• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.15-22
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• 1997

A variety of surgical approach for ankle and tibiotalocalcaneal arthrodesis has been described. We used a transfibular approach between the sural nerve and lateral branch of the superficial peroneal nerve. This permits excellent visualization of the ankle and subtalar joint so that the fusion can readily be achieved under the direct visualization. Eight ankle fusions and four tibiotalocalcaneal fusions were carried out through a transfibular approach and reviewed. The resected fibula was utilized for bone graft. The follow up period was from 12 to 22 months. Ages of the patients ranged from 27 to 58 years. The postoperative regimen was six weeks nonweight bearing in a short leg cast, followed by weight bearing in a short leg cast until union occurred. All cases were fused except one who had preoperative pyogenic arthritis of the ankle and hindfoot. The results were as follows; 1. The chance of incisional neuroma is lessened through incision between the sural nerve and superficial peroneal nerve. 2. The possibility of a skin slough is reduced by using full thickness skin flaps. 3. Excellent visualization of the ankle and subtalar joint is easily achieved. So, we believed that the transfibular approach for ankle and tibiotalocalcaneal arthrodesis is the excellent surgical approach.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.18-22
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• 2001

Purpose : The purpose of this study was to evaluate stress fracture of vascularized fibular grafts(VFG) by analyzing factors associated with stress fracture and the treatment results. Materials and Methods : From June 1985 to May 1998, 7 patients with stress fractures in the 38 patients with long bone defect who had vascularized fibular graft were evaluated with clinical and radiologic methods including grafted fibular length and hypertrophic index of de Boer. The average age of the patients was 35 years(range, $14{\sim}60$ years). The mean follow-up period was 20 months(range, $16{\sim}32$ months). Results: 7(18.4%) stress fractures occurred in 38 patients. Characteristics of the fractures were (1) all occurred at lower extremity of male patients treated with VFG for long bone defected caused by infected nonunion; (2) all occurred 10 months at the average(range, $4{\sim}17$ months) after VFG; and (3) the length and hypertrophic index of grafted fibula had no influence on the incidence of stress fracture. Union was obtained in 3 patients by conservative treatment. 4 patients obtained union by internal fixation; one at immediately onset of fracture; and three after failure of conservative treatment who had fracture around the knee joint. Conclusion : Stress fracture may occur during the first one year after vascularized fibular graft and more attention must be paid for prevention of it, especially in the cases of infected nonunion. Stress fracture around the knee joint was expected to lead to a good result of early union by operative treatment.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.67-72
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• 2002

Purpose : Treatment of giant cell tumor of distal radius can be treated in several ways according to the agressiveness of the tumor. We treated 3 cases of widely involved giant cell tumor of distal radius with wide resection and proximal fibular graft and report the results with review of literatures. Material and Method : We have treated 3 cases of giant cell tumor of the distal radius since last 1990. Among 3 cases, two cases were grade III radiologically and treated by wide resection of distal radius and vascularized proximal fibular graft, and one case, grade II radiologically, treated by distal radial resection and non-vascularized proximal fibular graft. We followed up clinical results of above three cases 9 years, 12 years and 2 years. Result : In all three cases, tranplanted fibula graft showed solid union but grade III tumors recurred at 4 year and 6 year postoperatively. One of the case which recurred 4 year later was treated with secondary wide resection and wrist fusion with autogenous iliac bone graft, and didn't show any recurrent finding for these 5 years after re-operation. And another grade III, which recurred at 6th post-operative year, is under follow-up for 6 years after recur without 2nd operation. Grade II case didn't show any recurrent findings on 2 year follow-up. Conclusion : Grade III cases recurred at 4 year and 6 year follow-up. The cause of recurrence was thought to be invasion of remaining tumor cell in the soft tissue. To prevent recurrence, complete resection of primary tumor was necessary.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.88-93
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• 1996

Neurilemmomas are the most common benign tumor of the peripheral nerve trunks, and arises from the cells in the sheath of Schwann. Neurilemmomas are well encapsulated and may be separated easily from surrounding tissue and lie completely within a larger nerve trunk, with bundles of neurofibrils spread out over the surface of the tumor. A careful dissection and retraction of the nerve bundles will allow the tumor to be enucleated from the parent nerve without any significant interference with the function of the nerve. Resection of the involved nerve is seldom necessary and should be avoided if at all possible. Our aim in microscopic excision of neurilemmoma of extremities is to reduce any disturbance of the intact neurofibrils of the parent nerve. Thirteen cases of neurilimmomas were treated by microscopic excision at the Department of Orthopaedic Surgery, Korea University Hospital between January 1990 and March 1995. The results was as follows ; 1. The average age at surgical intervention was 40.1 years. Cases in fourth and fifth decades predominated. 2. In their anatomical distribution, 8 cases were in the upper extremity and 5 cases in the lower extremity. 11 cases were on the flexor surface. 3. On the operative field, all the tumors were well encapsulated, however 1 case of 13 was adherent to the periosteum of fibula. 4. In all cases, the tumor were enucleated from the parent nerve without any injury to nerve under high-power magnification, preserving individual fascicles, and sensory and motor function.

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.46-52
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• 1993

Soft-tissue deficits over the plantar forefoot, plantar heel, Achilles tendon, and distal parts of lower leg are often troublesome to cover with a simple graft or local flap due to limited mobility of surrounding skin and poor circulation in these area. Soft-tissue reconstruction in these regions should provide tissue components similar to the original lost tissue, supply durability and minimal protective pressure sensation and result in a donor site that is well tolerated and treated. We analysed 7 cases that were treated with the Instep flap due to soft-tissue defects over these regions from July of 1990 to July of 1993. All flaps were viable and successful at follow-up. 1. The age ranged from 9 years to 60 years, and 6 cases were male and 1 case female. 2. The sites of soft-tissue loss were the plantar forefoot(1 case), plantar heel(3 cases), Achilles tendon(2 cases), and distal parts of lower leg(1 case). 3. The causes of soft-tissue loss were simple soft-tissue crushing injury(1 case), crushing injury of the 1st toe(1 case) and posttraumatic infection and necrosis(5 cases). 4. The associated injury were open distal tibio-fibula, fracture(2 cases), medial malleolar fracture of the ankle(1 case), Achilles tendon rupture(2 case) and 1st metatarso-phalangeal disarticulation(1 case). 5. The size of flap was from $3{\times}4cm$ to $5{\times}10cm$(average $4{\times}5.6cm)$. 6. In 7 cases, we were not to find post-operative necrosis and infection, non-viability, limitation of ankle joint, and gait disturbance caused by the Instep flap surgery. 7. This study demonstrates that the Instep flap should be considered as another valuable technique in reconstruction of these regions.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.106-111
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• 1996

Purpose : Propose a surgical technique in donor harvesting method in free vascularized proximal fibular epiphysis. Methodology : Concerned about growth potentials of the transplanted epiphysis in our long term results of the epiphyseal transplanted 13 cases more than 4 years follow-up, anterior tibial artery which contains anterior tibial recurrent artery is most reliable vessel to proximal fibular epiphysis which is the best donor of the free vascularized epiphyseal transplantation. In vascular anatomical aspect proximal fibular epiphysis norished by latearl inferior genicular artery from popliteal, posterior tibial recurrent artery and anterior tibial recurrent artery from anterior tibial artery and peroneal artery through metaphysis. The lateral inferior genicular artery is very small and difficult to isolate, peroneal artery from metaphysis through epiphyseal plate can not give enough blood supply to epiphysis itself. The anterior tibial artery which include anterior tibial recurrent and posterior tibial recurrent artery is the best choice in this procedure. But anterior tibial recurrent artery merge from within one inch from bifucating point of the anterior and posterior tibial arteries from popliteal artery. So it is very difficult to get enough vascular pedicle length to anastomose in recipient vessel without vein graft even harvested from bifucating point from popliteal artery. Authors took recipient artery from distal direction of anterior tibial artery after ligation of the proximal popliteal side vessel, which can get unlimited pedicle length and safer dissection of the harvesting proximal fibular epiphysis. Results : This harvesting procedure can performed supine position, direct anterolateral approach to proximal tibiofibular joint. Dissect and isolate the biceps muscle insertion from fibular head, micro-dissection is needed to identify the anterior tibial recurrent arteries to proximal epiphysis, soft tissue release down to distal and deeper plane to find main anterior tibial artery which overlying on interosseous membrane. Special care is needed to protect peroneal nerve damage which across the surgical field. Conclusions : Proximal fibular epiphyseal transplantation with distally directed anterior tibial artery harvesting technique is effective and easier dissect and versatile application with much longer arterial pedicle.

• Applied Microscopy
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• v.31 no.4
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• pp.307-314
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• 2001

Safflower (Carthamus tinctorius L.) is a thistle-like annual plant mainly grown in dry hot climates as an oilseed or birdseed. Traditionally, the oil has mainly been sold in the health food market because it is unsaturated having high linoleic and oleic acid levels. With increased health consciousness in recent years, the oil quality has become a more general health issue. This study was designed to understand whether safflower seed powder has positive effects on the fracture healing in rats. Simple transverse fracture of rat fibula was made with a rotating diamond disc saw. The histologic changes of rats were observed with a scanning electron microscope. The fractured fibulae showed a complete fusion at the fracture site in the 4th to 5th week after a simple transverse fracture. Administration of safflower seed powder facilitated the speed of histologic changes without affecting qualitative changes. These results suggest that safflower seed powder nay have substances that help the fracture healing process.

• Korean Journal of Veterinary Research
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• v.51 no.1
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• pp.63-67
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• 2011

Supernumerary ectopic limb(s) (SEL) is a congenital anomaly defined as the presence of accessory limb(s) attached to various body regions. This paper describes a case of SEL with ectopic lung and ectopia cordis in a newborn calf, based on macroscopic, microscopic and radiographic findings. External features of multiple congenital anomalies included an ectopic lung growing over the middle of the backbone and covered with normal haired skin. Ectopia cordis was found in the abdominal cavity and attached to the liver. Two extra abnormal limbs originated separately from within the ectopic lung. Most of the abdominal organs were exposed to the outside through the opened abdominal cavity. Microscopically the ectopic lung tissue had edema in the connective tissue around the bronchus and artery. Changes in other organs included congestion of the renal medulla, infiltration of inflammatory cells (lymphocytes and eosinophils) around the hepatic portal tract, and edema surrounding blood vessels and neurons in the brain. The rudimentary humerus of the forelimb was attached to the thoracic spine, as viewed radiographically. The hindlimb was consisted of an irregularly shaped femur, short tibia and fibula, two tarsal bones, one metatarsal bone, and three phalanges. This is the first description of congenital anomalies involving the SEL, ectopic lung and ectopia cordis in a calf.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.6-14
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• 2000

Reconstruction of the composite mandibular defect resulting from ablative resection of tumor involved jaw has been challenging task to the plastic surgeon. A wide variety of different techniques were used with limited success until the advent of microsurgery. The high success rate of microsurgical procedures has allowed for significant improvement in both functional and aesthetic results. A variety of free flap donor sites have been used successfully for mandibular reconstruction. Between April of 1991 and August of 1998, 20 mandibular reconstructions were performed for oncologic defects. 4 patients underwent mandibular reconstruction with pectoralis major flap, 3 patients with free nonvascularized bone graft, 1 patient with metal plate. 12 patients underwent microvascular mandibular reconstruction(8: fibula, 4: ilium). The type of free flap was determined by the requirements of the defect. Satisfactory aesthetic and functional results were achieved in all cases without significant complications. So microvascular mandibular reconstruction should be considered as primary choice in all mandibular defect without hesitation.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.4137-4140
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• 2012

The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap. Vascularized iliac crest flaps provide sufficient high-quality bone suitable for reconstructing segmental madibular defects. Although fibular flaps allow longer donor bone tissue to be harvested, the iliac crest can provide an esthetic shape for mandibular body reconstruction and also provides sufficient bone height for dental implants. Conventional vascularized iliac crest myoosseous flaps have excessive soft tissue bulk for reconstruction of intraoral soft tissue defects. The modification discussed in the present article can reduce soft tissue volume, resulting in better functional reconstruction of the oral mucosa. Another advantage is that complete replacement of the oral mucosa is observed in as early as one month post-operation. The final mucosal texture is much better than that obtained with other skin paddle flaps, which is especially beneficial for the placement of dental implant prostheses. Donor site morbidity looks to be similar to, if not less than that observed for other modalities in terms of function and esthetics. For combined oral mucosa-mandible defects, the vascularized internal oblique-iliac crest myoosseous free flap shows good results with respect to hard and soft tissue reconstruction.