• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.101-107
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• 2008

Purpose: Free flaps from the great toe are an established method for reconstruction of absent or partially amputated thumbs. However, options differ as to which technique represents the ideal solution for each level of amputation. Various methods of distal thumb reconstruction have been proposed. We prefer to transplant the entire great toe nail complex with the almost all of the pulp rather than a portion of the nail. This paper reflects our experience in using the great toe mini wrap-around flap for distal thumb reconstruction. Materials and Methods: In the period from October of 2005 to July of 2007, 9 patients were treated for traumatic thumb defects localized at the distal phalanx of the thumb. The patients included seven men and two women. The mean age was 44 years (range, 21~60) and the dominant right hand was involved in seven of nine patients. Results: The transferred flaps have survived completely in all cases. The mean range of motion in the interphalangeal joints was 51o, with 73% of the normal uninjured opposite hands. The two-point discrimination was 10.5 mm (range, 5~13 mm). In Semmes-Weinstein monofilament test, the sensibility was 4.31 in 4 cases, 3.61 in 3 cases and 2.83 in 2 cases. The pinch power was 64% (range, 55~95%) of the opposite hand. All patients were satisfied with the appearance of the reconstructed thumb and felt comfortable at final follow-up. Conclusion: We have successfully reconstructed 9 cases of traumatic distal thumb defects using the mini wrap-around free flap. The mini wrap-around free flap in great toe is an excellent alternative method for distal thumb reconstruction in selected patients.

• 농촌의학ㆍ지역보건
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• 제20권1호
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• pp.15-23
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• 1995

As compared before, agricultural machines are used more commonly instead of animal or manpower in rural areas and the injuries due to those are common. This study was conducted by questionnaire method in order to find out the current status of injuries due to agricultural machines for farmers who was selected from three Gun's in Kyeongsangnam Province. The study subjects were 385 persons in all(210 male persons, 175 female reasons) and the study period was from July through September 1993. The results were as follows; 1. The injury rate due to agricultural machines was high in male(p<0.05), and it was higher in younger age group and higher educated group. 2. The injury occurred high in summer and autumn seasons(77.6%), in the afternoon(60.6%), and during harvest(35.2%). 3. The major injuries were contusion, fracture, amputation in order and the injured sites were arms, legs, and chest in order. 31.7% of the injured farmers had been admitted, and they were treated at hospitals, home, drugstores and health centers in order. 4. The casualty damage was highest by cultivators, and agricultural instruments, threshing machine were followed. Among traumatic injuries concerned with cultivators contusions were most common, and fractures, amputations were followed. In case of agricultural instruments bruises were most common, and incisions, contusion were followed. In case of threshing machines fractures were most common and contusion, bruise were followed.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.660-662
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• 2009

Purpose: There are several modalities to reattach the amputated auricle. Microvascular replantation can achieve the best outcome, but technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. Methods: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket (Fig. 1, Below, left). Results: The ear was reepithelialized spontaneously in 7 days. At 3 months, the reattached ear has satisfactory appearance without contour deformity(Fig. 1, Below, right). Conclusion: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.745-749
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• 2022

Background Soft tissue defects of the multiple finger present challenges to reconstruction surgeons. Here, we introduce the use of a lateral arm free flap and syndactylization for the coverage of multiple finger soft tissue defects. Methods This retrospective study was conducted based on reviews of the medical records of 13 patients with multiple soft tissue defects of fingers (n = 33) that underwent temporary syndactylization with a microvascular lateral arm flap for temporary syndactylization from January 2010 to December 2020. Surgical and functional outcomes, times of flap division, complications, and demographic data were analyzed. Results Middle fingers were most frequently affected, followed by ring and index fingers. Mean patient age was 43.58 years. The 13 patients had suffered 10 traumas, 2 thermal burns, and 1 scar contracture. Release of temporary syndactyly was performed 3 to 9 weeks after syndactylization. All flaps survived, but partial necrosis occurred in one patient, who required a local transposition flap after syndactylization release. The mean follow-up was 15.8 months. Conclusion Coverage of multiple finger defects by temporary syndactylization using a free lateral arm flap with subsequent division offers an alternative treatment option.

• 한국임상수의학회지
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• 제24권4호
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• pp.627-630
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• 2007

잡종의 사냥개가 멧돼지 사냥 중에 대퇴와 서혜부의 열상을 입고, 음경이 절단되었다. 음경은 요도, 해면체, 그리고 좌우측의 음경등쪽정맥을 문합함으로써 재접합되었다. 절단된 음경은 해부학적 그리고 기능적으로 회복되었다. 술 후의 음경 원위부의 부종이나 괴사는 발견되지 않았으며, 술 후 20일째 요도조영술에서 누관이나 협착 또한 발견되지 않았다. 본 수술과 별도로, 3마리의 비글견에서 음경등쪽정맥의 문합의 중요성을 확인하고자 실험적 해면체조영술을 실시하였다. 해면체조영에서 음경망울에 주입된 조영제는 좌우측의 음경등쪽정맥을 통해 배출되었고, 좌골궁 부위에서 하나의 혈관으로 수렴된 후 다시 좌우측 속음부정맥으로 분기되었다. 따라서 개의 절단된 음경의 증례에서 좌우측의 음경등쪽정맥의 재문합은 술 후 좋은 예후를 위해 중요하다고 사료된다.

• Journal of Chest Surgery
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• 제31권3호
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• pp.262-265
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• 1998

연세대학교 의과대학 영동세브란스병원에서는 1990년 3월 1일부터 1992년 7월 31일까지 2년 4개월 동안 치료했던 말초동맥 폐쇄질환에 대한 연령 및 성별분포, 수술방법, 수술후 경과, 수술후 합병증등을 관찰하였다. 이들 환자의 동맥폐쇄질환에 관계하는 병인에는 동맥경화증이 28예, 버거씨병이 31예, 외상에 의한 경우가 7예, 수술합병증이 4예, 악성종양에 의한 경우가 1예, 동맥염에 의한 경우가 1예 있었다. 환자들에서 행해진 치료방법에는 우회로 형성수술이 27예, PGE1 투여가 23예, 혈전제거술 16예, 교감신경절제술이 4예, 단단문합술이 2예가 있었다. 치료는 PGE1 투여가 18예, 우회로 형성수술이 4예, 자가정맥편을 이용한 재건술이 2예, In situ bypass graft가 1예, 교감신경 절제술이 4예에서 시행되었다. 동맥경화성 말초동맥 폐쇄질환의 수술후 경과에서 증상이 완전히 소실된 경우를 satisfactory, 증상이 호전되지 않은 경우를 unsatisfactory라 했을때, 21명의 환 渼\ulcorner증상의 호전이 있었고(good), 9명의 환자는 증상이 완전히 호전되지 않았다. 버거스씨 병에 의한 TAO의 경우 수술전 Fontain lass상 Grade III,IV에 해당하는 환자에서, 술후 완전히 증상의 소실이 된 경우(class 0) 14예 이었으며, 수술후 Fontain class I이 12예, Fontain class II가 3예가 있었다. 1예의 경우에는 amputation을 시행하였다. 외상에 의한 말초혈관 질환에서는 1예에서 amputation을 시행하였으며, 1예는 graft infection이 이었고, 1예에서는 사망하였다.

• 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 Plastic Surgery
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• 제47권5호
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• pp.444-450
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• 2020

Background Fingertip injuries are the most common type of traumatic injury treated at emergency departments and require prompt and adequate interventions for favorable wound survival outcomes. Hyperbaric oxygen (HBO₂) therapy is well known for its many positive effects on wound healing. We hypothesized that treatment with HBO₂ would improve the graft survival outcomes of amputated fingertip injuries treated with composite grafts. Methods This retrospective observational study included fingertip amputations that were treated between January 2013 and December 2017. A conventional group and an HBO₂ therapy group were statistically compared to evaluate the effect of HBO₂ treatment. Graft survival was categorized as either success or failure. Results Among 55 cases (digits), 34 digits were conventionally treated, while 21 digits were treated with HBO₂. No statistically significant differences were observed between the groups with regard to general characteristics. Among patients with guillotine-type injuries, the composite graft success rate was statistically significantly higher in the group that received HBO₂ therapy than in the conventional group (P=0.0337). Overall, the HBO₂ group also demonstrated a statistically significantly shorter healing time than the conventional group (P=0.0075). As such, HBO₂ treatment facilitates composite graft survival in cases of fingertip injury. Conclusions HBO₂ treatment was associated with an increased composite graft survival rate in guillotine-type fingertip injuries and reduced the time required for grafts to heal.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.5-11
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• 2009

Purpose: The mortality and the amputation rates due to vascular trauma remain high despite advanced vascular surgical techniques and supportive management. The clinical features of patients with vascular trauma have not been well studied in the Korean population. The aim of this study was to analyze the clinical characteristics of patients with vascular trauma and to develop a database and guidelines for improving the outcomes of treatment. Methods: The medical records of 37 patients with traumatic vascular injuries who had visited in an emergency center between January 2002 and December 2006 were retrospectively reviewed and statistically analyzed. Results: The mean age was 37.8 years, and the male-to-female ratio was 5.2 : 1. The mechanism of vascular trauma was penetrating in 18 patients and blunt in 19 patients. Upper extremities were most frequently injured (39.4%). The treatment methods were primary repair in 21 patients, exploratory laparotomies in 7, radiological interventions in 3, resections and graft interpositions of the pseudoaneurysm in 3, observations in 3 and a bypass graft in 1. Four out of the 37 patients died, and three of these who died had injuried abdominal vessels. Twenty-five of the patients recovered completely, four expired, seven had neuropathy in the course of treatement, one had his limb amputated, and one experienced wound necrosis. Conclusion: Peripheral vessel injuries are commonly accompanied by nerve, muscle, or tendon injuries. Patients without associated fractures or compartment syndrome had good prognosis. Although the time intervals from hospital arrival to definite treatment were the shortest among patients with blunt abdominal vascular injuries, three expired. Therefore, we offer a 'ritical pathway'to improve the outcomes of patients with blunt abdominal vascular injury.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.113-118
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• 2007

Purpose: The purpose of this work was to describe the results of treatment for motor vehiclerelated crushing injuries among children and adolescents under sixteen years in Korea. Materials and Methods: A retrospective analysis was conducted of data from children who were under sixteen year and injured foot by motor vehicles. Cases were documented 1) age at the time of injury, 2) injured site, 3) the area of accident, 4) the kind of vehicle, 5) associated injuries, 6) methods of treatment for soft tissue reconstruction and 7) complications. The relationships between the area of accident and associated injuries, and the kind of vehicle and associated injuries were analyzed using Chi-square test and Fisher exact test. Results: There were 97 children who were 15 year and younger. The mean age was 7.4 years, and 65% were boys. The left foot was more dominant side of injury (57%). Seasonal variation was seen with the number of injuries peaking during the summer (43%, p<0.05). Among the vehicles, 78.3% were the large vehicles (bus, truck or van). The where of accident was more frequent at an alley or less than two lanes of traffic. But, the relationships between the place of accident and associated injury or the kind of vehicles and associated injury were not statistically significant. The associated injury were fracture or dislocation (23 cases, 35.9%), injury of tendon (21 cases, 32.8%). There were amputation or disarticulation of foot in 8 cases (8.2%) and post-traumatic deformities such as flatfoot, hindfoot varus or valus deformities by tendon injury in 7 cases (7.2%). Conclusion: More than 50% of crushing or degloving injuries of child's foot by traffic accidents happened in boys between 5 to 9 years old. The associated injury was unrelated with size of vehicles or accident place at the time of accident. But, even though foot injury happened in an alley or one lane by small vehicles, child who hurt feet by car need thorough investigation about associated injury. If a surgeon keep in mind and treat child to associated injury necessarily, can minimize complication. Microsurgical reconstruction for soft tissue defect was prior to other methods.