The treatment of massive bone and soft tissue defect in the lower leg has a high complication rate of nonunion, chronic infection, and amputation without well-vascularized tissue coverage of the open fracture. Despite adequate free soft tissue coverage, massive skeletal defect may result in segmental bone defects, angulation deformity, and limb length discrepancies. In the last decade, major advances have occurred in the Ilizarov method of distraction osteogenesis in lower leg salvage as a delayed procedure or simultaneous distraction after free-tissue transfer. The authors have performed Ilizarov transport in conjunction with muscle and musculocutaneous flap coverage in nine cases of lower leg salvage. The flaps consist of rectus, gracilis, latissimus dorsi, parascapular, and serratus muscle or musculocutaneous fashioning using ipsilateral or contralateral pedicle in consideration of vessel condiation. Revision, recorticotomy and flap elevation were also used as a secondary procedure for satisfactory results. The conclusions, were as follows: 1) Multidisciplinary team approach with conjoining departments at the time of preoperative evaluation, postoperative care and rehabilitation care; 2) Muscle flap covered with split-thickness skin graft was preferred to musculocutaneous flap; 3) To reduce the total reconstructive period, simultaneous free tissue transfer with Ilizarov distraction should be considered.
Amputation ; Congenital Abnormalities ; Extremities ; Fractures, Open ; Ilizarov Technique ; Leg* ; Myocutaneous Flap ; Osteogenesis* ; Osteogenesis, Distraction ; Postoperative Care ; Rehabilitation ; Skin ; Superficial Back Muscles ; Transplants

PURPOSE: To investigate the arterial rupture, we evaluated the 15 victims of high tension injury. METHOD: The review included clinical course of injured limbs (entrance vs exit), site of spontaneous ruptures (subeschar: G1 vs zone of ischemia: G2), causes (spontaneous vs iatrogenic: G3, inflammatory vs associated thrombi), time and consequences of rupture (site of ligature, vascular manipulation). RESULT: 1) There were 18 spontaneous (G1, G2) and 4 iatrogenic ruptures (G3). 2) The G1 were 8 in 5 patients on the 19.6 +/- 8.1 (6-29)th post burn day: princeps pollicis/dorsalis indicis, dorsalis pollicis/superficial radial, radial, ulnar/radial and posterior tibial artery. The G2 were 10 in 8 patients on the 18.4 +/- 7.2 (9-31)th post burn day: brachial, ulnar, radial, ulnar/radial and branch/trunk of popliteal artery. 3) The G3 were superficial femoral/superficial femoral (at clamping site/anastomosis), subclavian (at clamping site) and princeps pollicis (at ligature) artery by inflammation 2-8 days after surgery. 4) The initial wound of limbs or fasciotomy cannot predict the possible ruptures. 5) The entrance had more ruptures than exit. 6) Five patients had multiple ruptures 1-13 days after first episode (3 at different, 2 at the same limb). 7) There was no difference of rupture time between G1 and G2. The G2 occurred at 2-7 cm apart from burn eschar. 8) Nine among 18 spontaneous ruptures were caused by inflammation. The rest 9 thrombotic ruptures occurred at the arterial wall over (2), at the margin (6) and 2 cm near (1) the thrombi. There was no time difference between inflammatory and thrombotic rupture [19.2 +/- 7.2 (9-31) vs 19.0 +/- 8.0 (6-29) days]. 9) There was no rupture after proximal 2-4 cm ligature at superficial arteries. The thrombi were formed finally in superficial femoral artery at 9 cm proximal to the rupture site. CONCLUSION: We recommend that timely decision to amputate must be made to reduce spontaneous ruptures. Also careful attention should be paid to select the safe distance, at least 10 cm in deep arterial injures, in vascular procedures.
Arteries* ; Burns* ; Constriction ; Extremities ; Femoral Artery ; Humans ; Inflammation ; Ischemia ; Ligation ; Popliteal Artery ; Rupture* ; Rupture, Spontaneous ; Tibial Arteries ; Wounds and Injuries

No abstract available.
Humans ; Urinalysis*

To evaluate the features of pyuria related to the bacteriuria, 140subjects were studied from Jan. 1987 to Dec. 1987. They pyuria was frequently developed from the age 30 to 60 years old, and male to female ratio was 1:1.41. The most common disease was urethrocystitis that was shown 42.8%. Common precipitating factors were urethral catheterization (25%) and urinary tract obstruction (11.4%). Through the observation, symptomatic pyuric patients were 66 subjects (47.1%), and the subjects with significant urine culture were 121 subjects (86.4%). In the urine culture, the most common bacteria was E. coli (41.4%), and the next was Pseudomonas (19.3%). A large percentage of E. coli and Pseudomonas was susceptible of amikin. The pyuria due to S. epidermidis and Accinatobacter was well treated. High therapeutic rate was observed in the acute pyelonephritis (71%) and urethrocystitis (67%). In the persistent urinary tract infection, there were relapsing (22 cases) and recurrent urinary tract infection (16 cases).
Amikacin ; Bacteria ; Bacteriuria ; Clinical Study* ; Female ; Humans ; Male ; Precipitating Factors ; Pseudomonas ; Pyelonephritis ; Pyuria* ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections

PURPOSE: The presence of urge incontinence may affect the results of stress urinary incontinence (SUI) treatment. In this study, women with SUI were divided according to their accompaniment with urge incontinence or not. The aim was to define a group in whom a urodynamic assessment was unnecessary prior to offering surgery. In other words, we wished to define a group where the treatment plan could be determined only with the clinical opinions based on the symptoms and physical examinations. MATERIALS AND METHODS: Two hundred and fifty five women with SUI between January 1997 and February 2001 were enrolled in this study. The women with SUI symptoms were divided into a group of patients who had symptoms of pure SUI, and those who had SUI as well as urge incontinence. The clinical and urodynamic variables were analyzed to identify the sub-groups of women where a urodynamic study was unnecessary before initiating treatment for SUI. RESULTS: Of the 101 women with symptoms of pure SUI, only 5 had a detrusor instability (DI). Of the 154 women with coexisting urge incontinence symptoms, only 33.8% (52/154) had DI, suggesting the poor predictability of urge incontinence symptoms for a diagnosis of DI based on the urodynamic study. An identification of SUI by the urodynamics were noted in 77.6% (198/255), which almost corresponding to the rate (76.9%) of positive urine leakage confirmed at the provocative stress test. CONCLUSIONS: If a patient has symptoms of pure SUI associated with a positive stress test, the SUI can be treated without a urodynamic study. For women with symptoms of mixed urinary incontinence, it may be better to undergo a urodynamic study before launching a definitive treatment.
Diagnosis ; Exercise Test ; Female ; Humans ; Physical Examination ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics*

PURPOSE: The presence of urge incontinence may affect the results of stress urinary incontinence (SUI) treatment. In this study, women with SUI were divided according to their accompaniment with urge incontinence or not. The aim was to define a group in whom a urodynamic assessment was unnecessary prior to offering surgery. In other words, we wished to define a group where the treatment plan could be determined only with the clinical opinions based on the symptoms and physical examinations. MATERIALS AND METHODS: Two hundred and fifty five women with SUI between January 1997 and February 2001 were enrolled in this study. The women with SUI symptoms were divided into a group of patients who had symptoms of pure SUI, and those who had SUI as well as urge incontinence. The clinical and urodynamic variables were analyzed to identify the sub-groups of women where a urodynamic study was unnecessary before initiating treatment for SUI. RESULTS: Of the 101 women with symptoms of pure SUI, only 5 had a detrusor instability (DI). Of the 154 women with coexisting urge incontinence symptoms, only 33.8% (52/154) had DI, suggesting the poor predictability of urge incontinence symptoms for a diagnosis of DI based on the urodynamic study. An identification of SUI by the urodynamics were noted in 77.6% (198/255), which almost corresponding to the rate (76.9%) of positive urine leakage confirmed at the provocative stress test. CONCLUSIONS: If a patient has symptoms of pure SUI associated with a positive stress test, the SUI can be treated without a urodynamic study. For women with symptoms of mixed urinary incontinence, it may be better to undergo a urodynamic study before launching a definitive treatment.
Diagnosis ; Exercise Test ; Female ; Humans ; Physical Examination ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics*

No abstract available.

The patient with unilateral or bilateral inverted nipple has both functional and cosmetic impairments. The structural and histopathologic features of inverted nipple are that inverted nipple has less fibromuscular tissue than normal nipple and has short lactiferous duct and dense fibrous tissue. For these reasons, surgical correction of inverted nipple requires release of the short lactiferous ducts and providing the bulkiness under the nipple. We combined the concept of both adding the bulkiness under the nipple and creating a tight neck at its base without sacrificing the duct system. We rotated the bilateral diamond shaped deepithelized dermal flaps around the nipple areolar complex for providing the nipple bulkiness without division of lactiferous duct and reinforced it with the purse-string suture around the dermal flap for providing the stability. This two rotational dermal flap method was applied 12 inverted nipple in 6 patients and followed up for 2 months to 24 months. We have got the satisfactory results in cosmetic and functional aspect without any complication such as sensory change, relapse, and nipple necrosis.
Diamond ; Humans ; Neck ; Necrosis ; Nipples* ; Recurrence ; Sutures

The surgeon is, at times, confronted with the problems of covering large defects of the soft tissue of the groin area, which result from trauma, ablative surgical treatment or prosthetic graft infection. Coverage is a challenging problem particularly when the wound is complicated by radiation. Defects of the soft tissue, however extensive, that do not have any vital structures exposed could be easily handled with skin grafting, provided there is a healthy vascular bed after surgical debridement and frequent dressing changes. The complicated wounds should be covered as expeditiously as possible to avoid desiccation and weakening of the vessel wall and, in the presence of vascular prosthesis, to avoid contamination and graft thrombosis. Exposure of the femoral vessels or prosthetic grafts requires urgent coverage with well vascularized muscle and muculocutaneous flaps based on well-defined vascular pedicle. Reonstruction with well-vascularized tensor fascia lata flap has enabled us to maintain the patency of native femoral artery and a viable distal lower extremity in a male patient, who had a sudden ruptured femoral artery after radiation therapy on burned groin.
Bandages ; Blood Vessel Prosthesis ; Burns ; Debridement ; Desiccation ; Fascia Lata ; Fascia ; Femoral Artery ; Groin ; Humans ; Lower Extremity ; Male ; Skin Transplantation ; Thrombosis ; Transplants ; Wounds and Injuries

A 13-month-old boy had irregularly shaped, erythematous to dusky red, slightly raised patches and plaques on the left antecubital fossa and arm for 7 months. The lesions were firm and tender. Histopathologically the lesion consisted of small, circumscribed, angiomatous tufts and lobules with a cannonball appearance scattered throughout dermis, a characteristic feature of tufted angioma. For 15 weeks, interferon-a intralesional injections have been performed and the lesions showed an improvement.
Arm ; Dermis ; Hemangioma* ; Humans ; Infant ; Injections, Intralesional ; Interferon-alpha* ; Male