• 대한관절경학회지
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• 제17권1호
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• pp.84-87
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• 2013

원위 대퇴부 후방은 주요 신경과 혈관이 위치하고 있고 여러개의 힘줄들과 근육들이 위치하여, 심부 근막 내에 농양이 발생시 근막, 힘줄과 근육을 따라 근위 대퇴부, 슬와부, 근위 하퇴부 후방 및 무릎 관절의 주변으로 광범위하게 퍼질 수 있다. 이런 경우에 단순히 항생제 투여만으로는 치료가 어렵고, 수술적인 배농과 변연 절제술이 필요하다. 하지만 고식적인 방법으로는 충분한 시야를 확보하기 어려울 수 있으며, 슬와부의 주요 신경과 혈관 등에 치명적인 손상을 줄 수도 있다. 저자들은 64세 남자 환자에서 발생한 좌측 원위 대퇴부의 광범위 심부 농양에 대하여 내시경적 치료를 시행하여 주요 신경, 혈관 등 정상 조직에 대한 손상이 없이 성공적인 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Yeungnam Medical Science
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• 제37권1호
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• pp.40-46
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• 2020

Background: Postoperative pain occurring after hip arthroplasty has become common since the expanded use of cementless femoral stems. The characteristic pain develop in the anterolateral thigh area. This study aimed to predict anterior thigh pain based on the measurements of postoperative anteroposterior (AP) and lateral (Lat) radiographs of the hip joint. Methods: The present study included 26 patients (29 hips) who underwent total hip replacement or bipolar hemiarthroplasty between March 2010 and May 2016, whose complete clinical information was available. AP and Lat radiographs of the affected hip were taken on the day of surgery and 1 and 6 months postoperatively. Patients with improper radiographs were excluded. The distance from the femoral stem to the nearest cortical bone in the distal region of the stem was measured. The patient group with a visual analog scale (VAS) score of ≥6 points was designated as patients with anterior thigh pain. Results: Sex, age, weight, height, body mass index, and bone mineral density in the lumbar spine and femur did not have a significant effect on postoperative VAS scores (p>0.05). Presence of contact between the femoral stem and cortical bone was associated with postoperative anterior thigh pain. Conclusion: Hip AP and Lat radiographs are usually taken to confirm fixation and alignment of the femoral stem after hip arthroplasty. The measurement method introduced in this study can be utilized for predicting anterior thigh pain after hip arthroplasty.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.457-460
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• 2010

Purpose: The great toe presents a reconstructive challenge for plastic surgeons. The big toe has much importance not only for the gait and the stability, but also for appearance aspects. Few reports have documented the reconstruction of big toe defects and we report a unique case of free flap reconstruction technique. Methods: A 41-year-old man with right great toe open fracture with soft tissue necrosis was referred from the orthopedic surgery department. On physical examination, there was the skin necrosis circumferentially and the fratured bone was severely fragmented. The metatarsophalangeal (MTP) joint of the big toe was intact. After the wound debridement, we harvested the innervated anterolateral thigh flap and transposed to the defected area. After five months, we finally retouched the flap by the dorsal defatting and distal debulking. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. He has remained asymptomatic for eight months without any recurrence such as the osteomyelitis. Finally, he kept the normal gait and posture with weight bearing on the reconstructed great toe and foot. Conclusion: The anterolateral thigh flap is described for the reconstruction of the great toe. It involves two stage procedure with the minimal donor site morbidity and provides a good cosmetic result.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.485-489
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• 2007

Purpose: The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. Methods: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the $14{\times}10cm$ sized flap was transferred to cover the defect. The pedicle measured 14 cm in length with pivot point 7 cm above the patella. Results: The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months. Conclusion: Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.51-56
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• 2011

During below knee amputation, the amputation stump must be covered with well-vascularized and sensate soft tissue. Many flaps can be used for this purpose, but available reconstructive options are limited. We performed reverse flow ALT flap elevation on two patients with below knee amputations to reconstruct defects in the stumps. The sizes of the defects in the stumps were $4{\times}16$ cm and $5{\times}5$ cm, respectively. The most distal portion of the defects were located 20 cm and 16 cm lateral to the knee joint in a curve, respectively. The size of the elevated flap was $5{\times}18$ cm for case 1 and $18{\times}10$ cm for case 2. The respective pivot points of the pedicles were 7 cm and 6 cm above the patella and the respective lengths of the pedicles were 17 cm and 16 cm. In both cases, venous congestion occurred on the second postoperative day and the flap distal to 10 cm or more from below the knee joint was necrotized at the second postoperative week. Surgeons should be cautious when using a reverse ALT flap to reconstruct a soft tissue defect located 10 cm or more distal from below the knee joint. Since a pedicle longer than 15 cm may develop partial necrosis of the flap, simultaneous application of antegrade venous drainage is recommended.

• 한국임상수의학회지
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• 제37권3호
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• pp.135-140
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• 2020

The purpose of this study was to determine the outcome of distal femoral osteotomy for distal femoral varus and medial patellar luxation (MPL) grade 4 in small-breed dogs. Radiographs and medical records were reviewed to collect data and plan the surgery in small-breed dogs with MPL grade 4. Computed tomography (CT) imaging was also performed in cases of severe bone deformities. Signalment, weight, medial patellar luxation and lameness grade, radiographic bone union, complications, pre- and postoperative femoral varus angle, passive range of motion, static weight bearing distribution and visual analogue scale scores were recorded. Thirteen corrective distal femoral osteotomies were performed with ancillary and additional procedures in 9 dogs; 4 dogs had staged bilateral procedures; and four stifles were suspected to have partial or complete rupture of the cranial cruciate ligament. One stifle underwent patellar groove replacement. The mean ± SD pre- and postoperative femoral varus angles were 109.15°± 3.71° and 96.30°± 2.97°, respectively. Significant improvements in passive range of motion, thigh circumference and visual analogue scale (VAS) scores were observed. There was no reluxation of the patella. This study suggests that distal femoral osteotomy with traditional and additional procedures provided satisfactory outcomes in patient healing and functional recovery in small-breed dogs with excessive femoral varus angles.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.114-120
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• 2021

Background The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author's experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap. Methods The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients' demographic data, operative details, and postoperative complications were evaluated. Results Between October 2018 and December 2019, 10 consecutive patients (age range, 13-45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed. Conclusions The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.

• Advances in pediatric surgery
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• 제10권1호
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• pp.52-55
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• 2004

A newborn male baby was transferred to our hospital with a left inguinal mass. The mass was huge measuring $10{\times}10cm$, engorged, and dark-blue colored as a result of internal hemorrhage. Unstable vital signs were combined with DIC and acute renal failure. Emergency operation was performed because of the suspicion of bowel perforation. The peritoneal cavity was full of ascitis and the distal jejunum had a 0.5 cm perforation. Segmental resection of the jejunum and incisional biopsy of the inguinal mass were performed. On pelvic and thigh MRI, the mass protruded into pelvic cavity and encircled large vessels and nerves of the thigh. Pathologic diagnosis was congenital infantile fibrosarcoma. Fifteen days after operation, primary tumor excision was undertaken. The second look operation, performed after 6 times VAC chemotherapy, revealed no remained malignant cell on microscopic section. The baby has been followed closely for the last eight months.

• Archives of Plastic Surgery
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• 제46권1호
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• pp.84-87
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• 2019

With the recent development in microsurgery, the use of a perforator flap has been widely implemented. If the length of the ALT flap pedicle is insufficient despite adequate preoperative planning, pedicle length extension is necessary. We planned for a reverse ALT free flap using the distal vessel of the descending branch for pedicle length extension in the case of ALT perforator branch originating from the proximal portion of the descending branch. For the management of venous congestion, the distal venae comitantes were anastomosed to the proximal venous stump in an antegrade manner, successfully resolving the venous congestion. Modified reverse-flow ALT free flap, wherein the venae comitantes are anastomosed to the proximal vein stump, is a good option that allows for relatively simple pedicle extension within the same operative field when securing an adequate pedicle length is difficult because of the origin of the perforator from the proximal descending branch, unlike the initial surgical plan.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.146-156
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• 1998

저자들은 1997년 1월부터 1998년 7월까지 두경부 악성종양 및 반안면왜소증과 같은 선천성 안면기형을 주소로 본원에 내원하였던 환자 9명을 대상으로 하여 9례의 외측대퇴 유리피판술을 시행하여 다음과 같은 결과를 얻을 수 있었다. 첫째, 두경부 재건에 있어서 외측대퇴 유리피판은 다른 유리피판술에 비해 여러 장점을 가지고 있었다. 특히, 공여부 추형이 노출되지 않는 부위이며 동시에 두팀이 수술에 참여할 수 있어서 수술시간이 단축될 수 있었다. 둘째, 술후 방사선치료를 시행하면 피판의 모발은 사라지지만 모공의 과각화증 및 색조 침착이 증가하므로, 외측대퇴부에 모발이 많은 환자는 술후 방사선치료의 여부와 관계없이 미용적인 금기사항에 해당한다. 셋째, 악성종양 절제후에 발생하는 결손의 재건시 피판의 두께가 문제시 되지 않았으며, 피판의 두께는 피판을 도안할 때의 위치, 성(sex), 피하지방층의 제거정도, 근육의 포함 정도, 술 후 피판의 위축정도에 따라 조절 가능하였다. 넷째, 모든 증례에서 정맥이식없이 혈관문합이 가능하였으므로 두경부 재건시 혈관경의 길이는 충분한 것으로 사료된다. 다섯째, 가능한 피판을 장축으로 길게 도안하여 두 번째 또는 네 번째 관통동맥을 포함시켜 수술 후 발생할지도 모르는 혈류부전에 대비하는 것도 피판의 생존률을 높이는 좋은 방법으로 사료된다.