Soft Tissue Reconstruction Using Perforator Flap in Patients with Infected Knee Prosthesis

PURPOSE: Soft-tissue reconstruction in the knee area requires thin, pliable, and tough skin. The range of motion of the knee also acts as a limitation in using only local flaps for coverage. The author has successfully used various perforator flaps for soft tissue reconstruction around the knee while preserving its functional and cosmetic characteristics. MATERIALS AND METHODS: Out of the twenty patients assessed from April 2009 to March 2011, seven received anterolateral thigh perforator flaps, four received medial sural perforator island flaps, four received lateral supragenicular perforaor perforator flaps, and five received medial genicular artery flaps. The age of the patients ranged from 44 to 79 and the size of the defects ranged from 4x5 cm to 17x11 cm. Fifteen of the twenty patients had histories of total knee replacement (TKR) surgery. RESULTS: There were no flap losses in any of the twenty patients assessed. Two patients showed partial losses in the distal area of the flap, but were treated through careful wound care. One patient presented with pedicle adhesion at the drainage site from a past TKR, but it did not hinder the flap survival. Primary closure at the donor site was possible in nine patients, while split skin graft was necessary for the other 13. CONCLUSION: In soft tissue reconstruction of the knee, various perforator flaps can be used depending on the condition of the preoperation scar, wound site, and size. It also proved to provide better functional and cosmetic results than in primary wound closure or skin grafts.

Versatility of the Distally-Based Sural Artery Fasciocutaneous Flap on the Lower Leg and Foot in Patients with Chronic Disease

BACKGROUND: A recent advancement in microsurgery, the free flap is widely used in the reconstruction of the lower leg and foot. The simple and effective methods of local flaps, including transposition and advancement flaps, have been considered for patients with chronic debilitation who are unable to endure long surgical procedures or general anesthesia. However, the location and size of the wound may restrict the clinical application of a local flap. Under these circumstances, a sural flap can be an excellent alternative, rendering satisfying clinical outcomes in chronically debilitated patients. METHODS: Between 2008 and 2012, 39 patients underwent soft tissue defect treatment by sural artery flap as a final method. All of the patients had at least one chronic disease or more (diabetes, hypertension, vascular disease, etc.). Also, all of the patients had a history of chronic lower extremity ulceration, which revealed no response to several months of conservative treatment. RESULTS: The results of the 39 cases had a success rate of 100% with 39 complete recoveries. Nine cases suffered complications: partial necrosis (n=4), wound dehiscence without necrosis (n=3), hematoma (n=1), and infection (n=1). CONCLUSIONS: The sural artery flap is not only useful for the lower leg but also for the heel, and other various parts. Furthermore, it is a relatively simple surgical technique for reconstructing the defect area for patients with various chronic conditions with a high surgical risk or contraindications to surgery.

Ischemic Necrosis of the Upper and Lower Extremities after the Use of Norepinephrine

PURPOSE: Norepinephrine is initially used to increase blood pressure in patients with septic shock. It increases blood flow to vital organs but decrease the flow to end-organs resulting in ischemic changes in end-organs. We report five patients with ischemic necrosis of upper and lower extremities after using norepinephrine in septic shock. MATERIALS AND METHODS: We retrospectively reviewed medical record of five patients with ischemic necrosis of upper and lower extremities after treating septic shock from March 2010 to March 2011. RESULTS: Five patients developed ischemic necrosis of upper and lower extremities during intensive care. All patients experienced septic shock due to medical problems, which required norepinephrine to increase blood pressure. After conservative treatment, stump revision or below knee amputation were done. CONCLUSION: We believe that more active treatment and protection of the end-organs will be needed to prevent poor prognosis during the recovery of septic shock.

A Case of Myxoid Liposarcoma of the Cheek

PURPOSE: Liposarcoma is the most common soft tissue sarcoma, and usually occurs on the thigh or in the retroperitoneal space, but rarely in the oral region. This report presents a case of liposarcoma of the cheek and includes a review of the literatures. METHODS: A 21-year-old woman was admitted with a palpable mass in her cheek of about two years duration, which increased in size gradually initially, but had increased rapidly over the three months. There was no particular pain or tenderness. MRI showed a well-enhanced, well-defined mass, which suspected to be hemangioma. RESULTS: The spherical, well-encapsulated mass was surgically excised. Biopsy results revealed myxoid liposarcoma. FDG PET-CT on the seventh postoperative day, revealed a minimal to mild FDG-uptake soft tissue lesion around the mass defect area without evidence of distant metastasis. The patient is being observed and undergoing radiation therapy. CONCLUSION: Liposarcoma in the head and neck region is a rare disease, and can be overlooked as a benign tumor without a pathologic diagnosis. Therefore, proper treatment and follow-up are required based on an understanding of this disease.

Statistical Analysis for Organ Weights in Korean Adult Autopsies / 대한해부학회지

The organ weight is one important indicator to discern normal condition from abnormal in forensic pathology as well as in clinical medicine. This study includes organ weights of Korean population, which can be fundamental sources to be analyzed comparatively with other ethnic groups. Seven organs (heart, lung, liver, kidney, spleen, thyroid gland, and brain), which were harvested from 526 Korean adults (369 males and 157 females) during ordinary postmortem examination, were weighed. All of the organs in males were heavier than those in females. With variables controlled, the organ weights of hearts, spleens, and thyroid glands in males were not different from those in females, and the rest of organs were heavier in males than females. Mean weight of left kidneys was higher than that of right ones (P<0.05). All of the organs but heart became lighter in weight, as one got older. The liver and kidney weights of the middle-aged adults were heavier than those of any other age groups (P<0.05). The weights of all organs except for lungs and cerebrums were more related to body weight than height. These results are considered for useful anatomical data to understand the disease properties in Koreans.

Inadequacies of Death Certification: The Role of Forensic Pathologist / 대한법의학회지

Death certification is a public health surveillance tool and a valuable source of information at the national and local levels. Among activities that benefit from the availability of cause-of-death statistics obtained from death certificates are the monitoring of the health of populations, the setting of priorities and the targeting of intervention. Such statistics are also the keystone of much epidemiological study. So adequate writing cause-of-death statements for death is very important. The present study was undertaken to evaluate death certification in Seoul and Kyung-in area of Korea. The available 203 death certificates were obtained from the 1026 autopsy files of National Institute of Scientific Investigation(june, 2002-september, 2002). The summary of the results were: 1. Cases that writing the phenomenon such as cardiac or respiratory arrest, heart failure in the box of cause-of-death were 64 cases(31.5%). Cases that writing the immediate cause of death in the second or third line of box were 50 cases(24.6%). Cases that writing two or more immediate cause-of-death in one line of box were 36 cases(17.7%). 2. Cases that the statement of cause-of-death not correlated with the statement of manner-of-death were 18 cases(8.4%). 3. Cases that the immediate cause-of-death and manner-of-death is changed after autopsy were 179 cases(88.2%). The results of this study showed inadequacies of death certification in Seoul, Kyung-in area of Korea. We thought the reasons for this inadequacies of death certification were mainly insufficient education and campaign for physicians about accurate understanding of cause of death, manner of death. The forensic pathologists certified a number of deaths and have responsibility for education about cause of death, manner of death. So we emphasized need for forensic pathologists to be involved in works related with death certification forms and policies.