• The Journal of the Korean bone and joint tumor society
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• v.13 no.2
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• pp.96-104
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• 2007

Purpose: The authors investigated whether 35 flexible nail-rotating hinge composite reconstructions around knee joint minimize junctional osteolysis of host bone. Material and Method: The reconstructive technique was as follows: 1) en bloc tumor resection, 2) filling of the host bone marrow cavity with multiple Ender nails, 3) assembling the Ender nails and an Endo-Link type total knee component with wire and bone cement. Result: Mean follow-up was 53 months (ranged 30~79). At final follow-up, 29 patients retained a mobile joint. Resection of more than 40% of bone showed a positive relationship with junctional hypertrophy (p=0.028). Eight patients showed nail breakage and eight prostheses were removed due to early or late infection. The cumulative prosthetic survival rate was 33% at 6 year. Average functional score according to the MSTS criteria was 26.8. Conclusion: Mid-term evaluations showed that results were fair. The revision process was straightforward. Junctional hypertrophy observed appears to give some clues as to how to minimize osteolysis at the prosthesis-host junction after modular prosthesis fixation.

• Archives of Reconstructive Microsurgery
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• v.21 no.2
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• pp.143-148
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• 2012

Purpose: This report presents the authors' experience of twelve patients with sural artery flap for soft tissue defects around the knee joint. Materials and Methods: The patients' age ranged from 25 to 80 years; seven of the patients were male and five were female. The cause of soft-tissue defects involved wide excision for malignant soft tissue tumor, tumor prosthesis related infection, infection after total knee arthroplasty and chronic osteomyelitis. Postoperative range of motion was checked. The sensibility of flap was evaluated by Semmes-Weinstein monofilaments and two-point discrimination. Results: All flaps survived and provided satisfactory coverage of the defect. There was no complication except one delayed skin graft incorporation at donor site. Seven knee joints which had been stiff previously gained average 58 degrees of ROM postoperatively. All flaps retained sensibility and showed no significant increase in sensory thresholds comparing with contralateral side. Conclusion: Sural artery flap not only shows high survival rate and broad coverage ability, but also offers improvement in range of motion and preservation of sensation. We speculate that sural artery flap is valuable for the reconstruction of the soft tissue defects around knee joint.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.45-50
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• 2007

Purpose: To evaluate the short-term clinical outcomes of total ankle arthroplasty for the post-traumatic osteoarthritis. Materials and Methods: Fourteen patients who had undergone total ankle arthroplasty from February 2005 to June 2006 were reviewed. Eleven patients were male and three patients were female. The mean age was 52.8 years (range, 33 to 69 years). The mean follow-up duration was 15.9 months (range, 12 to 24 months). Primary injuries were pilon fractures in eight cases, malleolar fractures in three, ankle syndesmotic injury in one, talus fracture and dislocation in one, and distal tibial physeal injury in one. Visual analogue scale (VAS), Range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and complications were evaluated. Results: The mean VAS improved from 8.6 preoperatively to 2.6 at last follow-up. The mean ROM improved from 24.6 degrees preoperatively to 33.1 degrees postoperatively. The mean AOFAS score improved from 44.5 points preoperatively to 75.1 points postoperatively. Radiographically, all components were stable, but there were component malpositions in two cases, including one varus malposition of tibial component and one increased anterior translation of talar component. Complications were deep infection in one case, intraoperative malleolar fracture in three, marginal wound necrosis in two, and heterotopic ossification in one. One prosthesis was revised because of deep infection. Conclusion: Total ankle arthroplasty for the post-traumatic osteoarthritis is believed to be an useful method for preservation of the motion, relief of the pain and high satisfaction of patients in short-term results.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.124-135
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• 2017

Background In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. Methods A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. Results A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. Conclusions Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.146-152
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• 2011

Purpose: To describe the recent clinical results and complications of total elbow arthroplasty based on the literature review. Materials and Methods: The indications of total elbow arthroplasty include rheumatoid or inflammatory arthritis, posttraumatic arthritis, anklylosed elbow, tumor resection which cannot recover elbow function by other reconstructive procedures, and comminuted distal humerus fracture in elderly patients. Complications are aspetic loosening, infection, prosthesis fracture, periprosthetic fracture, ulnar neuropathy, ectopic ossification, triceps insufficiency, dislocation, and bushing wear. Results and Conclusion: Mean 10 year survival rate following total elbow arthroplasty has been reported 85% on the basis of revision. The prognosis in patients with an inflammatory arthritis is reported to be best, and loosening rate in patients with a posttraumatic arthritis tends to be high. Complication rate is known to be higher than that of other joint arthroplasty. In particular, deep infection occurs in 3~5% of the patients. Total elbow arthroplasty provide satisfactory results when it is performed properly in selected patients who have an elbow joint with irreversible dysfunction and low level activities.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.815-818
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• 1997

Prosthetic valve endocarditis(PVE), although uncommon, is associated with significant mortality if the infection spreads into the paravavular structures with later abscess formation. However, combined antibiotic and surgical treatment is often successful. Accurate diagnosis by on echocardiography, effective myocardial protection during operation and increased surgical experience have improved the short-term and long-term outcomes for patients with PVE. A 35-year-old male had a history of replacement of aortic and mitral valve, and tricuspid annuloplasty on August 1994, was admitted due to sudden onset of aphasia, leftward deviation of both eyeballs and spiking fever and diagnosed of having PVE by echocardiography. Reoperation was done after 6weeks of antibiotic treatment. On the operative field, we could notice circumferential vegetation along aortic valve annulus, paravalvular leakage and abscess pocket. The mitral valve amlulus was healthy. The patient underwent redo aortic valve replacement using cryopreserved aortic homograft after radical debridement of infected issue. During the follow up of 7 months period the homograft was well functioning without recurrence of symptoms.

• Journal of Periodontal and Implant Science
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• v.43 no.5
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• pp.243-247
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• 2013

Purpose: The aim of this work is to evaluate a surgical technique for mobilization of mal posed dental implant in anterior area. Methods: A 38-year-old patient consulted our unit for esthetic dissatisfaction with the implant treatment of a central incisor. An implant was observed in 11 and 21, where 11 was 3 mm above the ideal limit, with excessive vestibular angulation. The choice was made to perform a segmental osteotomy and mobilize the bone block and the implant down and forward; a bone block extracted from the mandibular ramus was installed between the implant block and the bed to stabilize the segment. Results: After 4 months, a conventional fixed prosthesis was created and the esthetic result achieved was close to what the patient wanted, with no need for further surgery. The surgical condition was stabilized and maintained for the long-time and no complications how necrosis, infection or bone defects was present. Conclusions: It was concluded that the procedure is efficient, and the biological arguments in favor of the procedure are discussed.

• Journal of Trauma and Injury
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• v.18 no.1
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• pp.70-79
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• 2005

Background: Abdominal compartment syndrome has multiple etiologies that are not only related to trauma but also any problem condition in the absence of abdominal injury. To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma victims justifies the use of temporary abdominal coverage with monofilament knitted polypropylene mesh (Malex mesh) in severely injured patients. Method: Medical records at the Ajou University Medical Center were reviewed for a 32-month period from May 1st, 2002 to December 31st, 2004. Twenty-nine consecutive patients requiring celiotomy who were survived until at the end of celiotomy received temporary abdominal coverage and staged abdominal repairs with Malex mesh. One of them was dissecting aortic aneurysm patient and the others were all trauma victims. Malex mesh prosthesis coverage was used in cases of abdominal compartment syndrome due to excessive fascial tension, severe bowel edema and retroperitoneal hemorrhage or edema followed by staged abdominal repairs. Result: Eighteen of twenty-nine patients were survived. Demographic characteristics, injury severity number of abdominal-pelvic bone injuries, mortality rate, complications, number of operations for permanent closure, required time for permanent closure showed no difference between man and women or child and adult. Except one dissecting aortic aneurysm patient, trauma cases showed $3.24{\pm}0.98$ injury sites. All cases that received temporary abdominal coverage and staged abdominal repairs did not show abdominal compartment syndrome. $10.08{\pm}5.85$ days and $2.27{\pm}0.82$ times of operation required making permanent abdominal closure after temporary abdominal coverage followed by staged abdominal repairs. Most of surviving patients have shown antibiotic-resistant organism and fungus infection. Patients who received permanent closure recovered from infectious problem completely. Conclusion: The use of Malex mesh for temporary abdominal coverage in severely injured patients undergoing celiotomy was effective treatment method.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.296-306
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• 1992

A 6 year experience with the bileaflet St. Jude Medical valve is reported. Between Feb. 1986 and Dec. 1992, 68 patients received 87 such valves[36 mitral, 13 aortic, and 19 double mitral-aortic valve replacements]. The results are summarized as follows 1. There were 35 male and 33 female patients ranging in age from 17 to 55 years the mean age of 35.3 $\pm$ 9.7 years. 2. The mean aortic clamp time[ACT] of the MVR, AVR and DVR groups were 91.5$\pm$16.4, 117.2$\pm$28.7 and 165.5$\pm$24.1 minutes. The mean total bypass time [TBT] of the MVR, AVR and DVR groups were 112.8$\pm$19.5, 134.7$\pm$31.4 and 192.2$\pm$28.5 minutes. 3. Eighty seven valves were used [55 mitral site, 32 aortic site]. 31mm[20], 33mm[15], 29mm[15], 27mm[2], 25mm[2] and 35mm[1] were used in mitral site and 23mm[13], 21mm[8], 19mm[7] and 25mm[4] were used in the aortic site. In the DVR, there were valve combinations such as 4 cases of M[29mm]-A[19mm], 4 of M[31mm]-A[23mm], 3 of M[33mm]-A[23mm] and others. 4. Preoperative NYHA functional classes were II [3 cases], III [46 cases], IV[19 cases] and improved to I [52 cases] and Il [13 cases] postoperatively. 5 Early postoperative complications were occurred in 15 cases[2Z.l%] and there were LOS in 5 cases[7.4%], arrythmia [3 cases], wound infection [2 cases], hepatitis [2 cases], sudden cardiac arrest [2 cases] and postoperative bleeding [1 case]. The early hospital death was occurred in 3 cases[4.4%] with LOS [1 case] and sudden cardiac arrest [2 cases]. 6. Mean follow-up time of survival cases[65 cases] was 31.3$\pm$21.9 months and the total follow-up time was 169.8 patient-years. Late postoperative complications were occurred in 4 cases[2 thromboembolism, 1 paravalvular leak, 1 thromboembolism br paravalvular leak, 1 valve endocarditis] with the occurrence rate as 2.35% per patient-years. Reoperation was performed in 2 cases [1 paravalvular leak, 1 left atrial thrombus] and there was one [1.5%] late valve related death. Therefore the 6 year complication free rate was 90.6% and 6 year actuarial survival rate was 98.3$\pm$1.7%. On the basis of this experience and the results, SJMvalve appears to be one of the best performing mechanical prosthesis currently available, in terms of both hemodynamics and lower complications with warfarin antioagulation.

• Journal of Yeungnam Medical Science
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• v.20 no.1
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• pp.45-52
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• 2003

Background: Immediate implant placement has become an acceptable treatment for the edentulous area. The advantages of the immediate implant placement include considerable decrease in time from tooth extraction to placement of the finial prosthesis, fewer surgical procedures, and better acceptance of the overall treatment plans. But the success is dependent on the quantity and quality of the extraction socket. The purpose of this study is to evaluate the success of the immediate implant placement. Materials and Methods: Twenty-one sites in 16 patients were selected for the evaluation of the immediate implant placement. All of the cases were followed using clinical and radiographic examinations. Criteria of success were the absence of peri-implant radiolucency, mobility, and persistent pain or sign of infection. Results: Of the 21 implants, 13 implants have been succeeded. Of the 13 implants, 10 implants were replaced for the periodontal disease and 3 implants were replaced for the trauma. Conclusion: The criteria of the success in immediate implant placement are as follows. 1) Implants placed into fresh extraction sockets have a high rate of survival. 2) Implant should be placed as close as possible to the alveolar crest. 3) Implant placed into available bone beyond the apex have a high success rate.