Reconstruction of Soft Tissue Defects after Snake Bites (뱀교상 후 발생한 연부조직 결손의 재건)
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- Archives of Plastic Surgery
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- v.36 no.5
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- pp.605-610
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- 2009
Purpose: Substantial tissue necrosis after snake bites requiring coverage with flap surgery is extremely rare. In this article, we report 7 cases of soft tissue defects in the upper and the lower extremities caused by snake bites, which needed to be covered with flaps. Among the vast mass of publications on snake bites there has been no report that focuses on flap coverage of soft tissue defects due to snake bite sequelae. Methods: Seven cases of soft tissue defects with tendon, ligament, or bone exposure after snake bites were included. All patients were males without comorbidities, the average age was 35 years. All of them required coverage with a flap. In 6 cases, the defect was localized on the upper extremity, in one case the lesion was on the lower extremity. Local flaps were used in 6 cases, one case was covered with a free flap. The surgical procedures included one kite flap, one cross finger flap and digital nerve reconstruction with a sural nerve graft, one reverse proximal phalanx island flap, one groin flap, one adipofascial flap, one neurovascular island flap, and one anterolateral thigh free flap. The average interval from injury to flap surgery was 23.7 days. Results: All flaps survived without complication. All patients regained a good range of motion in the affected extremity. Donor site morbidities were not observed. The case with digital nerve reconstruction recovered a static two point discrimination of 7 mm. The patient with foot reconstruction can wear normal shoes without a debulking procedure. Conclusion: The majority of soft tissue affection after snake bites can be treated conservatively. Some severe cases, however, may require the coverage with flap surgery after radical debridement, especially, if there is exposure of tendon, bone or neurovascular structures. There is no doubt that definite coverage should be performed as soon as possible. But we also want to point out that this principle must not lead to a premature coverage. If the surgeon is not certain that the wound is free of necrotic tissue or remnants of venom, it is better to take enough time to get a proper wound before flap surgery in order to obtain a good functional and cosmetic result.
Objective: This study was conducted to assess the level of pregnancy-associated glycoprotein (PAG) in whole and skim milk samples, and its suitability for early pregnancy diagnosis in goats. Methods: A two-step sandwich enzyme-linked immunosorbent assay (ELISA) system for estimation of milk PAG was developed and validated, which employed caprine-PAG specific polyclonal antisera. Whole and skim milk samples (n = 210 each) from fifteen multiparous goats were collected on alternate days from d 10 to d 30, and thereafter weekly till d 51 post-mating. PAG levels in milk samples were estimated by ELISA and the pregnancies were confirmed at d40 post-mating by transrectal ultrasonography (TRUS). Results: The level of PAG in whole and skim milk samples of both pregnant and nonpregnant goats remained below the threshold values until d 24 after mating. Thereafter, PAG concentration in whole and skim milk increased steadily in pregnant goats, whereas it continued below the threshold in non-pregnant does. The PAG profiles in whole and skim milk of pregnant goats were almost similar and exhibited strong positive relationship (r = 0.891; p<0.001). Day 26 post-mating was identified as the first time-point for significantly (p<0.05) higher milk PAG concentration in pregnant goats than to non-pregnant goats. When compared to TRUS examination for pregnancy diagnosis, the accuracy and specificity of PAG ELISA using whole and skim milk samples were 94.5% and 95.4%; and 95.3% and 100%, respectively. The high values of area-under-curve (0.904 [whole milk] and 0.922 [skim milk]), demonstrate outstanding discrimination ability of the milk assays. Among the sampling dates chosen, d 37 post-mating was identified as the best suitable time point for collection of milk samples to detect pregnancy in goats. Conclusion: The PAG concentration in whole and skim milk of goats collected between days 26 and 51 post-breeding can be used for the accurate prediction of pregnancy and may be useful for assisting management decisions in goat flocks.
Free flap reconstruction of the foot has become one of the standard procedures at the present time, but choice of a free flap for the soft tissue defect of the foot according to location and size remains controversial. We evaluated the results of free flap reconstruction for the soft tissue defects of the foot. Twenty seven free flaps to the foot were performed between May 1986 and December 2000 in the department of Orthopedic Surgery. Patient age ranged from 3 to 60 years. Male to female distribution was 20:7. Mean follow-up period was 30.5 months which ranged from 12 months to 60 months. The indications for a specific flap depended on the location and extension of the foot defect. In weight-bearing area and amputation stump, the authors chose the sensate (reinnervated) dorsalis pedis flaps (n=7) and sensate radial forearm flaps (n=2). In nonweight-bearing area including dorsum of the foot and area around Achilles tendon, we performed nonsensate (non-reinnervated) free flap reconstructions which included dorsalis pedis flaps (n=5), groin flap (n=1), radial forearm flaps (n=6), scapular flaps (n=4), latissimus dorsi flaps (n=2). Twenty-six flaps transferred successfully (96.3%). The sensate flaps which were performed in weight-bearing area and amputation stumps survived in all cases and recovered protective sensation. Mean two-point discrimination was 26 mm at the last follow up. As a conclusion, the selection of a proper flap depends on the location and extension of the foot defect and patient's age. Fasciocutaneous flap including radial forearm flaps and dorsalis pedis flaps were the best choice in nonweight-bearing area. The sensate free flaps which are performed in the weight-bearing area and amputation stumps can produce better outcome than nonsensate free flap.
Purpose: The purpose of this study is to present extended indications for the use of arterialized venous flaps in reconstructing soft tissue, tendon, nerve, blood vessel, and composite tissue defects of the hand of various sizes based on researches and clinical experiences of the authors. Moreover, procedures to achieve complete flap survival and postoperative results are presented. Materials & methods: This study is based on 154 cases of arterialized venous flaps performed to reconstruct the hand during the past 11 years. The most common cause of injury was industrial accidents with 125 cases. One hundred thirty patients or 84% of the cases had emergency operation within 2 weeks of the injury. The flaps were categorized depending on the size of the flap. Flaps smaller than
Purpose: First introduced by Buncke and Rose in 1979, the neurovascular partial
Pending issues present in the Nation Technical Qualifications System (NTQS) have been discussed to deal with the causes and improvements of the issues. The key present situations of the NTQS were investigated to analyze the problems of the NTQS. The acquisition distribution of the items of additional points in employment and the items applied to the laws and regulations of duty employment was revealed to be related with preferential items. The AHP analysis has been conducted based on issues for improvement of the NTQS raised till now. The urgency priority of the elements to be improved was ranked according to the AHP analysis result. The agendas for the improvement of the NTQS was suggested by consideration of the priority of the elements. First, a solution to raise discrimination of the NTQS was suggested by taking the view points of the experts into account. Second, an opinion was proposed that the preferential policies in employment should be directed toward expansion of qualification for duty employment. Third, two ideas were proposed to rectify problems embedded in the technician career handbook system. And four remedies have been made suggested, including the merger of similar events. The results of this research are expected to serve as a useful material for the future design of the NTQS.
Background and Objectives: Surgical ablation of tumors in the oral cavity and the oropharynx results in a three dimensional defect because of the needs to resect the adjacent area for the surgical margin. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for this defect, which offers a thin, pliable, and relatively hairless skin and a long vascular pedicle. We report the clinical results of our 54 consecutive radial forearm free flaps used for oral cavity and oropharynx cancers. Materials and Methods: We reviewed the medical records of patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for oral cavity and oropharyngeal cancers from August 1994 to February 2003 and analyzed surgical methods, flap survival rate, complication, and functional results. Among these, 20 cases were examined with modified barium swallow to evaluate postoperative swallowing function and other 8 cases with articulation and resonance test for speech. We examined recovery of sensation with two-point discrimination test in 15 cases who were offered sensate flaps. Results: The primary sites were as follows : mobile tongue (18), tonsil (17), floor of mouth (4), base of tongue (2), soft palate (2), retromolar trigone (3), buccal mucosa (1), oro-hypopharynx (6), and lower lip (1). The paddles of flaps were tailored in multilobed designs from oval shape to tetralobed design and in variable size according to the defects after ablation. This procedures resulted in satisfactory flap success rate (96.3%) and showed good swallowing function and social speech. Eight of 15 cases (53.3%) who had offered sensate flap showed recovery of sensation between 1 and 6 postoperative months (average 2.6 month). Conclusion: The reconstruction with radial forearm free flap might be an excellent method for the maximal functional results after ablative surgery of oral cavity and oropharyngeal cancers that results in multidimensional defect.
The purpose of this study is to validate the Reactive-Proactive Aggression Questionnaire (RPQ), a tool for measuring reactive-proactive aggression, in the context of South Korea. A thorough translation was conducted in collaboration with the original author. An exploratory factor analysis (EFA), exploratory structural equation modeling (ESEM), rating scale model (Rasch), differential item functioning (DIF), and convergent validity were performed on a sample of 510 South Korean individuals. The results revealed a two-factor structure of reactive and proactive aggression after removing one item showing dual loading. Rating scale analysis based on the Rasch model indicated the appropriateness of the 3-point Likert scale, with all items meeting fit criteria. Although the separation index and separation reliability of proactive aggression was marginally lower, the overall discrimination between participants and items was satisfactory. Examination of participant-item distribution indicated a suitable alignment between reactive aggression and participant ability levels, whereas proactive aggression exhibited slightly elevated item difficulty. Furthermore, three items were found to function differently based on gender. A moderate but statistically significant positive correlation was found between the Barratt Impulsiveness Scale-11-R (Korean version) and RPQ from the results of the convergent validity evaluation. Overall, this study employed rigorous statistical methods to validate the suitability of the RPQ for use in Korea, taking cultural nuances into account, and introduced the concepts of reactive and proactive aggression to the Korean general population.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70