• Archives of Plastic Surgery
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• 제47권5호
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• pp.451-459
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• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.306-312
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• 2018

안면 신경의 측두지는 그 해부학적 위치로 인하여 외상성 손상에 취약하며, 이로 인해 환자는 종종 상당한 미용적, 기능적 손실을 경험한다. 나아가 결손이 있는 만성 손상은 신경 이식 등의 추가적인 시술이 필요한 경우가 많기에 급성 손상에 비하여 그 치료가 까다롭다. 본 연구에서는 안면 신경의 측두지 손상 발생으로부터 1개월 후에 지연된 신경 이식을 한 남성 환자의 증례를 다루었다. 우리는 성공적으로 비복 신경을 분할 이식하였으며 환자는 양호한 미용적, 기능적 회복을 보였다.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.107-112
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• 2010

Purpose: Recently, the change to a more complex social structure has led to an increased frequency of traumas due to violence, accident and so on. In addition, the severity of the traumas and the frequency of penetrating injuries have also increased. Traumas to cervical and abdominal areas, what are commonly seen by general surgeons, can have mild to fatal consequences because in these areas, various organs that are vital to sustaining life are located. The exact location and characteristics of the injury are vital to treating patients with the trauma to these areas. Thus, with this background in mind, we studied, compared, and analyzed clinical manifestations of patients who were admitted to Wonju Christian hospital for penetrating injuries inflicted by themselves or others. Methods: We selected and performed a retrospective study of 64 patients who had been admitted to Wonju Christian Hospital from January 2005 to December 2009 and who had cervical or abdominal penetrating injuries clearly inflicted by themselves or others. Results: There were 51 male (79.7%) and 13 female (20.3%) patients, and the number of male patients was more dominant in this study, having a sex ratio of 3.9 to 1. The range of ages was between 20 and 86 years, and mean age was 43.2 years. There were 5 self-inflicted cervical injuries, and 19 self-inflicted abdominal injuries, making the total number of self-inflicted injury 24. Cervical and abdominal injuries caused by others were found in 11 and 29 patients, respectively. The most common area involved in self-inflicted injuries to the abdomen was the epigastric area, nine cases, and the right-side zone II was the most commonly involved area. On the other hand, in injuries inflicted by others, the left upper quadrant of the abdomen was the most common site of the injury, 14 cases. In the neck, the left-side zone II was the most injured site. In cases of self-inflicted neck injury, jugular vein damage and cervical muscle damage without deep organ injury were observed in two cases each, making them the most common. In cases with abdominal injuries, seven cases had limited abdominal wall injury, making it the most common injury. The most common deep organ injury was small bowel wounds, five cases. In patients with injuries caused by others, six had cervical muscle damage, making it the most common injury found in that area. In the abdomen, small bowel injury was found to be the most common injury, being evidenced in 13 cases. In self-inflicted injuries, a statistical analysis discovered that the total duration of admission and the number of patients admitted to the intensive care unit were significantly shorter and smaller, retrospectively, than in the patient group that had injuries caused by others. No statistically significant difference was found when the injury sequels were compared between the self-inflicted-injury and the injury-inflicted-by-others groups. Conclusion: This study revealed that, in self-inflicted abdominal injuries, injuries limited to the abdominal wall were found to be the most common, and in injuries to the cervical area inflicted by others, injuries restricted to the cervical muscle were found to be the most common. As a whole, the total duration of admission and the ICU admission time were significantly shorter in cases of self-inflicted injury. Especially, in cases of self inflicted injuries, abdominal injuries generally had a limited degree of injury. Thus, in our consideration, accurate injury assessment and an ideal treatment plan are necessary to treat these patients, and minimally invasive equipment, such as laparoscope, should be used. Also, further studies that persistently utilize aggressive surgical observations, such as abdominal ultrasound and computed tomography, for patients with penetrating injuries are needed.

• Archives of Plastic Surgery
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• 제39권6호
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• pp.637-642
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• 2012

Background Fingertip injuries involving subtotal or total loss of the digital pulp are common types of hand injuries and require reconstruction that is able to provide stable padding and sensory recovery. There are various techniques used for reconstruction of fingertip injuries, but the most effective method is functionally and aesthetically controversial. Despite some disadvantages, cross-finger pulp flap is a relatively simple procedure without significant complications or requiring special techniques. Methods This study included 90 patients with fingertip defects who underwent cross-finger pulp flap between September 1998 and March 2010. In 69 cases, neurorrhaphy was performed between the pulp branch from the proper digital nerve and the recipient's sensory nerve for good sensibility of the injured fingertip. In order to evaluate the outcome of our surgical method, we observed two-point discrimination in the early (3 months) and late (12 to 40 months) postoperative periods. Results Most of the cases had cosmetically and functionally acceptable outcomes. The average defect size was $1.7{\times}1.5$ cm. Sensory return began 3 months after flap application. The two-point discrimination was measured at 4.6 mm (range, 3 to 6 mm) in our method and 7.2 mm (range, 4 to 9 mm) in non-innervated cross-finger pulp flaps. Conclusions The innervated cross-finger pulp flap is a safe and reliable procedure for lateral oblique, volar oblique, and transverse fingertip amputations. Our procedure is simple to perform under local anesthesia, and is able to provide both mechanical stability and sensory recovery. We recommend this method for reconstruction of fingertip injuries.

• 한국치위생학회지
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• 제9권3호
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• pp.545-557
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• 2009

Objectives : This study was to investigate the use of mouth-guards and maxillofacial injuries and to examined the relationship among variables in athletes group. Methods : The subjects were 459(86.5%), who were 18 years or older with mean age of 20.7 years. Data was collected using a self administrated questionnaire from May 25 to June 15, 2009. We surveyed maxillofacial injuries(temporo-mandibular disorders contained) and mouth-guards usage and confidence concerning mouth-guards in athletes. The data were analysed with chi-square analysis, fisher's exact test and logistic regression using the SPSS 15.0 windows. Results : Prevalence of body or maxillofacial injuries experiences was 54.5% for athletes and 47.1% for non-athletes groups(p>0.05). The other hand, the incidence temporo-mandibular disorders was 67.0% for athletes and 49.8% for non-athletes groups(p<0.05). The experience of the use of mouth-guards was 83.3% for athletes and 78.8% for non-athletes, there were not significant differences between athletes and non-athletes groups (p>0.05). Risk factors found to be significantly related to the occurrence of maxillofacial injury were: unused mouth-guards(OR=2.83), no rules for use of mouth-guards(OR=2.46). Conclusions : Based on the findings, maxillofacial injuries experience is highly associated with mouth-guards usage, not only athletes also general people should be educated on the use of mouth-guard in order to reduce the incidence of maxillofacial injuries.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.397-403
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• 2012

Background Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. Methods Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. Results Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. Conclusions Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.

• 대한물리치료과학회지
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• 제10권1호
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• pp.222-231
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• 2003

The ACL(Anterior cruciate ligament) is the smallest of the four main ligaments of the knee, but it is the primary stabilizer. Injuries have a tendency to occur when the foot is firmly planted and the knee is twisted. Any sports that requires acceleration, change of direction and deceleration can increase the chances of suffering an ACL tear. The incidence of severe knee sprains that involve the ACL are at an all-time high. Since 1980, the number of these injuries have increased at least three-fold. Although the rate of increase has been much less dramatic since the middle 1980s, even the ultra-modem releasable ski binding has not been able to start reducing the incidence of ACL injuries. An ACL injury prevention program developed for downhill skiers by the Vermont Safety Research group emphasized increasing awareness of situations that can potentially result in an ACL injury and pre-planning strategies if events, leading to these situations, begin to fall in place. As part of the above study by Ettlinger et al., an educational prevent program was developed to teach these principles and thus reduce the rate of serious knee injuries. Four thousand instructors and patrol at 20 ski resorts who received the training had a 62% decline in serious knee injuries compared to a similar group that did not receive this training. Whenever you fall, try not to fully straighten your legs. Don't try to get up until you've stopped sliding(unless you are try to avoid an obstacle or other skier). When you're down, stay down. And don't land on your hand. So, if you feel yourself falling: arms forward, ski plates together, hands over knee. Then you will be able to save your ACL.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.580-586
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• 2007

Purpose: High tension electrical injuries result in major tissue(eg. bones, tendons, vessels and nerves) destruction. Therefore, the management of mutilating wrist caused by electrical injuries still represents a challenge. There are various approaches to this problem including local and regional flaps as well as pedicled distant flaps and microsurgical free tissue transfer. Although it has not gained wide acceptance, because of the technically demanding dissection of the pedicle, posterior interosseous flap is now well accepted for the reconstruction of hand and wrist in hand surgery. The principal advantages of this flap are minimal donor site morbidity, minimal vascular compromise, one stage operation. This flap also offers the advantages of ideal color match and composition. In this report, we describe our experience with the reverse posterior interosseous island flap for reconstruction of mutilating wrist with main vessel injuries. Methods: From October, 2004 to June, 2006, we treated 11 patients with soft tissue defects and main vessel injuries on the wrist that were covered with reverse posterior interosseous island flap. Results: These 11 patients were all male. The ages ranged from 27 to 67 years(mean age 41.75) and the follow-up period varied from 4 to 19 months. Complete healing of the reverse posterior interosseous island flaps were observed in 11 patients(12 flaps). The majority of these flaps showed a certain degree of venous congestion, which in a flap was treated with medical leech. 1 flap has partial necrosis owing to sustained venous congestion, requiring secondary skin graft. flap size varied from $3.5{\times}8cm$ to $10{\times}12cm$(mean size $6.4{\times}8.9m$). The donor site defect was closed directly in 5 flaps, and by skin graft in 7 flaps. Conclusion: We found that the reverse posterior interosseous island flap is reliable and very useful for reconstruction of mutilating wrist and we recommend it as first choice in coverage of soft tissue defects in the wrist with electrical arc injuries.

• 한국직업건강간호학회지
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• 제19권2호
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• pp.205-216
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• 2010

Purpose: The purpose of this study was to explore relationship among pain, body image and satisfaction in hand-injured workers. Methods: Using a sample of 96 out-patient workers with hand injuries, pain, body image and satisfaction were measured by VAS and Modified Jung Keum-hee's Tennesee Self Concept Scale. Repeated measured ANOVA and a Bonferroni correction for multiple statistical testing during post hoc analyses were conducted to evaluate relationship among pain, body image and satisfaction in hand-injured workers. Result: Functional satisfaction(r=.46, p<.001) and appearance satisfaction(r=.55, p<.001) significantly increased by treatment satisfaction. Functional satisfaction(r=.35, p=.001) and appearance satisfaction(r=.31, p=.002) increased by body image. But treatment satisfaction(r=-.20, p=.049), functional satisfaction (r=-.34, p=.001) and appearance satisfaction (r=-.39, p<.001) significantly decreased by pain. Conclusion: Poor pain management was related to bad body image and treatment satisfaction. Therefore, interventions targeting at pain management are needed for hand-injured workers.

• 한국산업보건학회지
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• 제16권1호
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• pp.17-26
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• 2006

In order to obtain basic reference information for the establishment of effective industrial safety programmes in migrant workers who live in Seoul and Kyungin Area, accident causes were investigated among 210 injured workers. The data were analyzed according to the USA Standards Institute and International Labour Organization method. The results obtained were as follows: 1. The major distribution of national were mostly from china(82.9%), ages are mostly between 30 and 40 years old(32%), and males are more than females, and mostly married. 2. The parts of body most frequently injured were hand and finger, foot and toe, which were 55.3% of total 210 cases. 3. According to the accident type, caught in, under or between were most frequently observed, 40.2% of the total number of injuries. 4. The most responsible source of injuries were power machine, others, moving machine and tool, building construction. 5. According to the unsafe acts, carelessness and unsafety information were most frequently observed, 66.7% of the total number of injuries. 6. There were significantly difference(p<0.05), between type of accident and source of injury, and between working period and unsafe act.