• Archives of Plastic Surgery
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• 제41권6호
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• pp.709-715
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• 2014

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

• 한국운동역학회지
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• 제16권2호
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• pp.193-205
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• 2006

This study was to analysis the kinematic and kinetic differences between new walking shoe(NWS : RYN) and general walking shoe(GWS). The subjects for this study were 10 male adults who had the walking pattern of rearfoot shrike with normal foot. The movement of one lower leg was measured using plantar pressure and Vicon Motion Analysis Program(6 MX13 and 2 MX40 cameras : 100 f / s) while the subjects walked at the velocity(1.5m/s. on 2m).. The results of this study was as follows : 1. The NWS was better than the GWS that caused injuries such as adduction, abduction and pronation are reduced While walking on a perpendicular surface, the landing angle and the knees angles were extensive which makes walking more safe which reduces anxiety and uneasiness. 2. The bottom of the NWS were now made into a more circular arch which supports the weight of the body and reduces the irregular angles when wearing GWS. This arch made the supporting area more wide which made the upholding the trunk of the body more effective. The whole bottom of the foot that supports the weight is more flexible in addition, increases the safeness of walking patterns and the momentum of the body. 3. The moment the heel of the foot of the NWS touch the ground, the range of the pressure were partially notable and the range of the pressure on the upper part of the thigh were dispersed The injuries that occurred while walking. primary factors when a shock related injuries are reduced Judgements of the impacts of the knees and the spinal column dispersing could be made.

• 한국운동역학회지
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• 제20권2호
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• pp.221-230
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• 2010

The purpose of this study was to analyze biomechanical factors of trail running shoes applied to korean shoe-lasts. 10 healthy male subjects with an average age of 37.2 years(SD=8.28), weight of 69.6 kg(SD=10.56) and a height of 171 cm(SD=4.93) were recruited for this study. Ten males walked on a treadmill wearing four different shoes. Foot pressure data was collected using a Pedar-X mobile system(Novel Gmbh., Germany) operating at the 1000 Hz. Surface EMG signals for tibialis anterior, gastrocnemius, vastus lateralis and biceps femoris were acquired at 1000 Hz using Noraxon TeleMyo DTS system(Noraxon Inc., USA). Foot pressure and leg muscle fatigue were measured and calculated during walking. The results are as follows: After walking 60 minutes, Type A showed a lower MPF. MPF values were significantly different from each muscle(p<.05). Therefore, Type A shoe might decrease muscle fatigue in the legs while walking. In addition, Type It showed that Type A shoe has the highest contact area and the lowest maximum pressure. As a result of the analysis, Trail running shoes will use a new design to reduce muscle fatigue and are expected to increase comfort and fitting.

• 한국전문물리치료학회지
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• 제18권1호
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• pp.18-27
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• 2011

This study was to investigate the positive effects of specially designed trunk-stabilization exercise program on lower extremity balance of elderly with history of leprosy. In this participants, lower extremity functions has been undermined by the development of damage in peripheral nerves. A total of 40 elderly with history of leprosy were divided into 2 groups of equal size ($n_{1,\;2}=20$): a group that participated in the exercise program, and a control group that did not exercise but did continue to engage in normal daily activities (including walking). The exercise group exercised for 60 minutes 2 days a week for 12 weeks. Static balance ability was measured by asking study participants to a one leg standing test: dynamic balancing ability was measured with a tandem walking test and a timed up-and-go test. The participants in the exercise program and the control group were tested before and after completion of the exercise program for comparison, and then divided according to their ability to feel sensory in the soles of their feet into the categories of normal sensory group: group with sensory loss in one foot: and group with sensory loss in both feet. The participants in the exercise program showed a positive, statistically significant difference in static balance compared with the control group (p<.05) as measured using the one leg standing test. Similarly, the participants in dynamic balance (p<.05) as measured using the tandem walking and timed up-and-go tests. Finally, these improvements were related to the severity of sensory loss in the soles of the feet for all study participants.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.1-9
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• 1998

From January 1985 to February 1997, 96 patients had undergone the free vascularized groin flap on the upper and lower extremities with microsurgical technique at the department of orthopaedic surgery, Yonsei University College of Medicine. The results were as follows: 1. Average age at the time of operation was 24.9 years. and there were 71 men and 25 women and mean follow up was 62.4 months. 2. The lesion site was 82 cases on the lower extremity: foot(40), leg(20), ankle(13), and 14 cases on the upper extremity: forearm(6), elbow(3), hand(3), wrist(2). 3. The anatomical classification of the superficial circumflex iliac artery was as follows: 1) 39.8% of common origin with superficial inferior epigastric artery, 2) 30.1% of isolated origin and absent superficial inferior epigastric artery, 3) 13.3% of separate origin, 4) 16.9% of origin from the deep femoral artery. 4. There was no statistical significance on arterial anastomosis between end to end and end to side, and on venous anastomosis(end to end) between one vein and two veins. 5. The success rate was average 84.4% in 81 of 96 cases. 6. In the 15 failed cases, the additional procedures were performed: 5 cases of free vascularized scapular flap, 6 cases of full thickness skin graft, 2 cases of cross leg flap, 1 case of latissimus dorsi flap, 1 case of split thickness skin graft. In conclusion, the free vascularized groin flap can be considered as the treatment of choice for the reconstruction of the extensive soft tissue injury on the extremities, and show the higher success rate with the experienced surgeon.

• 한국콘텐츠학회논문지
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• 제9권12호
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• pp.364-375
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• 2009

본 연구는 하지 저항운동 시 고령자 보행의 하지분절과 관절의 운동학적 차이를 분석하여 낙상예방을 위한 기초자료를 제공하는데 있다. 이를 위해 70대 이상 80세 이하의 여성 고령자 7명을 선정하여 3차원 영상분석을 실시하였다. 하지 분절과 관절의 3차원 위치좌표를 얻기 위해 ProReflex MCU(Qualisys, Sweden) 카메라를 사용하여, 100Hz/s로 촬영하였다. 촬영된 영상은 QTM(Qualisys, Sweden) 프로그램을 이용하여 위치좌표에 대한 원자료(raw data)를 얻었으며, Matlab 6.5 프로그램을 이용하여 3차원 각도를 산출한 결과, 다음과 같은 결론을 얻었다. 대퇴와 하퇴분절의 굴곡과 신전은 E5에서 운동 후 굴곡의 움직임이 크게 나타났으며, 발 분절은 E4에서 외번을 보이면서 통계적 차이를 나타냈다. 무릎관절은 운동 후 E4에서 굴곡을 보였고, 발목관절은 E3에서 내번, E4에서 외번의 움직임을 나타내면서 통계적인 차이(p<.05)를 보였다.

• Archives of Reconstructive Microsurgery
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• 제15권1호
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• pp.17-25
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• 2006

Twelve cases in eleven patients with segmental bone defects were treated with contralateral fibula free flap and ipsilateral island fibula flap in an antegrade, retrograde or bidirectional flow fashion. Five cases were managed with free flaps and seven were with ipsilateral fibula island transfer. Among seven cases, antegrade fashion was three, retrograde was three, and bidirectional was one. All patients were related with open tibial fractures and its sequelae except one who had open foot bone fracture. According to Gustilo's classification, ten patients were type IIIb and one was type IIIc. Basically, antegrade-flow flaps based on the peroneal vessels as in the conventional free flap were used for the proximal or middle one-third tibial defects. On the contrary, retrograde-flow flaps based on the communicating branch between the peroneal and posterior tibial vessels were used for the middle or distal one-third of the tibia. Bidirection-flow flap based on intact peroneal vessels were used for the middle portion of the tibia. The patients who have undergone ipsilateral fibula island flap had one of the following problems: a previously failed free flap, below-knee amputation of the opposite leg because of open tibial fracture, refusal to use the contralateral sound leg, or poor general condition to stand a lengthy operation. Six of the patients who have got ipsilateral fibula island flap also had an associated fibula fracture on the same leg, which was ultimately used as one of the osteotomy sites. The follow-up period was from 1 to 10 years. Two cases of free flap were failed: one patient had below-knee amputation and the other patient had ipsilateral fibula transfer. Other cases were successful and excellent hypertophy of the transferred fibula was achieved. Time to bone union ranged from 4 to 11 months. Time to full weight bearing was from 5 to 13 months after surgery. All of the transferred fibulas showed hypertrophy after weight bearing. In one case, stress fracture was developed during ambulation, which was healed conservatively. Nonunion occurred in two cases, which were treated with a long leg cast and cancellous bone graft, respectively. Length discrepancy of the legs was noted. The limb was shorter by an average 0.5 cm in three cases, longer by 1.1 cm in one case. In the case of island fibula transfer, limited arc of rotation was not a problem. Other disabling complications were not seen. We believe that these diverse modalities using a vascularized fibula will make us more comfortable to handle major bone defects.

• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.153-161
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• 2002

Purpose : Plantar surfaces, calcaneal area, and region of Achilles insertion, which are extremely related with weight-bearing area and shoes application, must be reconstructed with glabrous and strong fibrous skin. Numerous methods of reconstructing defects of these regions have been advocated, but the transfer of similar local tissue as a cutaneous flap with preservation of sensory potential would best serve the functional needs of the weight-bearing and non-weight-bearing surfaces of this region. Therefore it is recommended to use the limited skin of medial surface of foot that is similar to plantar region and non-weight-bearing area. In this paper we performed the medial plantar flap transfered as a fasciocutaneous island as one alterative for moderate-sized defects of the plantar forefoot, plantar heel, and area around the ankle in 25 cases and report the result, availability and problem of medial plantar flap. Materials and methods : We performed proximally based medial plantar flap in 22 cases and reverse flow island flap in 3 cases. Average age was $36.5(4{\sim}70)$ years and female was 3 cases. The causes of soft tissue defect were crushing injury on foot 4 cases, small bony exposure at lower leg 1 case, posterior heel defect with exposure of calcaneus 8 cases, severe sore at heel 2 cases, skin necrosis after trauma on posterior foot 4 cases, and defect on insertion area of Achilles tendon 6cases. Average follow up duration was 1.8(7 months-9.5 years) years. Results: Medial plantar flaps was successful in 22 patients. 18 patients preserved cutaneous branches of medial plantar nerve had sensation on transfered flap but diminished sensation or dysesthesia. At the follow up, we found there were no skin ulceration, recurrence of defect or skin breakdown in all 18 patients. But there was one case which occurred skin ulceration postoperatively among another 4 cases not contained medial plantar nerve. At the last follow up, all patients complained diminished sensation and paresthesia at medial plantar area distally to donor site, expecially with 4 patients having severe pain and discomfort during long-time walking. Conclusion : Medial plantar island flap based on medial plantar neurovascualr pedicle have low failure rate with strong fibrous skin and preserve sensibility of flap, so that it is useful method to reconstruct the skin and soft tissue defect of foot. But it should be emphasized that there are some complications such like pain and paresthesia by neuropraxia or injury of medial plantar nerve at more distal area than donor site. We may consider that medial plantar flap have limited flap size and small arc of rotation, and require skin graft closure of the donor defect and must chose this flap deliberately.

• 기본간호학회지
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• 제17권3호
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• pp.314-323
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• 2010

Purpose: This study was performed to identify skin hydration status and skin surface pH according to the body parts of the aged with immobilization. Methods: The subjects were 101 aged patients in a hospital and a institution for the elderly in Seoul. Data for skin hydration and skin surface pH were collected using corneo-meter and skin pH-meter. The body parts of measurement were 10 parts; face, forearm, back of the hand, flank, upper abdomen, leg, back of the foot, heel, scapular, and sacrum. The data were analyzed by SPSS/WIN 12.0 program. Results: Skin hydration status were relatively low especially on lower extremity and back of body, and skin surface pH of scapular and sacrum were high. There was significant negative correlation between skin hydration status and skin surface pH on the 6 body parts. Conclusion: Skin hydration status and skin surface pH, especially on scapular, sacrum, and lower extremity need to be considered as important control factors for increasing skin health status of the aged with immobilization.

• 한국방사선학회논문지
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• 제13권4호
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• pp.605-611
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• 2019

본 연구의 목적은 여러 가지 하지입식검사에 적용할 수 있는 Multi-Function Device(MFD)를 제작하여 기존에 사용하던 Weight Bearing Platforms(WBPs)들과 X 선 영상의 비교를 통해 임상 활용을 제안하고자 한다. MFD는 단상(보조기구)를 이용한 Weight Bearing Foot/Ankle, Hindfoot Alignment View 검사시 X선 장치의 X선 관구의 최하 조절 높이를 고려하여 제작하였다. 그리고 Foot/Ankle Phantom으로 MFD와 WBPs에서 Weight Bearing Lateral Foot과 Hindfoot Alignment View를 검사하여 X선 영상의 해상력을 Quick MTF(modulation transfer function)프로그램으로 비교하였다. 연구결과 MFD와 WBPs에서 검사한 두 가지 영상 모두 MTF 50(50% Contrast Spatial Frequency)과 10-90%(10-90% of Maximum Energy Rise Distance) Rise의 C/P(Cycles Per Pixel)평균과 LPH(Lines Per Image Height)평균 모두 유의한 차이는 없었다(p>0.05). 연구에서 제작한 MFD는 환자의 안전과 여러 가지 검사를 복합적으로 수행 할 수 있는 유용한 보조기구로 임상 활용을 제안한다. 또한 정책적으로 보조기구의 활용을 권장한다면 전문 업체의 활성화를 돕는 길이며 의료의 질도 더욱 향상할 수 있을 것이다.