• 대한족부족관절학회지
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• 제27권1호
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• pp.24-29
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• 2023

Macrodactyly of the toe is a rare congenital anomaly characterized by the overgrowth of a digit/digits in the foot and is one of the most difficult conditions to treat. Since the condition alters functionality and appearance, the treatment goal is to restore function and cosmetically enhance the appearance. Various surgical techniques are used for toe macrodactyly, including amputation, debulking, and epiphysiodesis. Herein, we present a case of a six-year-old patient with a second toe macrodactyly who was successfully treated with a two-stage operation over a seven-year period. We initially performed an ostectomy of the middle phalanx with a fusion of the proximal and distal phalanges and then performed a soft tissue debulking procedure.

• 대한치과교정학회지
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• 제20권1호
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• pp.111-122
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• 1990

To investigate the relationship of skeletal maturity among the normal occlusion group and each malocclusion groups, the author used hand and wrist X-ray of 133 Korean 13 year old boys (normal occlusion 30, Class I malocclusion 35, Class II malocclusion 35 and Class III malocclusion 33) and assessed their skeletal maturity. In this study, fourteen skeletal maturity stages were selected from; Radius, Hamate, Pisiform, Ulnar sesamoid of the metacarpophalangeal joint of the first thumb, proximal phalanges of the first, second and third finger, middle and distal phalanx of the third finger. The difference of skeletal maturity of each malocclusion groups in relative to normal occlusion group and that of each malocclusion groups were analyzed. The findings of this study can be summerized as follows: 1. Average skeletal maturity stage of each groups were MP3cap stage in normal occlusion group, H-2 stage in Class I malocclusion group, midstage between S and H-2 stage in Class II malocclusion group, MP3cap stage in Class III malocclusion group. 2. There was no significant difference in skeletal maturity of Class I malocclusion and Class III malocclusion groups in relative to normal occlusion group. 3. There was significant retardation of skeletal maturity in Class II malocclusion group in relative to normal occlusion group. 4. There was no significant difference in skeletal maturity between Class I and Class II malocclusion groups. 5. There was no significant difference in skeletal maturity between Class I and Class III malocclusion groups. 6. There was significant retardation of skeletal maturity in Class II malocclusion group in relative to Class III malocclusion group.

• 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.

• Archives of Plastic Surgery
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• 제42권2호
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• pp.207-213
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• 2015

Background Pincer nail deformity is a transverse overcurvature of the nail. This study aimed to define the anatomical characteristics of pincer nail deformity and to evaluate the surgical outcomes. Methods A retrospective review was conducted on 20 cases of pincer nail deformity of the great toe. Thirty subjects without pincer nail deformity or history of trauma of the feet were selected as the control group. Width and height indices were calculated, and interphalangeal angles and base widths of the distal phalanx were measured with radiography. We chose the surgical treatment methods considering perfusion-related factors such as age, diabetes mellitus, kidney disease, and peripheral vascular disease. The zigzag nail bed flap method (n=9) and the inverted T incision method (n=11) were used to repair deformities. The outcomes were evaluated 6 months after surgery. Results The interphalangeal angle was significantly greater in the preoperative patient group ($14.0^{\circ}{\pm}3.6^{\circ}$) than in the control group ($7.9^{\circ}{\pm}3.0^{\circ}$) (P<0.05). The postoperative width and height indices were very close to the measurements in the control group, and most patients were satisfied with the outcomes. Conclusions We believe that the width and height indices are useful for evaluating the deformity and outcomes of surgical treatments. We used two different surgical methods for the two patient groups with respect to the perfusion-related factors and found that the outcomes were all satisfactory. Consequently, we recommend taking into consideration the circulatory condition of the foot when deciding upon the surgical method for pincer nail deformity.

• 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.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.113-116
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• 2011

Purpose: Many fingertip injuries are associated with nail injury and it is hard to repair to original shape due to its unique characteristic. Mucosal graft is used for a defect of the nail bed injury. Hereby, we introduce a DAP flap and buccal mucosal graft, with which we could reduce the defect size of the injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Also, mucosal graft makes good cosmetic and functional outcome of nail. Methods: This method was performed in a 56-year-old man with fingertip injury on dorsal side of left thumb due to electrical saw. First, DAP flap was performed on the injured finger to reduce the size of the defect of fingertip and cover the bone exposure. Second, nail bed part of the DAP flap was de-epithelized and buccal mucosal graft was done from left side of intraoral cavity wall. Results: Flap and graft survived without any necrosis but some nail bed could not be covered with flap due to insufficient flap size. All wounds healed well and did not present any severe adversary symptoms. Conclusion: DAP flap with mucosal graft is an effective method that we can easily apply in reconstruction of fingertip injury. We suggest that the combination of the two procedures makes good functional and cosmetic outcome compared to the usual manner, especially in cases of nail bed injury without distal phalanx bone defect.

• Archives of Plastic Surgery
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• 제44권1호
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• pp.53-58
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• 2017

Background Adequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation. Methods A single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups. Results The exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%). Conclusions In this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.

• Journal of Hospice and Palliative Care
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• 제15권2호
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• pp.108-111
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• 2012

손으로의 전이성 암은 드문 질환으로 환자를 진료함에 있어 간과되기 쉽다. 간세포성 암종 환자에서 손으로의 전이는 지금까지 전세계적으로 5예가 보고되고 있으며, 이 논문에서는 간세포성 암종의 우측 4번째 손가락으로의 전이를 보고하고자 한다. 환자는 통증과 부종을 호소하였으며 보존적 치료에도 증상이 점차 악화되어 절단 수술을 받고 증상이 호전되었다. 이 보고는 진료의사들이 암환자의 손에 병변이 관찰될 때 전이성 암의 가능성을 염두에 두고 접근하여 증상 조절을 해야 한다는 것을 시사한다.

• 한국임상수의학회지
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• 제26권3호
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• pp.259-262
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• 2009

Focal adnexal dysplasia(FAD) is a rare non-neoplastic lesion of adnexal appendages that occurs in dogs and has good prognosis. We report a case in which FAD diagnosis was favored by its histopathological features. A 8-year-old, castrated male American cocker spaniel dog presented with papillomatous masses on the distal phalanx of left forelimb. Histopathologically, the stroma was sharply demarcated from the adjacent dermis and subcutis. The adnexa was surrounded and interspersed with abundant, hyalinized collagen and the numerous sebaceous lobules distributed haphazardly around hair follicles, which is thickened, dilated and tortuous with abundant keratin. Epidermis was acanthotic. Proliferative lesions of the skin region are very common with similar gross features, thus the basic histopathological examination supported by additional diagnostic methods allow to establish the definitive diagnosis in most cases of cutaneous tumor or tumor-like lesions. And it is important that physicians and pathologists are aware of this unusual tumour-like nonneoplastic lesion.

• 대한골관절종양학회지
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• 제15권1호
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• pp.65-68
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• 2009

증식성 모낭 종양은 모낭 말단부위의 외근모초에서 기원하는 드문 종양이다. 악성 변화는 드물지만 갑작스러운 크기의 증가, 침윤성 성장 및 두피 이외에서 종양의 발생 등은 악성 증식성 모낭 종양을 시사한다. 병리조직학적으로 핵의 이형성, 다형성 및 유사분열 소견은 악성증식성 모낭 종양의 특징이다. 악성 증식성 모낭 종양은 재발 및 전이가 보고되고 있어 정상조직을 포함한 충분한 절제와 추적관찰이 요구된다. 53세 남자 환자의 우측 제 5수지 원위 지골에 7년전 발생한 종양을 중위 지이하 절제술 후 병리조직검사상 악성 증식성 모낭 종양으로 진단되었고, 환자가 외래로 더 이상 방문하지 않아 재발과 전이를 확인할 수 없었다.