미세혈관문합때 염산 ticlopidine의 항혈전 효과

전종완,강진성 啓明大學校 醫科大學 1998 계명의대학술지 Vol.7 No.1

Recent progress in microvascular surgery has opened new clinical possibilities in tissue transplantation and replantation by direct anastomoses of vessels less than one mm in external diameter. However, a large obstacle still remains in microsurgery, that is, occlusion of the anastomosis site by thormbosis which is mainly composed of platelets. Many anticoagulants and topical vasodilatic agents such as heparin, aspirin, persantin, coumarin, magnesium sulfate have been used to solve this problem. Heparin inhibits the conversion of prothrombin to thrombin and Factors V, IX, XI. Aspirin inhibits collagen-induced platelet aggregation wheras the primary action of persantin is to inhibit ADP-induced platelet aggregation and release reaction of platelets, Currently, ticlopidine-HCl which is known to inhibit the platelet aggregation to ADP, collagen and epinephrine, is widely in use as and effective anticoagulant for the patients of atherosclerosis, hemodialysis and subarachnoid hemorrhage. Animal study was carried out for the tichlopidine-HCl to investigate the possibility of this agent to be used as a choice of anticoagulant in microvascular surgery. One hundred and twenty rats were divided into 3 groups Group A was the control groups. Aspirn and persantin were given orally in group B. Ticlopidine-HCl was given orally in group C. A femoral artery in one inguinal region and one femoral vein in the other side were severed and then were anastomosed with 10-0 nylon. The wounds were closed with 4 ㅡ0 black silk. The patency was confirmed grossly and microscopically at 20 minutes, 3 days and 3 weeks after anastomoses. The patency rates were as follows: At 20 minutes after anastomoses, patency rates of arteries and veins were 100% in all groups. At 3 days after anastomoses, in the control group the patency rates of arteries and veins 95% and 85% respectively. Group B (aspirin-prersantin) were 100% and 90% each. Compared with these, the patency rates of group C (ticlopidine) were better, all of the arteries and veins were patent. At 3 weeks after anastomoses, the patency rates of arteries were 90% and veins were 80% in the control group. Arteries were 95% and veins were 90% in group B, whereas arteries were100% and veins were 95% in group C. Therefore, it is concluded that the ticlopidine can be used in microvasular surgery as and anticoagulant of choice.

흰쥐에서 외상성 신경종예방에 대한 연구

김승한,전종완,강진성,김찬환,정재홍 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.5

Prevention of traumatic neuroma has been the subject of extensive since early in the nineteenth century. Odier described this enlargement which develops at the distal end of proximal segments of peripheral nerves after partial or complete transsection. However, there seems to be no unanimity of opinion regarding the treatments of nerve at the time of severed injury. Ligating the proximal end of such a nerve, implanting it into muscle or born, resecting it, injecting it with a sclerosing agent or capping it with a silicone cuff are commonly used at the present time. Petropoulos introduced a nitrogen mustard as a sclerosing agent to prevent the neuroma. Tupper and Booth reported funniculecomy and epincurial ligation with satisfactory result obtained in many patients. However there is no commonly acceptable method. The authers carried out animal studys to find out the better operative procedure to prevent the traumatic neuroma. The sciatic nerve of the rat was exposed under the operating microscope and resected about 1㎝ from the end of the divied portion. Eighty rats were divided into 4 groups by a technique to differentiate management of the severed proximal nerve ends, that is, a control group, a nitrogen mustard injected group, a epineurial ligation group and a combined group(epineurial ligation following the injection of nitrogen mustard). The wound was closed with 4-0 black silk. Three months later, the wound was reopened and the presence of neuroma was observed grossly and microscopically. The results were as follows : 1) The proximal portion of the severed nerve in the combined group were tapered to the end and neuromas were hardly seen grossly. 2) The diameters of minifascicle and the numbers of nerve fibers of the combined group were the smallest and fewest compared with others(p<0.05). 3) The combined group took only 2 to 3 minutes more than the others, but it was better method. The authors found the superiority of this latter method, epineurial ligation following nitrogen mustard injection in the severed end, compaired with the others.

미세혈관문합때 염산 Ticlopidine의 항혈전 효과

강진성,전종완,한기환,정재홍,김선영 大韓成形外科學會 1987 Archives of Plastic Surgery Vol.14 No.1

Recent progress in microvascular surgery has opened new clinical possibilities in tissue transplantation and replantation by direct anastomoses of vessels less than one mm in external diameter. However, a large obstacle still remains in microsurgery, that is, occlusion of the anastomosis site by thrombosis which is mainly composed of platelets. Many anticoagulants and topical vasodilatic agents such as heparin, aspirin, persantin, coumarin and magnesium sulfate have been used to solve this problem. Heparin inhibits the conversion of prothrombin to thrombin and Factos Ⅴ,Ⅸ,--, Aspirin inhibits collagen-induced platelet aggregation whereas the primary action of persantin is to inhibit ADP-induced platelet aggregation and the release reaction of platelets. Currently, ticlopidine-HCI which is known to inhibit the platelet aggregation to ADP, collagen and epinephrine, is widely in use as an effective anticoagulant for the patients of atherosclerosis, hemodialysis, and subarachoid hemorrhage. Animal study was carried out for the ticlopidine-HCI to investigate the possibility of this agent to be used as a choice of anticoagulant in microvascular surgery. One hundred and twenty rats were divided into 3 groups. Group A was the control group. Aspirin and persantin were given orally in group B. Ticlopidine-HCI was given orally in group C. A femoral artery in one inguinal region and one femoral vein in the other side were severed and then were anastomosed with 10-0 nylon. The wounds were closed with 4-0 black silk. The patency was confirmed grossly and microscopically at 20 minutes, 3 days, and 3 weeks after anastomoses. The patency rates were as follows: 1. At 20 minutes after anstomoses, patency rates of arteries and veins were 100% in all groups. 2. At 3 days after anastomoses, in the control group the patency rates of arteries and veins were 95% and 85% respectively. Group B (aspirin-persantin)were 100% and 90% each. Compared with these, the patency rates of group C (ticlopidine) were better, all of the arteries and veins were patent. 3. At 3 weeks after anastomoses, the patency rates of arteries were 90% and veins were 80% in the control group. Arteries were 95% and veins were 90% in group B, whereas arteries were 100% and veins were 95% in group. C. Therefore, it is concluded that the ticlopidine can be used in microvasular surgery as an anticoagulant of choice.

액취증 수술중 한선절제술에 대한 장기추적조사

강진성,전종완,한기환,이동훈 大韓成形外科學會 1987 Archives of Plastic Surgery Vol.14 No.4

We have no doubt the fundamental way solving osmidrosis is surgical excision, and various operative technique have been introduced. Resection of the sweat glandular layer in the axillae is attactive because of certain advantages. Sensation and sweating begins to return between 6 weeks and 3 years postoperatively. For this reason, several previous reports on the resection procedure of sweat glands were inadequate because the period of follow up were too short. A follow up study using the questionnaire was done from 36 to 60 months postoperatively in the 24 cases of the patients and the following results were obtained: 1) There was no more foul odor from axillae. 2) Although there was a remarkable decrease in axillary sweating, moisture was preserved because sebaceous and eccrine glands were partially retained. 3) Axillary hairs were scanty, compared to the preoperative condition. 4) The operative scar was invisible 5) There was no motion limitation of the axillae. 6) All the patients were satisfied with the results of the operation. We can recommend the superiority of this resection procedure of sweat glands above other surgical technique with the above results.