• 대한관절경학회지
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• 제1권1호
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• pp.55-62
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• 1997

Various surgical techniques has been advocated for reconstruction of anterior cruciate ligament using the bone-patella tendon-bone graft. Recently endoscopic technique provides good clinical results, with minimal skin incision, accurate positioning of the graft to the femoral tunnel, and decreasing wear rate of the graft. But the graft-tunnel mismatch remains problematic in endoscopic technique. The purpose of this paper is to described causes of the graft-tunnel mismatch and to provide important steps to prevent or minimize the graft-runnel mismatch following anterior cruciate ligament while using the endoscopic technique. Our guideline for prevention of the graft-tunnel mismatch are as follows: (1) The tunnel should he positioned closely to isometric point as much as possible. (2) Anterior placement of the tunnel should be avoided. (3) The change of graft length should be within 2mm between flexion and extension position.

• 한국임상수의학회지
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• 제36권5호
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• pp.282-284
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• 2019

A 8-year-old, intact female, 2.1 kg, yorkshire terrier dog was referred to Animal Medical Center, Chonbuk National University due to right hindlimb lameness. Orthopedic examinations revealed pain during extension and flexion on stifle joint, positive cranial drawer sign, positive tibial compression test and patella luxation. Radiography showed the cranial displacement of right tibia with mildly increasing the synovial volume. The surgical procedure involved radial osteotomy of the proximal tibia and fixation by 1.2 T-locking plate. At two weeks after surgery, the patient was able to weight-bearing and gait gradually improved. This case report describes circular Tibial Tuberosity Advancement (cTTA) surgical technique and the successful surgical repair of cranial cruciate ligament rupture a dog.

• 한국임상수의학회지
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• 제37권3호
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• pp.163-167
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• 2020

A 13-month-old, 3.3 kg castrated male Shih-tzu presented with right hindlimb lameness. The physical examination revealed atrophy of the right thigh muscles, hyperextension of the stifle joint and external torsion of the tibia. On the radiographic examination, patella alta and genu recurvatum were observed. A biapical deformity of the tibia and external torsion of the distal tibia were detected by computed tomography (CT). A three-dimensional (3D) printed bone model was designed and constructed for the preoperative plan prior to surgery. Rectus femoris muscle transposition, femoral shortening ostectomy and open wedge osteotomy of the distal tibia were performed using hybrid external skele/t0al fixation (hybrid-ESF). A dynamic stifle flexion apparatus was used to prevent recurrence of a quadriceps contracture (QC). Intense physiotherapy was administered postoperatively. The dog began to use the affected limb one week after surgery. Functional improvement in the affected limb was observed, and full weight-bearing was possible at 3 months after surgery. Union of the osteotomy lines was observed at 3 months, and the stifle joint was fully movable at 7 months after surgery. Regarding the treatments for QC, these methods may be excellent candidates, as they do not lead to severe damage to the limb or amputation.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.595-599
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• 2010

Purpose: Trochanteric pressure sores management has been improved through the development of musculocutaneous flaps. But it has many drawbacks such as donor site morbidity and functional muscle sacrifice. With the introduction of perforator flap, it is possible to use in every location where musculocutaneous perforators are present. We have reconstructed trochanteric pressure sores using perforator-based flaps from the ascending branch of lateral circumflex femoral artery. Methods: Between May of 2006 and April of 2008, we performed six cases of perforator-based flap from the ascending branch of lateral circumflex femoral artery for the coverage of trochanteric pressure sores. For identifying perforators, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella as the vertical axis, from the pubis to the trochanteric prominence as the horizontal axis. In the lateral aspect of the intersection of these two axes, various flap were designed according to its defects. The flap was raised in the subcutaneous plane above the fascia and the pedicle was traced by doppler and identified. The pedicle was meticulously dissected not to injure the periadventitial tissues and transposed to the defect. The donor site was closed primarily. Results: The mean age of patients was 56.2 years. Four male and two female patients were studied. Five patients were paraplegic. The mean defect size was $6{\times}4\;cm$. The largest flap dimension was $14{\times}7\;cm$. Donor sites were closed primarily without any complications. All flaps survived completely without necrosis, hematoma or infection. There were no recurrence during the follow-up period. Conclusion: Trochanteric pressure sores using perforator-based flap from the ascending branch of lateral circumflex femoral artery can be performed safely and it would be a reliable option for coverage of trochanteric pressure sores with minimal donor site morbidity.

• 대한골관절종양학회지
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• 제5권1호
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• pp.29-34
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• 1999

Chondroblastoma is an uncommon neoplasm in bone, occurring at the epiphysis or apophysis of growing long bones and is known to have a recurrence rate of around 10% after surgical treatment. We reviewed 14 patients of pathologically proven chondroblastoma, who were surgically treated, from December 1987 to August 1997. The location of tumors was proximal femur in 4 cases, distal femur in 4 cases, proximal tibia in 2 cases, patella in 1 case, proximal humerus in 1 case and calcaneus in 1 case. The most common complaint was pain. In all nine cases in which MRI was performed, the MR imaging showed a lobulated low signal intensity(SI) rim. Low SI foci within the tumor were present in 4 of 9 cases and corresponded to calcification seen on radiographs or CT. Bone marrow edema was also present in 4 of 9 cases on MR imaging. The average duration of follow-up was 2 years, 5 months, ranging from 1 year to 7 years, 2 months. Twelve patients were treated by curettage and autogenous bone graft, one by curettage only, and one by curettage and bone cementing. Two cases which showed local recurrence were treated with curettage and bone graft. Two recurred cases had the presence of bone marrow edema on MR imaging. The presence or absence of bone marrow edema may be a useful indication of tumor activity, although further study will be required.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.51-56
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• 2011

During below knee amputation, the amputation stump must be covered with well-vascularized and sensate soft tissue. Many flaps can be used for this purpose, but available reconstructive options are limited. We performed reverse flow ALT flap elevation on two patients with below knee amputations to reconstruct defects in the stumps. The sizes of the defects in the stumps were $4{\times}16$ cm and $5{\times}5$ cm, respectively. The most distal portion of the defects were located 20 cm and 16 cm lateral to the knee joint in a curve, respectively. The size of the elevated flap was $5{\times}18$ cm for case 1 and $18{\times}10$ cm for case 2. The respective pivot points of the pedicles were 7 cm and 6 cm above the patella and the respective lengths of the pedicles were 17 cm and 16 cm. In both cases, venous congestion occurred on the second postoperative day and the flap distal to 10 cm or more from below the knee joint was necrotized at the second postoperative week. Surgeons should be cautious when using a reverse ALT flap to reconstruct a soft tissue defect located 10 cm or more distal from below the knee joint. Since a pedicle longer than 15 cm may develop partial necrosis of the flap, simultaneous application of antegrade venous drainage is recommended.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권1호
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• pp.9-14
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• 2001

With the object of providing a temporary artificial periodonal ligament-like membrane around the dental implant, 10 Branemark type implants were coated with commercially available chitosan(Fluka Co., Buchs, Switzerland) which has a molecular weight of 70,000 and 80% deacetylation degree. Once this bioactive hydrophillic polymer(chitosan) contacts with blood or wound fluids, it becomes swollen and penetrates into the adjacent cancellous bone. Thus the interface between implant and surrounding bone is completely filled with chitosan. This tight junction in early healing phase enhances primary stability. The chitosan coated dental implants were implanted into the fresh patella bones from porcine knees, since the thickness of cortical bone is relatively even and their cancellous structure is homogenous. To test the shock absorbing effect, 1mm delta-rogette strain gage was installed behind the implant. The results showed 1. The principal strain peak value directed to the impact of coated implant was 0.064 0.018(p<0.05) and that of uncoated implant was 0.095(0.032 p<0.05). 2. The peak time delay of coated implant was 0.056sec(0.011 p<0.05) and that of uncoated implant was 0.024sec(0.009 p<0.05). It can be reasoned from this results that the chitosan coating has a shock absorbing effect comparable with a temporary artificial periodontal ligament.

• Archives of Plastic Surgery
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• 제35권1호
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• pp.20-27
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• 2008

Purpose: The anterolateral thigh flap has many advantages over other conventional free flaps. But the anterolateral thigh flap has yet to enter widespread use because perforating arteries exhibit a wide range of anatomic variations and are difficult to dissect when small. The aim of this study is to identify the vascular variability of perforating arteries and pedicle in the anterolateral thigh free flap. Methods: We studied 12 cadavers and dissected 23 thighs. An anterolateral thigh flap ($12{\times}12cm$) was designed and centered at the midpoint of the line drawn from anterior superior iliac spine to the superolateral border of the patella. After we identifed the perforating arteries we dissected up to their origin from lateral circumflex femoral artery along descending branch of lateral circumflex femoral artery. We then investigated the number and the position of perforating arteries, length and diameter of vascular pedicle and pattern of lateral circumflex femoral arterial system. Results: On average $2.3{\pm}1.1$ perforating arteries per thigh were identified. The musculocutaneous perforators were 63.1%. In those perforators five perforators were arose from transverse branch of lateral circumflex femoral artery and two were arose from rectus femoral artery. Most of the perforators were near the intermuscular septum between rectus femoris muscle and vastus lateralis muscle. The length and diameter of pedicle were $11.9{\pm}3.5cm$ and $3.1{\pm}0.8mm$ on average. Conclusion: This study will be helpful for the success in anterolateral thigh free flap.

• 대한정형외과스포츠의학회지
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• 제3권1호
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• pp.56-59
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• 2004

슬괵건은 최근 여러 가지 재건술에 흔히 사용되는 자가 건으로 자가 슬개 건-골에 비해 건 채취 부위의 낮은 이환율과 쉬운 술기 등의 이점으로 그 사용이 늘어나고 있다. 그러나, 건의 부정확한 분리에 의해 두렁신경의 슬개 하분지 손상, 조기 건 절단, 건 균열 등의 합병증이 알려지고 있어 본 교실에서는 이러한 합병증을 줄이고자 변형된 방식의 슬괵건 채취 방법을 사용하였다. 슬괵건의 거위발 건을 뒤집는 술식으로 신경 손상과 건 균열 등의 합병증이 발생하지 않았다. 변형된 자가 슬괵건 채취 방식은 고식적 방식에 비해 각각의 건의 확인과 분리가 용이하고 봉공근의 보존이 가능하며 신경 손상을 방지할 수 있어 유용한 방법으로 사료된다.

• 한국임상수의학회지
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• 제20권2호
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• pp.229-232
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• 2003

Ultrasonographic examination of the stifle joint four clinically and radiographically normal adult dogs was performed before and after inducing the cranial cruciate ligament (CrCL) rupture of the bilateral stifle surgically. At Pre- or post-surgery, the hyperechoic patella ligament and the echogenic infrapatella fat interfered the visualization of the CrCL by the plain scanning method. However when the stifle joint was imaged by the scanning method injecting normal saline within the joint capsule, the hyperechogenic ligament was visualized by the separation of the infrapatella fat and the CrCL and the contrast effect of anechoic saline. When the stifle joint was imaged by the real time scanning method after the induction of the surgical rupture, fluttering of the ligament and anechoic area between the bone and the CrCL was identified due to the lack of tonicity and continuity of the ligament. Enlargement of the ligament because of its increased diameter as well as fluttering of the CrCL and the increased joint space's thickness was visualized. Consequently, confirming fluttering of the CrCL, increased ligament diameter and anechoic region between the CrCL and the bone, ultrasonographic examination is a valuable diagnostic tool as well as cranial drawer test and radiographic examination.