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Dongkyung Seo,Yutaka Dannoura,Riku Ishii,Keisuke Tada,Katsumi Horiuchi 대한수부외과학회 2022 대한수부외과학회지 Vol.27 No.1
Distal bypass combined with a free flap is a frequent surgical option for ischemic ulcers of the lower extremities. Here, we describe a patient in whom there was a change in the direction of blood flow in a distal bypass graft. A 68-year-old male patient with an ischemic ulcer on his left heel was referred to our facility by a local dermatology clinic. Surgical revascularization was performed between the popliteal artery and the dorsalis pedis artery using an ipsilateral great saphenous vein as the graft vessel. The wound site did not heal postoperatively, so it was covered using a free latissimus dorsi muscle flap. At the same time, the thoracodorsal artery was anastomosed to the bypass graft in an end-to-side manner to serve as a nutrient vessel. Initially, blood flow into the thoracodorsal artery from the bypass graft was via the popliteal artery. However, after occlusion of the proximal anastomotic site of the bypass graft, blood flow into the thoracodorsal artery from the bypass graft was via the dorsalis pedis artery, which was the distal anastomotic site. The change in direction of blood flow might have been the result of an increase in blood flow in the collateral vessels in the ischemic lower leg, which eventually overwhelmed the blood flow in the bypass graft.
Free Flap Salvage in the Ischemic Foot: A Case Report
Dongkyung Seo,Yutaka Dannnoura,Riku Ishii,Keisuke Tada,Kunihiro Kawashima,Tetsunori Yoshida,Katsumi Horiuchi 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.5
We performed distal bypass and free flap transfer in a single-stage operation to repair an extensive soft tissue defect in an ischemic foot of an 84-year-old woman. The nutrient artery of the free flap was anastomosed to the bypass graft in an end-to-side manner. Subsequently, the bypass graft became occluded on several occasions. Although intravascular and surgical interventions were performed each time, the bypass graft eventually became completely occluded. However, despite late occlusion of the nutrient artery, the free flap has remained viable and the patient is ambulatory. The time required for a transplanted free flap to become completely viable without a nutrient artery is likely longer for an ischemic foot compared with a healthy foot. However, the exact period of time required is not known. A period of month was required in our patient. We report this case to help clarify the process by which a free flap becomes viable when applied to an ischemic foot.
서동경(Dongkyung Seo),카와시마 쿠니히로(Kunihiro Kawashima),호리우치 카츠미(Katsumi Horiuchi),요시다 테츠노리(Tetsunori Yoshida) 대한두경부종양학회 2021 대한두경부 종양학회지 Vol.37 No.1
Schwannomas are benign tumors of neuroectodermal origin and can be found in any part of the body. Although schwannomas are common in the head and neck region, they are rare in the auricle. Auricular schwannomas are rarely symptomatic but the mass itself or a surgical procedure to remove it may disrupt the complicated structure of the auricle. We report a rare case of auricular schwannoma with a literature review and describe the surgical technique used in this case.
정경환(Kyeonghwan Jeong),정동경(Dongkyung Jung),박정규(Jeongkyu Park),최현우(Hyeonwoo Choi),서정민(Jeongmin Seo) 한국방사선학회 2020 한국방사선학회 논문지 Vol.14 No.5
의료기술 발전으로 인해 의료기기 사용이 증가하는 추세이다. 의료기기 중 이식 및 치료를 위해 인체 내에 사용되는 경우가 많다. 그러므로 의료기관에서는 감염 예방을 위해 의료기기 형태와 재질에 따른 멸균법들이 다양하게 적용되고 있다. 뼈 이식에서 수산화인화석 재료가 가장 많이 보급되어 있다. 소형 의료기기에 알맞은 비전리방사선 중 고출력에너지를 가진 Q-switch Nd:YAG 레이저를 이용한 멸균법을 제시하고자 한다. 대장균과 충치균을 수산화인화석 디스크에 오염시켜, 출력1.5 W, 파장은 각각 자외선(266, 355 nm), 가시광선(532 nm), 적외선(1,064 nm), 1과 10 펄스를 각각 조사하였다, 본 연구에서 자외선 파장인 1.5 W, 266 nm, 10 pulse에서 멸균력을 가장 이상적으로 보여주었다. 다른 파장대인 적외선, 가시광선은 소극적 멸균력을 보였으며, 자외선 A와 자외선 C는 펄스에 따라 멸균 차이를 보였다. 레이저 멸균에서 파장 및 펄스에 따라 멸균 차이를 알 수 있었다. The use of medical devices is increasing due to the development of medical technology. Among medical devices, it is often used in the human body for graft and treatment. Therefore, in medical institutions, various sterilization methods according to the type and material of medical devices are applied to prevent infection. Hydrophosphite (HA) materials are the most popular in bone grafts. We would like to present a sterilization method using Q-switch Nd:YAG laser with high output energy among non-ionizing radiation suitable for small medical devices. In this study, sterilization power was most ideally shown at UV wavelengths of 1.5 W, 266 nm, and 10 pulses. Different wavelength bands; infrared and visible light; showed passive sterilization, and ultraviolet A and C showed differences in sterilization according to the pulse. In laser sterilization were differences that found according to the wavelength bands and pulses.