• Journal of Trauma and Injury
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• 제34권1호
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• pp.75-78
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• 2021

A Morel-Lavallée lesion is a post-traumatic closed degloving soft tissue injury after blunt trauma. Infection and skin necrosis frequently occur if it is not treated properly in the early stages. However, there is no clearly established treatment algorithm. In the acute stage, it is mainly treated with aspiration, simple compression, and incisional drainage. In the chronic stage, sclerotherapy is usually performed. If skin necrosis develops, the necrotic tissue is resected and a skin graft is needed. We describe a case of acute Morel-Lavallée lesion in the buttock region that was treated with limited incisional drainage and negative-pressure wound therapy, and also present a review of the literature.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.605-610
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• 2009

Purpose: Substantial tissue necrosis after snake bites requiring coverage with flap surgery is extremely rare. In this article, we report 7 cases of soft tissue defects in the upper and the lower extremities caused by snake bites, which needed to be covered with flaps. Among the vast mass of publications on snake bites there has been no report that focuses on flap coverage of soft tissue defects due to snake bite sequelae. Methods: Seven cases of soft tissue defects with tendon, ligament, or bone exposure after snake bites were included. All patients were males without comorbidities, the average age was 35 years. All of them required coverage with a flap. In 6 cases, the defect was localized on the upper extremity, in one case the lesion was on the lower extremity. Local flaps were used in 6 cases, one case was covered with a free flap. The surgical procedures included one kite flap, one cross finger flap and digital nerve reconstruction with a sural nerve graft, one reverse proximal phalanx island flap, one groin flap, one adipofascial flap, one neurovascular island flap, and one anterolateral thigh free flap. The average interval from injury to flap surgery was 23.7 days. Results: All flaps survived without complication. All patients regained a good range of motion in the affected extremity. Donor site morbidities were not observed. The case with digital nerve reconstruction recovered a static two point discrimination of 7 mm. The patient with foot reconstruction can wear normal shoes without a debulking procedure. Conclusion: The majority of soft tissue affection after snake bites can be treated conservatively. Some severe cases, however, may require the coverage with flap surgery after radical debridement, especially, if there is exposure of tendon, bone or neurovascular structures. There is no doubt that definite coverage should be performed as soon as possible. But we also want to point out that this principle must not lead to a premature coverage. If the surgeon is not certain that the wound is free of necrotic tissue or remnants of venom, it is better to take enough time to get a proper wound before flap surgery in order to obtain a good functional and cosmetic result.

• Archives of Plastic Surgery
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• 제39권2호
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• pp.130-136
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• 2012

Background : Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner. Methods : A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study. Results : We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from $4{\times}9cm$ ($36cm^2$) to $15{\times}30cm$ ($450cm^2$) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was $102^{\circ}$ (range, $45^{\circ}$ to $140^{\circ}$). Conclusions : In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권5호
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• pp.273-277
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• 2015

Angiosarcoma is a rare and aggressive malignant tumor that has a poor prognosis. It represents less than 1% of all malignancies occurring in the oral cavity and salivary glands. We present a 35-year-old male with angiosarcoma of the cheek following traumatic injury and a review of the current literature.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권3호
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• pp.174-177
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• 2022

Facial degloving injuries are due to separation between the skin and subcutaneous tissues from the underlying muscles, bones, and fascia. These injuries often create a reconstructive challenge for surgeons especially when there are associated complications like wound infection or necrosis of the avulsed flap. This case report presents management of a case of facial degloving injury with full thickness necrosis of the avulsed flap. The authors concluded that treatment of such complex wounds requires a multi-disciplinary approach along with proper planning and staging of the surgical procedures for optimum aesthetic and functional outcomes.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.21-28
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• 2010

Purpose: To report the clinical results of the use of arterialized venous free flaps in reconstruction in soft tissue defects of the finger and to extend indications for the use of such flaps based on the clinical experiences of the authors. Materials and Methods: Eighteen patients who underwent arterialized venous free flaps for finger reconstruction, between May 2007 and July 2009 were reviewed retrospectively. The mean flap size was 4.7${\times}3.2$ cm. The donor site was the ipsilateral volar aspect of the distal forearm in all cases. There were 8 cases of venous skin flaps, 5 cases of neurocutaneous flaps, 4 cases of tendocutaneous flaps, 1 case of innervated tendocutaneous flap. The vascuality of recipient beds was good except in 4 cases (partial devascuality in 2, more than 50% avascuality (bone cement) in 2). Results: All flaps were survived. The mean number of included veins was 2.27 per flap. Mean static two-point discrimination was 10.5 mm in neurocutaneous flaps. In 3 of 5 cases where tendocutaneous flaps were used, active ROM at the PIP joint was 60 degrees, 30 degrees at the DIP joint and 40 degrees at the IP joint of thumb. There were no specific complications except partial necrosis in 3 cases. Conclusions: An arterialized venous free flap is a useful procedure for single-stage reconstruction in soft tissue or combined defect of the finger; we consider that this technique could be applied to fingers despite avascular recipient beds if the periphery of recipient bed vascularity is good.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.165-174
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• 1998

Large soft tissue defect of the ankle and foot can present a difficult reconstructive problem to the surgeon. Local musculocutaneous, local fasciocutaneous or free flap is usually the first choice for providing soft tissue coverage. However, in certain situations, local flaps from the same leg and free flap may not be suitable. These include extensive soft tissue injury, where no suitable recipient vessels can be found, previous local fasciocutaneous flap or free flap failure. In such cases, we have utilized the septocutaneous(fasciocutaneous) branch flap of posterior tibial artery from the opposite healthy limb. We present 5 cases of cross leg flaps, which have been modernized with current understanding of vascular anatomy and current fixation technology. All cross leg flaps were based on the axial blood supply of the fasciocutanous branch of the posterior tibial artery. Cross-clamping with bowel clamp was used to create intermittent periods of ischemia. Adjacent lower extremity joints were exercised during the periods of attachment. The results have been quite encouraging. We conclude that the cross leg flap using septocutaneous flap and cast immobilization can be successfully and expeditiously used to cover defects of the ante and foot.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.128-136
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• 1996

Radial nerve injury is caused by variety of etiologies, mainly traumatic. It is primarily a motor nerve and loss of it's function leads to a significant disability. Surgical treatments of radial nerve comprise of neurolysis(internal or external), neurorrhaphy(eineural, perineural or epi-perineural), nerve graft and tendon transfer. However, there is still controversies in treatment methods and time of operation. Authors experienced 23 cases of radial nerve injuries who were treated by operative methods and followed up over 1 year's duration. The male to female ratio was 18 to 5 and mean age was 30.7 years old. The causes were 13 cases in fractures, 5 cases in crushing injury, 3 cases in laceration, 1 case in CO poisoning and 1 case in unknown cause. The summary of the study were as follows ; 1. Excellent or good results were obtained in overall 16 cases among 23 cases; 5 of 9 cases in neurolysis, 3 of 3 cases in neurorrhaphy, 2 of 3 cases in nerve graft and 6 of 8 cases in tendon transfer. 2. In cases of neurorrhaphy and nerve graft, primary or delayed repair showed excellent or good results and neurolysis performed before 6 months leads to better results. But there was no correlations between the time of injury and operation in tendon transfer. 3. The radial nerve injury associated with extensive soft tissue defect or any conditions that leads to nerve ischemia results poor prognosis. 4. The patients aged under 40 years showed better prognosis in clinical results according to the age of surgical treatment. 5. If the surgeon decide the method and the time of operation through the exact evaluation of the factors which influencing the end result such as age of the patient, level and type of injury, extent of nerve lesion and the associated tissue injury, good result could be expected.

• 한국치위생학회지
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• 제13권5호
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• pp.819-826
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• 2013

Objectives : The purpose of this study was to analyze the types of dental emergencies. This study was carried out for dental trauma patients visiting the emergency room in H hospital from 2005 to 2006. Methods : Subjects were 252 patients. Demographic characteristics consisted of age, gender, dentition, and dental related injury. Results : Male patients had 1.65 times higher tooth injury than female. Teenagers had higher prevalence of tooth injury. Main cause of dental injury was falling down. Young children accounted for 41.7% of the injuries. Late evening was the highest outbreak time of injury. The most commonly affected teeth were central incisor and lateral incisor. The damage of oral soft tissue was more common than the that of alveolar bone. Main area of primary tooth loss was gingiva(10.7%), tongue or soft palate(7.5%), and frenulum(6.0%). Subluxation(28.6%) and luxation(28.6%) were main cause for the primary teeth. Tooth fracture(50.0%) were the most common injury. Conclusions : Thus, to understand the incidence, causes and patterns of dental trauma is to help preserving natural teeth. The results of this study could provide the clinical guidelines on the treatment of dental emergency patients.

• 한국콘텐츠학회논문지
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• 제6권5호
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• pp.145-152
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• 2006

전산화단층촬영에서 자동주입기에 의한 방사선 조영제의 혈관외유출(140mL)이 우측 손등의 IV 카테터 부위에서 발생하였다. 혈관외유출은 부종 및 괴사를 동반하였고, 구획증후군으로 발전하였다. 혈관외유출 부위를 MDCT로 스캔하여, 3D 재구성 영상인 MPR, MIP, volume rendering으로 재구성하였다. 이러한 3D 재구성 영상은 조영제의 혈관외유출 부위를 침범 정도를 정확하게 확인하여 환자 예방의 필요성 및 사후 조치에 적절한 치료 및 수술 계획에 유용하게 이용될 수 있다.