• 대한족부족관절학회지
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• 제23권4호
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• pp.216-219
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• 2019

In clinical practice, recurrent Achilles ruptures have been noted to occurr at the original ruptured site. However, reports of new developed fresh rupture of the Achilles tendon in other sites are is extremely rare. Our report is about one uncommon case of a traumatic calcaneal tuberosity avulsion fracture following augmented repair, which was performed using the Krackow locking loop technique. We performed open reduction and intra-osseous fixation using a suture anchor. This procedure was done through the primary longitudinal incision for the calcaneal avulsion fracture fragment. After 6 months of follow-up, our patient has achieved a complete functional recovery and he can normally perform daily and work-related tasks without pain.

• Archives of Plastic Surgery
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• 제50권2호
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• pp.166-170
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• 2023

Diaphragmatic reconstruction is required for extensive diaphragmatic defects associated with tumor resection. Methods using artificial mesh and autologous tissues, such as pedicled flaps, have been reported predominantly for diaphragmatic reconstruction. We present the case of a 61-year-old woman who presented with a 14×13×12 cm tumor in the abdominal cavity of the upper left abdomen on computed tomography. The diaphragm defect measuring 12×7 cm that occurred during excision of the malignant tumor was reconstructed using the rectus abdominis muscle and fascial flap. The flap has vertical and horizontal vascular axes; therefore, blood flow is stable. It also has the advantage of increasing the range of motion and reducing twisting of the vascular pedicles. Fascial flap does not require processing such as thinning and can be used during suture fixation. This procedure, which has rarely been reported so far, has many advantages and may be a useful option for diaphragm reconstruction.

• 대한관절경학회지
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• 제6권1호
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• pp.31-36
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• 2002

목적 : 진구성 전방 십자 인대 견열 골절의 치료후 임상적, 방사선학적 결과를 평가하고자 하였다. 대상 및 방법 : 손상후 3개월 이상 지난 진구성 전방 십자 인대 견열 골절로 진단 받고 본원에서 치료받은 환자중 2년 이상 추시 관찰이 가능하였던 11예를 대상으로 하였으며 평균 연령은 26세(9-66)이었고 평균 추시 기간은 53개월(24-131)이었다. 수술은 전 예에서 관절경하에 병변의 확인 및 동반 손상의 치료후 관혈적 정복을 통한 내고정이나 골편 제거술을 시행하였다. 고정 방법은 8예에서 견인 봉합술을 2예에서 나사못 고정을 시행하였다. 결과 : Lysholm knee score는 술전 평균 64.3점에서 술후 96.2점으로 호전되었으며, 술전 Lachman 검사상 7예에서 경도의 양성, 4예에서 중등도의 양성 소견을 보였으며 술후 Lachman 검사상 9예는 음성이었으며, 2예에서 경도의 양성소견을 보였다. Meyers와 Mckeever의 평가 기준에 의하면 9예$(81.8\%)$에서 우수, 2예$(18.2\%)$에서 양호의 결과를 보였다. $Telos^{\circledR}$기기를 이용한 건측과의 전방이완도 차이의 평가에서 술전 평균 7.8(10-4)mm의 차이를 보였으며 술후 최종 추시상 평균 2.1(6-0)mm의 차이를 보였다. 결론 : 진구성 전방 십자 인대 견열 골절에 대한 치료에 있어 관절경 검사를 통해 동반 손상의 평가와 관절 절개술을 통해 해부학적 정 복과 고정 또는 골편 제거를 병행함으로서 만족할만한 결과를 얻을 수 있을 것으로 생각된다.

• 대한족부족관절학회지
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• 제26권2호
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• pp.95-102
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• 2022

Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades. Materials and Methods: A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency. Results: Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis. Conclusion: This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries.

• Clinics in Shoulder and Elbow
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• 제13권2호
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• pp.237-243
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• 2010

목적: 관절경적 회전근 개 봉합술 시 뼈에 봉합 나사못을 안정적으로 고정하는 것이 중요하다. 그러나 고령의 환자에서 상완골 결절부위에 골다공증이 있는 경우 봉합 나사못이 빠지거나 고정이 불안정할 수 있다. 이에 저자들은 관절경적 회전근 개 봉합술에서 봉합 나사못의 고정 실패시 골 시멘트를 이용한 봉합 나사못 구멍 보강 기법을 소개하고 그 결과를 보고하고자 한다. 대상 및 방법: 2005년부터 2009년까지 관절경적 회전근 개 봉합술을 시행받은 223명 중 골 시멘트로 봉합 나사못 구멍을 보강했던 15명을 대상으로 하였다. 모두 여자로 평균 65 (49~77)세였고, 평균 추시 기간은 16 (6~32)개월 이었다. 주사기를 이용해 골 시멘트를 걸쭉한 액상의 상태에서 봉합 나사못 구멍에 주입한 후 압박기로 압력을 가하였으며 항아리 모양의 시멘트 맨틀을 만들도록 노력하였다. 시멘트가 굳어가기 시작할 무렵 봉합 나사못을 구멍에 삽입하였다. 최종 임상적 평가는 시각척도 통증 점수, 능동적 관절 운동범위, age-sex matched Constant score, UCLA score 등을 이용하여 분석하였다. 결과: 수술 전 촬영한 방사선 사진상, 상완골 대결절부의 낭종성 변화 또는 피질골의 위축 등이 전 예에서 보였다. 최종 추시 방사선 사진상 시멘트 음영의 변화는 볼 수 없었으며, 충진된 시멘트는 원래의 형태를 그대로 유지하였다. UCLA score는 평균 31점 (28~35점) 이었으며 최우수 6예, 우수 8예이었으며 1예는 보통의 결과를 보였다 (p-value 0.008). Age-sex matched Constant score는 평균 90점 (74~98점)으로 상승하였다 (p-value 0.008). 결론: 관절경적 회전근 개 봉합술에서 상완골 대결절부의 골위축이 있는 경우에도 골 시멘트를 이용한 봉합 나사못 구멍 보강술에 의하여 관절경적 봉합술을 시행할 수 있었으며 골 시멘트의 사용이 수술 후 결과에 부정적 영향을 미치지 않는 것으로 보인다.

• Clinics in Shoulder and Elbow
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• 제18권2호
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• pp.68-74
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• 2015

Background: The purpose of our study was to evaluate the functional and radiologic outcomes of additive augmentation sutures through rotator cuff for proximal humeral fractures stabilized locking plate in elderly patients. Methods: We enrolled 74 patients over the age of 60 years who received internal fixation using locking plates for proximal humeral fractures. Of these, 50 patients had additive augmentation sutures through rotator cuff. The mean age at the time of surgery was 72.1 years (range, 60-89 years), and the mean follow-up period was 17.5 months (range, 12-62 months). The humeral neck-shaft angle and humeral head height were used as radiological markers to assess the effect of additive augmentation sutures through rotator cuff. We allocated the patients who received additive augmentation sutures into group A and those who did not into group B. Results: At the final follow-up, the mean Korean Showlder Society score and Constant scores were $88.96{\pm}12.1$ and $86.6{\pm}11.9$, respectively, in group A and $86.21{\pm}11.8$ and $85.3{\pm}11.7$, respectively, in group B (p=0.368, 0.271). At the final follow-up, the mean loss in humeral neck-shaft angle from the time of immediate postoperative measurement was $1.6^{\circ}$ in group A and $4.8^{\circ}$ in group B, whereas the mean loss in humeral head height was 0.82 mm in group A and 0.52 mm in group B (p=0.029, 0.178). Conclusions: The surgical outcomes of internal fixation using locking plates for proximal humeral fractures were clinically and radiologically good in elderly patients over the age of 60 years without any observable complications. Further, the loss of humeral head shaft angle at the final follow-up from its initial postoperative measurement was significantly smaller in patients who received an additive augmentation suture than in those who did not. Thus, we conclude that augmentation sutures are a beneficial option for elderly patients that clinicians can consider at the time of surgical decision making.

• Clinics in Shoulder and Elbow
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• 제9권1호
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• pp.89-95
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• 2006

Purpose: Arthroscopic repair of rotator cuff tears are many techniques that have been developed to improve the initial postoperative strength of the repair. There was a doubt that current arthroscopic cuff repairs using a single row of suture anchors reproduce insufficient area of the anatomic cuff insertion, and concerns about failure of fixation often lead surgeons to limit early motion. Newer technique of double-row repair in arthroscopic treatment may provide initial stronger fixation and more contact with bone at the repair site than single-row repair did. We studied the comparison between clinical outcomes of arthroscopic single- and double-row repair in cuff tears at 1year postoperatively. Materials and methods: We retrospectively analyzed 40 shoulders with single-row repair and 38 shoulders with double-row repair of full-thickness rotator cuff tears between May 2002 and October 2004. Out of total 78 shoulders, 42 (54%) were male patients and 36 (46%) were female patients and the mean age at surgery was 56 years. All patients were diagnosed by physical examination and MRI. At 1year' follow-up after operation, we evaluated with the ASES and the Constant scoring system, and measured muscle power of abduction, internal and external rotation of the affected shoulder then compared with each other. Results: Mean ASES scores and Constant scores in double-row repair group improved more than single-row repair group significantly at 1year postoperatively. Muscle power of abduction and internal rotation, especially abduction power, improved more significantly in double-row repair group than in single-row repair. Conclusion: Arthroscopic double-row repair for the full thickness rotator cuff tear may be a superior technique, which showed better clinical outcomes and restoration of muscle power compared with single-row repair at relatively short period of postoperative follow-up. Restoration of footprint close to normal anatomy by double-row repair seems to play an important role in the recovery of muscle strength.

• 대한두개안면성형외과학회지
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• 제21권2호
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• pp.92-98
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• 2020

Background: Posttraumatic acquired facial deformities require surgical treatment, with options including scar revision, fat grafts, implant insertion, and flap coverage. However, each technique has specific advantages and disadvantages. Methods: From 2016 to 2018, 13 patients (eight with scar contracture and five with a depressed scar) were treated using dermofat grafts from the groin. The harvested dermofat was then inserted into the undermined dead space after the contracture was released, and a bolster suture was done for fixation considering the patient's contour and asymmetry. A modified version of the Vancouver Scar Scale and satisfaction survey were used to compare deformity improvements before and after surgery. Results: In most cases, effective volume correction and an aesthetically satisfactory contour were maintained well after dermofat grafting, without any major complications. In some cases, however, lipolysis proceeded rapidly when inflammation and infection were not completely eliminated. A significant difference was found in the modified Vancouver Scar Scale before and after surgery, with a p-value of 0.001. The average score on the satisfaction survey was 17.07 out of 20 points. Conclusion: A dermofat graft with the groin as the donor site can be considered as an effective surgical option that is the simplest and most cost-effective method for the treatment of acquired facial deformities with scar contracture.

• Clinics in Shoulder and Elbow
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• 제11권2호
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• pp.77-81
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• 2008

회전근 개 파열에 대한 봉합 수술의 목적은 봉합 초기에 고정력을 높이고 건-골 사이의 간격 형성을 최소화 하며 반복적인 부하에 기계적인 안정성을 유지시키고 회전근 개의 끝이 뼈에 부착되어 치유될 때까지 건-골 사이의 치유 환경을 최적화시키는 것이다. 일열 봉합은 원래의 회전근 개 부착부에 건을 완전히 부착시키는 면적이 제일 적고 간격 형성에 취약하다. 이열 봉합은 고정 실패를 방지하는 힘이 일열 봉합보다는 우수하고 간격 형성도 더 적으며 교량형 봉합은 최대 인장력이 가장 크며 전단력 및 회전력에 강하고 간격 형성도 제일 적다. 이러한 것을 볼 때 이열 봉합 및 교량형 봉합이 일열 봉합보다 우수한 점이 많지만 수술 시간이 좀 더 오래 걸리고 삽입하는 나사못의 개수도 많아 수술료가 비싸다는 단점도 가지고 있다. 따라서 일열 봉합도 회전근 개의 점액 낭측 부분층 파열이나 작은 완전 파열에 쓰여질 수 있는 아직은 유용한 방법으로 사료된다.

• Archives of Plastic Surgery
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• 제32권2호
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• pp.219-226
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• 2005

Muller's muscle-levator aponeurosis advancement procedure was performed to correct mild to moderate congenital blepharoptosis with moderate to good levator function and to correct severe aquired blepharoptosis with poor levator function. Through the blepharoplasty incision, the upper half of the tarsal plate was exposed and the orbital septum was opened to show the levator aponeurosis. The Muller's muscle was dissected from the superior margin of the tarsal plate and from the posteriorly located conjunctiva with sharp scissors. The Muller's muscle and levator aponeurosis were advanced on the anterior surface of the tarsal plate as a composite flap and fixed approximately 3 to 4 mm inferior to the upper edge of the tarsal plate with three horizontal 6-0 nylon mattress sutures. The amount of advancement of the composite flap was controlled by the location of the upper eyelid margin 2 mm below the upper limbus in primary gaze after the first suture in the middle portion of the flap. The excess flap was trimmed off with scissors, but trimming was usually not necessary in cases of mild to moderate ptosis. Nine cases underwent this Muller's muscle-levator aponeurosis advancement procedure from September 2003 to September 2004. Five cases were congenital blepharoptosis with 2-4 mm ptosis and more than 5 mm of levator function, but three of the four acquired ptosis cases had more than 4 mm ptosis with poor levator function. The age of the patients ranged from 7 to 81 years. In operative results, all patients except one traumatic case were within 1 mm of the desired eyelid height in primary gaze. This procedure can provide not only tightening of the Muller's muscle but also advancement and firm fixation of the levator aponeurosis to the tarsal plate, yielding predictable results.