• 대한골관절종양학회지
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• 제2권1호
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• pp.88-93
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• 1996

Neurilemmomas are the most common benign tumor of the peripheral nerve trunks, and arises from the cells in the sheath of Schwann. Neurilemmomas are well encapsulated and may be separated easily from surrounding tissue and lie completely within a larger nerve trunk, with bundles of neurofibrils spread out over the surface of the tumor. A careful dissection and retraction of the nerve bundles will allow the tumor to be enucleated from the parent nerve without any significant interference with the function of the nerve. Resection of the involved nerve is seldom necessary and should be avoided if at all possible. Our aim in microscopic excision of neurilemmoma of extremities is to reduce any disturbance of the intact neurofibrils of the parent nerve. Thirteen cases of neurilimmomas were treated by microscopic excision at the Department of Orthopaedic Surgery, Korea University Hospital between January 1990 and March 1995. The results was as follows ; 1. The average age at surgical intervention was 40.1 years. Cases in fourth and fifth decades predominated. 2. In their anatomical distribution, 8 cases were in the upper extremity and 5 cases in the lower extremity. 11 cases were on the flexor surface. 3. On the operative field, all the tumors were well encapsulated, however 1 case of 13 was adherent to the periosteum of fibula. 4. In all cases, the tumor were enucleated from the parent nerve without any injury to nerve under high-power magnification, preserving individual fascicles, and sensory and motor function.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.65-69
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• 2006

Purpose: We performed vastus lateralis (VL) muslce or myocutaneous flap for close of the trochanteric skin defect usually happened in paraplegia and report our 6 cases. Materials and Methods: Between March 2004 and August 2005 we performed 4 cases of VL muscule flap with skin graft and 2 cases of VL myocutaneous flap for close of the trochanteric skin defect in 6 paraplegia patients. There were 5 men and 1 woman and mean age was 52.2 years and mean diameters of skin defect was $8.3{\times}8.3\;cm$. The mean follow up period was 18 months. The survival of flap, complications, healing time and patient's satisfaction were evaluated. Results: All flaps were survived except 1 case of margin necrosis. In 2 cases, blood-serous discharges were continued after operation which might be due to dead space and treated with $2{\sim}3$ times debridement and delayed close. Mean time to heal the skin defect was 7.6 weeks. No infection and recurrence in follow up periods. Cosmetic results judged by patients are that 3 cases are good and 3 cases are fair. Conclusion: VL muscle and myocutaneous flap is good treatment method among the numerous methods in treatment-failed cases of trochanteric skin defects of paraplegia patients. This surgical procedure is simple, constant blood supply, good pliability, cosmetic results and also appliable to other skin defect of pelvis girdle like sacrum and ischium.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.101-106
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• 2006

The purpose of this study was to analyze the mid to long-term clinical and radiological outcome of vascularized pronator quadratus-wrapped radial bone flap arthroplasty for symptomatic advanced $Kienb{\ddot{o}}ck's$ disease. Between 1982 and 2000, 41 cases of advanced $Kienb{\ddot{o}}ck's$ disease were treated with vascularized pronator quadratus wrapped radial bone flap arthroplasty. There were 17 men and 24 women, with a mean age of 39 years at the time of operation. According to Lichtman's classification, there were 13 stage IIIb and 28 stage IV patients. The duration of follow-up averaged 6.1 ($3{\sim}22$) years. We assessed the clinical outcome by subjective pain and active range of motion of the wrist, and evaluated the radiologic outcome by using carpal height ratio and radioscaphoid angle. Postoperatively, all patient reported an improvement in their symptoms. The mean active extension and flexion were improved by $9^{\circ}$ and $6^{\circ}$, respectively (p<0.05). The carpal height ratio was decreased from a mean of 0.52 to 0.48, and the radioscahpoid angle was increased from a mean of $61^{\circ}$ to $66^{\circ}$, but the differences were not significant statistically. Vascularized pronator quadratus-wrapped radial bone flap arthroplasty improves the wrist motion and may prevent serious carpal collapse in advanced $Kienb{\ddot{o}}ck's$ Disease.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.58-64
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• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• Archives of Reconstructive Microsurgery
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• 제16권1호
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• pp.6-13
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• 2007

Purpose: To report the clinical results of the vascularized fibular graft in the treatment of intractable infected nonunion of femur. Materials and Methods: We reviewed 3 patients who were performed vascularized fibular graft in treated for intractable infected nonunion of femur. They had received an average of 5.6 times($4{\sim}8\;times$) surgical treatment at different hospitals. 1 case was of a infected nonunion in a fracture treated with internal fixation, the fracture having occurred after resection of a malignant tumor and transplantation of pasteurized autologous bone. 2 cases occurred after internal fixation in closed fractures. Surgical treatment was performed an average of 4 times($3{\sim}5\;times$) at our hospital and in all of the cases debridement of necrotic tissue and sequestrectomy. And vascularized fibular graft was performed. In all cases unilateral external fixation devices were used, of these, 1 case was changed into internal fixation. The final conclusion was made by assessment of functional outcomes and complications according to the standards of Paley. Results: As a result, in all of the cases bone union was achieved, and in the last follow up the functional results were excellent in 2 cases and good in 1 case. There were not presented leg length discrepancy of more than 2 cm, and further loss of knee joint motion. After previous treatment, average 23.3 months($16{\sim}30\;months$) was taken to eliminate infection and achieve complete bone union via vascularized fibular graft in our hospital. Conclusion: In treatment of intractable infected nonunion of femur, fairly good results can be expected after firm fixation, through debridement and vascularized fibular graft.

• Archives of Reconstructive Microsurgery
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• 제16권1호
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• pp.39-47
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• 2007

With the advent of microsurgery, perforator free flap is nowadays considered the first choice for reconstruction of the extensive defect of the extremities because of their moderate thickness. Among them, anterior (anterolateral and anteromedial) thigh perforator free flaps provide the first choice for reconstruction of various soft tissue defects of the extremities with many advantage such as its large, uniform thickness, long vascular pedicle with proper vessel size and minimal donor site morbidity. But, it has still some criticism of unreliable perforators which makes us very careful in elevating the flap. Between March of 2006 and February of 2007, we treated 7 patients of soft tissue defects in the hand and lower extremities with anterior thigh perforator free flap at Hallym and DongGuk University Hospital. We performed 6 anterolateral thigh perforator free flaps based on the descending branch of lateral circumflex femoral artery (LCFA) and 1 anteromedial thigh perforator free flap based on the innominate branch of the LCFA. While approaching for the anterolateral thigh free flap, we happen to meet the cases which we should change into the anteromedial thigh free flap uneventfully on the operating field. In contrast to the original design of anterolateral thigh free flap, we had to harvest the anteromedial thigh perforator free flap in 1 case. All the anterior thigh perforator free flaps survived completely except 1 case of partial necrosis due to venous congestion. Donor sites were closed primarily and healed uneventfully within 2 weeks. Patients were satisfied with the functionally and aesthetically acceptable results. Although doppler sonography is strongly recommended preoperatively in planning the anterior thigh perforator free flaps, we should always remember the variation in vascular anatomy and be ready to change the flap choice from the anterolateral to anteromedial intraoperatively. we provide a review of the literature and present our series of anterior thigh perforator free flaps for reconstruction of the extremities.

• Archives of Reconstructive Microsurgery
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• 제16권1호
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• pp.48-51
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• 2007

There could be several methods for trochanteric reconstruction including local flap, pedicled perforator flaps, free flap, etc. We performed greater trochanteric reconstruction with lumbar artery perforator free flap in some aberrant method. So we report this experience with review of literatures. A 42-year-old man visited our hospital with a large soft tissue defect in his left greater trochanteric area by traffic accident. The patient had wide skin and soft tissue defect combined with open femur fracture. During one month period of admission, he underwent femur open reduction and wound debridement four times. After that we planned thoracodorsal perforator free flap reconstruction. The flap was outlined as large as $20{\times}15\;cm$ and elevated in a suprafascial plane from the lateral border. During intramuscular perforator dissection, we found that two 1.5 mm diametered perforator vessels coursed inferomedially toward second lumbar region. Finally the flap became lumbar artery perforator flap based on second lumbar artery perforator as a main pedicle. After flap transfer, the perforator vessels were connected with inferior gluteal artery and vein microsurgically. The operation was successful without uneventful course. We found no significant postoperative complication and donor site morbidity during six months follow up periods. Lumbar artery perforator flap could be an alternative procedure for thoracodorsal perforator flap in some patients with anatomic variant features.

• Archives of Reconstructive Microsurgery
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• 제2권1호
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• pp.20-28
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• 1993

From 1981 to 1991, twenty one vascularized bone grafts had been performed for the treatment of large bone defects of the extremities, with average follow-up of 65.4 months. Fibulae were used in 15 patients Including two cases of osteocutaneous flap, iliums in 5 including two of osteocutaneous flap, and osteocutneous rib in one. Ten of these patients were treated for segmental defects derived from trauma or infection sequelae of long bones, while eight for locally aggressive benign or malignant bone tumors ; and three for congenital pseudarthrosis of tibia. The location of the lesions were 8 cases in tibia; 7 in humerus ; 3 in forearm bone ; 2 in foot ; and 1 in femur. The length of bone defects were averaged as 10 cm, ranging from 3 to 17.5. In eighteen patients(85.7%), the operation was successful. The duration from operation to bony union was average 5.1 months on successful cases, and three of them needed additional procedures, such as bone graft and electrical stimulation to promote bony union. Local recurrence was found in one case of chondrosarcoma, resulting in AK amputation. Wound infections were noted each one case on donor or recipient site. In five cases, the fracture of grafted bone, which united with cast immobilization in four, occurred average 16.7 months after operation.

• Archives of Reconstructive Microsurgery
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• 제2권1호
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• pp.13-19
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• 1993

Although the etiology of $Kienb\"{o}ck's$ disease is clearly related to avascular changes in the lunate, but the actual cause leading to this vascular impairment has remained elusive. Therefore, a great many different surgical procedures have been proposed for the correction of the multiple factors leading to lunate collapse or for the treatment of the lunatomalacia. The treatment modalities includes lunate excision, intercarpal arthrodesis, lunate implant resection arthroplasty, joint levelling operation(e.g ulnar lengthening & radial shortening), pronater quadratus pedicle graft and vascular loop graft. In the period from Jan. 1981 to Dec. 1992, we performed operative treatment in 19 cases of $Kienb\"{o}ck's$ disease. Among them, 6 cases were treated with vascular loop graft. We analysed all patients who were treated with vascular loop graft after followed up of 4 year 6 months, on an average(range from 1 year to 8 year 10 months). The results analysed are as follows, 1. All cases were stage III according to Lichtman's classification. 2. Ulnar variance was -1.5(range$-2{\sim}0$), on an average. 3. The average age of patients were 37.7years old(range 31-41). 4. Postoperatively, there were considerable restoration of range of motion and complete relief of pain in all cases, but continued decrease of grip power in one case. 5. Decreased sclerosis, loss of fragmentation and new bone formation were appeared in the last follow up film, in all cases. The vascular loop graft considered as a useful method for the treatment of the $Kienb\"{o}ck's$ disease.

• Archives of Reconstructive Microsurgery
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• 제2권1호
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• pp.46-52
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• 1993

Soft-tissue deficits over the plantar forefoot, plantar heel, Achilles tendon, and distal parts of lower leg are often troublesome to cover with a simple graft or local flap due to limited mobility of surrounding skin and poor circulation in these area. Soft-tissue reconstruction in these regions should provide tissue components similar to the original lost tissue, supply durability and minimal protective pressure sensation and result in a donor site that is well tolerated and treated. We analysed 7 cases that were treated with the Instep flap due to soft-tissue defects over these regions from July of 1990 to July of 1993. All flaps were viable and successful at follow-up. 1. The age ranged from 9 years to 60 years, and 6 cases were male and 1 case female. 2. The sites of soft-tissue loss were the plantar forefoot(1 case), plantar heel(3 cases), Achilles tendon(2 cases), and distal parts of lower leg(1 case). 3. The causes of soft-tissue loss were simple soft-tissue crushing injury(1 case), crushing injury of the 1st toe(1 case) and posttraumatic infection and necrosis(5 cases). 4. The associated injury were open distal tibio-fibula, fracture(2 cases), medial malleolar fracture of the ankle(1 case), Achilles tendon rupture(2 case) and 1st metatarso-phalangeal disarticulation(1 case). 5. The size of flap was from $3{\times}4cm$ to $5{\times}10cm$(average $4{\times}5.6cm)$. 6. In 7 cases, we were not to find post-operative necrosis and infection, non-viability, limitation of ankle joint, and gait disturbance caused by the Instep flap surgery. 7. This study demonstrates that the Instep flap should be considered as another valuable technique in reconstruction of these regions.