• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.87-95
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• 1997

Traumatic injury to the hand often leads to soft tissue defects with exposed tendons, bones, or joints. Though many new flap have been introduced, the choice of flap that would be best for the patient depends on such factors as the site, size, and degree of wounds. Additionally the selected surgical method should be yielded cosmetic and functional superiority by the one-staged reconstruction. In our experience, small to medium sized soft tissue defect with bone and tendon exposure of hand can be resurfaced with an arterialized venous free flap from the volar aspect of distal forearm. Wide and deep defects of the hand can be covered with a sensory cutaneous free flap such as the medial plantar free flap, dorsalis pedis free flap, and radial forearm free flap. Specialized flap such as wrap-around flap, toe-to-finger transfer, onychocutaneous free flap can be used for the recontruction of defect on the thumb and finger. Based on the above considerations and our clinical experience of 60 free flap cases of the hand, the various methods for the proper repair of soft tissue defects of the hand are described. And we obtained satisfactory functional and cosmetic results with 95% success rate of free flap.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.120-126
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• 2000

Microsurgical reconstruction of the hand demands recovery of the sensation of the reconstructed free flap as well as microsurgeon's intelligence, technique and experience. Even with adequate soft tissue coverage and skeletal mobility, an insensate hand is prone to further injury and is unlikely to be useful to the patients. Authors have performed 8 cases of neurosensory free flaps in the hand, 4 cases of wrap around, 3 dorsalis pedis and 1 lateral arm flap, from July 1992 through June 1999 and followed up average 4 years and 4 months. Wrap around flap was performed for reconstruction of 4 cases of thumb, repairing deep peroneal nerve and superficial radial nerve by epineurial neurorrhaphy, and followed up for average 3 years and 10 months and calculated 9mm in the static 2 point discrimination test. Dorsalis pedis flap were 3 cases for reconstruction of the ray amputation, extensor tendon exposure and wrist exposure. Deep peroneal nerve and branch of the ulnar nerve was repaired by epineurial neurorrhaphy calculating 6mm and superficial peroneal nerve and superficial radial nerve averaging 18mm in the static 2 point discrimination test for follow up average 2 years and 9 months. Lateral arm flap was 1 case for reconstruction of the ray amputation in the hand repairing posterior cutaneous nerve to the arm to the superficial radial nerve calculating 20mm for follow up 6 years and 8 months.

• International conference on construction engineering and project management
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• 2005.10a
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• pp.892-896
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• 2005

This paper collected 132 schools reconstruction projects in central Taiwan, which received the most serious damage from the Chi-Chi Earthquake. Regression analysis was implemented to build the prediction model of the cost and the duration for the collected projects. It is found that the cubic regression models are capable for predicting the cost and the duration of the projects contracted by the central agency of which the contracting awarding approach was based on the most advantageous tendering (MAT) approach. On the other hand, power regression models are capable for predicting the cost and the duration of the projects contracted through the low bid tendering (LBT) approach. It is also found that the performance of the regression prediction model differs in accordance with organizations that contracted the reconstruction projects.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.3
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• pp.227-232
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• 2007

The radial forearm fasciocutaneous flap(RFFF) is a well-known flap for the reconstruction of oral and maxillofacial defects. It was first described by Yang et al. in 1981 and Soutar et al. developed it for the reconstruction of intraoral defect. RFFF provides a reliable, thin, and pliable soft tissue/skin paddle that is amenable to sensate reconstruction. It also has a long vascular pedicle that can be anastomosed to any vessel in either the ipsilateral or contralateral neck. However, split thickness skin graft(STSG) is most commonly used to cover the donor site, and a variety of donor site complications have been reported, including delayed healing, swelling of the hand, persistent wrist stiffness, reduced hand strength, and partial loss of the graft with exposure of the forearm flexor tendon. Various methods for donor site repair in addition to STSG have been developed and practiced to minimize both functional and esthetic morbidity, such as direct closure, V-Y closure, full thickness skin graft, tissue expansion, acellular dermal graft. We got a good result of using artificial dermis($Terudermis^{(R)}$) and secondary STSG for the repair of RFFF donor site defect esthetically and report with a review of literature.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.555-558
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• 2009

Purpose: The high success rate of free flap transfers is well documented in previous literature, and is possible due to the early detection of vascular compromise and timely reoperation. We specifically analyzed the operative results of immediate and delayed reconstruction with free transverse rectus abdominis musculocutaneous(TRAM) flap respectively in order to reveal its distinctive features on timing and causes of vascular compromise. Methods: The senior author operated on 158 patients, 161 cases of free TRAM flap for breast reconstruction. 51 patients underwent delayed reconstruction, whilst immediate reconstruction was performed in the other 107 patients. All patients were monitored every 3 hours for the first 3 days. We reviewed medical records of all patients, and tested statistical significance with the Fisher's test. Results: Reoperation was performed in 20 cases, but the cases include hematoma with bleeding focus and arterial anastomosis site rupture due to abrupt arm abduction. We performed reoperation in 15 cases of suspicious vascular compromise. Flap compromise was noticed mostly within 24 hours, but not longer than 72 hours. Venous compromise was dominant by 11 cases (73.3%). There was difference in the timing of flap compromise between immediate and delayed reconstruction. All the cases of delayed reconstruction did not show signs of vascular compromise after 12 hours postoperatively. On the other hand, cases of vascular compromise were observed until 72 hours postoperatively in cases of immediate reconstruction. Conclusion: Delayed reconstruction showed vascular compromise within 12 hours postoperatively, while immediate reconstruction showed compromised until the 3rd postoperative day. If more aggressive monitoring is maintained during this period, we believe salvage of flaps may be increased with more efficiency.

• The Journal of Engineering Research
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• v.2 no.1
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• pp.49-56
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• 1997

In emission computed tomography, statistical reconstruction methods in the context of a Bayesian framework have been a topic of interest over the last decade. This was mainly due to the fact that Bayesian approaches can incorporate a priori information into the reconstruction algorithm. Although these approaches can exhibit good performance, their applications to the clinic is hindered mainly by their high computational cost. On the other hand, the speed and simplicity of the filtered backprojection (FBP) algorithm have led to its widespread use in most clinical applications. In this work, we use spline models, which have been quite useful in Bayesian reconstruction, as regularizers for high-frequency apodization in FBP algorithm and show that the effects of using spline models as priors in Bayesian reconstruction can also be achieved in FBP reconstruction.

• Journal of Korean Foot and Ankle Society
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• v.22 no.3
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• pp.91-94
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• 2018

Ankle sprain is one of the most common musculoskeletal injuries. Although most ankle sprains respond well to conservative measures, chronic instability following an acute sprain has been reported to occur in 20% to 40% of patients. Some individuals are eventually indicated for a lateral ankle ligament reconstruction due to persistent ankle instability. More than 80 surgical procedures have been described to address lateral ankle stability. These range from direct repair of the anterior talofibular ligament (ATFL) and of the calcaneofibular ligament (CFL) to reconstructions based on the use of autograft or allograft tissues. However, the best surgical option remains debatable. The modified $Brostr{\ddot{o}}m$ procedure is most widely used for direct ligament repair, but not always possible because of the poor ATFL or CFL quality or deficiency of these ligaments, which prevents effective shortening imbrication. Furthermore, the importance of a CFL reconstruction has been emphasized recently. On the other hand, it is difficult to achieve an efficient CFL reconstruction during the $Brostr{\ddot{o}}m$ procedure. Others have reported that an anatomic reconstruction of injured ligaments restores the normal resistance to anterior translation and inversion without restricting subtalar or ankle motion, and as a result, anatomic reconstructions for lateral ankle instability utilizing an autograft or allograft tendon have gained popularity.

• Journal of Korean Foot and Ankle Society
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• v.23 no.1
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• pp.1-5
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• 2019

Surgical treatment to restore stability in the ankle and hindfoot and prevent further degenerative changes may be necessary in cases in which conservative treatment has failed. Anatomical direct repair using native ligament remnants with or without reinforcement of the inferior retinaculum is the so-called gold standard operative strategy for the treatment of lateral ankle instability. Non-anatomical lateral ligament reconstruction typically involves the use of the adjacent peroneus brevis tendon and applies only those with poor-quality ligaments. On the other hand, anatomic reconstruction and anatomic repair provide better functional outcomes after the surgical treatment of chronic ankle instability patients compared to a non-anatomic reconstruction. Anatomical reconstruction using an autograft or allograft applies to patients with insufficient ligament remnants to fashion direct repair, failed previous lateral ankle repair, high body mass index, or generalized ligamentous laxity. These procedures can provide good-to-excellent short-term outcomes. Arthroscopic ligament repair is becoming increasingly popular because it is minimally invasive. Good-to-excellent clinical outcomes have been reported after short and long-term follow-up, despite the relatively large number of complications, including nerve damage, reported following the procedure. Therefore, further investigation will be needed before widespread adoption is advocated.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.492-495
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• 2023

Extra-articular deposition of monosodium urate crystals is a widely recognized manifestation of gout. However, gouty infiltration of flexor tendons in the hand resulting in tendon rupture is exceedingly rare. This case report highlights a patient with gouty infiltration of flexor tendons in the right middle finger resulting in rupture of both the flexor digitorum profundus and flexor digitorum superficialis. Given the extent of gouty infiltration and need for pulley reconstruction, the patient was treated with two-stage flexor tendon reconstruction. Febuxostat was prescribed preoperatively to limit further deposition of monosodium urate crystals and continued postoperatively to maximize the potential for long-lasting results. Prednisone was prescribed between the first- and second-stage operations to prevent a gout flare while the silicone rod was in place. In summary, tendon rupture secondary to gouty infiltration is the most likely diagnosis in patients with a history of gout presenting with tendon insufficiency.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.14-23
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• 2004

Introduction: The hand and wrist are particularly susceptible to electrical burn. Skin defect with damage or exposure of underlying vital structure requires coverage by skin flap especially in case of the need for late reconstruction. We are reporting 4 cases of electrical burned hand treated by posterior tibial arterial free flap. The commonly used skin flaps such as scapular flap or groin flap are too bulky so that they are not satisfactory in function and cosmetic appearance. So we tried to cover them with a more thin skin flap. Materials and Method: From January 2002 to June 2003, four cases of hand and wrist electrical burn were covered using posterior tibial arterial free flap. All the cases were due to high voltage electrical burn. Age ranged from 31 years to 38 years old and all the cases were male patients. Recipient sites were 2 wrist, one thenar area and one knuckle of 2.3rd MP joint. Additional procedures were flexor tenolysis (simultaneous), FPL tenolysis and digital nerve graft (later) and extensor tendon reconstruction (later). Result: All the flap have survived totally without any complication including circulatory concern about the donar foot. Posterior tibail arterial free flap was so thin that debulking procedure was not required. Conclusion: For skin coverage of the hand & wrist region, posterior tibial arterial free flap have many advantages such as reliable anatomy, easy dissection and easy anastmosis with radial or ulnar artery and possibility of sensory flap. The most helpful advantage for hand coverage is its thinness. So we think this flap is one of the very useful armamentarium for reconstructive hand surgery.