• 대한정형도수물리치료학회지
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• 제27권2호
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• pp.37-43
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• 2021

Background: The purpose of this study is to compare and analysis the changes in strength and endurance of the knee extensor muscles after Anterior cruciate ligament reconstruction. Methods: Twelve male subjects with ligament injury were seated on Biodex and the hip joint was flexed at 110°, and torso, lower extremities, and legs were fixed using Velcro. The resistance device was placed at a point 3cm above the ankle, and measurements were taken before and a surgery at 60°/sec and 180°/sec when the knee was maximally extended. The postures ingeniously combine forward-bending poses countered with backward-bending ones. Results: There was no significant difference in the comparison of muscle strength of 60°/sec and 180°/sec before surgery. But there was a significant difference after surgery. There was significant difference in muscle endurance both before and after surgery. There was a significant difference in the pre- and post- operative comparison values of muscle strength and endurance in isokinetic movements at 60°/sec and 180°/sec during knee extension on the injured side. Conclusion: For cruciate ligament tears, Orthopedic reconstruction is recommended. Correct alignment of the knee ligament after surgery can enhance the strength and endurance of the quadriceps femoris during knee extension rejuvenated.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.69-71
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• 2016

Reconstruction of the lower extremities is difficult due to a lack of skin laxity and muscular tissues. Here, we present a case of lower extremity reconstruction via the anterior tibial artery perforator based segmental muscle island flap. Our patient was a 75-year-old male with a chronic ulcerative wound on the right lower leg from an old car accident. A $5.0{\times}0.5cm$ size ulcerative wound with tibial bone exposure was noted. We planned to reconstruct the lower extremity defect with a free flap, but the vessel status was severely compromised intraoperatively. Thus, we found the anterior tibial artery perforator using Doppler ultrasound, elevated the tibialis anterior muscle segment flap, and transposed it to cover the defect successfully. The flap presented with a nice contour and the skin graft covering the flap survived completely. There were no complications of the surgical site at three months follow-up and no gait morbidity. This is a meaningful case applying the concept of segmental muscle flap based on a perforator that had advantages including proper bulkiness, vascularization, and preservation of function, which were well applied, leading to great success.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.575-583
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• 2013

Background The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction. Methods We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremity reconstruction at our institution during a 10-year period. In these patients, we evaluated causes and sites of defects, types of flaps, recipient vessels, types of anastomosis, survival rate, and complications. Results There were 42 men and 10 women with a mean age of 32.7 years (range, 3-72 years). The sites of defects included the dorsum of the foot (19), pretibial area (17), ankle (7), heel (5) and other sites (4). The types of free flap included latissimus dorsi muscle flap (10), scapular fascial flap (6), anterolateral thigh flap (6), and other flaps (30). There were four cases of vascular complications, out of which two flaps survived after intervention. The overall survival of the flaps was 96.2% (50/52). There were 19 cases of other complications at recipient sites such as partial graft loss (8), partial flap necrosis (6) and infection (5). However, these complications were not notable and were resolved with skin grafts. Conclusions The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site.

• Archives of Reconstructive Microsurgery
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• 제26권1호
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• pp.18-22
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• 2017

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.

• Archives of Plastic Surgery
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• 제43권5호
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• pp.438-445
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• 2016

Background The goal of reconstruction is to provide coverage of exposed vital structures with well-vascularized tissue for optimal restoration of form and function. Here, we present our clinical experience with the use of the scapular fascial free flap to correct facial asymmetry and to reconstruct soft tissue defects of the extremities. Methods We used a scapular fascial free flap in 12 cases for soft tissue coverage of the extremities or facial soft tissue augmentation. Results The flaps ranged in size from $3{\times}12$ to $13{\times}23$ cm. No cases of total loss of the flap occurred. Partial loss of the flap occurred in 1 patient, who was treated with a turnover flap using the adjacent scapular fascial flap and a skin graft. Partial loss of the skin graft occurred in 4 patients due to infection or hematoma beneath the graft, and these patients underwent another skin graft. Four cases of seroma at the donor site occurred, and these cases were treated with conservative management or capsulectomy and quilting sutures. Conclusions The scapular fascial free flap has many advantages, including a durable surface for restoration of form and contours, a large size with a constant pedicle, adequate surface for tendon gliding, and minimal donor-site scarring. We conclude that despite the occurrence of a small number of complications, the scapular fascial free flap should be considered to be a viable option for soft tissue coverage of the extremities and facial soft tissue augmentation.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.61-67
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• 2010

Emergency free flap has been advocated to cover the severely injured extremity for more than two decades, due to its numerous advantages such as low incidence of flap failure and infection rate and early recovery of function. But there are very few reports about these. The authors report their experience in using the emergency free flap for reconstruction of extremities. For last 10 years, 4 patients ranging from 3 to 27 years old with severely traumatized extremities were treated with emergency free flap transfers. Three were males and the other was a female. Flap size ranged from $2{\times}5\;cm^2$ to $7{\times}22\;cm^2$. The locations of the recipient site were the dorsum of the foot, the cubital fossa, the popliteal fossa and the upper arm. The number of the donor sites used was as follows: one scapular flap, two parascapular flaps, and one radial forearm flap with the radial bone. All of the flaps survived without need of re-exploration. There was no infection or flap loss. Involved joints have recovered a normal range of motion. Therefore, we consider that the emergency free flap is a very safe and reliable method to cover the severely injured extremities.

• Archives of Reconstructive Microsurgery
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• 제4권1호
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• pp.58-64
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• 1995

사지의 연부조직 결손으로 고려대학교 의과대학 정형외과학 교실에서 입원했던 12명의 환자 13례에 대하여 전완부 유리 피판술을 시행 후 최저 3개월에서 최고 37개월간 평균 14.3개월간 추시하여 다음과 같은 결론을 얻었다. 1. 13례 전례에서 연부조직 결손의 치료로 만족할만한 결과를 얻었다. 2. 이식피판의 크기는 평균 $54cm^2$였으며 유리피판의 평균 혈류 차단시간은 74분 이었다. 3. 술후 3례에서 합병증이 발생하였으며 3례중 2례는 동맥 문합부위에 혈전이 발생하였으나 술후 제 2일에 혈전 재거술을 시행하여 해결하였으며, 1례는 이식 정막내의 혈전으로 이식피판의 표층괴사가 발생하여 고식적인 피부이식술로 치료하였다. 4. 체중 부하를 받는 족저부의 재건에는 감각신경을 포함한 전완부 유리피판술이 좋은 방법의 하나이다. 5. 전완부 피판술은 비교적 넓은 연부조직 결손을 치료할 수 있고 이식 혈관의 내경이 커서 문합이 비교적 쉬워 숙련된 미세수술 수기를 익힌 외과의사에게는 성공률이 높은 유리피판술 중의 하나이다.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.578-582
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• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.619-625
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• 2015

Background The reconstruction of ankle and heel defects remains a significant problem for plastic surgeons. The following options exist for reconstructing such defects: local random flaps, reverse flow island flaps, and free flaps. However, each of these methods has certain drawbacks. Peroneal artery perforators have many advantages; in particular, they are predictable and reliable for ankle and heel reconstructions. In this study, we report our clinical experience with peroneal artery perforator-based pedicled flaps in ankle and heel reconstructions. Methods From July 2005 to October 2012, 12 patients underwent the reconstruction of soft tissue defects in the ankle and heel using a peroneal artery perforator-based pedicled flap. These 12 cases were classified according to the anatomical area involved. The cause of the wound, comorbidities, flap size, operative results, and complications were analyzed through retrospective chart review. Results The mean age of the patients was 52.4 years. The size of the flaps ranged from $5{\times}4$ to $20{\times}8cm^2$. The defects were classified into two groups based on whether they occurred in the Achilles tendon (n=9) or heel pad (n=3). In all 12 patients, complete flap survival was achieved without significant complications; however, two patients experienced minor wound dehiscence. Nevertheless, these wounds healed in response to subsequent debridement and conservative management. No patient had any functional deficits of the lower extremities. Conclusions Peroneal artery perforator-based pedicled flaps were found to be a useful option for the reconstruction of soft tissue defects of the ankle and heel.

• Archives of Reconstructive Microsurgery
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• 제13권2호
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• pp.123-129
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• 2004

Lower extremity injuries are frequently accompanied with large soft-tissue defects. Such Injuries are difficult to manage for its poor vascularity, rigid tissue distensibility, easy infectability and a relatively long healing period. Also, osteomyelitis, and/or non-union of the fractured bones are relatively common in lower extremity injuries and its weight-bearing role should be considered. Therefore, it is important to select appropriate reconstruction method of the lower extremities, which is applicable to a variety of surgical techniques according to these considerations. The goal of flap coverage in the lower extremity should not only be satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. In this article, we have tried to establish a reconstruction method in the lower extremity based on our experiences and clinical analysis of soft tissue reconstruction using free muscle flap transfer in 27 cases from Jan. 2000 to Dec. 2002. The results showed 96% flap survival, and flap failure noted in one of the cases due to vascular insufficiency. In conclusion, we believe that in cases of lower extremity soft-tissue defects especially with open comminuted fractures and infections, muscle free flaps should be considered as the first line of treatment.