• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.153-161
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• 2002

Purpose : Plantar surfaces, calcaneal area, and region of Achilles insertion, which are extremely related with weight-bearing area and shoes application, must be reconstructed with glabrous and strong fibrous skin. Numerous methods of reconstructing defects of these regions have been advocated, but the transfer of similar local tissue as a cutaneous flap with preservation of sensory potential would best serve the functional needs of the weight-bearing and non-weight-bearing surfaces of this region. Therefore it is recommended to use the limited skin of medial surface of foot that is similar to plantar region and non-weight-bearing area. In this paper we performed the medial plantar flap transfered as a fasciocutaneous island as one alterative for moderate-sized defects of the plantar forefoot, plantar heel, and area around the ankle in 25 cases and report the result, availability and problem of medial plantar flap. Materials and methods : We performed proximally based medial plantar flap in 22 cases and reverse flow island flap in 3 cases. Average age was $36.5(4{\sim}70)$ years and female was 3 cases. The causes of soft tissue defect were crushing injury on foot 4 cases, small bony exposure at lower leg 1 case, posterior heel defect with exposure of calcaneus 8 cases, severe sore at heel 2 cases, skin necrosis after trauma on posterior foot 4 cases, and defect on insertion area of Achilles tendon 6cases. Average follow up duration was 1.8(7 months-9.5 years) years. Results: Medial plantar flaps was successful in 22 patients. 18 patients preserved cutaneous branches of medial plantar nerve had sensation on transfered flap but diminished sensation or dysesthesia. At the follow up, we found there were no skin ulceration, recurrence of defect or skin breakdown in all 18 patients. But there was one case which occurred skin ulceration postoperatively among another 4 cases not contained medial plantar nerve. At the last follow up, all patients complained diminished sensation and paresthesia at medial plantar area distally to donor site, expecially with 4 patients having severe pain and discomfort during long-time walking. Conclusion : Medial plantar island flap based on medial plantar neurovascualr pedicle have low failure rate with strong fibrous skin and preserve sensibility of flap, so that it is useful method to reconstruct the skin and soft tissue defect of foot. But it should be emphasized that there are some complications such like pain and paresthesia by neuropraxia or injury of medial plantar nerve at more distal area than donor site. We may consider that medial plantar flap have limited flap size and small arc of rotation, and require skin graft closure of the donor defect and must chose this flap deliberately.

• The Journal of Korean Physical Therapy
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• v.22 no.5
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• pp.71-76
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• 2010

Purpose: The present study was designed to investigate the effect of a Rollator on plantar pressure and foot balance during gait in older adults. Methods: Twenty consecutive subjects (8 men, 12 women; age: $69.9{\pm}8.9$) had the following measurements done: plantar pressure in 10 areas of the foot, foot balance including heel rotation, foot balance, forefoot balance, medial forefoot balance, and meta loading during gait with or without a Rollator. Results: Significant differences in plantar pressure were observed in the areas of toes 2-5 or etatarsal areas 1, 4, 5 during gait with and without a Rollator. There were no significant differences in other areas of the foot. Regarding foot balance during gait with or without a Rollator, there were statistically significant differences in heel rotation, forefoot balance, medial forefoot balance, and meta loading. Conclusion: For older adults, the use of a Rollator can decrease plantar pressure and increase foot balance in various foot areas.

• Archives of Plastic Surgery
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• v.42 no.4
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• pp.469-474
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• 2015

Background Many methods have been proposed for the correction of sunken upper eyelids. These methods include surgical treatments, such as micro-fat, dermofat, or fascia-fat grafts, or the use of alloplastic materials. Here, we present our experience of sunken upper eyelid correction involving the simple addition of anchoring the central fat pad to the medial fat pad during upper blepharoplasty. Methods We performed 74 cases of upper blepharoplasty with sunken upper eyelid correction between October 2013 and September 2014. The lateral portion of the central fat pad was partially dissected to facilitate anchoring. The medial fat pad was gently exposed and then pulled out to facilitate anchoring. After the rotation of the dissected lateral portion of the central fat pad by $180^{\circ}$ to the medial side, it was anchored spreading to the medial fat pad. Photographs taken at 6 months postoperatively were presented to three physicians for objective assessment. Of the 74 patients, 54 patients followed at 6 months postoperatively were included in this retrospective, objective assessment. Results Sunken eyelids were effectively corrected in 51 of the 54 patients, but 3 had minimal effect because preaponeurotic fat pads had been removed during previous upper blepharoplasty. In addition to correcting sunken eyelids, lateral bulging was corrected and a better definition of the lateral portion of upper lid creases was obtained. Conclusions Anchoring the central fat pad to the medial fat pad provides an effective means of correcting sunken upper eyelids during upper blepharoplasty.

• The Korean Journal of Physiology and Pharmacology
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• v.1 no.5
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• pp.505-513
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• 1997

To search the correlations between electrical activity and c-Fos expression in the process of vestibular compensation, we examined the changes of those two parameters in the medial vestibular nuclei (MVN) of unilaterally labyrinthectomized (ULX) rats. Spontaneous nystagmus with fast component toward the intact side disappeared gradually within 48 hours. Fourty eight hours after ULX, directional preponderance of the eye movement induced by sinusoidal rotation of the whole body which represents the symmetry of bilateral vestibular functions showed less than 20% by rotation of 0.1, 0.2, and 0.5 Hz, indicating the recovery of symmetry in bilateral vestibular functions. Six hours after ULX, spontaneous electrical activity of type I neurons resulted in asymmetry between bilateral MVN, however, the asymmetry of the electrical activity was decreased 48 hours after ULX. Immunocytochemical staining revealed that ULX produced dramatic induction of c-Fos positive cells in the MVN bilaterally. The number of c-Fos immunoreactive cells in the contralateral MVN was significantly higher than those in the ipsilateral MVN (p＜0.0001) 2 hours after ULX. Thereafter, the number of c-Fos positive cells decreased bilaterally and was slightly, but not significantly higher in the ipsilateral MVN at 48 hours after ULX. The present results suggest that both electrical activity of type I neurons and c-Fos expression in MVN following ULX will reflect underlying mechanisms of recovery process of vestibular compensation.

• The Korean Journal of Physiology and Pharmacology
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• v.1 no.3
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• pp.263-273
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• 1997

The purpose of this study was to evaluate the effects of electrical stimulation on vestibular compensation following ULX in rats. Electrical stimulation (ES) with square pulse ($100{\sim}300uA$, 1.0 ms, 100 Hz) was applied to ampullary portion bilaterally for 6 and 24 hours in rats receiving ULX. After ES, animals that showed the recovery of vestibular symptoms by counting and comparing the number of spontaneous nystagmus were selected for recording resting activity of type I, II neurons in the medial vestibular nuclei (MVN) of the lesioned side. And then the dynamic neuronal activities were recorded during sinusoidal rotation at a frequency of 0.1 Hz and 0.2 Hz. The number of spontaneous nystagmus was significantly different 24 hours (p<0.01, n=10), but not 6 hours after ULX+ES. As reported by others, the great reduction of resting activity only in the type I neurons ipsilateral to lesioned side was observed 6, 24 hours after ULX compared to that of intact labyrinthine animal. However, the significant elevation (p<0.01) of type I and reduction (p<0.01) of type II neuronal activity were seen 24 hours after ULX+ES. Interestingly, gain, expressed as maximum neuronal activity(spikes/sec)/maximum rotational velocity(deg/sec), was increased in type I cells and decreased in type II cells 24 hours after ULX+ES in response to sinusoidal rotation at frequencies of both 0.1 Hz and 0.2 Hz. This result suggests that accompanying the behavioral recovery, the electrical stimulation after ULX has beneficial effects on vestibular compensation, especially static symptoms (spontaneous nystagmus), by enhancing resting activity of type I neurons and reducing that of type II neurons.

• Journal of Veterinary Clinics
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• v.35 no.5
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• pp.200-205
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• 2018

This retrospective study is designed to compare the clinical results of tibial tuberosity transposition (TTT) and anti-rotation suture (ARS) treatments for medial patellar luxation (MPL). Medical records of 133 dogs were reviewed that had undergone surgical correction of MPL between January 2013 and May 2017. MPL correction was performed on 182 stifles, with TTT and ARS being performed on 101 stifles and 81 stifles. The common dog breeds receiving surgical treatment for MPL were Maltese, Pomeranian, Chihuahua and Poodle. Mean age of dogs with MPL was 32.6 months, and their mean body weight was 4.26 kg. Seventy dogs (52.6%) were male and 63 (47.4%) were female. Of the 182 stifles with MPL, grade II, III and IV were 18.7%, 72.0% and 9.3%. Total complications after TTT and ARS were recorded in 16.8% and 29.6%. Major complications after TTT and ARS were recorded in 5.9% and 12.3%, minor complications after TTT and ARS were recorded in 10.9% and 17.3%. The risk of complication and reluxation rate after TTT were significantly lower than that for ARS (p < 0.05). However, the rate of reluxation among dogs treated by ARS (1.2%) for grade II MPL was significantly lower than that for dogs treated by ARS (8.6%) for grade III MPL (p < 0.05). The TTT group had a shorter recovery period after surgical intervention than that in the ARS group (p < 0.001). In conclusion, TTT had a significantly lower incidence of complication and a shorter recovery period than ARS. However, ARS for grade II MPL appears to be a good surgical option for reducing the rate of reluxation after surgery. These results of this study could be used to provide therapeutic guidelines for surgical MPL correction in small-breed dogs.

• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.282-287
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• 2022

Background: Muscular forces drive proximal humeral fracture deformity, yet it is unknown if arm position can help mitigate such forces. Our hypothesis was that glenohumeral abduction and humeral internal rotation decrease the pull of the supraspinatus and subscapularis muscles, minimizing varus fracture deformity. Methods: A medial wedge osteotomy was performed in eight cadaveric shoulders to simulate a two-part fracture. The specimens were tested on a custom shoulder testing system. Humeral head varus was measured following physiologic muscle loading at neutral and 20° humeral internal rotation at both 0° and 20° glenohumeral abduction. Results: There was a significant decrease in varus deformity caused by the subscapularis (p<0.05) at 20° abduction. Significantly increasing humeral internal rotation decreased varus deformity caused by the subscapularis (p<0.05) at both abduction angles and that caused by the supraspinatus (p<0.05) and infraspinatus (p<0.05) at 0° abduction only. Conclusions: Postoperative shoulder abduction and internal rotation can be protective against varus failure following proximal humeral fracture fixation as these positions decrease tension on the supraspinatus and subscapularis muscles. Use of a resting sling that places the shoulder in this position should be considered.

• Korean Journal of Applied Biomechanics
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• v.15 no.1
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• pp.207-219
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• 2005

The purpose of this study was to determine the effect of the foot rotation on the lower limb muscles. Fourteen subjects performed step-up/step-down at a cadence of 80 beats/min, exercises with the foot neutral, $35^{\circ}$ internally rotated, and $35^{\circ}$ externally rotated, respectively. For each variable, a one-way analysis of variance (ANOVA) was used to determine whether there were significant differences between genders and among the eight types of jump. When a significant difference was found in jump type, post hoc analyses were performed using the Tukey procedure. A confidence level of p < .05 was used to determine statistical significance. The results showed that significant changes in averaged IEMG values occurred with the internal rotation of the foot in the lateral gastrocnemius during the knee extension, and in the semitendinosus during the knee flexion. During the knee extension, however, the internal rotation of the foot produced a significantly lower Averaged IEMG values than the neutral foot position in the medial gastrocnemius. The results also found that the peak IEMG activity of the rectus femoris during the knee extension for the external rotation of the foot was Significantly higher than the corresponding values in the neutral position of the foot, while the intenal rotaion of the foot exhibited a significant difference with the neutral position of the foot in the semitendinosus during the knee flexion. In general, the foot rotation position did not influence the average IEMG and Peak IEMG values of most muscles. The practice of adopting foot rotation to selectively strengthen individual muscles of the lower limb was not supported by this study. The external rotation of the foot produced high muscle activities in the quadriceps during the knee extension. For the knee extension, therefore, maintaining a laterally rotated position should be need for stable and comfortable position.

• Korean Journal of Applied Biomechanics
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• v.24 no.3
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• pp.239-248
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• 2014

The purpose of this study was to quantify kinematic and kinetic characteristics of Yin-yang Bo gait according to their motor expertise, one of the Seokmun Ilwol martial art gait patterns. Yin-yang Bo gait pattern shows initial forefoot contact instead of heel contact, and increased time of stance phase time, internal-external rotation of ankle-knee-hip joints and pelvic. It aims to produce and store the more energy through continuous homeostasis of center of gravity (COG) and performance of stretch-shortening cycle. Some of these characteristics also were similar to the gait modification strategies for reducing knee adduction moment such as toe-out progression, medial thrust, internal rotation of hip joint. To identify the characteristics, four factors of expert Yin-yang Bo gait performance group were compared to that of none expert group; 1) angles of COG displacement and rotation 2) distal joint pre-rotation in internal-external rotation of ankle-knee-hip joints and pelvic, 3) invariability pelvic potential and pelvic segment total energy 4) knee abduction moment. Six healthy(three male) subjects participated in the experiment to perform Yin-yang gait pattern. Three-dimensional and force plate data were collected. Kinematic and kinetic data were compared between two groups using t-tests. Results showed that 1) the peak point of COG internal rotation angle was reduced in expert group, 2) kneeexternal and hip joint -internal and pelvic rotation angle peak frames were more near points in expert group.

• Clinics in Shoulder and Elbow
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• v.21 no.4
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• pp.192-199
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• 2018

Background: The currently available reverse shoulder arthroplasty (RSA) designs can be classified into medial glenoid/medial humerus (MGMH), lateral glenoid/medial humerus (LGMH), and medial glenoid/lateral humerus (MGLH) prosthesis designs. The purpose of this study was to radiologically analyze the effect of different RSA designs on humeral position following RSA. Methods: A total of 50 patients who underwent primary RSA were retrospectively analyzed. Among 50 patients, 33 patients (group A: MGMH) underwent RSA with Aequalis system (Wright, Inc, Bloomington, MN, USA), 6 (group B: LGMH) with Aequalis system using bony increased offset, and 11 (group C: MGLH) with Aequalis Ascend Flex system. The acromiohumeral distance, acromioepiphyseal distance (AED), lateral humeral offset (LHO), LHO from the center of rotation ($LHO^{COR}$), and deltoid length were radiologically measured to quantify the distalization and lateralization of the humerus. Results: The increment in postoperative AED was $19.92{\pm}3.93mm$ in group A, $24.52{\pm}5.25mm$ in group B, and $25.97{\pm}5.29mm$ in group C, respectively (p=0.001). The increment in postoperative LHO was $0.13{\pm}6.30mm$, $8.00{\pm}12.14mm$, and $7.42{\pm}6.88mm$, respectively (p=0.005). The increment in postoperative $LHO^{COR}$ was $20.76{\pm}6.06mm$, $22.04{\pm}5.15mm$, and $28.11{\pm}4.14mm$, respectively (p=0.002). Conclusions: The radiologic analysis of the effect of different RSA designs on humeral position following RSA showed significant differences in the increment in postoperative AED, LHO, and $LHO^{COR}$ between the 3 groups. Therefore, MGLH design seems to be more effective for humeral distalization and lateralization compared to original Grammont design.