In spite of proper maneuver of total knee replacement arthroplasty, some patients suffer from skin necrosis just above the implant. From Mar. 2000 to Jan. 2004, the authors performed reconstruction of knee skin defects after total knee replacement athroplasty. Total 6 cases of flap surgery were performed and patients ranged between 43-years-old to 82-years-old. Rectus femoris perforator based reversed adipofascial flaps were used in 2 cases, medial gastrocnemius muscular island flaps were used in 2 cases and sural artery based on adipofascial rotation flap was used in 1 case. One patient with extended necrosis underwent reconstruction with dual flaps of sural artery based adipofascial rotation flap and medial gastrocnemius muscular island flap. There were no distinctive complication needing additional procedure in all cases during the long term follow up. Reconstruction of necrosis following total knee replacement arthroplasty had several characteristics different from simple knee defect. The patients might have the history of long term steroid usages, excessive skin tension due to implants, underlying disease such as diabetes, rheumatoid disease, and etc. In addition, the early ambulation is mandatory in these patients of total knee replacement arthroplasty. With regards to these special considerations, a single stage and reliable operation must be needed. The authors introduce various reconstruction methods and algorithm that may aid easy decision making.
Arteries ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Decision Making ; Early Ambulation ; Follow-Up Studies ; Humans ; Knee ; Necrosis* ; Quadriceps Muscle ; Skin ; Surgical Flaps

PURPOSE: Myelodysplastic syndrome (MDS) in children needs to be elucidated in terms of clinical characteristics, natural history, the most effective treatment and prognostic factors, as the disease is very rare and its definition and classification has not reached a consensus by many physician. This study was aimed to describe the characteristics and the disease courses of Korean children with MDS, and to analyze the usefulness of prognostic scoring systems in the prediction of transformation to acute myelogenous leukemia (AML) and overall survival among subgroups. MATERIALS AND METHODS: Fourteen children with MDS seen at Chonnam University Hospital and additional 59 patients identified by the review of Korean literature were evaluated to define clinical characteristics and disease courses. Kaplan-Meier (K-M) probability of leukemic transformation and overall survival were plotted. FAB subtypes, subgroups by Boumemouth Scoring System (BSS), and International Prognostic Scoring System (IPSS) risk groups were compared to predict transformation to AML and overall survival. RESULTS: The median age of 14 patients was 36.5 months. The sex ratio was 3.7:1 (M: F). The frequency of FAB subtypes in Korea was similar to that of other countries except for higher proportion of RA (37%). K-M 3-yr probability of AML transformation and survival for Korean patients were 54.7%, and 49.8%, respectively. Although FAB system, BMS and IPSS were all capable of discriminating subgroups in the prediction of AML transformation and survival, they did not reach the significant level possibly due to small number of patients assigned to each subgroup. CONCLUSION: The clinical characteristics of Korean children with MDS were not different from those of other countries. This study showed the high rate of AML transformation and poor survival in children with MDS.
Child ; Classification ; Consensus ; Humans ; Jeollanam-do ; Korea ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes* ; Natural History ; Prognosis ; Sex Ratio

PURPOSE: To analyze, using finite element model analysis, the causes of postoperative pain in patients who had arthroscopic treatment for femoroacetabular impingement (FAI). MATERIALS AND METHODS: Ten patients with FAI treated by arthroscopic surgery between July 2004 and July 2007 were selected. Five cases whose condition improved to a pain score of 3 postoperatively were assigned to comparative group A and 5 cases who had a second operation done due to a pain score of 1 were assigned to experimental group B. Finite element model analysis was done for the impingement test position. Femoral offset and alpha angle were measured to compare with contact pressure or von Mises stress. RESULTS: Preoperative von Mises stress and contact pressure were all higher in group B than group A. Maximal stress and pressure location was the anterolateral surface of the femoral head and neck, and this location was removed more accurately in group A. CONCLUSION: Finite element model analysis of FAI indicated that incomplete removal of a bump was the cause of pain, and that accurate location of the lesion and adequate bump removal are the definitive factors in reducing pain.
Arthroscopy ; Femoracetabular Impingement ; Head ; Hip ; Humans ; Neck ; Pain, Postoperative

PURPOSE: To determine the significance of Magnetic Resornance Arthrography (MRA) and arthroscopy for diagnosis and treatment of acetabular labral tears as a cause of chronic hip pain. MATERIALS & METHODS: Thirty-seven hips with clinical suspicion of labral lesions were examined with MRA between Mar. 1995 and Mar. 1998. Among them, twenty-two patients underwent the diagnostic and operative arthroscopy. Another fifteen patients were observed closely without management. RESULTS: The mean age was 43 years (18-68 years) and male was twenty-five (68%) . Most common causes was degenerative (10 cases, 27%) and idiopathic (10 cases, 27%) . In MRA, stage IIA (partial tear by Czerny classification) were most common findings (twenty-one portion, 47%) . Including double tears in several patients, most common labral tear was located in the anterosuperior portion ( twenty-three cases, 51%) . Comparing arthroscopic finding, the accuracy of MRA for diagnosis of labral tear was 86.4%. Arthroscopically, we modified the morphological classification of labral tear to radial fibrillated (10 portions) , radial fibrillated + peripheral longitudinal (3) , peripheral longitudinal (4) , complete detachment (5) . All patients except three (86.4%) were improved by the arthroscopic partial labrectomy. In conservative patients, only three (20%) were spontaneously improved. CONCLUSION: MRA, and subsequent arthroscopic management appears to be a promising modality for detection and treatment of labral tear in patients with chronic hip pain.
Acetabulum* ; Arthrography ; Arthroscopy ; Classification ; Diagnosis* ; Hip ; Humans ; Male

BACKGROUND AND OBJECTIVES: Despite significant advances in the treatment of acute myocardial infarction (MI), the prevention of sudden cardiac death (SCD), the most common mode of death in patients with MI, remains challenging. Furthermore, previous Korean MI registries did not address the issue of post-MI SCD. Additional risk stratifiers of post-MI SCD are still required to compensate for the limitation of using left ventricular ejection fraction to predict lethal arrhythmic events. SUBJECTS AND METHODS: We designed the first Korean prospective nationwide multicenter registry primarily focused on SCD; the Korean noninvasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (K-REDEFINE). The registry consists of 2 groups of patients presenting with (1) acute MI or (2) acute heart failure (HF) at 25 tertiary referral cardiovascular centers. The primary endpoint of the MI group study of K-REDEFINE registry is the incidence and risk factors of post-MI SCD. In particular, the association between the risk of SCD and non-invasive Holter-based electrocardiogram (ECG) variables will be evaluated, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/variability (a marker of autonomic function). Other secondary study outcomes include atrioventricular arrhythmias, HF-related admission, repeated myocardial ischemic events, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will provide new prospects for the better management of MI patients with high risk of SCD by clarifying the burden and predictors of SCD and the clinical utility of various non-invasive ambulatory ECG-based variables in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction* ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke ; Stroke Volume

BACKGROUND AND OBJECTIVES: Sudden cardiac death (SCD) is one of the most common causes of death in patients with heart failure (HF). However, there are no available data on SCD in previous Korean HF registries. Additionally, although widely used, the utility of left ventricular (LV) ejection fraction (EF) in risk stratification for SCD is limited. SUBJECTS AND METHODS: The Korean non-invasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (KREDEFINE) is the first Korean prospective, nationwide multicenter registry, primarily focused on SCD. The registry consists of 2 groups of patients presenting with (1) acute HF or (2) acute myocardial infarction (MI) at 25 tertiary referral cardiovascular centers. Using the HF-group data of the K-REDEFINE registry, the incidence and risk factors of SCD in patients with HF will be assessed. In particular, the efficacy of Holter-based ECG variables, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/ variability (maker of autonomic function), in risk stratification for SCD will be evaluated. Other cardiovascular outcomes will also be analyzed, including atrioventricular arrhythmias, HF-related admission, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will pave the way for better management of patients with HF at high risk of SCD by elucidating the burden and risk factors of SCD and the clinical utility of various non-invasive ambulatory ECG-based parameters in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Cause of Death ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke