• Archives of Reconstructive Microsurgery
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• 제20권2호
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• pp.108-112
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• 2011

Purpose: Gracilis muscle free flap transplantation is chosen in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity. We set a study to search for gracilis free flaps to know whether symptoms were cured or recurred in patients that have passed over 10 years from flap transplantation. Materials and Methods: From August 1995 through September 2010, we have performed 28 cases of gracilis muscle free flap in the lower extremities. Ever since no case visited to demand any discomfort, breakdown or recurrence in the flap site on outpatient basis. We made a telephone call to patients or relatives documented in the medical record and only 2 cases visited outpatient department and 9 cases postponed the visit who satisfied with the final result but 17 cases had wrong telephone numbers. Causes, area of lower extremity, recipient vessels in the lower extremity, condition of the donor thigh and overall satisfaction of the flap transplantation in activities of daily living were investigated and written down in the medical record. Results: 11 cases were reviewed after average postoperative 13.7 years. Gracilis muscle flaps were not break down at the recipient site in all cases. The wound of donor thigh wound healed good and overall activities of daily living was satisfied in all cases. Conclusion: Gracilis muscle flaps which had performed and followed up average 13.7 years revealed confident in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.58-64
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• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• 대한족부족관절학회지
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• 제23권3호
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• pp.110-115
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• 2019

Purpose: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. Materials and Methods: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. Results: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. Conclusion: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.335-339
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• 2010

Purpose: Diabetic foot ulcer with osteomyelitis is notorious with its complexity and healing difficulties. Bone biopsy is considered to be the gold standard method of guidance for antibiotic therapy. However, it is often replaced by cultures of ulcer swabs or by superficial samples because of the technical difficulties and possible adverse events. In this study, we compared microbiologic results of bone biopsy with those of superficial tissue biopsy or swab culture to investigate concordance and diagnostic value in bone involved diabetic foot ulcers. Methods: This study involved 106 patients with diabetic foot ulcers who showed positive results in bone probing test. Tissue samples for microbiologic tests were collected from all the patients by using superficial cotton swab, superficial tissue biopsy, and bone biopsy. The microbiologic results of bone biopsy were compared with swab culture and superficial tissue biopsy statistically. Results: The positive predictive value of bone probing test for underlying osteomyelitis was 82.1%. Microbiology of the bone biopsy showed same results with those of the swab culture and superficial tissue in 64% and 63%, respectively. Statistical analysis demonstrated that the microbiology of the swab culture or superficial tissue did not coincide with that of the bone biopsy. Conclusion: These results suggest that the microbiologic results of superficial tissue or swab culture do not coincide with those of bony tissue. To select appropriate antibiotic regimen for diabetic ulcer with bone involvement, the specimen for the microbiologic test should be obtained from involved bone.

• 대한족부족관절학회지
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• 제24권4호
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• pp.148-155
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• 2020

Purpose: Minor foot amputations are performed for recurrent or infected ulcers or osteomyelitis of the diabetic feet. Patients may require a large amount of bone resection for wound closure. On the other hand, this results in more foot dysfunction and a longer time to heal. The authors describe fillet flap coverage to avoid more massive resection in selected cases. This study shows the results of fillet flap coverage for the closure of diabetic foot minor amputation. Materials and Methods: This was a retrospective case series of patients who underwent forefoot and midfoot amputation and fillet flap for osteomyelitis or nonhealing ulcers between March 2013 to November 2017. In addition, the patient comorbidities, hospital days, complications, and duration to complete healing were evaluated. Results: Fourteen fillet flap procedures were performed on 12 patients. Of those, two had toe necrosis, nine had forefoot necrosis, and three had midfoot necrosis. Eleven forefoot amputations and three midfoot amputations were performed. Among forefoot necrosis after a fillet flap, three patients had revision surgery for partial necrosis of the flap, and two patients had an additional amputation. Two patients had additional amputations among those with midfoot necrosis. By the fillet flap, the amputation size was reduced as much as possible. The mean initial healing days, complete healing days, and hospital stay was 70.6 days, 129.0 days, and 60.0 days, respectively. Conclusion: The fillet flap facilitates restoration of the normal foot contour and allows salvage of the metatarsal or toe.

• 대한영상의학회지
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• 제85권3호
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• pp.531-548
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• 2024

발달성 고관절 이형성증은 영아기 비구 형성이상으로 인해 고관절 불안정성이 발생하는 질환으로 정확한 초음파 검사가 이루어져야 한다. 특발성 대퇴골두 무혈성 괴사는 아동기 대퇴골두의 일시적인 혈류 장애로 인해 발생하며 무혈성, 분절화, 재골화, 잔여기 단계를 거치게 된다. 대퇴골두 골단분리증은 청소년기에 체중 부하와 같은 스트레스로 인해 대퇴골두가 골단선을 따라 내측으로 전위되는 질환이다. 일과성 고관절 활액막염과 화농성 관절염은 감별을 위해 관절액 흡인술이 필요할 수 있다. 골수염은 연부 조직 부종과 골 용해를 동반할 수 있다. 하지만, 다발성 병변의 경우 랑게르한스 세포 조직구증, 전이성 신경모세포종 등을 감별해야 한다. 본 종설에서는 이런 질환에 대한 영상 검사 방법 및 대표적인 소견을 소개하고자 한다.

• Korean Journal of Radiology
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• 제22권4호
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• pp.604-611
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• 2021

Objective: The aim of this pilot study was to investigate the potential of early-phase single-photon emission computed tomography (SPECT)/computed tomography (CT) using technetium-99m methyl diphosphonate (^99mTc-MDP) for diagnosing osteomyelitis (OM). Materials and Methods: Twenty-one patients with suspected OM were enrolled retrospectively. Three-phase bone scan (TPBS), early-phase SPECT/CT (immediately after blood pool planar imaging), and delayed-phase SPECT/CT (immediately after delayed planar imaging) were performed. The final diagnoses were established through surgery or clinical follow-up for over 6 months. We compared three diagnostic criteria based on (I) TPBS alone, (II) combined TPBS and delayed-phase SPECT/CT, and (III) early-phase SPECT/CT alone. Results: OM was diagnosed in 11 of 21 patients (nine surgically and two clinically). Of the 11 OM patients, criterion-I, criterion-II, and criterion-III were positive in six, seven, and 10 patients, respectively. Of the 10 non-OM patients, criterion-I, criterion-II, and criterion-III were negative in five, five, and seven patients, respectively. The sensitivity/specificity/accuracy of criterion-I, criterion-II, and criterion-III for diagnosing OM were 54.5%/50.0%/55.0%, 63.6%/50.0%/57.1%, and 90.9%/70.0%/87.5%, respectively. Conclusion: This pilot study demonstrated the potential of using the early-phase SPECT/CT to diagnose OM. Based on the results, prospective studies with a larger sample size should be conducted to confirm the efficacy of early-phase SPECT/CT.

• Pediatric Infection and Vaccine
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• 제18권1호
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• pp.31-39
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• 2011

목 적 : 급성 화농성 관절염 및 골수염은 성인에 비해 소아에서 비교적 흔히 볼 수 있는 질환으로 진단 및 치료가 지연되거나 부적절할 경우 만성적인 후유증을 초래할 수 있다. 본 연구에서는 최근 6년간 우리나라 2개 대학병원에서 경험한 급성 관절염 및 골수염의 원인균과 임상 양상을 분석하였다. 방 법: 2003년 6월부터 2009년 7월까지 지역사회에서 발생한 급성 화농성 골관절염으로 서울대학교 어린이 병원과 분당 서울대학교병원에 입원한 15세 이하 환아들 중 혈액이나 관절액, 조직에서 시행한 세균 배양 검사상 원인균이 증명된 63례를 대상으로 하여 의무 기록을 후향적으로 분석하였다. 결 과:총 63명의 중앙 연령은 60개월이고, 남아는 35명, 여아는 28명으로 약 1.25:1의 비율을 보였다. 침범 부위 중 관절은 고관절을 침범한 것이 15례(37.5%) 로 다수를 차지하였고, 슬관절 7례(17.5%), 견관절과 주관절이 각각 4례(10%)에서 침범되었고, 골수 침범 부위는 대퇴골이 20례(33.9%), 경골이 13례(22%), 요골과 상완골이 각각 7례(11.9%)씩 차지하였다. 원인균 중 S. aureus가 49례로 77.8%를 차지하였고, 이 49례 중 MSSA가 41례(83.7%), MRSA는 8례(16.3%)를 나타내었다. GBS, Salmonella spp.는 각각 3례를 차지하였다. 한편 생후 1개월 미만의 신생아 4례중 3례에서 GBS가 동정되었다. 초기 항생제로는 1세대 cephalosporin 또는 nafcillin 단독 요법을 선택한 경우가 27례(42.9%)로 가장 흔했고 vancomycin을 포함한 경우는 총 9례 (14.3%)이었다. 총 63례 중 54례(85.7%)에서 합병증 없이 호전되었고, 만성 골수염, 성장판 손상, 관절 신전 장애, 재감염 및 재수술 등 합병증을 동반한 호전을 보인 경우가 9례(14.3%)이었고 사망례는 없었다. 결 론 : 지역사회에서 발생한 소아청소년 관절염 및 골수염의 가장 흔한 원인균은 S.aureus이고 이 중 MRSA 는 16.3%를 차지하므로 신중한 항생제 선택을 필요로 한다.

• Imaging Science in Dentistry
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• 제46권4호
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• pp.229-237
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• 2016

Purpose: The aim of this article is to review a group of lesions associated with periodontal ligament (PDL) widening. Materials and Methods: An electronic search was performed using specialized databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus to find relevant studies by using keywords such as "periodontium", "periodontal ligament", "periodontal ligament space", "widened periodontal ligament", and "periodontal ligament widening". Results: Out of nearly 200 articles, about 60 were broadly relevant to the topic. Ultimately, 47 articles closely related to the topic of interest were reviewed. When the relevant data were compiled, the following 10 entities were identified: occlusal/orthodontic trauma, periodontal disease/periodontitis, pulpo-periapical lesions, osteosarcoma, chondrosarcoma, non-Hodgkin lymphoma, progressive systemic sclerosis, radiation-induced bone defect, bisphosphonate-related osteonecrosis, and osteomyelitis. Conclusion: Although PDL widening may be encountered by many dentists during their routine daily procedures, the clinician should consider some serious related conditions as well.

• 대한족부족관절학회지
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• 제16권2호
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• pp.135-139
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• 2012

The interphalangeal joint (IPJ) of the hallux has received little attention compared with the first metatarsophalangeal joint. But, the hallucal IPJ has several disorders such intra-articular fractures, dorsal dislocation, alignment disorder, and inflammatory or degenerative arthritis. Among these disorders septic arthritis of the IPJ of the hallux is rare. We report a case of sepsis of the hallucal IPJ and adjacent underlying osteomyelitis without neuropathic problem and was performed through infected soft tissue and osseous debridement, temporary antibiotic-impregnated cement spacer, and delayed intercalary allogenic fibular bone graft with K-wire fixation.