• 대한물리치료과학회지
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• 제7권1호
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• pp.311-319
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• 2000

This study was to measure whether single axis foot or the SACH foot applied to below-knee amputation patients would bring positive changes to the patients' cardiopulmonary function, and help them to overcome their disability. The experiment took place at Asan Medical Center, University of Ulsan, from July 20th to November 20th, 1999 with 10 below-knee amputation patients. The patients were asked to equip single axis foot and SACH foot by turns and lead them to walk on a treadmill which was designed to increase its steep slope. Patients heart rate and blood pressure were recorded before and after their walking, The heart rate, systolic blood pressure, diastolic blood pressure of the patients who were equipped with, either SACH foot or single axis foot, have been increased with as the slant becoming steeper. The heart rates during the experiment did not show relevant changes according to the kind of foot used and the gradient, but the changes occurred before and after the walking(p=0.0001), The similar result of systolic blood pressure was found during the waking(p=0.01). Below-knee amputation patients are expected to walk and perform the routines better, no matter what type of foot is used, as long as they wear an artificial foot properly and taking features of foot product into consideration

• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.167-172
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• 2002

The only treatment method for crushed soft tissue injuries in the proximal leg involving the knee joint is the microsurgical free flap transplantation, especially latissimus dorsi myocutaneous free flap is useful to cover the extensive soft tissue defects, therefore prevents iatrogenic below knee amputation and facilitates early wound healing, early ambulation and shortens hospital stay. Authors have treated the open amputation with crushed soft tissue and bone injuries in the proximal leg, and the repeated abrasion and infectious wound with traumatic neuroma in the below knee with myocutaneous free flap and succeeded to wear below knee amputation prosthesis and return to normal activities of the daily living in the relatively shorter period than usual.

• Archives of Plastic Surgery
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• 제50권5호
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• pp.501-506
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• 2023

This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.51-56
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• 2011

During below knee amputation, the amputation stump must be covered with well-vascularized and sensate soft tissue. Many flaps can be used for this purpose, but available reconstructive options are limited. We performed reverse flow ALT flap elevation on two patients with below knee amputations to reconstruct defects in the stumps. The sizes of the defects in the stumps were $4{\times}16$ cm and $5{\times}5$ cm, respectively. The most distal portion of the defects were located 20 cm and 16 cm lateral to the knee joint in a curve, respectively. The size of the elevated flap was $5{\times}18$ cm for case 1 and $18{\times}10$ cm for case 2. The respective pivot points of the pedicles were 7 cm and 6 cm above the patella and the respective lengths of the pedicles were 17 cm and 16 cm. In both cases, venous congestion occurred on the second postoperative day and the flap distal to 10 cm or more from below the knee joint was necrotized at the second postoperative week. Surgeons should be cautious when using a reverse ALT flap to reconstruct a soft tissue defect located 10 cm or more distal from below the knee joint. Since a pedicle longer than 15 cm may develop partial necrosis of the flap, simultaneous application of antegrade venous drainage is recommended.

• 대한족부족관절학회지
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• 제16권4호
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• pp.257-264
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• 2012

Purpose: The diabetic foot lesions are intractable, and aggravation often leads to amputation. None or minor amputation group was treated debridement or toe amputation and major amputation group was treated Ray, Lisfranc, Chopart, Below Knee and Above Knee amputation. We investigate the risk factors for major limb amputations among patients with diabetic foot lesion. Materials and Methods: The subjects were 73 diabetic foot lesion patients (83 diabetic foot lesions) treated at our department from January 2006 to December 2010. Non or Minor amputation group of 44 cases were treated with debridement or toe amputation. Major amputation group of 39 cases were treated with Ray, Lisfranc, Chopart, below or above Knee amputation. We investigated socioeconomic factors, diabetes mellitus related factors and wound related factors and laboratory factors. Statistical analysis was done by Students t-test, Chi-square test, Mann-Whitney's U test. Results: In our analysis, wound size, wound classification (Wagner classification, Brodsky classification), white blood cell counts, polymorphoneuclear neutrophil percentage, hemoglobin, C-reactive protein and albumin were risk factors for major amputation (p<0.05). Conclusion: Low education level, nutritional condition, premorbid activity level and progressed wound condition were observed in major amputation group compared with non or minor amputation group. In the major amputation group, higher white blood cell count, C-reactive protein level and lower albumin level were observed. Together with maintenance of adequate nutritional condition, early detection of lesions and foot care for early treatment is important. Therefore, active investigation with full risk evaluation of vascular complication is also important.

• The Journal of Korean Physical Therapy
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• 제15권3호
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• pp.166-172
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• 2003

The aim of this study is to present the basic reference data of age and specific gait parameters for comparisons of the gait characteristics depended on amputation length of the Unilateral Trans-Tibial Prostheses. The basic gait parameters were extracted from 10 Adult, and 20 below knee(B/K) patients, 50 to 60 years of age using VICON 512 Motion Analyzer. The results were as follows; 1. The mean Cadence of the above knee(A/K) patients and below knee(B/K) patients were $87.77{\pm}8.64$ steps/min, to $99.84{\pm}11.14$ steps/min.(p<0.05) 2. The mean Walking Speed of the above knee(A/K) patients and below knee(B/K) patients were $0.84{\pm}0.15$ m/s, to $0.96{\pm}0.25$ m/s.(p>0.05) 3. The mean Stride Length of the above knee(A/K) patients and below knee(B/K) patients were $1.14{\pm}0.14\;m$, to $1.14{\pm}0.22m$.(p>0.05) 4. The mean maximal angles of joint on the hip flexion motion for different above knee(A/K) patients and below knee(B/K) patients were $34.75{\pm}10.18_{\circ}$, to $32.32{\pm}6.34_{\circ}$.(p>0.05) 5. The mean maximal angles of joint on the knee flexion motion for different above knee(A/K) patients and below knee(B/K) patients were $66.97{\pm}15.08_{\circ}$, to $52.65{\pm}9.21_{\circ}$. (p<0.05) 6. The mean maximal angles of joint on the ankle dorsi-flexion motion for different above knee(A/K) patients and below knee(B/K) patients were $14.41{\pm}4.82_{\circ}$, to $10.04{\pm}3.49_{\circ}$.(p>0.05) 7. The mean maximal angles of joint on the ankle plantar-flexion motion for different above knee(A/K) patients and below knee(B/K) patients were $5.77{\pm}3.17_{\circ}$, to $2.75{\pm}4.49_{\circ}$.(p>0.05)

• 한국전문물리치료학회지
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• 제3권1호
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• pp.65-72
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• 1996

The purpose of this study was to introduce rotation-plasty procedure and prosthetic ambulation training. The recent development of chemotherapy and diagnostic facility have permitted the orthopaedic surgeons to try limb saving procedures rather than amputations for the treatment of the malignant bone tumors. If the tumors around the knee joint were treated by mid-thigh amputation or hip disarticulation, it would impose the client with a great handicap for rehabilitation. Rotation-plasty procedure was first done by Borggreve, in 1930 for the congenital short femur. Recently this procedure was used a malignant bone tumor at the distal femur by Kotz and Salzer in 1982. In spite of its cosmetic problem of the distal stump, this procedure has the great functional advantage of converting the above-knee amputation to the below-knee amputation. The inverted foot was also good to control the prosthesis as a below-knee stump and heel functioned as a patella to support the body weight. This 15 years old girl case was had rotation-plasty due to osteosarcoma of the distal femur with 3rd postoperative chemotherapy, and admitted to Yonsei rehabilitation hospital for prosthetic ambulation training. Then, the case had excellent functional results of prosthetic ambulation training with rotaion-plasty after 3 months.

• 대한족부족관절학회지
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• 제11권2호
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• pp.216-220
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• 2007

Purpose: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) below the knee as a treatment in diabetic foot gangrene. Materials and Methods: Between May 2003 and May 2006, angiography was performed in 35 diabetic foot gangrene classified as either Wagner grade IV or V. Infrapopliteal PTA was performed in 10 patients among them. Clinical success was defined as prevention of major amputation. Results: Among 25 patients who did not receive infrapopliteal PTA, the major amputation rate is 22% (in one arterial occlusion cases), 50% (in two arterial occlusion cases), 63% (in three arterial occlusion cases), respectively. Infrapopliteal PTA was successfully performed in 8 among 10 patients. Two patients were failed and undergone below-knee amputation. Toe amputation were performed in 2 patients with one arterial occlusion. Out of 6 patients with three arterial occlusions, toe amputations were performed in 4 patients and the other 2 patients were healed through debridement. Conclusion: As a first choice revascularization procedure for limb salvage in diabetic foot gangrene, infrapopliteal PTA can be one of treatment options.

• 대한족부족관절학회지
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• 제6권1호
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• pp.35-39
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• 2002

Purpose: The purpose of this study was to evaluate the effect of hyperbaric oxygen therapy(HBOT) and the resultant amputation rate in the treatment of diabetic foot ulcer. Material and methods: From 2000 Jan. to 2002 April, thirty two diabetic foot patients were admitted for treatment of foot ulcers and infection. Of the thirty two cases, thirteen patients received HBOT and nineteen did not. The results were analyzed by amputation rate and healing time. All were classified according to the Wagner classification. Results: Of the HBOT treated group, three(23%) patients underwent amputation: two below knee and one metatarsophalangeal disarticulations. Of the non-treated group, eleven(58%) patients underwent amputation, : four below knee and seven metatarsophalangeal disarticulations. The healing times, based on hospital days were average 16, 38, 43 days in the HBOT treated group and average 20, 50, 35 days in the non treated group respectively in Wagner grade II, III, IV. Conclusions: HBOT might be effective in decreasing amputation rate and hospital stay in diabetic patients with severe foot ulcers.

• 대한골관절종양학회지
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• 제11권2호
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• pp.204-207
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• 2005

골육종은 슬관절 주위에 호발하며 족부에 발생하는 경우는 흔하지 않다. 20세 남자 환자가 수개월간 지속된 좌측 종골 부위의 통증으로 내원하였으며 종골의 골육종으로 진단하여 슬하부 절단술 및 술 후 화학요법을 시행하였다. 이에 저자들은 종골에 발생한 골육종 1례를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.