• Archives of Plastic Surgery
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• 제41권4호
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• pp.362-365
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• 2014

Background Many implants are being used for the reconstruction of orbital wall fractures. The effect of the choice of implant for the reconstruction of an orbital wall fracture on the surgical outcome is under debate. The purpose of this article is to compare the outcomes of orbital wall reconstruction of small orbital wall fractures on the basis of the implants used. Methods The authors conducted a retrospective study using electronic databases. Between March 2001 and December 2012, 461 patients with orbital wall fractures were included in this study. Among them, 431 patients in whom the fracture size was less than $300mm^2$ were analyzed. The fracture size was calculated using computed tomography scans of the orbit in the sagittal and coronal images. Cases in which the fracture size was less than $300mm^2$ were included in this study. Results One hundred and twenty-nine patients were treated with silastic sheets; 238 patients were treated with titanium meshes; and absorbable meshes were used in the case of 64 patients. Overall, 13 patients required revision, and the revision rate was 3.0%. The revision rate of the silastic sheet group was 5.4%. In the multivariable analysis, the revision rate of the group reconstructed with silastic sheets was highly statistically significant (P=0.043, odds ratio=3.65). However, other factors such as age, sex, fracture type, and fracture size were not significant. Conclusions Reconstruction of orbital wall fractures with silastic sheets may cause more complications than that with other materials such as titanium meshes and absorbable meshes.

• 대한관절경학회지
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• 제13권2호
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• pp.119-125
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• 2009

회전근 개 재파열에서 재봉합의 일차적 목적은 동통의 완화와 기능의 회복에 있다. 따라서 재봉합을 위한 적응증은 동통이 주된 증상으로 근력 약화를 동반한 기능적 결손이 있는 경우가 가장 적절하다. 회전근 개 재봉합 시 고려해야 할 중요한 요소로는 파열 건의 상태이며 특히 건 결손의 크기, 근 위축, 지방 변성 그리고 건의 퇴축 정도를 충분히 고려하여 재봉합이 가능한 지를 판단하여야 한다. 회전근 개의 재봉합술은 점액낭의 반흔과 건의 퇴축이 존재하고, 재파열된 회전근개가 대범위 이상의 파열이 많기 때문에 재봉합하기가 어려우며, 파열이 보통 오랜 기간 동안 존재하고 근-건의 질이 불량하기 때문에 술기상 어렵고 결과도 비교적 만족스럽지 않다. 이에 저자는 회전근 개 봉합술 후 재수술에 대해 문헌 고찰과 함께 저자의 경험을 논의하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제44권1호
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• pp.19-25
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• 2008

Objective : To analyze the relationship of concomitant foraminallumbar disc herniation (FLDH) with postoperative leg pain after microdecompression for extraforaminallumbar disc herniation (EFLDH) at the L5-S1 level. Methods : Sixty-five patients who underwent microdecompression for symptomatic EFLDH at the L5-S1 level were enrolled, According to the severity of accompanying FLDH, EFLDH was classified into four categories (Class I : no FLDH; Class II : mild to moderate FLDH confined within a lateral foraminal zone; Class III : severe FLDH extending to a medial foraminal zone; Class IV : Class III with intracanalicular disc herniation). The incidence of postoperative leg pain, dysesthesia, analgesic medication, epidural block, and requirement for revision surgery due to leg pain were evaluated and compared at three months after initial surgery. Results : The incidences of postoperative leg pain and dysesthesia were 36.9% and 26.1%, respectively. Pain medication and epidural block was performed on 40% and 41.5%, respectively, Revision surgery was recommended in six patients (9.2%) due to persistent leg pain, The incidences of leg pain, dysesthesia, and requirement for epidural block were higher in Class III/IV, compared with Class I/II. The incidence of requirement for analgesic medication was significantly higher in Class III/IV, compared with Class I/II (p=0,02, odds ratio=9,82). All patients who required revision surgery due to persistent leg pain were included in Class III/IV. Conclusion : Concomitant FLDH seems related to postoperative residual leg pain after microdecompression for EFLDH at the L5-S1 level.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.97-101
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• 2020

Although the success rate of deep inferior epigastric perforator (DIEP) flaps has increased, late flap failures still occur and have a low salvage rate. The present article describes a case of salvage of a case of late flap failure using the pedicle vein as a vein graft source. A 50-yearold woman underwent a bilateral DIEP free flap procedure. On postoperative day 6, she experienced flap compromise and underwent emergency flap revision. In the flap revision, flap venous drainage and the superficial inferior epigastric vein were completely obstructed. A Fogarty catheter was used to remove a thrombus from the completely obstructed pedicle vein, and this pedicle vein was used as a graft source and was ligated in retrograde fashion to the flap vein stump. After injection of urokinase into the arterial branch, venous flow to the flap was restored. At a 6-month follow-up visit in the outpatient clinic, only partial fat necrosis at the flap was noted. By dissecting various perforators in the initial operation, decisions regarding immediate revision can be made with more confidence. Additionally, the combined procedures performed in this case may be helpful even for practitioners treating cases of late flap compromise.

• Hip & pelvis
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• 제35권2호
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• pp.142-146
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• 2023

Stenotrophomonas maltophilia, a well-established opportunistic bacterium, primarily impacts healthcare settings. Infection of the musculoskeletal system with this bacterium is rare. We report on the first known case of hip periprosthetic joint infection (PJI) caused by S. maltophilia. The potential for development of a PJI caused by this pathogen should be considered by orthopaedic surgeons, particularly in patients with multiple severe comorbidities.

• 대한두개안면성형외과학회지
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• 제24권4호
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• pp.159-166
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• 2023

Background: Free tissue transfer is the preferred method of reconstructing head and neck defects, with a success rate of approximately 95%. Although flap failure is uncommon, it has a major impact on patient morbidity and diminishes quality of life, making it is important to investigate the causes of flap failure. Methods: This retrospective chart review analyzed patients who underwent free tissue transfer during head and neck reconstruction at a single institution between 2016 and 2021. Results: During the study period, 58 patients underwent 60 free flap procedures. Revision surgery was needed in 14 patients. Subsequent free flap surgery was performed in one patient, and three free flaps (5%) could not be salvaged. Cardiovascular disease was significantly associated with flap failure, and venous congestion (thrombosis) was the most common reason for revision surgery. Conclusion: Cardiovascular disease clearly emerged as a factor related to the failure of free flap surgery, and this issue warrants particular attention in patients for whom free tissue transfer is planned.

• Asian Spine Journal
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• 제12권6호
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• pp.973-980
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• 2018

Study Design: Retrospective review. Purpose: To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery. Overview of Literature: A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion. Methods: We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were performed using logistic regression analysis, chi-square test, and odds ratio (OR) analysis. Results: Approximately 19% of the patients (495/2,613) received external stimulators following ALIF surgery. There was a slight increase in stimulator use from 2008 to 2014 (multi-level $R^2=0.08$, single-level $R^2=0.05$). Patients who underwent multi-level procedures were more likely to receive stimulators than patients who underwent single-level procedures (p<0.05; OR, 3.72; 95% confidence interval, 3.02-4.57). Grafting options associated with most frequent stimulator use were bone marrow aspirates (BMA) plus autograft or allograft for single-level and allograft alone for multi-level procedures. In both cohorts, patients treated with bone morphogenetic proteins were least likely to receive electrical stimulators (p<0.05). Patients who received stimulation generally had higher reimbursements. Concurrent posterior lumbar fusion (PLF) (ALIF+PLF) increased the likelihood of receiving stimulators (p<0.05). Patients who received electrical stimulators had similar revision rates as those who did not receive stimulation (p>0.05), except those in the multilevel ALIF+PLF cohort, wherein the patients who underwent stimulation had higher rates of revision surgery. Conclusions: Concurrent PLF or multi-level procedures increased patients' likelihood of receiving stimulators, however, the presence of comorbidities did not. Patients who received BMA plus autograft or allograft were more likely to receive stimulation. Patients with and without bone stimulators had similar rates of revision surgery.

• 대한관절경학회지
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• 제7권2호
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• pp.169-175
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• 2003

목적 : 실패한 전방십자인대 재건술후 시행한 전방십자인대 재 재건술의 단기추시 결과를 평가하고자 하였다. 대상 및 방법 : 1997년 8월부터 2002년 2월까지 실패한 전방십자인대 재건술에 대하여 재 재건술을 시술 받았던 18예를 대상으로 하였으며, 재건술후 재 재건술까지의 평균기간은 39$(7\~120)$개월 이었으며, 동종이식건 14예$(78\%)$, 자가이식건 4예$(22\%)$를 관절경을 이용하여 전방십자인대 재 재건술을 시술하였다. 주 증상으로는 불안정성이 16예$(89\%)$로 가장 많았고, 전방십자인대 재건술을 한번 시행받았던 경우가 16예$(89\%)$, 두번 시행받았던 경우가 2예$(11\%)$였다. 술전, 술후 및 추시관찰시 Lachman test, pivot shift test, KT 2000 및 방사선학적으로 전방십자인대의 안정성을 평가하였으며, Lysholm score 및 HSS score를 비교 분석하였고 환자의 주관적 만족도를 조사하였다. 결과 : 평균 추시관찰 기간은 27$(12\~60)$개월이었으며, 술전 Lachman test 및 pivot shift test는 전예에서 양성의 소견을 보였으나 술후 대부분의 예에서 음성으로 나타났으며, KT 2000은 술전 7.75$(3.5\~12.5)$mm에서 술후 최종추시시 2.36$(1.0\~6.0)$mm로 안정되었다. Lysholm score 및 HSS score는 각각 술전 72.6$(66\~77)$점, 72.5$(68\~78)$점에서 술후 최종추시 시 89.2$(80\~92)$점, 88.2$(81\~92)$점으로 향상되었다. 환자의 대부분은 수술결과에 만족$(89\%)$하고 있었다. 전방십자인대 재건술의 실패원인으로는 대퇴터널의 부정위치가 11예$(61\%)$로 가장 많았다. 결론 : 실패한 전방십자인대 재건술의 치료로 적절한 이식건을 이용하여 관절경적 전방십자인대 재 재건술을 시술함으로서 주관적 및 객관적으로 비교적 안정적인 슬관절을 얻을 수 있었으나, 일차 전방십자인대 재건술의 가장 많은 실패의 원인이 수술 수기의 오류임을 감안한다면 정확한 수술 수기로 전방십자인대 재건술을 시술하는 것이 중요할것으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.32-38
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• 2024

Background: Open reduction and internal fixation (ORIF) with a locking plate is a popular surgical treatment for proximal humeral fractures (PHF). This study aimed to assess the occurrence of complications in elderly patients with PHF treated surgically using ORIF with a locking plate and to investigate the potential differences between patients treated by shoulder surgeons and non-shoulder surgeons. Methods: A retrospective study was conducted using a single-center database to identify patients aged ≥70 years who underwent ORIF for PHF between January 1, 2011, and December 31, 2021. Data on the Neer classification, follow-up, occurrence of avascular necrosis of the humeral head, implant failure, and revision surgery were also collected. Statistical analyses were performed to calculate the overall frequency of complications according to the Neer classification. Results: The rates of implant failure, avascular osteonecrosis, and revision surgery were 15.7%, 4.8%, and 15.7%, respectively. Complications were more common in patients with Neer three- and four-part fractures. Although the difference between surgeries performed by shoulder surgeons and non-shoulder surgeons did not reach statistical significance, the rate of complications and the need for revision surgery were nearly two-fold higher in the latter group. Conclusions: PHF are highly prevalent in the elderly population. However, the ORIF surgical approach, as demonstrated in this study, is associated with a considerable rate of complications. Surgeries performed by non-shoulder surgeons had a higher rate of complications and a more frequent need for revision surgery. Future studies comparing surgical treatments and their respective complication rates are crucial to determine the optimal therapeutic options. Level of evidence: III.

• Archives of Plastic Surgery
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• 제42권6호
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• pp.741-745
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• 2015

Background Microvascular complications after free-flap breast reconstructions are potentially devastating problems that can increase patient morbidity and lead to flap loss. To date, no comprehensive study has examined the rates of salvage and the methods of microvascular revision in breast reconstruction. We reviewed the treatment of microvascular complications of free-flap breast reconstruction procedures over a seven-year period. Methods A retrospective review of all patients who underwent microvascular breast reconstruction at our institution between April 2006 and December 2013 was conducted. Based on their surgical records, all patients who required emergency re-exploration were identified, the rate of flap salvage was determined, the factors associated with flap salvage were evaluated, and the causes and methods of revision were reviewed. Results During the review period, 605 breast reconstruction procedures with a free lower abdominal flap were performed. Seventeen of these flaps were compromised by microvascular complications, and three flaps were lost. The overall salvage rate was 82.35%. No significant differences between the salvaged group and the failed group were observed with regard to age, BMI, axillary dissection, number of anastomotic arteries and veins, recipient vessel types, or use of the superficial inferior epigastric vein in the revision operation. Successful salvage of the flap was associated with a shorter time period between recognizing the signs of flap compromise and the take-back operation. Conclusions The salvage rate of compromised lower abdominal flaps was high enough to warrant attempting re-exploration. Immediate intervention after the onset of flap compromise signs is as important as vigilant postoperative monitoring.