• 한국전문물리치료학회지
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• 제2권1호
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• pp.80-87
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• 1995

The purpose of this case study was to introduce a myoelectric hand prosthesis for upper extremity amputee and prosthetic training program. Limb loss can result from disease, injury, or congenital causes. Trauma has been increasingly important role as the cause of amputaion in young, vigorous, and otherwise healthy individuals. The higher the level of amputation the greater the functional loss of the part, and the more the amputee must depend on the prostheis for fuction and cosmesis. Myoelectrical control of prostheses is a recent development and has been steadily gaining in clinical use over the past 20 years. Such a prosthesis uses signals from muscle contraction within the stump to activate a battery driven moter that operates specific component fuctions of the prosthesis. This twenty years old male case was operated a right above-elbow amputation due to tracffic accident and admitted to Yonsei Rehabilitaion hospital for the preprosthetic and prosthetic training. The case was able to successfully complete his myoelectric hand prosthesis training in the February of 1995.

• Archives of Plastic Surgery
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• 제41권5호
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• pp.562-570
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• 2014

Background Knee disarticulations (KD) are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center. Methods A retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A.) between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified. Results Between 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%), arterial thrombosis (35%), and trauma (9%). Postoperative complications included superficial cellulitis (13%), soft tissue infection (4%), and flap ischemia (4%) necessitating one case of surgical debridement (4%) and four transfemoral amputations (9%). 9 (22%) patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01. Conclusions Knee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2003년도 춘계학술대회 논문집
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• pp.723-728
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• 2003

The physical restoration technology for lower limb amputees is being advanced as the biomechatronics is being applied to the area of rehabilitation. As the advanced prosthetics for lower limb amputees are introduced, a suitable prescription of biomechanical rehabilitation training becomes important to utilize the advanced full features of the devices. Since lower limb amputation significantly affects biomechanical balance of mosculoskeletal system for gait, an appropriate and optimal biomechanical training and exercise should be provided to rebalance the system before wearing the prostheses. Particularly, biomechanical muscular training for hip movements in the both affected and sound lower limbs is important to achieve a normal-like ambulation. However, there is no study to understand the effect of hip muscle strength on the gait performance of lower limb amputees. To understand the hip muscle strength characteristics for normal and amputated subjects, the isokinetic exercises for various ratios of concentric contraction to eccentric contraction were performed for hip flexion-extension and adduction-abduction. As a results. biomechanical isokinetic training protocols and performance measurement methodologies for lower limb amputees were developed in this study. Using the protocols and measurement methods, it has been understood that the appropriate and optimal biomechanical prescription for the rehabilitation process for lower limb amputees is important for restoring their gait ability

• Archives of Plastic Surgery
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• 제40권5호
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• pp.630-632
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• 2013

Vacuum-assisted wound healing has been proven to be more efficacious than conventional dressings. Vacuum dressing has been frequently modified given the restrictions in resources available. Here we present a modified method of vacuum dressing by using surgical or gynaecological gloves for lower and upper limb wounds. Vacuum dressing was applied with parts of a surgical or gynaecological glove and Opsite with T-tailing of the suction outlet. Vacuum-assisted wound healing using the surgical gloves showed relatively good wound healing in the amputation stump, finger, arm, and leg in the cases studied.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.311-317
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• 2009

Purpose: Traditionally, external bleeding is needed when only an arteriorrhaphy can be performed in cased where a venorrhaphy cannot be done at the initial reconstruction for a zone1 complete amputation. However, this salvage procedure has several iatrogenic complications. Therefore, we did not perform an external bleeding procedure, in cases where external bleeding was not appropriate due to the small size of the stump. Methods: From September 2006 to August 2007, 19 fingertip amputations, among 18 patients, were performed using only arteriorrhaphy without external bleeding; In total 95 fingertip amputations, with venorrhaphy or external bleeding procedures were excluded. The results were reviewed retrospectively to compare survival and complication rates. Results: The survival rate of only arteriorrhaphy without external bleeding is 84.2%. Additional operations for soft tissue problems of total or partial necrosis were performed in 5 cases. Conclusions: We found no difference in the survival and complication rates of only arteriorrhaphy without external bleeding compared to results of only arteriorrhaphy with external bleeding in other articles. Therefore, our results suggest that in some cases with a fingertip amputation, performing arteriorrhaphy only, without external bleeding, might be a better option than external bleeding due to reduced iatrogenic injuries and complications.

• Archives of Plastic Surgery
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• 제46권4호
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• pp.303-310
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• 2019

Background Prosthetic hands with a myoelectric interface have recently received interest within the broader category of hand prostheses, but their high cost is a major barrier to use. Modern three-dimensional (3D) printing technology has enabled more widespread development and cost-effectiveness in the field of prostheses. The objective of the present study was to evaluate the clinical impact of a low-cost 3D-printed myoelectric-interface prosthetic hand on patients' daily life. Methods A prospective review of all upper-arm transradial amputation amputees who used 3D-printed myoelectric interface prostheses (Mark V) between January 2016 and August 2017 was conducted. The functional outcomes of prosthesis usage over a 3-month follow-up period were measured using a validated method (Orthotics Prosthetics User Survey-Upper Extremity Functional Status [OPUS-UEFS]). In addition, the correlation between the length of the amputated radius and changes in OPUS-UEFS scores was analyzed. Results Ten patients were included in the study. After use of the 3D-printed myoelectric single electromyography channel prosthesis for 3 months, the average OPUS-UEFS score significantly increased from 45.50 to 60.10. The Spearman correlation coefficient (r) of the correlation between radius length and OPUS-UEFS at the 3rd month of prosthetic use was 0.815. Conclusions This low-cost 3D-printed myoelectric-interface prosthetic hand with a single reliable myoelectrical signal shows the potential to positively impact amputees' quality of life through daily usage. The emergence of a low-cost 3D-printed myoelectric prosthesis could lead to new market trends, with such a device gaining popularity via reduced production costs and increased market demand.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.29-35
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• 2002

Free flap reconstruction of the foot has become one of the standard procedures at the present time, but choice of a free flap for the soft tissue defect of the foot according to location and size remains controversial. We evaluated the results of free flap reconstruction for the soft tissue defects of the foot. Twenty seven free flaps to the foot were performed between May 1986 and December 2000 in the department of Orthopedic Surgery. Patient age ranged from 3 to 60 years. Male to female distribution was 20:7. Mean follow-up period was 30.5 months which ranged from 12 months to 60 months. The indications for a specific flap depended on the location and extension of the foot defect. In weight-bearing area and amputation stump, the authors chose the sensate (reinnervated) dorsalis pedis flaps (n=7) and sensate radial forearm flaps (n=2). In nonweight-bearing area including dorsum of the foot and area around Achilles tendon, we performed nonsensate (non-reinnervated) free flap reconstructions which included dorsalis pedis flaps (n=5), groin flap (n=1), radial forearm flaps (n=6), scapular flaps (n=4), latissimus dorsi flaps (n=2). Twenty-six flaps transferred successfully (96.3%). The sensate flaps which were performed in weight-bearing area and amputation stumps survived in all cases and recovered protective sensation. Mean two-point discrimination was 26 mm at the last follow up. As a conclusion, the selection of a proper flap depends on the location and extension of the foot defect and patient's age. Fasciocutaneous flap including radial forearm flaps and dorsalis pedis flaps were the best choice in nonweight-bearing area. The sensate free flaps which are performed in the weight-bearing area and amputation stumps can produce better outcome than nonsensate free flap.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.44-49
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• 1999

From January 1990 to December 1998, 449 consecutive single-digital replantations were reviewed retrospectively in order to determine the essential number of vascular anastomoses for successful finger replantation. The correlations between the number of anastomosed vessels and survival rate were examined according to the amputated digital levels and all of the correlated results were compared with each other statistically. In zone I, The survival rate of the digits with a repaired vein was higher than that of digits treated with external bleeding method. In zone II, the equal number(s) between the arterial and venous repair was an important factor in successful replantation. And the repaired arteries more than repaired veins in number led to venous congestion and resulted in a failure of replantation, which was maybe due to the large amount of arterial input relative to small volume of amputated stump with small sized vein. In zone III, the equal number(s) between the arterial and venous repair was also an important factor in successful replantation. But unlike in zone II, venous congestion was scarcely happened if the venous drainage was sufficient with a repaired large vein alone. In zone IV, two or more arteries and veins were required for successful replantation. In conclusion, it is desirable that the repair of vessels as many as possible to increase the possibility of a good result. But digital amputations and their condition for replantation were variable, therefore, the numbers in vascular repair should to be modified and straightforward as the case may be.

• 대한두개안면성형외과학회지
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• 제19권4호
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• pp.304-308
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• 2018

Replantation using microvascular anastomosis is considered to be the optimal method in treating the amputated ear in terms of resulting color, texture, and shape. Only a few cases of ear replantation have been reported because it is anatomically difficult to identify suitable vessels for anastomosis. We successfully replanted the amputated helical rim of the ear using single arterial anastomosis. A 37-year-old man had his helical rim amputated by a human bite. The amputee was about $4{\times}1cm$ in dimension, composed of skin and soft tissue including auricular cartilage. Replantation was performed anastomosing a small artery of the amputee with a terminal branch of the posterior auricular artery. After replantation, intravenous heparinization was performed and prostaglandin E1 and aspirin were administered. Venous congestion was decompressed by stab incisions applied with heparin solution soaked gauze. Venous congestion of the amputee slowly began to resolve at 4 days after the operation. The amputated segment of the helical rim survived completely with good aesthetic shape and color. The authors propose that performing microvascular anastomosis should be attempted especially if it is possible to detect vessels on cut surfaces of ear amputee and stump. Proper postoperative care for venous congestion, arterial insufficiency, and infection should be followed for amputee survival.