• Archives of Plastic Surgery
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• v.34 no.6
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• pp.796-798
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• 2007

Purpose: Giant cell tumor is the second most common benign neoplasm in upper extremity. Unlike usual chief complaint of painless mass, an atypical case with giant cell tumor presented a distinguishing characteristics of which accompany pain and tenderness and is histologically giant-cell free. Methods: A 31-year-old male patient complained of a rapid growing painful mass on the proximal phalanx of the left ring finger. Under microscopic operation, a $1.6{\times}1.3cm$ sized mass was found to be surrounded by areolar tissue and attached to a tendon sheath, encircling the digital nerve and artery. Diagnostic confirmation was assisted by positive finding in histologic immunohistochemical stain-CD68. Characteristic pathologic finding is an atypical distribution of spindle cells & histiocytes without giant cells in fascicular pattern. Results: Giant cell tumor was carefully removed under microscopic approach, while preserving digital nerve & artery. In postoperative 13th month, the patient presented with a 6mm of static two-point discrimination test, similar to that of the adjacent fingers. Conclusion: We report an atypical case with painful mass on tendon sheath, surrounding the digital nerve and artery that was diagnosed of giant cell tumor, but without giant cells on pathology. This case provides broader understanding of the giant cell tumor that should not only rely its typical findings of the painless mass and positive sign on H&E stain.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.250-255
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• 2010

Purpose: Pincer nail is a relatively rare deformity characterized by an increase in transverse curvature along the longitudinal axis of the nail. This curvature commonly increases from proximal to distal end of nail, leading to pinching, curling, and distortion of the underlying soft tissue and resulting frequently in severe pain. Numerous surgical procedures have been reported. Preserving the width of the nail in the correction of the pincer nail is very important for functional and aesthetic reasons. We report the results of the correction of the pincer nail using autogenous dermofat graft with a good result. Methods: From May 2006 to September 2008, dermofat graft was performed in 6 patients with pincer nail. Patients were four women and two men, and the average age was 51. The affected digits were the unilateral great toes in four patients and the unilateral thumbs in two patients. Average follow-up period was 13 months. Surgical procedure was removal of nail using an elevator to avoid damage to the nail bed. An incision was created in distal portion of hyponychium. Paronychium was dissected from distal phalanx by periosteal elevator through incision of hyponychium and tunnel was made. Then dermofat grafts harvested from inguinal area were inserted into the tunnel. Finally, a silicone sheet was inserted eponychial fold for prevention of synechia. Objective assessment was evaluated by use of the width index and height index. Results: All patients reported resolution of the pain and soft tissue pinching sensation that they had before the operation. There was good adherence between the nail plate and the underlying nail bed. The nails have regrown and were corrected in a normal and flattened appearance. The width index and height index were improved. Conclusion: The autogenous dermofat graft seems to provide an effective treatment of the pincer nail with preservation of the nail matrix.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.14-19
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• 2008

Purpose: We tried to understand the effects of the derotational closing wedge Akin osteotomy during the operation for the hallux valgus with pronation of great toe. Materials and Methods: Eighty five patients who had undergone Akin osteotomy among the eighty seven patients who had been treated with Scarf osteotomy with hallux valgus were included in this study. Derotational supination was added on the medial closing wedge Akin osteotomy at the base of proximal phalanx and it was secured with K-wire, headless screw or staple. We measured and analyzed pre- and post-operative hallux primus valgus angle and hallux pronational rotatory angle. Results: The hallux primus valgus angle improved an average of $14{\pm}2.98$ degrees to $-1{\pm}1.68$ degrees with the hallux pronational rotatory angle respectively from $24.8{\pm}7.64$ degrees to $4.7{\pm}4.22$ degrees. Conclusions: After the metatarsal osteotomy for the treatment of the hallux valgus with the pronation of great toe, derotational closing wedge Akin osteotomy can give us a belief that it can correct the hallux primus valgus angle and hallux pronational rotatory angle also and it can be a helpful method for minimizing the recurrence rate of the hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.12-18
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• 1999

Eleven patients with calcaneal fracture had 2 acute compartment syndrome of the feet and 9 late complication of the compartment syndrome of the feet. An interstitial pressure of more than 30 mmHg in either the central or interosseous compartment was considered pathologic and was treated by fasciotomy performed medially. Rigid claw toe deformity was treated by excision of the head and neck of the proximal phalanx, dorsal capsular release of the metatarsophalangeal joint, and lengthening of the extensor tendon. Patients were evaluated at a mean of 35 months(range, 21 - 44 months) after operation, and the examination was directed specifically toward symptoms and signs of myoneural ischemia, and walking pain. At follow -up, 2 patients with acute compartment syndrome of the foot had no evidence of myoneural ischemla, 9 patients with claw toe deformity had no pain with walking. Based on our clinical observations, we concluded that compartment syndrome of the foot may occur after the calcaneal fracture and fasciotomy is effective treatment for the prevention of the long term sequelae of this debilitating condition.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.134-139
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• 2008

Purpose: The purpose of this study was to evaluate the radiological and clinical results of modified scarf osteotomy for hallux valgus with lesser metatarsalgia. Materials and Methods: Total 19 patients (24 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 46.4 years. The mean follow-up time was 14.8 months. We modified original scarf osteotomy by adding the procedure of closing wedge osteotomy at the medial side of distal fragment for achieving of the supination of the first metatarsal head. Additionally, Akin osteotomy of the first proximal phalanx was done in 16 patients (20 feet) and no lesser metatarsal operation was done. First-second intermetatarsal, hallux valgus and distal metatarsal articular angles were analyzed radiologically before and after the operation. And 3-dimensional CT was used to evaluate the supination of the first metatarsal head. Clinical results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) score and persistence of lesser metatarsalgia. Results: First-second intermetatarsal and hallux valgus angles were reduced from the mean pre-operative values of $14.2^{\circ}$ and $32.5^{\circ}$ to $8^{\circ}$ and $12.5^{\circ}$, respectively, 12 months after the operation. And the supination of the first metatarsal head was confirmed by 3-dimensional CT. The mean AOFAS score improved from 41.4 points pre-operatively to 87.2 points at follow-up. Lesser metatarsalgia still remained in 2 patients (2 feet). Conclusion: Modified scarf osteotomy would be an effective surgical procedure, especially, for achieving downward displacement and supination of the first metatarsal head in hallux valgus with lesser metatarsalgia.

• Journal of Korean Foot and Ankle Society
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• v.16 no.4
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• pp.235-240
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• 2012

Purpose: The aim of this study was to evaluate the radiographic and clinical results of short scarf osteotomy that has minimized longitudinal cut for moderate hallux valgus. Materials and Methods: Total 12 patients (12 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 41.5 years. The mean followup time was 21.2 months. We modified original scarf osteotomy by shortening the longitudinal cut to 15~20 mm in length. Additionally, Akin osteotomy of the first proximal phalanx was done in 7 feet and Weil osteotomy of the second metatarsal was done in 4 feet. First-second intermetatarsal and hallux valgus angles were analyzed radiographically before and after the operation. And the clinical result was assessed by AOFAS (American Orthopaedic Foot and Ankle Society) hallux score. Results: First-second intermetatarsal and hallux valgus angles were reduced from the mean preoperative values of $14.6^{\circ}$ and $32.8^{\circ}$ to $6.5^{\circ}$ and $11.2^{\circ}$, respectively. The mean AOFAS hallux score was increased from 52.4 points preoperatively to 88.2 points at followup. Three complications were found: metatarsal fracture during the operation, painful scar around second metatarsal head after Weil osteotomy and postoperative neuralgia. There was no transfer metatarsalgia or recurrence of hallux valgus during followup. Conclusion: Short scarf osteotomy would be an effective surgical procedure for moderate hallux valgus with the benefits of minimized soft tissue dissection and stable fixation.

• The korean journal of orthodontics
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• v.15 no.2
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• pp.197-209
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• 1985

To investigate the relationship between the pubertal spurt in body height and bone maturity of the hand-and-wrist in normal occlusion, the author X-rayed the hand-and-wrists of 1,141 students (male 614, female 527) and assessed their bone maturity. In this study, eleven skeletal stages were selected. The bones used to determine skeletal maturity were the ulnar sesamoid of the metacarpophalangeal joint of the first finger, the epiphyses of the proximal, middle, distal phalanges of the third finger, and middle phalanx of the fifth finger, and distal epiphysis of the radius. From the longitudinal data for height, an assessment was made of the change in growth velocity. The pubertal growth stage was divided into onset and peak height velocity phases. The results were as follows; 1. The onset of the pubertal growth was between the $PP_3=\;and\;MP_3=$ stage for boys, and between the $MP_3=\;and\;MP_5=$ stage for girls; the mean age of onset was 10.6 years for boys and 9.0 years for girls. 2. The peak height velocity was between the S and $MP_{3_{cap}}$ stage for boys, and between the $MP_{3_{cap}}$ and $MP_{5_{cap}}$ stage for girls; the mom age of peak height velocity was 12.5 years for boys and 10.9 years for girls. 3. As the stages of bone maturity progressed from $DP_{3u},\;to\;PP_{3u},\;MP_{3u}$, Ru, the peak height velocity had been reached, and the growth rate retarded, therefore the approach to full physical maturity was attained. 4. The evidence for the period of onset, peak height velocity and bone maturation suggested that girls were in advance of boys. During the latter part of pubertal growth, the rate of boys' bone maturation was faster than that of girls'.

• Archives of Plastic Surgery
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• v.46 no.1
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• pp.57-62
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• 2019

Background Full-thickness nail bed defects with significant exposure of the distal phalanx are typically challenging to reconstruct. We describe a novel method of nail bed defect reconstruction using a thenar fascial flap combined with nail bed grafting. Methods Full-thickness nail bed defects were reconstructed in a 2-stage operation involving the placement of a thenar fascial flap and subsequent nail bed grafting. A proximally-based skin flap was designed on the thenar eminence. The flap was elevated distally to proximally, and the fascial layer covering the thenar muscle was dissected proximally to distally. The skin flap was then closed and the dissected fascial flap was turned over (proximal to distal) and inset onto the defect. The finger was immobilized for 2 weeks, and the flap was dressed with wet and ointment dressings. After 2 weeks, the flap was divided and covered with a split-thickness nail bed graft from the great toe. Subsequent nail growth was evaluated on follow-up. Results Nine patients (9 fingers) treated with the novel procedure were evaluated at follow-up examinations. Complete flap survival was noted in all cases, and all nail bed grafts took successfully. Five outcomes (55.6%) were graded as excellent, three (33.3%) as very good, and one (11.1%) as fair. No donor site morbidities of the thenar area or great toe were observed. Conclusions When used in combination with a nail bed graft, the thenar fascial flap provides an excellent means of nail bed reconstruction.

• The Journal of the Korean bone and joint tumor society
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• v.19 no.2
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• pp.56-63
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• 2013

Purpose: This study was performed to evaluate the efficiency of demineralized bone matrix (DBM, Genesis$^{(R)}$) used for bone defect after operative traetment of benign bone tumors by clinical and radiological methods. Materials and Methods: DBM was used to treat bone defect after operative treatment of benign tumor from February 2012 to May 2013. Total 25 benign bone tumor cases (15 males, and 10 females) with mean age of 30.3 were studied. The diagnoses were solitary bone cyst in 9 cases, non ossifying fibroma in 5, fibrous dysplasia in 5, aneurysmal bone cyst in 3 and enchondroma in 3. In categorization by location of tumor, there were 5 cases of distal femur, 4 of proximal tibia, 3 of proximal femur, 3 of proximal humerus, 3 of phalanx, 2 of distal radius, 2 of hip bone, 2 of calcaneus, and 1 of scapula. Autogenous bone was used with DBM in 6 cases, and only DBM used in 19 cases. Mean periods of follow up were 8.7 months (range: 6 to 14 months). Amount of graft resorption and bone formation was observed with compare of post operation radiograph and the difference was shown by percentage. Resorption level was measured by DBM level which could be observed from simple x-ray, and bone formation level by bone trabecular formation level at impaired site. Results: Twenty three cases of total 25 cases showed bone union. In the 23 cases, more than 98% DBM resorption was observed after mean 4.3 months, and more than 98% bone formation was observed after mean 6.9 months. Lesser bone defect sizes showed faster bone formation and it was statistically significant (p=0.036). But other comparative studies on other factors such as, sex, age of patients and combination of autogenous bone were no statistically significant differences in graft resorption and bone formation. And there was no significant complication in periods of follow-up. Conclusion: Demineralized Bone Matrix (Genesis$^{(R)}$) is thought to be useful treatment for bone defect after operative treatment of benign bone tumor, however longer follow-up periods appears to be needed.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.143-148
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• 2001

The hand with amputation of all fingers is useless for activities of daily living and traumatic amputation of some of the fingers can result in the diminished ability to perform power grip and precision grip which is vital to maintain normal function of the hand. Precision grip is used to hold an object between the opposable thumb and flexed fingers. In power grip the object is held between the flexed fingers and the palm while the thumb applies the necessary counterpressure to maintain the grip on the object. A 35 year old male lost his right all fingers including thumb at the level of proximal phalanx from the pressure machinary accident. Thumb was reconstructed using wrap around flap and the second and third fingers were reconstructed using the second and third toe transplantation. Seven years after reconstruction, he uses the reconstructed thumb and the second and the third fingers for eating meals, writing down a paper with a pencil and putting on socks.