• Archives of Plastic Surgery
• /
• v.50 no.5
• /
• pp.523-528
• /
• 2023

The Gustilo IIIB tibiofibular fractures often result in long bone loss and extensive soft tissue defects. Reconstruction of these complex wounds is very challenging, especially when it includes long bone grafts, because the donor site is limited. We describe our experience using a set of chimeric ipsilateral vascularized fibula grafts with a thoracodorsal artery perforator free flap to reconstruct the traumatic tibia defects. A 66-year-old male suffered a severe comminuted tibia fracture and segmented fibula fracture with large soft tissue defects as a result of a traffic accident. He also had an open calcaneal fracture with soft tissue defects on the ipsilateral side. All the main vessels of the lower extremity were intact, and the cortical bone defect of the tibia was almost as large as the fractured fibula segment. We used an ipsilateral vascularized fibula graft to reconstruct the tibia and a thoracodorsal artery perforator flap to resurface the soft tissue, using the distal ends of peroneal vessels as named into sequential chimeric flaps. After 3 weeks, the calcaneal defect was reconstructed with second thoracodorsal artery perforator free flap. Reconstruction was successful and allowed rapid rehabilitation because of reduced donor site morbidity.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.49 no.6
• /
• pp.354-359
• /
• 2023

The temporomandibular joint is a unique structure composed of the joint capsule, articular disc, mandibular condyles, glenoid fossa of the temporal bone, surrounding ligaments, and associated muscles. The condyle is one of the major components of a functional temporomandibular joint. Reconstruction of large mandibular defects involving the condyle is a surgical challenge for oral and maxillofacial surgeons. To restore large mandibular defects, there are different options for free flap method such as fibula, scapula, and iliac crest. Currently, the vascularized fibula free flap is the gold standard for reconstruction of complex mandibular defects involving the condyle. In the present report, neocondyle regeneration after mandible reconstruction including the condyle head with fibula free flap was evaluated. In this report, two patients were evaluated periodically, and remodeling of the distal end of the free fibula was observed in both cases after condylectomy or mandibulectomy. With preservation of the articular disc, trapezoidal shaping of the neocondyle, and elastic guidance of occlusion, neocondyle bone regeneration occured without ankylosis. Preservation of the articular disc and maintenance of proper occlusion are critical factors in regeneration of the neocondyle after mandible reconstruction.

• Applied Microscopy
• /
• v.24 no.3
• /
• pp.1-9
• /
• 1994

Pardosa astrigera possessed eight eyes arranged in three rows on the frontal carapace. A pair of small anterior lateral eyes (ALE) flanked each side by an anterior median eyes (AME) lay along the anterior margin that was situated on the anterior row of clypeus. The anterior lateral eye was composed of cornea, vitreous body, and retina. Cornea was made up mainly of exocuticle lining the cuticle. Lens in anterior lateral eye was biconvex type which bulged into the cavity of the eyecup. Outer and inner central region of lens were approximately spherical with radius of curvature $5.6{\mu}m$ and $12.5{\mu}m$, respectly. Vitreous body formed a layer between the cuticular lens and retina. They formed biconcave shape. Retina of the anterior lateral eyes was composed of three types of cells: visual cells, glia cells, and pigment cells. The visual cells were unipolar neuron, as were the receptor of the posterior lateral eye. But cell body was unique to the anterior lateral eyes. They were giant cell, relatively a few in number, and under the layer of vitreous bodies. Each visual cell healed rhabdomeres for a short stretch beneath the cell body. Rhabdomes were irregulary pattern in retina and electron dense pigment granules scattered between the rhabdomes. Glia cell situated at the cell body of visual cell and glia cell process reached to rhabdomere portion. Below the rhabdome, tapetum were about $30{\mu}m$ distance from lens, which composed of 4-5 layers. It was about $25{\mu}m$ length that intermediate segment of distal portion of visual cell. Electron dense pigment granules between the intermediate segment were observed.

• Journal of Korean Neurosurgical Society
• /
• v.59 no.6
• /
• pp.564-569
• /
• 2016

Objective : This study used the intradural procedural time to assess the overall technical difficulty involved in surgically clipping an unruptured middle cerebral artery (MCA) aneurysm via a pterional or superciliary approach. The clinical and radiological variables affecting the intradural procedural time were investigated, and the intradural procedural time compared between a superciliary keyhole approach and a pterional approach. Methods : During a 5.5-year period, patients with a single MCA aneurysm were enrolled in this retrospective study. The selection criteria for a superciliary keyhole approach included : 1) maximum diameter of the unruptured MCA aneurysm <15 mm, 2) neck diameter of the MCA aneurysm <10 mm, and 3) aneurysm location involving the sphenoidal or horizontal segment of MCA (M1) segment and MCA bifurcation, excluding aneurysms distal to the MCA genu. Meanwhile, the control comparison group included patients with the same selection criteria as for a superciliary approach, yet who preferred a pterional approach to avoid a postoperative facial wound or due to preoperative skin trouble in the supraorbital area. To determine the variables affecting the intradural procedural time, a multiple regression analysis was performed using such data as the patient age and gender, maximum aneurysm diameter, aneurysm neck diameter, and length of the pre-aneurysm M1 segment. In addition, the intradural procedural times were compared between the superciliary and pterional patient groups, along with the other variables. Results : A total of 160 patients underwent a superciliary (n=124) or pterional (n=36) approach for an unruptured MCA aneurysm. In the multiple regression analysis, an increase in the diameter of the aneurysm neck (p<0.001) was identified as a statistically significant factor increasing the intradural procedural time. A Pearson correlation analysis also showed a positive correlation (r=0.340) between the neck diameter and the intradural procedural time. When comparing the superciliary and pterional groups, no statistically significant between-group difference was found in terms of the intradural procedural time reflecting the technical difficulty (mean${\pm}$standard deviation : $29.8{\pm}13.0min$ versus $27.7{\pm}9.6min$). Conclusion : A superciliary keyhole approach can be a useful alternative to a pterional approach for an unruptured MCA aneurysm with a maximum diameter <15 mm and neck diameter <10 mm, representing no more of a technical challenge. For both surgical approaches, the technical difficulty increases along with the neck diameter of the MCA aneurysm.

• Korean Journal of Applied Biomechanics
• /
• v.19 no.1
• /
• pp.77-85
• /
• 2009

This study is aimed at providing information on injury prevention and skill improvement by inducing the accurate movements in exercise as well as understanding the principles of badminton drive movements. Movement displacement of racket head showed the similar patterns among those surveyed but, it seemed that slight differences resulted from external factors such as height, length of brachial and forearm and individual trend of swing locus. Regarding upper joint angle per phase, the angles of shoulder joint, elbow joint and wrist joint were closely associated in taking drive movements and they supported the segment order theory that power was conveyed from proximal into distal. It was shown that angular velocity of upper joint became larger in follow through movement after impact among all those surveyed, which meant the importance of follow through in racket sports such as badminton. In conclusion, this follow through movement acts as an important factor in racket sports in terms of pose stability maintenance, pose correction of movements and injury prevention of joints. In summary, when swings are made according to segment order theory, efficient movements can be taken.

• Korean Journal of Applied Biomechanics
• /
• v.17 no.1
• /
• pp.191-199
• /
• 2007

This study was conducted to examine the biomechanical characteristics of open spike in the volleyball to improve the technique of the volleyball spike. The subjects were six male college and high school athletes. The motions of volleyball spike were filmed by using two Sony VX 2000 Video Cameras. The mechanical factors were angle and angular velocity of body segments in the upper and the lower limbs. The conclusions were as follows; 1. The angle of the shoulder joint of the skilled showed larger than that of the unskilled in impacting of the volley ball spike. 2. The angle of the elbow joint of the skilled showed larger than that of the unskilled in impacting of the volley ball spike. 3. The angle of the wrist joint of the skilled showed smaller than that of the unskilled in impacting of the volley ball spike. 4. The angle of the hip joint of skilled showed larger than that of unskilled in impacting of the volley ball spike. 5. The angle of the knee joint of the skilled and the unskilled showed same in take off and impacting of the volley ball spike, and that of the skilled showed smaller than that of the unskilled in take-off touchdown and touchdown after impact of the volley ball spike. 6. The angle of the ankle joint of skilled showed larger than unskilled in take-off of the volley ball spike. 7. The angular velocity of the shoulder joint, elbow joint, wrist joint of the skilled showed faster than that of the unskilled in impacting of the volley ball spike. Taken together the result of them, I have come to conclusion that knee joint angle in touchdown of the take off should be decreased and knee joint angle in take off should be increased, and then stability of the take off should be made and, and that extension of the elbow joint should be made and wrist joint angle decreased and shoulder and hip joint angle increased, and then C.O.G of the arm and hand should be positioned ahead C.O.G of the body in impacting for effective impact of the spike, and that the transfer of the angular velocity of body segments for effective impact of the spike make from the proximal segment to the distal segment at spike in volleyball.

• Journal of Korean Neurosurgical Society
• /
• v.64 no.3
• /
• pp.437-446
• /
• 2021

Objective : To investigate the radiographic characteristics of the uppermost instrumented vertebrae (UIV) and UIV+1 compression fractures that are predictive of revision surgery following long-segment spinal fixation. Methods : A total 27 patients who presented newly developed compression fracture at UIV, UIV+1 after long segment spinal fixation (minimum 5 vertebral bodies, lowest instrumented vertebra of L5 or distal) were reviewed retrospectively. Patients were divided into two groups according to following management : revisional surgery (group A, n=13) and conservative care (group B, n=14). Pre- and postoperative images, and images taken shortly before and after the occurrence of fracture were evaluated for radiologic characteristics Results : Despite similar degrees of surgical correction of deformity, the fate of the two groups with proximal junctional compression fractures differed. Immediately after the fracture, the decrement of adjacent disc height in group A (32.3±7.6 mm to 23.7±8.4 mm, Δ=8.5±6.9 mm) was greater than group B (31.0±13.9 mm to 30.1±15.5 mm, Δ=0.9±2.9 mm, p=0.003). Pre-operative magnetic resonance imaging indicated that group A patients have a higher grade of disc degeneration adjacent to fractured vertebrae compared to group B (modified Pfirrmann grade, group A : 6.10±0.99, group B : 4.08±0.90, p=0.004). Binary logistic regression analysis indicated that decrement of disc height was the only associated risk factor for future revision surgery (odds ratio, 1.891; 95% confidence interval, 1.121-3.190; p=0.017). Conclusion : Proximal junctional vertebral compression fractures with greater early-stage decrement of adjacent disc height were associated with increased risk of future neurological deterioration and necessity of revision. The condition of adjacent disc degeneration should be considered regarding severity and revision rate of proximal junctional kyphosis/proximal junction failures.

• The korean journal of orthodontics
• /
• v.25 no.1 s.48
• /
• pp.73-85
• /
• 1995

Multi-Vertical Loop Arch Wire(MVLAW) is a kind of appliance for uprighting the mesially inclined posterior teeth axes simultaneously. In this study MVLAW was classified as 3 types by modifing the vertical loop design and named type A, B and C. Each MVLAW was fabricated from .017'x.025' TMA wire and preactivated at the distal end of the open vertical loop with 10 degree tip-back bend(type B has an electric welding stop at the distal end of each loop and type C has no electric welding stop). Type A MVLAW was preactivated at the apex of each open vertical loop with 10 degree tip-back bend(the electric welding stop of type A is positionod at the mesial side of each loop). The aim of the present study was to identify when and which MVLAW is more effective to correct the buccal segment axes simultaneously. The Photoelastic overview of the upper and lower right quadrant showed that stress concentrations were observed in its photoelastic model. The obtained results were as follows : 1. Higher level compression can be seen clearly at the distal curvature of the lower 1st and 2nd molar when A type MVLAW was applied without short class m elastic, but mild compression cannot be seen at the distal curvature of lower anterior teeth using the class m elastic. 2. Higher concentration was presented at the mesial curvature from the lower 1st premolar to the 2nd molar than the anterior teeth when B type MVLAW without short class III elastic was applied, but using the short class III elastic, higher concentration of compression was presented in the anterior teeth area. 3. Areas of higher compression and tension were not observed at the mesial and distal curvature of the entire 1ower teeth except lower central and lateral incisors in C type MVLAW without short class III elastic, but using the short class III elastic, higher concentration was seen at the mesial curvature of the lower 1st premolar and 1ower anterior teeth.

• Journal of Korean Foot and Ankle Society
• /
• v.8 no.2
• /
• pp.121-125
• /
• 2004

Purpose: We try to retrospectively evaluated the amount of dorsal angulation angle of the first metatarsal commonly occurring as the complication of proximal dome osteotomy for hallux valgus. Materials and Methods: Between January 2004 and March 2004, 34 patients who underwent proximal dome osteotomy for moderate to severe hallux valgus. Two of 34 patients were male, and thirty-two were female. The average age was 57.6 years. We measured and compared hallux valgus angle, 1st-2nd intermetatarsal angle, dorsal angulation angle of 1st metatarsal on preoperative, postoperative, postoperative 3 weeks', postoperative 3 months' X-ray. Results: Osteotomy sites were completely united on plane X-ray in all cases. The hallux valgus angle averaged $41.2^{\circ}$ ($30{\sim}60^{\circ}$) at preoperative, $4.3^{\circ}$ ($-10{\sim}20^{\circ}$) at postoperative, $5.5^{\circ}$ ($-1{\sim}20^{\circ}$) at 3 weeks after operation, $7.8^{\circ}$ ($-2{\sim}20^{\circ}$) at 3 months after operation. The 1st-2nd intermetatarsal angle averaged $17.1^{\circ}$ ($12{\sim}24^{\circ}$) at preoperative, $6.3^{\circ}$ ($0{\sim}13^{\circ}$) at postoperative, $7.2^{\circ}$ ($0{\sim}15^{\circ}$) at 3 weeks after operation, $8.7^{\circ}$ ($0{\sim}18^{\circ}$) at 3 months after operation. The dorsal angulation angle averaged $0.4^{\circ}$ ($0{\sim}3^{\circ}$) at postoperative, $1.6^{\circ}$ ($0{\sim}7^{\circ}$) at 3 weeks after operation, $2.1^{\circ}$ ($0{\sim}8^{\circ}$) at 3 months after operation. There were no statistically correlation between increase of dorsal angulation angle of the distal segment of the first metatarsal and increase of hallux valgus angle or 1st-2nd intermetatarsal angle. Conclusion: Our results shows that the dorsal angulation of distal fragment occurring after the proximal dome osteotomy in the treatment of hallux valgus may be minimized with meticulous surgery and patient's education.

• Archives of Reconstructive Microsurgery
• /
• v.6 no.1
• /
• pp.29-38
• /
• 1997

A peripheral nerve when approximation of the ends imparts tension at the anastomosis and with a relatively long segment defect after excision of neuroma and neurofibroma cannnot be repaired by early primary suture. The one of the optimistic reconstruction method of severed peripheral nerves is to restore tension-free continuity at the repair site putting an autogenous nerve graft into the neural gap despite of ancipating motor or sensory deficit of the donor nerve area. To overcome the deficit of the autogenous nerve graft, several other conduits supplying a metabolically active environment which is able to support axon regeneration and progression, providing protection against scar invasion, and guiding the regrowing axons to the distal stump of the nerve have been studied. An author have used ipsilateral femoral vein, ipsilateral femoral vein filled with fresh thigh muscle, and autogenous sciatic nerve for the sciatic nerve defect of around 10 mm in length to observe the regeneration pattern in rat by light and electron microscopy. The results were as follows. 1. Light microscopically regeneration pattern of nerve fibers in the autogenous graft group was more abundant than vein graft and vein filled with muscle group. 2. On ultrastructural findings, the proxial end of the graft in various groups showed similar regenerating features of the axons, myelin sheaths, and Schwann cells. The fascicular arrangement of the myelinated and unmyelinated fibers was same regardless of the type of conduits. There were more or less increasing tendency in the number and the diameter of myelinated fibers correlated with the regeneration time. 3. In the middle of the graft, myelinated nerve fibers of vein filled with muscle group were more in number and myelin sheath was thinner than in the venous graft, but the number of regenerating axons in autogenous nerve graft was superior to that in both groups of the graft. The amount of collagen fibrils and amorphous materials in the endoneurial space was increased to elapsed time. 4. There was no difference in regenerating patterns of the nerve fibers of distal end of the graft. The size and shape of the myelinated nerve fbers were more different than that of proximal and middle portion of the graft. From the above results, the degree of myelination and regenerating activity in autogenous nerve is more effective and active in other types of the graft and there were no morphological differences in either ends of the graft regardless of regeneration time.