• Archives of Plastic Surgery
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• 제42권1호
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• pp.73-77
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• 2015

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

• The Korean Journal of Pain
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• 제8권1호
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• pp.164-167
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• 1995

대상포진후 신경통으로 체성신경 차단과 함께 성상신경절 차단을 반복적으로 받아오던 64세 여자환자에서 열세번째 우측 성상신경절 차단후 반대측인 좌측에 호너씨 증후군이 발생되었다. 그 원인은 명확하지 않지만 시술 도중 환자머리의 좌측회전으로 인한 해부학적 위치변화와 술자의 부정확한 지표선정 및 주사바늘의 안쪽방향등으로 약제가 중앙선을 넘어 주입된 것으로 추정할수 있다.

• Clinics in Shoulder and Elbow
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• 제25권3호
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• pp.240-243
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• 2022

Isolated deltoid paralysis is a rare pathology that can occur after axillary nerve injury due to shoulder trauma or infection. This condition leads to loss of deltoid function that can cause glenohumeral instability and inferior subluxation, resulting in rotator cuff muscle fatigue and pain. To establish dynamic glenohumeral stability, a novel technique was invented. Humeral suspension is achieved using a double button implant with non-resorbable high strength cords between the acromion and humeral head. This novel technique was used in two patients with isolated deltoid paralysis due to axillary nerve injury. The results indicate that the humeral suspension technique is a method that supports centralizing the humeral head and simultaneously dynamically stabilizes the glenohumeral joint. This approach yielded high patient satisfaction and reduced pain. Glenohumeral alignment was improved and remained intact 5 years postoperative. The humeral suspension technique is a promising surgical method for subluxated glenohumeral joint instability due to isolated deltoid paralysis.

• The Korean Journal of Pain
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• 제25권3호
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• pp.168-172
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• 2012

Background: The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). Methods: Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block. Results: The average NRS was decreased from $4.8{\pm}0.6$ to $0.6{\pm}0.5$ after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of $15.1{\pm}2.2$ ($11-19^{\circ}$) and a caudal angle of $15.4{\pm}1.7^{\circ}$ ($12-18^{\circ}$). The average distance from the skin to the scapular notch was $5.8{\pm}0.6$ cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block. Conclusions: SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.105-115
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• 2016

Purpose: While all midshaft clavicle fractures have traditionally been treated with conservative measures, recent operative treatment of displaced, communited midshaft clavicle fractures has become more common. Though a recent increase in operative treatment for midshaft clavicle fractures, we have done the operative methods in limited cases. The aim of this study is to present indications, operative techniques and outcomes of the experienced cases that have applied to this limited group over the previous 10 years. Methods: This study consists of a retrospective review of radiological and clinical data from January of 2005 to July of 2015. Operative criteria for midshaft clavicle fractures having considerable risk of bone healing process were 4 groups - a floating shoulder, an open fracture, an associated neurovascular injury, and a nonunion case after previous treatment. Results: The study consisted of 18 patients who had operative treatment for midshaft clavicle fractures in adults. The most common surgical indication was a floating shoulder (10 cases, 55.6%), followed by nonunion (5 cases, 27.8%), an associated neurovascular injury (4 cases, 22.2%), and open fracture (3 cases, 16.7%). All cases were treated by open reduction and internal fixation in anterosuperior position with reconstruction plate or locking compression plate. Bone union was achieved in all cases except 1 case which was done bone resection due to infected nonunion. Mean bone union period was 19.5 weeks. There were no postoperative complications, but still sequelae in 4 cases of brachial plexus injury. Conclusion: We have conducted an open reduction and internal fixation by anterosuperior position for midshaft clavicle fractures in very limited surgical indications for last 10 years. Our treatment strategy for midshaft clavicle fractures showed favorable radiological results and low postoperative complications.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.644-649
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• 2010

Purpose: As the mean life expectancy of people has been prolonged, and the elderly people who participate in the production activities has been increasing, it is expected that the demand on the replantation of amputated digits in elderly patients would increase. But, there are few studies about the replantation of amputated digits in elderly patients. Therefore, we report treatment outcomes of replantation of amputated digits in elderly patients. Methods: From 1998 to 2008, the replantation was performed in 51 completely amputated digits of 33 patients aged 60 years or older. We performed the replantation in the usual manner. Under the brachial plexus block, the surgical procedures carried out in the following sequence: internal fixation using Kirschner wire, tenorrhaphy, arteriorrhaphy, neurorrhaphy and venorrhaphy. If the arterial ends could not be approximated without tension, a vein graft was performed. Results: Of a total of 51 digits, 46 digits (90%) survived. 13 patients (40%) had underlying medical problem preoperatively. But, in all the patients, there were no postoperative medical complications. As the postoperative surgical complications, excluding five cases of the total necrosis of digit, there were three cases of venous congestion, two cases of arterial insufficiency, seven cases of infection and 16 cases of partial necrosis. Conclusion: Age alone does not affect the survival of replanted digits. Type of injury is the most important factor that affects the survival of replanted digits.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.50-55
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• 2010

Injury of the musculocutanous nerve can be associated with a proximal humeral fracture or shoulder dislocation, and injury of the brachial plexus. However, injury of this nerve associated with a humeral shaft fracture has rarely been reported. Diagnosis of the musculocutaneous nerve injury is difficult because its sensory loss is ill-defined, and examination of elbow flexion is difficult when it is associated with fractures. We report an unusual case of musculocutaneous nerve injury in a 27 years old woman who had multiple injuries including a humerus shaft fracture, an ipsilateral radius shaft fracture, and an associated radial nerve laceration. Diagnosis of the musculocutaneous nerve injury was delayed because combined fractures of the humerus and radius prevented proper examination of the elbow motion and nerve grafting of the radial nerve delayed early elbow motion exercise. Delayed exploration of the musculocutaneous nerve 6 months after trauma showed complete rupture of the nerve at its entry into the coracobrachialis muscle and the defect was successfully managed by sural nerve graft.

• 대한골관절종양학회지
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• 제11권1호
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• pp.105-109
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• 2005

제 2형 신경섬유종증(Neurofibromatosis)의 임상적 특징 없이 말초에 발생한 티넬징후를 보이는 다발성신경초종(Schwannomatosis) 3례를 경험하여 이를 보고하고자 한다. 주증상은 동통이었으며 3예에서 청장년에서 발생하였다. 발생부위는 상완신경총, 슬와부 그리고 수부였다. 상기 환자 모두에서 이명과 현훈 및 시력저하소견 관찰되지 않았으며 가족력은 없었다. 3예에서 모두에서 두부 자기공명영상 촬영상 전정신경초종(Vestibular schwannoma)이 관찰되지 않았다. 병리소견상 신경초종이 확인되었다. 앞으로 더 많은 증례의 수집과 연구로 다발성 신경초종의 임상양상, 임상경과 그리고 유전학적 특징에 대한 추가적인 연구가 필요할 것으로 사료된다.

• The Korean Journal of Pain
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• 제28권1호
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• pp.45-51
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• 2015

Background: Arthroscopic shoulder operations (ASS) are often associated with severe postoperative pain. Nerve blocks have been studied for pain in shoulder surgeries. Interscalene brachial plexus blocks (ISB) and an intra-articular injection (IA) have been reported in many studies. The aim of the present study is to evaluate the effect of ISB, a continuous cervical epidural block (CCE) and IA as a means of postoperative pain control and to study the influence of these procedures on postoperative analgesic consumption and after ASS. Methods: Fifty seven patients who underwent ASS under general anesthesia were randomly assigned to one of three groups: the ISB group (n = 19), the CCE group (n = 19), and the IA group (n = 19). Patients in each group were evaluated on a postoperative numerical rating scale (NRS), their rescue opioid dosage (ROD), and side effects. Results: Postoperative NRSs were found to be higher in the IA group than in the ISB and CCE groups both at rest and on movement. The ROD were $1.6{\pm}2.3$, $3.0{\pm}4.9$ and $7.1{\pm}7.9$ mg morphine equivalent dose in groups CCE, ISB, and IA groups (P = 0.001), respectively, and statistically significant differences were noted between the CCE and IA groups (P = 0.01) but not in between the ISB and CCE groups. Conclusions: This prospective, randomized study demonstrated that ISB is as effective analgesic technique as a CCE for postoperative pain control in patients undergoing ASS.

• Clinics in Shoulder and Elbow
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• 제23권3호
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• pp.144-151
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• 2020

Background: This study was designed to evaluate characters of the rotator cuff tear (RCT) recognized after primary shoulder dislocation in patients older than 40. Methods: From 2008 to 2019, patients who visited two hospitals after dislocation were retrospectively reviewed. Inclusion criteria were patients over 40 who had dislocation, with magnetic resonance imaging (MRI) undergone. Exclusion criteria were patients who lost to follow-up, combined with any proximal humerus fracture, brachial plexus injury, and previous operation or dislocation history in the ipsilateral shoulder. Also patients who had only bankart or bony bakart lesion in MRI were excluded. We evaluated RCTs that were recognized by MRI after the primary shoulder dislocation with regard to tear size, degree, involved tendons, fatty degeneration, the age when the first dislocation occurred, and the duration until the MRI was evaluated after the dislocation. Results: Fifty-five RCTs were included. According to age groups, the tear size was increased in coronal and sagittal direction, the number of involved tendons was increased, and the degree of fatty degeneration was advanced in infraspinatus muscle. Thirty-two cases (58.2%) conducted MRI after 3 weeks from the first shoulder dislocation event. This group showed that the retraction size of the coronal plane was increased significantly and the fatty accumulation of the supraspinatus muscle had progressed significantly. Conclusions: Age is also a strong factor to affect the feature of RCT after the shoulder dislocation in patients over 40. And the delay of the MRI may deteriorate the degree of tear size and fatty degeneration.