• Archives of Plastic Surgery
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• 제49권1호
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• pp.76-79
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• 2022

Kienböck disease, a rare disease that can cause chronic pain and motor dysfunction, occurs due to avascular necrosis of the lunate bone, which leads to dislocation of the carpal bone. Among various other etiologies, Kienböck disease can cause closed tendon rupture of the finger. In this report, we introduce a case of total rupture of the second extensor digitorum communis and the extensor indicis proprius tendons caused by undiagnosed Kienböck disease in an elderly female patient.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.397-403
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• 2012

Background Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. Methods Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. Results Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. Conclusions Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.

• Anatomy and Cell Biology
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• 제56권2호
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• pp.191-199
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• 2023

The anterior cruciate ligament (ACL) is mostly damaged in sporting activities. To reconstruct the damaged ACL, a patellar tendon (PT) is often the most preferred graft due to its fast healing and bone integration i.e. bone-patellar tendon-bone graft. Suitability of the PT often depends on the morphometric profile of the tendon. This study reported on the harvestable surface area (SA) of the tendon using a simple tracing method. The PT of 79 adult formalin-fixed cadavers of South Africans of European Ancestry were dissected, and the margins of the PT were traced on a wax paper before the tracings were scanned. The SA, straight proximal width (SPW), curved proximal width (CPW), straight distal width (SDW), curved distal width (CDW) and length of tendon (LOT) from the digitized image of the PT was measured. In addition, the length of the lower limbs was measured to normalize the measurements. The results showed no significant side differences, and the measurements were not sexually dimorphic. A strong correlation was reported for SA vs. LOT, SPW vs. CPW and SDW vs. CDW for both sexes and sides. The presented morphological profile provides additional information on the usability of the graft and with respect to healing and recovery.

• Archives of Plastic Surgery
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• 제46권3호
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• pp.228-234
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• 2019

Background The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model. Methods The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded. Results The maximum tensile strength until failure was $44.6{\pm}4.3N$ in group 1, $35.7{\pm}5.2N$ in group 2, and $56.7{\pm}17.3N$ in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P<0.05). Furthermore, the barbed sutures showed the shortest repair time (P<0.05). Conclusions This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.

• Archives of Plastic Surgery
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• 제45권4호
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• pp.357-362
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• 2018

Background The most common complication after tendon repair is the development of adhesion, with subsequent rupture. Methods In this study, we present a new method in which the tendon healing contact surface is increased to reduce these complications. The tendons of chickens in groups 1, 3, and 5 were transversely cut and repaired with in the traditional fashion with double-modified Kessler method and 5/0 polypropylene. In the other groups, 3 mm of the tendon was removed from the proximal half of the upper end and from the distal half of the lower end of the tendon, and they were repaired with the modified Kessler method. The tendons of the chickens in groups 1 and 2 were evaluated immediatelly after surgery. Groups 3 and 4 were evaluated at 4 weeks after surgery. Groups 5 and 6 were evaluated at 6 weeks. Results Increases in transient inflammation and connective tissue formation were observed more clearly in the group treated with the new method in histopathological investigations at weeks 4 and 6. The stretching test showed statistically significant differences between groups 3 and 4 (P<0.05) and groups 5 and 6 (P<0.05). Conclusions When repairing tendons with the new method, the healing surface increases and the direction of collagen fibers at the surface changes. Because of these effects, the strength of the tendon healing line increases; we therefore expect that this technique will enable patients to safely engage in early active exercise after the operation, with less risk of tendon rupture.

• 대한정형외과스포츠의학회지
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• 제2권2호
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• pp.136-141
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• 2003

슬관절의 후외측 불안정성은 많은 연구가 필요한 손상 중의 하나이다 치료에 있어서도 여러 술기들이 고안되어 왔지만 아직 까지 만족할 만한 치료법은 없는 상황이다. 이에 저자들은 동종 후경골건을 이 용하여 외측측부인대와 슬와건을 동시에 재건하는 새로운 술식을 소개하고자 한다.

• 한방재활의학과학회지
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• 제32권4호
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• pp.97-103
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• 2022

The objective of this study is to report the improved case of Korean medicine treatment with Aconitum ciliare decaisne pharmacopuncture for supraspinatus tendon full-thickness tear. We used Aconitum ciliare Decaisne pharmacopuncture with other Korean medicine treatments (acupuncture, electroacupuncture, and cupping) for this patient. This case is measured and assessed by the numerical rating scale (NRS), shoulder range of motion (ROM), shoulder pain and disability index (SPADI) and shoulder physical examination. As the result, we found the improvement of NRS, SPADI, ROM, and shoulder physical examination. This study suggested that Korean medicine treatment with Aconitum ciliare Decaisne pharmacopuncture is proved to be helpful to relieve pain and recover function for supraspinatus tendon full-thickness tear. But further clinical studies are needed to clarify the effect of Aconitum ciliare Decaisne pharmacopuncture therapy for patients with supraspinatus tendon full-thickness tear.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.769-772
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• 2022

Femoral nerve injuries are devastating injuries that lead to paralysis of the quadriceps muscles, weakening knee extension to prohibit ambulation. We report a devastating case of electrical injury-induced femoral neuropathy, where no apparent site of nerve disruption can be identified, thus inhibiting the traditional choices of nerve reconstruction such as nerve repair, grafting, or transfer. Concomitant spinal cord injury resulted in spastic myopathy of the antagonist muscles that further restricted knee extension. Our strategy was to perform (1) supercharge end-to-side technique (SETS) to augment the function of target muscles and (2) fractional tendon lengthening to release the spastic muscles. Dramatic postoperative improvement in passive and active range of motion highlights the effectiveness of this strategy to manage partial femoral nerve injuries.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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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.

• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.211-216
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• 2015

Background: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. Methods: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. Results: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. Conclusions: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.