• Journal of Chest Surgery
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• v.53 no.5
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• pp.291-296
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• 2020

Background: We report our 10-year experience with traumatic peripheral arterial injury repair at an urban level I trauma center. Methods: Between January 2007 and December 2016, 28 adult trauma patients presented with traumatic peripheral arterial injuries. Data were retrospectively collected on demographic characteristics, the mechanism of injury, the type of vascular injury, and physiological status on initial assessment. The analysis also included the Mangled Extremity Severity Score (MESS), Injury Severity Score, surgical procedures, and outcome variables including limb salvage, hospital stay, intensive care unit stay, and postoperative vascular complications. Results: Four (14.3%) patients required amputation due to failed revascularization. MESS significantly differed between patients with blunt and penetrating trauma (8.2±2.2 vs. 5.8±1.3, respectively; p=0.005). The amputation rate was not significantly different between patients with blunt and penetrating trauma (20% vs. 0%, respectively; p=0.295). The overall mortality rate was 3.6% (1 patient). Conclusion: Blunt trauma was associated with higher MESS than penetrating trauma, and amputation was more frequent. In particular, patients with blunt trauma had significantly higher MESS than patients with penetrating trauma (8.2±2.2 vs. 5.8±1.3, respectively; p=0.005), and amputation was performed when revascularization failed in cases of blunt trauma of the lower extremity. Therefore, particular care is needed in making treatment decisions for patients with peripheral arterial injuries caused by blunt trauma.

• Journal of Korean Foot and Ankle Society
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• v.28 no.3
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• pp.96-101
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• 2024

Purpose: Diabetic foot ulcers and gangrene are major complications of diabetes, often accompanied by peripheral vascular occlusion. Revascularization is performed to restore blood flow and reduce complications such as amputation surgery. Nevertheless, reocclusion, a frequently reported complication after revascularization, often necessitates further lower limb amputations to facilitate rehabilitation and ambulation. This study examined the factors influencing the performance of secondary revascularization procedures in patients with diabetic foot gangrene who even underwent transtibial amputation (TTA) following revascularization. Materials and Methods: A retrospective study was conducted on 36 patients with diabetic foot gangrene who underwent TTA after revascularization from March 2005 to March 2022. The factors influencing restenosis were classified into three categories: revascularization factors, preoperative factors, and intraoperative factors. The revascularization factors were categorized based on whether percutaneous transluminal angioplasty (PTA) or bypass surgery had been performed. Preoperative factors included the patient's age, gender, body mass index (BMI), hypertension, and other relevant factors. Intraoperative factors included surgery duration, blood loss, and transfusion. The study examined the factors influencing secondary revascularization in these three categories. Results: Among the 36 patients in the study, 27.8% (11 patients) underwent secondary revascularization procedures. There was no significant correlation between the performance of secondary revascularization and the type of revascularization procedure, whether PTA or bypass surgery (p>0.05). Similarly, no significant differences were observed in preoperative factors (including age, BMI, smoking status, HbA1c, and underlying diseases) and intraoperative factors (surgery duration, blood loss, and transfusion). On the other hand, regarding gender, all patients who underwent revascularization procedures were male, indicating a statistically significant result (p=0.039). Conclusion: This study suggests that while most clinical variables showed no association with reocclusion, the fact that all patients who underwent secondary revascularization procedures were male indicates that gender may be a significant predictive factor of revascularization.

• Journal of the Korean Society for Precision Engineering
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• v.29 no.2
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• pp.239-244
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• 2012

The prevalence of knee osteoarthritis was higher people with lower limb amputation. This was identified that transfemoral amputees have a greater external knee adduction moment than ablebodied subjects by biomechanical studies. Therefore, they need rehabilitative intervention for prevention and reduction of knee osteoarthritis. The purpose of this study was to determine the effect of lateral wedge insole used in the treatment of knee osteoarthritis. This study was participated in fourteen unilateral transfemoral amputees and we were analyzed the difference gait variables between without lateral wedge insole and with $5^{\circ}$ and $10^{\circ}$ lateral wedge insole during gait. Our results showed that step length ratio was more symmetrical and, hip adduction and ankle inversion angle were more close to normal value, and knee adduction moment was decreased as the wedge angle increases. We proposed that these data would be utilized conservative treatment of knee osteoarthritis in lower limb amputees.

• Journal of Korean Physical Therapy Science
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• v.12 no.4
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• pp.33-41
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• 2005

The purpose of this report was to describe the gait pattern and parameters of the complicated bilateral amputee with right transtibial and left tarsometatarsal amputation. Using a Vicon 370 three dimensional gait analysis system, the gait analysis was performed at pre and post-test. Treadmill Training with 15 degree, incline was practiced for 8weeks, 3times per week. In linear parameters, the Velocity, Stride length and Single limb support were increased than pre-test. but Cadence and Double limb support were less post-test than pre-test. In kinematics, the maximal pelvic tilt angle showed right side $21.87^{\circ}$, left side $20.67^{\circ}$ at pre-swing phase, and decreased as compared with pre-test. Especially, the inimal hip flexion angle showed right side $-6.83^{\circ}$, left side $1.52^{\circ}$ at pre-swing phase and increased as compared with pre-test. The maximal knee flexion angle disclosed right side $2.66^{\circ}$, left side $21.71^{\circ}$ at stance phase, and decreased as compared with pre-test. In kinetics, the hip extension moment on initial contact stage was right side 0.938NM/Kg, left side 0.09NM/Kg, which was impaired compared with normal person.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.500-511
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• 2021

The prevalence of lower extremity disease is increasing with age. With recent technological advancements, endovascular treatment is being performed more frequently. The treatment goal of intermittent claudication is to improve walking and reduce claudication. To achieve these goals, anatomical durability and patency are important. In patients with critical limb ischemia, the lesions are diffuse and particularly severe in below-the-knee arteries. The treatment goal of critical limb ischemia is to promote wound healing and to prevent major amputation, which is evaluated by the limb salvage rate. Primary stenting using covered or bare metal stents is a widely accepted endovascular treatment. While drug-eluting technologies with or without atherectomy are widely used in the treatment of femoropopliteal disease, balloon angioplasty is the mainstay treatment for below-the-knee intervention. CT angiography provides a road map for planning endovascular treatment in patients without absolute contraindications.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.274-279
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• 1995

To evaluate clinical pattern and operative outcome of atherosclerotic obstructive disease in the lower extremity, surgical experience in 25 patients between September 1987 and June 1994 was analyzed. There were 24 male patients and 1 female patient. The age of the patients ranged between 36 and 77 years[mean:60.9 years . Disabing intermittent claudication, rest pain, or ischemic gangrene[or ulceration was the operative indication. The patients were classified into three groups according to the level of obstruction: Aortoiliac level[11 cases/44% , femoropopliteal level[6 cases/24% , and whole level[8 cases/32% . Anatomic bypass with prosthetic graft was performed in all cases: aortobifemoral or aortofemoral bypass in 15 procedures, iliofemoral bypass in 5 procedures, femoropopliteal bypass in 13 procedures. The perioperative mortality rate was 12%. Two patients received postoperative major amputation. Twenty two patients were followed-up for 1 to 70 months[mean: 21 months . Late graft obstruction occurred in two patients. The cumulative patency rate at 3 years was 69.5%. The cumulative limb salvage rate at 3 years was 92.0%.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.298-303
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• 2006

Background: This study was performed to investigate the outcomes of vascular operations that were done in patients with atheroscerosis obliterans (ASO) of lower limb. Material and Method: Forty patients underwent vascular operations from December 1996 to June 2004. The patient's records were analyzed retrospectively. Mean age was $66{\pm}8$ years (range, $47{\sim}81$ years). Gender ratio was 37:3 (male:female). Result: The operations were done on 50 lower limbs of 40 patients. The names of operations were femoropopliteal bypass in 12 patients (30%), femorofemoral bypass in 12 (30%), femorofemoral bypass and femoropopliteal bypass in five (12.5%), aorta-lower limb artery bypass in five (12.5%), axillofemoral bypass in two (5%), iliopopliteal bypass in two (5%), and endarterectomy in two (5%). All bypass surgeries were done with prosthetic conduits. Mean follow up period was $33.2{\pm}23.2$ months (range, $3.8{\sim}90.2$ months). The cumulative patency rates of 1 and 5 years were 75.5 and 58.7% respectively. In six patients, amputation of the lower limb was done. In eight patients, 12 complications occurred. After the first operation, 10 patients underwent reoperations. Conclusion: Our lower limb arterial bypass surgery revealed acceptable patency rate, but not a few patients required reoperations. An epochal treatment modality that can inhibit the progress of ASO and improve long term patency should be established.

• Archives of Plastic Surgery
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• v.51 no.2
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• pp.234-250
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• 2024

Background The impact of diabetes on complication rates following free flap (FF), pedicled flap (PF), and amputation (AMP) procedures on the lower extremity (LE) is examined. Methods Patients who underwent LE PF, FF, and AMP procedures were identified from the 2010 to 2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) database using Current Procedural Terminology and International Classification of Diseases-9/10 codes, excluding cases for non-LE pathologies. The cohort was divided into diabetics and nondiabetics. Univariate and adjusted multivariable logistic regression analyses were performed. Results Among 38,998 patients undergoing LE procedures, 58% were diabetic. Among diabetics, 95% underwent AMP, 5% underwent PF, and <1% underwent FF. Across all procedure types, noninsulin-dependent (NIDDM) and insulin-dependent diabetes mellitus (IDDM) were associated with significantly greater all-cause complication rates compared with absence of diabetes, and IDDM was generally higher risk than NIDDM. Among diabetics, complication rates were not significantly different across procedure types (IDDM: p = 0.5969; NIDDM: p = 0.1902). On adjusted subgroup analysis by diabetic status, flap procedures were not associated with higher odds of complications compared with amputation for IDDM and NIDDM patients. Length of stay > 30 days was statistically associated with IDDM, particularly those undergoing FF (AMP: 5%, PF: 7%, FF: 14%, p = 0.0004). Conclusion Our study highlights the importance of preoperative diabetic optimization prior to LE procedures. For diabetic patients, there were few significant differences in complication rates across procedure type, suggesting that diabetic patients are not at higher risk of complications when attempting limb salvage instead of amputation.

• Archives of Plastic Surgery
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• v.40 no.5
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• pp.630-632
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• 2013

Vacuum-assisted wound healing has been proven to be more efficacious than conventional dressings. Vacuum dressing has been frequently modified given the restrictions in resources available. Here we present a modified method of vacuum dressing by using surgical or gynaecological gloves for lower and upper limb wounds. Vacuum dressing was applied with parts of a surgical or gynaecological glove and Opsite with T-tailing of the suction outlet. Vacuum-assisted wound healing using the surgical gloves showed relatively good wound healing in the amputation stump, finger, arm, and leg in the cases studied.

• PNF and Movement
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• v.18 no.3
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• pp.453-463
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• 2020

Purpose: This study aimed to investigate the effect of an intensively rehabilitation program on the gait, balance, functional performance, and wearing satisfaction of patients with traumatic lower extremity amputations caused by industrial accidents. Methods: In this study, the anonymized electronic medical records of individuals who participated in the intensive rehabilitation program (among those who were admitted to the hospital belonging to the Labor Welfare Corporation) due to an industrial accident from August 2018 to September 2019 were collected. As a result, the records of 12 subjects meeting the screening criteria were analyzed. Results: According to the time of application to the intensive rehabilitation program, the 10 Meter Walk Test (10MWT) (p < 0.01), Berg Balance Scale (BBS) (p < 0.01), Timed Up and Go Test (TUG) (p = 0.01), the L Test of Functional Mobility (L-test) (p < 0.01), Prosthetic Limb Users Survey of Mobility (Plus-M) (p < 0.01), and Houghton Score Question (HSQ) (p < 0.01) values significantly improved with time. Conclusion: This study confirmed the positive effect of an intensive rehabilitation program on the gait, balance, functional performance, and wearing satisfaction of patients with traumatic lower extremity amputations caused by industrial accidents. However, this study was limited by the absence of a control group, and, thus, it highlights the need for more extensive research with a large sample.