• Archives of Plastic Surgery
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• v.34 no.1
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• pp.64-69
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• 2007

Purpose: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. Methods: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. Results: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. Conclusion: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.642-648
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• 2011

Purpose: The recent advances in microsurgical techniques and their refinement over the past decade have greatly expanded the indications for digital replantations and have enabled us to salvage severed fingers more often. Many studies have reported greater than 80% viability rates in replantation surgery with functional results. However, replantation of multi-level amputations still remain a challenging problem and the decision of whether or not to replant an amputated part is difficult even for an experienced reconstructive surgeon because the ultimate functional result is unpredictable. Methods: Between January of 2002 and May of 2008, we treated 10 multi-level amputated digits of 7 patients. After brachial plexus block, meticulous replantation procedure was performed under microscopic magnification. Postoperatively, hand elevation, heat lamp, drug therapy and hyperbaric oxygen therapy were applied with careful observation of digital circulation. Early rehabilitation protocol was performed for functional improvement. Results: Among the 19 amputated segments of 10 digits, 16 segments survived completely without any complications. Overall survival rate was 84%. Complete necrosis of one finger tip segment and partial necrosis of two distal amputated segments developed and subsequent surgical interventions such as groin flap, local advancement flap and skin graft were performed. The overall result was functionally and aesthetically satisfactory. Conclusion: We experienced successful replantations of multi-level amputated digits. When we encounter a multi-level amputation, the key question is whether or not it is a contraindication to replantation. Despite the demand for skillful microsurgical technique and longer operative time, the authors' results prove it is worth attempting replantations in multi-level amputation because of the superiority in aesthetic and functional results.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.788-794
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• 2010

Purpose: The fingertip is the most commonly injured part of the hand and its injury frequently results in avulsion or crushing of a segment of the nail bed and fracture of the distal phalangeal bone. Restoration of a flat and smooth nail bed is essential for regrowth of a normal nail, which is important not only for cosmetic reasons but also for tactile capability of the fingertip. It is also anatomical reduction of the distal phalanx to promote patient's cosmetics and prevent nail bed deformity. Absence or no replacement of the nail plate results in obliterated proximal skin fold. When the avulsed nail plate cannot be returned to its anatomic position or when it is absent, we use a synthetic material for splinting the nail bed and alternative reductional method for distal phalangeal bone fracture, especially, instead of hardwares. Methods: From January of 2006 to June of 2009, a total of ten patients and fourteen fingers with crushing or avulsion injuries of the fingertip underwent using the artificial nails for finger splint. We shaped artificial nails into the appropriate sizes for use as fingernail plates. We placed them under the proximal skin fold and sutured to the fold proximally and to the lateral and medial edges of the nail bed or to the distal fingertip. Our splints were as hard as K-wire and other fixation methods and more similar to anatomic nail plates. Artificial nails were kept in place for at least 3 weeks. Results: No artificial nail related complication was noted in any of the ten cases. No other nail fold or nail bed complications were observed, except for minor distal nail deformity because of trauma. Conclusion: In conclusion, in order to secure the nail bed after injury and reduce the distal phalangeal bone fracture, preparing a nail bed splint from a artificial commercial nail is a cheap and effective method, especially, for crushed or avulsion injuries of the fingertip.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.674-677
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• 2009

Purpose: Typical cross finger flap is still a good method for reconstruction of fingertip injuries. However, it is necessarily followed by great loss and aesthetically unpreferable result of donor finger. Hereby, we introduce a modification of cross finger flap with reduction pulp plasty and full thickness skin graft, with which we could reduce the defect size of injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Method: This method was performed in the patients with fingertip injuries of complete amputation or in case of loss of fingertip due to necrosis after replantation. Firstly, reduction pulp plasty was performed on the injured finger to reduce the size of defect of fingertip. Additional skin flap was obtained from the pulp plasty. Secondly, cross finger flap was elevated from the adjacent finger to cover the defect on the injured finger. At the same time, defect on the donor finger produced by the flap elevation was covered by full thickness skin graft with the skin obtained from the pulp plasty of injured finger. Results: Flap and graft survived without any necrosis after surgical delay and flap detachment. All of them were healed well and did not present any severe adversary symptoms. Conclusion: Cross finger flap with reduction pulp plasty and full thickness skin graft is an effective method that we can easily apply in reconstruction of fingertip injury. We think that it is more helpful than the usual manner, especially in cases of children with less soft tissue on their fingers for preservation and reduction of the morbidity of donor finger.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.27 no.4
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• pp.58-66
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• 2014

Objectives : The purpose of this study was to investigate the clinical manifestations and influences of occupation, concomitant allergic diseases, various aggravating factors and seasonal changes for patients with dyshidrotic eczema. Methods : A total of 219 patients who showed clinical manifestations of dyshidrotic eczema were included in this study. We retrospectively reviewed the clinical characteristics of all the patients. Results : 1. Among 219 patients, there were 76 male patients (34.7%), 143 female patients (65.3%), male to female ratio was 1: 1.88. The average age of the patients at admission was $31.9{\pm}9.8$ years, had a lot of 20s and 30s the distribution. 2. The average of duration of the admission to the clinic after the onset was $4.01{\pm}4.42$ years. 3. Common accompaning diseases dyshidrotic eczema patients have were allergic rhinitis(87 cases), and atopic dermatitis(55 cases), sweating(45 cases), and asthma(10 cases) in order. 4. The most commonly occurring sites for dyshidrotic eczema patients are fingers(60.3%), palm(53.4%), dorsum of hand(19.2%) and nails(5.5%) in order. 5. The most commonly contacted materials for dyshidrotic eczema patients are water(130 cases), cosmetics(40 cases) and rubber gloves(34 cases) in order. The aggravating factors of dyshidrotic eczema patients are emotional stress(110 cases), fatty food(22 cases) and alcohol(22 cases) in order. 6. The number of patients showing seasonal changes in symptoms was 111. The season with the most severe symptom was summer with 76 cases, which was statistically significant. Conclusions : This study demonstrated the various clinical characteristics of Korean patients with dyshidrotic eczema.

• Safety and Health at Work
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• v.13 no.4
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• pp.440-447
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• 2022

Background: Agricultural handle equipment is present on all production areas' farms. They are handy and portable; however, excessive use can lead to acute traumas or accidental injuries. Repetitive movements, awkward postures, and hand-arm vibrations predispose them to pain and work-related musculoskeletal disorders. The purpose of this study was to observe the interaction of handle equipment in terms of electromyographic activity and analyze the postural work-related alterations. Materials and methods: Twenty male agricultural operators, mean age 24±1.54 years, underwent the electromyographic analysis testing their muscular activities with a brushcutter, electric saw, and hedge trimmer in four different test conditions. Results: The brushcutter proved to be the agricultural handle equipment with the higher mean frequency (3.37±0.38 Hz) and root mean square (5.25±1.24 ms^-2). Furthermore, the digital postural analysis showed a general asymmetry of the main arm and the respective side of the trunk. The head resulted right inclined in the anterior frontal plane by 5.7°±1.2°; the right scapula lower than the left in the posterior frontal plane (8.5°±1.8°), and a working trunk inclination of 34.15°±5.7°. Conclusions: Vibrations of handle equipment and awkward working postures represent a risk for agricultural operators. Preventive measures are required to avoid young operators from experiencing musculoskeletal disorders all lifelong.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.3
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• pp.341-347
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• 2003

Smith-Magenis syndrome (SMS) is a clinically recognizable multiple congenital anomaly and mental retardation syndrome caused by an interstitial deletion of chromosome 17 p11.2. Physical features include short stature, characteristic facial appearance: flattened mid-face, down-turned mouth, prominent and often rosy cheeks; prominent jaw in older children and adults, chronic ear infections, hearing impairment, eye problems, including: strabismus (an eye which turns in or out) and myopia (nearsightedness), hoarse voice, short fingers and toes, heart defects or murmurs, problems related to the urinary system, scoliosis (curvature of the spine), an unusual gait (walking pattern), and decreased sensitivity to pain. Behavioral and developmental characteristics include speech delay and articulation problems, developmental delay, learning disability, mental retardation, hyperactivity, self-injury, including: head banging; hand biting; picking at skin, sores and nails; pulling off finger- and toenails; inserting foreign objects into ears, nose, or other body orifices, explosive outbursts, prolonged tantrums, destructive and aggressive behavior, excitability, arm hugging or hand squeezing when excited. This report is the case of a Korean 3-year-3-month old male with Smith-Magenis syndrome referred from local clinic for the treatment of dental caries. The patient was treated by physical restraint after prophylatic administration of antibiotic(Amoxacillin 50mg/kg).

• The Journal of the Korea institute of electronic communication sciences
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• v.9 no.3
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• pp.311-322
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• 2014

This study was conducted to assess the impact of work-related musculoskeletal disorders (WMSDs) on health related quality of life (QoL) in the firefighter under the recent IT environment. The data were collected by face to face interview using a structured questionnaire in the 366 respondents. WMSDs symptoms were measured by a self-assessed questionnaire on symptom table of NIOSH and health-related QoL was measured by SF-36. The prevalence of WMSDs was 38.0% in upper limbs, 35.5% in the low back, 21.6% in lower limbs, and 59.3% in two or more parts of the body. Subjects with symptoms of WMSDs had significantly lower scores in 7 dimensions of QoL except 'emotional role limitation' than those without symptoms of WMSDs at the area of upper extremities (neck, shoulder, arm/wrist, and hand/wrist/fingers). On the other hand, subjects with symptoms of WMSDs had significantly lower scores on all QoL dimensions than those without symptoms of WMSDs at the area of lower back or lower extremities. These results suggest that WMSDs had a negative effect on QoL. Therefore, prevention of WMSDs should be considered intervention strategies for improvement of QoL, especially in firefighters.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.836-844
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• 2011

Purpose: Hands are the chief organs for physically manipulating the environment, using anywhere from the roughest motor skills to the finest, and since the fingertips contain some of the densest areas of nerve endings on the human body, they are continuously used organ with complex functions, and therefore, often gets injured. To prevent any functional loss, a detailed anatomical knowledge is required to have a perfect surgical treatment. Also it is necessary to have a thorough understanding of arrangements of the human extensor tendons and intertendinous connections when tenoplasty or tendon transfer is required. We performed a study of the arrangements of the human extensor tendons and the configuration of the intertendinous connections over the dorsum of the wrist and hand. Methods: A total of 58 hands from Korean cadavers were dissected. The arrangements of extensor indicis proprius, extensor digitorum communis, and extensor digiti minimi tendons and intertendinous connections were studied. Results: The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius (EIP) tendon which inserted ulnar to the extensor digitorum-index (EDC-index); a single EDC-index; a single EDC-middle; a double EDC-ring; an absent EDC-little; a double extensor digiti minimi (EDM), a single EDC-index (98.3%), a single EDC-middle (62%), a double EDC-ring (50%), and an absent (65.5%) or a single (32.8%) EDC-little. A double (70.6%) EDM tendons were seen. Intertendinous connections were classified into 3 types: type 1 with thin filamentous type, type 2 with a thick filamentous type, and type 3 with a tendinous type subdivided to r shaped 3r type and y shaped 3y type. The most common patterns were type 1 in the 2nd intermetacarpal space, type 2 in the 3rd intermetacarpal space, and type 3r in the 4th intermetacarpal space. And in the present study, we observed one case of the extensor digitorum brevis manus (EDBM) on the boht side. Conclusion: A knowledge of both the usual and possible variations of the extensor tendon and the intertendinous connection is useful in the identification and repair of these structures.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.2
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• pp.75-80
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• 2012

Purpose: The purpose of this study is to evaluate the usefulness of ultrasonographic examination for diagnosis and removal of small sized foreign bodies, which invaded extremity but difficulty to find on physical examination and/or plane radiographs. Materials and Methods: Since March, 2009 to February, 2012, we performed preoperatively ultrasonography and operation in 9 cases of foreign bodies of hand or foot. Mean symptom duration periods was 32 months. The location were fingers in 5, palms in 2, hand dorsum in 1, heel in 1 case. In 2 cases, foreign bodies were seen on plane radiographs. In the remaining 7 cases, foreign bodies could be diagnosed by ultrasonography only. Using high resolution stick probe, we performed evaluation on size, location, character of foreign bodies and compared preoperative ultrasonographic findings to intraoperative ones. Results: The site of foreign bodies in preoperative ultrasonography corresponded well with intraoperative findings. Foreign bodies were glass particles in 5, plant thorns in 4, pencil lead in 1. Mean size was 3.9 mm (2~7 mm). Conclusion: Ultrasonography is usefull evaluation tool for diagnosis and treatment in whom residual foreign bodies were suspected.