• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.19-28
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• 2002

From 1994-2001, 25 mutilated digits were reconstructed with immediate toe-to-hand transfer in acute hand injury in 21 patients. There were 15 cases of great toe-to-hand transfer(partial great toe transfer 8 cases, modified wrap-around procedure 2 cases, and trimmed great toe transfer 2 cases) for thumb reconstruction, 2 cases of second toe transfer for index reconstruction, and 4 cases of simultaneous two toe-to-hand transfer(great toe & second toe transfer 1 case, bilateral second-toe transfer 2 cases, combined second & third toe transfer 1 case) for reconstruction of multiple digit amputations. Two cases of emergency exploration(2/25, 8%) were successfully salvaged. The incidence of emergency exploration and postoperative infection was not significantly different from that of the elective toe-to-hand transfer cases. Duration of industrial insurance coverage was 225 days, which is much shorter than that of elective cases. Among 43% of patients maintained their original job even after injury and immediate toe-to-hand transfer. The subjective satisfaction self- assessment scores of aesthetic appearance and function on the new reconstructed thumb were 80 and 88 in average, respectively, over a total score of 100. These were higher than those of reconstruction of other digits, but lower than those of elective reconstruction. The donor site after harvest of the great toe was mostly unsatisfied in a view of appearance. Immediate toe-to-hand transfer provides many advantages over elective procedure in acute hand injuries such as single stage reconstruction, shortened convalescent period, early return to work and efficient socio-economic factor. Furthermore because there were no significant differences in success rate, frequency of complications or ultimate functional result, immediate toe-to-hand transfer is a safe and reliable procedure in case of limited indications for acute digits loss.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.56-60
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• 2012

Purpose: Thumb reconstruction plays most important role in hand injuries because total loss of a thumb constitutes about 40% disability in the hand. The reconstruction can be accomplished by pollicization, free toe-to-thumb transfer, wrap around procedure and lengthening extraction. However, we sometimes need consecutive or double free flaps in the reconstruction of mutilating hand injuries. Methods: We reconstructed a mutilating hand injury in a 54-years old man. Because of severe crushing injury of right thumb and index fingers, we reconstructed a thumb with pollicization using nearly amputated middle finger. Although it survived completely, the adjacent soft tissues which had been covered by fillet flap from the space past was necrosed on 1 month. We debrided the necrotic tissues and covered it with anteromedial thigh perforator free flap consecutively because he had an anatomical variation in branches of lateral femoral circumflex artery. Results: He had an uneventful postoperative course without any complication such as infection, dehiscence and flap necrosis. Three months later, he had undergone tenolysis and defatting procedure of flap site. He recovered the some amount of grip function and was happy with the result. Conclusion: In severe hand trauma including thumb amputation, thumb reconstruction using pollicization and perforator free flap could be an alternative option. It provides minimal donor site morbidity and an acceptable functional result.

• Journal of Korean Physical Therapy Science
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• v.10 no.2
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• pp.246-257
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• 2003

Even though the automation of industrial machinery has dramatically increased, most industries still require human hands for the production of goods. Our hands are essential to our existence. For this reason, hand injuries caused by industrial accidents have become an important issue lately. Most hand injuries are external wounds and constitute 38.6% of disabling industrial accidents. This significant statistic cannot be ignored by rehabilitation programs. The rate of success in operations of finger and hand injuries has increased, but relatively less consideration has been given to physical therapy, rehabilitation, research, or systematic installment in terms of welfare, which would help the injured carry on the nominal life they lived before their injury. Therefore, it is necessary to study systematically all related aspects to provide patients with physical therapy, rehabilitation, and social welfare, in order to restore their social, professional, and economical capabilities. Physical considerations, functional usability, and cosmetic restoration, as well as the patients' mental state must be addressed. The results of the study shows several problems. Medical appliances, manpower, and the environment of the treatment rooms are very poor. The patients cannot receive treatment early enough nor enough treatment because of too many patients for too few physical therapists. Close cooperation between physical therapists and doctors, nurses, or related departments is lacking. Furthermore, it is irrational that industrial accident premiums for the exert; e treatment of hand injury patients are not itemized. Lack of recognition of the importance of specialty in hand injury therapists leads to the lack of professionalization of systematic hand injury treatment In order to solve these problems, the professonalism of physical therapy should be acknowledged and particular treatment courses should be available and/or required. Based on the understanding of the hand injury patients' needs, new theories of physical therapy should be developed and modem medical appliances and facilities should be available, in order to provide the patients with qualitative medical treatment, which then will facilitate the patients' recovery.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.4 no.1
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• pp.20-23
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• 2011

Penetrating injury and retained foreign substances in human body are the main causes of visiting to the emergency room. In hand, foreign substances are caused by trauma. The most common plant pieces, the glass fragments and metal fragments should occur in the order. Especially, it's hard to find fragments of plants and plastic materials because of their radiolucency. And although these fragments are removed, it's difficult to differentiated clearly whether residual foreign bodies are in human hand or not. This study reports the authors' experience in the treatment of a patient from whom he removed a residual tree thorn in the operating room. The thorn was found 4 weeks after the trauma by ultrasonography and then the patients' symptoms were improved.

• Archives of Plastic Surgery
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• v.35 no.1
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• pp.67-72
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• 2008

Purpose: The hand is frequently affected area in high voltage electrical burn injury as an input or output sites. Electrical burn affecting the hand may produce full thickness necrosis of the skin and damage deep structures beneath the eschar, affecting the tendon, nerve, vessel, even bone which result in serious dysfunction of the hand. As promising methods for the reconstruction of the hand defects in electrical burn patients, we have used the peroneal perforator free flaps. Methods: From March 2005 to June 2006, we applied peroneal perforator free flap to five patients with high tension electrical burn in the hand. Vascular pedicle ranged from 4cm to 5cm and flap size was from $4{\times}2.5cm$ to $7{\times}4cm$. Donor site was closed primarily.Results: All flaps survived completely. There was no need to sacrifice any main artery in the lower leg, and there was minimal morbidity at donor site. During the follow-ups, we got satisfactory results both in hand function and in aesthetic aspects.Conclusion: The peroneal perforator flap is a very thin, pliable flap with minimal donor site morbidity and is suitable for the reconstruction of small and medium sized wound defect, especially hand with electrical burn injury.

• Journal of Korean Physical Therapy Science
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• v.6 no.1
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• pp.905-913
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• 1999

The hand is a part of the body which has various functions and a sophisticated structures bone, Joint, tendon, ligament and logical nerve organ are aggregated densely in the hand of anatomy its functions are delicate. The hand's functions are very important for doing ADL and a worker's As the hand is structure which is used often and commonly it is a site that can be easily damaged by a accident on work. This study was investigated and analyzed by the results from 238 workers who had hand injury and physical therapy from January, 1997 to June, 1998 at Shin-Pung, Jang-Lim industrial complex which is located in Pusan. 1. A hand injury most frequertly happened in worker in their 30's and 20's(66 case, 28%), second was 57 case(24%) their 40's. 2. Among workers suffering from injury, who had one or less than 2 years on the job, a injury most frequently occurred. 3. Scale of workers, A injury most frequently happend in a place where had workers from 10 to 50. 99 workers from that place were 42% of total. 4. Month of occurrence rate in March were the highest compared to other months 40 injury workers in march were 17% of the total. Second was July, and the least was April that injury appeared with 10 workers. (4.2% of the total) 1. Frocture was the most common lesion 82 workers had that lesion(34%) soft tissue rupture was 71 workers who were 30% of total in type of lesion. 2. Of the site of lesion multiple case was the most common in which 57 workers had that lesion it were 24% of the total. The next was the index finger site in which 44 workers were 19% of the total. The index finger was the most common mono-site that can be lesion 36 workers were the middle finger lesion workers who were 15% of the total. Of the joint lesion, PIP was the most in which 76 workers were 44% and in MC 27 workers were 15% of the total. 3. Interval of physical therapy 79 workers from one month to 2 months, was 33% of the total and 174 workers who had therapy below 3 months were 71% 4. Post injury of disablity of the site, phalangeous disability was the most in which 148 workers had that injury and they were 62% of the total of the grade of disability 110 workers who were 46% of the total state from less than 25% disability in hand-function and 59 patients who were 25% had no disability. There were 6 workers (3% of the total) who had over -75%-dibability in the hand-function.

• The Journal of Korean Physical Therapy
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• v.13 no.1
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• pp.83-96
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• 2001

The purpose of this study is to provide the fundamental information fer the rehabilitation of hand injury and to emphasize the point of early treatment of hand injury after operation. The subjects are composed with the physical therapists who care hand injury and are engaged in 76 university hospitals,59 general hospitals and 88 semi and local clinics respectively. Investigator take the research form chart with 41 questionnaire and use the cross tabulation frequencies and one-way ANOVA of SPSS WIN(ver 10.0) for the statistic analysis. The results of this research are as follows :1. The number of physical therapists who care hand injury are 110 men and 113 women. 2. The beginning period of active assistive exorcise on the various type of injuries are as follows: At the case of flexor tendon injury, the most part of physical therapists make response to the period that is above 4 weeks in the rate of 29.1%. At the case of fracture, the most part of physical therapists make response to the period those are from 3 weeks to less than 4 weeks and from 4 weeks to less than 5 weeks in the rate of 28.7% respectively. At the case of crushing injury, the most part of physical therapists response to the period that is above 4 weeks in the rate of 32.2%. At the case of amputation injury, the most part of physical therapists response to the period that is above 4 weeks in the rate of 40.4%. 3. In the physical therapy request, treatment period are mentioned in 22.0%. 4. The most difficult factors in the hand treatment is to contracture soft tissue and joint to physical therapist in the rate of 59.6%. 5. Among the reasons of the intervention between physical therapy request and actual treatment, the case of wrong physical therapy request is examined in 69.4%.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.62-66
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• 2009

Purpose: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. Materials and methods: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. Results: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. Conclusion: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.396-399
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• 2010

Purpose: In hand injury, pedicle is usually damaged by avulsion injury or crushing injury. Because of postoperative pedicle obliteration, it is often hard to save the injured hand and fingers, even after successful replantation. The author introduces three cases of extensive hand injury, and successful results after applicatoin of multiple venous grafts to these patients. Methods: In all cases there was no circulation in any finger. In the first case, some vessels were extracted, so venous graft was applied to two sites of severely damaged venous sites. In the second case, venous grafts were applied to all four digital arteries of all fingers except thumb which got severely crushed, and two sites of dorsal veins. In the third case, venous graft was applied to all four digital arteries of all five fingers, and two sites of dorsal veins and palmar veins each. Results: In all cases, survival of hands and fingers was successful. In the second case, however, amputation in thumb and little finger at DIP joint level was inevitable, because of its severe damage, and the large dorsal defect on index finger was filled with DIEP free flap. Thumb was reconstructed with toe-to-thumb free flap, and additional debulking procedures and contracture release is furtherly needed. In the first case, additional surgery was done, as FDP tendon got re-ruptured, but in long term follow-up, satisfactory range of motion was attained. In the third case, FTSG on dorsal skin region was planned. as flap on dorsal area got partial necrosis. Conclusion: In hand injury, there are many structures to be repaired, but sometimes venous graft is avoided for its long operating time. Even though the length of damaged vessel is enough for anastomosis, the endothelium is often damaged (zone of injury). In extensive hand injury, successful reconstruction would be possible with active venous graft to all vessels suspicious for damage.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.595-601
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• 2003

Background: It has been known that the most effective treatment method of hyperhidrosis is video-assisted thoracoscopic sympathetic nerve block. Postoperative compensatory hyperhidrosis and anhidrosis are major factors that decrease the postoperative satisfaction. Although sympathetic rami have been selectively blocked to decrease the complications, technical difficulties and excessive bleeding have prevented the universal application. Material and Method: Three pre-fixative cadavers were dissected before clinical application. Bilateral sympathetic chains were exposed in supine position after the whole anterior chest wall was removed. Second and third sympathetic rami were blocked using clips. After the sympathetic chains including ganglia were removed, we evaluated the extents of rami block. Twenty-five patients were subjected to the clinical application. Surgeries were performed in semi-fowlers position under general anesthesia and bilateral ventilation. 2 mm thoracoscopy and 5 mm trocar were intro-duced through third and fourth intercostal space, respectively. Second and third sympathetic rami were blocked using thoracoscopic clips. The postoperative complications, satisfaction, and compensatory hyperhidrosis rate were evaluated retrospectively. Result: Sympathetic rami were completely blocked in cadaver dissection study Hyper-hidrosis symptom was improved in all patients without operative complication. Operative time was shorter than that of traditional ramicotomy. All patients, except four, were satisfied with postoperative palmar hyperhidrosis. Com-pensatory hyperhidrosis was more severely happened in fifteen patients (60%). The remaining six patients had no complaint. Two patients had a minimal degree of gustatory hyperhidrosis. Conclusion: This operative method had shorter operative time and less complication rate, compared with traditional ramicotomy Operative success rate was similar to the traditional syrnpathicotorny; lower extent and occurrence rate of compensatory hyperhidrosis. The thoracic sympathetic rami clipping was suggested as an alternative method for treatment of palmar hyperhidrosis.