• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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• pp.62-67
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• 2014

Purpose: Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities. Materials and Methods: The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters. Results: The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from $27.5^{\circ}$ to $46.7^{\circ}$. In radiographic measurements, calcaneal pitch angle improved from $19.1^{\circ}$ to $15.8^{\circ}$, Meary angle from $13.0^{\circ}$ to $9.3^{\circ}$, Hibb's angle from $44.3^{\circ}$ to $37.0^{\circ}$, and tibio-calcaneal axis angle from varus $17.5^{\circ}$ to varus $1.5^{\circ}$ Conclusion: We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.

• Journal of Veterinary Clinics
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• v.25 no.2
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• pp.96-101
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• 2008

This study was performed to quantify the pleural effusion in radiography, ultrasonography and computed tomography(CT) and to evaluate and compare the usefulness of these methods. Normal saline of 10 ml/kg was infused into the pleural space until a final loading volume of 60 ml/kg body weight was reached in six Beagle dogs. The radiographic examination was performed for the detection and quantification of pleural effusion. On the ultrasonographic study, the maximum perpendicular distance was measured between the surface of the lung and the thoracic wall to evaluate pleural effusion. On the CT image, pleural effusion was evaluated as the perpendicular distance to the thoracic surface in the maximum pleural effusion volume on any transverse images with soft tissue window. Statistical analysis was performed using linear regression test. The volume of pleural effusion and measurements of radiography and ultrasonography had no statistical relationship. However, a significant correlation was identified between the volume of pleural effusion and the depth at right ($r^2=0.715$), left ($r^2=0.745$), and mean right and left depth ($r^2=0.844$) on the CT images. All of the thoracic radiographs, ultrasonography, and CT are useful in recognition of pleural effusion. In quantification of pleural effusion, the CT measurement method is superior to radiographic and ultrasonographic measurements.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.161-165
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• 2011

Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. Methods: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. Results: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n=2), lateral displaced comminuted fracture of arch (n=6), comminuted arch fracture combined posterior root fracture (n=9), and communited arch and body fracture (n=12), severely contused soft tissue (n=9). After the manipulations outcomes were acceptable. Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.113-118
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• 2007

Purpose: The purpose of this work was to describe the results of treatment for motor vehiclerelated crushing injuries among children and adolescents under sixteen years in Korea. Materials and Methods: A retrospective analysis was conducted of data from children who were under sixteen year and injured foot by motor vehicles. Cases were documented 1) age at the time of injury, 2) injured site, 3) the area of accident, 4) the kind of vehicle, 5) associated injuries, 6) methods of treatment for soft tissue reconstruction and 7) complications. The relationships between the area of accident and associated injuries, and the kind of vehicle and associated injuries were analyzed using Chi-square test and Fisher exact test. Results: There were 97 children who were 15 year and younger. The mean age was 7.4 years, and 65% were boys. The left foot was more dominant side of injury (57%). Seasonal variation was seen with the number of injuries peaking during the summer (43%, p<0.05). Among the vehicles, 78.3% were the large vehicles (bus, truck or van). The where of accident was more frequent at an alley or less than two lanes of traffic. But, the relationships between the place of accident and associated injury or the kind of vehicles and associated injury were not statistically significant. The associated injury were fracture or dislocation (23 cases, 35.9%), injury of tendon (21 cases, 32.8%). There were amputation or disarticulation of foot in 8 cases (8.2%) and post-traumatic deformities such as flatfoot, hindfoot varus or valus deformities by tendon injury in 7 cases (7.2%). Conclusion: More than 50% of crushing or degloving injuries of child's foot by traffic accidents happened in boys between 5 to 9 years old. The associated injury was unrelated with size of vehicles or accident place at the time of accident. But, even though foot injury happened in an alley or one lane by small vehicles, child who hurt feet by car need thorough investigation about associated injury. If a surgeon keep in mind and treat child to associated injury necessarily, can minimize complication. Microsurgical reconstruction for soft tissue defect was prior to other methods.

• The Journal of Advanced Prosthodontics
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• v.7 no.2
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• pp.138-145
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• 2015

PURPOSE. The objective of this study was to conduct an in vitro comparative evaluation of polished and laser-dimpled titanium (Ti) surfaces to determine whether either surface has an advantage in promoting the attachment of epithelial-like cells and fibroblast to Ti. MATERIALS AND METHODS. Forty-eight coin-shaped samples of commercially pure, grade 4 Ti plates were used in this study. These discs were cleaned to a surface roughness (Ra: roughness centerline average) of 180 nm by polishing and were divided into three groups: SM (n=16) had no dimples and served as the control, SM15 (n=16) had $5-{\mu}m$ dimples at $10-{\mu}m$ intervals, and SM30 (n=16) had $5-{\mu}m$ dimples at $25-{\mu}m$ intervals in a $2{\times}4mm^2$ area at the center of the disc. Human gingival squamous cell carcinoma cells (YD-38) and human lung fibroblasts (MRC-5) were cultured and used in cell proliferation assays, adhesion assays, immunofluorescent staining of adhesion proteins, and morphological analysis by SEM. The data were analyzed statistically to determine the significance of differences. RESULTS. The adhesion strength of epithelial cells was higher on Ti surfaces with $5-{\mu}m$ laser dimples than on polished Ti surfaces, while the adhesion of fibroblasts was not significantly changed by laser treatment of implant surfaces. However, epithelial cells and fibroblasts around the laser dimples appeared larger and showed increased expression of adhesion proteins. CONCLUSION. These findings demonstrate that laser dimpling may contribute to improving the peri-implant soft tissue barrier. This study provided helpful information for developing the transmucosal surface of the abutment.

• Journal of Biomedical Engineering Research
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• v.24 no.4
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• pp.363-367
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• 2003

Contact area and pressure are important factors which directly influence a life of knee implants. Since implant's mechanical functions should be experimentally evaluated for clinical use, many studies using a knee simulator and a pressure sensor system have been conducted. However it has not been reported that the contact pressure's distribution of a knee implant motion was estimated in real-time during a gate cycle. Therefore. the objective of this study was to analyze the contact pressure distribution for the motion of a joint using the knee simulator and I-scan sensor system. For this purpose, we developed a force-controlled dynamic knee simulator to evaluate the mechanical performance of artificial knee joint. This simulator includes a function of a soft tissue and has a 4-degree-of-freedom to represent an axial compressive load and a flexion angle. As axial compressive force and a flexion angle of the femoral component can be controlled by PC program. The pressure is also measured from I-scan system and simulator to visualize the pressure distribution on the joint contact surfaces under loading condition during walking cycle. The compressive loading curve was the major cause for the contact pressure distribution and its center move in a cycle as to a flexion angie. In conclusion, this system can be used to evaluate to the geometric interaction of femoral and tibial design due to a measured mechanical function such as a contact pressure, contact area and a motion of a loading center.

• Journal of Korea Entertainment Industry Association
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• v.14 no.7
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• pp.539-548
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• 2020

TTH(tension-type headache) is the most common primary headache among adults. Long-term headaches cause chronic headaches and have a better impact on daily life. The purpose of this study is to compare the contributions to TTH through AVE(audio-visual entertainment) and STM(soft tissue mobilization) suitable for management of pathogenic and psychogenic factors of TTH. The participants of this study were from 30 people who complained of intermittent or persistent headaches for more than 6 months, and 10 participants each in the AVE group, STM group, and AVE plus STM group. In the assigned group, a total of 12 sessions were performed three times a week for 4 weeks after the baseline, followed by post-test. Outcome measures measured PPTs(pressure pain thresholds), psychophysiological parameters, and EEG(electroencephalogram). The measured results were analyzed for interaction between time and group through a two way rmANOVA(repeated measurement variance analysis). As a result of the PPTs, interaction was found in the results of the right trapezius (p<.05), and the more improvement was observed in the AVE group. Therefore, through AVE based on psychological factors rather than direct access to the muscles of pathogenic factors, a positive impact on the PPTs was shown, but the average value of the psychophysiological parameters and brain waves that were not statistically significant. The amount of change was observed. Through this, it is suggested that audio-visual stimulation could be considered in the management of TTH.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.22 no.1
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• pp.161-168
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• 1992

The authors observed a 27-year-old male patient who came to the Infirmary of Kyungpook National University Hospital who had complained of dull pain in right mandibular angle area 1 month ago. As a result of careful analysis of clinical, radiological, and histopathological findings, the authors diagnosed it as Ewing's sarcoma and obtained the results as follows: 1. In clinical examination, main clinical symptoms were continuous dull pain and gingival swelling on the 2nd and 3rd molar area of the right mandible. 2. In radiographic examination, ill-defined radiolucent area was seen on mandibular right angle area, and apparent periosteal reaction of sun-ray spicule was emanated from the lingual cortex of mandibular angle area. And computed tomograph also revealed moderate-defined 3. soft tissue mass of the same area. In histopathological examination, small round-shaped, and closely packed cells with scanty cytoplasm were observed in this specimen, and positive reaction in PAS staining was also observed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.2
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• pp.184-199
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• 1996

The challenges to achieve three dimensional facial proportionality and occusal stability in many patients with complex dentofacial deformity have been met by the development and use of the maxilla, mandible, and chin surgery techniques in combination with efficient orthodontic treatment. There is a clinical, biological, and biomechanical foundation for simultaneous surgical repositioning of the maxilla, mandible, and chin in a significant proportion of adult and adolescent patients. A combination of the surgical and orthodontic approach may provide increased treatment efficiencies and optimal esthetic results. Art and science to determine the treatment objectives, specifically, the desired soft tissue changes are firstly established by using the clinician's "esthetic sense" of the facial beauty and proportion aided to a few cephalometric guidelines. In this sense, the dependence on the clinician's "esthetic eye" by Dr. Bell is more important in analyzing the facial proportion than the satisfaction of rigid cephalometric norms. The purpose of this article was to elucidate the indication for simultaneous surgical repositioning of the maxilla, mandible, and chin, and to describe the clinical cephalometric analysis for orthognathic surgery. Representative 6 case reports were presented and discussed to illustrate the esthetic, orthodontic, and surgical treatment objectives with long-term follow-up.