• Archives of Plastic Surgery
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• v.36 no.5
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• pp.605-610
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• 2009

Purpose: Substantial tissue necrosis after snake bites requiring coverage with flap surgery is extremely rare. In this article, we report 7 cases of soft tissue defects in the upper and the lower extremities caused by snake bites, which needed to be covered with flaps. Among the vast mass of publications on snake bites there has been no report that focuses on flap coverage of soft tissue defects due to snake bite sequelae. Methods: Seven cases of soft tissue defects with tendon, ligament, or bone exposure after snake bites were included. All patients were males without comorbidities, the average age was 35 years. All of them required coverage with a flap. In 6 cases, the defect was localized on the upper extremity, in one case the lesion was on the lower extremity. Local flaps were used in 6 cases, one case was covered with a free flap. The surgical procedures included one kite flap, one cross finger flap and digital nerve reconstruction with a sural nerve graft, one reverse proximal phalanx island flap, one groin flap, one adipofascial flap, one neurovascular island flap, and one anterolateral thigh free flap. The average interval from injury to flap surgery was 23.7 days. Results: All flaps survived without complication. All patients regained a good range of motion in the affected extremity. Donor site morbidities were not observed. The case with digital nerve reconstruction recovered a static two point discrimination of 7 mm. The patient with foot reconstruction can wear normal shoes without a debulking procedure. Conclusion: The majority of soft tissue affection after snake bites can be treated conservatively. Some severe cases, however, may require the coverage with flap surgery after radical debridement, especially, if there is exposure of tendon, bone or neurovascular structures. There is no doubt that definite coverage should be performed as soon as possible. But we also want to point out that this principle must not lead to a premature coverage. If the surgeon is not certain that the wound is free of necrotic tissue or remnants of venom, it is better to take enough time to get a proper wound before flap surgery in order to obtain a good functional and cosmetic result.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.253-260
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• 2020

Purpose: Soft tissue defects of the distal lower extremity are commonly accompanied by a fracture of the lower extremities. Theses defects are caused by the injury itself or by complications associated with surgical treatment of the fracture, which poses challenging problem. The reverse superficial sural artery flap (RSSAF) is a popular option for these difficult wounds. This paper reviews these cases and reports the clinical results. Materials and Methods: Between August 2003 and April 2018, patients who were treated with RSSAF for soft tissue defects of the lower third of the leg and ankle related to a fracture were reviewed. A total of 16 patients were involved and the mean follow-up period was 18 months. Eight cases (50.0%) of the defects were due to an open fracture, whereas the other eight cases (50.0%) were postoperative complication after closed fracture. The largest flap measured 10×15 cm² and the mean size of the donor sites was 51.9 cm². The flap survival and postoperative complications were evaluated. Results: All flaps survived without complete necrosis or failure. One case with partial necrosis of the flap was encountered, but the wound healed after debridement and repair. One case had a hematoma with a pseudoaneurysmal rupture of the distal tibial artery. On the other hand, the flap was intact and the wound healed after arterial ligation and flap advancement. A debulking operation was performed on three cases for cosmetic reasons and implant removal through the flap was performed in three cases. No flap necrosis was encountered after these additional operations. Conclusion: RSSAF is a relatively simple and safe procedure for reconstructing soft tissue defects following a fracture of the lower extremity that does not require microsurgical anastomosis. This can be a useful treatment option for soft tissue defects on the distal leg, ankle, and foot.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.13 no.1
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• pp.44-57
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• 2007

Purpose: The objective of this study is to analyze the activities of muscles importantly functioning when walking with different inclinations and speeds of a treadmill, in order to provide basic data on walking exercise using a treadmill. Method: The selected subjects of this study were 16 men and women who had lower extremity injury. A treadmill was used to provide the activation of muscle, and the electromyography was used to analyze the muscle activity variables. The Biodex was used to measure the value of maximum isometric contraction. The inclinations of the treadmill were 0%, 5% and 10%, respectively, and its speeds were 2Km/h. 3Km/h, 4Km/h, 5Km/h, and 6Km/h, respectively. Result: For quadriceps femoris muscle and trunk muscle, there were significant differences in muscle activity when different speeds were applied at 0%, 5% and 10% inclinations.(p<0.05) The activity of vastus medialis muscle was 9.78% at 0% inclination and 2km/h speed, whereas it was 9.32% at 0% inclination and 3km/h, which was slightly lower. The activity of erector spinae muscle was 24.93% at 0% inclination and 2km/h speed, whereas it was 24.84% at 0% inclination and 3km/h, whereas it was 23.99% at 0% inclination and 4km/h, which was slightly lower. The activity of vastus medialis muscle was 11.89% at 10% inclination and 2km/h speed, whereas it was 10.65% at 10% inclination and 3km/h, which was slightly lower. The activity of rectus femoris muscle was 10.26% at 10% inclination and 2km/h speed, whereas it was 9.77% at 10% inclination and 3km/h, which was slightly lower. Conclusion: It was found that the activities of trunk muscle and quadriceps femoris muscle increase as the inclination and the speed of a treadmill increase during treadmill walking.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.774-780
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• 2004

Although traumatic thoracic aortic rupture is potentially a fatal condition requiring surgical attention, the presence of concomitant injury involving other parts of the body may greatly increase the risk of cardio-pulmonary bypass. We report our experience of treating associated injuries prior to the thoracic aortic rupture in these patients. Material and Method: From 1997 to 2003, the medical records of 24 traumatic aortic rupture patients were retrospectively reviewed and checked for the presence of associated injury, surgical method, postoperative course, and complications. Surgical technique comprised thoracotomy with proximal anastomosis under deep hypothermic circulatory arrest followed by side arm perfusion to reestablish cerebral circulation. CSF drainage was performed to prevent lower extremity paraplegia. Result： Major concomitant injuries (n=83) were noted in all of the reviewed patients, Of these, there were 49 thoracic injuries, 18 musculoskeletal injuries, and 13 abdominal injuries, Operations for associated injuries (n=16) were performed in 12 patients on mean 7.6$\pm$12.6 days following the injury. The diagnosis of aortic rupture at the time of injury was detected in only 18 patients. Delayed surgery of the thoracic aorta was performed on average 695$\pm$1350 days after injury and there were no deaths or progression of rupture in any of these patients during the observation period. There were no operative deaths and no major postoperative complications. Conclusion: Treating concomitant major injuries prior to the aortic injury in traumatic aortic rupture may reduce surgical mortality and morbidity.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.88-93
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• 1996

Neurilemmomas are the most common benign tumor of the peripheral nerve trunks, and arises from the cells in the sheath of Schwann. Neurilemmomas are well encapsulated and may be separated easily from surrounding tissue and lie completely within a larger nerve trunk, with bundles of neurofibrils spread out over the surface of the tumor. A careful dissection and retraction of the nerve bundles will allow the tumor to be enucleated from the parent nerve without any significant interference with the function of the nerve. Resection of the involved nerve is seldom necessary and should be avoided if at all possible. Our aim in microscopic excision of neurilemmoma of extremities is to reduce any disturbance of the intact neurofibrils of the parent nerve. Thirteen cases of neurilimmomas were treated by microscopic excision at the Department of Orthopaedic Surgery, Korea University Hospital between January 1990 and March 1995. The results was as follows ; 1. The average age at surgical intervention was 40.1 years. Cases in fourth and fifth decades predominated. 2. In their anatomical distribution, 8 cases were in the upper extremity and 5 cases in the lower extremity. 11 cases were on the flexor surface. 3. On the operative field, all the tumors were well encapsulated, however 1 case of 13 was adherent to the periosteum of fibula. 4. In all cases, the tumor were enucleated from the parent nerve without any injury to nerve under high-power magnification, preserving individual fascicles, and sensory and motor function.

• Journal of Korean Physical Therapy Science
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• v.4 no.1
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• pp.229-242
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• 1997

This study was performed to figure out effects of stroke rehabilitation on education using isokinetic exercise on physical function recovery. It is considered isokinetic exercise will playa primary role in muscle strength, ROM of joint, and body balance recovery for stroke rehabilitation and so far can be used as a basic references to increase the health of all people. The study consisted of 42 stroke patient(21 training group, 21 control group) diagnosed as cerebral hemorrhage from Oriental Rehabilitation Department of Kyung Hee University. Upper extremity and lower extremity exercise was performed in the training group using isokinetic ergometer. The recovery of physical function(muscle strength, ROM of joint, body balance) data between the two groups were compared and ana lysed by paired t-test are as followed. 1. Muscle testing record showed increased in the strength of elbow flexion, knee flexion, knee extension, ankle extension of the training group com paired to control group(p < .05). In the measurement of ROM, however other parts of the body motion showed no significant changes, only shoulder extension of the training group was increased(p < .05). 2. Body balance increase was highly significant in all training group compaired to control group(p<001). Based on these findings, stroke rehabilitation education with isokinetic ergometer showed available effects on recovery of physical function rehabilitation program with isokinetic exercise will play a primary role in the recovery of physical function of stroke or brain injury patients as well as to promote the health of all people.

• Journal of Trauma and Injury
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• v.37 no.3
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• pp.182-191
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• 2024

Purpose: Vascular injuries require immediate surgical treatment with standard vascular techniques. We aimed to identify pitfalls in vascular surgery for trauma team optimization and to suggest recommendations for trauma and vascular surgeons. Methods: We reviewed 28 victims and analyzed the patterns of injuries, methods of repair, and outcomes. Results: Ten patients had torso injuries, among whom three thoracic aorta injuries were repaired with thoracic endovascular aortic repair, one left hepatic artery pseudoaneurysm with embolization, and two inferior vena cava with venorrhaphy, three iliac arteries with patch angioplasty or embolization, and three common femoral arteries with bypass surgery or arterioplasty. Four patients had upper extremity injuries, among whom one brachial artery and vein was repaired with bypass surgery after temporary intravascular shunt perfusion, two radial arteries were repaired with anastomoses, and one ulnar artery was repaired with ligation. One radial artery under tension was occluded. Fourteen patients had lower extremity injuries, among whom one superficial femoral artery and vein was repaired with bypass and concomitant ligation of the deep femoral artery and vein, three superficial femoral arteries were repaired with bypass (two concomitant femoral veins with bypass or anastomosis), one deep femoral artery with embolization, two popliteal arteries with bypass or anastomosis, four infrapopliteal transected arteries, one arteriovenous fistula with ligation, and one pseudoaneurysm with bypass. However, one superficial femoral artery and all femoral veins were occluded. One leg replantation failed. Conclusions: There are potential complications of vascular access during resuscitative endovascular balloon occlusion of the aorta procedures. Vascular repair should be performed without tension or spasm. Preservation of the harvested vein in papaverine solution and blood while using a temporary intravascular shunt is a method of eliminating spasms.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.69-74
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• 2006

Purpose: To perform the retrospective analysis of the sports injuries sustained by the college Taekwondo athletes in the respect of the injury patterns, mechanism of injury and clinical outcome Materials and Methods: This study is based on 47 out of 49 college Takwondo athletes, who had experienced the Takwondo related musculoskeletal injuries severe enough to visit the clinic for medical treatment. The mean age at the time of injury was 18.8 years and 39 were males and 8 females. The Taekwondo career was average 9.6 years and the injuries were sustained at average 6.7 years of their career. The injuries were analyzed by the detailed interview with thorough physical examination. Results: Forty-seven Taekwondo athletes in the study experienced average 1.8 injury/person (total 85 cases) with 26 persons of one time experience(55.3%), 11 persons of 2 times(23.4%),4 persons of 3 times (8.5%),5 persons of 4 times (10.6%) and 1 person of 5 times (2.2%). Injuries occurred during training in 50 cases (58.8%), while during match in 35 cases (41.2%). Injuries occurred during the attack phase of the match are 26 cases (31.7%) while 49 cases (57.6%) during the defense phase. As for the pattern of injury, fracture was the most common with 49 cases (57.6%), followed by ligament injury with 21 cases (24.7%). The upper extremity injuries were 32 cases (37.7%) while the lower extremity injuries were 44 cases (51.8%) Mode of medical treatment were operation in 15cases(17.7%), cast in 21 cases(24.7%), splint in 33 cases (38.8%), physical therapy in 15cases(17.7%) and acupuncture in 1 case(1.1%) Conclusion: Almost all the college Taekwondo athletes (96%) experienced sports injuries severe enough to receive medical treatments with the fracture being the most common injury pattern. The injuries occurred more commonly during the defense phase of the competition.

• The Journal of Korean Physical Therapy
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• v.24 no.3
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• pp.216-222
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• 2012

Purpose: Weight-bearing exercise is a type of physical exercise that is widely performed for rehabilitation after acquiring nervous-system diseases or sports-related injuries. It is one of the most commonly prescribed rehabilitation programs for strengthing of the lower extremities. Weight-bearing exercise is important for the conduct of such activity of daily living (ADLs) as walking, and up and down the stairs. The purpose of this study was to investigate the muscle activities during one-leg standing and one-leg squatting, the two most representative weight-bearing exercises. Methods: A total of 43 elderly (60~70 years old) males who could perform weight-bearing exercises were included in the study. During the one-leg standing and one-leg squatting, the electromyographic (EMG) signals were quantified as maximum voluntary isometric contraction (%MVIC) using surface EMG, and then the muscle activities of the lower extremities during the two exercises were compared. For statistical analysis, an independent sample t-test and one-way ANOVA were performed. Results: The results of the study are as follows: (1) in the one-leg standing, the activity of the gluteus medius was the greatest among the vastus medialis, vastus lateralis, bicep femoris, (2) in the one-leg squatting, the activity of the vastus medialis was the greatest; and (3) the activity was greater in the one-leg squatting than in the single-leg standing exercise. Conclusion: The one-leg standing and squatting exercises are suitable for strengthening the muscles for the prevention of and recovery from lower-extremity injury, and for functional ADL in elderly people. In addition, dynamic exercise was shown to be more effective than static exercise for strengthening the muscles.

• Journal of Environmental Health Sciences
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• v.17 no.2
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• pp.78-94
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• 1991

The purpose of this study is to research the actual conditions of industrial accident patients and to produce worker satisfaction and a rational and effective counter measure pain. Direct interviews with 179 cases (in and out patients) were carried out during a three month period from April to July 1990, at six hospitals two general hospitals Sun Lin and Sung Mo in Po Hang, and four general hospitals in Taegu Kyung Pook University Hospital, Dong San Medical Center, Young Nam Medical Center and Catholic Hospital. The results of this study are summarized as follows: 1. Among the 179 cases, 51.6 % were male and 48.4 % were female. The two largest age groups were 30~39, 31.8 % and 20~29, 27.4 %. Among the 179 cases, 51.6% were married, the largest family number was 2 to 3, 41.1% and 4 to 5, 25.6%. Educationally, graduation from high school was the largest group, 46.4% among the patients, followed by middle school and primary school. The largest group income level was from 40~69만원, 45.2%. The largest group of patients who worked over 50 hrs. a week was 52.0%. The largest group of patients who worked less than 1 year was 44.7%, of the patients in work places of less than 100 people, 60.3% were injured and in work places of 100~299 people, 20.1% were injured. In manufacturing, the lagest group injured was 55.3%, the next group was transport, stroage, communication. The largest group of production workers injured was 40.2%. 2. The cause of injury in the largest group was facility problems, 33.5%. The next group was unsafe habits, 30.2% a lack of safety knowledge, 17.9% and insufficient supervision, 12.3%. The 30~39 year age group was head the highest number of injuries, 40.4% work places with more than 10 yeras of work, 44.4% work palces with more than 1000 people, 56.3% and mining accidents, 80.0%. Among these groups the highest cause of injury was due to facility problems. 3. The accident pattern showed machinery injuries 28.5% as the largest group, followed by falls & falling objects 17.3%, fire & electric 15.1%, struke by an object 14.5%, followed by overaction and vehicular accidents. The accident pattern showed 46.4 % among workers over the 50 year age group, workers in the 5~10 year group, 50.0 % places employing more than 1000 workers, 35.3 % : construction 73.7%, and construction workers 57.1%, among these fall & falling objects caused the greatest number of injuries. 4. The largest group of injuries was fractures 54.8%, trauma 14.5%, amputation 11.7%, open wound, and burns. The largest number of fractures occurred in people in the 30~39 year age group, 63.2 % over 10 years of work, 55.6% in work places of 300~400 people, 63.6% construction 63.2% and general workers 57.2 %. 5. The largest group of injuries was upper extremity 45.3%, lower extremity 24.0%, trunk 18.5 % and head or neck 12.2%. Of these groups, upper extremity injuries were the highest in those less 20 years old 75.0%, less than 1 years of work 59.5%, in work places of 500~999 people 60.0%, manufacturing 56.6 % and production workers 55.6%. 6. Periods of injury showed 34 people injured in September, to be the largest followed by October, 32 August, 22 people July, 19 people and the lowest December, 2 people. During the week, Friday had the largest group injured, 35 people followed by Saturday, 26 people and the lowest was Wednesday, 17 people, During the day 1400 hours had the largest group injured, 38 people followed by 800 hours, 31 people. 7. On a basis of 5 as the highest mark, the average, according to worker satisfaction showed facility safety 3.55, work environment 3.47, income 3.44, job 3.21 and treatment 2.98. 8. The correlation between general characteristics and injury showed that age was directly correlated to the duration of work(r=.2591) p<0.01, age was directly correlated to industry (r=2311) p<0.01, and the duration was directly correlated to occupation(r =.4372) p<0.001.