• 제목/요약/키워드: Secondary deformities

검색결과 54건 처리시간 0.022초

족근 중족 관절의 특발성 골관절염에 대한 수술적 치료 및 임상적 결과에 대한 분석 (Surgical Treatments and Clinical Outcomes for Idiopathic Osteoarthritis of the Tarsometatarsal Joints)

  • 정홍근;변우섭
    • 대한족부족관절학회지
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    • 제8권1호
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    • pp.31-38
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    • 2004
  • Purpose: The purpose of the study was to identify the subtypes of idiopathic osteoarthritis of the tarsometatarsal joints based on accompanying hindfoot, midfoot, or foot deformities and their corresponding surgical options and also to evaluate the overall clinical results. Materials and Methods: The study included 59 patients (67 feet) with idiopathic tarsometatarsal joint osteoarthritis. Tarsometatarsal fusion was performed for tarsometatarsal joint and accompanied secondary change was divided into subtypes and various bony reconstruction was carried out. The patients were evaluated with the AOFAS midfoot score and FFI. The average patient age was 60.2 years with 40.6 months follow-up. Fifty-four feet (80.6%) had been treated with realignment fusion. Twenty-six feet had first and second tarsometatarsal joint fusion, and 20 feet had first tarsometatarsal fusion only. Six subtypes were identified based on associated foot deformities: 1) in-situ without deformities (18%), 2) pes planovalgus (45%), 3) rockerbottom (15%), 4) cavus foot (1%), 5) hallux valgus (12%), and 6) hallux valgus with pes planovalgus or rockerbottom (9%). Plantar-medial closing-wedge resection was used in 10 feet to correct rockerbottom. For pes planovalgus, a medial sliding calcaneal osteotomy was done. Lateral column lengthening with medial sliding calcaneal osteotomy was done for severe pes planovalgus, and triple arthrodesis was done for rigid pes planovalgus. Hallux valgus was corrected with the Lapidus procedure (85.7%). Results: AOFAS midfoot scores improved from preoperative 34.1 points to postoperative 83.9 points (p<0.05). The Foot Function Index postoperatively also showed significant improvement (p<0.05), with a high satisfaction rate (86.6%). There were 29 complications, most commonly sesamoid pain. Conclusion: Idiopathic tarsometatarsal OA feet can be classified into six categories. Pes planovalgus feet should be treated with medial sliding calcaneal osteotomy, lateral column lengthening, or triple arthrodesis in addition to tarsometatarsal joint realignment fusion. Rockerbottom and hallux valgus deformities should also be addressed.

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개에서 외골격 고정을 이용한 성장 기형의 교정 (Application of External Skeletal Fixations to Correct the Growth Deformities in a Dog)

  • 김영삼;변예은;윤성진;오태훈;박옥지;임지혜;최민철;권오경
    • 한국임상수의학회지
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    • 제20권3호
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    • pp.410-412
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    • 2003
  • A male, 11-month-old, Shih-tzu dog weighing 5.2kg showing knuckling secondary to severe cranial bowing of left antebrachium with valgus deformity of the carpus was presented to the Veterinary Medicine Teaching Hospital of Seoul National University. Radiographic findings were a premature closure of the distal ulnar physis, a cranial bowing of the radius, subluxation of the elbow joint, and degenerative changes in the carpal joint. The patient was treated by performing an oblique osteotomy of the radius and ulna, followed by application of External Skeletal Fixations. At 18 weeks postoperatively, the radius was healed. An incongruency of the elbow joint and radial angular deformity was corrected.

일측성 이차 구순열 비변형에서 비공저와 비공턱 함몰의 수술적 교정 (Surgical correction of nostril base and nostril sill depression in unilateral secondary cleft lip nose deformity)

  • 이수향;이경진;황은아;최현곤;김순흠;신동혁;엄기일
    • Archives of Plastic Surgery
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    • 제36권5호
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    • pp.637-641
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    • 2009
  • Purpose: Most unilateral secondary cleft lip nose deformities have depressed nostril base and sill on the cleft side. To obtain a symmetric nose, correction of the recession on nostril is critical. The authors have worked out effective methods to elevate the nostril of the cleft side according to the extent of the depression. Methods: A total of 115 unilateral secondary cleft lip nose deformity patients with nostril depression were evaluated. Data were acquired from patients' charts and photography with special reference to the height difference of the nostrils between the cleft side and the non - cleft side. Patients were divided into three groups based on the difference and operated with various techniques : (1) mild degree(< 1 mm) with graft, (2) moderate degree(1 ~ 3 mm) with C - flap or suspension suture of septal cartilage (3) severe degree(> 3 mm) with graft, C - flap and suspension suture. Follow - up period averaged 21.3 months. Results: Forty - six patients(40 percent) were in mild group, and forty - two(37 percent) were in moderate. In twenty - seven patients(23 percent), nostril recession was more than 3 mm. The elevated nostril base and sill were maintained without height alteration during follow - up. Conclusion: The symmetry of the nostril base, especially projection of nostril sill influences successful correction of unilateral cleft lip nose deformity. Our tolerable techniques can be applied to most deformities with nostril depression and can present a new guideline.

Change in nostril ratio after cleft rhinoplasty: correction of nostril stenosis with full-thickness skin graft

  • Suh, Joong Min;Uhm, Ki Il
    • 대한두개안면성형외과학회지
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    • 제22권2호
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    • pp.85-92
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    • 2021
  • Background: Patients with secondary deformities associated with unilateral cleft lip and nose might also suffer from nostril stenosis due to a lack of tissue volume in the nostril on the cleft side. Here, we used full-thickness skin grafts (FTSGs) to reduce nostril stenosis and various methods for skin volume augmentation. We compared the changes in the symmetry of both nostrils before and after surgery. Methods: From February 2016 to January 2020, 34 patients underwent secondary cheiloplasty and open rhinoplasty for secondary deformities of the unilateral cleft lip and nose with nostril stenosis. FTSG was used on the nostril floor, nasal columella, and alar inner lining. The measured nasal profile included the nostril surface, nostril circumference, width of the nostril floor, and distance from the alar-facial groove to the nasal tip. The "overlap area," which was defined as the largest overlapping area when the image of the cleft nostril was flipped to the left and right and overlaid on the image of the normal side nostril, was also calculated. The degree of symmetry was evaluated by dividing the value of the cleft side by that of the normal side of each measured profile and expressed as "ratios." Results: The results of all profile ratios, except for the nostril floor width, became significantly close to 1, which represents full symmetry. The overlap area ratio improved from 62.7% to 77.3%, meaning that the length and width of the nostril as well as the overall shape became similar (p< 0.05). Conclusion: When performing cleft rhinoplasty with nostril stenosis, FTSG is useful to achieve symmetry in the nostril size and shape. Skin grafting is simpler to perform than the other types of local flap, and the results are generally satisfactory.

이차구순열변형에서 상순반흔제거술 후 Abbe 피판을 이용한 재건: 사진계측학적 연구 (Correction of Secondary Cleft Lip Deformities by Scar Excision and Abbe Flap Coverage: Photogrammetric Analysis)

  • 한기환;곽민호;여현정;권혁준;김준형;손대구
    • Archives of Plastic Surgery
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    • 제38권6호
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    • pp.747-754
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    • 2011
  • Purpose: The Abbe flap procedure has been used to correct disharmony of the upper and lower lips as well as for making a philtrum for patients with secondary cleft lip deformities. But the Abbe flap procedure adds two scars in addition to the prior operative scar on the upper lip. This study was conducted to determine the treatment outcomes of esthetic subunit excision of the scar on the philtrum and Abbe flap coverage for correction of cleft lip deformities with photogrammetric analysis. Methods: This study investigated a total of 11 patients with cleft lip deformities who underwent scar excision with Abbe flap coverage, and the patients were followed up for at least 6 months. Under general anesthesia, a mushroom-shaped Abbe flap was drawn on the lower lip with a width of 8 mm and a height 1~2 mm longer than that of the philtral midline. The epidermis and dermis of the scar on the upper lip were excised. In the cases with alar base depression, the orbicularis oris muscle was split vertically and transposed to the alar base. The Abbe flap was harvested as a pedicled flap containing a small amount of muscle and this was rotated 180-degree to be inserted into the upper lip. Mucosa, muscle, subcutaneous tissue and skin were closed in layers. The flap was divided at the 7~14 postoperative day. The postoperative outcomes were evaluated by using photogrammetric analysis. Three indices were measured from the standard clinical photographs taken before and after the surgery. For anthroposcopic assessment, observers described the postoperative outcomes using an ordinary scale method. Results: The postoperative values obtained in the photogrammetric analysis showed improvement as compared with the preoperative ones. Improved anthroposcopic outcomes were also noted. Conclusion: Scar excision and Abbe flap coverage were proven to be effective in improving protrusion and the height of the upper lip, the scar of the upper lip and the symmetry of Cupid's bow and the philtral column, as well as formation of the philtral dimple.

Secondary Reconstruction of Frontal Sinus Fracture

  • Kim, Yang Woo;Lee, Dong Hun;Cheon, Young Woo
    • 대한두개안면성형외과학회지
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    • 제17권3호
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    • pp.103-110
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    • 2016
  • Fractures of frontal sinus account for 5%-12% of all fractures of facial skeleton. Inadequately treated frontal sinus injuries may result in malposition of sinus structures, as well as subsequent distortion of the overlying soft tissue. Such inappropriate treatment can result in aesthetic complaints (contour deformity) as well as medical complications (recurrent sinusitis, mucocele or mucopyocele, osteomyelitis of the frontal bone, meningitis, encephalitis, brain abscess or thrombosis of the cavernous sinus) with potentially fatal outcomes. Frontal contour deformity warrants surgical intervention. Although deformities should be corrected by the deficiency in tissue type, skin and soft tissue correction is considered better choice than bone surgery because of minimal invasiveness. Development of infection in the postoperative period requires all secondary operations to be delayed, pending the resolution of infectious symptoms. The anterior cranial fossa must be isolated from the nasal cavity to prevent infectious complications. Because most of the complications are related to infection, frontal sinus fractures require extensive surgical debridement and adequate restructuring of the anatomy. The authors suggest surgeons to be familiar with various methods of treatment available in the prevention and management of complications following frontal sinus fractures, which is helpful in making the proper decision for secondary frontal sinus fracture surgery.

장무지 굴곡근의 혈관성 기형에 동반된 발가락의 굴곡 변형: 증례 보고 (Vascular Malformation of Flexor Hallucis Longus Muscle Associated with a Flexion Deformities of Toes: A Case Report)

  • 안종철;김정래;신지훈;신덕섭
    • 대한골관절종양학회지
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    • 제17권2호
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    • pp.100-105
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    • 2011
  • 혈관성 기형은 주로 무통성 종괴나 종창과 통증을 수반한 종괴의 형태로 나타난다. 드문 경우에서, 근육에 발생한 혈관성 기형은 침범한 근육의 위축을 유발하여 관절의 변형을 초래한다. 혈관성 기형이 하퇴부의 굴곡근에 발생한 경우 발목의 첨족 변형을 유발한다. 그러나, 발가락의 장족지 또는 장무지 굴곡근에 혈관성 기형이 발생하여 발가락의 굴곡 변형을 초래한 것에 대한 문헌 보고의 예는 없다. 이에 저자들은 40세 여자 환자에서 장무지 굴곡근에 발생한 혈관성 기형으로 인해 유발된 발가락의 굴곡 변형을 경험하고 수술적 절제술을 통해 치료하였기에 문헌 고찰과 함께 보고하는 바이다.