• The Journal of the Korean bone and joint tumor society
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• v.14 no.1
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• pp.10-16
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• 2008

With the advent of effective chemotherapy and the realization of high economic cost associated with amputation, limb salvage surgery has become the standard of treatment in children with primary malignant bone tumors. Reconstruction after resection of malignant bone tumors of children has to address the leg length inequality and also has to be durable to cope with high functional demands of young patients. Expandable endoprostheses have been used in children for achieving limb length equality with substantial risk of complications. Recently, significant advances in prosthetic designs have reduced the morbidities associated with these prostheses. The purpose of this study was to review the indications, characteristics, complications and recent developments of expandable endoprostheses used for malignant bone tumors in children.

• Archives of Plastic Surgery
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• v.48 no.4
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• pp.395-403
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• 2021

Background Groin wounds occurring after vascular surgical site infection, oncologic resection, or occasionally orthopedic surgery and trauma may represent a surgical challenge. Reconstruction of these defects by the usual workhorse flaps may be contraindicated following previous surgery and in patients with lower limb lymphedema or extreme morbidity. Methods This study included 15 consecutive patients presenting with inguinal wounds after vascular or general surgery that required debridement and soft tissue coverage. All cases had absolute or relative contraindications to conventional reconstructive techniques, including a compromised deep femoral artery network, limb lymphedema, scarring of potential flap harvesting sites, or poor overall condition. Abdominal adipocutaneous excess enabled the performance of adipocutaneous advancement flaps in an abdominoplasty-like fashion. Immediate and long-term outcomes were analyzed. Results Soft tissue coverage was effective in all cases. Two patients required re-intervention due to flap-related complications (venous congestion and partial flap necrosis). All patients fully recovered over a mean±standard deviation follow-up of 2.4±1.5 years. Conclusions Abdominal flaps can be an effective and simple alternative technique for inguinal coverage with reproducible outcomes. In our experience, the main indications are a compromised deep femoral artery network and poor thigh tissue quality. Relative contraindications, such as previous open abdominal surgery, should be considered.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.244-252
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• 2020

Purpose: Total femoral replacement (TFR) is an extreme form of limb salvage. Considering the rarity of this procedure, reports have focused on the complications and a proper indication is unclear. This study analyzed 36 patients with TFR who were asked the following: 1) prognostic factors related to survival in patients who underwent TFR with a tumoral cause; 2) overall implant and limb survival; 3) complications, functional outcome, and limb status for patients surviving for more than 3 years. Materials and Methods: According to the causes for TFR, 36 patients were categorized into three groups: extensive primary tumoral involvement (group 1, 15 cases), tumoral contamination by an inadvertent procedure or local recurrence (group 2, 16 cases), and salvage of a failed reconstruction (group 3, 5 cases). The factors that may affect the survival of patients included age, sex, cause of TFR, and tumor volume change after chemotherapy. Results: The overall five-year survival of the 36 patients was 31.5%±16.2%. The five-year survival of 31 patients with tumoral causes was 21.1%±15.6%. The five-year survival of 50.0%±31.0% in patients with a decreased tumor volume after chemotherapy was higher than that of increased tumor volume (p=0.02). The five-year survival of 12 cases with a wide margin was 41.7%±27.9%, whereas that of the marginal margin was 0.0%±0.0% (p=0.03). The ten-year overall implant survival of 36 patients was 85.9%±14.1%. The five-year revision-free survival was 16.6%±18.2%. At the final follow-up, 12 maintained tumor prosthesis, three underwent amputation (rotationplasty, 2; above knee amputation, 1), and the remaining one had knee fusion. Among 16 patients with a follow-up of more than three years, 14 patients underwent surgical intervention and two patients had conservative management. Complications included infection in 10 cases, local recurrences in two cases, and one case each of hip dislocation, bushing fracture, and femoral artery occlusion. Conclusion: Patients showing an increased tumor volume after chemotherapy and having an inadequate surgical margin showed a high chance of early death. In the long-term follow-up, TFR showed a high infection rate and the functional outcome was unsatisfactory. Nevertheless, this procedure is an inevitable option of limb preservation in selected patients.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.787-792
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• 2004

Even though there well developments in various treatment techniques for acute limb ischemia, this disease is both life threatening and limb threatening. We investigated early and mid-term results of operation for acute limb ischemia with symptoms, the combined diseases, location of occlusion, complication in our patients. Material and Method: A retrospective review was conducted in 54 patients (43 men, 11 women, mean age 67.2 years) presenting with acute limb ischemia due to arterial thrombosis or embolism between Jan. 1996 and Dec. 2003, initially underwent thromboembolectomy. Result: In 33 patients (61.1%) the timeinterval from the onset of symptom to admission was within 24 hours. Causes of acute limb ischemia were embolic occlusion (27.8%), native arterial thrombosis (66.7%), and bypass graft thrombosis (5.6%). The distribution of arterial occlusion location was at 8 aortoiliac (14.8%) and 43 distal to femoral (79.6%) and brachial (5.6%). Clinical categories were grade I in 64.8%, IIa in 24.1%, IIb in 7.4%, and III in 3.7%, All the patients were received embolectomy. Underlying diseases were heart disease (72.2%), hypertension (33.3%), cerebrovascular accident (16.7%) and diabetes (18.5%). History of smoking was noted in 96,3% of the cases. Mortality rate was 5.6％ and overall amputation rate was 9.3% (5/54). The 1-year limb salvage rate was 93.62%. Postoperative complications were 1 wound infection, 1 G1 bleeding, 3 acute renal failure, and 1 compartment syndromes. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 68.5%, +2 in 9.3%, +1 in 7.4%, -1 in 5.6%, -2 in 3.7%, and -3 in 5.6%. Conclusion: This study revealed 5.6% mortality and the amputation rate was 9.3%. We have retrospectively shown good results from early diagnosis & early operation. To improve outcome, early diagnosis and understand the underlying diseases, prompt treatment and operation would be appreciated.

• Biomolecules & Therapeutics
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• v.28 no.3
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• pp.240-249
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• 2020

Despite the therapeutic effect of mesenchymal stem cells (MSCs) in ischemic diseases, pathophysiological conditions, including hypoxia, limited nutrient availability, and oxidative stress restrict their potential. To address this issue, we investigated the effect of melatonin on the bioactivities of MSCs. Treatment of MSCs with melatonin increased the expression of peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α). Melatonin treatment enhanced mitochondrial oxidative phosphorylation in MSCs in a PGC-1α-dependent manner. Melatonin-mediated PGC-1α expression enhanced the proliferative potential of MSCs through regulation of cell cycle-associated protein activity. In addition, melatonin promoted the angiogenic ability of MSCs, including migration and invasion abilities and secretion of angiogenic cytokines by increasing PGC-1α expression. In a murine hindlimb ischemia model, the survival of transplanted melatonin-treated MSCs was significantly increased in the ischemic tissues, resulting in improvement of functional recovery, such as blood perfusion, limb salvage, neovascularization, and protection against necrosis and fibrosis. These findings indicate that the therapeutic effect of melatonin-treated MSCs in ischemic diseases is mediated via regulation of PGC-1α level. This study suggests that melatonin-induced PGC-1α might serve as a novel target for MSC-based therapy of ischemic diseases, and melatonin-treated MSCs could be used as an effective cell-based therapeutic option for patients with ischemic diseases.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.222-222
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• 2009

Primary malignant bone tumors of the scapula are very rare, and little literature is available regarding their characteristics and outcome. We studied the clinical characteristics, and outcome of patients with primary malignant bone tumors of the scapula. From 1979 to 2008, we treated 7 patients at our institute (4 men and 3 women; chondrosarcoma 3, Ewing's sarcomas 3, Osteosarcoma 1). The mean age was 45 years (range, 5~65 years). The follow-up period was 2 - 180 months. Six patients were performed operations: total scapulectomy 3, partial scapulectomy 1, forequarter resection 1, total resection of the shoulder girdle (Tikhoff-Linberg procedure) 1. No-operative treatment was chosen for one patient with a limited life expectancy. Local recurrence occurred in one patient. Distant metastasis occurred in 3 patients. Of the 7 patients, 4 patients are died because of propagation of the disease. Three patients were alive and apparently disease-free, and these patients were evaluated for functional results with the functional evaluation system of the International Society of Limb Salvage (ISOLAS). Functional result of partial scapulectomy was excellent, however, the function after total scapulectomy or Tikhoff-Linberg procedure is severely impaired. Our study indicates reconstruction procedure needs to be reconsidered following total scapulectomy or Tikhoff-Linberg procedure.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.31-38
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• 2006

The effect of melatonin on morphological changes after ischemia-reperfusion injury was investigated in rat skeletal muscle. Dimethyl-sulfoxide(DMSO) was also tested for comparison. Muscle injury was evaluated in 4 groups as a single laparotomy group(control), ischemia-reperfusion group, DMSO group, melatonin group. Left hind limb ischemia was induced for 4 hours by vascular clamping of the common femoral artery and followed by 24 hours of reperfusion. The midportion of gastrocnemius muscle was taken for histological evaluation. In light microscopic study, ischemia-reperfusion group showed severe neutrophil infiltration, interstitial edema, and partial loss or degeneration of muscle fibers. The muscle tissue of melatonin group showed relatively normal architecture with mild inflammatory cell infiltration. In electron microscopic study, dilated cisternae of sarcoplasmic reticulum, dilated mitochondria with electron loose matrix and dilated cristae, disordered or loss of myofilament, indistinct A-band and I-band, intracytoplasmic vacuoles, and markedly decreased glycogen granules were observed in ischemia-reperfusion group. But relatively well maintained A-band, I-band, Z-line, M-line, and mildly dilated mitochondria with well preserved cristae were observed in melatonin group. The DMSO group showed intermediately attenuated ultrastructural changes. The results show that melatonin improves morphologically ischemia-reperfusion injury more effectively than DMSO. In conclusion, melatonin seems to be a promising agent that can salvage the skeletal muscle from severe ischemia-reperfusion injury.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.417-421
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• 2012

We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time.

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.231-236
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• 2021

Mucormycosis is an invasive, rapidly progressive, life-threatening fungal infection, with a propensity for diabetic, immunosuppressed, and trauma patients. The classic rhinocerebral variation is most common in diabetic patients. While the cutaneous form is usually caused by direct inoculation in immunocompetent patients. Cutaneous mucormycosis manifests in soft tissue and risks involvement of underlying structures. Tibial osteomyelitis can also occur secondary to cutaneous mucormycosis but is rare. Limb salvage is typically successful after lower extremity cutaneous mucormycosis even when the bone is involved. Herein, we report two cases of lower extremity cutaneous mucormycosis in diabetic patients that presented as acute worsening of chronic pretibial ulcers. Despite aggressive antifungal therapy and surgical debridement, both ultimately required amputation. Such aggressive presentation has not been reported in the absence of major penetrating trauma, recent surgery, or burns.

• Archives of Plastic Surgery
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• v.49 no.6
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• pp.782-784
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• 2022

Diabetic foot ulcers are a severe complication of diabetes, and their management requires a multidisciplinary approach for optimal management. When treating these ulcers, limb salvage remains the ultimate goal. In this article, we present the "hanging" free flap for the reconstruction of chronic lower extremity diabetic ulcers. This two-staged approach involves standard free flap harvest and inset; however, following inset the "hanging" pedicle is covered within a skin graft instead of making extraneous incisions within the undisturbed soft tissues or tunnels that can compress the vessels. After incorporation, a second-stage surgery is performed in 4 to 6 weeks which entails pedicle division, flap inset revision, and end-to-end reconstruction of the recipient vessel. Besides decreasing the number of incisions on diabetic patients, our novel technique utilizing the "hanging" pedicle simplifies flap monitoring and inset and allows reconstruction of recipient vessels to reestablish distal blood flow.