Normative Measurements of Grip and Pinch Strengths of 21st Century Korean Population

BACKGROUND: Measuring grip and pinch strength is an important part of hand injury evaluation. Currently, there are no standardized values of normal grip and pinch strength among the Korean population, and lack of such data prevents objective evaluation of post-surgical recovery in strength. This study was designed to establish the normal values of grip and pinch strength among the healthy Korean population and to identify any dependent variables affecting grip and pinch strength. METHODS: A cross-sectional study was carried out. The inclusion criterion was being a healthy Korean person without a previous history of hand trauma. The grip strength was measured using a Jamar dynamometer. Pulp and key pinch strength were measured with a hydraulic pinch gauge. Intra-individual and inter-individual variations in these variables were analyzed in a standardized statistical manner. RESULTS: There were a total of 336 healthy participants between 13 and 77 years of age. As would be expected in any given population, the mean grip and pinch strength was greater in the right hand than the left. Male participants (137) showed mean strengths greater than female participants (199) when adjusted for age. Among the male participants, anthropometric variables correlated positively with grip strength, but no such correlations were identifiable in female participants in a statistically significant way. CONCLUSIONS: Objective measurements of hand strength are an important component of hand injury evaluation, and population-specific normative data are essential for clinical and research purposes. This study reports updated normative hand strengths of the South Korean population in the 21st century.

Thermal Burn in Patients with Replanted Fingers or Reconstructed Ones with Free Flap

PURPOSE: In order to rehabilitate patients with replanted fingers or reconstructed ones with free flap, the warm therapy is cost-effective, clean, and easy to use. However, the risk of thermal burn in patients with replanted fingers or reconstructed ones with free flap is not clearly identified yet and only few clinical prognosis exist. For that reason, this study was designed to evaluate the incidence, characteristics and risk factors of thermal burn in patients with replanted fingers or reconstructed ones with free flap. METHODS: We reviewed all the medical records of patients retrospectively, especially who showed clinically important thermal burn of replanted fingers or reconstructed ones with free flap from February 2010 to March 2011. RESULTS: 10 patients out of 370 with successfully replanted fingers or reconstructed ones with free flap presented clinically important thermal burn. (2.70% incidence). The causes of thermal burn were warm therapy (4 cases) and touching hot bowls such as a coffee cup, hot pot or hot grill (6 cases). Among them, 7 patients suffered superficial 2nd degree burn with bullae, 1 patient deep 2nd degree burn, 1 patient 4th degree burn and another 1, 1st degree burn with mild erythema. All of them except two cases were treated with conventional dressing with antibiotic ointment, while one was treated by skin graft and another one by 2nd toe pulp free flap. On the other hand, there were only 3 thermal burn cases among 7,010 patients who had undergone the hand surgeries other than replantation and free flap (0.04% incidence). And 2 were by warm therapy and 1 by hot pot. All of them were superficial 2nd degree burn with bullae and treated with conventional dressing with antibiotic ointment for about 1 week. CONCLUSION: These results suggest that patients with replanted fingers or reconstructed ones with free flap are more likely to have thermal burn than any other. Therefore we should be aware of the possibility of thermal burn for these patients, paying more attention to prevent it during the warm therapy and letting them always keep an appropriate distance from anything that can cause thermal burn.

Lipoabdominoplasty: A Comparative Study of Combined Operation Versus Lipoabdominoplasty Only

Abdominoplasty may be applied to achieve aesthetic outcome and it also can be combined with other surgeries. In addition, liposuction has been offered to patients to improve contour. Liposuction combined with abdominoplasty gives us the advantage of higher patient satisfaction, better aesthetic outcome, and one-staged surgery. The authors performed a retrospective study to evaluate the outcomes. A total of 6 patients who underwent lipoabdominoplasty were included. The patients were all female and the mean age of the patients was 50.5 years old(age range, 32 to 58 years). This study surveyed lipoabdominoplasty based on the purpose of operation, type of suture, and application of quilting suture. Complication rates, patient satisfaction, and postoperative contour of the abdomen were questioned. A mild abdominal complication occurred in one patient, flap bullae, but this was healed within a week and overall flap survival was excellent with good satisfactory outcome. It appears that complication rates of simple lipoabdominoplasty group is low(1/6), and only minor complication occurs. Preservation of perforators during liposuction accounts for improved flap survival. In addition, abdominoplasty may be combined with other abdominal surgeries since other abdominal surgeries usually involve the lower abdomen, which will eventually be cut away curing the abdominoplasty stage.

Reconstruction of the Bone Exposed Soft Tissue Defects in Lower Extremities using Artificial Dermis(AlloDerm(R))

PURPOSE: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to succeed, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one-stage operation on bone exposed soft tissue defect with AlloDerm(R)(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. METHODS: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm(R)(25/1000 inches, meshed type) was applicated on wound, and thin split thickness(6-8/1000 inches) skin graft was done at the immediately same operative time. RESULTS: Average age of patients was 53.6 years(25 years-80 years, SD=16.8), and 13 patients were male (male:female=13:1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site(tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm(R) took without additional surgery in 12 of 14 patients. Partial graft loss was shown in four cases. Two cases were small in size under 1x1cm, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm(R) was enough. Average duration of admission period of patients without additional surgery was 15 days(13-19 days). CONCLUSION: AlloDerm(R) and thin split thickness skin graft give us an advantage of short surgery time and less limitations in donor site than flap surgery. Postoperative scar is smaller compared to in conventional skin graft because of firmer restoration of dermal structure with AlloDerm(R). We propose that AlloDerm(R) and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

Acceleration of Integra Incorporation in Reconstruction of Burn Scar Contracture with the Vacuum-Assisted Closure(VAC)

PURPOSE: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study is to evaluate usefulness of the VAC(Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra(R) in reconstruction of burn scar contracture. METHODS: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The patient's ages ranged from 5 to 27 with an average of 19.7 years. The surface area ranged from 24 to 1,600cm2 with an average of 785cm2. The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra(R) was sutured in place with skin staple and Steri-strip(R). Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra(R). Negative-Pressure ranging from 100 to 125mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP-site(R). The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra(R) deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006-0.008 inches) was performed after silicone sheet removal. RESULT: The mean time for clinically assessed incorporation of Integra(R) was 10.00 days(range 9-12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra(R) had successful incorporation in tissue without serious complications. CONCLUSION: Integra(R) in combination with Vacuum- Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.