Recently, increasing interest has emerged in contouring of the lower leg. Harmonious legs are considered one of the most important elements of women's beauty. Calf augmentation is routinely performed using silicone implants or autologous fat grafting. However, such surgical options may be unsuitable for some patients with specific medical conditions or preferences. Herein, we report a rare case of a 36-year-old woman who selected the use of a free deep inferior epigastric perforator (DIEP) flap to correct a left calf contour deformity caused by a previous gunshot injury. The free DIEP flap procedure was carried out successfully without any postoperative complications. Moreover, the patient obtained good aesthetic improvements and was satisfied with the outcome. We therefore recommend the free DIEP flap as an option for the correction of large and irregularly shaped atrophic scars in the lower leg, whether caused by injury, illness, or congenital conditions.
Adult ; Beauty ; Cicatrix* ; Congenital Abnormalities ; Female ; Free Tissue Flaps ; Humans ; Leg ; Perforator Flap* ; Postoperative Complications ; Silicon ; Silicones ; Transplants

BACKGROUND: Random type small V-Y advancement flap is widely used for facial reconstruction with advantages including good color and texture match. However, the flap is not as widely used in the extremities and back as in the face because of apprehension of the relatively poor vascularity as a risk factor of flap necrosis. We used a small bilateral V-Y advancement flap for the repair of extremity and back defects from various causes. Competent clinical outcomes are described. METHODS: Between 2007 and 2014, 24 patients (48 flaps) with skin defects in the upper or lower extremities and back were enrolled. The site of the defect was on back (n=6), forearm (n=7), upper arm (n=2), lower leg (n=5), thigh (n=3), and axilla (n=1). RESULTS: Among the 48 flaps, 47 survived (no event: 42 flaps, total necrosis: 1 flap, partial necrosis: 5 flaps). All partial necrotized flaps healed in 3–4 weeks with conservative care. However, debridement and skin grafting was required for the total necrosis flap. One total necrosis and two partial necroses occurred on the anterolateral side of the lower leg. Two partial necroses occurred on the paraspinal area. CONCLUSIONS: Contour deformities including central depression and the dog-ear deformity were not observed. Small bilateral V-Y advancement in the extremity and back could be a safe and useful flap, if thick subcutaneous fat and subcutaneous plexus were saved. But areas with thin subcutaneous fat layer, such as the anterolateral lower leg, are poor candidates and carry the increased risk of improper subcutaneous pedicle circulation.
Arm ; Axilla ; Congenital Abnormalities ; Debridement ; Depression ; Extremities* ; Forearm ; Humans ; Leg ; Lower Extremity ; Necrosis ; Reconstructive Surgical Procedures ; Risk Factors ; Skin ; Skin Transplantation ; Subcutaneous Fat ; Surgical Flaps ; Thigh

OBJECTIVE: Femoral fracture is one of the most frequent fractures in children and complications occurs such as malunion and leg length discrepancy after internal fixation using flexible intramedullary nail. The author intended to consider operational treatment using flexible intramedullary nailing through a quantitative data including age, pattern and location of fracture for angulation, and leg length discrepancy. METHODS: A retrospective survey was performed by 30 cases of child patients who underwent internal fixation using flexible intramedullary nail for femoral shaft fracture. Using a simple radiography, duration of union and angulation were measured. Leg length discrepancy was evaluated by scanogram. By measuring each 2 times at an interval of 1 week by 2 observers, error among observers and error in observer were excluded. For statistical validation, t-test and lineal regression analysis were used. RESULTS: Immediate postoperatively, valgus condition of 7 degrees was represented and affected side was represented to show varus of 5.6 degrees on average in 46.6% of child patients. The more age of patient is young, more angulation was represented to be significantly taken place in transverse fracture rather than oblique fracture, but depending on fracture location, significant difference was not observed. Leg length discrepancy showed overgrowth of 6.39 mm on average. And cases of overgrowth over 5 mm being were represented and age of all the child patients was below 9 years old. As a result of statistical analysis, it was observed that the age is younger, leg length discrepancy was prone to be occurred, and its significant relevance with fracture form or fracture location was not represented. CONCLUSION: Transverse fracture is represented at the time of performing internal fixation using flexible intramedullary nail. Occurrence rate of angulation and leg length discrepancy was high but follow-up period is required to be extended even after the time when growth is completed on a long-term basis and in case of imperfect correction, additional treatment such as physeal plate stapling is required. Bone shortening and lengthening may be required and it is considered to be a useful method for femoral shaft fracture of children.
Child ; Congenital Abnormalities* ; Femoral Fractures ; Follow-Up Studies ; Fracture Fixation ; Fracture Fixation, Intramedullary ; Humans ; Leg Length Inequality ; Leg* ; Methods ; Radiography ; Retrospective Studies

Neurofibromatosis 1 (NF1) is a common autosomal dominant disorder that causes several systemic diseases. Many studies have reported that NF1 is associated with intrathoracic meningoceles and scoliosis. The incidence of vertebral artery dissection is estimated to be 1-1.5 per 100,000 population. We experienced an autopsy case of massive intrathoracic hemorrhage due to spontaneous vertebral artery dissection in a patient with NF1, who had intrathoracic spinal meningoceles and scoliosis. A 47-year-old man was found dead at his home in the morning. He had a history of NF1 including numerous cutaneous neurofibromas and hyperpigmented macules, scoliosis, and deformity of the leg. The autopsy revealed the dissection and rupture of the left vertebral artery, and a pseudocyst that had formed due to arterial leakage on the wall of the meningocele on the left side. The pseudocyst had eventually ruptured and leaked blood, resulting in a massive hemothorax on the left side. Thus, it was revealed that the patient had suffered from NF1-associated intrathoracic meningoceles and scoliosis, and we concluded that the cause of his death was a massive hemothorax on the left side, caused by the dissection and rupture of the left vertebral artery.
Autopsy* ; Congenital Abnormalities ; Hemorrhage ; Hemothorax ; Humans ; Incidence ; Leg ; Meningocele* ; Middle Aged ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1* ; Rupture ; Scoliosis* ; Vertebral Artery Dissection* ; Vertebral Artery*

PURPOSE: To evaluate the radiological and clinical effects of early eightbearing after distal reverse oblique osteotomy of bunionette. MATERIALS AND METHODS: Between 2009 and 2015, 52 patients who underwent surgical treatment at our hospital for bunionette deformity with a minimum follow up of one year were included in the study. Postoperatively, foot cast was applied and full weightbearing was permitted in 28 patients. And short leg splint was applied with only partial weightbearing using crutches allowed in 24 patients. Clinical scores were evaluated. Radiologically, the 4th~5th intermetatarsal angle (IMA), and 5th metatarsophalangeal angle (MPA) were analyzed preoperatively and at the final follow up visit. RESULTS: The visual analogue scale and American Orthopaedic Foot and Ankle Society scores improved in the partial weightbearing group and full weightbearing group, but without significant differences. The average 4th~5th IMA and average 5th MPA correction also did not showed significant differences between the partial weightbearing group and full weightbearing group. Moreover, the full weightbearing group did not encourage non-union rate compared with the partial weightbearing group. CONCLUSION: Effective bone union may be achieved through early weightbearing, resulting in better clinical outcomes. It is considered that early weightbearing did not have any effect on the changes of IMA and bone union.
Ankle ; Bunion, Tailor's* ; Congenital Abnormalities* ; Crutches ; Follow-Up Studies ; Foot ; Humans ; Leg ; Osteotomy* ; Splints ; Weight-Bearing*

OBJECTIVE: To evaluate the effect of custom molded foot orthoses on children with growing pains of the lower extremities. METHODS: Children with growing pains were recruited during a clinic visit. None had any bony deformities, inflammatory joint disease or depression. Resting calcaneal stance position (RCSP) and calcaneal pitch angle were measured, and individual custom molded rigid foot orthoses were prescribed using the inverted orthotic technique to control for foot overpronation using the RCSP angle. Pain sites, degree and frequency of pain, and balance ability were evaluated using Balance Master computerized posturography prior to foot orthosis fitting, and 1 and 3 months later. RESULTS: Twenty children completed the study. Seventeen (75%) had overpronated feet. Significant improvements were noted after 1 and 3 months in pain degree and frequency, and after 3 months in balancing ability. CONCLUSION: The use of custom molded foot orthoses is a good method for treating children with multiple musculoskeletal pains in the leg.
Ambulatory Care ; Child* ; Congenital Abnormalities ; Depression ; Foot ; Foot Orthoses* ; Fungi ; Humans ; Joint Diseases ; Leg ; Lower Extremity* ; Musculoskeletal Pain ; Orthotic Devices ; Pediatrics ; Postural Balance

Leri-Weill dyschondrosteosis is characterized by SHOX deficiency, Madelung deformity, and mesomelic short stature. In addition, SHOX deficiency is associated with idiopathic short stature, Turner syndrome, and Langer mesomelic dysplasia. We report the first case of a Leri-Weill dyschondrosteosis patient confirmed by SHOX gene mutation analysis in Korea. The patient, who was a 7-year-old female, showed short stature. Her height and weight were 108.9 cm (<3rd percentile) and 19.7 kg (5th-10th percentile), respectively. Her arm span, height of trunk, leg length, and sitting length were 100.5 cm, 58 cm, 50.9 cm, and 62.5 cm, respectively. Her body proportion was 1.13:1. Extremities to trunk ratio was 2.61. Her hand radiograph showed Madelung deformity. And the growth hormone stimulation test showed a normal response. Furthermore, because of Madelung deformity with idiopathic short stature, she was suspected of SHOX deficiency. We performed SHOX gene mutation analysis and found a c.491G>A (p.W164X) mutation of the SHOX gene. Accordingly, this patient was diagnosed with Leri-Weill dyschondrosteosis. Recently, many mutations have been reported in the SHOX gene. However, to date, mutation analysis of the SHOX gene for Leri-Weill dyschondrosteosis has not been reported in Korea as yet. We report the first case of a Leri-Weill dyschondrosteosis patient confirmed by mutation analysis of the SHOX gene.
Arm ; Child ; Congenital Abnormalities ; Extremities ; Female ; Growth Hormone ; Hand ; Humans ; Korea ; Leg ; Turner Syndrome

Postpoliomyelitis syndrome is a common neurological disorder that occurs in patients who have experienced paralytic poliomyelitis. Recently, as a result of vaccination against poliovirus, incidence of poliomyelitis is exceedingly low. However, many patients with postpolio syndrome may encounter anesthesia when undergoing surgery, such as for correction of foot deformity and other operations. We report on a 45-year-old woman who experienced paralysis of her contralateral limb after operation on the left foot under spinal anesthesia. Postoperative electromyography/nerve conduction study (EMG/NCS) was performed in order to determine the cause of paralysis. Motor power of the sequelae involved leg showed improvement with time and recovered fully to the preoperative level at six months after the index operation. A precise evaluation, including a physical examination and EMG/NCS, should be performed preoperatively when spinal anesthesia is planned for postpolio syndrome patients.
Anesthesia ; Anesthesia, Spinal ; Congenital Abnormalities* ; Extremities* ; Female ; Foot Deformities ; Foot* ; Humans ; Incidence ; Leg ; Middle Aged ; Nervous System Diseases ; Paralysis ; Physical Examination ; Poliomyelitis* ; Poliovirus ; Postpoliomyelitis Syndrome ; Vaccination

STUDY DESIGN: Case report. OBJECTIVES: To report a case of extensive spinal epidural abscess and bilateral psoas abscesses combined with pyogenic spondylodiscitis after a L3 vertebroplasty. SUMMARY OF LITERATURE REVIEW: Infection after vertebroplasty or kyphoplasty is a rare medical complication. Few reports on spinal epidural abscess and bilateral psoas abscesses, coupled with pyogenic spondylodiscitis after vertebroplasty, are available in the English medical literature. MATERIALS AND METHODS: The authors performed a clinical and radiographic case review. RESULTS: A 74-year-old woman, without any existing medical illness, presented with a history of three weeks of lower back pain, fever, and neurologic deficits of both legs after vertebroplasty performed in another hospital. Magnetic resonance imaging demonstrated an extensive spinal epidural abscess from T10 to S1 and huge bilateral psoas abscesses combined with spondylodiscitis at L3-4. Urgent limited laminectomies and abscess drainage were performed from L1 to S1. The day after the operation, ultrasound-guided percutaneous drainage was performed to manage bilateral psoas abscesses. Methicillin-resistant Staphylococcus aureus was identified by intraoperative culture. Antibiotic therapy during hospitalization was maintained for six weeks with vancomycin and rifampicin. The infection was successfully treated without any neurologic deficit and spinal deformity. CONCLUSIONS: Vertebroplasty is relative safe and simple procedure; however, the procedure also may cause severe spinal infection. Aseptic techniques under sterile environment was required during surgery. It is important that early diagnosis and prompt surgical decompression in spinal epidural abscess with neurologic deficit. Limited surgery and antibiotic therapy could be a good treatment option in spinal epidural abscess combined with pyogenic spondylodiscitis.
Abscess ; Aged ; Congenital Abnormalities ; Decompression, Surgical ; Discitis* ; Drainage ; Early Diagnosis ; Epidural Abscess* ; Female ; Fever ; Hospitalization ; Humans ; Kyphoplasty ; Laminectomy ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Methicillin-Resistant Staphylococcus aureus ; Neurologic Manifestations ; Psoas Abscess* ; Rifampin ; Vancomycin ; Vertebroplasty*

The rapid increase of elderly population has resulted in increased prevalence of adult scoliosis. Adult scoliosis is divided into adult idiopathic scoliosis and adult degenerative scoliosis. These two types of scoliosis vary in patient age, curve pattern and clinical symptoms, which necessitate different surgical indications and options. Back pain and deformity are major indications for surgery in adult idiopathic scoliosis, whereas radiating pain to the legs due to foraminal stenosis is what often requires surgery in adult degenerative scoliosis. When selecting a surgical method, major symptoms and underlying medical diseases should be carefully evaluated, not only to relieve symptoms but also to minimize postoperative complications. Surgical options for adult degenerative scoliosis include: decompression alone; decompression and limited short fusion; and decompression coupled with long fusion and correction of deformity. Decompression and limited short fusion can be applied to patients with a small Cobb's angle and normal sagittal imbalance. For those with a large Cobb's angle and positive sagittal imbalance, long fusion with correction of deformity is required. When long fusion is applied, a careful decision regarding the extent of fusion level should be made when selecting L5 or S1 as the distal fusion level and T10 or the thoracolumbar junction as the proximal fusion level. For the fusion extending to the sacrum, restoration of sagittal balance and rigid fixation with additional iliac screws should be considered. Any surgical procedures for adult degenerative scoliosis are known to have relatively high occurrences of complications; therefore, risks and benefits should be meticulously considered before selecting a surgical procedure.
Adult* ; Aged ; Back Pain ; Congenital Abnormalities ; Constriction, Pathologic ; Decompression ; Humans ; Leg ; Lumbar Vertebrae ; Postoperative Complications ; Prevalence ; Risk Assessment ; Sacrum ; Scoliosis*