• Archives of Reconstructive Microsurgery
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• 제22권2호
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• pp.90-93
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• 2013

Old post burn contractures on feet still remain challenging problem for reconstructive surgeon. A 43-year-old male visited Hallym University Sacred Heart Hospital with the complain of foot deformity and difficulties in shoe fitting. His right 4th and 5th toes were inverted at dorsal foot. We released the contracture of 4, 5th metatarsophalangeal joint and lengthened extensor tendon by Z-plasty, and covered the resultant defect with the anterolateral thigh flap. The flap was successful and the deformity was corrected. As there have been few reports on reconstruction of foot dorsum, especially on post burn extension contractures in the toes, we report a rare case of contracture release and coverage by free flap.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2004년도 추계학술대회 논문집
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• pp.1154-1159
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• 2004

Unexpected postoperative changes, such as growth in rib hump, has been occasionally reported after corrective surgery for scoliosis. However there has been experimental data for explanation of these changes, nor the suggestion of optimal correction method. This numerical study was designed to investigate the main correlating elements in operative kinematics with post-operative changes of vertebral rotation and rib cage deformation in the corrective surgery of scoliosis. To develop a scoliotic spine model automatically, a special program for converting normal spine model to scoliotic spine model was developed. A mathematical finite element model of normal spine including rib cage, sternum, both clavicles, and pelvis was developed with anatomical details. The skeletal deformity of scoliosis was reconstructed, by mapping the X-ray images of a scoliosis into this three dimensional normal spine and rib cage model. The geometric mapping was performed by translating and rotating the spinal colume with the amount analyzed from the digitized 12 built-in coordinate axes in each vertebral image. By utilizing this program, problems generated in mapping procedure such as facet joint overlapping, vertebral body deformity could be automatically resolved.

• 대한족부족관절학회지
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• 제26권4호
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• pp.157-162
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• 2022

Total ankle arthroplasty has become a viable motion-preserving alternative to ankle arthrodesis, especially in the last two decades. Recent improvements have been achieved in the strength of implant design and surgical technique. Nevertheless, addressing preoperative deformities is essential for successful outcomes of total ankle arthroplasty. Residual malalignment can produce instability and edge loading, causing acceleration of polyethylene wear, followed by osteolysis and an increased risk of revision surgery. Therefore, the accompanying deformities and their correction techniques need to be comprehensively elucidated and understood. In this article, we provide a review of the application of total ankle arthroplasty in arthritis with coronal plane varus and valgus deformities.

• 대한족부족관절학회지
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• 제21권4호
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• pp.135-138
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• 2017

Purpose: The purpose of this study is to determine the correlation between the correction loss of hallux valgus angle and the severity of valgus angle of the second toe. Materials and Methods: We selected 312 cases from 268 surgical patients with hallux valgus deformity receiving distal chevron osteotomy. For a radiological evaluation, we analyzed the changes in the hallux valgus angles, first to second intermetatarsal angles, and valgus angle of the second toe post index operations. All patients were women; the mean age was 46 years. The mean follow-up period was 17 months. Results: The mean hallux valgus angle was $33.6^{\circ}$ preoperatively (range, $25.7^{\circ}{\sim}44.8^{\circ}$), $13.1^{\circ}$ (range, $8.4^{\circ}{\sim}16.4^{\circ}$) after 4 weeks of postoperative period, and $17.1^{\circ}$ (range, $9.4^{\circ}{\sim}28.5^{\circ}$) at their final follow-up. The mean valgus angle of the second toe was $8.4^{\circ}$ preoperatively (range, $2.0^{\circ}{\sim}25.8^{\circ}$) and $8.3^{\circ}$ (range, $1.7^{\circ}{\sim}24.9^{\circ}$) at the final follow-up. Preoperatively, there was a positive correlation between the valgus angle of the second toe and hallux valgus angle (r=0.747, p=0.001). The correction loss of hallux valgus angle had a significant correlation with the severity of valgus angle of the second toe (r=0.802, p=0.001). Conclusion: The existence of the second toe valgus deformity may present itself as a cause of correction loss of hallux valgus angle. The preoperative measurement of the second toe valgus angle may be a good predictor of correction loss; therefore, thorough preoperative warning on the possibility of correction loss should be conducted to maximize patient satisfaction after the procedure.

• Journal of Korean Neurosurgical Society
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• 제61권6호
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• pp.716-722
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• 2018

Objective : Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion. Methods : Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36" anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI). Results : Forty patients with a mean age of 66.3 (range, 49-79) met inclusion criteria. A mean of 3.8 levels (range, 2-5) were fused using LIF, while a mean of 9.0 levels (range, 3-16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1-6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from $36.4^{\circ}$ preoperatively up to $48.9^{\circ}$ (71.4% of total correction) after LIF and $53.9^{\circ}$ after PSF. Lumbar coronal Cobb was prominently improved from $38.6^{\circ}$ preoperatively to $24.1^{\circ}$ (55.8% of total correction) after LIF, $12.6^{\circ}$ after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from $22.2^{\circ}$ preoperatively to $8.1^{\circ}$ (86.5% of total correction) after LIF, $5.9^{\circ}$ after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores. Conclusion : LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.4.1-4.6
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• 2016

Background: Most cases of facial asymmetry involve yaw deformity, and determination of the yaw correction level is very difficult. Methods: We use three-dimensional soft tissue simulation to determine the yaw correction level. This three-dimensional simulation is based on the addition of cephalometric prediction to gradual yaw correction. Optimal yaw correction is determined visually, and an intermediate splint is fabricated with computer-aided design and computer-aided manufacturing. Application of positioning devices and the performance of horseshoe osteotomy are advisable. Results: With this procedure, accurate repositioning of jaws was confirmed and patients obtained fairly good facial contour. Conclusions: This procedure is a promising method for a widespread, predictable treatment of facial asymmetry.

• 대한족부족관절학회지
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• 제17권3호
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• pp.225-233
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• 2013

Purpose: This study was performed to evaluate the impact of the lesser toe operation on the overall clinical outcomes, and to analyze the clinical results of concomitant surgery for hallux valgus and lesser toe deformities. Materials and Methods: Forty-six cases underwent surgery for hallux valgus with concomitant lesser toe deformities were followed up for at least 1 year. Lesser toe deformities consisted of 9 crossover toes, 10 claw toes, 12 hammer toes and 15 bunionettes. Clinical evaluation was performed according to AOFAS (American Orthopaedic Foot and Ankle Society) score, patient's satisfaction score, and pain VAS (visual analogue scale) score. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and period to union were measured. Preoperative expectation about lesser toe deformities, postoperative satisfaction, complication rate, hospitalization period, medical expenses, and frequency of outpatient follow-up were analyzed. Results: AOFAS score, VAS score, HAV and IMA had improved significantly. On preoperative expectation of patients, correction of lesser toe deformities was ranked third, following the improvement of big toe(bunion) pain and the correction of hallux valgus. Patient's satisfaction score was average 92.8 points, and the importance of lesser toe operation was 30.2%. When compared to hallux valgus operation only, there were average 2.5 days of additional hospitalization, 2.4 times of additional outpatient follow-up, 386000 won of additional medical expenses. Conclusion: Combined operation for hallux valgus and concomitant lesser toe deformities showed good clinical results. When compared to hallux valgus operation only, there were longer hospitalization, more frequent follow-up, more medical expenses, more complications. However, lesser toe deformity correction in patients underwent hallux valgus operation is considerable, because of high preoperative expectation and postoperative satisfaction.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.143-147
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• 2010

Purpose: Nostril stenosis is an uncommon deformity that develops as a consequence of smallpox, chickenpox, tuberculosis, syphilis, congenital malformations etc. There have been several studies on the surgical techniques to treat it. However, it is difficult to maintain the result for a long time. The goal of this study is to evaluate the use of Wplasty, perialar flap as an operative techniques and expansion exercise using Foley catheter as a method to keep the patency of nostril. Methods: This is a retrospective review of the senior surgeon's (Y.L.) patients who underwent W-plasty and a perialar flap. Patients treated from 2005 to 2009 were reviewed and the postoperative results were evaluated. Average patient age was 24 years, ranged from 1 to 61 years, average follow-up period was 27.5 months, ranged from 3 to 77 months. The mild deformity was released with an incision and expansion by the ballooning of a Foley catheter and corrected by W-plasty only. However, a severe deformity required an additional procedure including perialar flap transposition. During the postoperative period, the patients maintained a nasal stent and exercise using a Foley catheter to prevent recurrence. Results: Five cases of nostril stenosis in four patients were treated using this technique. One case was corrected with W-plasty only, but four cases were more severe and were corrected with W-plasty and a perialar flap. There were no perioperative complications. The patients were satisfied with the results and retained a good shape during the follow-up periods. Conclusion: Nostril stenosis can be corrected with W-plasty and a perialar flap. A perialar flap is added if W-plasty is unable to correct the deformity. A postoperative nasal stent and expansion with a Foley catheter can help in preventing recurrences.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.53-60
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• 2019

Objective : The purpose of this study was to determine the efficacy of intra-operative cell salvage system (ICS) to decrease the need for allogeneic transfusions in patients undergoing major spinal deformity surgeries. Methods : A total of 113 consecutive patients undergoing long level posterior spinal segmental instrumented fusion (${\geq}5$ levels) for spinal deformity correction were enrolled. Data including the osteotomy status, the number of fused segments, estimated blood loss, intra-operative transfusion amount by ICS (Cell $Saver^{(R)}$, $Haemonetics^{(C)}$, Baltimore, MA, USA) or allogeneic blood, postoperative transfusion amount, and operative time were collected and analyzed. Results : The number of patients was 81 in ICS group and 32 in non-ICS group. There were no significant differences in demographic data and comorbidities between the groups. Autotransfusion by ICS system was performed in 53 patients out of 81 in the ICS group (65.4%) and the amount of transfused blood by ICS was 226.7 mL in ICS group. The mean intra-operative allogeneic blood transfusion requirement was significantly lower in the ICS group than non-ICS group (2.0 vs. 2.9 units, p=0.033). The regression coefficient of ICS use was -1.036. Conclusion : ICS use could decrease the need for intra-operative allogeneic blood transfusion. Specifically, the use of ICS may reduce about one unit amount of allogeneic transfusion in major spinal deformity surgery.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.383-390
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• 2011

Purpose: To correct the upper lip depression after the correction of unilateral cleft lip, autologous grafts such as bone, dermal, fascial grafts and fat injections or alloplastic implants are used. Transplanted bones, dermis and fascia have a tendency to be absorbed and have donor morbidity. Fat injections are absorbed inconsistently and alloplastic implants have problems such as foreign body reactions, protrusions and infections. Authors corrected the upper lip depression using conchal cartilage graft in unilateral cleft lip deformity and the results was analysed with photos. Methods: 26-unilateral cleft lip and 2-microform cleft lip cases, totally 28 cases were performed. Their mean age was 21.89 years. The male and female cases were 12 and 16, respectively. Under anesthesia (general: 18 cases and local: 10 cases), cavum conchae (n=8), cymba conchae (n=16) and whole conchae (n=4) were harvested. Transversely cut the margin of the obtained cartilage, we cut out the most bent portion and put a partial-thickness incision on concave surface in cases of excessive convexity. Then, we performed the onlay graft of the conchal cartilage via scar revision site in unilateral cleft lip and via the reconstruction site of the cupid bow in microform cleft lip. The augmentation of the upper lip was evaluated with photos. Adapting the baseline connecting between the both cheilions as a horizontal standard line, we measured the highest point among the tangents between the upper lip and nose (point a), the lowest point (point c), the middle point between a and c (point b) and the vertical line from the alare (point d) to the horizontal standard line. To assess the postoperative symmetry, we compared cleft side upper lip contour index (%) A,B,C,D=(a,b,c,d)-ch ${\times}$ 100/(ch-ch) and non-cleft side upper lip contour index (%) A',B',C',D'= (a',b',c',d')-ch ${\times}$ 100 / (ch-ch).h) Results: After the surgery, no complication was found except in one case which double layers graft performed in the cleft lip deformity, the lateral portion was protruded. The upper lip contour index, the difference of A and A' were-0.83%, and thus the mild depression was persisted. Difference of B and B', C and C', D and D' were 0.83%, 1.07%, 0.90%. There were statistically significant difference, and thus the depression of upper lip were improved generally. Conclusion: Authors performed the onlay graft of the conchal cartilage in unilateral cleft lip deformity and found that the depression of the upper lip was well corrected except the uppermost part when photogrammetrically analyzed.