• Archives of Plastic Surgery
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• 제37권5호
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• pp.650-658
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• 2010

Purpose: In the case of repair for far distal parts of FDP (Flexor digitorum profundus) division, the method of either pull-out suture or fixation of tendon to the distal phalanx is preferred. In this paper, the results of a modified loop suture technique used for the complete division of FDP from both zone 1a and distal parts of zone 1b in Moiemen classification are presented. Methods: From July 2006 to July 2009, the modified loop suture technique was used for the 10 cases of FDP in complete division from zone 1a and distal parts of zone 1b, especially where insertion sites were less than 1 cm apart from a tendon of a stump. In a suture technique, a loop is applied to each distal and proximal parts of tendon respectively. Core suture of 2-strand and epitendinous suture are done with PDS 4-0. Out of 10 patients, the study was done on 6 patients who were available for the followup. The average age of the patients was 49.1 years (in the range from 26 to 67). 5 males and 1 female patients were involved in this study. There were 3 cases with zone 1a and distal parts of zone 1b. The average distance to the distal tendon end was 0.6 cm. There were 5 cases underwent microsurgical repair where both artery and nerve divided. One case of only tendon displacement was presented. The dorsal protective splint was kept for 5 weeks on average. The results of the following tests were measured: active & passive range of motion, grip strength test, key pinch and pulp pinch test. Results: The follow-up period on average was 11 months, in the range from 2 to 20 months. There was no case of re-rupture, but tenolysis was performed in 1 cases. In all 6 cases, the average active range of motion of distal interphalangeal joint was 50.8 degree. The grip strength (ipsilateral/contralateral) was measured as 88.7% and the pulp pinch test was 79.2% as those of contralateral side. Flexion contracture was presented in 2 cases (15 degree on average) and there was no quadrigia effect found. Conclusion: Despite short length of tendon from the insertion site in FDS rupture in zone 1a and distal parts of zone 1b, sufficient functional recovery could be expected with the tendon to tendon repair using the modified loop suture technique.

• Archives of Reconstructive Microsurgery
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• 제14권1호
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• pp.1-13
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• 2005

Purpose: The purpose of this study is to present extended indications for the use of arterialized venous flaps in reconstructing soft tissue, tendon, nerve, blood vessel, and composite tissue defects of the hand of various sizes based on researches and clinical experiences of the authors. Moreover, procedures to achieve complete flap survival and postoperative results are presented. Materials & methods: This study is based on 154 cases of arterialized venous flaps performed to reconstruct the hand during the past 11 years. The most common cause of injury was industrial accidents with 125 cases. One hundred thirty patients or 84% of the cases had emergency operation within 2 weeks of the injury. The flaps were categorized depending on the size of the flap. Flaps smaller than $10\;cm^2$ were classified as small (n=48), those larger than $25\;cm^2$ classified large (n=42) and those in between medium (n=64). Classified according to composition, there were 88 cases (57.1 %) of venous skin flaps, 28 cases of innervated venous flaps, 15 cases of tendocutaneous venous flaps, which incorporated the palmaris longus tendon, for repair of extensor tendons of the fingers, and 17 cases of conduit venous flaps to repair arterial defect. There were 37 cases where multiple injuries to multiple digits were reconstructed. Moreover, there were 6 cases of composite tissue effects that involved soft tissue, blood vessels and tendons. The donor sites were ipsilateral forearm, wrist and thenar area, foot dorsum, and medial calf. The recipient sites were single digit, multiple digits, first web space, dorsum and palm of hand, and wrist. Results: There were seven cases (4.5%) of emergent re-exploration due to vascular crisis, and 3 cases of flap failure characterized by more than 50% necrosis of the flap. The survival rate was 98.1 % (151/154). In small flaps, an average of 1.01 afferent arteries and 1.05 efferent veins were microanastomosed, and in large flaps, an average of 1.88 afferent arteries and 2.19 efferent veins were anastomosed. In 8 cases where innervated flaps were used for reconstructing the palm of the hand, the average static two-point discrimination was $10\;(8{\sim}15)\;mm$. In 12 cases where tenocutaneous flaps were used, active range of motion at the proximal interphalangeal joint was 60 degrees, 20 degrees at the distal interphalangeal joint, and 75 degrees at the metacarpophalangeal joint. Conclusion: We conclude that the arterialized venous flap is a valuable and effective tool in the reconstruction of hand injuries, and could have a more comprehensive set of indications.

• Clinical and Experimental Pediatrics
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• 제57권6호
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• pp.292-296
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• 2014

The deletion of the distal long arm of chromosome 1 is associated with a characteristic facial appearance and a pattern of associated malformations. Characteristic manifestations include a round face with prominent 'cupid's bow' and downturned corners of the mouth, thin vermilion borders of lips, a long upper lip with a smooth philtrum, a short and broad nose, epicanthal folds, apparently low-set ears, micrognathia, microcephaly, abnormal hands and feet, variable cardiac or genital anomalies, moderate to severe mental retardation, and growth retardation. Using fluorescent in situ hybridization (FISH) analysis to map precisely the deletion, we present a case of chromosome 1q44 deletion with craniofacial characteristics, multiple congenital anomalies, and growth and psychomotor retardation. In comparison with other reported cases of 1q43-44 deletion, the subject does not show hydrocephalus, seizure, syn- or polydactyly of hands, and a urogenital anomaly. However, an arachnoid cyst, pinpoint dimple on the midline of the forehead, a right-sided supernumerary nipple and auricular pit, polydactyly of the right foot, adducted thumb, and flexion restriction of the proximal interphalangeal joint with a simian line in both hands were observed additionally.

• Journal of Yeungnam Medical Science
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• 제36권2호
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• pp.92-98
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• 2019

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

• Archives of Plastic Surgery
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• 제43권2호
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• pp.134-144
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• 2016

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

• 한국전문물리치료학회지
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• 제21권4호
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• pp.1-8
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• 2014

Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that delivers low-intensity direct current to cortical areas, thereby facilitating or inhibiting spontaneous neuronal activity. This study was designed to investigate changes in various sensory functions after tDCS. We conducted a single-center, single-blinded, randomized trial to determine the effect of a single session of tDCS with the current perception threshold (CPT) in 50 healthy volunteers. Nerve conduction studies were performed in relation to the median sensory and motor nerves on the dominant hand to discriminate peripheral nerve lesions. The subjects received anodal tDCS with 1 mA for 15 minutes under two different conditions, with 25 subjects in each groups: the conditions were as follows tDCS on the primary motor cortex (M1) and sham tDCS on M1. We recorded the parameters of the CPT a with Neurometer$^{(R)}$ at frequencies of 2000, 250, and 5 Hz in the dominant index finger to assess the tactile sense, fast pain and slow pain, respectively. In the test to measure CPT values of the M1 in the tDCS group, the values of the distal part of the distal interphalangeal joint of the second finger statistically increased in all of 2000 Hz (p=.000), 250 Hz (p=.002), and 5 Hz (p=.008). However, the values of the sham tDCS group decreased in all of 2000 Hz (p=.285), 250 Hz (p=.552), and 5 Hz (p=.062), and were not statistically significant. These results show that M1 anodal tDCS can modulate sensory perception and pain thresholds in healthy adult volunteers. The study suggests that tDCS may be a useful strategy for treating central neurogenic pain in rehabilitation medicine.

• 대한족부족관절학회지
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• 제23권4호
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• pp.166-172
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• 2019

Purpose: This study evaluated the clinical and radiological results after reinforcement of the weakened medial joint capsule using Internal Brace (Arthrex) for treating severe hallux valgus. Materials and Methods: This study reviewed 56 cases of 50 patients that were followed-up postoperatively for at least 12 months, from September 2017 until August 2018. An extended distal chevron osteotomy combined with a distal soft-tissue release was performed by a single surgeon to treat severe hallux valgus. Internal Brace was applied in 12 cases (group A) who had weakened medial joint capsules, and capsulorrhaphy was performed in 44 cases (group B), and these two groups were compared postoperatively for the clinical and radiological results. The postoperative complications were also investigated. Results: No significant differences at 1-year follow-up on the Manchester-Oxford Foot Questionnaire and the patients' satisfaction scores were found between the two groups (p=0.905 and p=0.668, respectively). For the radiology, the changes of the values between before surgery and at 1-year follow-up according to the group showed no significant differences in the hallux valgus angle, intermetatarsal angle, and the hallux interphalangeal angle (p=0.986, p=0.516, p=0.754, respectively). Recurrence of hallux valgus was reported in two cases in group A, and in three cases in group B. Transfer metatarsalgia occurred in 4 cases in group B. Conclusion: Based on these results, we recommend the capsule reinforcing technique using Internal Brace as a successful operative option for treating a weakened medial capsule in patients with severe hallux valgus.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.187-190
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• 2010

Purpose: Pediatric trigger thumb is a condition of flexion deformity of the interphalangeal (IP) joint. The known surgical treatment is the release of the flexor pollicis longus by transection of the A1 pulley. We report two cases of pediatric trigger thumb that were resolved by releasing of additional pulley as well as A1 pulley. Methods: From March 2006 to April 2008, a total of 10 children with trigger thumb were operated. In two cases, transection of only the A1 pulley was insufficient to relieve the triggering. When more distally dissection, we found an additional pulley. After release of the additional pulley, the full extension of IP joint is obtained. Results: There were no significant complications. In 8 cases, the trigger thumbs were resolved by transecting only the A1 pulley, does not extend beyond the base of the proximal phalanx. In one case, the additional pulley was found to be more distal to the A1 pulley. It was necessary to extend the release up to the half in the proximal phalangeal shaft. In other case, the additional pulley was immediately adjacent to the A1 pulley. Conclusion: In most cases of trigger thumb, division of just A1 pulley is sufficient to relieve the triggering. However, dividing the A1 pulley in two patients proved to be insufficient to relieve the flexed deformity. In these cases, we found that the additional pulley, different from previous known A1 pulley, had existed, which must be transected to allow full excursion of flexor pollicis longus.

• 대한골관절종양학회지
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• 제7권1호
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• pp.20-27
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• 2001

목적 : 건초에서 생긴 거대세포종은 수부에서 발생하는 종양 중 두 번째로 흔하나 절제술 후에 재발이 드물지 않으며 국내에서의 연구는 많지 않다. 이에, 저자들은 완관절부를 포함한 수부에 생기는 건초의 거대세포종의 임상적 특성과 수술적 치료후 결과를 분석하여 문헌고찰과 함께 보고하고자 한다. 대상 및 방법 : 1991년부터 1998년까지 수부에서 발생한 종물로 절제생검술을 시행받은 환자 중 조직병리학적으로 건초의 거대세포종으로 진단받은 총 38명, 41예에 대해 성별, 나이, 증상, 증상발현기, 종양이 발생한 부위, 발생한 건, 크기, 다발성 여부, 양측성 여부, 방사선학적 소견 및 골 침범, 재발여부 등에 대해 분석하였으며, 추시기간은 평균 13.1개월(5~40개월)이었다. 결과 : 38명 중 여자에서 29명으로 빈발하였고, 발생연령은 6세에서 66세까지 다양하였으나 50대에서 12례로 가장 호발하였으며 평균연령은 40.1세였다. 지배수지와 비지배수지의 발생경향은 비슷하였고(17례:21례), 모두 일측성이었다. 신전건(17례)보다 굴곡건(24례)에서 더 호발하였으며 증상발현기는 2개월에서 120개월(평균 23.4개월)이었다. 증상으로 대부분 무통성 종물을 호소하였으나, 5례에서 압통, 36례에서 운동장애, 5례에서 압박에 의한 신경증상을 호소하기도 하였다. 재발을 주소로 내원한 경우가 3례였다. 부위별 발생빈도는 수지에서 36례, 수장부에서 3례, 완관절부위 장측에서 2례 순으로 빈발하였으며, 수지별 발생빈도는 인지에서 14례(34%)로 가장 많았고, 엄지가 10례(24%), 중지는 9례, 환지는 5례, 소지는 3례의 빈도순을 보였다. 수지상 발생부위는 원위지골간 관절부 및 중위지골부에서 20례(48.8%), 근위지골 및 근위지골간 관절부가 9례, 중수지절관절부가 7례 순으로 호발하였다. 방사선학적 소견상 연부조직에 방사선 비투과적인 균일한 연부조직 음영을 보이고 있었고 3명에서 피질골 미란을 보였다. 37명에서 종양은 단발성 병변이었으나 이 중 4명에서 다엽상으로 넓게 분포하였고, 1명에서 다발성 병변을 보였다. 변연부 절제술후 재발된 경우가 2명으로 재발율은 5.1%였다. 결론 : 수부에서 발생한 건초의 거대 세포종은 호발조건으로 50대, 여성, 인지, 굴곡건, 수지 원위부를 추정해 볼 수 있었으며, 불완전한 변연부 절제술을 시행하거나, 수술 후 재발한 경우, 다발성, 다엽상 소견을 보인 경우 재발이 잘 되므로 이 경우 광범위 절제술이 필요할 것으로 사료된다.

• Archives of Plastic Surgery
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• 제43권6호
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• pp.590-594
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• 2016

Recently, the number of cases of animal bite wounds has increased significantly in concordance with an increase in the pet population around the world. The authors report two rare cases of osteomyelitis of the phalanx following cat and dog bites. On initial physical examination, signs of a severe infection were observed. Radiographs of both patients showed the presence of osteomyelitis, and in one of the patients, the diagnosis was confirmed with a bone biopsy. After use of empirical antibiotics, intravenous antibiotic therapy that matched the identified bacterium's sensitivity was initiated, and at the same time, secure dressing including debridement was performed to induce secondary healing. In addition, the patients were closely monitored with serial X-rays, and culture and blood test follow-up. One patient fully recovered without sequelae, but the other patient suffered a loss of distal interphalangeal joint motion. When dealing with bite wounds located on the hand, it is important to visit the hospital as soon as possible and receive the appropriate treatment early. Moreover, to prevent severe complications such as osteomyelitis, it is important to administer antibiotic therapy to which the cultured bacteria are sensitive, along with proper wound management and prophylactic antibiotic treatment.