• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.132-139
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• 2011

The concept of double-bundle ACL reconstruction was introduced recently to restore the anatomical and biomechanical functions of the native ACL. According to anatomical and biomechanical studies, the separate reconstruction of anteromedial and posterolateral bundle expect to increase the overall postoperative stability and clinical results compared to single-bundle ACL reconstruction. But there is still a lack of available clinical outcome studies with sufficient follow-up to demonstrate the real advantages of double-bundle ACL reconstruction. The purpose of this article is to review the evidence to support double-bundle technique and to address controversies existing over the usefulness of this technique.

• Journal of Korean Neurosurgical Society
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• v.44 no.2
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• pp.72-77
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• 2008

Objective : The objective of this study was to evaluate the characteristics and surgical outcome of the conus medullaris tumors. Methods : We retrospectively reviewed 26 patients who underwent surgery for conus medullaris tumor from August 1986 to July 2007. We analyzed clinical manifestation, preoperative MRI findings, extent of surgical resection, histopathologic type, adjuvant therapy, and outcomes. Results : There were ependymoma (13), hemangioblastoma (3), lipoma (3), astrocytoma (3), primitive neuroectodermal tumor (PNET) (2), mature teratoma (1), and capillary hemangioma (1) on histopathologic type. Leg pain was the most common symptom and was seen in 80.8% of patients. Pain or sensory change in the saddle area was seen in 50% of patients and 2 patients had severe pain in the perineum and genitalia. Gross total or complete tumor resection was obtained in 80.8% of patients. On surgical outcome. modified JOA score worsened in 26.9% of patients, improved in 34.6%, and remained stable in 38.5%. The mean VAS score was improved from 5.4 to 1.8 among 21 patients who had lower back pain and leg pain. Conclusion : The surgical outcome of conus medullaris tumor mainly depends on preoperative neurological condition and pathological type. The surgical treatment of conus medullaris tumor needs understanding the anatomical and functional characteristics of conus meudllaris tumor for better outcome.

• Journal of Korean Neurosurgical Society
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• v.67 no.2
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• pp.217-226
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• 2024

Objective : The efficacy of sciatic nerve decompression via transgluteal approach for entrapment of the sciatic nerve at the greater sciatic notch, called piriformis syndrome, and factors affecting the surgical outcome were analyzed. Methods : The outcome of pain reduction was analyzed in 81 patients with sciatic nerve entrapment who underwent decompression through a transgluteal approach. The patients were followed up for at least 6 months. The degree of pain reduction was analyzed using a numerical rating scale-11 (NRS-11) score and percent pain relief before and after last follow-up following surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. In addition, demographic characteristics, anatomical variations, and variations in surgical technique involving sacrotuberous ligamentectomy were analyzed as factors that affect the surgical outcome. Results : At a follow-up of 17.5±12.5 months, sciatic nerve decompression was successful in 50 of 81 patients (61.7%), and the pain relief rate was 43.9±34.17. Subjective improvement based on a 10-point Likert scale was 4.90±3.43. Among the factors that affect the surgical outcome, only additional division of the sacrotuberous ligament during piriformis muscle resection played a significant role. The success rate was higher in the scarotuberous ligementectomy group (79.4%) than in the non-resection group (42.6%), resulting in statistically significant difference based on average NRS-11 score, percent pain relief, and subjective improvement (p<0.05, independent t-test). Conclusion : Sciatic nerve decompression is effective in pain relief in chronic sciatica due to sciatic nerve entrapment at the greater sciatic notch. Its effect was further enhanced by circumferential dissection of the sciatic nerve based on the compartment formed by the piriformis muscle and the sacrotuberous ligament in the greater sciatic notch.

• International Journal of Vascular Biomedical Engineering
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• v.1 no.1
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• pp.32-40
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• 2003

Axillo-bifemoral (Ax-Fem) bypass are now well accepted for bilateral iliac artery occlusion as the second best option. This extra-anatomical (unnatural) bypasses, however, have various hemodynamic liabilities affecting the patency. Hemodynamic conditions of each different type of Ax-Fem bypass were assessed with computer simulation model to determine the hemodynamically more sound type. Simulation models of five different types of Ax-Fem bypass were constructed. Our investigation based on the computer simulation models have shown distinct differences between two most popular Lazy-S type and Inverted-C type on the distribution of flow volume, shear stress and recirculation zone, etc., though both types have shown similar clinical results. Lazy-S type has shown better hemodyanmic status than inverted-C type. The theoretical advantage of "Lazy-S" type has never been adequately proved for its superiority clinically over the inverted-C type. Inverted-C type is now in more favor with clinically better results in spite of many hemodynamic liabilities including retrograde flow to the branching graft. The improvement of over-all long-term patency rate of various extra-anatomical bypasses is still warranted through proper correction of the hemodynamic liability. Even though clinical outcome of the extra-anatomical bypass has been equal regardless of the type of crossover femoral graft configuration, there are distinct differences on the hemodynamic characteristics among various types of configuration. Further hemodynamic study in the pulsatile flow status is warranted to correct hemodynamic defects with proper modification of various hemodynamic factors of each model.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.146-154
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• 2011

Injury of posterolateral corner is unusual, but it can cause disability due to severe instability and cartilage damage. However, the anatomical structures, diagnosis and treatment have not defined clearly yet. Posterolateral corner injury is regarded as the one of main factor to the results of failure in cruciate ligament reconstcution if it was undiagnosed and untreated. Diagnosis of postetolateral corner injury is consists of physical exam, radiographic finding, MRI, and arthroscopic findings. The treatment method of of postetolateral corner injury depends on the time and severity of injury. Anatomical reconstruction of posterolateral corner shows the better clinical outcome than non anatomical reconstructions, but the clinical results of long term follow up is still needed. Therefore, the aim of this article is to review the recent literatures and to organize diagnosis and treatment of posterolateral corner injury.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.326-328
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• 2011

Purpose: The anatomical anomaly of the rectus abdominis muscle and it's fascia is very rare. No case of the absence of the linea alba below the umbilicus has yet been reported. During breast reconstruction with pedicled TRAM flap, we experienced one case of absence of linea alba. Methods: The patient was a 38-years old female who underwent immediate breast reconstruction with pedicled TRAM flap after Right modified radical mastectomy in June 2010. While the TRAM flap was being elevated, bilateral twitching of the rectus abdominis muscle occurred when electrocautery was applied, and we found the absence of the linea alba below the umbilicus. Results: When the rectus abdominis muscle was exposed, the linea alba below the umbilicus was not observed, and the bilateral rectus abdominis muscle was indistinguishably fused in a gross observation. In addition, bilateral twitching of rectus abdominis muscle was simultaneously observed as one muscle unit when electrocautery was applied. As with both rectus abdominis muscles was bluntly dissected with scissors, the scanty fatty tissues were observed between the both rectus muscles, and the bilateral rectus abdominis muscle was easily separated. The flap was transposed into the corresponding defect to make breast mound. Midline fascia was fixed to the posterior rectus sheath to reconstruct smilar anatomic linea alba. Abdominal defect was reinforced by suturing between remaining anterior rectus sheath. Conclusion: As the unexpected anatomical anomaly may affect the operation outcome, surgeons should be careful when they unexpectedly encounter the anatomical anomaly during an operation. Here, we report a rare case of absence of the linea alba seen at the time of pedicled TRAM flap elevation for breast reconstruction.

• Clinics in Shoulder and Elbow
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• v.17 no.1
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• pp.10-17
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• 2014

Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.

• Journal of Korean Neurosurgical Society
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• v.55 no.4
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• pp.200-204
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• 2014

Objective : To evaluate the incidence of postsurgical sensory complications in patients with scalp masses and classify the locations of them from a surgical standpoint according to anatomical considerations. Methods : A total of 121 patients who underwent surgery for scalp mass were included in this study. The authors reviewed medical records and preoperative radiologic images. We investigated the complications related to sensory changes after procedure. Enrolled patients have been divided into three groups. Group A included patients with tumors above the superior nuchal line (SNL), Group B with tumors within the trapezius muscle area and patients who had tumors on the lateral trapezius muscle area were assigned to Group C. We compared the incidence related to postoperative sensory complications and summarized their additional treatments for these with clinical outcome. Results : There were 12 patients (10%) with sensory complications related on the mass excision site (Group A : 1 patient, Group B : 2 patients, Group C : 9 patients). Six patients were affected with lesser occipital nerve (LON), 2 patients on greater occipital nerve (GON) and 4 patients on GON and LON. Over 6 months after surgery, two of the twelve patients with sensory complications did not have complete recovered pain in spite of proper medications and local chemical neurolysis with 1.0% lidocaine and dexamethasone. Conclusion : Occipital neuropathy should be considered as a complication related excision of scalp mass. The sensory complications are more frequent in Group C because of the anatomical characteristics of the occipital nerves and there were no statistical difference for other variables.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.660-662
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• 2009

Purpose: There are several modalities to reattach the amputated auricle. Microvascular replantation can achieve the best outcome, but technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. Methods: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket (Fig. 1, Below, left). Results: The ear was reepithelialized spontaneously in 7 days. At 3 months, the reattached ear has satisfactory appearance without contour deformity(Fig. 1, Below, right). Conclusion: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.391-396
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• 2007

Objective : This study was performed to review the clinical characteristics and operative results of brain abscess in order to define the therapeutic strategy for this disease. Methods : We reviewed the medical records and radiology images of brain abscess patients treated in our hospital during the last 16 years. A total of 35 cases included 23 males and 12 females, with the mean age of 48 years old. We excluded cases of postoperative, post traumatic, and fungal abscess. All patient underwent at least one surgical treatment such as stereotactic aspiration or craniotomy with excision. Results : Twenty seven [77.1%] patients presented with symptoms of increased intracranial pressure. The frontal lobe was the most common anatomical place, and streptococcal species were the most frequently encountered pathogens. The chronic pulmonary diseases and chronic otitis media are common underlying condition. Eighteen patients underwent stereotactic aspiration and 17 patients had excision of their abscess as an initial treatment. Seven patients had a repeated surgery, 6 of them had been treated with aspiration initially. At discharge, 60.0% patients showed a favorable outcome. Conclusion : The stereotactic drainage would be more suitable for the brain abscess located in deep and eloquent area. A large, solitary, and well-encapsulated lesion of superficial location could be best treated with complete excision, and this procedure was more definite because it is associated with less repeated surgery and showed more favorable outcome compared to aspiration surgery.