• 대한기계학회:학술대회논문집
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• 대한기계학회 2003년도 추계학술대회
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• pp.1373-1377
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• 2003

Current prostheses for amputees are generally extrinsic wearing socket type that the coupling between body stump and appliance wraps the soft tissue and this structure causes several problems :applying direct weight to soft tissue such as skin and muscle, skin trouble of contacting area and pain. In this study, osseointegration implant is a method to directly connect prosthesis to the residual stump skeletal tissue of arm, finger and leg through surgical operation. Technology presented in this paper essentially solves the problems of pain and abnormal weight transfer system indicated above and recovers the functions of the amputated arm and leg. In this paper, implant shape was designed for the first step for the development of osseointegration implant and then we studied the possibility to apply this osseointegration implant to human body by performing implant insertion operation to beagle tibia for the clinical animal test and normal beagle's gait analysis was executed in order to quantitatively verify the beagle's skeletal functions after the implant insertion.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.404-410
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• 2012

Background First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. Methods Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm. Results Of a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results. Conclusions A composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.273-276
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• 2009

A 54-year-old man experienced injury to the second finger of his left hand due to damage from a paintball gun shot 8 years prior, and the metacarpo-phalangeal joint was amputated. He gradually developed mechanical allodynia and burning pain, and there were trophic changes of the thenar muscle and he reported coldness on his left hand and forearm. A neuroma was found on the left second common digital nerve and was removed, but his symptoms continued despite various conservative treatments including a morphine infusion pump on his left arm. We therefore attempted median nerve stimulation to treat the chronic pain. The procedure was performed in two stages. The first procedure involved exposure of the median nerve on the mid-humerus level and placing of the electrode. The trial stimulation lasted for 7 days and the patient's symptoms improved. The second procedure involved implantation of a pulse generator on the left subclavian area. The mechanical allodynia and pain relief score, based on the visual analogue scale, decreased from 9 before surgery to 4 after surgery. The patient's activity improved markedly, but trophic changes and vasomotor symptom recovered only moderately. In conclusion, median nerve stimulation can improve chronic pain from complex regional pain syndrome type II.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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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.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.1-7
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• 2012

Purpose: This retrospective study was to determine the functional results of patients who were amputated of their fingertip between patients who were treated with replantation and patients who were treated with thenar flap. Materials and Methods: From 2004 to 2007, we identified and operated 159 patients who were diagnosed with fingertip amputations. Of 159 patients, Eighty-two patients were treated by replantation (67 in men and 14 in women) and the mean age at the operation was 41 years (range, 15-68 years). Seventy-nine patients was treated with thenar flap(54 in men and 25 in women) and the mean age at the operation was 43 years(range, 21-70 years). We compared variables between two groups including, age, gender, diagnosis, duration of hospital admission, grip strength, two-point discrimination, Semmes Weinstein monofilament test, active range of motion (ROM) of the proximal and distal interphalangeal (PIP and DIP) joint, pain (or tenderness), paresthesia, cold intolerance, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and finger for activities of daily living (ADLs). Results: The duration of admission was longer in Replantation group than in Thenar flap group(p=0.001). However, the grip strength (p=0.003) and Semmes Weinstein monofilament test (p=0.029) in the Replanation group were statistically superior to the Thenar flap group. The average DASH disability (p=0.003)/symptom score (p=0.007) and ADLs (p<0.001) in the Replantation group was statistically better. In addition, cold intoleranace test of Thenar flap group is worse than the Replantation group. Conclusion: This study demonstrate that fingertip replantation have demonstrated not only to obtain the best appearance but also to gain better functional outcome. However, it is impossible to perform replatation, the thenar flap can be limited alternative method for fingertip amputation in aspect of preservation of range of motion and hospitalization time.

• Archives of Plastic Surgery
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• 제44권2호
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• pp.150-156
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• 2017

Background Digital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients. Methods A retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded. Results Seven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported. Conclusions When autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.

• Archives of Reconstructive Microsurgery
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• 제15권1호
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• pp.10-16
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• 2006

We retrospectively evaluated our results of replantations of distal digital amputations and analyzed the factors deterrent to the survival of replanted digits. From January 2004 to 2005 June, we performed 101 cases of replantations following complete amputations at or distal to interphalangeal joint level. The study included 98 patients with a mean age of 35.6 years (range 1 to 63 years). Amputation level correlated to zone I (distal to the lunula)in 47 cases and zone II (lunula to distal interphalangeal joint) in 54 cases according to Yamano's classification. According to the mechanism of amputation, 24 cases (22.9%) suffered from guillotine type injury, 27 cases (27.1 %) from avulsion type injury and 50 cases (50%) from crush type injury. In all cases, a single arterial anastomosis was performed. Venous anastomosis on either volar or dorsal side was performed in 12 cases of amputation in zone II. Salvage procedure for venous drainage was performed in 98 cases. The mean duration of salvage procedures was 5.9 days (ranging from 4 to 14 days). Successful replantation was achieved in 96 cases (95.1%), which included 93.7% cases in zone I amputations and 96.3% cases in zone II amputations. A single venous anastomosis was performed in 12 cases of amputation in zone II. All of them survived completely. Among the 5 cases that failed to survive, 3 cases were related with avulsion injury in zone I. Initial mechanism of injury determines the survival rate of amputated parts as it is directly related with the status of vessels and soft tissues. Meticulous precaution during the salvage procedure may affect the overall survival rate of distal digital replantations.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.636-641
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• 2011

Purpose: There are multiple dependent variables commonly attributed to survival of replanted digits. The ischemia time is thought to be a clinically relevant factor. However, controversy exists as large hand centers have reported successful replant outcomes independent of ischemic time. In this study, we present a single institution experience on the effect of ischemia time on the survival of completely amputated digits. Methods: A retrospective review of a single institution experience was performed. This cohort included all comers who had suffered complete amputation of a digit (Zone 2-4) and underwent replantation from 2003 to 2009. Demographic information as well as injury mechanism, ischemic time, and replantation outcome were recorded for each patient. Chi-square was used to analyze the result. Results: Mean age was 35.5 years old (2-69). Mean replantation survival was 89.5% (37/317). Survival rates were 94, 88, and 88% in respective groups of 0~6, 6~12, of > 12 hours of ischemia time. In chi-square analysis, there was no difference with $p$ value of 0.257. No other independent patient factors showed statistically significant relationship to replant survival rate. In the group with longest ischemia time (12~18 hours) replant survival rate was 88% (37/42). Conclusion: Prolonged ischemia time is commonly believed to be a contributing factor for replant survival. However, our experience has shown that survival rate is uniform up to 18 hours of ischemia.

• Archives of Plastic Surgery
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• 제45권1호
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• pp.62-68
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• 2018

Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated $90^{\circ}$ cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes.