No abstract available.
Fractures, Spontaneous* ; Humerus* ; Replantation* ; Sarcoma, Ewing*

Degloving injuries of the fingers result in avulsion of skin and subcutaneous tissue from the underlying deep fascia, the arterial supply is embarrassed and necrosis may result. Theoretically primary microvascular replantation may be a complete solution, however, the prognosis in terms of both immediate and long term function following avulsed digits is poor. The ideal reconstruction aims at retension of mobility and restoration of a skin cover that is adherent, has a sensibility approaching the norm, and is free from pain. A method of finger reconstruction for an avulsion injury using a free neurovascular wrap-around flap from the big toe may be a choice of treatment for both esthetic and functional aspects.
Fascia ; Fingers ; Hallux ; Methods ; Necrosis ; Prognosis ; Replantation ; Skin ; Subcutaneous Tissue

This article introduces a new method of thumb reconstruction with the use of an iliac bone graft and a free neurovascular wrap-around flap from the big toe, previously reported by Morrison et al. in 1980. Using this method it is possible to reconstruct a thumb similar to the missing part without total sacrifice of the toe. There is no mobile portion in the reconstructed thumb and motion is provided only by intact joint of traumatized thumb. In thumb reconstruction, it is possible to preserve the nail and its pulp, thus preventing swivelling of the nail and loss of pulp sensation as well as ensuring continued nail growth. This is achieved by free tissue transfer from the 1st web space of the foot, innervated by the deep peroneal nerve and supplied by the dorsalis pedis artery with relatively large diameter. Three cases of thumb reconstruction were performed with this method. Follow up was done for an average of 11.3 months; the rate of viability was 100% with excellent appearance; the 2-point discrimination averaged 8.3 mm.
Arteries ; Discrimination (Psychology) ; Follow-Up Studies ; Foot ; Hallux ; Joints ; Methods ; Peroneal Nerve ; Sensation ; Thumb ; Toes ; Transplants

A 41 year-old man had dark pigmented papules and plaques, 4 to 15 mm in size, on the proximal portion of the dorsum of the penile shaft and pubic area of 8 months duration. Over next several months, flesh colored, macerated papules, 2 to 4 mm in size, appeared on the left side of the scrotum Light microscopic examination from a pigmented lesion of the penile shaft showed typical findings of Bowen's disease. Ultrastructural findings included: widening of intercellular space, a decrease in the number of desmosomes with microvillous projections, aggregation of tonofilaments, an increase in the mitotic keratinocytes, an increase in the number of melanin granules, and disorganized bundles of tonofilaments surrounding chromosomes. Virus-like particles were not observed. Based on the ultrastructural findings and review of literatures, it seems to be probable that bowenoid papulosis is a clinical variant of Bowens disease.
Adult ; Bowen's Disease ; Desmosomes ; Extracellular Space ; Genitalia* ; Humans ; Intermediate Filaments ; Keratinocytes ; Melanins ; Scrotum

No abstract available.
Replantation*

From March 1983, 20 patients had undergone reconstruction of the upper limb with 22 vascularized composite tissue grafts. The microsurgical procedures had several advantages for reconstruction of injured upper limbs as follows: 1. Free tissue transfer was quite an important and attractive procedure for reconstruction of an injured limb, expecially an upper limb. 2. Free vascularized transfer of composite tissue with its overlying skin was a reliable technique to obtain full thickness soft tissue coverage of a severely injured upper limb when more conservative procedures, such as the use of skin graft or local muscle flaps, had failed or were not feasible. 3. A simple skin flap could be transfered to close an open wound of the limb, but a sensory flap or a special flap such as a nail-skin, tendon-skin or muscle-skin flap was a much better donor for reconstructing the function of the upper limb. 4. When appropriate, the wrap-around procedure was the method of choice for thumb reconstruction because the great toe was preserved. The procedure provided length, stability and adequate sensibility for a functional pinch and grasp. 5. The cosmetic effect of a second-toe transplant might be inferior to the wrap-around flap, but it had the great advantage of being able to provide mobile joints in the reconstructed thumb. As far as the donor foot was concerned, no patients had real trouble functional impairment.
Extremities ; Foot ; Hand Strength ; Humans ; Joints ; Methods ; Microsurgery ; Skin ; Thumb ; Tissue Donors ; Toes ; Transplants ; Upper Extremity ; Wounds and Injuries

No abstract available.
Hyperpigmentation*

No abstract available.
Extremities* ; Hemangioma*

The transfer of a sensory island of skin to an anesthetic area on the hand has been the most important development in hand surgery in the past decade. A neurovascular island flap transfer has proved useful for the treatment of finger injuries in primary cases and in secondary cases. The purpose of this paper is to describe the use of local composite tissue, isolated and transferred on a neurovascular pedicle graft for the secondary reconstruction procedures of finger injuries. Thirty two fingers had been operated on for "neurovascular island flap" coverage operation at the Department of Orthopedic Surgery, Yonsei University, Severance Hospital and Inchon Severance Hospital during the period from 1983 to 1992. The follow up study was carried out on twenty hands over a year period after an operation. The results obtained were as follows. 1. Among twenty hands the cases of thumb are ten. The index are eight, other fingers are two. 2. The ratio between male and female was about 4: 1 The most common procedures of primary treatment were abdominal distant flap (14cases). 3. All had better touch, pain and temperature sensibility in the flap than the surrounding recipient area. Thirteen patients reffered a pinprick in the flap to the donor finger, All had decreased two point discrimination corresponding to the pulp about 6 months after operation. 4. The use of neurovascular pedicle graft as a method of tissue transfer which permits a wide range of motion and comfortable appearance without jeopardizing either circulation or sensation.
Clinical Study ; Discrimination (Psychology) ; Female ; Finger Injuries ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Incheon ; Male ; Methods ; Orthopedics ; Range of Motion, Articular ; Sensation ; Skin ; Thumb ; Tissue Donors ; Transplants

The diagnostic accuracy of myelography, electromyography, and clinical-neurological findings in 64 patients on whom the presence of herniated intervertebral disc was proved surgically from March, 1974 to February, 1980 in Severance Hospital was discussed and the results of this study was compared with those in comparable studies in the literature. 1. Of the cases in which operation revealed disc herniation or protrusion, the clinical neurological diagnosis was correct in 71.9%, the myelographic diagnosis was coincided in 79.7%, the electromyographic diagnosis was agreed in 73.4%. 2. In the patients which the patellar tendon reflex was weak or absent, operation revealed a herniation between L3 and L4 in 66.7%. The disc herniation bewteen L4 and L5 was noted in 93.0% of patients with weakness of the extensors of the great toe. Of the patients in whom the Achilles tendon reflex was weak or absent, operation revealed a tumbosacral disc herniation in 87.0%. 3. If the myelogram showed lumbar disc changes, these changes were confirmed at operation in the same level in all patients. 4. A disc herniation between L3 and L4 was demonstrated in aH cases of the patients had L4 denervation of the electromyographic findings. The disc herniation between L4 and L5 was seen in 93.0% of them had L5 denervation. A lumbosacral disc herniation was noted in 83.3% of them had 51 denervation. 5. Polyphasic motor units were significant in the absence of diagnosis of the herniated lumbar disc. 6. Signs of denervation in the spinal muscalature but not in the leg muscles were considered significant in patients with diagnostic problems of the lumbar radiculopathy. In summary, it is suggested that electromyography is not superior to the myeolgraphy or the clinicalneurogical examination. But the electromyography aids the surgeon in the dlagnosis of a compression lesion of a specific nerve root.
Achilles Tendon ; Denervation ; Diagnosis ; Electromyography ; Humans ; Intervertebral Disc ; Leg ; Muscles ; Myelography ; Patellar Ligament ; Radiculopathy ; Reflex ; Toes