• Journal of the Korean Arthroscopy Society
• /
• v.10 no.1
• /
• pp.118-122
• /
• 2006

Purpose: We introduce a technique of all inside arthroscopic capsular imbrication and lateral release used to treat patellofemoral instability. Methods: With the arthroscope in the anteromedial portal for best viewing, the arthroscopic scissor is placed through superolateral portal for proximal to distal release. The release performed 5mm to 1cm from the edge of the patella. After completion of the procedure, with the arthroscope in anterolateral portal, we inserted 5mm cannula in superolateral portal and made working portal from superomedial portal. Medial reefing was performed with all inside technique by using curved needle of the spectrum suturing system and No. 1 monofilament PDS suture is passed through the superomedial portal percutaneously and retrieved through a superolateral portal. Conclusion: Several methods for arthroscopic patella realignment have been proposed, but they have consisted primarily of arthroscopically assisted techniques using a medial incision. We believe that our procedure is preferable to arthroscopically assisted methods commonly used, in that an incision is avoided and the vastus medialis obliqqus is not violated. Our technique is minimally invasive and is easy to control the tightness of the medial patellofemoral ligament (MPFL) under direct vision.

• The korean journal of orthodontics
• /
• v.41 no.4
• /
• pp.237-254
• /
• 2011

Objective: The purpose of this study was to compare the displacement patterns shown by finite element analysis when the maxillary anterior segment was retracted from different orthodontic miniscrew positions and different lengths of lever arms in lingual continuous and segmented arch techniques. Methods: A three dimensional model was produced, the translation of teeth in both models was measured and individual displacement was calculated. Results: When traction was carried out from miniscrews in the palatal slope, lingual tipping of crowns and extrusion of the maxillary anterior segment were found in both continuous and segmented arches as the lever arms were made shorter. With miniscrews in the midpalatal suture area, the displacement patterns were similar to the palatal slope, but bodily movement of the upper incisors was observed in both continuous and segmented arches with the lever arm at 20 mm. When lever arms were longer, there was less extrusion of the incisors and more buccal displacement of the canines. Such displacement was shown less in the continuous arch than the segmented arch. The second premolar showed crown mesial tipping and intrusion, and the molars showed distal tipping in the continuous arch. The posterior segment was displaced three dimensionally in the segmented arch, but the amount of displacement was less than the continuous arch. Conclusions: It is recommended that lever arms of 20 mm in length be used for bodily movement of the anterior segment. Use of continuous or segmented arches affect the displacement patterns and induce differences in the amount of displacement.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.36 no.3
• /
• pp.464-474
• /
• 2009

To distalize the maxillary molars, the traditional techniques such as extra-oral traction, Wilson distalizing arches, removable spring appliances and Schwarz plate-type appliances have been used. But, these need considerable patient cooperation. For minimal patient compliance, many practitioners use the pendulum appliances. Several clinical studies demonstrated pendulum is effective molar distalization appliance in the growing patient(using the premolars and the palate as anchorage). But unfortunately, maxillary anterior teeth also shift mesially as the molar moves distally. As a result anchorage loss is occurred. To overcome these disadvantages, we used bone-supported pendulum, combined the conventional pendulum with Skeletal Anchorage System(SAS). The miniscrew was implanted in the anterior paramedian region of the median palatal suture, which has comparatively sufficient bone thickness and is low risk to damage on the dental follicles. We report three cases, using bone-supported pendulum for the maxillary molar distalization in children. After treatment, we find out anchorage stability, minimal unfavorable anterior tooth movement and sufficient molar distalization.

• Archives of Plastic Surgery
• /
• v.37 no.1
• /
• pp.59-66
• /
• 2010

Purpose: In the finger, there are three major palmar arches in the arterial system. The location of this arches are constant. The middle and distal transverse arches are consistently large (almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. This paper describes our experiences in reconstruction and replantation of the finger using rerouting the transverse digital palmar arch. Methods: 31 patients with injuries according to our classification were treated from March of 2005 to October of 2008. In this study the authors subdivided injuries into those with amputation distal to the insertion of the flexor digitorum profundus (Class I, 31 fingers); those with amputation distal to the insertion of the flexor digitorum superficialis (Class II, 4 fingers). Replantation was performed using the artery-only technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration or converting the arch. Venous drainage was provided by an external bleeding method with partial nail excision, medical leech, and repaired margin. Results: The success rate was 87% (n=27) in class I and 75% (n=4) in class II. The authors conclude that crushing and complete avulsion injuries & amputations are salvageable, with acceptable functional results in select patients, especially those with amputation distal to the insertion of the flexor digitorum superficialis. Conclusion: We performed replantation and reconstruction with only-arterial transposing anastomosis successfully, resulting in good recovery of aesthetic and functional outcome. Three major digital palmar arches, especially distal two branches, give us additional treatment options. In the finger replantation and reconstructive techniques using rerouting healthy the transverse digital palmar arch increase the survival rate of the finger.

• Clinics in Shoulder and Elbow
• /
• v.9 no.1
• /
• pp.89-95
• /
• 2006

Purpose: Arthroscopic repair of rotator cuff tears are many techniques that have been developed to improve the initial postoperative strength of the repair. There was a doubt that current arthroscopic cuff repairs using a single row of suture anchors reproduce insufficient area of the anatomic cuff insertion, and concerns about failure of fixation often lead surgeons to limit early motion. Newer technique of double-row repair in arthroscopic treatment may provide initial stronger fixation and more contact with bone at the repair site than single-row repair did. We studied the comparison between clinical outcomes of arthroscopic single- and double-row repair in cuff tears at 1year postoperatively. Materials and methods: We retrospectively analyzed 40 shoulders with single-row repair and 38 shoulders with double-row repair of full-thickness rotator cuff tears between May 2002 and October 2004. Out of total 78 shoulders, 42 (54%) were male patients and 36 (46%) were female patients and the mean age at surgery was 56 years. All patients were diagnosed by physical examination and MRI. At 1year' follow-up after operation, we evaluated with the ASES and the Constant scoring system, and measured muscle power of abduction, internal and external rotation of the affected shoulder then compared with each other. Results: Mean ASES scores and Constant scores in double-row repair group improved more than single-row repair group significantly at 1year postoperatively. Muscle power of abduction and internal rotation, especially abduction power, improved more significantly in double-row repair group than in single-row repair. Conclusion: Arthroscopic double-row repair for the full thickness rotator cuff tear may be a superior technique, which showed better clinical outcomes and restoration of muscle power compared with single-row repair at relatively short period of postoperative follow-up. Restoration of footprint close to normal anatomy by double-row repair seems to play an important role in the recovery of muscle strength.

• Archives of Plastic Surgery
• /
• v.38 no.5
• /
• pp.616-620
• /
• 2011

Purpose: Mayer-Rokitansky-Kuster syndrome (MRK) is second common cause of primary amenorrhea. It is a syndrome of vaginal aplasia and Mullerian duct anomaly. Vaginal aplasia varies from agenesis of whole vagina to aplasia of upper 2/3. For reconstructing vagina, various methods are introduced. Gracilis myocutaneous flap was the first attempt in that the flap is used in vaginal reconstruction. Various flap-based vaginal reconstruction methods have been introduced. Modified Singapore flap (pedicled neurovascular pudendal thigh fasciocutaneous flap) is one of those methods that used posterior labial artery as pedicle, and pudendal nerve branch as sensory root. As its donor lies on inguinal crease that is easily hidden and there are benefits on sexual intercourse by early sensory recovery, authors think that modified Singapore flap is effective for young MRK syndrome patients. Methods: Eight patients underwent surgery between 2008 and 2010. The flap was designed on both groin area with external pudendal artery branch as a pedicle. All flaps were fixated in pelvic cavity with absorbable suture, and additional compression on neovaginal wall was supplied by polyvinyl alcohol sponge ($Merocel^{(R)}$). Results: All patients were successfully reconstructed without flap related complications such as congestion or partial flap loss. The average size of the flap (each side) was 69.34 $cm^2$. Polyvinyl alcohol sponge ($Merocel^{(R)}$) was inserted into neovagina for 5 days on every patient. One case of rectal laceration was occurred while making pelvic pocket by OBGY team. Other complications such as lumen narrowing, wound contracture or vaginal prolapsed were not reported during 8 months of follow up. Conclusion: Modified Singapore flap is a sensate fasciocutaneous flap that is thinner than other myocutaneous flap such as VRAM, and more durable over skin graft. Therefore this is a good choice for vaginal reconstruction in MRK syndrome. And known complications of Modified Singapore flap could be reduced with careful procedure and mild compression techniques.

• Journal of Korean Foot and Ankle Society
• /
• v.26 no.2
• /
• pp.95-102
• /
• 2022

Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades. Materials and Methods: A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency. Results: Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis. Conclusion: This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries.

• Journal of the Korean Arthroscopy Society
• /
• v.12 no.3
• /
• pp.211-216
• /
• 2008

Purpose: The frequency of foreign body in the knee joint is not as high, but it sometimes required wide or multiple arthrotomy in order to remove, which can baffle the surgeon in some ways. Our study is to evaluate for effectiveness of arthroscopic retrieval for intra-articular foreign body in the knee joint. Materials and Methods: The 22 patients(16 males, 6 females) had received arthroscopic foreign body retrieval in the knee joint from March 1983 to September 2006. The causes of foreign bodies of the knee joint were 7 of trauma (31.9%) related cases, 13 of surgery related cases (59.0%), 2 found during follow up after operation (8.1%) in pathologies of foreign body. Results: There were 15 of metal showed the most percentage (68.1%), 7 of non-metal (31.9%) in types of foreign bodies, and others included bullet, suture material, pencil lead, broken wire etc. All cases were used by arthroscopic techniques. All foreign bodies were removed easily and were showed no complication such as postoperative joint stiffness. Conclusion: Arthroscopic foreign body retrieval in the knee joint is effective surgery in terms of easy access to foreign body and less postoperative complication.

• Journal of Chest Surgery
• /
• v.37 no.10
• /
• pp.833-838
• /
• 2004

Background: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. Material and Method: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). Result: Mean age was $41\pm14$ years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of $38\pm17$ months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from $1.9\pm0.6$ to $1.2\pm0.5$ (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from $45\pm9$ and $67\pm10$ to $37\pm10$ and $56\pm10,$ respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative $(3.1\pm1.2)$ to post-bypass $(0.9\pm0.7).$ However, the grade at last follow-up $(1.7\pm1.1)$ was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. Conclusion: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.