• 제목/요약/키워드: Zone of injury

검색결과 90건 처리시간 0.028초

수부 손상에서 정맥이식의 유용성 (Usefulness of Venous Graft in Hand Injury)

  • 이학승;김연환;김창연;김정태;안희창
    • Archives of Plastic Surgery
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    • 제37권4호
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    • pp.396-399
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    • 2010
  • Purpose: In hand injury, pedicle is usually damaged by avulsion injury or crushing injury. Because of postoperative pedicle obliteration, it is often hard to save the injured hand and fingers, even after successful replantation. The author introduces three cases of extensive hand injury, and successful results after applicatoin of multiple venous grafts to these patients. Methods: In all cases there was no circulation in any finger. In the first case, some vessels were extracted, so venous graft was applied to two sites of severely damaged venous sites. In the second case, venous grafts were applied to all four digital arteries of all fingers except thumb which got severely crushed, and two sites of dorsal veins. In the third case, venous graft was applied to all four digital arteries of all five fingers, and two sites of dorsal veins and palmar veins each. Results: In all cases, survival of hands and fingers was successful. In the second case, however, amputation in thumb and little finger at DIP joint level was inevitable, because of its severe damage, and the large dorsal defect on index finger was filled with DIEP free flap. Thumb was reconstructed with toe-to-thumb free flap, and additional debulking procedures and contracture release is furtherly needed. In the first case, additional surgery was done, as FDP tendon got re-ruptured, but in long term follow-up, satisfactory range of motion was attained. In the third case, FTSG on dorsal skin region was planned. as flap on dorsal area got partial necrosis. Conclusion: In hand injury, there are many structures to be repaired, but sometimes venous graft is avoided for its long operating time. Even though the length of damaged vessel is enough for anastomosis, the endothelium is often damaged (zone of injury). In extensive hand injury, successful reconstruction would be possible with active venous graft to all vessels suspicious for damage.

제 5중족골 근위부 골절과 동반된 족관절, 족부 손상과 유형 (Ankle and Foot Injuries Accompanying 5th Metatarsal Fractures)

  • 이효범;박진호;이채호;김갑래
    • 대한족부족관절학회지
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    • 제26권4호
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    • pp.163-170
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    • 2022
  • Purpose: The proximal fifth metatarsal fracture is one of the most common foot fractures. However, few studies have evaluated the associated injuries in patients with a proximal fifth metatarsal fracture. The purpose of this study was to investigate the incidence of foot and ankle joint injuries associated with proximal fifth metatarsal fractures and compare the incidence of these injuries based on the injury mechanisms and location of the fracture. Materials and Methods: This retrospective study included 157 patients with a proximal fifth metatarsal fracture who underwent surgery from January 2014 to August 2021. Their medical records and radiology images were reviewed to classify and analyze the associated injuries. The proximal fifth metatarsal fractures were classified using Lawrence and Botte's classification. Injury mechanisms were divided into direct and indirect injuries. The incidence of injuries was statistically analyzed according to the injury mechanism and classification. Results: Of the 157 patients with proximal fifth metatarsal fractures, 81 (51.6%) were diagnosed with foot and ankle joint injuries. The incidence of foot injuries was 65.4%, that of ankle joint injuries was 19.8%, and of both foot and ankle joint injuries was 14.8%. In patients with direct injuries, the incidence of foot and ankle joint injuries was 82.5% and that of indirect injuries was 41.0%. Statistical differences were observed between the incidence of direct and indirect injuries (p<0.001). The incidence of injuries, according to Lawrence and Botte's classification, was 54.9% (Zone I), 41.2% (Zone II), and 50.0% (Zone III) respectively. However, there were no statistically significant variations in the locations of the proximal fifth metatarsal fractures (p=0.051). Conclusion: In this study, the incidence of foot and ankle joint injuries associated with proximal fifth metatarsal fractures was found to be high. Therefore, a careful physical examination and appropriate radiological evaluation are recommended for patients with such fractures.

척수 손상 환자의 중추성 통증에 대하여 시행한 Microsurgical DREZotomy의 효과 (Microsurgical DREZotomy for Treatment of Intractable Central Pain in Patient with Spinal Cord Injury)

  • 이지인;김성호;안상호;장성호
    • Journal of Yeungnam Medical Science
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    • 제19권1호
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    • pp.49-54
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    • 2002
  • 척수손상 환자에게 동반되는 통증은 흔하지만 치료에 잘 반응하지 않고 환자들의 일상생활에 더욱 장애를 줄 수 있는 합병증의 하나로 알려져 있다. 3년 전 외상성 척수손상으로 인하여 불완전 하지 마비 소견을 보였던 52세 된 남자 환자로 손상 직후부터 발생된 양측 T10위치의 분절통과 손상 1개월 후부터 발생된 양하지 통증이 있어 약물요법, 물리치료, 및 운동치료 등의 여러 가지 치료를 시행하였으나 치료에 잘 반응하지 않아 DREZ(Dorsal Root Entry Zone)otomy 수술을 시행한 후 분전통이 호전된 증례가 있어 이를 보고하고자 하였다. 보존적 치료에 잘 반응하지 않는 척수손상 후 통증의 경우 DREZotomy 수술도 도움이 될 것으로 사료된다.

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둔상에 의한 흉부대동맥 손상에서 TEVAR에 관한 임상연구 (Clinical Analysis of TEVAR in Blunt Thoracic Aortic Injury)

  • 구관우;최진호;최민석;박상순;설영훈;고승제;예진봉;김중석;김영철;황정주
    • Journal of Trauma and Injury
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    • 제28권4호
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    • pp.232-240
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    • 2015
  • Purpose: Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury. Methods: Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014. Results: Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was $105.64{\pm}24.60mm\;Hg$, and the mean heart rate was $103.64{\pm}20.02per$ minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was $21.82{\pm}16.37hours$. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur. Conclusion: Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.

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Cross-Leg Free Flap: Crossing the Border Zone of Ischemic Limb-A Case Report of Limb Salvage Procedure following a Delayed Diagnosis of Popliteal Artery Injury

  • Hui Yuan Lam;Wan Azman Wan Sulaiman;Wan Faisham Wan Ismail;Ahmad Sukari Halim
    • Archives of Plastic Surgery
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    • 제50권2호
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    • pp.188-193
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    • 2023
  • Vascular injury following traumatic knee injury quoted in the literature ranges from 3.3 to 65%, depending on the magnitude and pattern of the injury. Timely recognition is crucial to ensure the revascularization is done within 6 to 8 hours from the time of injury to avoid significant morbidity, amputation, and medicolegal ramifications. We present a case of an ischemic limb following delayed diagnosis of popliteal artery injury after knee dislocation. Even though we have successfully repaired the popliteal artery, the evolving ischemia over the distal limb poses a reconstruction challenge. Multiple surgical debridement procedures were performed to control the local tissue infection. Free tissue transfer with chimeric latissimus dorsi flap was done to resurface the defect. However, the forefoot became gangrenous despite a free muscle flap transfer. His limb appeared destined for amputation in the vicinity of tissue and recipient vessels, but we chose to use a cross-leg free flap as an option for limb salvage.

농업 기후 지대 구분과 기상 재해 특성 (Agroclimatic Zone and Characters of the Area Subject to Climatic Disaster in Korea)

  • 최돈향;윤성호
    • 한국작물학회지
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    • 제34권s02호
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    • pp.13-33
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    • 1989
  • 농업기후는 적지 적작을 통하여 주어진 기후자원을 최대한 활용한다는 의미에서 더욱 정밀하게 분석되고 평가되어야 한다. 작물 생산의 안정성 증대와 생산비 절감을 도모하기 위해서는 작물별로 농업기후 지대를 구분하여, 지대별로 알맞은 품종과 재배 기술을 도입 실시하는 것이 바람직하다. 농업기후지대 구분은 농업생산을 지배하는 기온, 강수량, 일조, 습도, 바람 등 작물의 생육과 수량에 직접적으로 영향을 미치는 기후요소들을 종합적으로 평가하여 지대를 구분한다. 벼재배를 위한 농업기수지대는 이앙기의 강수량과 한발지수, 생육 유효 온도(15$^{\circ}C$ 이상)의 출현시기와 지속기간(작물기간), 생육 단계별 저온 출현율을 비롯하여 기온, 일조시수 등의 분석과 종합 판단을 통하여 비슷한 지역을 하나의 지대로 묶어 구분한다. 구분된 우리나라의 벼재배 농업기후 지대는 19개 지대로서, (1) 태백고령지대, (2)태백준고령지대, (3)소백산간지대, (4) 노령소백산간지대, (5)영남내륙산간지대, (6) 중북부내륙지대, (7) 중부내륙지대, (8) 소백서부내륙지대, (9) 노령동서내륙지대, (10) 호남내륙지대, (11) 영남분지지대, (12) 영남내육지대, (13) 중서부평야지대, (14) 차령남부평야지대, (15) 남서해안지대, (16) 남부해안지대, (17) 동해안북부지대, (18) 동해안중부지대, (19) 동해안남부지대이다. 한편 작부농계를 위한 농업기후지대는 벼재배 농업기후지대를 바탕으로 하고, 각 지대별로 여름 작물과 겨울 작물을 위한 기후요소들과 전래되어온 작부농계를 고려하여 9개 지대로 구분하였다. 9개의 작부농계 농업기후지대는 (I) 산간고령지대, (II) 산간지대, (III) 중북부내륙지대, (IV)중북부서부해안지대, (V) 중남부서부해안지대, (VI) 경북내륙지대, (VII) 남부내륙지대, (VIII) 남부해안지대, (IX)동해안지대 등이다. 농업기후지대별 농업기상재해의 특성은 벼 이앙기에 한발지수 1.4 이상을 보인 (11) 영남분지지대, 동해안의 북부(17)와 중부(18) 지대 등이 가뭄 상습지로 나타났고, 냉해 위험지대에는 (2)태백준고냉지대가 포함된다. 태풍과 집중호우에 의한 피해가 년평균 4회 이상인 지대는 (10) 호남내륙지대, (15) 남서해안지대, (16) 남부해안지대로서 강수량분포와 태풍 진로와 관계가 깊다. 그 다음으로 년2~3회 풍수재를 입게 되는 지대는 동해안의 (17), (18), (19) 지대인데, 이 지대는 한발, 냉해, 풍수해가 겹친 지대이다.

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복부와 경부 관통상 환자에 대한 임상적 고찰 (Clinical Analysis of Patients with Abdomen or Neck-penetrating Trauma)

  • 노하니;김광민;박준범;류훈;배금석;강성준
    • Journal of Trauma and Injury
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    • 제23권2호
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    • pp.107-112
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    • 2010
  • Purpose: Recently, the change to a more complex social structure has led to an increased frequency of traumas due to violence, accident and so on. In addition, the severity of the traumas and the frequency of penetrating injuries have also increased. Traumas to cervical and abdominal areas, what are commonly seen by general surgeons, can have mild to fatal consequences because in these areas, various organs that are vital to sustaining life are located. The exact location and characteristics of the injury are vital to treating patients with the trauma to these areas. Thus, with this background in mind, we studied, compared, and analyzed clinical manifestations of patients who were admitted to Wonju Christian hospital for penetrating injuries inflicted by themselves or others. Methods: We selected and performed a retrospective study of 64 patients who had been admitted to Wonju Christian Hospital from January 2005 to December 2009 and who had cervical or abdominal penetrating injuries clearly inflicted by themselves or others. Results: There were 51 male (79.7%) and 13 female (20.3%) patients, and the number of male patients was more dominant in this study, having a sex ratio of 3.9 to 1. The range of ages was between 20 and 86 years, and mean age was 43.2 years. There were 5 self-inflicted cervical injuries, and 19 self-inflicted abdominal injuries, making the total number of self-inflicted injury 24. Cervical and abdominal injuries caused by others were found in 11 and 29 patients, respectively. The most common area involved in self-inflicted injuries to the abdomen was the epigastric area, nine cases, and the right-side zone II was the most commonly involved area. On the other hand, in injuries inflicted by others, the left upper quadrant of the abdomen was the most common site of the injury, 14 cases. In the neck, the left-side zone II was the most injured site. In cases of self-inflicted neck injury, jugular vein damage and cervical muscle damage without deep organ injury were observed in two cases each, making them the most common. In cases with abdominal injuries, seven cases had limited abdominal wall injury, making it the most common injury. The most common deep organ injury was small bowel wounds, five cases. In patients with injuries caused by others, six had cervical muscle damage, making it the most common injury found in that area. In the abdomen, small bowel injury was found to be the most common injury, being evidenced in 13 cases. In self-inflicted injuries, a statistical analysis discovered that the total duration of admission and the number of patients admitted to the intensive care unit were significantly shorter and smaller, retrospectively, than in the patient group that had injuries caused by others. No statistically significant difference was found when the injury sequels were compared between the self-inflicted-injury and the injury-inflicted-by-others groups. Conclusion: This study revealed that, in self-inflicted abdominal injuries, injuries limited to the abdominal wall were found to be the most common, and in injuries to the cervical area inflicted by others, injuries restricted to the cervical muscle were found to be the most common. As a whole, the total duration of admission and the ICU admission time were significantly shorter in cases of self-inflicted injury. Especially, in cases of self inflicted injuries, abdominal injuries generally had a limited degree of injury. Thus, in our consideration, accurate injury assessment and an ideal treatment plan are necessary to treat these patients, and minimally invasive equipment, such as laparoscope, should be used. Also, further studies that persistently utilize aggressive surgical observations, such as abdominal ultrasound and computed tomography, for patients with penetrating injuries are needed.

원위 수지 재접합술 뒤 간헐적 실혈 요법 (Intermittent Bleeding Method after Replantation o the Distal Phalanx)

  • 이병호;박찬일;이준모
    • Archives of Reconstructive Microsurgery
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    • 제20권1호
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    • pp.38-42
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    • 2011
  • Purpose: To evaluate the effect of intermittent bleeding method in the distal phalanx replantation. Materials and Methods: From January 2007 through June 2009, authors have replanted 117 cases of distal phalangeal amputation in adults at Soo Hospital and Chonbuk National University Hospital. Cases of zone II were 60 cases and zone III 57 according to Allen classification. Male to female ratio was 8.7:1.3. The most common cause was machinery injury in the factory, 98 cases(83.8%), next one was belt injury of the machine, 11 cases(9.4%) and others, 8(6.8%). At least one digital artery and digital nerve were anastomosed under the operating microscope, but vein was impossible to anastomosis as unable to find out in the zone II and III. After anastomosis of one or more digital arteries and nerves, heparine(6,000-10,000 units) was kept to intravenous injection for 24 hours and at the same time fish mouth incision in 2-3 millimeter diameter was made in the distal radial and ulnar margin of the replanted distal phanlanx. From the first 30 minutes to an hour after replantation, incision site was swabbed with heparinized cotton ball for 5 minutes in every 30 to 40 minutes to make sure perfusion for 24 hours, every an hour at the second day, every two hours at the postoperative third to fifth day. Results: 92 cases(78.6%) was completely survived at average postoperative third week follow-up and satisfied with preservation of the finger nail, digit length, good range of motion of the distal interphalangeal joint and acceptable sensibility at average 1.2 years follow-up. Conclusions: Intermittant bleeding method in replantation of crushed distal phalanx impossible to anastomosis of vein at zone II and III of Allen classification was regarded as one of the notable salvage procedure.

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