• Journal of Chest Surgery
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• 제16권3호
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• pp.342-348
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• 1983

The Fontan principle of redirecting systemic venous blood into the pulmonary arteries via a conduit was initially proposed for Tricuspid Atresia, but it and its modifications have now gained a much wider application than initially intended. From September 1978 to July 1983, Atriopulmonary anastomosis has been performed in 23 patients, 2 months to 19 years of age, Seoul National University Hospital. The diagnoses were Tricuspid Atresia [TA] in 13, Univentricular Heart [UVH] in 9 and one case of Double Outlet of Right Ventricle [DORV]. Previous procedures included two Glenn shunts and one Blalock-Taussl8 shunt. Among these 23 patients, 10 patients had Right Atrial to Pulmonary Artery conduit, with a valve in 7 and without in 3. The remaining 13 patients had direct anastomosis between RA to PA. There were 14 early deaths, 7 of 13 TA patients, 6 of 9 UVH patients and one DORV, and the total hospital mortality was 60%. But there were no later deaths, 9 of these 23 patients survived operation and are presently alive. The Fontan procedure can be done with an acceptable low mortality with good functional results for Tricuspid Atresia and other complex lesion in foreign hospital, but till now our results revealed much higher risks. For our good operative results and effective patients selection, we must clarify the exact condition of pulmonary arterial system and accumulate much more experiences and technique.

• Archives of Reconstructive Microsurgery
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• 제14권2호
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• pp.112-116
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• 2005

The auricle is easy to be amputated in the face due to its protruding position. When facial parts are amputated, the mechanism of injury usually involves some form of avulsion, which damages these fragile vessels over a distance and renders them unsuitable for anastomosis. Replantation of the ear remains a challenging problem because of the tiny vessels and the paucity of adequate veins for anastomosis. Reattachment as a composite graft of the total or subtotal amputated ear is unreliable. Microsurgical replantation can be performed in a minority of cases because of technical difficulties and long operation time. In this article, the authors report two case of a successful ear replantation of completely amputated auricle. Only one artery and one vein were anastomosed in first case. In the other case one artery was anastomosed without vein. Instead of venous repair, multiple incision was done with leech application therapy. and the outcome was successful. In spite of the technical difficulties and long operation time, microsurgical replantation of amputated ear is better than other reconstructive method or reattachment without microsurgery.

• Journal of Chest Surgery
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• 제39권11호
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• pp.861-863
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• 2006

우리는 만성 신부전 환자에서 혈액투석을 위한 상완동맥-두정맥단락술(brachiocephalic arteriovenous shunt)을 시행한 후 최근 빠르게 성장하는 아주 거대한 정맥의 동맥류 1예를 경험하였기에 보고하는 바이다. 환자는 48세 남자로 7년 전 본원에서 동정맥단락술을 시행한 후 혈액투석을 해왔으나 좌측 상완의 정맥을 따라 점점 성장하는 정맥의 동맥류와 박동성 통증으로 혈액투석을 지속할 수 없었다. 내원 1개월 전 혈액투석을 지속하기 위해 타 의료기관에서 우측 손목관절부에 새로운 동정맥루를 조성하여 혈액 투석을 하고 있었다. 동정맥류가 너무 거대하여 동정맥단락 재건술은 시도하지 않았으며 수술은 전신마취하에서 동정맥루를 결찰하고 확장된 정맥의 동맥류를 모두 제거하였다. 환자의 술 후 경과는 양호하였다.

• Journal of Chest Surgery
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• 제30권5호
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• pp.493-500
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• 1997

심방 이성체를 가지는 복합 심장 기형 환자에서 n시행시 간정맥 환류의 형태를 분석하고 전대정맥폐단 락술시 어떠한 도움을 줄 수 있는지를 평가하여 bnl의 임상적 유용성을 알아보고 자 하였다. 22명의 이성체(좌이성체 9명,우이성체 13명)를 가진 복합 심장 기형 환자를 대상으로 m을 시행하여 간 정맥이 심방으로 환류되는 개구(opening)의 수와 위치, 하대정맥과의 연결 등을 조사하였다. 전대정맥폐단락 (total cavopulmonary shunt)을 시행한 6명의 환자에서 간정맥환류에 대한 수술 방법과 수술 후 체동맥 산소 분 압을 비교하였다. 9명의 모든 좌이성체 .환자에서 하대정맥 단절이 있었고 간정맥은 심방으로 직접 연결되었다. 이 중 1예에 서 간정맥이 두개의 개구를 통하여 땅측 심방으로 각각 환류되었다. 13명의 우이성체 환자중 1예에서는 모든 간 정맥은 하나의 개구를 통하여 하대 정맥과는 분리되어 심방으로 연결되었다. 4예에서는 일부의 간 정맥은 하대정맥과 연결되어 심방으로 들어갔고 일부의 간정맥은 직접 심방으로 연결되었다. 전대정맥폐단락 수술 을 시행한 6예 중 심방으로 연결되는 하대정맥 또는 간정맥의 개구가 하나인 경우나 2개 嗤\ulcorner같은 쪽 심방 에 위치한 4예는 심방내 터널 형성에 의해 모든 간정맥에서 환류되는 혈액이 폐순환을 할 수 있게 수술하였 고 수술 1주후 체동맥 산소 포화도는 평균 91.5%였다. 간정맥 또는 하대정맥의 개구가 2개이며 심방의 양측 으로 각각 연결된 2예중 1 예에서는 간정맥의 일부만 폐순환을 할 수 있게 수술하였고 1예는 수술후 로든 간정맥혈이 폐 순환을 거치지 않게 되었다. 이들의 수술 1 주후 체동맥 산소 포화도는 각각 88.6%와 90%였 다. 심방 이성체 환자에서 다양한 간정맥 환류 기형이 자주 동반되며 간정맥 환류 이상을 수술 전에 발견하는 것이 전대정맥폐단락 수술시 간정맥의 폐순환 여부를 결정하는데 도움을 준다. m은 복합 심장 기형을 가 진 이성체 환자에서 간정맥 환류를 고사하는데 유용하다.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.761-765
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• 2013

Background Partially resecting ribs of the recipient site to facilitate easy anastomosis of the internal mammary vessels to free flaps during breast reconstruction can cause chest wall pain or deformities. To avoid this, the intercostal perforating branches of the internal mammary vessels can be used for anastomosis. The purpose of this study was to investigate the location and size of the internal mammary perforator vessels based on clinical intraoperative findings and to determine their reliability as recipient vessels for breast reconstruction with microsurgical free tissue transfer. Methods Twelve patients were preoperatively screened for the presence of internal mammary perforators using Doppler tracing. After modified radical mastectomy was performed by a general surgeon, the location and size of the internal mammary perforator vessels were microscopically investigated. The external diameter was examined using a vessel-measuring gauge from a mechanical coupling device, and the distance from the mid-sternal line to the perforator was also measured. Results The largest arterial perforator averaged 1.5 mm, and the largest venous perforator averaged 2.2 mm. Perforators emerging from the second intercostal space had the largest average external diameter; the second intercostal space also had the largest number of perforators arising from it. The average distance from the mid-sternal line to the perforator was 20.2 mm. Conclusions Internal mammary perforators presented consistent and reliable anatomy in this study. Based on these results, the internal mammary perforators appear to have a suitable diameter for microvascular anastomosis and should be considered as an alternative recipient vessel to the internal mammary vessel.

• Archives of Reconstructive Microsurgery
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• 제18권2호
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• pp.79-83
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• 2009

Purpose: Avulsion injuries of digits have been presented for a long time as complex management problems. Despite of microsurgical advances, it is difficult to achieve good functional results and their management remains somewhat controversial. However, in a finger there are three transverse digital palmar arches. The middle and distal transverse digital palmar arches are consistently large(almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. 39-year-old man presented with avulsion amputation of the ulnar three digits, was operated using only arterial anastomosis with rerouting the transverse digital palmar arches. Methods: Replantation was performed using the artery-only technique. Because the digital arteries had been damaged, we did that the transverse digital palmar arches were transposed in an inverted Y to I configuration and were lengthened with rerouting them for the purpose of direct anastomosis of the digital artery. Venous drainage was provided by an external bleeding method with partial nail excision and external heparin irrigation. Results: The authors conclude that complete avulsion amputations with only soft tissue at the distal to insertion of the flexor digitorum superficialis tendon were salvageable with acceptable functional results. All three fingers survived. Conclusion: With technical advancements, the transverse digital palmar arches play an important role for finger amputation. Three digital palmar arches give us additional treatment option for the finger amputation. In this case, replantation with only-arterial anastomosis was successful and we obtained good aesthetic and functional outcome.

• Archives of Plastic Surgery
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• 제46권3호
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• pp.214-220
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• 2019

Background Microvascular anastomosis patency is adversely affected by local and systemic factors. Impaired intimal recovery and endothelial mechanisms promoting thrombus formation at the anastomotic site are common etiological factors of reduced anastomosis patency. Epigallocatechin gallate (EGCG) is a catechin derivative belonging to the flavonoid subgroup and is present in green tea (Camellia sinensis). This study investigated the effects of EGCG on the structure of vessel tips used in microvascular anastomoses and evaluated its effects on thrombus formation at an anastomotic site. Methods Thirty-six adult male Wistar albino rats were used in the study. The right femoral artery was cut and reanastomosed. The rats were divided into two groups (18 per group) and were systemically administered either EGCG or saline. Each group were then subdivided into three groups, each with six rats. Axial histological sections were taken from segments 1 cm proximal and 1 cm distal to the microvascular anastomosis site on days 5, 10, and 14. Results Thrombus formation was significantly different between the EGCG and control groups on day 5 (P=0.015) but not on days 10 or 14. The mean luminal diameter was significantly greater in the EGCG group on days 5 (P=0.002), 10 (P=0.026), and 14 (P=0.002). Intimal thickening was significantly higher on days 5 (P=0.041) and 10 (P=0.02). Conclusions EGCG showed vasodilatory effects and led to reduced early thrombus formation after microvascular repair. Similar studies on venous anastomoses and random or axial pedunculated skin flaps would also contribute valuable findings relevant to this topic.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.323-328
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• 2021

Background Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. Volumetric measurements and quality-of-life assessments are often performed to assess the effectiveness of LVA, but there is no method that provides information regarding postoperative morphological changes in lymphatic vessels and veins after LVA. Photoacoustic lymphangiography (PAL) is an optical imaging technique that visualizes the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and provides three-dimensional images of superficial lymphatic vessels and the venous system simultaneously. In this study, we performed PAL in lymphedema patients before and after LVA and compared the images to evaluate the effect of LVA. Methods PAL was performed using the PAI-05 system in three patients (one man, two women) with lymphedema, including one primary case and two secondary cases, before LVA. ICG fluorescence lymphography was performed in all cases before PAL. Follow-up PAL was performed between 5 days and 5 months after LVA. Results PAL enabled the simultaneous visualization of clear lymphatic vessels that could not be accurately seen with ICG fluorescence lymphography and veins. We were also able to observe and analyze morphological changes such as the width and the number of lymphatic vessels and veins during the follow-up PAL after LVA. Conclusions By comparing preoperative and postoperative PAL images, it was possible to analyze the morphological changes in lymphatic vessels and veins that occurred after LVA. Our study suggests that PAL would be useful when assessing the effect of LVA surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권5호
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• pp.284-293
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• 2013

Purpose: For reconstruction of craniomaxillofacial defects caused by tumor, trauma, infection etc, free flap transplantation with microvascular surgery is a very useful method. Thrombus formation at the anastomosis site is the major cause of graft failure. 4-Hexylresorcinol (4-HR) is generally known as an antiseptic and antiparasitic agent. This study was conducted in order to evaluate the effect of 4-HR on blood coagulation in vitro. In addition, we investigated thrombus formation and endothelial repair of an injured vessel in an animal model. Methods: In the in vitro experiment, we compared blood coagulation time between the 4-HR treated group and normal blood. Thirty rats were used for in vivo animal experiments. After exposure of the right femoral vein, a micro vessel clamp was placed and the femoral vein was intentionally cut. Microvascular anastomosis was performed on all rats using 10-0 nylon under microscopy. The animals were divided into two groups. In the experimental group (n=15), 4-HR (250 mg/kg) mixed with olive oil (10 mL/kg) was administered per os daily. Animals in the control group (n=15) were given olive oil only. The animals were sacrificed at three days, seven days, and fourteen days after surgery and rat femoral vein samples were taken. Vascular patency and thrombus formation were investigated just before sacrifice. Histologic analysis was performed under a microscope. Results: Results of an in vitro blood coagulation test showed that coagulation time was delayed in the 4-HR treated group. The results obtained from an in vivo 4-HR administered rat model showed that the patency of all experimental groups was better at thirty minutes, seven days, and fourteen days after microvascular anastomosis than that of the control group at seven and fourteen days after anastomosis, and the amount of thrombus in the experimental groups was much less than that of the control group. Endothelial repair was observed in the histologic analysis. Conclusion: Findings of this study demonstrated that blood coagulation was delayed in the vitro 4-HR treated group. In addition, good vascular patency, anti-thrombotic effect, and repair of venous endothelial cells were observed in the vivo 4-HR administered rat group.

• Journal of Chest Surgery
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• 제21권6호
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• pp.990-995
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• 1988

Seventeen cases of vascular injuries treated in Chungnam National University Hospital during the period from Apr. 1980 to Sep. 1988 were reviewed. Common causes of injuries were stab wound, automobile accidents and iatrogenic injuries. Of the 11 arterial injuries, 3 were femoral artery which was the commonest in frequency, the next was 2 cases of subclavian, common carotid, iliac artery. Of the 10 venous injuries, the subclavian vein and internal jugular vein were common in frequency. The most frequent type of injuries was laceration[13 cases in 21]. Vascular reconstruction was done by lateral suture repair in 8 cases, autogenous vein graft in 2, prosthetic vascular graft in 5, direct anastomosis in 1 case. Simple ligation was done in 5 cases. There was 1 case of visual field defect as a sequelae in right common carotid artery transaction and 1 case of mortality.