• Journal of Korean Neurosurgical Society
• /
• v.52 no.4
• /
• pp.423-426
• /
• 2012

Spinal infection is an inflammatory process around the vertebral body, and it can extend to the epidural space, posterior elements and paravertebral soft tissues. Infectious spondylitis is a rare infectious disorder, which is often associated with significant neurologic deficits and mortality. When an extensive soft tissue defect is accompanied by infectious spondylitis, effective infection control and proper coverage of soft tissue are directly connected to successful outcomes. However, it is not simple to choose the appropriate treatment methods for infectious spondylitis accompanied by a soft tissue defect. Herein, we report a case of severe infectious spondylitis that was accompanied by an extensive soft tissue defect which was closed with a reverse latissimus muscle flap after traumatic spinal epidural hemorrhage.

• The Journal of Dong Guk Oriental Medicine
• /
• v.5
• /
• pp.79-95
• /
• 1996

When we see normal gait, gait cycle is seperated as stance phase and swing phase. It needs 6 determinant of gait of pelvic rotation, pelvic tilt, knee joint of stance phase, ankle and foot motion, ankle and knee motion, and pelvic movement to be accomplished. In addition, a joint and muscle action is accomplished biomechanically at the same time with its gait cycle. In oriental medicine, the relationships between chang-fu physiology and meridian physiology are summaried as follows ; ${\bullet}$ chang-fu physiology : Spleen manages the extremities. Liver manages soft tissues. Liver stores blood. Kidney stores essences. Kidney manages bones. ${\bullet}$ meridian physiology : The Leg Greater Yang Meridian and meridian soft tissues The Leg Yang-Myeong Meridian and meridian soft tissues The Leg Lesser Yang Meridian and meridian soft tissues The Leg Greater Yin Meridian and meridian soft tissues The Leg Lesser Yin Meridian and meridian soft tissues The Leg Absolute Yin Meridian and meridian soft tissues Especially, we can find out relations between in a "blood supplied feet can walk well" that explains "blood regulations and by liver nourishing effects"that is the closest concept of muscle. Abnormal gaits are due to three causes as following; first, physical defect secoud, pain third, nervous system or instability of muscle. In oriental medicine, we can know relationship in "atrophy, numbness, stroke, convulsion, muscular dystrophy of knee, rheumatoid arthritis, five causes of infantile growing defects, five causes of softening, sprain". Especially, atrophy is the most important symptom. Gait evaluation should be emphasized where a point can walk 8 feet to 10 feet considering stride width, stride length, the body weight center, stride number, flexion, extension, rotation of a joint as a standard factor. The point is we should find out something strange in a patient's side, front and back view. After that we should find out its cause as an index that we can observe abnormal findings in a joint and muscle.

• Archives of Plastic Surgery
• /
• v.38 no.5
• /
• pp.691-694
• /
• 2011

Purpose: With an increase in the population of immunocompromised patients, the incidence of maxillary sinus aspergillus infection has also escalated. Maxillary sinus aspergillosis is generally extended to the sinus antrum, base or thin orbital wall and ethmoid air cell region. We experienced a case of maxillary sinus aspergillosis which was extended directly to the soft tissue of the cheek. Methods: A 46-year-old man with acute myelogenous leukemia was consulted for the defect of the anterior wall of the maxillary sinus, and cheek. Radiologic and histologic findings were consistent with invasive maxillary sinus aspergillosis. The otolaryngology department performed debridement via endoscopic sinus surgery first. Coverage of the resulting defect in the anterior wall of the maxillary sinus and its inner layer was undergone by the plastic and reconstructive surgery department, using a pedicled superficial temporal fascia flap and a split thickness skin graft. The remaining skin defect of the cheek was covered with a local skin flap. Results: The patient went through an uneventful recovery. There was no recurrence during 6 months of follow-up. Conclusion: Maxillary sinus aspergillosis usually involves the orbit or the gingiva but in some cases it may directly invade soft tissues of the cheek. Such an atypical infection extending into the cheek may lead to a large soft tissue defect requiring coverage. Thus, any undiagnosed soft tissue defect involving the cheek or maxillofacial area, especially in immunocompromised patients, should be evaluated for aspergillosis. We present this rare case, with a review of the related literature.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.38
• /
• pp.46.1-46.7
• /
• 2016

Background: Osteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better reconstruction. Methods: A total of eight consecutive patients who underwent fibula reconstruction due to jaw necrosis from March 2008 to December 2015 were included in this study. Patients were classified according to stages, primary sites, radiation dose, survival, and quality of life. Results: Five male and three female patients underwent operation. The mean age of the patients was 60.1 years old. Two male patients died of recurred disease of oral squamous cell carcinoma. The mean dose of radiation was 70.5 Gy. All fibular free flaps were survived. Five patients could eat normal diet after operation; however, three patients could eat only soft diet due to loss of teeth. Five patients reported no change of speech after operation, two reported worse speech ability, and one patient reported improved speech after operation. The ipsilateral side of the fibular flap was used when intraoral soft tissue defect with proximal side of the vascular pedicle is required. The contralateral side of the fibular flap was used when extraoral skin defect with proximal side of the vascular pedicle is required. Conclusions: Osteonecrosis of the jaw is hard to treat because of poor healing process and lack of vascularity. Free fibular flap is the choice of the surgery for jaw bone reconstruction and soft tissue fistula repair. The design and selection of the right or left fibular is dependent on the available vascular pedicle and soft tissue defect sites.

• Archives of Reconstructive Microsurgery
• /
• v.22 no.2
• /
• pp.52-56
• /
• 2013

Purpose: We had proceeded seven iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defects and followed-up average for 5 years and 9 months to evaluate the survival rate, neurosensory function and cosmesis in final results. Materials and Methods: From January 1999 through October 2012, we have performed iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defect (average around $3.6{\times}2.4cm$) in 7 cases and average age was 41.6 years (21.5 to 59.0 years). Lesion site was posterior heel in 4 cases, distal anterior leg in 3 cases. Donor structure was the dorsalis pedis artery and the first dorsal metatarsal vessel and deep peroneal nerve in 3 cases and the dorsalis pedis artery and the first dorsal metatarsal vessel in 4 cases. Results: Seven cases (100%) were survived and defect area was healed with continuous dressing without skin graft. The sensory function in the neurovascular flap was restored to normal in 3 cases. Cosmesis was good and fair in 7 cases (85.7%). Conclusion: Ipsilateral dorsalis pedis vascularized pedicle flap in the distal leg and foot is one of the choice to cover the exposed bone and soft tissues without microsurgical procedure.

• Archives of Reconstructive Microsurgery
• /
• v.15 no.2
• /
• pp.111-116
• /
• 2006

An infection after total knee arthroplasty has many complications such as severe bone defect, skin and soft tissue problems, devastated general condition, so arthrodesis is preferred as treatment option. However, poor bony contact due to severe bone defect and inadequate conditions of the soft tissue often cause nonunion or severe limb shortening after arthrodesis. More over these conditions, it is not easy to choose appropriate fixative devices. In these situations, the arthrodesis using vascularized fibular graft can be the solution. Vascularized fibular graft (VFG) can playa role as a suitable material for the treatment of bone defects. And VFG can overcome poor blood circulation caused by scar tissues, and can be relatively more durable and adequate length. In the long term, VFG can be hypertrophied by weight bearing, and will give mechanical stablility. The purpose of the paper is to report the successful results of arthrodesis using VFG in a patient who got extensive bone defect after failed revision total knee arthroplasty with infection.

• The Journal of Korean Academy of Prosthodontics
• /
• v.27 no.1
• /
• pp.181-192
• /
• 1989

Loss of teeth causes the inevitable reduction of residual ridge. Among the various methods solving this problem, hydroxyapatite proved to be useful for correction of ridge defect and irregularity. The purpose of this study is to evaluate the tissue responses of two types Of hydroxyapatites and resin polymer. Calcitite 2040 (Calcitek Inc.), Interpore 200 (Interpore Int.), and HTR polymer (HTR Sciences) were implanted into the jaw of an adult dog. The procedure was designed to obtain the results of 1 week, 2 week, 4 week, and 12 week-intervals. And after 12 weeks from the first operation day, the dog was sacrificed and evaluated histologically by light microscope. The results were as follows : 1. The mucosa was healed after two weeks. 2. After 1 week, there were acute inflammatory cells, but diminished after 2 weeks and were not seen after 12 weeks. 3. The hydroxyapatites implanted in soft tissues were surrounded by fibrous connective tissue. And some foreign body giant cells were found. 4. Calcitite and Interpore particles implanted subperiosteally were surrounded by newly formed bone after 12 months. And direct contact between bone and particles was noted. 5. The HTR particles implanted in soft tissues were encapsulated by fibrous connective tissues. The sample where the particles contacted directly to bone could not obtained by some probable insufficiencies of surgical technique or care of the animal. And the residue of HTR particles was digested by macrophage.

• Archives of Reconstructive Microsurgery
• /
• v.12 no.2
• /
• pp.112-118
• /
• 2003

Purpose : Soft tissue defect and exposed tendons and bones with concomitant infection in the foot and lower leg have to be covered with vascularized flap as the one stage treatment. Authors have performed 6 cases of pedicled dorsalis pedis island flaps under the loupes magnification and evaluated the benefits. Materials and methods : From 1994 through 2003, we have performed 6 pedicled dorsalis pedis island flaps for reconstruction of soft tissue defects in the foot and lower leg. The causes were trauma in 3 cases, skin necrosis and secondary infection after Achilles tendon repair in 2 cases and acute osteomyelitis in 1 case. Average age was 38 years and 5 cases were male and 1 female. The results of the procedure was evaluated by survival of the island flap, comfort in putting on shoes and walking, comfort in the donor site, comfort in the recipient site and range of motion of the ankle joint. Results : All pedicled dorsalis pedis island flaps survived except 1. Three cases felt discomfort in the dorsum of foot as the donor site and 1 case of the Achilles tendon ruptured and repaired showed limited dorsiflexion of ankle joint. Conclusion : Nonmicrosurgical pedicled dorsalis pedis island flaps under the loupes magnification are one of the useful treatment methods because procedure is rapid, survival is confident and overall reconstructive results are good.

• Archives of Reconstructive Microsurgery
• /
• v.18 no.2
• /
• pp.49-54
• /
• 2009

Purpose: To evaluate the result of muscle free flap transplantation in chronic osteomyelitis of the tibia and calcaneus occurred from open fractures and exposed bones and internal fixatives. Materials and Methods: The free muscle flap were transferred in the tibia and calcaneus and followed up average 7.3 years at the department of orthopedic surgery from March 1997 to September 2009. Six patients were male and 1 case female averaged 50.3 years of age. Two latissimus dorsi myocutaneous free flaps were transplanted to the exposed 2/3 of the tibia with soft tissue defect, one rectus abdominis muscle free flap to the mid 1/3 of the tibia and four gracilis muscle free flaps to the distal 1/3 of the tibia and calcaneus. Results: At average 7.2 years follow-up, all of the 7 cases obtained solid bone union in the X-ray and kept sound soft tissues without pus discharges. The overall result of bone union, healed soft tissues defect and normal knee and ankle joint range of motion were excellent. Conclusion: The free muscle flap transferred to the chronic osteomyelitis of the tibia and calcaneus showed excellent results in bone union and eradication of the pus forming bacteria by its abundant blood flow.

• Archives of Plastic Surgery
• /
• v.38 no.4
• /
• pp.415-420
• /
• 2011

Purpose: The reconstruction of a soft tissue defect of the heel pad can be challenging. One vital issue is the restoration of the ability of the heel to bear the load of the body weight. Many surgeons prefer to use local flaps or free tissue transfer rather than a skin graft. In this study, we evaluated the criteria for choosing a proper flap for heel pad reconstruction. Methods: In this study, 23 cases of heel pad reconstruction were performed by using the flap technique. The etiologies of the heel defects included pressure sores, trauma, or wide excision of a malignant tumor. During the operation, the location, size and depth of the heel pad defect determined which flap was chosen. When the defect size was relatively small and the defect depth was limited to the subcutaneous layer, a local flap was used. A free flap was selected when the defect was so large and deep that almost entire heel pad had to be replaced. Results: There was only one complication of poor graft acceptance, involving partial flap necrosis. This patient experienced complete recovery after debridement of the necrotic tissue and a split thickness skin graft. None of the other transferred tissues had complications. During the follow-up period, the patients were reported satisfactory with both aesthetic and functional results. Conclusion: The heel pad reconstructive method is determined by the size and soft-tissue requirements of the defect. The proper choice of the donor flap allows to achieve satisfactory surgical outcomes in aesthetic and functional viewpoints with fewer complications.