• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.

• 대한기계학회논문집A
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• 제41권9호
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• pp.825-837
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• 2017

본 논문에서는 하지 보행 장애를 가진 환자가 사용하는 크러치에 로봇 기술이 적용된 새로운 타입의 착용식 족형 보행 재활 로봇에 대해 서술하였다. 개발된 로봇의 주된 특징은 크게 세 가지로 나뉜다. 첫 번째, 착용 방식의 특징으로서, 팔꿈치에 착용하여 환자를 보조하는 엘보 크러치와 달리 환자의 가슴부에 족형 로봇을 착용함으로써 보행 시 넓은 가슴 면적으로부터 하중을 분산시키고 팔에 작용하는 집중 하중을 제거하였으며, 팔과 손의 움직임을 자유롭게 하였다. 두 번째, 사용자의 보행 의지를 파악하는 방법으로서, 족형 로봇의 발에 부착된 3축 힘센서를 이용하여 지면 반발력의 크기와 방향으로부터 사용자의 보행의도를 추정하는 알고리즘을 제안하였고 이에 따라 가슴 착용형 로봇을 보행시켰다. 마지막으로, 계단 보행을 위한 근력 강화 방법으로서, 둔턱을 오르내리는 근력 훈련이 가능하도록 바닥 높낮이에 따라 상하 운동 궤적이 변화할 수 있는 둔턱 보행 기능을 구현하였다. 최종적으로 개발된 로봇이 보행 의도를 인지하고 로봇 다리로부터 보행 보조를 효과적으로 수행할 수 있다는 것을 실험을 통하여 확인하였고, 하지 근전도 측정을 통하여 보행 시 로봇이 하지 근력을 보조하는 성능을 정량적으로 검증하였다.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.583-590
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• 2009

Purpose: In the cases of a vascular compromised condition in an injured lower extremity, soft tissue coverage with free tissue transfer presents a challenging problem to the reconstructive surgeon. For this reason, cross - leg flaps are still used in unusual circumstances. Advances in surgical technique has made the cross - leg free flap possible although it may require long operation time along with significant donor site morbidity. Therefore, a pedicled cross - leg muscle flap may be an alternative treatment modality when local flap or free flap is not possible. Methods: Twelve patients(9 males and 3 females) underwent the operation between October of 2001 and December of 2008. The patients' age ranged from 6 to 82 years. The unusual defects included the regions such as the knee, popliteal fossa, distal third of the tibia, dorsal foot, and the heel. Indications for the cross - leg gastrocnemius flap are inadequate recipient vessels for free flap(in eight cases), extensive soft tissue injuries(in three cases) and free flap failure(in one case). The muscle flap was elevated from contralateral leg and transferred to the soft tissue defect on the lower leg while both legs were immobilized with two connected external fixator systems. Delay procedure was performed 2 weeks postoperatively, and detachment was done after the establishment of the adequate circulation. The average period from the initial flap surgery to detachment was 32 days (3 to 6 weeks). Mean follow - up period was 4 years. Results: Stable coverage was achieved in all twelve patients without any flap complications. Donor site had minimal scarring without any functional and cosmetic problems. No severe complications such as deep vein thrombosis or flap necrosis were noted although mild to moderate contracture of the knee and ankle joint developed due to external fixation requiring 3 to 4 weeks of physical treatment. All patients were able to walk without crutches 3 months postoperatively. Conclusion: Although pedicled cross - leg flaps may not substitute free flap surgery, it may be an alternative method of treatment when free flap is not feasible. Using this modification of the gastrocnemius flap we managed to close successfully soft tissue defects in twelve patients without using free tissue transfers.