The survival of skin flap has vital importance in plastic surgery. Many clinical and experimental researches have been carried out to increase the survival of skin flap. As a result of these researches, many drugs have been used clinically and experimentally for increasing the survival of skin flap, and prostaglandin E1 is known to be used for improving peripheral circulatory disturbance. The pharmacophysiologic mechanisms of the effect of prostaglandin E1 are 1) increasing blood flow by dilatation of smooth muscle of small sized vessels, 2) inhibition of aggregation of platelets, 3) increasing arteriolar blood flow by improving fluidity of erythrocytes, 4) preclusion of free-radical formation, 5) decreasing the endothelial cell damage by down- regulation of sensitivity for eosinophils, 6) making the endothelial cell be refractory to adrenergic stimulation, and 7) promotion of secretion of erythropoietin in the kidney. In this terms, in order to validate effectiveness of preoperative administration of prostaglandin E1 as a pharmacological flap delay, following experimental study was performed. Forty male Sprague-Dawley rats were divided into 4 groups and caudally based 2x8 cmsized flap was elevated on dorsal surface. In group 1, normal saline (0.25 ml/kg) was injected intraperitoneally as control, in group 2, 1 microgram/kg of prostaglandin E1 was injected intraperitoneally for preoperative seven days, in group 3, 1 microgram/kg of prostaglandin E1 was injected intraperitoneally for seven preoperative days, and in group 4, 1 microgram/kg of prostaglandin E1 was injected intraperitoneally for seven days preoperatively and for seven postoperative days. On the seventh postoperative day, the animals were sacrificed and the flap survival area was measured. The following results were obtained. 1. On the seventh postoperative day, the flap survival rates of group 2, 3, 4 were higher than that of group 1 with a statistical significance. 2. On the seventh postoperative day, the flap survival rate of group 3 was higher than group 2, but there was no statistical significance. 3. On the seventh postoperative day, the flap survival rate of group 4 was higher than that of group 2 and 3 with a statistical significance.In conclusion, preoperative administrations of prostaglandin E1 increase flap survival equally as when it is administrated postoperatively, and the improvement in flap survival can be enhanced by continuous administration of prostaglandin E1 in preoperative and postoperative period. So it is expected that surgical flap delay procedure is replaced by pharmacological flap delay by the use of prostaglandin E1 preoperatively.
Alprostadil* ; Animals ; Dilatation ; Endothelial Cells ; Eosinophils ; Erythrocytes ; Erythropoietin ; Humans ; Kidney ; Male ; Muscle, Smooth ; Postoperative Period ; Rats* ; Rats, Sprague-Dawley ; Skin ; Surgery, Plastic ; Surgical Flaps ; Survival Rate

In view of the problems with infection, traditional orthopedic teaching has held that the use of metalic fixation in open fractures is contraindicated. But the bone shortening and internal fixation of amputated limb is a principle for replantation. The authors experienced 23 patients of replanted limbs including femur, tibia, humerus, radius and ulnar among total 142 replantations and also analysed them in the respect of the relationship among soft tissue injury, fixatives, bone union and infection rate from February, 1975 to July, 1981 in this department. The rate of delayed union, nonunion and infection were 22.6%, 6.5% and 25.8% respectively. It seems that the union process of bone in replanted limbs is similar to that of the open fracture and also rigid internal fixation is the most useful for bony union.
Extremities ; Femur ; Fixatives ; Fractures, Open ; Humans ; Humerus ; Orthopedics ; Radius ; Replantation ; Soft Tissue Injuries ; Tibia

Eleventh heel pad reconstruction with neurovascularized dorsalis pedis free flap or rotation flap have performed during recent three years in department of Orthopedic Surgery, Kyung Hee University Hospital. Neurovascularized dorsalis pedis free flaps were seven and neurovascularized dorsalis pedis rotation flaps were four. All patients had complained of painful limping and ulceration in grafted heel. In 5 months to 34 months follow up study, the following results were obtained. The success rate of dorsalis pedis flap was 100% except one partial peripheral necrosis. The weight bearing function and tactile protective sensation on reconstructed heel pads were excellent. Neurovascularized dorsalis pedis free flap or rotation flap is recommended to satisfactory methods in heel pad reconstruction. Neurovascularized dorsalis pedis rotation flap easier and safer technique than neurovascularized dorsalis free flap.
Follow-Up Studies ; Free Tissue Flaps ; Heel ; Humans ; Necrosis ; Orthopedics ; Sensation ; Transplants ; Ulcer ; Weight-Bearing

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a case of stent dislodgement in the ascending thoracic aorta. The stent was mechanically distorted in the left circumflex artery (LCX) while being delivered to the proximal LCX lesion. The balloon catheter was withdrawn, but the stent with the guide wire was remained in the ascending thoracic aorta. The stent was unable to be retrieved into the guide catheter, as it was distorted. A goose neck snare was used successfully to catch the stent in the ascending thoracic aorta and retrieved the stent externally via the arterial sheath.
Angioplasty, Balloon, Coronary/*adverse effects/*instrumentation ; *Aorta, Thoracic/radiography ; Cardiac Catheterization/*adverse effects/*instrumentation ; Coronary Angiography ; Device Removal/*instrumentation ; Foreign Bodies/etiology/radiography/*therapy ; Humans ; Male ; Middle Aged ; Radiography, Interventional ; *Stents ; Treatment Outcome

PURPOSE: To analyze the clinical and radiological results after revision total knee arthroplasty(TKA) using structural allograft for severe bone defect, MATERIALS AND METHODS: Between l992 and 1997, we used structural allograft for revision TKA in 20 knees of 18 patients with severe bone defect, The average age at surgery was of 61.6 years. The follow-up period averaged 43 months(range, 1 3-80 months). All patients had severe bone defect of the femur and/or tibia. Ten distal femur and thirteen proximal tibia required allografting. Fresh frozen femoral heads were used in all patients. We used posterior stabilized stemmed PFC knee component in all cases except one case with constrained condylar type. Patients were evaluated with physical examination, radiographs and the Hospital for Special Surgery knee rating scale. RESULTS: Average range of motion before surgery was 87degrees and after surgery 107degrees. Average knee score was 65 before and 90.4 after surgery. Preoperative alignment averaged 1.8degrees valgus, ranging from 17degrees varus to 13degrees valgus, and postoperative alignment averaged 7,2 degrees velgus, ranging from 3degrees valgus to 10 val-gus, All patient improved pain and stability. Postoperatively average HSS score improved from 65(rang- ing from 46 to 92) to 90.4(ranging from 75 to 100). All of the allografts united with host bone. There was no radiolucent line, lysis, fracture and infection. CONCLUSION: Structural allograft can be a satisfactory method of managing large bone defects in the failed total knee arthroplasty.
Allografts* ; Arthroplasty* ; Femur ; Follow-Up Studies ; Head ; Humans ; Knee* ; Physical Examination ; Range of Motion, Articular ; Tibia ; Transplantation, Homologous

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a rare case of dislodgement of two intracoronary stents. On withdrawal of two balloon catheters, one with a guide wire was mechanically distorted from the left main (LM) to the proximal left anterior descending artery (LAD) while the other was dislodged from the LM to the ostial left circumflex artery. The stent in the LAD could not be retrieved into the guide catheter using a Goose neck snare, because it was caught on a previously deployed stent at the mid LAD. A new stent was quickly deployed from the LM to the proximal LAD, because the patient developed cardiogenic shock. Both stents, including a distorted and elongated stent, were crushed to the LM wall. Stent deployment and crushing may be a good alternative technique to retrieving a dislodged stent.
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation ; Cardiac Catheterization/adverse effects/*instrumentation ; Coronary Angiography ; Coronary Stenosis/diagnosis/*therapy ; Female ; Humans ; Middle Aged ; Prosthesis Failure ; Shock, Cardiogenic/etiology/therapy ; *Stents ; Treatment Outcome

BACKGROUND: Adequate evaluation and monitoring for pre-eclamptic paturient and capable assistance before induction for anesthesiologist, must be taken to avoid sudden severe maternal hypertension with intubation during a Rapid Sequence intravenous induction. Such event predispose the paturient to intracranial hemorrhage and pulmonary hypertension with pulmonary edema. To diminish danger of hypertension that can be developed during general anesthesia and facilitate control of blood pressure, 24 women presenting for cesarean section were studied. METHODS: All received 17.9+/-2.6ml of 0.5% bupivacaine, including 3ml of test dose, through the epidural catheter inserted in T12-L1 interspace using 18 gauge Tuohy needle to the patients with a lateral decubitus position. We measured blood pressure and heart rate in 5, 10, 15, 20, 30, 45, and 60 minutes after injection of 0.5% bupivacaine and 15 minutes after transferred to recovery room. RESULTS: The blood pressure of the patients started to decrease in 5 minutes and most decreased in 20 minutes after injection, the heart rate had little change but decreased significantly in 45 minutes. Apgar Scores of the neonates at 1 and 5 minutes were 7.3+/-2.0 and 9.2+/-1.5. The patients used ephedrine and crystalloid solution for correction of hypotension were 6 of 24 women and had no any systemic toxicity or neurologic symptoms by local anesthetics(bupivacaine). CONCLUSION: Continuous epidural anesthesia for cesarean section in preeclamptic patients is recommended for safe anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Blood Pressure ; Bupivacaine ; Catheters ; Cesarean Section* ; Ephedrine ; Female ; Heart Rate ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hypotension ; Infant, Newborn ; Intracranial Hemorrhages ; Intubation ; Needles ; Neurologic Manifestations ; Pregnancy ; Pulmonary Edema ; Recovery Room

No abstract available.
Head Injuries, Penetrating*

No abstract available.
Arteriovenous Malformations* ; Hematoma*

Rupture of the trachea as a result of external trauma is well documented. But, rupture of the membranous trachea following tracheal intubation has been infrequently noted. Risk factors associated with tracheobronchial rupture include inexperienced endoscopists, intubating stylets, multiple vigorous attempts at intubation, tracheal abnormalities, overdistension of tracheal or bronchial cuff with high pressure, low volume cuffs, and old age. We report a case of tracheal rupture occurred during one lung ventilation using Robertshaw double-lumen endotracheal tube for right upper lobe lobectomy. The etiology and treatment are discussed and the recent literature is reviewed.
Intubation ; One-Lung Ventilation* ; Risk Factors ; Rupture* ; Trachea