• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.7-13
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• 2004

Purpose: The purpose of this study was to present the clinical analysis of the results and our experience of the replantation surgery of the great toe. Materials and Methods: Between March 1995 and December 2002, twelve great toes, amputated from the distal phalanx to proximal phalanx were replanted. The complete types were 5 cases and incomplete types were 7 cases. The guillotine injuries were 4 cases and the crushing injuries were 8 cases. Results: Replantation in eleven out of the twelve amputations survived. The cases of revision were 3 cases due to venous thrombosis. Patients were followed up for a mean period of 2.2 years. The mean total active motion of the first MTP joint was $80^{\circ}$. The fusion of IP joint was carried in 7 cases due to the amputation of the IP joint level. The shortening of the replanted great toes was present, with average 0.9cm. The two point discrimination was 7-8mm except 2 cases with loss of nerve. Conclusion: Although replantation of the great toe remains to be controversial, replantation of the great toe should be considered in well-motivated patients because successful replantation regains an important component of the foot and good functional, cosmetic results.

• 대한물리의학회지
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• 제7권1호
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• pp.77-85
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• 2012

Purpose : The purpose of this study was to investigate the effects of trunk exercises on the balancing ability of elderly Hansen's disease patients with lower extremity dysfunction. Method : A total of 24 elderly Hansen's disease patients were divided into two groups: 10 without lower extremity dysfunction and 14 with lower extremity dysfunction. The groups exercised for 60 minutes, two days a week, for a total 12 weeks; balancing ability was measured with the one leg standing test, tandem walking test, and timed up-and-go test. The patients were tested and their results were compared both before and after the completion of their exercise programs. Lower extremity dysfunction was assessed according to the following criteria: unilateral foot-drop, toe-loss, and below-knee amputation. Results : After the exercises, participants in both groups showed a positive, statistically significant difference in balance, compared with before the exercises (the one leg standing test, tandem walking test, and timed up-and-go test; p<.05). For comparison purposes, the group with dysfunction and the group without dysfunction were tested before and after the completion of their exercises. Before the exercises, there was a statistically significant difference in the one leg standing test, tandem walking test, and timed up-and-go test (p<.05). However, after the exercises, there was no significant difference in the one leg standing test, tandem walking test, and timed up-and-go test (p>.05). Conclusion : Ultimately, balancing ability was improved in both of the groups after trunk exercises were performed. Although balancing ability was improved, elements of lower extremity dysfunction remained, such as unilateral foot-drop, toe-loss, and below-knee amputation.

• Archives of Reconstructive Microsurgery
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• 제2권1호
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• pp.7-12
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• 1993

저자들은 우수 및 좌수의 제 2수지 결손을 주소로 고려대학병원 정형외과로 내원한 8명의 환자에 대하여 7례에서는 제 2족지, 1례에서는 반대편 제 4수지를 이용한 수지 재건술을 시행하여 다음과 같은 결과를 얻었다. 1. 대부분의 경우 수상원인은 기계적 손상에 의한 것이 8례중 7례를 차지하였다. 2. 수상후 수술까지의 기간은 평균 8년 3개월이었다. 3. 평균 수술시간은 5시간 58분이었으며, 이식족지의 평균 허혈시간은 1시간 52분이었다. 4. 피부편은 7례에서 생존하였으며, 술후 1년때 시행한 기능 평가에서 6례에서 양호이상의 결과를 보였다. 외상으로 인한 수지결손 환자에 있어서 족지를 이용한 수지 재건술은 한번의 수술로 미용 및 기능상으로 결손 수지의 기능을 회복할 수 있는 유용한 수술방법의 하나로 생각된다.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.101-107
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• 2008

Purpose: Free flaps from the great toe are an established method for reconstruction of absent or partially amputated thumbs. However, options differ as to which technique represents the ideal solution for each level of amputation. Various methods of distal thumb reconstruction have been proposed. We prefer to transplant the entire great toe nail complex with the almost all of the pulp rather than a portion of the nail. This paper reflects our experience in using the great toe mini wrap-around flap for distal thumb reconstruction. Materials and Methods: In the period from October of 2005 to July of 2007, 9 patients were treated for traumatic thumb defects localized at the distal phalanx of the thumb. The patients included seven men and two women. The mean age was 44 years (range, 21~60) and the dominant right hand was involved in seven of nine patients. Results: The transferred flaps have survived completely in all cases. The mean range of motion in the interphalangeal joints was 51o, with 73% of the normal uninjured opposite hands. The two-point discrimination was 10.5 mm (range, 5~13 mm). In Semmes-Weinstein monofilament test, the sensibility was 4.31 in 4 cases, 3.61 in 3 cases and 2.83 in 2 cases. The pinch power was 64% (range, 55~95%) of the opposite hand. All patients were satisfied with the appearance of the reconstructed thumb and felt comfortable at final follow-up. Conclusion: We have successfully reconstructed 9 cases of traumatic distal thumb defects using the mini wrap-around free flap. The mini wrap-around free flap in great toe is an excellent alternative method for distal thumb reconstruction in selected patients.

• 대한정형외과학회지
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• 제56권5호
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• pp.450-454
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• 2021

고혈압 이외에 급성 폐쇄동맥경화증의 내과적 위험요소가 없던 75세 남자 환자가 경한 발열을 동반한 기침, 호흡 곤란으로 내원하여 코로나바이러스감염증-19 진단을 받았다. 격리입원 치료를 시작한 지 1주일째에, 우측 족부의 동통 및 저린감을 호소하기 시작하였으며, 그 다음 1주일 동안 서서히 한랭감, 전족지의 색깔 변화와 족배동맥의 소실이 나타나게 되었다. 하지 혈관조영 3차원 컴퓨터 단층촬영 검사에서 좌, 우측 모두에서 슬와동맥 이하로 전, 후경골 동맥 및 비골동맥의 혈류가 관찰되지 않았으며, 우측 총장 골동맥 내부에 혈전이 생성되어 있는 모습을 확인할 수 있었다. 우측 하지에 대하여 경피적 풍선 혈관 성형술 및 스텐트 삽입술, 항응고제 투여를 시행하였으며, 시술 직후부터 우측 족배동맥의 맥박이 온전히 촉지되고, 호소하던 한랭감이 개선되었음을 확인하였다. 혈류가 개선되었음에도 불구하고 우측 족무지의 괴사는 회복되지 않아 결국 족무지 절단술을 시행하였다.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2005년도 심포지엄 논문집 정보 및 제어부문
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• pp.39-41
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• 2005

The population of diabetes is continuously increasing because of the economic development and the lifestyle modification. If diabetes become chronic condition, it can cause various complications. Among many other complications, diabetic foot is the most fatal issue since it may require amputation of the legs. Diabetic foot has three different types such as neuropathic, neuro-ischemic and ischemic. Among these types, patients of neuropathic foot experience sensory abnormality. Nerve conduction velocity (NCV) is used for diagnosing neuropathic foot but this method uses strong electric stimulus to cause severe pain to the patients In this study, two channel photo-plethysmography was used as noninvasive screening tool for distinguish neuropathic foot and normal group by observing blood flow of both finger and toe simultaneously.

• Journal of Chest Surgery
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• 제14권2호
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• pp.175-178
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• 1981

Since the first report by Freeman of renal artery repair for renovascular hypertension in 1954, there has been a gradual improvement in the results of renovascular reconstruction. This is case report of renovascular hypertension due to diffuse primary arteritis, which was performed aorto-bllateral renal bypass graft with using of Y -woven dacron graft. This 33 y-o male has complained intermittent headache, facial edema & malignent hypertension symptoms for 1.5 years. He had the history of Rt. B-K amputation due to unhealed wound after trauma of the Rt. great toe about 7 years ago. The abdominal aortography revealed nearly not visualized the Rt. renal artery & severe narrowing of the Lt. renal arterly. During postop. course, Blood pressure was well controlled. At postop. 3rd week, systolic pressure was down to 130-140mmHg But, diastolic pressure was remained to 100-110mmHg. At postop. 30th day, exploration was done due to intestinal obstruction signs. But severe ischemic enteritis was occured due to fibrotic obstruction of the superior mesenteric artery. The next day, he was dead. in spite of Rt. common iliac artery-sup. mesenteric artery bypass graft.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.143-148
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• 2001

전북대학교병원 정형외과에서 우측 제 1-5 수지가 모두 절단된 35세 남자에서, 우 수부 무지는 포장주위 피판(wrap around flap)시 제 1 배부 중수골동맥(the first dorsal metacarpal artery)의 고유 동맥(proper digital artery)을 제 1 배부 중족골 동맥(the first dorsal metatarsal artery)에, 두 정맥 분지(tributary of the cephalic vein)는 대 복재 정맥의 분지 (tributary of the greater saphenous vein)에 각각 문합하였고, 수부의 요골신경의 감각 분지는 거상된 포장 주위 피판의 심부비골 신경(deep peroneal nerve)에 신경 외막 봉합술을 시행하였다. 제 2, 3 수지 재건술에서는, 우 2, 3 족지의 족 배 동맥을 요골 동맥에, 대, 소 복재 동맥의 분지를 두 개의 두 정맥 분지에 각각 단-단 문합하였으며, 우 제 2, 3 족지의 표재 비골 신경을 요골 신경 분지에 신경 외막 봉합하였고, 동시에 우 제 2, 3족지의 지골 신경을 우 2, 3 수지의 지골 신경에 신경 외막 봉합하고 7년 추시하였으며, 우 수부 무지와 제 2, 3수지를 이용한 식사하기, 글씨 쓰기 그리고 양말 신기 등의 동작이 가능하였다.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.158-169
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• 2015

Purpose: Frostbite can affect still soldiers. Initial clinical manifestations are similar for superficial and deep frostbite, so early treatment is identical. It is under-estimated by physicians. We try to identify the challenges of managing these complex tissue injuries. Methods: A retrospective analysis of 84 patients hospitalized at AFCH from 2009 to 2015 was conducted. We investigated differences of epidemiological characteristics, identification of soft tissue injury, treatment and complications between superficial (SF: 43; 51.2%) and deep (DF: 41; 48.8%) frostbite. Results: The major (94.0%) developed frostbite in dry circumstances (89.3%). Wet circumstances (66.7%) were more susceptible to DF rather than dry (46.7%). The 38 (45.2%) arrived to specialist within 7days. Most prone sites were feet, followed by hands. Toes had more deep injuries. DF presented more increased levels of ALT, CPK, CKMB, CRP. The bone scan of W+S+ was 48.3%, 87.1% and W+S- was 20.7%, 12.9%, respectively. The treatment resulted in improved or normalized perfusion scan with matching clinical improvement. It was a good tool to assess treatment response. Eighteen normal and 8 stenotic type of PCR resulted in normal with matching clinical improvement. One continuous obstructive waveform led to minor amputation. Twelve underwent both PCR and MRA. Among 6 normal PCR, 5 showed normal and one stenosis in MRA. All 5 stenosis and one obstruction showed the same findings in MRA. It was a good tool to evaluate vascular compromise. They were treated with rapid rewarming (11.6%, 22.0%), hydrotherapy (16.3%, 29.3%), respectively. Six (14.6%) underwent STSG, 2 (4.9%) had digital amputation in DF. Berasil, Ibuprofen, Trental were commonly administered. PGE1 was administered selectively for 6.8, 10.8 days, respectively. Raynaud's syndrome (16.3%), CRPS (4.7%), LOM (14.6%) and toe deformity (4.9%) were specific sequelae. Conclusion: We should recommend intensive foot care education, early rewarming and evacuation to specialized units. The bone scanning and PCR should allow for a more aggressive and active approach to the management of tissue viability.

• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.72-80
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• 1994

저자들은 수무지 절단 및 연부조직 결손을 주소로 고려대학병원 정형외과로 내원한 환자들을 대상으로 30례의 족무지 유리피부편을 이용한 수무지 재건술을 시행하고 비교적 장기간의 추시 관찰을 시행한 바 다음과 같은 결과를 얻었다. 1. 총 30례중 1례를 제외한 29례에서 이식이 성공하였으며 미용적 측면과 기능적인 면에서 모두 우수한 결과를 얻을 수 있었다. 2. 합병증으로 1례에서 이식실패, 6례에서 부분피부괴사, 1례에서 부정유합, 15례에서 이식골의 흡수가 있었으며 그중 1례에서 피로 골절이 관찰되었다. 3. 제1수장골 경부 절단시에도 수무지의 재건이 가능하였으나 무지 운동성의 제한과 많은 이식골의 골흡수가 문제점으로 제시되었다. 이상에서 족무지 유리 피부편을 이용한 수무지 재건술은 수무지 절단환자에 있어 미용상 및 기능적인 면에 있어 우수하며 공여부에도 비교적 결손이 적은 추천할 만한 수술법으로 사료되며 또한 술자는 합병증의 방지를 위하여 세심한 주의를 기울여야 할 것이며 미세수술수기에도 숙달되어야 할 것이다.