatment resulted in some loss of crestal bone height.

• Journal of Periodontal and Implant Science
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• 제31권2호
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• pp.421-436
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• 2001

Transforming growth $factor-{\beta}(TGF-{\beta})$is a polypeptide biologic mediator considered to play a role in promoting bone formation in bony defect area. The purpose of this study was to examine the effect of $TGF-{\beta}$ to the periodontal regeneration of class III furcation defect in dogs. Classs III furcation defects were surgically created on the third and the fourth premolars bilaterally in the mandibles of eight mongrel dogs. Experimental periodontitis were induced by placing small cotton pellets into the created defects for 3 weeks. Experimental sites were divided into 4 groups according to the treatment modalities: Group I-Surgical debridement only; Group II-allogenic demineralized freeze dried bone grafting; Group III-allogenic demineralized freeze dried bone soaked in $TGF-{\beta}(4ng/10{\mu}l)$grafting; Group IV-allogenic demineralized freeze dried bone soaked in $TGF-{\beta}(20ng/10{\mu}l)$ grafting. The animals were sacrificed in the 8th week after periodontal surgery and the decalcified and undecalcified specimens were for histological and histometric examination. Although no significant differences was seen in the length of epitheial growth and connective attachment, group III showed the least apical migration among treatment groups. The amount of bone repair was significantly greater in group III, IV compared to group I and group II. New attachment formation was significantly greater in group III and group IV compared to group I and group II. These results suggest the allogenic demineralized freeze dried bone with $TGF-{\beta}$ in class III furcation defect has the potentiality of promoting alveolar bone formation and periodontal regeneration.