• Archives of Plastic Surgery
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• 제37권2호
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• pp.137-142
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• 2010

Purpose: Tumor ablation and traumatic intractable ulceration of the plantar surface of the foot results in skin and soft tissue defects of the weight-bearing sole. Simple skin grafting is not sufficient for reconstruction of the weight-bearing areas. Instead, the island medial plantar flap (instep flap) and distally-based island medial plantar flap was used for proper reconstruction of the weight bearing area. However, there are some disadvantages. In particular, an island medial plantar flap has a short pedicle limiting the mobility of the flap and the distally-based island medial plantar flap is based on a very small vessel. We investigated whether good results could be obtained using a reverse island medial plantar flap based on the lateral plantar vessel as a solution to the above limitations. Methods: Three patients with malignant melanoma were cared for in our tertiary hospital. The tumors involved the lateral forefoot, the postero-lateral heel, and the medial forefoot area. We designed and harvested the flap from the medial plantar area, dissected the lateral and medial plantar artery and vena comitans, and clamped and cut the vessel 1 cm proximal to the branch from the posterior tibial artery and vena comitans. The medial plantar nerve fascicles of these flaps anastomosed to the sural nerve, the 5th interdigital nerve, and the 1st interdigital nerve of each lesion. The donor sites were covered with skin grafting. Results: The mean age of the 3 subjects was 64.7 years (range, 57 - 70 years). Histologically, all cases were lentiginous malignant melanomas. The average size of the lesion was $5.3\;cm^2$. The average size of the flap was $33.1\;cm^2$. The flap color and circulation were intact during the early postoperative period. There was no evidence of flap necrosis, hematomas or infection. All patients had a normal gait after the surgery. Sensory return progressively improved. Conclusion: Use of an island medial plantar flap based on the lateral plantar vessel to the variable weight-bearing sole is a simple but useful procedure for the reconstruction of any difficult lesion of the weight-bearing sole.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.709-715
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• 2014

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.240-243
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• 2010

Objective : Radiofrequency (RF) medial branch neurotomy is an effective management of lumbar facet syndrome. However, pain may recur after period of time. When pain recurs, it can be repeated, but the successful outcome and duration of relief from repeated procedures are not clearly known. The objective of this study was to determine the success rate and duration of pain relief from repeated radiofrequency medial branch neurotomy for lumbar facet syndrome. Methods : A retrospective review of medical records was done on 60 consecutive patients, from March of 2006 to February of 2009, who had an initial successful RF neurotomy but subsequently underwent repeated procedures due to recurrence of pain. All procedures were done in carefully selected patients after at least two responsive medial branch nerve blocks. C-arm fluoroscopic guide, impedance, sensory and motor threshold monitoring tools were used for the precise placement of electrodes. Responses of repeated procedures were compared with initial radiofrequency neurotomy for success rates and duration of pain relief. Results : There were 48 females and 12 males. Mean age was 52.4 years (range, 26-83). RF medial branch neurotomy was done on one side in 38 and both sides in 22 patients, each covering at least three segments. Average visual analog scale at last procedure was 6.8. Twelve patients had previous lumbar operations, including 4 patients with instrumentations. Fifty-five patients had two procedures and five patients had three procedures. Mean duration of successful pain relief (> 50% of previous pain for at least 3 months period) after initial radiofrequency neurotomy was 10.9 months (range, 3-28) in 51 (85%) patients. From repeated procedures, successful pain relief was seen in 50 (91%) patients with average duration of 10.2 months (range, 3-24). Five patients had third procedure, which was successful in 4 (80%) patients with mean duration of 9.8 months (range, 5-16). This was not statistically different from initial results. There were no permanent neurological complications from the procedures. Conclusion : Results of this study indicate that the frequency of success and durations of relief from repeated RF medial branch neurotomy for lumbar facet syndrome are similar to initial results that provided relatively prolonged period of pain relief without major side effects Each procedure seems to provide successful pain relief for about 10 months in more than 85% of carefully selected patients when properly done.

• 대한족부족관절학회지
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• 제15권4호
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• pp.223-231
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• 2011

Purpose: Pathogenesis of intraneural ganglion is controversial, however, the synovial theory that the intraarticular region is the origination of disease has come into the spotlight nowadays. But there are a few researches about intraneural ganglion in foot and ankle. We studied 7cases of intraneural ganglion. We are going to prove the synovial theory by indentifying articular branch of intraneural ganglion. Materials and Methods: From August 2003 to May 2011, we evaluated 7 ouf of 8 patients diagnosed as a intraneural ganglion in foot and ankle. The gender ratio were 4 male and 3 female, and the mean age at the time of surgery was 52.9 years. Clinically, we checked pre and post operative symptom, muscle tone and whether loss of muscle tone and sensation exists. We analyzed surgical records and preoperative MRI and compared those with intra-operative finding. Results: In MRI analysis of 7cases, the connection around the joints were confirmed, and 1 case was confirmed in the retrospective analysis of MRI. Intraneural ganglions occurred in medial plantar nerve 3 cases, lateral plantar nerve 1 case, superficial peroneal nerve 1 case and sural nerve 1 case. We could not found recurrence during the follow up periods. Most patients relieved pain after operation, but recovery of sensation was unsatisfactory. We could find some cases pathological finding of the nerve intraoperatively, and clinical result of that cases was poor. Conclusion: Intraneural ganglion can occur in various parts in foot and ankle. We concluded that the intranneural ganglion originated from joint by identifying the artichlar branch of ganglion. Due to its small size, it is difficult to find articular branch in operation field. But we do our best to find and remove articular branch. Currently, considering the small amount of research in foot and ankle, more research about articular brach is needed.

• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.256-261
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• 2006

Objective : The goal of this study was to establish the benefit and prognostic factors of lumbar medial branch block[MBB] for low back pain. Methods : A retrospective analysis was based on the data obtained from 281 patients with low back pain, who visited our hospital between January 2001 and November 2004. Pain relief was evaluated at 2 weeks, 1 month and 3 months. The authors analyzed the results of MBB according to the patient's age, sex, symptom duration, pathologic condition, and presence of radiating pain. Results : Two hundred eighty one patients had sprain [151]. lumbar fracture [27], spinal stenosis [50], herniated lumbar disc [24] acute post-operative pain [8], and chronic post-operative pain [21] with success rate of 63.6%, 59.3%, 26.0%, 25.0%, 87.5% and 42.9%, respectively. The effects of MBB in sprain, lumbar fracture, and acute post-operative pain were significantly better than those in stenosis, herniated lumbar disc and chronic post-operative pain patients. The patients in young age group [<60 years], with short symptom duration [<6 months] and without radiating pain showed good response to lumbar MBB. Conclusion : The lumbar MBB appears to be safe and effective for low back pain in certain selected patients. Good prognostic factors were low back pain without surgical conditions and radiating pain, with short symptom duration [<6 months], and in relatively young age [<60 years] group.

• 대한약침학회지
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• 제12권2호
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• pp.21-29
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• 2009

Objective : This study was carried to identify the anatomical component of FTMM(Foot Taeyang Meridian Muscle) in human lower limb, and further to help the accurate application to real acupuncture. Methods : FTM at the surface of the lower limb was labelled with latex. And cadaver was stripped off to demonstrate muscles, nerves and the others and to display the internal structures of FTMM, being divided into outer, middle, and inner layer. Results : FTMM in human lower limb is composed of muscles, nerves, ligaments etc. The internal composition of the FTMM in human lower limb are as follows : 1) Muscle : Gluteus maximus. biceps femoris, semitendinosus, gastrocnemius, triceps calf, fibularis brevis tendon, superior peroneal retinacula, calcaneofibular ligament, inferior extensor retinaculum, abductor digiti minimi, sheath of flexor tendon at outer layer, biceps femoris, semimembranosus, plantaris, soleus, posterior tibialis, fibularis brevis, extensor digitorum brevis, flexor digiti minimi at middle layer, and for the last time semimembranosus, adductor magnus, plantaris, popliteus, posterior tibialis, flexor hallucis longus, dorsal calcaneocuboidal ligament at inner layer. 2) Nerve : Inferior cluneal nerve, posterior femoral cutaneous n., sural cutaneous n., proper plantar branch of lateral plantar n. at outer layer, sciatic nerve, common peroneal n., medial sural cutaneous n., tibial n. at middle layer, and for the last time tibial nerve, flexor hallucis longus branch of tibial n. at inner layer. Conclusions : This study proves comparative differences from already established studies from the viewpoint of constituent elements of FTMM in the lower limb, and also in the aspect of substantial assay method. We can guess that there are conceptional differences between terms (that is, nerves which control muscles of FTMM and those which pass near by FTMM) in human anatomy.

• Anatomy and Cell Biology
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• 제56권3호
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• pp.313-321
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• 2023

The details of the facial nerve pattern were clearly explained in the parotid gland (PG), lateral area of the face, and periorbital areas to prevent the unexpected outcome of medical intervention. However, it remains unclear whether information about the zygomatico-buccal plexus (ZBP) in the masseteric and buccal regions. Therefore, this study aimed to help clinicians avoid this ZBP injury by predicting their common location. This study was conducted in forty-two hemifaces of twenty-nine embalmed cadavers by conventional dissection. The characteristics of the buccal branch (BB) and the ZBP were investigated in the mid-face region. The results presented that the BB gave 2-5 branches to emerge from the PG. According to the masseteric and buccal regions, the BB were arranged into ZBP in three patterns including an incomplete loop (11.9%), a single-loop (31.0%), and a multi-loop (57.1%). The mean distance and diameter of the medial line of the ZBP at the corner of the mouth level were 31.6 (6.7) and 1.5 (0.6) mm respectively, while at the alar base level were 22.5 (4.3) and 1.1 (0.6) mm respectively. Moreover, the angular nerve arose from the superior portion of the ZBP at the alar base level. The BB formed a multiloop mostly and showed a constant medial line of ZBP in an area approximately 30 mm lateral to the corner of the mouth, and 20 mm lateral to the alar base. Therefore, it is recommended that physicians should be very careful when performing facial rejuvenation in the mid-face region.

• Clinical Pain
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• 제20권2호
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• pp.93-98
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• 2021

The use of ultrasonography has recently been increasing in musculoskeletal diagnosis or intervention treatment. Ultrasound guided procedure offers a reliable alternative to fluoroscopy or computed tomography for lumbar medial branch block, facet joint block and peripheral nerves of lower extremity. Further, there is no exposure to radiation and additional equipment necessary for the protection against radiation is required. And ultrasound guided procedure needs smaller space than fluoroscopy guided procedure with real time images in the outpatient department. This article reviews ultrasound guided procedure at lumbar vertebra and peripheral nerves of lower extremity.

• The Korean Journal of Pain
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• 제21권2호
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• pp.150-154
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• 2008

Pulsed or conventional radiofrequency (RF) denervation of the third occipital nerve (TON) is considered to be a safe and effective alternative for the treatment of pain originating from the cervical 2-3 facet joint, including cervicogenic headache. However, proper positioning of the RF probe in the TON can be difficult and time consuming due to the possible involvement of various lesions along the target nerve. We found that bipolar RF is easier to perform and more convenient than unipolar RF when administering a lumbar medial branch block. Here, we report the successful treatment of a patient with a cervicogenic headache by pulsed RF (PRF) denervation of the TON, using a bipolar probe. We believe that bipolar PRF denervation of the TON is an effective alternative to unipolar RF or PRF for the treatment of pain originating from the cervical 2-3 facet joint.

• 대한정형외과 초음파학회지
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• 제1권2호
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• pp.128-133
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• 2008

신경 압박의 원인은 외부로부터 가해지는 것도 있고, 신체 내부 병리가 발생하여 신경 주행에 따라 발생할 수 있다. 주관절 이하부에서 압박성 신경병증으로 정중 신경, 척골 신경, 요골신경병증이 있다. 정중 신경은 굴곡 지대부위에서 수근관 증후군이 대표적이며, 모든 신경 포착 증후군 가운데 가장 흔하다. 그 외 주관절 부위에서 스트러더스 인대, 상완 이두근 건막, 회내근, 천수지 굴근 기시부 그리고 비정상 근육들에 의한 회내근 증후군과 전 골간 신경 증후군이 있다. 척골 신경은 스트러더스 궁, 내측 상과 후방의 주관, 척수근 굴근 두 기시부 사이의 건막 등에서 눌리는 주관 증후군과, 수근부에서 결절종, 유구골 갈고리 골절 그리고 혈관성으로 오는 척골 관 증후군이 있다. 요골 신경의 심부 분지가 회외근속을 지나면서 만들어지는 부위에서 눌리는 경우 요골 관 증후군이라고 한다. 치료는 초기에는 소염제나 야간부목, 스테로이드 주사와 같은 보존적 치료를 시행할 수 있으며, 이에 호전되지 않을 경우 전기적 검사나 영상 검사에서 이상이 나타나면 수술적 감압술을 시행하여야 한다.