• Archives of Reconstructive Microsurgery
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• 제14권1호
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• pp.63-69
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• 2005

Purpose: The purpose of this study was to analyze the clinical results after Steindler flexoplasty. Materials and Methods: We analyzed 6 cases who had nearly normal finger and wrist joint flexion function, but could not flex elbow joint actively because of upper arm type brachial plexus injury. We performed operation during the period from February 1997 to July 2003. There were 5 males and 1 female with mean age of 28 years (range: $19{\sim}51$ years) when Steindler flexoplasty was done. The average follow-up period was 3 years 11 months (range: 12 months${\sim}$7 years 4 months). We assessed active range of motion of elbow joint, muscle power and elbow function by Mayer & Green grade scale at last follow-up. We assessed how much they were favorable for Steindler flexoplasty and had improvement of upper extremity function and correction of deformity. Results: Postoperative, flexion range of elbow joint improved to average $111.7^{\circ}$ (range: $90{\sim}130^{\circ}$). $25.8^{\circ}$ (range: $15{\sim}45^{\circ}$) in flexion contracture and $16.6^{\circ}$ (range: $10{\sim}35^{\circ}$) in pronation contracture were remained. Range of motion of elbow joint improved to average $85.3^{\circ}$ (range: $45{\sim}105^{\circ}$). Flexion power of elbow joint improved to Grade 5 in all cases. Postoperatively on Mayer & Green grade scale, there were excellent in 3 cases(50%), good in 2 cases(33.3%), fair in 1 case(16.7%). On patient's own assessment of functional improvement, there were excellent in 4 cases(66.6%), good in 1 case(16.7%) and fair in 1 case(l6.7%). Conclusion: Steindler flexoplasty can reserve good clinical results with being improved to active flexion of elbow joint in cases who have functional hand and wrist, but paralysis upper arm muscle in brachial plexus injury.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.485-490
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• 2006

Purpose: As the traditional treatment of the Wassel's type I or II of bifid thumb, Bilhaut-Cloquet, has always been the standard method despite several disadvantages such as tearing of the finger nail, injuries of the growth plate, joint instability, and long visible scarring. To overcome these drawbacks, we applied a modified Bilhaut-Cloquet Method. Methods: The subjects used for the this study were 10 of 20 patients evaluated. The patients underwent modified methods under every type of Wassel's classification. We designed a central wedge Zig-Zag incision and removed the nail and bony tissues in the remaining digit, but not soft tissue if possible, and transferred the ligaments, tendons, and soft tissue to the remaining thumb from the extra digit. We evaluated the patients' lack of extension, the total ROM of the MP and IP joints, the ROM of IP joints, and the lateral deviations of the reconstructed thumb. Results: The results were encouraging, with all patients showing a good functional and aesthetic outcome. Conclusion: The modified method proved a very effective procedure in the treatment of bifid thumb in all types, especially types I or II.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.546-550
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• 2012

Background This study was designed to introduce the feasibility of toe tissue transfer without venous outflow for fingertip reconstruction. Methods Five cases of fingertip defects were treated successfully with this method. Four cases were traumatic fingertip defects, and one case was a hook-nail deformity. The lateral pulp of a great toe or medioinferior portion of a second toe was used as the donor site. An arterial pedicle was dissected only within the digit and anastomosis was performed within 2 cm around the defect margin. The digital nerve was repaired simultaneously. No additional dissection of the dorsal or volar pulp vein was performed in either the donor or recipient sites. Other surgical procedures were performed following conventional techniques. Postoperative venous congestion was monitored with pulp temperature, color, and degree of tissue oxygen saturation. Venous congestion was decompressed with a needle-puncture method intermittently, but did not require continuous external bleeding for salvage. Results Venous congestion was observed in all the flaps, but improved within 3 or 4 days postoperatively. The flap size was from $1.5{\times}1.5cm^2$ to $2.0{\times}3.0cm^2$. The mean surgical time was 2 hours and 20 minutes. A needle puncture was carried out every 2 hours during the first postoperative day, and then every 4 hours thereafter. The amount of blood loss during each puncture procedure was less than 0.2 mL. In the long-term follow-up, no flap atrophy was observed. Conclusions When used properly, the free toe tissue transfer without venous anastomosis method can be a treatment option for small defects on the fingertip area.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.773-778
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• 2013

Background In the management of mallet deformities, oblique retinacular ligament (ORL) reconstruction provides a mechanism for automatic distal interphalangeal (DIP) joint extension upon active proximal interphalangeal joint extension. The two variants of ORL reconstruction utilize either the lateral band or a free tendon graft. This study aims to compare these two surgical techniques and to assess any differences in functional outcome. As a secondary measure, the Mitek bone anchor and pull-in suture methods are compared. Methods A single-institutional retrospective review of ORL reconstruction was performed. The standard patient demographics, injury mechanism, type of ORL reconstruction, and pre/postoperative degree of extension lag were collected for the 27 cases identified. The cases were divided into lateral band (group A, n=15) and free tendon graft groups (group B, n=12). Group B was subdivided into the pull-in suture technique (B-I) and the Mitek bone anchor method (B-II). Results Overall, ORL reconstructions had improved the mean DIP extension lag by $10^{\circ}$ (P=0.027). Neither the reconstructive technique choice nor bone fixation method identified any statistically meaningful difference in functional outcome (P=0.51 and P=0.83, respectively). Soft-tissue injury was associated with $30.8^{\circ}$ of improvement in the extension lag. The most common complications were tendon adhesion and rupture. Conclusions The choice of the ORL reconstructive technique or the bone anchor method did not influence the primary functional outcome of extension lag in this study. Both lateral band and free tendon graft ORL reconstructions are valid treatment methods in the management of chronic mallet deformity.

• Archives of Plastic Surgery
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• 제45권4호
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• pp.351-356
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• 2018

Background Mallet fracture can easily occur during sports activities or in daily life; however, the principles and methods of treatment for such fractures remain debated. Among the surgical treatments, various methods of closed reduction have been proposed. We treated patients with the extension block method (EBM) and the direct pinning method (DPM), and then compared the results. We assessed differences in range of motion and measurements of finger movement after surgery. Methods A total of 41 patients who underwent surgery from August 2013 to September 2015 were evaluated retrospectively. Among them, 21 patients were treated with the EBM and 20 patients were treated with the DPM. We then compared extensor lag, range of motion, and outcomes according to Crawford's criteria between before surgery and at 6 to 8 months postoperatively. Results The postoperative extensor lag improvement was $4.28^{\circ}$ and $10.73^{\circ}$, and the postoperative arc of motion was $55.76^{\circ}$ and $61.17^{\circ}$ in the EBM and DPM groups, respectively. The Crawford assessment showed no statistically significant difference between the groups, although the score in the DPM group was higher than that in the EBM group (3.5 vs. 3.1). Conclusions As closed reduction methods for the treatment of mallet fracture, both the EBM and DPM showed good results. However, the DPM proved to be superior to the EBM in that it produced greater improvements in extensor lag and range of motion.

• 한국산업보건학회지
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• 제18권1호
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• pp.72-79
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• 2008

This study was surveyed to assess the status of safety accidents occurred in work-places and prepare the fundamental data and prevent the safety accidents. The authors reviewed and analysed the charts of accident cases treated at a primary care clinic in A city from January 1991 to December 2006. The data were classified according to the USA Standards Institute and International Labour Organization method. We analyzed the data using SPSS program. The results were as follows : 1. The total cases of accidents were 455 for 8 years. 2. Accidents were mostly common in the workers who are in thirties and forties age(84.4%). 3. As season variation, spring and summer were common than others, but there was no statistical significance on season, month and weekday. 4. The most frequent injured part of the body were hand and finger, which was 36.0% among total cases. 5. According to the accidents type, cases of caught in, under or between were most frequently observed as 53.9% of the total cases. 6. The most common source of injuries was power machine(50.5%). 7. According to the unsafe acts, cases of carelessness and unsafe information were most frequently observed as 71.2% of the total cases. 8. Admission rate(5.5%) and official report rate(2.2%) were very low rate. As above results, the authors recommend to prepare the systemic control programs on environmental and human factors of safety accidents such as improving the working conditions, working facilities, working methods and safety education, and control of working time for working day.

• 대한한방내과학회지
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• 제37권5호
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• pp.847-854
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• 2016

Background and Objective: The Korean agricultural population is now rapidly aging. Older people in rural areas are weak due to work-related musculoskeletal disorders. The aim of this case is to report treatment of injuries to the nerves at the wrist and hand level by Korean medicine. Methods: The patient in this case was a 74-year-old male. He had injured nerves at the right wrist and hand level due to agriculture work. We treated him with acupuncture, herbal medicine, etc. Results: The patient showed the first sign of recovery of his wrist after 13 days treatment. After 37 days of treatment, his wrist movement was restored to a nearly normal range. He showed the first sign of recovery in a finger after 19 days of treatment and his grasping power increased from 0% to 60%. The cold sensation in his hand and arm also disappeared. Conclusions: We cannot generalize based only on this one case study. Nevertheless, this report suggests that Korean medicine may be an effective treatment for injury of nerves at the wrist and hand level.

• 재활간호학회지
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• 제13권1호
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• pp.44-52
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• 2010

Purpose: The purposes of this study were to explore changes in pain, mood and the level of posttrauma risk for 2 weeks after acute hand microsurgery and determine predictors of pain 2-week after microsurgery. Method: Using a sample of 84 patients with hand microsurgery, pain, mood, and posttrauma risk were measured by the Brief Pain Inventory-Korea, the modified Profile of mood states, and the Posttrauma risk checklist at 1-day, 1-week and 2-week post-microsurgery. Repeated measures ANOVA and Multiple regression analysis were conducted to evaluate changes in pain, mood, and posttrauma risk over time after the surgery and determine predictors of pain 2-week after the surgery. Results: Pain significantly decreased (F=63.22, p<.001), mood significantly improved (F=41.04, p<.001) 2 weeks after microsurgery and interestingly, posttrauma risk significantly decreased from baseline to 1-week microsurgery but increased at 2-week after microsurgery (F=24.66, p<.001). Approximately 57% of the variance of pain 2-week post-microsurgery was explained by pain at 1-week post-microsurgery, mood and the numbers of injured fingers. Conclusion: The findings suggest the pain control for 1week after acute surgery being critical and posttrauma rehabilitation of injured finger being necessary. Developing nursing interventions is urgently needed to help individuals with impending hand microsurgery.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.394-397
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• 2014

Background Proximal interphalangeal joint (PIPJ) dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries. Methods We retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame. Results There were a total of 77 dislocations of the PIPJ (57 men and 20 women) that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (P<0.05) used. There were significantly fewer hospital visits in the figure-of-eight splint group than in the other treatment groups. Conclusions The treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.649-654
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• 2011

Purpose: Split-or full-thickness skin grafts are used to reconstruct palmar skin and soft tissue defects after trauma or to release burn scar contracture on the hand. Glabrous skin defects should be substituted with similar skin to preserve function and aesthetics. The authors report their experiences with a technique that uses a full-thickness graft taken from glabrous skin on the ulnar edge of the palm for the reconstruction of soft tissue defects of the hand. Methods: During a three-year period from 2007 to 2010, 22 patients with burn scar contracture and 12 patients with post-traumatic skin defects on their hands were treated with full-thickness skin graft operations. The palmar skin and soft tissue defects after release of burn scar contracture or debridement of post-traumatic wounds were reconstructed with full-thickness skin grafts harvested from the ulnar border of their palms. All donor-site wounds were primarily closed. Results: The followup periods ranged from 3 to 25 months. Contractures of the hand were corrected without recurrence, and the grafts showed relatively good contour and color match to the adjacent fields. There were no reported complications such as significant color change or hypertrophic scarring. The grafted skin showed an average 5.9 mm static two-point discrimination obtained in fingertip reconstruction cases, indicating satisfactory reinnervation. Conclusion: Glabrous full-thickness grafts harvested from the palmar ulnar border is a very useful way of reconstructing soft tissue defects on hands, including fingertips, for function restoration, favorable aesthetic results, and low donor-site morbidity.