• 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.

• 대한영상의학회지
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• 제82권3호
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• pp.500-511
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• 2021

하지동맥 질환의 유병률은 고연령 군에서 증가한다. 최근의 기술적 진보로 혈관 내 치료가 점점 더 많은 빈도로 시행되고 있다. 간헐적 파행의 치료 목표는 보행 능력을 향상시키고 증상을 완화시키는 것이다. 이를 위해 해부학적 내구성을 높이는 것이 중요한 전략이며 개통률이 치료 평가 기준이 된다. 임계 하지허혈을 가진 환자에서는 병변이 광범위하고 특히 무릎아래동맥을 심하게 침범한다. 임계 하지허혈의 치료 목적은 상처 회복을 촉진하고 주요 절단을 예방하는데 있으며 사지 보존율이 평가의 기준이 된다. 장골동맥 협착의 치료에는 피복 혹은 비피복 스텐트 삽입술이 일차적 치료로 인정된다. 대퇴슬와동맥 질환은 죽종제거술과 함께 약물방출풍선 및 스텐트가 자주 사용되는 반면 무릎아래동맥 질환에서는 풍선확장술이 주요 치료 방법이다. 컴퓨터단층 혈관조영술은 절대적 금기증이 없는 환자에서 혈관 내 치료계획 수립을 하는데 로드맵을 제공한다.

• Journal of Korean Biological Nursing Science
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• 제18권2호
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• pp.78-86
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• 2016

Purpose: Diabetic foot ulcers are significant problems in diabetes mellitus and often result in lower extremity amputation. This study was conducted to evaluate the effects of a self-care management program on Korean patient's self-efficacy, self-care behavior, size of the wound, and wound related pain. Methods: This study was a quasi-experimental study of pre-test and post-test design in a non-equivalent control group. The intervention strategies of the self-care management program consisted of individual intervention (education, practice and demonstration), computer animation, and face-to-face counseling. There were thirty seven patients, and 20 were assigned to the experimental group while the other 17 were assigned to the control group. The experimental group was given a self-care management program. The control group received information on diabetic mellitus care by means of a leaflet. The data was analyzed using descriptive statistics, a chi-square test, an independent t-test, and a Mann-Whitney test. Results: There were significant differences in self-care behavior and wound related pain. Conclusion: A Self-care program is an effective way to increase patient's self-care ability. This program is highly applicable to diabetic foot ulcer patients in various settings.

• 대한간호
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• 제23권3호통권126호
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• pp.68-76
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• 1984

본 환자를 간호하면서 절단으로 인해 신체적 고통을 받고 있는 존재로서, 생각과 정서, 욕구를 지닌 존재로서의 환자를 돕고자 시도해 보았다. 신체적인 적응을 돕기 위해서 근력강화와 관절가동역증진, 통증조절, 보조기 착용을 위한 단단의 관리, 잔여관절의 변형예방에 중점을 두었다. 심리적인 적응을 돕기 위해서 환자가 절단 수술과 수술 후 변화된 신체외모를 수용하는 과정을 증시했다. 끝으로 사회적인 면에서는 의미있는 사람들의 집단속에서 존재하는 인간으로서의 환자에게 관심을 두었다. 환자의 우측 슬관절 가동역은 완전히 회복된 상태는 아니지만 목발을 이용하여 걷거나 기타 일상생활을 하는데 불편함은 없으며 앞으로 계속적인 노력을 통해 회복될 수 있을 것이다. 그의 좌측 고관절 가동역은 정상유지되고 있으며 절단부위는 보조기 착용에 적합하게 형성되어 가고 있다. 비슷한 처지에 있는 이씨환자의 도움과 환자의 독립적인 생활태도는 환자가 자신의 불구에 적응하고 일상생활에 적응하는데 많은 도움이 되었다. 협조적이고 동정적인 환자들과 의료진의 도움으로 환자는 보호된 병원환경내에서 신체적 제한점을 주목하고 자신의 불구에 적응하면서 타인들과 원만한 관계를 유지해 왔다. 그는 앞으로 사회에 돌아가서 생활하게 될 것이다. 우리 사회는 아직도 그들에 대해 편견을 가지고 있으며 직업적 교육적 의료치료적 배려가 부족한 상태이다. 사회속에서의 적응은 병원에서의 적응보다 훨씬 더 어려울 것이며 때로는 그를 좌절하게 할 것이다. 그의 신체적 결함이 자기 자신만의 책임은 아니며 어느 누구나 사고에 희생될 가능성은 있다. 사회인들이 그들에게 관심있고 수용적인 태도를 지니고 그들의 정상 요구와 인간으로서 동등하게 살아갈 권리를 인정하고 받아들인다며 좀더 쉽게 자신의 슬픔을 극복할 수 있을 것이다.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.204-208
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• 2016

For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

• 대한족부족관절학회지
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• 제23권2호
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• pp.58-66
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• 2019

Purpose: To evaluate the efficacy of antibiotic-loaded cement spacers (ALCSs) for the treatment of diabetic foot infections with osteomyelitis as a salvage procedure and to analyze the risk factors of treatment failure. Materials and Methods: This study reviewed retrospectively 39 cases of diabetic foot infections with osteomyelitis who underwent surgical treatment from 2009 to 2017. The mean age and follow-up period were $62{\pm}13years$ and $19.2{\pm}23.3months$, respectively. Wounds were graded using the Wagner and Strauss classification. X-ray, magnetic resonance imaging (or bone scan) and deep tissue cultures were taken preoperatively to diagnose osteomyelitis. The ankle-brachial index, toe-brachial index (TBI), and current perception threshold were checked. Lower extremity angiography was performed and if necessary, percutaneous transluminal angioplasty was conducted preoperatively. As a surgical treatment, meticulous debridement, bone curettage, and ALCS placement were employed in all cases. Between six and eight weeks after surgery, ALCS removal and autogenous iliac bone graft were performed. The treatment was considered successful if the wounds had healed completely within three months without signs of infection and no additional amputation within six months. Results: The treatment success rate was 82.1% (n=32); 12.8% (n=5) required additional amputation and 5.1% (n=2) showed delayed wound healing. Bacterial growth was confirmed in 82.1% (n=32) with methicillin-resistant Staphylococcus aureus being the most commonly identified strain (23.1%, n=9). The lesions were divided anatomically into four groups; the largest number was the toes: (1) toes (41.0%, n=16), (2) metatarsals (35.9%, n=14), (3) midfoot (5.1%, n=2), and (4) hindfoot (17.9%, n=7). A significant difference in the Strauss wound score and TBI was observed between the treatment success group and failure group. Conclusion: The insertion of ALCSs can be a useful treatment option in diabetic foot infections with osteomyelitis. Low scores in the Strauss classification and low TBI are risk factors of treatment failure.

• Journal of Chest Surgery
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• 제39권4호
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• pp.298-303
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• 2006

배경: 하지의 폐쇄성 동맥경화증을 치료하기 위해 시행한 하지동맥 혈관수술에 대한 성적을 알아보고자 이 연구를 시행하였다. 대상 및 방법: 1996년 12월부터 2004년 6월까지 하지의 폐쇄성 동맥경화증으로 수술 받은 40명의 환자를 대상으로 의무기록을 토대로 후향적 분석을 하였다. 환자의 평균 나이는 $66{\pm}8$세($47{\sim}81$세)였고 성비는 37:3 (남:여)이었다. 결과: 수술은 40명에서 시행되었으며 10명의 환자에서는 양측 하지에 우회술을 시행하였다. 수술명은 대퇴-슬와동맥 우회술-12예(30%), 대퇴-대퇴동맥 우회술-12예(30%), 대퇴-대퇴동맥 우회술+대퇴-슬와동맥 우회술-5예(12.5%), 대동맥-하지동맥 우회술-5예(12.5%), 액와-대퇴동맥 우회술-2예(5%), 장골-슬와동맥 우회술-2예(5%), 내막절제술-2예(5%)였다. 모든 혈관우회술의 우회도관은 인조혈관이 사용되었다. 평균 추적기간은 $33.2{\pm}23.2$개월($3.8{\sim}90.2$개월)이었으며 우회도관의 1년, 5년간 누적 개존율은 각각 75.5, 58.7%였다. 6예에서 수술후 하지절단술이 시행되었다. 수술 후 합병증은 8명의 환자에서 12건이 발생하였다. 재수술은 10예에서 시행되었다. 결론: 본원에서 시행한 하지동맥 우회술은 비교적 양호한 개존율을 보였으나 적지 않은 환자에서 우회도관 폐쇄로 인한 재수술이 필요하였다. 하지의 폐쇄성 동맥경화증의 치료성적을 향상시키기 위해서는 동맥경화증의 진행을 억제할 수 있고 우회술의 장기 개존율을 높이는 획기적인 치료법이 연구되어야 할 것으로 생각된다.

• 대한골관절종양학회지
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• 제11권2호
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• pp.219-223
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• 2005

간엽성 연골육종은 전형적인 연골육종과는 달리 매우 드문 것으로 알려져 있으며, 골격계 부위에서는 하지, 특히 대퇴골에서 대부분 발생하며, 다음으로 두안면부, 골반부에서 발생하는 것으로 보고되어 왔다. 11세 남아가 좌측 후족부 통증으로 타 병원에서 양성 골 종양 추정 하에 수술적 제거술을 시행 받고, 수술 후 조직검사 결과, 악성 종양으로 진단되어, 본원으로 전원 되었다. 조직 재 판독 결과, 좌측 종골 간엽성 연골 육종으로 진단되어, 슬하부 절단을 시행하였다. 외래 경과 관찰 중 술 후 3개월에 흉부 컴퓨터 촬영상 다발성 폐 전이성 결절 소견 보여 전이절제술 및 항암 치료를 시행하였다. 문헌상 간엽성 연골육종이 족저부 연부 조직에 발생한 경우는 1예가 있으나 종골 골조직에 발생한 경우는 없어 문헌 고찰과 함께 보고하는 바이다.

• 대한족부족관절학회지
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• 제15권3호
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• pp.165-169
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• 2011

Purpose: The objective of this study was to analyze diabetic foot patients' direct service costs until the cure of the disease. Materials Methods: The subjects of this study were randomly sampled 60 patients who had been treated for diabetic foot at one of two tertiary hospitals and cured of the disease during from January 2008 to December 2009, and whose diagnostic code was E11.5 or E14.5. Data were collected from medical records and direct service costs were analyzed using data on the payments of individual service charges. Direct service costs spent at other medical institutions for the same disease were excluded. Collected data were analyzed using descriptive statistics. Results: The subjects' mean hospital stay was 29 days, and mean period until cure was 132 days. The inpatient cost per patient was 10,844,648 won, outpatient cost was 715,751 won, and home care services cost was 641,854 won, so total direct service cost per patient was 11,913,419 won. The total direct service cost in patients who had their foot amputated was 12,769,822 won, 1.3 times higher than without amputation, who had vascular intervention was 16,219,477 won, 1.9 times higher than non-vascular intervention, who had both infection and artery occlusion was 17,522,435 won, 2.0 times higher than either infection or artery occlusion. Conclusion: In diabetic foot patients, the direct service cost was highest as 17,522,435 won in patients accompanied with both infection and occlusion of lower extremity artery.

• 대한골관절종양학회지
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• 제7권2호
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• pp.51-58
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• 2001

목적 : 어린이나 혹은 성인에 생긴 대퇴부 절단술이 필요한 슬관절 주위의 악성 및 침윤성 골종양에서, 분절 절제 및 회전 성형술을 시행한 치험례를 분석하여 보고하는 바이다. 대상 및 방법 : 1988년 2월부터 1994년 6월까지 슬관절 부위의 악성 및 침윤성 골종양으로 하지 분절 절제 및 회전 성형술을 시행 받은 2 6명을 대상으로 하였으며, 추시 기간은 악성종양의 경우 평균 57(6~120)개월이었고, 평균 연령은 21.4(5~37)세였다. 26례 중 stage IIB 이상의 골육종이 18례, 활막 육종이 2례, 병적골절 또는 재발된 거대 세포종이 6례였다. 결과 : 기능적 결과는 사망 또는 절단술을 받은 4례를 제외한 22례에 대하여 Shriner's rating system에 따라 실시하였으며, 18례에서 우수, 3례에서 양호, 1례는 보통이었다. 족관절의 평균 운동범위는 $-11^{\circ}$(족배굴)~$80^{\circ}$(족저굴)였으며, 보조기 착용 후 일상 생활의 보행이 가능하였다. 국소 재발은 2례, 원격 전이는 10례에서 관찰되었다. 초기 합병증은 혈전증 3례와 패혈증 1례가 있었다. 후기 합병증은 불유합 및 지연유합이 6례, 부정 회전이 2례, 족관절의 운동제한이 1례 있었다. 결론 : 약 10세 미만의 소아에서 많은 하지 부동이나 성장에 따른 골수강의 확장으로 종양 삽입물의 해리가 예상되는 경우와 악성 및 침윤성 골종양으로 절단술이 불가피한 경우에, 기능적으로 우수한 회전 성형술은 부분 사지 구제술로써 유효한 방법으로 사료된다.