No abstract available.
Humans ; Outpatients*

A new balloon dissector, a modification of a Foley catheter, was devised and it can be used either as a dissector or a tissue expander. Since most operating time was spent in balloon manipulation (inflation/deflation), the duct for saline injection was made to be wider than the Foley catheter. As a result, the balloon could be inflated faster than before. In order to reduce the scar at the donor site, harvest of the sural nerve using endoscopic technique is currently applied, but utilization of this method is technically difficult and requires a long operating time. For these reasons, new our method of using a balloon dissector was devised. The balloon dissector can also be used for immediate intraoperative tissue expansion for the reconstruction of small skin defects without distortion. We have found that the advantages of using the new balloon dissector include a reduction in operating time, preservation of the perforating vessels, and primary closure with less tension. In addition, this simple and inexpensive instrument is cost-beneficial to patients.
Catheters ; Cicatrix ; Humans ; Skin ; Sural Nerve ; Tissue Donors ; Tissue Expansion ; Tissue Expansion Devices

No abstract available.
Abscess* ; Reoperation*

No abstract available.
Hemorrhage*

We have experienced 29 cases of microvascular surgery during a year since Apr. 1981. We performed 18 cases of composite tissue transfer in 17 patients. 3 cases of axillary flap, 5 cases of dorsalis pedis flap, 4 cases of living fibula transplantation, 2 cases of groin flap using deep circumflex iliac vessels, a case of osseocutaneous flap using the 11th rib, living M-P joint from the 2nd toe to finger, neurovascular island flap from the lateral side of the 3rd finger, and a case of musculocutaneous flap using the gracilis muscle were done. The causes of the soft tissues and/or bone loss were open fracture, which is the most common cause, osteomyelitis, congenital pseudarthrosis of the tibia, bone tumor, and scar contractures, etc. The success rate of the composite tissue transfer was 89%. The 2 cases of failure were observed. The one is due to the vascular damage after the leg lengthening in congenital pseudarthrosis of the tibia and the other due to the infection on the grafted area. The follow up period was from 4 to 18 months. The patients except failed 2 cases were pleased the result of the surgery. The composite tissue transfer using microvascular surgery has many advantages in that the tissue defect can be filled by one stage operation, the patient would be less dependent wish shorter hospital stay, the patient would be less morbid with better function than the patient with multi-staged complex operations. The composite bone and soft tissue transfer used for the infected bony defect made the infection heal more rapidly than the other conventional methods. The deep circumflex iliac artery played a good role in making the osseocutaneous flap, which has many advantages such that Taylor had described. But it is not the truth for the skin only problem. So we darely suggest the third category of the arterial supply to the skin as osseocutaneous artery to supply the overlying skin through the bone, which is exampled with the deep circumflex iliac artery. The vessels in the area of a limb lengthening would be stretched and severely damaged. And the overstretched vessels in limb lengthening should not be used in the microvascular surgery, if the time interval from the traction is not plentifully elapsed and the vessel status is not converted to normal.
Arteries ; Cicatrix ; Contracture ; Extremities ; Fibula ; Fingers ; Follow-Up Studies ; Fractures, Open ; Groin ; Humans ; Iliac Artery ; Joints ; Leg ; Length of Stay ; Myocutaneous Flap ; Osteomyelitis ; Pseudarthrosis ; Ribs ; Skin ; Tibia ; Toes ; Traction ; Transplants

No abstract available in English.
Classification ; Polydactyly

Seventeen patients with classical rheumatoid arthritis have been treated with gold sodium thiomalate(G.S.T) injection and followed up for 1.7 years on average. The results obtained are as follows: 1. Clinical improvement was obtained in 12(70.3%) out of 17 cases, but only in 5 cases(29.3%) marked and persisting improvement was obtained. Such improvement was first noticed when the total dose of the gold sodium thiomalate reached 500mg or more, and also noticed about 10 weeks after initiation of G.S.T therapy. 2. Changes in laboratory parameters such as hemoglobin, hematocrit, eosinophilia, titers of rheumatoid factor and C-reactive protein, and proteinuria began to appear at the time of the clinical improvement. 3. Adverse reaction consisted mostly of mucocutaneous lesions. The main causes of drop-out during therapy also are severe skin rashes and pruritus. Most of the adverse reactions appeared when the total dose of G.S.T. administered reached over 500mg. In two severe cases skin rashes terminated the gold therapy. Our findings suggest, because of high incidence of adverse reaction during G.S.T therapy, repeated careful clinical and laboratory examination of the patient are mandatory especially when the total dose of G.S.T is reached 500mg. In spite of the well documented reports of the maintenance gold therapy for rheumatoid arthritis it is felt that the maintenance gold therapy should be studied further before it can be safely used as a routine in daily rheumatology practice because of its toxicity.
Arthritis ; Arthritis, Rheumatoid ; C-Reactive Protein ; Eosinophilia ; Exanthema ; Gold Sodium Thiomalate ; Hematocrit ; Humans ; Incidence ; Proteinuria ; Pruritus ; Rheumatoid Factor ; Rheumatology ; Sodium

Repeated throwing of baseballs by juvenile pitchers is known to cause damages to bone and cartilage as well as soft tissue in the involved upper extremity. Authors present 4 cases of osteochondral lesion at capitellum of the humerus as a result of repeated insult by throwing baseballs in the juvenile pitchers. Pain and limitation of extension of the affected elbow were the commonest symptoms. Cystic change or osteochondral loose body was found on plain X-ray. Treatment consisted of rest and analgesic administration in the patient who has no loose body, while in case of having loose body it was removed surgically without further treatment to the crater. In spite of the rapid relief of the pain by these treatment, limitation of extension persisted for considerable period of time. It is strongly suggested not to overlook elbow pain in young adolescent whose bone is still growing and who can hardly withstand repeated insult to prevent the development of baseball elbow.
Adolescent ; Baseball ; Cartilage ; Elbow ; Humans ; Humerus ; Osteochondritis ; Upper Extremity

Diaphyseal fractures of the long bone associated with massive soft tissue injury or severe comminution is difficult to treat. Fracture healing is often delayed due to the damaged soft tissue, deep seated wound infection, fracture instability and poor local circulation. The delayed fracture healing necessitates prolonged immobilization of the limb which results in joint stiffness. Various type of fracture treatment was suggested for this type of fractures to ease the treatment. The Wagner's apparatus was one of the device to treat it, which was originally introduced as a device for controlled leg lengthening. Its use also has been expanded to serve as a rigid unilateral external fixation frame for fracture. In order to obtain satisfactory fracture union without adjacent joint contracture, the Wagner's apparatus has been employed by us in three cases who were hospitalized in Kangnam St. May's Hospital. The experience of this technique was very encouraging; therefore we recommend its wide application in fracture treatment in cases of the patient who can not receive the bilateral external fixation frame.
Contracture ; Extremities ; Fracture Healing ; Humans ; Immobilization ; Joints ; Leg ; Lower Extremity ; Soft Tissue Injuries ; Wound Infection

No abstract available.
Case-Control Studies* ; Placenta Previa* ; Placenta* ; Risk Factors*