• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.137-142
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• 2001

This study evaluated the results of reconstructions of thumb web space in the patients with adduction contracture of thumb. Between February 1990 and April 2000, 28 patients with thumb web space adduction contracture were treated with various reconstruction methods. We divided the patients according to the severity; mild$(41^{\circ}{\sim}80^{\circ})$, moderate$(21^{\circ}{\sim}40^{\circ})$, severe$(20^{\circ}less)$ contracture. The number of patients with mild contracture was 5, moderate; 12, severe; 11. We performed Z-plasty in 15, free flap in 8, local flap in 3, abdominal flap in 1 and scar release only in 1 case. The mean follow-up period was 5.7 years, ranged from 1.5 to 11.2 years. The results of web reconstruction were evaulated by thumb web space angle. There were excellent in 9, good in 16, fair in 3 cases. Z-plasty was performed in the 5 cases with mild contracture, and all the results were excellent. Especially, free flap was performed in the 6 cases with severe contracture, and all the results were good or excellent. in the reconstruction of thumb web space contracture, we recommend Z-plasty for a mild contracture, and free flap for large soft tissue defect created by release of a severe contracture.

• 대한화상학회지
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• 제24권2호
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• pp.46-49
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• 2021

An anatomically normal first web space is essential for optimal prehensile movements of the thumb and hand. A 28-year-old woman presented with severe scarring and contractures of the first web space of both hands, following a flame burn injury sustained 25 years prior to presentation. First web space contracture may occur secondary to severe injuries, burns (as observed in our patient), or congenital hand anomalies. A significant amount of additional skin is required to release a severe first web space contracture. Reconstruction of wide areas of contractures using only local flaps is challenging. Among other free flaps used in clinical practice, the thinned lateral arm free flap provides flexible vascularized tissue for reconstruction of the skin after severe first web space contracture release. Reconstruction using lateral arm free flaps facilitated thumb abduction and opposition (which were initially difficult) and improved hand function in our patient.

• Archives of Plastic Surgery
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• 제36권2호
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• pp.147-152
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• 2009

Purpose: First web space contracture of the hand has been treated with various surgical techniques such as Z - plasty, local flap, pedicled flap, distant free flap, and anterolateral thigh free flap. Among those surgical techniques, anterolateral thigh free flap provide a thin and pliable flap, which is a useful method for correction of first web space contracture. Methods: From August 2003 to September 2007, authors selected 9 patients who had first web space contracture with limitation of thumb abduction within 30 degrees. All of patients had received first web contracture release with anterolateral thigh free flap. Age ranged from 24 to 51, and all the patients were male. Average follow up period was 12 months and authors performed photographic analysis of the thumb abduction angle of postoperative increase. Result: All the flaps were survived. Donor site was closed with primary closure in 8 cases and covered with split - thickness skin graft in 1 case. Average flap size was $8{\times}9cm$ and average thickness was 0.6 cm in suprafascial flap. The procedure resulted in increased thumb abduction angle of $34.7^{\circ}$ in average and showed concave shape of first web space in suprafascial flap. Additional operations were performed with Z - plasty in 3 cases, local flap in 5 cases, and opponensplasty in 3 cases. Conclusion: In suprafascial flap, we obtained relatively thin flap thickness and were able to make natural concave shape of first web space. In releasing severe contracture of the first web space, anterolateral thigh free flap provided a good coverage of appropriate thickness and pliable soft tissue and allowed limited donor site morbidity.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.642-648
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• 2009

Purpose: Hexadactyly without thumb is a rare congenital anomaly of the hand where six triphalangeal digits are symmetrically distributed without thumb. Contrary to mirror hands, triphalangeal six digits are symmetrically distributed on each side at the midline with well - differentiated carpal bones, extensor tendons, one ulnar and one radius. The authors developed a new surgical technique based on a three - dimensional concept to correct the hexadactyly and applied to 2 cases of hexadactyly with good functional and aesthetic results. Here we document the surgical technique and its result. Methods: A 16 month old male patient visited our clinic with chief complaints of bilateral hexadactyly deformity. On physical examination most radial first and second digits showed no opposition and adduction motion on both side hands. Radiography showed 6 triphalangeal digits with normal development of carpal, radial and ulnar bone. Right side abnormality was corrected by removal of most radial side extra - digit, rotation and migration of 2nd ray to thumb position and creation of 1st web by transposing a mid - palm based rectangular palmar flap as in Snow & Littler procedure which has been being applied for correction of 1st web syndactyly in cleft hand deformity. Seven months later, left side abnormality was also corrected with the same procedure. Results: Postoperative appearances of the both hands were satisfactory. Flexion, extension, opposition and grasping were possible with the pollicized 2nd ray. Pinching power was 3.0 kg 15 months after surgery and 2.5 kg 22 months after in right hand respectively. Conclusion: In correction of hexadactyly deformity, satisfactory aesthetic and relevant functional results can be expected with authors' newly developed technique: removal of most radial digit, rotation and migration of 2nd digit to thumb position as well as creation of the 1st web space by transposition of mid - palm based rectangular flap.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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• pp.39-46
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• 1997

The methods of clinical applications of the foot as a free-flap donor site includes microvascular toe-to-finger transfer, free neurovascular flap transfer, first web space flap transfer, and osteocutaneous free flap transfer. We have evaluated the results of treatment for 35 patients to be undergone a microvascular reconstructive procedure with the foot as a donor site from January 1982 to June 1996. The performed operations were 16 cases of thumb reconstruction with wrap around procedure, 3 cases of tenocutaneous flap transfer, 10 cases of dorsalis pedis flap transfer, 2 cases of first web space free flap and 4 cases of toe-to-finger transfer. The follow up study was 69 months in average. Regarding to the various donor sites, morbidity was divided into five different categories: Cosmesis, Functional loss, Sensory loss, Wound complication, and Pain. According to the results of examination(35 patients), the results was excellent(25), good(9), fair(1), and poor(0). Among the categories, morbidity was higher at cosmesis. The patients under 50 years were better outcome. Among the operative methods from the foot as a donor site, thumb reconstruction with wrap around procedure showed poorest outcomes. So, We conclude that the foot as a free flap donor site is a good source for the microvascular reconstructive surgery. But, Preoperative donor site evaluation, adequate operative technique and post operative management are essential to decrease the morbidity of donor site.

• 융합정보논문지
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• 제7권2호
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• pp.25-29
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• 2017

본 연구의 목적은 손을 기능적 자세로 만들어주는 새로운 디자인의 보조기를 환자에게 적용하여 손기능에 어떠한 영향을 주는지 알아보고자 하는 것이었다. 새로운 보조기는 엄지와 검지의 샅공간(web space)을 넓히는 새로운 디자인이다. 보조기 착용 후 환자는 엄지 벌림의 자세를 유지할 수 있었고 작은 물건 잡기가 가능하게 되었다. 환자는 손 기능에서 향상을 보였고 Box and Block 검사의 수행이 가능해져 1분에 8개의 블록을 옮길 수 있게 되었다. 그러나 물건에 손바닥의 접촉이 요구는 잡기는 이전보다 더 어려웠고 일상에서 착용시 물이 닿으면 고정되지 못한다는 단점 또한 있었다. 본 연구는 3D 프린팅을 이용한 첫 보조기 적용 연구라는 점에서 의미가 있으며 앞으로 작업치료분야에서 3D 프린팅을 통해 다양한 환자 맞춤형 보조기가 개발될 수 있을 것이라 기대한다.

• 마케팅과학연구
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• 제18권4호
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• pp.157-194
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• 2008

온라인 커뮤니티에 대한 연구는 학자들과 실무자들의 많은 관심을 받아온 분야이다. 과거 많은 연구자들이 온라인 커뮤니티를 통해 큰 상업적 성과를 거둘 수 있다고 했지만 현실은 그렇지 못하며, 마케팅 연구 분야에서도 상업적 성공을 이끄는 변수들에 대한 연구가 많이 이루어지지 못한 것이 사실이다. 이러한 점에서 본 연구는 온라인 커뮤니티 사이트들이 콘텐츠 관련 마케팅 노력을 통해 소비자들의 자아일치성을 높이고, 긍정적 체험을 유도하면서 커뮤니티 사이트 내에서 소비자 간 상호작용성 등을 높여 결국, 커뮤니티 사이트의 방문충성도 및 구매충성도를 실현시킬 수 있는 프레임 웍을 제시하였다. 연구결과 온라인 커뮤니티 사이트에서 소비자 간 상호작용성이 방문충성도 그리고 특히 구매충성도의 구축에 매우 중요한 요인으로 밝혀졌고, 온라인 커뮤니티 사이트에 대한 자아일치성 지각 및 긍정적인 소비자 체험 또한 소비자의 상호작용성, 방문충성도 그리고 커뮤니티에 대한 애정에 상당히 중요한 요인임을 알 수 있었다. 또한 이러한 매개변수에 주된 영향요소로서 콘텐츠 우수성, 사이트 생동감, 네비게이션용이성, 고객화 등의 콘텐츠 관련 마케팅 노력의 역할의 중요성을 강조하였다.