• Annals of Clinical Neurophysiology
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• 제14권2호
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• pp.72-75
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• 2012

Ischemic monomelic neuropathy and myopathy are rare complications of peripheral arterial occlusive disease. We report a case of ischemic monomelic neuropathy of the right sural, common peroneal and posterior tibial nerves and ischemic myopathy of the right tibialis anterior resulting from the occlusion of the right common femoral arteries despite successful revascularization. Ischemic monomelic neuropathy and myopathy can occur as a result of occlusion of the specific peripheral artery.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.118-123
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• 2001

Introduction : We report advantages of distally based superficial sural artery flap in the soft tissue defect in lower leg, ankle and foot. They are easier and less complicated technique than others. Material & Method : Total 26 patients were operated and their soft tissue defect site were 10 cases of anterior tibial surface, 6 cases of Achilles tendon area, 3 cases of lateral and medial surface of tibia, 3 cases of foot dorsum surface, 3 cases of sole, 1 case of medial aspect of ankle. Average pedicle distance was 12.8 cm(range $8{\sim}21cm$) and follow up period was mean 18 months. Result : We obtained 24 cases of excellent and good results. The two cases were reported low complication rate, which were one case of skin necrosis covered full thickness skin graft, and the other case of infection. Conclusion : The advantage of distally based superficial sural artery flap in soft tissue defect are long distant pedicle, short operation time, easy elevation of pedicle, constant and reliable blood supply and good cosmetic result with thin-thickness flap.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.

• Journal of Chest Surgery
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• 제29권8호
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• pp.889-896
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• 1996

하지 동맥 혈관의 폐쇄로 인한 급,만성적인 하지 허혈은 혈관우회술이나 혈전제거술등의 적극적인 수술을 시행함으로 점차 좋은 경과를 얻고있다. 동아대학교 병원 흉부외과학 교실에서는 하지 허혈의 임상적 양상과 수술 결과를 살펴보고자 1990년 3월부터 1995년 8월까지 5년 5개월동안 101명의 환자를 대상으로 수술을 하여 이를 분석하였다. 연령 및 성별 분포는 25세에서 87세이고 남자가 92례, 여자가 9례로써 약 101로 남자에서 많았다. 이들 환자의 동맥폐쇄질환에 관계있는 병인에는 동맥경화성 협착이 54례, 혈전색전증이 21례. 버거씨병이 20례, 외상에 의한 동맥 폐쇄가 3례, 가성동맥류가 3례였다. 동맥경화성 협착에서 주 폐쇄부위는 대퇴동맥 폐쇄가 30례, 장골동맥 폐쇄 23례, 슬와 동맥 폐쇄 10례, 대동맥 분지부 6례. 경골동맥 폐쇄였고, 버거씨 병에서는 후경골동맥 폐쇄 14례, 전 경골동맥 폐쇄 8례. 슬와동맥 폐쇄 5례. 대퇴동맥과 비골동맥이 각각 2례 였다. 혈관 폐쇄로 인한 하지 혈행장애의 수술은 동맥경화성 협착에서 혈관우회술이 61례. 혈전 제거술 24 례, 교감 신경절제술 20례였다. 동맥경화성 협착 환자에서 혈관우회술을 시행한 苛\ulcorner61례로써 이중 대퇴동맥과 슬와 동맥간의 우회술이 21례, 대퇴동맥과 반대편 대퇴동맥간의 우회술이 15례. 맥와 동맥과 양측 대퇴동맥간의 우회술이 7례, 하복부 대동맥과 양측 대퇴동맥간에 Y graft를 이용한 우회술이 3례였 4술후 이식혈관에 대한 개존율은 전체적으로 술 후 1년에 83.6%. 2년에 77.1%. 3년에 75.5%의 결과를 보였고 하지 보존율은 86.8 %였다. 하지혈행장애의 모든 환자에서 수술후 사망은 6명이었는데 사망 원인은 급성 신부전증, 다장긴 기능 부전, 그리고 패혈중이었다.

• Journal of Yeungnam Medical Science
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• 제33권2호
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• pp.134-137
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• 2016

Bee sting causes mild symptoms such as urticaria and localized pain, and severe symptoms including anaphylaxis, cardiovascular collapse, and death. We reported on a patient with arterial thrombotic occlusion and severe ischemia in the lower limb after multiple bee stings. The patient was stung 5 times and complained of pallor, pain, and coldness in the left toe, and did not have dorsalis pedis pulsation. Computed tomography angiography showed multiple thrombotic occlusion of the anterior and posterial tibial artery below the knee. Local thrombolytic therapy using urokinase was administered and the occluded arteries were successfully recanalized.

• The Journal of Korean Physical Therapy
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• 제18권3호
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• pp.9-21
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• 2006

Purpose: This study was intended to examine the effects of electroacupuncture and therapeutic exercise on muscle atrophy and exercise function in an ischemic stroke model induced by middle cerebral artery occlusion. Methods: This study selected 120 Sprangue-Dawley rats, 8-week of age, divided them into six groups, and assigned 5 rats to each group. Experiments were conducted for 1, 3 days, 1, and 8 weeks, respectively. Group I was a group of electroacupuncture and therapeutic exercise after inducing ischemic stroke; Group II was a group of therapeutic exercise after inducing ischemic stroke; Group III was a group of electroacupuncture after inducing ischemic stroke; Group IV was a sham group of electroacupuncture after inducing ischemic stroke; Group V was a control group and Group VI was a sham group without ischemic stroke. In each group, changes in weight of muscle and relative muscle of TA muscle, neurologic motor behavior test, histologic observations were observed and analyzed. Results: For the changes in muscle weight of unaffected and affected sides of TA muscle, muscle atrophy was seen in an affected side 3 days after ischemic stroke was induced. There was statistically significant difference in Group I 1 week and 8 weeks after ischemic stroke was induced, compared to Group V (p<0.05). For the changes in relative muscle weight of unaffected and affected sides of tibial anterior muscle, there was significant decrease in each group 3 days after ischemic stroke was induced, compared to Group IV, while there was statistically significant increase in Group I 1 week after ischemic stroke was induced, compared to Group V (p<0.05). For neuologic exercise behavior test, Group I generally had the highest score, compared to other groups. Conclusion: electroacupuncture and therapeutic exercise may improve muscle atrophy and change in histologic observations expression of ischemic stroke rats and contribute to the improvement of exercise function.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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• pp.96-102
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• 1997

The gracilis that is frequently used as a donor of free muscle trasfer is appropriate in the muscular shape and vascular position. This muscle is belonged to the second type of muscle group by the classification of the pattern of muscular nutrient vessel. The adductor branch or first perforating branch of deep femoral artery which supplies the proximal 1/3 of this muscle is a dominant one and this is used for the microscopic anastomosis of muscle or musculocutaneous flap. The minor vascular pedicles which enter the distal 1/3 of this of this muscle are branches of the superficial femoral artery and it is 0.5mm in diameter, 2cm in length with two venae comitantes. These minor pedicles supplies distal half of the gracilis muscle. This island musculocutaneous flap using distal vascular pedicle can be used to cover the defect of soft tissue around the distal femoral supra-condylar area, knee joint and proximal tibial condyle area which cause limitation of motion of knee joint, or in the cases that usual skin graft is impossible. The important operative procedure is as follows; The dissection is carried proximally and distally and the entire gracilis muscle including proximal and distal pedicle is completely dissected. After temporary blocking of the proximal vascular pedicle, the adequate muscle perfusion by the distal pedicle is identified and it is rotated to the recipient site around knee joint. The advantages of this procedure are simple, no need of microscopic vascular anastomoses and no significant functional loss of donor site. Especially in the cases of poor condition of the recipient vessel, this procedure can be used effectively. From 1991 to 1996, we performed 4 cases; complete survival of flap in 3 cases and partial survival of flap with partial necrosis in 1 case. This procedure is though to be useful in the small sized soft tissue defect of distal femoral supra-condylar area, knee joint and proximal tibial condylar area, especially in the defect of anterior aspect which expected to cause limitation of motion of knee joint due to scar contracture. But the problems of this procedure are the diameter of distal vascular pedicle is small and the location of distal vascular pedicle is not constant. To reduce the failure rate, identify the muscular perfusion of distal vascular pedicle after blocking the proximal pedicle, or strategic delay will be helpful.

• 한국전문물리치료학회지
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• 제14권1호
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• pp.1-10
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• 2007

This study was designed to examine the effects of electroacupuncture and treadmill exercise on the improvement of muscle atrophy and Brain-Derived Neurotrophic Factor (BDNF) expression in an ischemic stroke model induced by middle cerebral artery occlusion. This study selected 120 Sprangue-Dawley rats, divided them into six groups, and assigned 5 rats to each group. Experiments were conducted for 1, 3 days and 1, 8 weeks, respectively. In each group, changes in weight of muscle and relative muscle of tibialis anterior muscle, histologic observations, and BDNF expression were observed and analyzed. For the changes in muscle weight of unaffected and affected sides of tibialis anterior, muscle atrophy was expressed in an affected side 3 days after ischemic stroke was induced. There was a statistically significant difference in Group VI 1 and 8 weeks after ischemic stroke was induced, compared to Group II (p<.05). For the changes in relative muscle weight of unaffected and affected sides of tibial anterior muscle, there was significant decrease in each group 3 days after ischemic stroke was induced, compared to Group I, while there was a statistically significant increase in Group VI 1 week after ischemic stroke was induced, compared to Group II (p<.05). For neurologic exercise behavior test, Group VI generally had the highest score, compared to other groups. The results of the behavior test suggests that 8 weeks after ischemic stroke was induced, Group VI improved in degeneration and inflammation of muscle fiber and decreased in destruction of nerve cells and cerebral infarction, thus indicating a similar state of muscle fiber and brain tissue in Group I. In immunohistochemical observations, Group 1 week showed increase in BDNF. Based on these results, electroacupuncture and treadmill exercise may improve muscle atrophy and change in BDNF expression of ischemic stroke rats and contribute to the improvement of exercise function.

• 대한관절경학회지
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• 제15권2호
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• pp.125-131
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• 2011

후방십자인대 파열의 최선의 치료법은 논쟁의 대상이며, 후방십자인대 재건술시 고려해야할 사항들로는 경골 고정방법(transtibial vs inlay), 대퇴터널의 위치(central, eccentric or isometric), 재건다발의 수(single-bundle vs double-bundle)등이 있다. 후방십자인대는 중슬부 동맥의 분지와 가깝게 위치하고, 두꺼운 활액막에 싸여있어 손상시 전방십자인대보다 자연 치유력이 뛰어난 것으로 알려져 있다. 일반적으로 후방십자인대 재건술시, 이식물 통과를 용이하게 하고 터널 위치 선정을 위한 인대 부착부를 잘 보기 위해 남아 있는 후방십자인대 잔여 조직을 모두 제거한다. 그러나 잔여 조직을 보존하면 슬관절 후방 안정성에 기여하며, 이식물 치유를 빠르게 하고, 잔여 인대에 남아 있는 기계 수용체의 고유 수용 감각 기능을 살리게 된다. 수술 술기의 어려움과 터널 합병증이 발생될 수 있는 이중 다발 재건술에 비해, 대퇴부 인대 부착부를 보전하기 쉽고 합병증이 적은 단일 다발 재건술을 이용한 잔여 조직을 보존한 보강법이 유용한 수술 방법으로 사료된다.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.175-180
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• 2006

Preoperative angiography is frequently used in the planning of microsurgical reconstruction for identification of vascular abnormality that influence the planning of operation. But, recently 3D CT angiography is considered as new technique that can provide detailed information about vascular anatomy as well as soft and bony tissue without the risks of invasive angiography. 3D CT angiograms were performed in 19 patients before microsurgical reconstruction for the lower extremity and hand between May of 2003 and Oct of 2004. Sixteen of the studies were of the donor site and all of 19 studies were of the recipient site. No complications were found from the 3D CT angiograms. In one case of the bone exposed open wound, the injury of anterior tibial artery was identified and the zone of injury was adequately demonstrated. With the improvement in quality of CT imaging, 3D CT angiograms may provide a favorable alternative to invasive angiography. It is capable of providing high-resolution, three dimensional vascular imaging without the need for arterial puncture and prolonged post-procedure observation. The relation among blood vessels, bones, and soft tissue is well demonstrated in 3D CT angiogram. Also The acquisition time and examination cost were considerably lower in comparison with invasive angiography. In conclusion, this study demonstrates that 3D CT angiography may provide accurate, safe, and cost-effective preoperative imaging. The 3D CT angiography with relatively low morbidity, low cost, ease of image acquisition can have an broader role in microsurgical reconstructive surgery.