Reconstruction of extensive soft tissue defects of the lower extremity, especially when complicated by open fracture and bone loss, is usually a difficult problem for the plastic surgeon. Many methods have been devised to treat these conditions Musculocutaneous flaps add a valuable surgical alternative that bring vascularized cover to the defects, and the free microvascular transfer of these flaps gives the surgeon an added dimension of versatility. The latissimus dorsi is an extremly reliable musculocutaneous flap with a long, large-caliber vascular pedicle, so that dissection of the muscle can be performed with relative ease. The size of the latissimus dorsi muscle lends itself to coverage of large defects. While these characteristics appear to make the free latissimus dorsi musculocutaneous transfer ideal in many circumstances, it has some disadvantages. At the recipient site, the flap is ofter too bulky, and donor-site closure requires skin grafts if the flap is wider than 10cm. These skin grafts on the posterior thorax seriously detract from the final appearance of the donor site. The authors have experienced 12 cases of reconstruction of extensive lower extremity soft tissue defect in which the latissimus dorsi muscle alone was transferred and covered with a split-thickness skin graft. This method improves the recipient-site contour by decreasing the bulk of the flap and it also improves the donor-site appearance. We described technical considerations in each case and the advantages of free latissimus dorsi muscle flap and skin graft for the reconstruction of extensive soft tissue defect in the lower extremity.
Fractures, Open ; Humans ; Lower Extremity ; Myocutaneous Flap ; Skin ; Superficial Back Muscles* ; Thorax ; Tissue Donors ; Transplants

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older. METHODS: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome-the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications-and the indicators of radiographic outcome-the time-to-union and the neck-shaft angle of the proximal humerus-were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients. RESULTS: The mean flexion was 155.0° (range, 90°–180°), the mean internal rotation was T8 (range, T6–L2), and the mean external rotation was 66.8° (range, 30°–80°). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was 131.4° at the 6-month follow-up. According to the Paavolainen method, “good” and “fair” radiographic results each accounted for 38 and 9 of the total patients, respectively. CONCLUSIONS: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.
Aged ; Classification ; Follow-Up Studies ; Humans ; Humerus ; Methods ; Osteoporotic Fractures ; Postoperative Complications ; Range of Motion, Articular ; Shoulder ; Shoulder Fractures*

No abstract available.
Colon, Ascending* ; Leiomyosarcoma*

No abstract available.
Aneurysm

Pyogenic osteomyelitis is at times tragic disease from which severe deformity and disability may result. The incidence and mortality rate of pyogenic osteomyelitis have decreased strikingly since penicillin became available for general use in the treatment of pyogenic osteomyelitis in 1944 and had a dramatic effect. Recently, since the use of new antlblotics, the effect of treatment has been expected in Pyogenic osteomyelitis. But causative organisms of pyogenic osteomyelitis was gradually increasing in resistance to antibiotics. There is also a trend of gradual increase of pyogenic osteomyelltis due to Gram negative bacilli. The author has been analysed 134 patients on whom followup was observed for a minimum of six months at the Department of Orthopedic Surgery of Hanyang University from May, 1972 to December, 1978. The results were as follows: 1. The incidence of pyogenic osteomyelitis is a trend of gradual increase with 14.2% in 1973, 15.7% in 1975 and 26.9% in 1978. 2. Sex ratio was 2.6: 1 (Male: Female): Age distribution showed the group between 5 and 15 years old was 20 patients(62.5%) in acute osteomyeIitis, and the group between 15 and 30 years oId was 52 Patients (51%) In chronic osteomyelitis. 3. The order of involved bones is femur(41%), tibia(27.8%) and humerus(10.4%). 4. Erythrocyte sedimentation rate was remarkably increased in 92.8% of male and 86.5% of female. 5. The causative organism was mostly staphylococcus aureus(84%) in acute osteomyelitis, and Staphylococcus aureus(44.8%), mixed organisms(20.9%) and Gram negative, bacilli(8.3%) in chronic osteomyelitis. Especially, mixed cases with Staphylococcus aureus and Gram negative bacilli contain 55% of mixed organisms. 6. Penicillin was most resistant (79.7%) to Staphylococcus aureus. Cloxacillin was most susceptable (91.3%) to Staphylococcus aureus. 7. The treatment of acute osteomyelitis showed arrest(72.7%) in case of massive antibiotics by early finding of clinical symptom, but if clinical symptoms were not improved within 48 hours with the use of antibiotics, early decompression was done and was arrested(84.6%) in acute osteomyelitis. Closed continuous irrigatlon with saucerization was done and was arrested(85.7%) in chronic osteomyelitis.
Age Distribution ; Anti-Bacterial Agents ; Blood Sedimentation ; Clinical Study ; Cloxacillin ; Congenital Abnormalities ; Decompression ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mortality ; Orthopedics ; Osteomyelitis ; Penicillins ; Sex Ratio ; Staphylococcus ; Staphylococcus aureus

No abstract available.
Temporomandibular Joint*

No abstract available.
Temporomandibular Joint*

Graft-versus-host disease can develop in immunosuppressed individuals who receive blood product transfusions that contain imrnunocompetent lymphocytes. We report a case of transfusion-associated graft-versus-host disease(TA-GVHD) that developed in a patient with acute lymphocytic leukemia who were undergoing therapy. The groups at risk for development of TA-GVHD, the clinical presentation and course, and methods of diagnosis are summarized. Prevention of TA-CVHD is possible by irradiation of blood products given to patients at risk, but problems remain in determining the groups that warrant such measures. We should be aware of the risk of developing TA-GVHD after routine blood transfusion, especially in areas where the population's HLA types are rather homogeneous.
Blood Transfusion ; Diagnosis ; Graft vs Host Disease ; Humans ; Leukemia* ; Lymphocytes ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Transplants*

This study was undertaken to investigate the effect of anesthesia(balanced anesthesia) and surgery on plasma thyroxine and triiodothyronine levels in ten surgical patients by means of the radioimmunoassay method which provides a quantitative measure of thyroid function. The sex ratio between male and female patients was 1:1, mean age was 30.1+/-12.26 and the average body weight was 57.38+/-15.81kg. The plasma triiodothyronine level before anesthesia and surgery was 138.1+/-32.64(ug/dl) but at 90 minutes and 120 minutes after anesthesia and surgery they were 100+/-19.64(ug/dl) and 92.4+/-7.49(ug/dl) respectively. The plasma thyroxine level remained unchanged during anesthesia and surgery. Consequently there was a statistically significant decreased level in plasma triiodothyronine but there was no change in plasma thyroxine level during anesthesia and surgery.
Anesthesia* ; Balanced Anesthesia* ; Body Weight ; Female ; Humans ; Male ; Plasma* ; Radioimmunoassay ; Sex Ratio ; Thyroid Gland ; Thyroxine* ; Triiodothyronine*

By Enzinger and Weiss classification, 664 cases of soft tissue tumors, which were confirmed histologically at the department of pathology of Hangang Sacred Heart Hospital from Janusry 1979 to December 1988, were analyzed statistically. The results were as follows : 1. Of the 664 cases, 261 cases (39.3%) were consulted at the Department of General Surgery, 124 cases (18.7%) were consulted at the Department of Orthopedic Surgery, 115 cases (17.3%)were consulted at the Department of Dermatology. 2, Of the 664 cases, 631 cases (95%) were benign and 33 cases (5%) were malignant. 3. The most common benign tumor was lipoma, which was followed by hemangioma and lymphangioma. Among malignant tumors liposarcoma was the most common one, followed by malignant fibrous histiocytoma. 4. The distribution of age of benign tumor was relatively even from childhood to old age but that of malignant tumor showed highest prevalence in 7th decade. 5. The distribution of sex of benign tumor showed male to female ratio of 1: 1.1 but that of malignant tumor showed male to female ratio of 1.5: l. 6. The predilection sites of benign tumors were head, neck and trunk, but those of malignant tumors were lower extremities and trunk. 7. Kinds of soft tissue tumors consulted at the Department of Dermatology were hemangioma, neurofibroma, lipoma, dermatofibroma, ymphangioma, leiomyoma, juvenile xanthogranuloma, xanthoma, keloid and neurilemmoma.
Classification ; Dermatology ; Female ; Head ; Heart ; Hemangioma ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous ; Humans ; Keloid ; Leiomyoma ; Lipoma ; Liposarcoma ; Lower Extremity ; Lymphangioma ; Male ; Neck ; Neurilemmoma ; Neurofibroma ; Orthopedics ; Pathology ; Prevalence ; Xanthogranuloma, Juvenile ; Xanthomatosis