ABSTRACT
The histologically confirmed endothelial damage (HCED) may lead to vasospasm, which increases the failure rate of microvascular anastomosis. Recently, vascular freezing has been reported to be the most effective and lasting method of alleviating or preventing vessel constriction in virgin microvessels. We question whether the application of freezing designed to relieve vasospasm is possible in microvessels accompanying with underlying acute endothelial damages without any harmful effects. We produced an experimental model with histologically confirmed endothelial damage and vasospasm in Sprague-Dawley rat. In crush injury group(group I, n = 15), the determined crushing load (0.07 J) was applied to femoral artery. In crush injury-freezing group(group II, n = 15), crushed arteries was frozen with ethyl chloride at 30 minutes after applying the crush injury. Gross and scanning electron microscopic appearances were inspected in both experimental groups on the 2nd, 14th and 30th day after the operation. In group I, vasospasm around the crushed segments were continued but in group II, the vasospasm disappeared immediately after vascular freezing, maintained its expansion even at postoperative 2, 14 and 30 days. On scanning electron microscopic examination, endothelium in group II showed slightly slower regeneration velocity but near complete regeneration was achieved at postoperative day 30. Regenerated endothelial cell in group II was more atypically shaped but arranged longitudinally at postoperative day 30. In conclusion, freezing with ethyl chloride could be a useful tool to reliably revert vasospasm without inducing thrombus even in acute endothelial damaged vessels after crush injury.
Subject(s)
Animals , Rats , Arteries , Constriction , Endothelial Cells , Endothelium , Ethyl Chloride , Femoral Artery , Freezing , Microvessels , Models, Theoretical , Rats, Sprague-Dawley , Regeneration , ThrombosisABSTRACT
From March 1997 to August 2001, Titanium mesh screen 1.0 (SYNTHES(R)) were applied to the repair of 29 medial orbital fractures; 18 patients with orbital inferior wall fracture, 16 patients with nasal bone fracture and 6 patients with pure medial wall fracture. Clinically, the periorbital ecchymosis and subconjunctival hemorrage were sensitive indications of orbital wall fracture. Even though there are no sign of diplopia or enophthalmos, in cases of simple nasal bone fracture with periorbital ecchymosis and subconjunctival hemorage, the evaluations of medial orbital wall fracture were strongly recommended because the medial orbital wall fractures occurred frequently combined with simple nasal bone fractures. Titanium mesh screen 1.0 was used as onlay implant to fit the anatomical shape on the fracture portion needed to be reconstructed and 1.3mm microscrews (SYNTHES(R)) were used to fix titanium mesh screen. The patients were followed up for 18 months with no significant enophthalmos or diplopia.
Subject(s)
Humans , Diplopia , Ecchymosis , Enophthalmos , Inlays , Nasal Bone , Orbit , Orbital Fractures , TitaniumABSTRACT
The histologically confirmed endothelial damage, which appears as a normal vessel under the operative microscope, may lead to thrombus formation or vasospasm, and ultimately result in the anastomotic failure. Vascular freezing has been reported to be an effective method of relieving spasm. This study examined if the freezing therapy could safely relieve the vasospasm accompanying microvascular anastomosis of vessels, which had histologically confirmed endothelial damage, but with no other harmful effects. In the experimental model, Microvascular anastomoses of the femoral arteries(n = 80) of 40 Sprague-Dawley rats were performed after producing crush injuries on both femoral arteries with energy to cause vasospasm and histologically confirmed endothelial damage. Freezing was achieved with ethyl chloride for 4 seconds before the anastomosis and the vascular spasm was disappeared immediately after freezing and maintained its expansion for 2,10 and 30 days after the operation. No significant difference was observed in the patency rates of the crush-freezing group and the crush group (p > 0.05). In the clinical model, a case was presented in which ethyl chloride in vivo freezing was used to relieve a refractory spasm in the recpient vessels of free latissimus dorsi muscle transfer in a soft tissue defect of dorsum of foot. The spasm was relieved and the flap survived. This study found that the vascular freezing relieved the spasm in the microvascular repair, which was accompanied by histologically confirmed endothelial damaged vessels, and that no harmful effects of vascular freezing were observed when the technique was used to prevent or elieve vascular spasm in case of microvascular repair.
Subject(s)
Endothelium , Ethyl Chloride , Femoral Artery , Foot , Free Tissue Flaps , Freezing , Models, Theoretical , Rats, Sprague-Dawley , Spasm , Superficial Back Muscles , ThrombosisABSTRACT
The thickness of the abdominal subcutaneous tissues is discussed in the data obtained in 40 middle-aged female patients(the range of the age 31 to 60 years) examined on a modern computed tomographic system. The authors have shown that the superficial fascia, which separates the superficial and deep layers of subcutaneous fat, forms a continuous circumferential fascial plane. We have analyzed cross-sectional CT images at the umbilical level in a middle ged women. The authors have made several linear measurements of the thickness of the superficial and deep fat compartments at various reference points around the trunk in order to demonstrate the regional distribution of the deep fat compartment. Our data shows the mean, standard deviation(SD) concerning the thickness measurements of the superficial and deep fat compartments around the abdomen in the 40 women. From these observations, we concluded that the thickness of subcutaneous tissue of superficial layer is relatively constant and the thickness of subcutaneous tissue of deep layer is greatest at posterolateral region with decrements in thickness at anterior, lateral region respectively. And such pattern is same as the total subcutaneous tissue thickness, therefore, relatively safe parts for much amount of liposuction around the abdomen are paralumbar region and anterior abdomen. Such study result could offer the appropriate depths for cannula insertion, that is, 18.8mm at anterior, 16.9mm at lateral and 32.5mm at posterolateral region. Such knowledge could offer a guide to the necessary depth of cannula insertion when performing of the SAL (suction-assisted lipectomy). It is deemed desirable to place the tip in the middle of the deep compartment.
Subject(s)
Female , Humans , Abdomen , Catheters , Lipectomy , Subcutaneous Fat , Subcutaneous Tissue , Tomography, X-Ray ComputedABSTRACT
Wound healing was a natural process proceeded by connective tissue deposition, epithelialization, and wound contracture. Streptozotocin-induced diabetes mellitus was known to impair wound healing. However, the extend of delayed wound healing was not evaluate objectively in the diabetic rats. Therefore, we studied the extend of delayed wound healing(epithelialization and wound contracture) and histologic difference between diabetic and control rats. Twenty adult Sprague-Dawley rats(200-250 gm) were used as experimental animals(Diabetes: 10 rats, control: 10 rats). The wounds(2 x 2 cm, sized) were made on the back of the rats by excision through the panniculus carnosus. The areas of both wounds in relation to original wound areas (operative day) were serially measured at 0, 1,2, 3, 4, 5 weeks postoperatively. In addition, we performed histological examination of biopsy taken at 0, 1,2, 3, 4, 5weeks postoperatively. The difference in the mean area ratio between two groups was then compared using Kruskal Wallis test(SAS Program). Results were as follows: At postoperative 1 week, there was a significant difference(p < 0.05) in degree of epithelialization between the two groups, 1) After postoperative 2 weeks, there was a significant difference(p<0.05) in degree of wound contracture between the two groups. 2) In the diabetic group, the collagen fibers were smaller and poor organized than control group. Conclusion was that delay of epithelialization early and delay of wound contracture late in wound healing, were important roles in diabetic wound problem.
Subject(s)
Adult , Animals , Humans , Rats , Biopsy , Collagen , Connective Tissue , Contracture , Diabetes Mellitus , Rats, Sprague-Dawley , Skin , Wound Healing , Wounds and InjuriesABSTRACT
In the case of crush injury, the failure rate of replantation of free tissue transfer is high. Recently, the freezing of intact and repaired microarteries has been known to relieve spasm without inducing thrombosis in vivo. Therefore, the author thought that the vascular freezing of crushed vein showing only unrecognized endothelial damage after adequate debridement of a damaged vessel can also relieve spasm without inducing thrombosis and improve the patency rate of microvascular anastomosis. In this study, the process of vascular freezing was investigated in veins with acutely damaged endothelium using ethly chloride in a rat model. Two experiments were performed in 30 Sprague-Dawley rats, weighing about 250 gm. In the first experiment, a new crush model was established on the femoral vein of the rats. The degree of vessel injury was evaluated as crush energy. The proper crush energy was determined only by the endothelial damage without inducing thrombosis(0.037 J). In the second experiment, femoral veins were crushed with the energy of 0.037 J on the left side and then frozen after inflicted crush injury with the same energy on the right side. The gross and pathologic findings and patency rates were observed at postoperative day 2, 10 and 30. Patency in both the crushed and crush-freezing group was 100%. Pathlolgic findings in the crush-freezing group were more severe loss of the intima and most parts of the media, as well as cellular depopulation of the media when compared to the crushed group. Microthrombi adherent to the wall were demonstrated in several crush-freezing specimens, but the crush-freezing group showed relief of crush-induced vasopasm and endothelial regeneration. In conclusion, the freezing of microveins with acute endothelial damage relieves spasm without inducing thrombosis. Therefore, this study presents the posslbility of clinical application of vascular freezing in a case of crush injury requiring microvascualr anastomosis.
Subject(s)
Animals , Rats , Debridement , Endothelium , Femoral Vein , Freezing , Models, Animal , Rats, Sprague-Dawley , Regeneration , Replantation , Spasm , Thrombosis , VeinsABSTRACT
During the period of 10 years from January, 1987 to December, 1996, 553 burn patients were admitted and treated at Ewha Womans University Hospital. Among them, 172 patients were under the age of fifteen. We reviewed the charts and analyzed the data retrospectively. The results revealed as follows; 1. Children under 15 years old were 31.1% of all admitted burn patients and males were frequently affected 1.46 times more than females. 2. The most prevalent age group was under 1 years old as 25.6%. 3. The most common cause of burn was scalds (84.3%), followed by flame (7.6%), contact (5.8%) and electricity (2.3%). 4. Burn accidents were frequently occurred in spring, especially March (11.6%). 5. Time interval from burn accident to arrival at hospital was 5.1 hours in direct visitors and 20.5 hours in referred patients. 6. Burn involved multiple sites of the body in 64.5% of cases. 7. In 60.2% of patients the extent of burn was under 9% of body surface. 8. Mean hospital day was 16.9 days and 17.4% of the patients were discharged against on 5.7 days. 9. The complications were developed in 38.7% of the patients. They were wound infection(61.8%), sepsis (20.0%), pulmonary complication (10.9%), urologic infection (3.6%), gastrointestinal bleeding(1.8%) and burn shock (1.8%). 10. Wound culture was positive in 66.7% of suspicious cases. The organisms cultured were Pseudomonas aeruginosa (58.9%), Staphylococcus species (26.5%), E. coli (11.8%) and Enterobacter species (2.9%). 11. Overall mortality rate was 5.6% and mean survival day was 14.7 days. The cause of death was sepsis in 50% of cases.
Subject(s)
Adolescent , Child , Female , Humans , Male , Burns , Cause of Death , Electricity , Enterobacter , Mortality , Pseudomonas aeruginosa , Retrospective Studies , Sepsis , Shock , Staphylococcus , Wounds and InjuriesABSTRACT
During the period of 10 years from January, 1987 to December, 1996, 553 burn patients were admitted and treated at Ewha Womans University Hospital. Among them, 172 patients were under the age of fifteen. We reviewed the charts and analyzed the data retrospectively. The results revealed as follows; 1. Children under 15 years old were 31.1% of all admitted burn patients and males were frequently affected 1.46 times more than females. 2. The most prevalent age group was under 1 years old as 25.6%. 3. The most common cause of burn was scalds (84.3%), followed by flame (7.6%), contact (5.8%) and electricity (2.3%). 4. Burn accidents were frequently occurred in spring, especially March (11.6%). 5. Time interval from burn accident to arrival at hospital was 5.1 hours in direct visitors and 20.5 hours in referred patients. 6. Burn involved multiple sites of the body in 64.5% of cases. 7. In 60.2% of patients the extent of burn was under 9% of body surface. 8. Mean hospital day was 16.9 days and 17.4% of the patients were discharged against on 5.7 days. 9. The complications were developed in 38.7% of the patients. They were wound infection(61.8%), sepsis (20.0%), pulmonary complication (10.9%), urologic infection (3.6%), gastrointestinal bleeding(1.8%) and burn shock (1.8%). 10. Wound culture was positive in 66.7% of suspicious cases. The organisms cultured were Pseudomonas aeruginosa (58.9%), Staphylococcus species (26.5%), E. coli (11.8%) and Enterobacter species (2.9%). 11. Overall mortality rate was 5.6% and mean survival day was 14.7 days. The cause of death was sepsis in 50% of cases.
Subject(s)
Adolescent , Child , Female , Humans , Male , Burns , Cause of Death , Electricity , Enterobacter , Mortality , Pseudomonas aeruginosa , Retrospective Studies , Sepsis , Shock , Staphylococcus , Wounds and InjuriesABSTRACT
Tongue-tie is recognized to have adverse influences in sucking and swallowing(infant feeding), growth of jaw, speech, and mechanical movement due to restrictions of tongue mobility. We used CO2-laser(RYJ-II) in frenulotomy of tongue-tie patients with expectations in reducing intraoperative bleeding, postoperative pain and edema. We operated 32cases of the patient group utilizing CO2-laser(RYJ-II) in frenulotomy, 20 cases of the patient group using classic frenulotomy method with scalpel. We compared following variables in two groups: intraoperative bleeding, operation time and postoperative pain and edema. Frenulotomy using CO2-laser(RYJ-II) resulted in reduction in bleeding, postoperative pain and postoperative edema, while reduction in operation time and wound healing time were not confirmed in this study. Authors suggest the ideal suitability of CO2-laser(RYJ-II) in frenulotomy of tongue-tie patients with a brief review of literature.
Subject(s)
Humans , Edema , Hemorrhage , Jaw , Pain, Postoperative , Tongue , Wound HealingABSTRACT
The purpose of this study was to evaluate the histologic difference that occured after trichloroacetic acid(TCA) chemical peel in an animal model that was pretreated with Tretinoin alone or Tretinoin-based combined pretreatment kit. Eight Hartley white guinea pigs were used in our study. The dorsal skin of the guinea pigs was divided into six equal squares(2x2 cm). Upper two areas of these six were not pretreated, middle two areas were pretreated for 4 weeks with Tretinoin alone and lower two areas were pretreated for 4 weeks with Tretinoin-based combined kit. Each guinea pig underwent chemical peel with 50% TCA. The wounded areas were biopsied at post-peeling 3 weeks and 6 weeks. The histology revealed that those animals pretreated with combined kit healed quicker than the animals pretreated with Tretinoin alone. This study implies that if patients are treated with Tretinoin-based-combined pretreatment kit before undergoing chemical peel, the pretreatment time will be shortened.
Subject(s)
Animals , Humans , Guinea Pigs , Guinea , Models, Animal , Skin , Tretinoin , Wounds and InjuriesABSTRACT
There have been several reports that nasal bone fractures are inadequately managed. They are probably due to poor understanding of the pathophysiology of nasal bone fracture and absence of the accurate diagnostic method. And there has been little adequate comprehensive classification of nasal bone fracture and nasal septal fracture. We examed 132 patients sustaining nasal bone fracture using computerized tomography. Fracture line, deviation, depression, associated skeletal deformities and the nasal septum were clearly identified. We compared our results with Murray & Maran's classification of nasal bone fracture. We found that they revealed almost same results and computerized tomography was good method for diagnosis of nasal septal fracture. The computerized tomography will be helpful for accurate diagnosis and preperative planning of the correction of nasal bone and septal fracture.
Subject(s)
Humans , Classification , Congenital Abnormalities , Depression , Diagnosis , Nasal Bone , Nasal SeptumABSTRACT
A new crush anastomosis model which can be evaluated as crush energy was established on the femoral artery and vein of the rats weighing 250g on the average. The degrees of vessel injury were evaluated as crush energy. The arteries underwent the crush injury with the energy of 0.3J, 0.4J, 0.5J, while the reins were crushed with the energy of 0.2J, 0.3J, 0.4J respectively then the vessels in each group were divided and anastomoses by a standard microsurgical technique. Saline and heparin were used as a luminal topical agent and systemic one, which allowed contact with the damaged endothelium. The heparin treated group had a patency rate of 95%(0.3J), 87.5%(0.4J), 40%(0.5J) vs. 55%(0.3J), 15%(0.4J), 10%(0.5J) in the saline irrigated group in the femoral arteries, which had the patency rate of 82.5%(0.2J), 72.5%(0.3J), 42.5%(0.4J) vs. 35%(0.2J), 12.5%(0.3J), 7.5%(0.4J) in the saline irrigated group in the femoral vein at 1 day. There was a energy-related decrease in patency rate. These findings indicate that the crush model of 0.4J in the rat femoral artery, 0.3J in the rat femoral vein is a reliable and reproducible thrombosis model. The model described in this study is to be used to evaluate and assess the ability of antithrombotic agent in preventing thrombosis at the anastomotic site.
Subject(s)
Animals , Rats , Arteries , Endothelium , Femoral Artery , Femoral Vein , Heparin , Phenobarbital , Thrombosis , VeinsABSTRACT
The presence of epicanthal folds in Asian eyelids is one of their unique features, in combination with the lack of supratarsal folds. Western culture has influenced many people to prefer to eliminate the prominent epicanthal fold. A number of surgical techniques have been suggested for their correction. However, difficulty with design, excessive and prominent scarring of medial canthal and nasal area, recurrence, and rigidity of application are potential problems associated with many procedures. This paper describes a epicanthoplasty with three-dimensional Z-plasty. Through epicanthal fold incision, the medial canthal tecdon is medially advanced and sutured to the periosteum of nasal bone. After the transposition of the flaps, trimming of the flap is usually required. Three-dimensional Z-plasty crates the attactive eyes. From March, 1995 to March, 1997, the technique was applied to 37 patients with epicanthal fold and was performed with or without double-fold operation. There were 34 females and 3 males with ages ranging from 17 to 30 years. Through 2 years follow-up, this techniques has delivered esthetically good results with minimal postoperative scar and could made the reduction of ICD from 40 +/- 2.13mm to 34 +/- 1.98mm. The advantages of epicanthoplasty procedure using three-dimensional Z-plasty(Yoon's method) are as follows; 1) simple in design 2) minimal postoperative scar in the medial canthal area 3) versatile in its application 4) no recurrence 5) no hypertrophic scar 6) preserving ethnic identity.
Subject(s)
Female , Humans , Male , Asian People , Cicatrix , Cicatrix, Hypertrophic , Eyelids , Follow-Up Studies , Nasal Bone , Periosteum , RecurrenceABSTRACT
It is recommened to remove the arterial adventitia from the vessel ends to prevent adventitial interpose between the edges of anastomoses vessels. We have analysed the effect of adventitial removal on the patency in microvascular anastomosis. using rat femoral artery Three groups of adventitial removal methods were studied: non-removal group, sharp dissection group and blunt dissecction group. Patency was evaluated one hour, 24hours and 7days after anastomosis. The patency rate of non-dissection group(n=40) was 90% one hour after anastomosis but it reduced to 62.5% both at 24 hours and at 7days because interpositioning of adventitia induced thrombosis. The blunt skipping group showed 62.5% of patency rate at one hour most likely due to vascular spasm, but after 24hours it was recovered to 80% and 78.5% at 7th day. The sharp dissection group showed persistently high patency rate of 97.5% after one hour,95% both after 24 hours and after 7 days. Scanning electron microscopy showed endothelial loss and medial edema in bluntly stripped vessels but it showed well preserved endothelial cells and medial wall in sharp dissection group. The reason of relatively low patency rates of blunt dissection group compared with sharp dissection group 24 hours and 7 days after anastomosis(p=0.043 and p=0.023, respectively) was endothelial damage induced by stretching force made during blunt stripping.