• The Korean Journal of Pain
• /
• 제28권3호
• /
• pp.198-202
• /
• 2015

Background: Lack of proper control of acute postoperative pain often leads to lingering or chronic pain. Several studies have emphasized the role of beta-blockers in reducing postoperative pain. Esmolol is a selective short-acting beta-blocker that produces few side effects. The purpose of this study was to examine the effect of intravenous intraoperative esmolol on postoperative pain reduction following orthopedic leg fracture surgery. Methods: In a clinical trial, 82 patients between 20-65 years of age with tibia fractures and American Society of Anesthesiologists (ASA) physical status I & II who underwent surgery were divided into two groups. Group A received esmolol and group B received normal saline. Postoperative pain was measured at three time points: entering the recovery unit, and at 3 h and 6 h following surgery, using the Visual Analogue Scale (VAS). A P value of < 0.05 was considered significant. Results: Mean VAS scores at all three time points were significantly different between the two test groups (P = 0.02, P = 0.0001, and P = 0.0001, respectively). The consumption of pethidine was lower in group A than in group B (P = 0.004) and the duration of its effect was significantly longer in time (P = 0.026). Conclusions: Intravenous intraoperative esmolol is effective in the reduction of postoperative pain following leg fracture surgery. It reduced opioid consumption following surgery and delayed patient requests for analgesics.

• Archives of Plastic Surgery
• /
• 제47권4호
• /
• pp.365-370
• /
• 2020

The ability to directly harvest thin and superthin perforator flaps without jeopardizing their vascularity depends on knowledge of the microsurgical vascular anatomy of each perforator within the subcutaneous tissue up to the dermis. In this paper, we report our experience with ultrahigh-frequency ultrasound (UHF-US) in the preoperative planning of thin and superthin flaps. Between May 2017 and September 2018, perforators of seven patients were preoperatively evaluated by both ultrasound (using an 18-MHz linear probe) and UHF-US (using 48- and 70-MHz linear probes). Thin flaps (two cases) and superthin flaps (five cases) were elevated for the reconstruction of head and neck oncologic defects and lower limb traumatic defects. The mean flap size was 6.5×15 cm (range, 5×8 to 7.5×23 cm). No complications occurred, and all flaps survived completely. In all cases, we found 100% agreement between the preoperative UHF-US results and the intraoperative findings. The final reconstructive outcomes were considered satisfactory by both the surgeon and the patients. In conclusion, UHF-US was found to be very useful in the preoperative planning of thin and superthin free flaps, as it allows precise anticipation of very superficial microvascular anatomy. UHF-US may represent the next frontier in thin, superthin, and pure skin perforator flap design.

• 한국운동역학회지
• /
• 제22권1호
• /
• pp.105-111
• /
• 2012

The purpose of this study was to investigate the effect that difference in forefoot of shoe flexibility during the quick lunge from a jump smashing on the lower limbs and the plantar pressure distribution. For this 10 elite badminton players with over 10 years experience and right handed participated. Two kinds of badminton shoes were selected and tested mechanical testing for the forefoot flexibility. Motion analysis, ground reaction forces and plantar pressure distribution were recorded. It was required to conduct lunge movement after jumping smashing as possible as high. Photo sensor was located in 3 meter away from standing position and its height was 40 cm. Subjects were conducted to return original position after touching the sensor as under clear movement as possible as fast. Forefoot stiffness had an effect on shoe peak bending degree and peak bending angular velocity in propulsion phase. Forefoot flexibility had an effect on ankle plantar flexion and knee flexion moment. It appears that joint power on lower limb and peak plantar pressure were not influenced by the flexibility of shoes.

• 한국운동역학회지
• /
• 제19권3호
• /
• pp.539-547
• /
• 2009

본 연구의 목적은 낙상 예방을 위한 12주간의 수중 운동 수행 후 장애물 보행의 특성을 운동학 및 운동역학적으로 분석하는 것이다. 여성 노인 8명이 참여하였으며, 대상자들은 수중 운동 전 후에 네 높이의 장애물(0, 2.5, 5.1, & 15.2cm)을 자기선호 속도로 넘었다. 수중 운동 수행 후 고관절의 최대각, 최소각, ROM(Range Of Motion)이 유의하게 증가하였으며, Swing 과 Stance 국면에서 소요시간은 줄어들었다. 수중 운동 후 모든 높이에서 보폭은 유의하게 증가하였고, 보간은 줄어들었다. 수중 운동 후 장애물을 넘는 순간 장애물과 오른발 사이의 수직 최단거리는 증가하였고(15.2cm 장애물 제외), 장애물을 넘는 속도는 증가하였다. 수중 운동 수행 후 제동력, 추진력, 제동 운동량, 추진 운동량은 통계적으로 유의하게 변화하였다. 12주간의 수중 운동은 여성 노인의 근력과 평형성을 향상시켰으며 이는 낙상과 관련된 장애물 보행의 운동학 및 운동역학적 변인의 변화를 가져와 여성 노인들이 장애물을 안전하고 신속하게 넘을 수 있었다. 따라서 노인에게 보행 능력 향상과 낙상 예방 운동으로 수중 운동이 추천된다.

• 한국운동역학회지
• /
• 제26권3호
• /
• pp.303-308
• /
• 2016

Objective: This study evaluated the vertical and horizontal forces in the frontal plane acting on a pedal due to the vertical alignment of the lower limbs. Method: Seven male subjects (age: $25.3{\pm} 0.8years$, height: $175.4{\pm}4.7cm$, weight: $74.7{\pm}14.2kg$, foot size: $262.9{\pm}7.6mm$) participated in two 2-minute cycle pedaling tests, with the same load and cadence (60 revolutions per minute) across all subjects. The subject's saddle height was determined by the height when the knee was at $25^{\circ}$ flexion when the pedal crank was at the 6 o'clock position (knee angle method). The horizontal force acting on the pedal, vertical force acting on the pedal in the frontal plane, ratio of the two forces, and knee range of motion in the frontal plane were calculated for four pedaling phases (phase 1: $330{\sim}30^{\circ}$, phase 2: $30{\sim}150^{\circ}$, phase 3: $150{\sim}210^{\circ}$, phase 4: $210{\sim}330^{\circ}$) and the complete pedaling cycle. Results: The range of motion of the knee in the frontal plane was decreased, and the ratio of vertical force to horizontal force and overall pedal force in the complete cycle were increased after vertical alignment. Conclusion: The ratio of vertical force to horizontal force in the frontal plane may be used as an injury prevention index of the lower limb.

• Archives of Plastic Surgery
• /
• 제41권5호
• /
• pp.562-570
• /
• 2014

Background Knee disarticulations (KD) are most commonly employed following trauma or tumor resection but represent less than 2% of all lower extremity amputations performed in the United States annually. KDs provide enhanced proprioception, a long lever arm, preservation of adductor muscle insertion, decreased metabolic cost of ambulation, and an end weight-bearing stump. The role for KDs in the setting of arterial insufficiency or overwhelming infection is less clear. The purpose of this study is to describe technique modifications and report surgical outcomes following KDs at a high-volume Limb Salvage Center. Methods A retrospective study of medical records for all patients who underwent a through-knee amputation performed by the senior author (C.E.A.) between 2004 and 2012 was completed. Medical records were reviewed to collect demographic, operative, and postoperative information for each of the patients identified. Results Between 2004 and 2012, 46 through-knee amputations for 41 patients were performed. The mean patient age was 68 and indications for surgery included infection (56%), arterial thrombosis (35%), and trauma (9%). Postoperative complications included superficial cellulitis (13%), soft tissue infection (4%), and flap ischemia (4%) necessitating one case of surgical debridement (4%) and four transfemoral amputations (9%). 9 (22%) patients went on to ambulate. Postoperative ambulation was greatest in the traumatic cohort and for patients less than 50 years of age, P<0.05. Alternatively, diabetes mellitus and infection reduced the likelihood of postoperative ambulation, P<0.01. Conclusions Knee disarticulations are a safe and effective alternative to other lower extremity amputations when clinically feasible. For patient unlikely to ambulate, a through-knee amputation maximizes ease of transfers, promotes mobility by providing a counterbalance, and eliminates the potential for knee flexion contracture with subsequent skin breakdown.

• Archives of Reconstructive Microsurgery
• /
• 제22권1호
• /
• pp.33-37
• /
• 2013

Purpose: The concept and development of perforator free flaps have led to significant advances in microsurgery. Ongoing developments in perforator free flap surgery are aimed at reducing complications and improving surgical outcomes. The aim of this study was to evaluate the effectiveness and application of supermicrosurgery in free flap surgery. Materials and Methods: A total of 267 patients with soft tissue defects of the lower extremity due to various etiologies from January, 2007 to January, 2013. The patients received either an anterolateral thigh free flap (n=83), a superficial circumflex iliac artery free flap (n=152), an upper medial thigh free flap (n=19), or a superior gluteal artery perforator free flap (n=13). Microanastomosis was performed using a perforator-to-perforator technique, either end-to-end or end-to-side. Results: The mean postoperative follow up period was eight months (range: one to 16 months) and flap loss occurred in 11 cases out of 267. All cases of flap loss occurred within two weeks of surgery due to either arterial insufficiency (n=5) or venous congestion (n=6). Conclusion: Supermicrosurgery enables the selection of the most efficient perforator for microanastomosis at the defect site. It also reduces the time required for dissection of recipient vessels, and reduces the possibility of injury to major vessels. Microsurgery using a vessel of less than 1 mm has been reported to increase the risk of flap failure; however, using the most advanced surgical tools and developing experience in the technique can produce success rates similar to those found in the literature.

• 한국전문물리치료학회지
• /
• 제24권1호
• /
• pp.61-70
• /
• 2017

Background: Scapular winging is a prominence of the entire scapular medial border, mainly caused by insufficient activity of the serratus anterior (SA) and imbalance of scapulothoracic muscles. Push-up plus (PUP) exercise has been commonly used to increase SA muscle activity. The facilitation of abdominal muscle may affect scapular muscle activity by myofascial connections. Thus, the sequential activation of the turnk muscles is suggested to facilitate the transition of proper force from upper limb and restore force couple of scapular muscles. The abdominal drawing-in maneuver (ADIM) has been effective in improving activation of the deep trunk muscles during movement. Objects: The aim of this study was to determine the effect of ADIM on the activity of the upper trapezius (UT), lower trapezius (LT), and SA during PUP exercises in subjects with scapular winging. Methods: Fourteen men with scapular winging (determined as a of distance between the scapular medial border and thoracic wall over 3 cm) volunteered for our study. The subjects performed the PUP exercise with and without ADIM. Surface electromyography was used to collect the electromyography data of the UT, LT, and SA. A scapulometer was used to measure the amount of scapular winging. Results: SA activity was significantly greater and scapular winging significantly lower during the PUP exercise with ADIM than during those without ADIM. Conclusion: PUP exercise with ADIM can be used as an beneficial method to improve SA activation and to reduce the amount of scapular winging in subjects with scapular winging.

• 대한족부족관절학회지
• /
• 제16권4호
• /
• pp.257-264
• /
• 2012

Purpose: The diabetic foot lesions are intractable, and aggravation often leads to amputation. None or minor amputation group was treated debridement or toe amputation and major amputation group was treated Ray, Lisfranc, Chopart, Below Knee and Above Knee amputation. We investigate the risk factors for major limb amputations among patients with diabetic foot lesion. Materials and Methods: The subjects were 73 diabetic foot lesion patients (83 diabetic foot lesions) treated at our department from January 2006 to December 2010. Non or Minor amputation group of 44 cases were treated with debridement or toe amputation. Major amputation group of 39 cases were treated with Ray, Lisfranc, Chopart, below or above Knee amputation. We investigated socioeconomic factors, diabetes mellitus related factors and wound related factors and laboratory factors. Statistical analysis was done by Students t-test, Chi-square test, Mann-Whitney's U test. Results: In our analysis, wound size, wound classification (Wagner classification, Brodsky classification), white blood cell counts, polymorphoneuclear neutrophil percentage, hemoglobin, C-reactive protein and albumin were risk factors for major amputation (p<0.05). Conclusion: Low education level, nutritional condition, premorbid activity level and progressed wound condition were observed in major amputation group compared with non or minor amputation group. In the major amputation group, higher white blood cell count, C-reactive protein level and lower albumin level were observed. Together with maintenance of adequate nutritional condition, early detection of lesions and foot care for early treatment is important. Therefore, active investigation with full risk evaluation of vascular complication is also important.

• 동의생리병리학회지
• /
• 제21권6호
• /
• pp.1663-1669
• /
• 2007

Acute transverse myelitis(ATM) is defined as an acute intramedullary dysfunction of the spinal cord, ascendng or static involving both halves of the cord and appearing without any history of previous neurological diseases due to traumatic accident, tumor of all kind, encephalitis and of course excluding all possible viral, bacterial and fungal infection. It is mainly characterized by acute motor disorder of both limbs in respect to which spinal segments are affected as well as sensory disorder and dysuria & dyschezia. The exact cause is unknown, however it is recently suggested that immunological factors are highly involved. It has been reported by several reliable sources that it is often accompanied by immunological diseases such as systemic lupus erythematosus(SLE). As treatments non steroid anti-inflammatory drugs(NSAIDS) are primarily recommended as to steroids, limited doses are injected only with the proper prescription from the physician. Operative methods are not options as traumatic accidents and tumors are excluded as factors. To enhance muscle strength and prevent articular contracture physical therapy and passive exercise is imperative. The following patient whose chief complaints were mainly about hypoesthesia of Rt. lower limb and stiffness of phalanges of both fingers as well as to weakness of lower extermity. Therefore it has been diagnosed as arthalgia syndrome. In oriental medicine factors such as wind evil heat-evil, dampness-heat evil, cold evil cause the arthalgia syndrome. In this case the patient was diagnosed as dampness-heat evil and herbal medicine Chunglijagam-Tang and Dong-Qi acupuncture was applied to treat bladder disorder.