During the last 18 years only a small number of successful replantation of lower extremities severed by trauma have been reported. In this paper we report the first successful case of replantation of completely amputated thigh In Korean literature. A 31-year-old man was admitted to Kyung Hee Unlversity Hospital on February 27th 1976, approximately 1 hour after accident in which the left thigh was completely amputated 15 cm above the knee joint. Circulation was restored 6 hours after amputation through anastomosis of the femoral vein, artery, great saphenous vein, profunda femoris artery and vein. The continuity of sciatic nerve was reestablished by secondary furnicular suture 7 week after injury. About 4 years and 7 months after injury the patient could walk without pain and returned to his occupation. Thre was a almost complete return of motor and sensory function of the posterior tibial nerve.
Adult ; Amputation ; Arteries ; Femoral Vein ; Humans ; Knee Joint ; Lower Extremity ; Microsurgery ; Occupations ; Replantation ; Saphenous Vein ; Sciatic Nerve ; Sensation ; Sutures ; Thigh ; Tibial Nerve ; Veins

36 consecutive cases of major limbs replantation and 81 consecutive cases of finger replantation performed at Kyung Hee University Medical Center from Oct. 1975 through Sept. 1979 were reviewed. In 19 cases, amputation had occurred in wirst or palm. In 11 cases, amputation had occurred between forearm and shoulder. In 4 cases, amputation had occurred in thigh and leg. In 26 cases, amputation had occurred in thumb, and in 47 cases in index. The youngest was 4, the oldest was 52 in limb amputation, but from 5 through 38 in finger amputation. All amputed parts were cooled while awaiting replantation. Ischemic period was from 4 hours and 30 minutes to 29 hours and 35 minutes in limb amputation. And circulation was reestablished from 4 hours and 30 minutes to 29 hours and 35 minutes in limb replantation, and from 4 hours and 40 minutes to 15 hours and 10 minutes in finger replantation. In all cases bone was shortened from 2 to 5 cm in limb replantation, and from 0.3 to 0.8 cm in finger replantation and stabillzed by means of skeletal fixation. Dicision regarding primany repair of nerves and tendons depended upon the level and extent of local injury, but most cases performed primary repair. The success rate were 80.6% (29/36) in limb replantation, and 88.9% (72/81) in finger replantation respectively. Main cases of failure were thrombosis at anastomosed vessel, tissue crushing at distal part, and too long ischemic period. Surgical technique, type and level of amputation, number of artery and vein anastomosis, and ischemic period had direct relationship to success rate. But degree of amputation, patients age, infection in amputed part, and systemic heparinization had no relationship to success rate. In limb replantation, 25 cases were achieved follow up study from 6 months to 43 months. All cases except two were satisfied wlth replanted Iimbs, and were fully independent carrying out activities of daily living. All cases show cold intolerance. In finger replantation, 59 cases were achieved follow up study from 6 months to 47 months. All cases were satisfied wlth replanted digits, and used their replanted digits for grip, pinch, and hook. 46 cases (80%) had return of two polnt discrimination of less than 10 mm and useful finger Joint motion. Early and aggressive rehabilitation can be achieved good functional result in replanted limb and digit.
Academic Medical Centers ; Activities of Daily Living ; Amputation ; Arteries ; Discrimination (Psychology) ; Extremities ; Finger Joint ; Fingers ; Follow-Up Studies ; Forearm ; Fracture Fixation ; Hand Strength ; Heparin ; Humans ; Leg ; Rehabilitation ; Replantation ; Shoulder ; Tendons ; Thigh ; Thrombosis ; Thumb ; Veins

Sixteen microvasular free flap transfers have performed during recent two years in this department, which was first attempt in Korea. Neurovascular free flap was nine and vascular free flap was seven. The donor flaps were thirteen dorsalis pedls falps, two groin flaps and one latissimus dorsi flap respectively. The recipient sites were heel pad loss, vital organ exposure and scar contracture lesions in extremity. Their main cause of soft tissue defect was traumatic in all. All patients have experienced more than two times of split thickness skin graft before free flap transfer. The success rate of vascular free flap transfer was 94%. The only one failure case was due to venous thrombosis, but secondary split thickness skin graft performed with satisfactory result. The follow up period was from 5 months to 20 months. Sweating in transferred free flap was found at all neurovascular free flap within postoperative 4 months. Adequate 2-point discrimination was obtained at six patients of nine neurovascular free flaps and protective sensation seems to progressively improve in remained three patients. Two point discrimination was shortened at hand after neurovascular dorsalis pedis flap transfer in two cases. The weight bearing function at heel pad region and tactile sensation at hand have satisfactorily recovered after free flap transfer. Free flap transfer have many advantages compare to conventional skin graft, such as shorter therapeutic time, lesser physical and economic burdens, primary covering to vital organs and protective sensation of neurovascular free flap transfer. The most important factors are meticulous microvascular operation technique and anatomic knowledge.
Cicatrix ; Contracture ; Discrimination (Psychology) ; Extremities ; Follow-Up Studies ; Free Tissue Flaps ; Groin ; Hand ; Heel ; Humans ; Korea ; Microsurgery ; Sensation ; Skin ; Superficial Back Muscles ; Sweat ; Sweating ; Tissue Donors ; Transplants ; Venous Thrombosis ; Weight-Bearing

Ten feet from 6 idiopathic congenltal clubfoot patients which had failed to respond to conservative mearsured were treated by aggreasive posteromedial release during infancy with generally good results. A modltication of Denis-Browne splint by splitting both aides and using dial lock to hold the foot still ln correeted position was found quite useful for post-operative maintenance.
Clubfoot ; Foot ; Humans ; Splints

It is notoriously difficult to obtain a sound bony union of congenital paeudarthrosis of tbe tibia with conventional methods. This paper is the results of using the free vascularized fibular graft for congenital pseudarthorsis of the tibia in 7 patients since 1978 in this hospital, which is the first attempt in Korea. During the follow-up periods from 9 months to 32 months, 5/7 patients(71%) had good or excellent bony union, 2 patients had bone resorption at tbe distal site of grafted bone and required a second supplementary cancellous bone graft with electrode insertion. So it is thought that the free vascularized fibular graft is one of good methods of treatment for congenital pseudarthrosis of the tibia.
Bone Resorption ; Electrodes ; Follow-Up Studies ; Humans ; Korea ; Pseudarthrosis ; Tibia ; Transplants

Chordomas are maligaant tumors which arise in the remnants of the embryonic notochord, and exhibit a definite predilection for the extremes of the spinal axis, the great majority arising either in the basioccipital or in the sacrococcy geal regions. Particularly, complete surgical removal is almost impossible, therefore, local recurrence after the surgical removal of this tumor is common or rule. This report describes a csse of chordoma arising sacrococcygeal region treated with block resection.
Chordoma ; Notochord ; Recurrence ; Sacrococcygeal Region

It is notoriously difficult to obtain a sound bony union of large segmental bone defects secondary to trauma or following tumor resection, infected nonunion, congenital pseudarthrosis of the tibia, and avascular necrosis of the femoral head with conventional methods. Recent advances in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization of bone fragments separated by a large defect without sacrificing viability. Thirty nine cases of the free vascularized fibular graft had been performed in the Department of Orthopedic Surgery, Kyung Hee University Hospital during the period of 3 years from October 1978 to December 1981. Of these, ll cases were congenital pseudarthrosis of the tibia, 4 cases were tuberculous spondylitis, 4 cases were infected nonunion, 7 cases were large segmental bone defects secondary to trauma, 9 cases were avascular necrosis of the femoral head and the other was one case. The results were obtained as follows: 1. The advantages of free vascularized living fibular graft are one stage procedure, resistance of torsion and angular stress, union with rapid hypertrophy of the graft, a shorter immobilization period and more rapid incorporation of the graft into the recipient area. 2. Free vascularized fibular graft can be widely used in the field of Orthopedic surgery. 3. The fibula is the bone best suited for reconstruction of a defect in a long bone. 4. In children, distal tibiofibular synostosis must be performed. 5. For prevention of clawing toe, the muscles around the bone is meticulously dissected, 6. Evaluation by selective arteriography and isotopic scanning both before and after operation may be used to assess the viability of the fibula graft.
Angiography ; Animals ; Child ; Fibula ; Head ; Hoof and Claw ; Humans ; Hypertrophy ; Immobilization ; Microsurgery ; Muscles ; Necrosis ; Orthopedics ; Pseudarthrosis ; Spondylitis ; Synostosis ; Tibia ; Toes ; Transplants

PURPOSE: This study using the finite element analysis (FEA) focused on evaluating the biomechanical stability of the LC-DCP in accordance with existing of the fracture gap at the facture site after bone fracture augmentation. MATERIALS AND METHODS: For FEM analysis, total eleven types with different fracture models considering clinical fracture cases were constructed according to the fracture gap sizes (0, 1, 4 mm)/widths (0, 25, 50, 75, 100%). Limited contact dynamic compression plate (LC-DCP) fixation system was used in this FEM analysis, and three types of load were applied to the bone-plate fixation system: compressive, torsional, bending load. RESULTS: The results in FEM analysis showed that the 1, 4 mm fracture gap sizes and 75% or more fracture gap widths increased considerably the peak von Mises stress (PVMS) both the plate and the screw under all loading conditions. PVMS were concentrated on the center of the LC-DCP bone-plate, and around the necks of screws. CONCLUSION: Based on the our findings, we recommend at least 50% contact of the fracture faces in a fracture surgery using the compression bone-plate system. Moreover, if x-ray observation after surgery finds 100% fracture gap or 50% or more fracture gap width, supplementary measures to improve biomechanical stability must be taken, such as restriction of walking of the patient or plastering.
Finite Element Analysis ; Fractures, Bone ; Humans ; Neck ; Walking

This study was carried out to investigate the characteristics of contents and utilization for cancer information that is serviced on the internet in the form of Q&A and FAQ. A total of 947 cases (340 in Q&A and 607 in FAQ) were collected from August 20th to November 20th, 2001. Data were analyzed with descriptive statistical methods regarding the type of service, contents, and cancer included in the contents. The prevalent pattern of cancer information service was FAQ, and the distribution of contents and kind of cancer that were serviced differed depending on their service pattern and resources. The contents for prevention and screening, general understanding of cancer, and rehabilitation appeared more often in FAQ than in Q&A and were also more frequent in cancer specialized websites than any others. This pattern may be because FAQ and cancer specialized websites have a view of contents provider. Clinical symptoms and diagnosis were the contents provided more frequently in Q&A than in FAQ. Additionally, information on breast cancer was the most frequently asked question in regard to major cancer in Korea. However, information on hematopoietic system was the most frequently asked in Q&A. From the results of this study, it is clear that cancer-related information varies according to the cancer types, service patterns, and website characteristics. However, the fundamental difference depends on whether the contents are created in terms of the information user or not. This study demonstrated that there is a difference between users and developers in the requested information regarding available cancer-related. It is therefore necessary to establish a basic plan for appropriate cancer information services according to the needs of the users.
Breast Neoplasms ; Diagnosis ; Hematopoietic System ; Information Services ; Internet* ; Korea ; Mass Screening ; Rehabilitation

Low Back Pain(LBP) is a disease entity that most people suffer more than once in their life by various causes, and also occurs after not only regional anesthesia but also general anesthesia. Most of the LBP after anesthesia remain temporarily. But sometimes it might persist and its treatment would be diffcult if psychosocial interaction was added. 445 patients, ASA class 1-2, over age 15 were included in our study. Patients of obstetric and gynecology department were excluded. No patients had LBP history and no facilities(example. pad) were applied during operation. We investigated the occurrence of LBP at the 1st, 3rd, 5th, and 7th postoperation days. The patients were classified according to age, sex, weight, height, operation site, duration of operation and department of surgery. Incidence of LBP in our study was 17.8 %(79/445). Among them the group of age 55-65; weight 51-60 kg ; height above 181 cm ; operation site at upper abdomen ; department of urology ; duration of operation 61-120 min ; and women tended to complain of LBP more comparing to the others in each group. But statistically, these showed no significance with LBP except age and sex(P<0.05).
Abdomen ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, General* ; Female ; Gynecology ; Humans ; Incidence* ; Low Back Pain* ; Supine Position* ; Urology