• 대한족부족관절학회지
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• 제17권1호
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• pp.11-16
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• 2013

Freiberg's disease is a osteochondrosis of a metatarsal head that is recognized as primarily a disorder of the second metatarsal. It is seen more often in girls. Pain and limitation of motion of the affected joint is the predominant clincal feature. The radiographic appearance demonstrates from osteosclerosis in the early stage to osteolysis with collapse in the later stage. Conservative therapy may take the form of rest, a stiff shoe, and even a cast support to decrease the stress across the joint. Surgical intervention may also be of benefit. Surgery have been attempted either to modify the diseae process or to salvage the situation once the metatarsophalangeal joint develops degenerative changes. Metatarsophalangeal joint instability is common cause of forefoot pain that can develop in association with a traumatic episode and inflamatory tissue disorders as well as neighboring toe deformities. The second ray is by far the most frequently involved. The diagnosis can be made by clinical observation and physical examination including drawer test. Many surgical procedures have beem recommended when conservative treatment has failed. Procedures described range from soft tissue releases and tendon trasfer to the direct plantar plate repair combined with a Weil osteotomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.25.1-25.4
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• 2018

Background: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. Case presentation: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. Conclusion: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.491-499
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• 2018

Background: Advances in surgical techniques, implant technology, radiotherapy, and chemotherapy have increased the recovery chances of patients with bone sarcomas. Accordingly, patients' expectations on life quality have also increased, highlighting the importance of objective evaluation of the functional results of reconstruction. Methods: Thirteen patients with distal femoral endoprosthesis, who had been followed for an average of 2.9 years were evaluated. Postural stability, daily energy expenditure, muscle power, and range of motion were the four parameters analyzed in this study. The Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS) were used to assess postoperative function and examine correlations with other parameters. Results: Patients had sedentary activities in 84% of their daily lives. They exhibited a slower speed in the walk across test and a higher sway velocity in the sit-to-stand test (p = 0.005). MSTS scores were significantly correlated with the daily energy expenditure and walking speed. Conclusions: Objective functional results acquired from various clinics will provide significant data to compare reconstruction techniques, rehabilitation protocols, and surgical techniques. In this way, it will be possible to satisfy the expectations of patients that increase in relation to enhanced recovery.

• 대한골관절종양학회지
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• 제7권4호
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• pp.139-143
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• 2001

목적 : 근위 경골 종양의 광범위 절제술에 따른 재건술은 적절한 연부 조직의 피복(cover age), 슬관절 신전 장치(knee extensor apparatus), 특히 슬개건의 견고한 재부착이 어려워 슬관절의 기능적 결과가 만족스럽지 않은 것으로 알려져 있는바, 근위 경골의 골육종으로 광범위 절제 후 종양 대치물 삽입으로 사지 구제술을 시행 받은 환자에서 기능을 평가하고 문제점을 분석하기 위하여 본 연구를 시행하였다. 대상 및 방법 : 1992년 4월부터 1998년 10월까지 경골 근위부의 골육종으로 확진된 후 종양 대치물을 이용한 사지 구제술을 시술 받은 11명을 대상으로 하였다. 남자가 6명, 여자가 5명이었으며, 환자의 나이는 15세에서 65세로 평균 23.7세였다. 추시 기간은 최단 1년에서 최장 4년 6개월로, 평균 2년 5개월이었다. 최종 기능평가는 1993년 국제 사지 보존 회의(International Symposium On Limb Salvage; ISOLS)에서 수정 보완한 방법을 이용하여 동통, 기능(functional activity), 환자의 정서적 만족도(emotional acceptance), 보조기 사용여부(use of external support), 보행 능력(walking ability), 그리고 보행 상태(gait)등 여섯 가지로 나누어 평가하였다. 각각의 요소를 최하 0점에서 최고 5점으로 하고 그 중간을 정도에 따라 1, 2, 3, 4점으로 점수화하여 정상 기능에 대한 백분율(% )로 표시하여 분석하였다. 결과 : 기능 평가 성적은 정상 기능에 대해 최고 86.7%에서 최저 53.3%로 평균 68.3%를 나타냈으며, 세부적으로 보면 동통이 82.5%, 기능이 62.5%, 정서적 만족도가 67.5%, 보조기 사용여부는 77.5%, 보행능력은 62.5%, 보행상태는 57.5%였다. 슬관절의 평균 운동범위는 신전 5도, 굴곡 85도였으며, 5례에서 최소 5도, 최고 15도, 평균 10도의 신전 제한(extension lag)을 보였다. 합병증으로는 2명에서 수술 후 감염 소견을 보였으며 1명은 항생제 치료로 호전되었으나 다른 1명은 종양 구조물 제거 후 관절고정술로 전환이 필요하였다. 결론 : 경골 근위부의 골육종 환자에서 광범위 절제 후 종양 대치물 삽입에 의한 사지구제술의 기능 평가 성적은 감염이 합병되지 않은 경우에는 전반적으로 양호하였으나, 동통 소실, 보조기 사용여부에 비해 슬관절의 부분 강직 및 extension lag로 인해 기능, 정서적 만족도, 보행등에서 덜 만족스러웠다. 임상적으로 더 만족스러운 결과를 얻기 위해 수술 후 대퇴사두근 강화 운동 및 굴곡 운동 등의 적극적인 재활 치료가 필요한 것으로 생각된다.

• Archives of Plastic Surgery
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• 제48권5호
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• pp.511-517
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• 2021

The use of free flaps is an essential and reliable method of reconstruction in complex head and neck defects. Flap failure remains the most feared complication, the most common cause being pedicle thrombosis. Among other measures, thrombolysis is useful when manual thrombectomy has failed to restore flap perfusion, in the setting of late or established thrombosis, or in arterial thrombosis with distal clot propagation. We report a case of pedicle arterial thrombosis with distal clot propagation which occurred during reconstruction of a maxillectomy defect, and was successfully treated with thrombolysis using recombinant tissue plasminogen activator. We also review the literature regarding the use of thrombolysis in free flap surgery, and propose an algorithm for the salvage of free flaps in head and neck reconstruction.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.589-593
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• 2019

Post-traumatic defects of the distal third of the leg often require skipping a few steps of the well-established reconstructive ladder, due to the limited local reliable reconstructive options. In rare cases, the reconstructive plan and flap choice may encounter challenges when the patient has psychiatric illness affecting compliance with postoperative care. We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures may be preferred over a long and complex surgical reconstruction requiring good compliance with postoperative care. The medical team should be aware of the risk of postoperative collapse, focus on the prevention of pain, and be wary of drug interactions. Whenever necessary, free tissue transfer should be performed despite potential compliance issues.

• Radiation Oncology Journal
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• 제32권4호
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• pp.238-246
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• 2014

Purpose: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. Materials and Methods: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using $^{192}Ir$ between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. Results: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT ${\pm}$ external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (${\leq}grade$ 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. Conclusion: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.

• Radiation Oncology Journal
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• 제12권3호
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• pp.331-336
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• 1994

Purpose : To assess the effectiveness and problems of the primary radiation therapy and salvage surgery in a series of patients affected by T1-T2NO glottic cancers treated from 1985 to 1991 at the Pusan National University Hospital. Materials and Methods : From 8/85 to 12/91,34 patients affected by early glottic carcinoma histologically proven were treated with curative radiation therapy, Distribution of patients according to T stage was 30 for T1 and 4 for T2. Male to female ratio was 33:1. Age of patients ranged from 31 to 73 with mean age of 58 years. All of the patients were treated with radical radiation with total tumor dose of 63-75. 3Gy(median 68.2Gy), of 5 weekly fractions of 1.8-2Gy and with 6MV photon beams through two laterally opposed fields. Results : The overall 5-year local control rates were $74\%$(8/30) for Tl, and $25\%$(3/4) for T2. The main cause of failure was progression or recurrence in T(10/11). One failures were observed in T and N at the same time. Of these 11 patients, 9($81\%$) were salvaged with surgery, After surgical salvage of radiation failures, the 5-year survival rates were $96\%$ for T1 and $75\%$ for T2. Among the survivors, $73\%$ of T1 and $33\%$ of T2 were able to preserve the larynx. Conclusion : It can be concluded that radiotherapy is the first choice in the treatment of glottic T1 carcinoma.

• 대한두개안면성형외과학회지
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• 제18권3호
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• pp.179-185
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• 2017

Background: The use of leeches can effectively increase the salvage rate of flap congestion. However, the first reaction from patients and carers in using leeches in clinical fields is strong aversion. This can be due to the fact that development of our culture from agriculture to industrial society, coming across leeches became fairly rare. Also because of the biological traits that leeches carry; staying attached to a leg or other body parts of the host, sucking blood, and leaving wounds. Methods: This study was conducted through questionnaires, divided into many subgroups. We scaled the compliance of the two therapies, with or without leech. Maximum scale of 10 showing no rejective response to the therapy and minimum scale of 0 showing the greatest rejective response. Results: Overall subjects' compliance was improved after explaining the benefits of hirudotherapy. Irrelevant to the explanation, there was no significant difference in general compliance between male and female. Young-aged group and medical personnel or people studying medicine showed higher compliance over older-aged group and the general public. Conclusion: In the terms of general social cognition, recognizing leech as a therapeutic material may not be welcomed at first, but provided with proper information and explanations, overall compliance of patients and carers can be improved and consequently result in superior outcomes in flap salvage.

• Journal of Chest Surgery
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• 제28권7호
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• pp.678-683
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• 1995

Arterial bypass for the chronic ischemia of the lower extremities underlying atherosclerotic obliterans has been performed with a number of alternative conduits from 1941 by Kunlin. It is indicated for the limb salvage of patients with threatened limb loss despite of several controversies in surgical treatment of atherosclerotic obliterans. From March 1991 to January 1995, 26 arterial bypasses were performed in 23 patients with the chronic ischemia of the lower extremities in our hospital. Their mean follow up period is 18.9 months ranging from 4 months to 44 months. Mean age is 60.9 years ranging 47 years to 76 years and the most prevalent incidence is the 6th decade. 21 patients are male and 2 patients are female. 19 of 23 patients are smokers. Clinical classifications by Fontaine are class II[21.7% , class III[34.8% and class IV[43.5% .Diabetes mellitus[47.8% , hypertension[43.5% , hyperlipid-emia[26% , tuberculosis[21.7% , cerebrovascular accident[13.0% and cardiac diseases[8.7% are associated. Aorto-single femoral bypass in 4 cases, aorto-bifemoral bypass in 5 cases, aortofemoral & femoropopliteal bypass in 2 cases, femoropopliteal bypass in 10 cases, popliteotibial bypass in 3 cases, femoropedal bypass[composite graft bypass in 2 cases were surgically approached. There are complicated early thrombosis in 4 cases those are required immediately reoperation, wound infection in 3 cases, hematoma in 3 cases, and so on. Postoperative complication rate is 53.8%.Postoperative patency rates are 84.6% at 6 months, 75.0% at 1 year, 70.0% at 2 years and 66.7% at 3 years. We usually used 6 mm & 8 mm graft for bypass, and the rate of thrombosis formation is 28.6%[2/7 in 6 mm graft and 12.5%[2/16 in 8 mm separately. In according to the graft materials, the rate of thrombosis formation is higher in the group using artificial graft than in that using autologous saphenous vein[16.6% vs 12.5% . Limb salvage rate is 76.9%. Postoperative mortality rate is zero %.