• Archives of Plastic Surgery
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• 제50권6호
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• pp.593-600
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• 2023

Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee jointmobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.240-252
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• 2022

Rather than just another "review," this is intended to be an "overview" of the entire subject of the medial sural artery perforator (MSAP) flap as has been presented in the reconstructive literature from its inception in 2001 until the present, with any exceptions not purposefully overlooked. Unfortunately, the pertinent anatomy of the MSAP flap is always anomalous like most other perforator flaps, and perhaps even more variable. No schematic exists to facilitate the identification of a dominant musculocutaneous perforator about which to design the flap, so some adjunctive technology may be highly valuable for this task. However, if a relatively thin free flap is desirable for a small or moderate sized defect that requires a long pedicle with larger caliber vessels, the MSAP flap deserves consideration. Indeed, for many, this has replaced the radial forearm flap such as for partial tongue reconstruction. Most consider the donor site deformity, even if only a conspicuous scar on the calf, to be a contraindication. Yet certainly if used as a local flap for the knee, popliteal fossa, or proximal leg, or as a free flap for the ipsilateral lower extremity where a significant recipient site deformity already exists, can anyone really object that this is not a legitimate indication? As with any perforator flap, advantages and disadvantages exist, which must be carefully perused before a decision to use the MSAP flap is made. Perhaps not a "workhorse" flap for general use throughout the body, the MSAP flap in general may often be a valuable alternative.

• 대한한방체열의학회지
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• 제3권1호
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• pp.60-66
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• 2004

Purpose This study is to examine of Neurometer for the diagnosis of cold hypersensitivity Method Among patients who visited the oriental gynecological department in Kangnam Korean Hospital from October. 2000 to December. 2000, 37 women were diagnosed as cold hypersensitivity by D.I.T.I. We measured the limbs' temperature by D.I.T.I. and Current perception threshold(CPT) of median N., ulnar N., radial N., peroneal N., sural N., tibial N., saphenous N. by neurometer Patients were divided into mild and severe group depending on the temperature difference between proximalis and distalis in limbs Result and Conclusion 1. In severe group, CPT of median N., ulnar N., radial N. was higher on 250Hz and 200Hz. 2. In severe group, Mean CPT of peroneal N., sural N., tibial N., saphenous N. was higher on every Hz.

• Archives of Plastic Surgery
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• 제45권6호
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• pp.601-604
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• 2018

• 대한족부족관절학회지
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• 제15권3호
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• pp.144-148
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• 2011

Purpose: To investigate the results of percutaneous repair technique of Achilles tendon ruptures, and to describe the surgical technique. Materials and Methods: We retrospectively analyzed the outcomes of 73 patients with ruptured Achilles tendon from October 1995 to September 2009. 28 patients were excluded due to short follow up period. 34 patients were male and 11 patients were female. The mean patient age was 37.19 (10~62) years. The location of rupture site was 6.58 cm proximal to the tendon insertion into the calcaneus on average. Mean follow up period was 55 months and All patients were surgically repaired using percutaneous technique with sural nerve isolation. Results: Arner-lindholm score were excellent in 32 (71%), good in 12 (27%), poor in 1 (2%) case. 44 cases (98%) had the score more than good. Mean American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot function score was 92.93 (67~100). We had 1 case of superficial infection, 1 case of soft tissue irritation by suture knot. Conclusion: Percutaneous repair with sural nerve isolation in treating ruptured Achilles tendon showed low complication rate and reliable clinical outcome.

• Journal of Acupuncture Research
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• 제27권5호
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• pp.13-24
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• 2010

Objectives : This study was designed to investigate the effects of bee venom acupuncture at Shinsu($BL_{23}$) and Daejangsu($BL_{25}$) on neuropathic pain induced by tibial and sural nerve injury in rats. Methods : Neuropathic pain model was made by partial resection of tibial and sural nerve. Three weeks after the neuropathic surgery, bee venom acupuncture was firstly injected at $BL_{23}$ and $BL_{25}$, then we measured withdrawal responses induced by von Frey filament and acetone stimulation. Bee venom acupunctures were injected 6times on every 2days. Measurement of withdrawal responses were conducted on the same days. After bee venom acupuncture injection, expression levels of c-Fos, nocieptin and KOR-3 were observed through using immunohistochemistry. Results : In this experiment, bee venom acupunctures at $BL_{23}$ and $BL_{25}$ decreased levels of withdrawal responses induced by von Frey filament and acetone stimulation respectively. In addtion, expression levels of c-Fos, nociceptin and KOR-3 in central gray part of brain in rats were decreased by bee venom acupuncture. Conclusions : These results imply that bee venom acupuncture was useful to treat patients with neuropathic pain, and related mechanisms were involved in opioid and their receptors such as nociceptin and KOR-3.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.22.1-22.4
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• 2018

Background: Cross-facial nerve graft is considered the treatment of choice for facial reanimation in patients with unilateral facial palsy caused by central facial nerve damage. In most cases, a traditional parotidectomy skin incision is used to locate the buccal and zygomatic branches of the facial nerve. Methods: In this study, cross-facial nerve graft with the sural nerve was planned for three patients with facial palsy through an intraoral approach. Results: An incision was made on the buccal cheek mucosa, and the dissection was performed to locate the buccal branch of the facial nerve. The parotid papillae and parotid duct were used as anatomic landmarks to locate the buccal branch. Conclusions: The intraoral approach is more advantageous than the conventional extraoral approach because of clear anatomic marker (parotid papilla), invisible postoperative scar, reduced tissue damage from dissection, and reduced operating time.

• Annals of Clinical Neurophysiology
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• 제8권2호
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• pp.146-151
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• 2006

Background: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the tibial nerve within fibrous tunnel on the medial side of the ankle. The most common cause of TTS is idiopathic. This is a retrospective study to define the electrophysiological characteristics of idiopathic TTS. Methods: We reviewed the medical and electrophysiological records of consecutive patients with foot sensory symptoms referred to electromyography laboratory. Inclusion of patients was based on clinical findings suggestive of TTS. Among them, patients with any other possible causes of sensory symptoms on the foot were excluded. Control data were obtained from 19 age-matched people with no sensory symptoms or signs. Routine motor and sensory nerve conduction study (NCS) including medial plantar nerve (MPN) using surface electrodes were performed. Result: Twenty one patients (13 women, 8 men, 9 unilateral, 12 bilateral) were enrolled to have idiopathic TTS (total 31 feet). Tinel's sign was positive in 16 feet (51.6%) of TTS and four feet (10.5%) in control group. The statistically significant electrophysiological parameter was difference of sensory conduction velocity (SCV) between sural nerve and MPN. Amplitude of sensory nerve action potential and SCV of MPN were not different significantly between idiopathic TTS feet and controls. Conclusion: Bilateral development in idiopathic TTS was more common. Tinel's sign and difference of SCV between sural nerve and MPN may be helpful for the diagnosis of idiopathic TTS.

• Annals of Clinical Neurophysiology
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• 제5권2호
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• pp.192-196
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• 2003

The Lateral dorsal cutaneous branch of sural nerve (LDCB) is a terminal sensory branch of lower extremities. It can be injured frequently in peripheral nerves. However, the normal data of each component of nerve conduction study (NCS) of were not studied at this time. The Nerve Conduction Study of LDCB adults were assessed for amplitude, area, duration and nerve conduction velocity (NCV) in normal fifty. We also evaluated how age, sex and dexterity affect the various components of NCS. The Mean amplitude of LDCB was $9.45{\pm}1.93{\mu}V$, area was $4.05{\pm}0.55{\mu}V/s$, duration was $1.50{\pm}0.13s$, and NCV was $37.9{\pm}3.09m/s$, respectively. The amplitude of right was $10.1{\mu}V$ in men, $8.65{\mu}V$ in women. The area of right was $3.83{\mu}V/s$ in less than 40 years and $4.24{\mu}V/s$ in older than 40 years. The areas of left was $3.86{\mu}V/s$ in less than 40 years and $4.30{\mu}V/s$ in older than 40 years. The NCV was 39.0 m/s in less than 40 years and 36.7 m/s in older than 40 years. All of above differences were statistically significant. There were no statistically significant differences between right and left NCS. Normal data of LDCB could be applicable in peripheral neuropathy or nerve injury.

• Korean Journal of Acupuncture
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• 제31권4호
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• pp.195-207
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• 2014

Objectives : The purpose of this study is to examine the effects of laser acupuncture according to the wavelength(532 nm, 650 nm, 830 nm, 904 nm, and 1064 nm) at the acupoint of GB34 GB39 on neuropathic pain rat induced by tibial and sural nerve transection(TST). Methods : Neuropathic pain in rats was induced by tibial nerve and sural nerve transection. The rats were divided into the intact group, the TST control group, and the laser acupuncture therapy group. The laser acupuncture therapy groups were then divided into subgroups with 532 nm(L532), 650 nm(L650), 830 nm(L830), 904 nm(L904), and 1064 nm(L1064) laser acupuncture therapy. The acupoint of GB34 GB39 was selected, and laser acupuncture therapy was provided on both sides alternatively twice a week in a total of 6 sessions. Results : All the laser acupuncture groups showed a significant decrease in reaction time and force intensity. L532, L904, and L1064 groups showed a significant decrease in Bax, the L532 group showed a significant increase in Bcl-2, L532 and L1064 groups showed a significant decrease in the Bax/Bcl-2 ratio, and L532 and L650 groups showed a significant increase in mGluR5, as compared with the TST control group, among nerve tissue reaction. Conclusions : These results showed that laser acupuncture therapy at each of the wavelengths had some significance on neuropathic pain.