PURPOSE: Management of the soft tissue defect in the lower extremity caused by trauma has always been difficult. Coverage with local and free muscle flaps after complete surgical excision of necrotic soft tissue and bone is a major strategy for treatment. There is no doubt that muscle provides a good blood supply, thus improving bone healing and increasing resistance to bacterial inoculation. However, accompanying problems are seen in cases with shallow dead space. This research was conducted to assess the efficacy of raising anterolateral thigh flaps and transferring them to the defect after complete debridement of non-viable, infected, and scar tissue as an alternative way to use local or free muscle flaps. METHODS: From March 2005 to October 2007, 18 cases of soft tissue defect on lower extremities were re-surfaced with an anterolateral thigh perforator free flap. RESULTS: The follow-up period ranged from 1 to 31 months with a mean of 15.9 months. All flaps survived completely. Satisfactory aesthetic and functional results were achieved. Under a two-point discrimination test, 13 patients had sensory recovery from 11 mm to 20 mm after 6 months postoperatively. CONCLUSION: Reconstruction of the lower extremity with anterolateral thigh perforator free flaps after appropriate debridement is a good alternative way to use local or free muscle flaps.
Cicatrix ; Debridement ; Discrimination (Psychology) ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Lower Extremity* ; Thigh*

BACKGROUND: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. METHODS: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. RESULTS: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 +/- 7.9 mm versus 7.3 +/- 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. CONCLUSIONS: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.
Arm ; Clavicle* ; Consensus ; Elbow ; Extremities ; Hand ; Humans ; Ligaments* ; Prospective Studies ; Seoul ; Shoulder ; Shoulder Fractures ; Skin ; Suture Anchors ; Sutures*

Syphilitic aortitis, passing out of our mind, is the most common systemic manifestation of late syphilis and is more typically manifestated 10 to 30 years afterward. This diagnosis has been made less frequently in recent decades than in the past, because of public awareness of syphilis and screening program. Treponema pallidum lodge within vasa vasorum, especially ascending aorta cause the histologic changes, which are responsible for the three major forms of symptomatic cardiovascular syphilis, including aortic insufficiency, coronary ostial stenosis, and aortic aneurysm. We experienced a case of syphilitic aortitis with aortic insufficiency and aortic aneurysm in a 48-year-old man presented with progressive dyspnea. Echocardiography, chest CT, and later surgical correction were performed and surgical specimen revealed the histologic finding consistent with syphilitic aortitis. We report this case with a review of the literature.
Aorta ; Aortic Aneurysm* ; Aortitis ; Constriction, Pathologic ; Diagnosis ; Dyspnea ; Echocardiography ; Humans ; Mass Screening ; Middle Aged ; Syphilis ; Syphilis, Cardiovascular* ; Tomography, X-Ray Computed ; Treponema pallidum ; Vasa Vasorum

A combined anterolateral and posterior approach with thoracotomy has been recommended as the traditional surgical approach for the tumors of the thoracic spine. Recently, because of the morbidity associated with open thoracotomy, the thoracoscopically assisted surgical technique was introduced successfully in thoracic spinal surgery. Herein, we report a combined surgical technique for giant cell tumor of the thoracic spine (T10) consisting of bilateral thoracoscopic anterior release of the spine followed by a posterior en bloc spondylectomy and reconstruction by orthopedic surgeons. The thoracoscopic spinal surgery is safe and effective alternative for other open thoracotomic procedures in the approach to the anterior thoracic spine, avoiding the disadvantage inherent to thoracotomy.
Giant Cell Tumors ; Orthopedics ; Spine* ; Thoracoscopy ; Thoracotomy

PURPOSE: Intracavernosal self injection therapy is now being widely used to treat patients with erectile dysfunction. However, there is a large number of patients who give up the self injection program due to the fear of injection. Therefore, less invasive route of drug administration is highly recommended. We investigated the efficacy of intraurethral instillation of Prostaglandin El (PGE1 ) solution in the patients who showed full erection with intracavernosal injection of PGE1. MATERIALS AND METHODS: Twenty-nine impotent patients who showed full erection with intracavernosal injection of PGE1 were included in this study. We estimated the grades and durations of the penile erection after intraurethral instillation of PGE1 RESULTS: Sixteen out of 29 patients(55.2%) showed full erection with intraurethral instillation. Two patients(6.9%) showed urethral pain which disappeared within 24 hours. But there was no systemic side effect CONCLUSIONS: Intraurethral instillation of PGE1 appears to be safe, well tolerated, and less invasive treatment modality Thus it can be selected as an alternative treatment of impotence in selected cases.
Alprostadil* ; Erectile Dysfunction* ; Humans ; Male ; Penile Erection

Bronchogenic cysts (BCs) are relatively common congenital anomalies in the mediastinum. Most of the patients with BC can be managed both safely and effectively by minimally invasive methods. Selected patients with a BC in a favorable location can have the cyst partially or completely excised by mediastinoscopic techniques. Herein we report on a case of a left lower paratracheal bronchogenic cyst that was completely resected by a video-assisted mediastinoscopic technique, and we discuss the technical aspects of this procedure.
Bronchogenic Cyst ; Humans ; Mediastinal Diseases ; Mediastinoscopy ; Mediastinum

STUDY DESIGN: A retrospective study. OBJECTIVES: To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy. SUMMARY OF LITERATURE REVIEW: A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for various spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications. MATERIAL AND METHODS: Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparoscopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow-up period was 19 months. RESULTS: Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. At the last follow-up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction. CONCLUSION: Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.
Allografts ; Blood Vessels ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Laparoscopy ; Ligation ; Recurrence ; Retrospective Studies ; Sacrum ; Sarcoma, Ewing ; Scoliosis ; Spine* ; Thoracoscopy

STUDY DESIGN: A retrospective study. OBJECTIVES: To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy. SUMMARY OF LITERATURE REVIEW: A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for various spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications. MATERIAL AND METHODS: Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparoscopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow-up period was 19 months. RESULTS: Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. At the last follow-up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction. CONCLUSION: Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.
Allografts ; Blood Vessels ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Laparoscopy ; Ligation ; Recurrence ; Retrospective Studies ; Sacrum ; Sarcoma, Ewing ; Scoliosis ; Spine* ; Thoracoscopy

Juvenile nasopharyngeal angiofibroma accounts for less than 0.5% of head and neck tumors. It primarily affects male adolescents, and originates in the posterolateral wall of the nasopharynx. Although angiofibromas extend beyond the nasopharynx commonly, they rarely originate outside the nasopharynx. Primary extranasopharyngeal angiofibromas have been sporadically reported in the literature. We report an unusual case of an angiofibroma arising from the middle turbinate. The tumor was completely removed through endonasal, endoscopic technique after pre-operative embolization.
Adolescent ; Adult* ; Angiofibroma* ; Female ; Head ; Humans ; Nasopharynx ; Neck ; Turbinates*

Purpose: To compare the thickness of the processed pericardial patch graft for glaucoma implant tube coverage using anterior segment optical coherence tomography (AS-OCT). Methods: Thicknesses of seven samples of two pericardial patch grafts (Tutoplast pericardium, IOP Inc, Costa Mesa, CA, USA; pericardium LYO, DCI Donor Services, Inc., Nashville, TN, USA) were measured using AS-OCT (CASIA2, Tomey Corporation, Nagoya, Japan). The thickness of each sample was measured at the center and eight points with 45-degree angular distance, 2 mm from the center. The thickness was measured using AS-OCT program tools. Results: The median thicknesses were 219 μm for Tutoplast pericardium and 157 μm for pericardium LYO. Tutoplast pericardium was significantly thicker than pericardium LYO (p = 0.001); pericardium LYO had a wider interquartile range within each sample, compared to Tutoplast pericardium (p = 0.017). Conclusions The thickness of the Tutoplast pericardium was greater and less variable than that of the pericardium LYO. These findings should be considered when choosing processed pericardium for coverage of glaucoma implants.