Failure of reattachment of finger is inevitable in replantation surgery and that failure rate is about 10 % are reported in many authors. Management of the failed finger replantation is challenge to microsurgeons. We report 7 cases of thumb reconstruction after failure of replantation. The reconstructive surgery composed with early debridement of soft tissue that are under gangrenous processing, extract the phalangeal bone without any soft tissues. Osteosynthesis of the extracted phalangeal bone with host phalangeal bone. The exposed bony portion covered with vascularized flaps such as reverse radial forearm pedicled flap, free radial forearm flap and neurovascular island finger flap. This procedure underwent within a week after vascular insufficiency developed. All of the flaps are survived, bone union achieved within 3 months . The function and external appearance of the reconstructed thumb were encouraging; pinch power was average 1.2 pounds. Early removal of necrotizing soft tissue followed by covering none vascular phalangeal bone which extracted from the dead phalanx with vascularized flap is one of the useful alterative solutions in failed replantation surgery in hand.
Debridement ; Fingers ; Forearm ; Hand ; Replantation* ; Surgical Flaps ; Thumb

1795 patients who visited orthodontic department from 1979 to 1987, were surveyed on the yearly tendency of patient distribution and state of Angle's classification. The results were as follows; 1. There was increased visiting rate of patient per year and higher visiting rate in female than in male. 2. 8-15 age group was 70.3% in total visiting patients and over 20 age group was 10.8%, under 7 age group was 7.3%. 3. Class I malocclusion was 26.3%, Class II div 1 was 31.0%, Class II div 2 was 1.6% and Class III was 41.1% in total visiting patient. 4. There was increased tendency to be received preventive treatment than fixed treatment and increased extracting rate per year in fixed treatment. 5. There was increased tendency for the number of the patient to be received orthognathic surgery.
Female ; Humans ; Male ; Malocclusion* ; Orthodontics* ; Orthognathic Surgery

PURPOSE: This paper describes a new anatomic reconstructive surgical procedure that simultaneously reconstructs the fibular collateral ligament, popliteal tendon and popliteofibular ligament using a split Achilles allograft and compares the clinical results of this new technique with the posterolateral corner sling procedure used for posterolateral instability of the knee. MATERIALS AND METHODS: Forty-six patients were treated for a posterolateral instability of the knee between 1998 and 2003. The posterolateral corner sling procedure (Group A) was performed in 25 patients and anatomic reconstructive surgery (Group B) in 21 patients. The minimum follow-up was 12 months. An arthroscopic evaluation was performed in all cases. The clinical review included the Lysholm knee scores as well as a lateral instability and tibial external rotation assessment. RESULTS: The mean Lysholm knee scores in groups A and B were 54.8 points and 54.4 points prior to surgery, and 86.9 and 93.6 points at the time of the latest follow-up, respectively (p<0.05). Tibial external rotation of 5 degrees more than the contralateral uninjured knee was noted in 12% of group A and in 5% of group B (p<0.05). Lateral instability of 5 mm greater than the contralateral knee was observed in 28% of group A and in 14% of group B (p<0.05). CONCLUSION: Anatomic reconstruction of the posterolateral corner resulted in less lateral instability and tibial external rotation than did the posterolateral corner sling procedure.
Allografts* ; Collateral Ligaments ; Follow-Up Studies ; Humans ; Knee* ; Ligaments ; Reconstructive Surgical Procedures ; Tendons

PURPOSE: To analyze the clinical results and functional assessments after debridement arthroplasty for a stiff elbow. MATERIALS AND METHODS: 30 elbows from 30 patients, who underwent debridement arthroplasty for a stiff elbow caused by primary osteoarthritis and secondary causes such as post-traumatic osteoarthritis and synovial chondromatosis from December 1995 to April 2003, were analyzed. The mean follow-up period was 52 months (range: 24 months-8 years 5 months). Among the stiff elbows, primary osteoarthritis was the cause in 11 cases, secondary osteoarthritis due to an old trauma was the cause in 18 cases, and synovial chondromatosis was the cause in 1 case. There were 20 males and 10 females with a mean age of 36 years (range: 14-61 years) at operation. They all had pain during elbow motion. Debridement arthroplasty was performed using the posterior approach. The clinical results were evaluated according to differences in the preoperative and postoperative ROM of the elbow and Mayo Elbow Performance Score (MEPS). RESULTS: Postoperatively, the elbow ROM improved to an average 122 degrees(range: 90-130 degrees) in flexion, 11 degrees(range: 0-30 degrees) in extension, 68 degrees(range: 20-90 degrees) in internal rotation and 74 degrees(range: 20-90 degrees) in external rotation. The improvement in flexion and extension was statistically significant (p<0.05). On the final follow-up, only moderate pain was reported in one case and none or mild pain was reported in 29 cases. MEPS improved from an average of 57.3 points (range: 33-75) to 88.9 points (range: 67-100). And there were 17 excellent cases (56.7%), 10 good cases (33.3%), 3 fair cases (10%) and no poor case. CONCLUSION: The stiff elbows were successfully treated with debridement arthroplasty. Therefore, debridement arthroplasty can preserve a good clinical outcomes using skillful surgical procedures and postoperative rehabilitation.
Arthroplasty* ; Chondromatosis, Synovial ; Debridement* ; Elbow* ; Female ; Follow-Up Studies ; Humans ; Male ; Osteoarthritis ; Rehabilitation

INTRODUCTION: Ulna is nearly equal to radius in function and bony architecture and strength in forearm. But in lower extremity, fibula is 1/5 of tibia in anatomic and functional point so we can find fibula transposition is commonly used in defect of tibia. We cannot find other article about segmental forearm bone transposition in man. The purpose of this study was to report our clinical and functional result of undergoing segmented transposition of ipsilateral ulna with its own vascular supply in defect of radius in 6 cases. MATERIAL AND METHOD: From June 1994 to October 2007, 7 segmented bone transpositional grafts in forearm were performed in Kyung Hee Medical Center. The distribution of age was from 20 years old to 73 years old. There was male in 6 cases and female in 1 case. The causes of operation were giant cell tumor in 1 case and traumatic origin in 6 cases; it was nonunion in 2 cases and fracture with severe comminution in 4 cases. Ipsilaterally segmented ulna keeping its own vascular supply was transported to defect of radius in severe traumatic patients and one patient whose tumor in radius had been excised. Transported ulna was fixed to proximal and distal radius remnants by plate and screw. In one case with giant cell tumor, transported ulna was connected to radius across wrist joint as wrist joint fusion. Joint preserving procedures were performed in 6 cases with crushing injury of radius. RESULTS: We could obtain solid bony union in all cases and good functional results. The disadvantage was relative shortening of forearm, but we could overcome this problem. CONCLUSION: We think that ipsilateral segmented ulna transposition keeping its own vascular supply to radius can be perfomed with one of procedures in cases with wide defect in radius.
Aged ; Female ; Fibula ; Forearm* ; Giant Cell Tumors ; Humans ; Joints ; Lower Extremity ; Male ; Radius* ; Tibia ; Transplants ; Ulna ; Wrist Joint ; Young Adult

The general treatment methods of chronic osteomyelitis of calcaneus with soft tissue defect was curettage of necrotic bone with antibiotics mixed bone cement insertion or cancellous bone grafting, and free or pedicled flap coverage. The muscle flap for soft tissue defect has many advantages including control of infection, but in cases of pedicled flap in calcaneus, there are some limitations because of functional loss of the donor site, limitation of pedicled length of donor muscle In these reason, free muscle flap was more preferred for pedicled muscle flap. But, in case of small sized defect which was located in center or lateral side of calcaneus, the abductor digiti minimi muscle flap can be one of the solutions. The abductor digiti minimi muscle flap has minimal functional loss of donor site and can be performed easily. There are some reports of the abductor digiti minimi muscle flap in other country, but in korea, this report is the first case report of the abductor digiti minimi muscle flap. We performed one case of abductor digiti minimi muscle flap as a treatment of chronic osteomyelitis of calcaneus and could obtain a good result.
Anti-Bacterial Agents ; Bone Transplantation ; Calcaneus* ; Curettage ; Humans ; Korea ; Osteomyelitis* ; Surgical Flaps ; Tissue Donors

Treatment of giant cell tumor of distal radius can be treated in several ways according to the aggressiveness of the tumor. But the management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. We have attempted to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle or anterior tibial vessel as living bone graft. From April 1984 to July 2005, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 14 cases, using Vascularized Fibular Graft, which occur at the distal radius. VFG with peroneal vascular pedicle was in 8 cases and anterior tibial vessel was 6 cases. Recipient artery was radial artery in all cases. Method of connection was end to end anastomosis in 11 cases, and end to side in 3 cases. An average follow-up was 6 years 6 months, average bone defect after wide segmental resection of lesion was 6.8 cm. All cases revealed good bony union in average 6.5 months, and we got the wide range of motion of wrist joint without recurrence and serious complications. Grafted bone was all alive. In functional analysis, there was good in 7 cases, fair in 4 cases and bad in 1 case. Pain was decreased in all cases but there was nearly normal joint in only 4 cases. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence.
Arteries ; Epiphyses* ; Fibula ; Follow-Up Studies ; Giant Cell Tumors* ; Giant Cells* ; Joints ; Microsurgery ; Radial Artery ; Radius* ; Range of Motion, Articular ; Recurrence ; Transplants ; Wrist Joint

PURPOSE: To report the clinical results and efficacies of one stage reverse lateral supramalleolar adipofascial flap for soft tissue reconstruction of the foot and ankle joint. MATERIAL AND METHODS: We performed 5 cases of one stage reverse lateral supramalleolar adipofascial flap from Jan 2005 to Sept 2005. All patients were males and mean age was 50(36~59) years old. The causes of soft tissue defects were 1 diabetic foot, 2 crushing injuries of the foot, 1 open fracture of the calcaneus, and 1 chronic osteomyelitis of the medial cuneiform bone. Average size of the flap was 3.6(3~4)x4.6(4~6) cm. All flaps were harvested as adipofascial flap and were performed with the split-thickness skin grafts (STSG) above the flaps simultaneously. RESULTS: All flap survived completely and good taking of STSG on the flap was achieved in all cases. There were no venous congestion and marginal necrosis of the flap. In diabetic foot case, wound was healed at 4 weeks after surgery due to wound infection. There was no contracture on the grafted sites. Ankle and toe motion were not restricted at last follow up. All patients did not have difficulty in wearing shoes. CONCLUSION: The reverse lateral supramalleolar adipofascial flap and STSG offers a valuable option for repair of exposure of the tendon and bone around the ankle and foot. Also one stage procedure with STSG can give more advantages than second stage with FTSG, such as good and fast take-up, early ambulation and physical therapy, and good functional result.
Ankle Joint* ; Ankle* ; Calcaneus ; Contracture ; Diabetic Foot ; Early Ambulation ; Follow-Up Studies ; Foot* ; Fractures, Open ; Humans ; Hyperemia ; Male ; Necrosis ; Osteomyelitis ; Shoes ; Skin ; Tarsal Bones ; Tendons ; Toes ; Transplants ; Wound Infection ; Wounds and Injuries

BACKGROUND: In Korean traditional medicine, human beings are classified into 4 groups accordance with the characteristics of physical constitution, named; Taeum, Taeyang, Soum, and Soyang. Most of Korean traditional doctors believe that the back ground of pathophysiology is differ among each group in many diseases. HLA is the most polymorphic gene and related with human immune response. It has been used for determination of individual identification, genetic diversity and a study of disease association in different ethnic group. It has well known that the most human inflammatory disease which thought to have some autoimmune basis are in some way promoted by genes of the HLA region. The purpose of this study is to observe the distribution of HLA-DR genotypes in 4 types of physical constitution in Korean traditional medicine. METHODS: Three hundred and ten Korean subjects(Soyang : 58cases, Soum :142cases, Taeum : 92cases, Taeyang : 18cases) were enrolled for this study. Genomic DNAs extracted by phenol/chroloform were amplified with allele specific primers and determined by 2% agarose gel electrophoresis with ethidium bromide staining for analysis of HLA-DR polymorphism. RESULTS: The genotype frequency of HLA-DR in a total or 310 Koreans was DR1 ; 7.2%, DR 2; 10.5%, DR 3;1.7%, DR 4; 19.9%, DR 5; 11.9%, DR 6;19.9%, DR 7; 7.0%, DR 8; 10.6%, DR 9; 8.7%, DR10;1.9%. There was no significant diffrence of HLA-DR genotype distribution among four physical constitution groups classified by Korean traditional medicine. CONCLUSION: Our results suggest that the classification of physical constitution in Korean traditional medicine is not related to HLA-DR genotypes.
Alleles ; Classification ; Constitution and Bylaws* ; DNA ; Electrophoresis, Agar Gel ; Ethidium ; Ethnic Groups ; Genetic Variation ; Genotype ; HLA-DR Antigens* ; Humans ; Medicine, Korean Traditional*

This study was undertaken to evaluate the tensile bond strength of In-Ceram alumina core treated by ion assisted reaction(IAR). Ion assisted reaction is a prospective surface modification technique without damage by a keV low energy ion beam irradiation in reactive gas environments or reactive ion itself. 120 In-Ceram specimens were fabricated according to manufacturer's directions and divided into six groups by surface treatment methods of In-Ceram alumina core. SD group(control group): sandblasting SL group: sandblasting + silane treatment SC group: sandblasting + Siloc treatment IAR I group: sandblasting + Ion assisted reaction with argon ion and oxygen gas IAR II group: sandblasting + Ion assisted reaction with oxygen ion and oxygen gas IAR III group: sandblasting + Ion assisted reaction with oxygen ion only For measuring of tensile bond strength, pairs of specimens within a group were bonded with Panavia 21 resin cement using special device secured that the film thickness was 80micrometer. The results of tensile strength were statistically analyzed with the SPSS release version 8.0 programs. Physical change like surface roughness of In-Ceram alumina core treated by ion assisted reaction was evaluated by Contact Angle Measurement, Scanning Electron Microscopy, Atomic Force Microscopy; chemical surface change was evaluated by X-ray Photoelectron Spectroscopy. The results as follows: 1. In tensile bond strength, there were no statistically significant differences with SC group, IAR groups and SL group except control group(P<0.05). 2. Contact angle measurement showed that wettability of In-Ceram alumina core was enhanced after IAR treatment. 3. SEM and AFM showed that surface roughness of In-Ceram alumina core was not changed after IAR treatment . 4. XPS showed that IAR treatment of In-Ceram alumina core was enabled to create a new functional layer. A keV IAR treatment of In-Ceram alumina core could enhanced tensile bond strength with resin cement. In the future, this ion assisted reaction may be used effectively in various dental materials as well as in In-Ceram to promote the bond strength to natural tooth structure.
Aluminum Oxide ; Argon ; Dental Materials ; Microscopy, Atomic Force ; Microscopy, Electron, Scanning ; Oxygen ; Photoelectron Spectroscopy ; Resin Cements ; Tensile Strength ; Tooth ; Wettability