PURPOSE: Surgery on digit requires a clear, bloodless field and it can be achieved by using a tourniquet. Several type of tourniquet have been used including Penrose drains and sterile glove with hemostat. We present a simple digital tourniquet using nelaton catheter, which is easily available, inexpensive, easy-to-apply, and effective for digital surgery. METHODS: We made a small incision on the opposite side of an opening at the tip of nelaton catheter. Then the other tip of nelaton catheter is passed through the incision to form a ring. Nelaton catheter is placed aournd the base of the injured finger, making a tight circle to desired pressure. RESULTS: A simple tourniquet using nelaton catheter effectively achieves a bloodless field and allows fine control of the pressure for digital surgery. CONCLUSION: We present a sismple digital tourniquet using nelaton catheter, which is easily available, inexpensive, tunable, and available for more than one finger.
Catheters ; Fingers ; Tourniquets

PURPOSE: In order to determine the amount of wound healing, objective sequential assessments of changes in wound size and depth are essential. Although a variety of measurements for wound healing have been proposed, a gold standard for quantifying day-to-day changes in healing has not been established. We present here a simple and non-invasive wound measurement method that quantitatively and accurately documents changes of the size of a raw surface and the volume of a soft tissue defect using a stereoimage optical topometer(SOT) system. METHODS: Using a 5mm diameter biopsy punch, four circular wounds were created on abdominal area of a diabetic mouse. Photographs were taken using SOT system at baseline, 5th day and 10th postoperative day. The wound margin was traced on a digitalized photo and evaluated the area and the volume of the wound by SOT system. RESULTS: The SOT system calculated a mean wound surface of 15.93+/-0.29mm2 and volume of 827.50+/-88.86 intensity/pixel x area(I/PA) immediately after wounding. On the 5th day after the operation wound surface declined by 10.73mm2 and on the 10th day declined by 5.95mm2. The wound volume also declined from 827.50 I/PA to 161.75 I/PA and 30.50 I/PA on 0, 5th and 10th day, respectively. CONCLUSION: The SOT system described in this study represents a reliable, simple, practical, and non-invasive technique to accurately monitor and evaluate wound healing.
Animals ; Biopsy ; Mice ; Organothiophosphorus Compounds ; Wound Healing

PURPOSE: Delayed rupture of flexor pollicis longus as a sequelae of the plate inserted for distal radius fracture is a very rare. This is the first case reported and published in Korea. METHODS: A 48 years old female patient visited hospital, complaining flexor disturbance of interphalangeal joint of left thumb, which suddenly occurred without any external wound. We found that she had received operation of fixing plate for fracture of left distal radius 10 years ago. As operational opinion, we have checked that flexor pollicis longus tendon has been ruptured with oblique ways being stimulated by extended plate to palmar side over long period. RESULTS: Authors performed tenorrhaphy of flexor pollicis longus without tendon graft and presented a successful active flexion of the left thumb interphalangeal joint 1 year after the operation. CONCLUSION: If the extruded part of the end plate is observed during the operation or follow-up, it is considered to be necessary to get rid of the plate as early as possible after the fracture healing.
Drug Combinations ; Female ; Follow-Up Studies ; Humans ; Joints ; Piperonyl Butoxide ; Pyrethrins ; Radius ; Radius Fractures ; Rupture ; Tendons ; Thumb ; Transplants

PURPOSE: Chemical burn accounts for a small proportion of burns in burn patient population. However, chemical injuries own importance to their deep tissue destruction which continues long after the initial exposure. YUHANROX(R) is a domestic bleach which has been widely used in Korea. Chemical burn by the domestic bleach is an unusual case. METHODS: A 70 yrs old female soiled with stool, her husband wiped the mess with YUHANROX(R). Skin edema, erythematous lesion was developed the second day, and she was admitted to our hospital via emergency department. RESULTS: Complete epithelization was done after 3 times STSG but, severe scar was formed. CONCLUSION: We report this case to warn about the dangers of domestic bleaches chemical substances and to emphasize that they should be used with caution. Public relation of the primary care of the chemical burn injury is needed.
Burns ; Burns, Chemical ; Cicatrix ; Edema ; Emergencies ; Female ; Humans ; Korea ; Primary Health Care ; Skin ; Sodium ; Sodium Hypochlorite ; Soil ; Spouses

PURPOSE: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. METHODS: We report a 58-year-old male patient who was admitted due to 3.5x5cm chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. RESULTS: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. CONCLUSION: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.
Abdominal Cavity ; Biopsy ; Burns ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cicatrix ; Extremities ; Follow-Up Studies ; Histiocytoma, Malignant Fibrous ; Humans ; Lung ; Male ; Middle Aged ; Necrosis ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Skin ; Thoracic Wall ; Thorax ; Transplants ; Ulcer

PURPOSE: Breast augmentation is one of the common procedures in plastic surgery today. The shape, size and insertion plane of the implant is decided preoperatively by physical examination of the breast. Pectus excavatum is one of the most common anomalies of chest wall, characterized by a depression of the anterior chest wall. For patients with a mild type of pectus excavatum, the main purpose of the treatment is aesthetic rather than functional improvement. Two most surgical treatment options for skeletal deformity are the Ravitch technique and minimally invasive Nuss repair. Other options for soft tissue repair are implant insertion and autologous soft tissue augmentation. We performed a surgical operation with Nuss procedures and breast augmentation for a patient with mild pectus excavatum and hypoplastic breast. METHODS: A 32 year-old female was presented with hypoplastic breast. Preoperative chest CT was performed, showing pectus excavatum. After Nuss procedure, we inserted saline implant(275cc textured round breast implant, moderate profile) submuscularly to restore adequately projected breast. RESULTS: Patient's postoperative course was uneventful without any complication. After 6 months of follow-up period, the patient had an excellent result, with high patient satisfaction and no complications. CONCLUSION: For patients with a mild type of pectus excavatum, who do not have cardiopulmonary symptoms and requires for aesthetic improvement, this simple approach with Nuss procedure and breast augmentation achieves excellent aesthetic correction with low complication rate and high patient satisfaction.
Breast ; Breast Implants ; Congenital Abnormalities ; Depression ; Female ; Follow-Up Studies ; Funnel Chest ; Humans ; Patient Satisfaction ; Physical Examination ; Surgery, Plastic ; Thoracic Wall ; Thorax

PURPOSE: Intraosseous hemangiomas are rare and account for fewer than 1% of all bone tumors. The site that is most commonly involved are the vertebral column and the skull. Within the facial skeleton, hemangiomas can occur in the mandible, maxilla, the nasal bones, and rarely the zygoma. METHODS: We report a case of an intraosseous hemangioma of the zygoma in a 49-year-old male. The patient had a slow growing hard mass in the left zygoma, which had been present for 8 years. Other than the cosmetic deformity, the patient experienced no pain and did not have any problem. He had no history of trauma in that area and no ocular symptoms. Preoperative computed tomography showed a trabeculated mass arising from the body of the left zygoma. The mass was surgically removed without having to reconstruct the bone defect by spairing the inner cortex. RESULTS: Histopatholgical examination indicated a cavernous hemangioma. After 4 months of follow up, no functional and cosmetic impairment was identified. The patient was satisfied with the result. CONCLUSION: An intraosseous hemangioma of the zygoma can be treated with total surgical excision with preservation of the inner cortex, thus eliminating the need for reconstruction of bone defect.
Congenital Abnormalities ; Cosmetics ; Follow-Up Studies ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Male ; Mandible ; Maxilla ; Middle Aged ; Nasal Bone ; Skeleton ; Skull ; Spine ; Zygoma

PURPOSE: The evaluation and management of a completely transected tendon of the hand is relatively clear. In most cases, the integrity is assessed by physical examination(eg, broken normal cascade, motion loss) but occasionally, It happens in troubles. because of pain, limited patient cooperation(eg, child, unconscious patient), and other associated injuries(eg, fractures, foreign bodies). METHODS: From september 2006 to August 2007, 28 patients were evaluated with real time ultrasonography preoperatively and postoperatively. Twenty eight patients with injured tendon were evaluated using an HDI 5000 Sono CT(Philips Medical Systems, Bothell, WA) machine with a high resolution, 7.5MHz hockey stick linear probe. Dynamic evaluation was performed in real time. RESULTS: Surgery was performed after the ultrasonographic evaluation. Sonographic diagnosis and intraoperative findings were correlated. Ultrasonographic findings show tendon discontinuity, gaps, and fluid collection. CONCLUSION: We conclude that ultrasonography is helpful in evaluating and managing acute tendon injury. Especially, in cases of completely lacerated tendon, ultrasonography can identify the location of the proximal tendon stump and partial lacerated tendon, ultrasonographic diagnostic tool can decrease misdiagnosis.
Child ; Hand ; Hockey ; Humans ; Tendon Injuries ; Tendons ; Unconscious (Psychology)

PURPOSE: The disinsertion of the phalangeal tendon distal insertion has difficulties in ordinary tenorrhaphy operation for the anatomical features, and still has controversy between non-surgical and surgical management. The purpose of this study is to select treatment for the injury of the phalangeal tendon distal insertion, as we've had a good results from operation treatment with Pull-in suture technique. METHODS: We reviewed the hospital records of 12 patients treated with Pull-in suture technique with disinsertion of the phalangeal extensor or flexor tendon distal insertion from June 2006 to June 2007. Eight patients were involved with the tendon disinsertion without bone fracture, and 4 patients were involved with the fracture of the phalangeal tendon distal insertion site. After removal of the K-wire in week 6, active physical exercises were commenced immediately. The mean follow-up period was 12.4 months. RESULTS: All the patients who had tendon disinsertion with bone fracture had IIB, by Wehbe and Schneider's classification 2, and we evaluated the results comparing the same finger of the other hand according to Crawford's evaluation criteria 5. The nine excellent and three good results were obtained and there were no limitation of motor for the patient who had operation for the rupture of flexor tendon as well. There were no particular complications during the follow-up period. CONCLUSION: The most important thing for the disinsertion of the phalangeal tendon distal insertion is to maintain an accurate and durable reduction state keeping the tension of tendon. At this point, after removal of the K-wire, the Pull-in suture technique allows accurate realignment of the tendon-bone unit without any specific instrumentation under the more stable state. The Pull-in suture technique seems to be a strong alternative for the treatment of disinsertion of the phalangeal tendon distal insertion, with successful treatment outcome(rapid functional recovery and high patient satisfaction).
Exercise ; Fingers ; Follow-Up Studies ; Fractures, Bone ; Hand ; Hospital Records ; Humans ; Rupture ; Suture Techniques ; Sutures ; Tendons

PURPOSE: Split or full thickness skin graft is generally used to reconstruct the palmar skin and soft tissue defect after release of burn scar flexion contracture of hand. As a way to overcome and improve aesthetic and functional problems, the authors used the preserved superficial fat skin(PSFS) composite graft for correction of burn scar contracture of hand. METHODS: From December of 2001 to July of 2007, thirty patients with burn scar contracture of hand were corrected. The palmar skin and soft tissue defect after release of burn scar contracture was reconstructed with the PSFS composite graft harvested from medial foot or below lateral and medial malleolus, with a preserved superficial fat layer. To promote take of the PSFS composite graft, a foam and polyurethane film dressing was used to maintain the moisture environment and Kirschner wire was inserted for immobilization. Before and after the surgery, a range of motion was measured by graduator. Using a chromameter, skin color difference between the PSFS composite graft and surrounding normal skin was measured and compared with full thickness skin graft from groin. RESULTS: In all cases, the PSFS composite graft was well taken without necrosis, although the graft was as big as 330mm2(mean 150mm2). Contracture of hand was completely corrected without recurrence. The PSFS composite graft showed more correlations and harmonies with surrounding normal skin and less pigmentation than full thickness skin graft. Donor site scar was also obscure. CONCLUSION: The PSFS composite graft should be considered as a useful option for correction of burn scar flexion contracture of hand.
Bandages ; Burns ; Cicatrix ; Contracture ; Foot ; Hand ; Humans ; Immobilization ; Necrosis ; Pigmentation ; Polyurethanes ; Range of Motion, Articular ; Recurrence ; Skin ; Tissue Donors ; Transplants