• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.128-134
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• 2008

Purpose: We evaluated the complications and failures after total ankle arthroplasty during at least 2 years short term follow up. Materials and Methods: There were 45 cases of 42 patients of HINTEGRA$^{{R}}$ (Newdeal SA, Lyon, France) model from November 2004 to August 2006. Follow up averaged at least 2 year. We evaluated the complications and analyzed the cause of the failures. Results: There were totally 15 cases of complication, 5 cases of medial impingement syndrome, 3 cases of varus malposition, 2 cases of delayed healing of wounds, and each one case of deep peroneal nerve problem, medial malleolus fracture, post-operative deep infection, gouty arthritis pain, and Achilles tendinitis. Conclusion: Total ankle arthroplasty had higher complication rate than any other joint arthroplasty, so we need a more meticulous preoperative and peri-operative care.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.52-56
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• 2013

Purpose: We had proceeded seven iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defects and followed-up average for 5 years and 9 months to evaluate the survival rate, neurosensory function and cosmesis in final results. Materials and Methods: From January 1999 through October 2012, we have performed iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defect (average around $3.6{\times}2.4cm$) in 7 cases and average age was 41.6 years (21.5 to 59.0 years). Lesion site was posterior heel in 4 cases, distal anterior leg in 3 cases. Donor structure was the dorsalis pedis artery and the first dorsal metatarsal vessel and deep peroneal nerve in 3 cases and the dorsalis pedis artery and the first dorsal metatarsal vessel in 4 cases. Results: Seven cases (100%) were survived and defect area was healed with continuous dressing without skin graft. The sensory function in the neurovascular flap was restored to normal in 3 cases. Cosmesis was good and fair in 7 cases (85.7%). Conclusion: Ipsilateral dorsalis pedis vascularized pedicle flap in the distal leg and foot is one of the choice to cover the exposed bone and soft tissues without microsurgical procedure.

• Journal of Korean Foot and Ankle Society
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• v.25 no.3
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• pp.145-148
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• 2021

A checkrein deformity can occur after a distal tibiofibular fracture. Usually, a checkrein deformity due to a dysfunction of the extensor hallucis longus muscle is rarer than that of the flexor hallucis longus. Only a few related studies have been reported. The authors encountered an extensor hallucis longus checkrein deformity due to extensor retinaculum syndrome while managing a triplane fracture. In magnetic resonance imaging, an increase in the heterogeneous signal was observed on the T2-weighted images suggesting muscle necrosis or ischemic changes in a part of the extensor hallucis muscle. Postoperative great toe motor weakness, unintentional movement, sensory changes, and weakness improved spontaneously during the follow-up.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.77-83
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• 1999

The skin on the dorsum of the foot is a source of the reliable thin and sensory cutaneous free tissue transplantation with or without tendon, bone and joint. A composite flap with attached vascularized tendon grafts for the combined loss of skin and tendon on the dorsum of the hand and foot offers an immediate one stage solution to this problem. The flap provides a very durable innervated tissue cover for the heel of the foot and the dorsum of the hand and an osteocutaneous transfer combined with the second metatarsal. The major dorsalis pedis artery is constant in size, but the first dorsal metatarsal artery is variable in size and location. The dorsal surface of the foot receives sensory innervation through the superficial peroneal nerve and the first web through the deep peroneal nerve. Authors had performed 5 dorsalis pedis free flap transplantation in the foot and hand at Department of Orthopedic Surgery, Chonbuk National University Hospital from August 1993 through August 1997 and followed up for the period of between 19 and 67 months until March 1999. The results were as follows 1. 5 cases dorsalis pedis free flap transfer to the foot(4 cases) and the hand(1 case) were performed and the recipient was foot dorsum and heel 2 cases each and hand dorsum 1 case. 2 All of 5 cases(100%) were survived from free flap transfer and recipient artery was dorsalis pedis artery(2 cases), anterior tibial artery(1 case), posterior tibial artery(1 case) and ulnar artery(1 case) and recipient veins were 2 in number except in the hand. 3. Long term follow up of the exterior and maceration was good and sensory recovery was poor 4. Donor site was covered with full thickness skin graft obtained from one or both inguinal areas at postoperative 3rd week and skin graft was taken good and no morbidity was showed.

• Journal of Korean Foot and Ankle Society
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• v.23 no.3
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• pp.91-99
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• 2019

Purpose: This retrospective study reports the intermediate-term clinical outcomes including the practical function in daily and sports activities after total ankle arthroplasty for end-stage rheumatoid arthritis, as well as the effects of modification of perioperative anti-rheumatic medications. Materials and Methods: Twelve patients were followed for a minimum of 2 years after total ankle replacement for end-stage rheumatoid arthritis. Perioperative anti-rheumatic medications in all patients were modified based on a specific guideline. Clinical evaluations consisted of American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores. Periodic radiographic evaluation was conducted to detect changes in ankle alignment and postoperative complications. Results: Mean AOFAS, FAOS, and FAAM scores improved significantly from 37.5 to 81.2, 39.1 to 72.4, and 33.8 to 64.0 points at final follow-up, respectively (p<0.001). Functional outcomes in daily and sports activities at final follow-up were found to be 76.5 and 55.8 points for the FAOS and 70.5 and 57.5 points for the FAAM, respectively. As early postoperative complications, there was one case of local wound necrosis, one case of medial malleolar fracture, and one case of deep peroneal nerve injury. Radiological evaluation revealed two cases of asymptomatic heterotopic ossification and one case of progressive arthritis in the talonavicular joint. Reoperation was performed in only one patient (8.3%) with a medial soft tissue impingement at a mean of 35.6 months follow-up. Conclusion: Total ankle arthroplasty appears to be an effective surgical option for end-stage rheumatoid arthritis. Practical functions in daily and sports activities were significantly improved at intermediate-term follow-up. Modification of perioperative anti-rheumatic medications can be one of the solutions to reduce the postoperative complication rate.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.143-148
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• 2001

The hand with amputation of all fingers is useless for activities of daily living and traumatic amputation of some of the fingers can result in the diminished ability to perform power grip and precision grip which is vital to maintain normal function of the hand. Precision grip is used to hold an object between the opposable thumb and flexed fingers. In power grip the object is held between the flexed fingers and the palm while the thumb applies the necessary counterpressure to maintain the grip on the object. A 35 year old male lost his right all fingers including thumb at the level of proximal phalanx from the pressure machinary accident. Thumb was reconstructed using wrap around flap and the second and third fingers were reconstructed using the second and third toe transplantation. Seven years after reconstruction, he uses the reconstructed thumb and the second and the third fingers for eating meals, writing down a paper with a pencil and putting on socks.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.43-50
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• 2004

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.