The Optimal Surgical Approach and Complications in Resecting Osteochondroma around the Lesser Trochanter / 대한정형외과학회잡지

PURPOSE: Surgical risks associated with the resection of osteochondroma around the proximal tibia and fibula, as well as the proximal humerus have been well established; however, the clinical presentation and optimal surgical approach for osteochondroma around the lesser trochanter have not been fully addressed. MATERIALS AND METHODS: Thirteen patients with osteochondroma around the lesser trochanter underwent resection. We described the chief complaint, duration of symptom, location of the tumor, mass protrusion pattern on axial computed tomography image, tumor volume, surgical approach, iliopsoas tendon integrity after resection, and complication according to the each surgical approach. RESULTS: Pain on walking or exercise was the chief complaint in 7 patients, and numbness and radiating pain in 6 patients. The average duration of symptom was 19 months (2–72 months). The surgical approach for 5 tumors that protruded postero-laterally was postero-lateral (n=3), anterior (n=1), and medial (n=1). All 4 patients with antero-medially protruding tumor underwent the anterior approach. Two patients with both antero-medially and postero-laterally protruding tumor received the medial and anterior approach, respectively. Two patients who underwent medial approach for postero-laterally protruded tumor showed extensive cortical defect after resection. One patient who received the anterior approach to resect a large postero-laterally protruded tumor developed complete sciatic nerve palsy, which was recovered 6 months after re-exploration. CONCLUSION: For large osteochondromas with posterior protrusion, we should not underestimate the probability of sciatic nerve compression. When regarding the optimal surgical approach, the medial one is best suitable for small tumors, while the anterior approach is good for antero-medial or femur neck tumor. For postero-laterally protruded large tumors, posterior approach may minimize the risk of sciatic nerve palsy.

Regional Analysis of Soft Tissue Thickness on Korean Buttocks and Application to Fasciocutaneous Flap Design

BACKGROUND: Various shapes and designs of the gluteal artery perforator flap have been used for treating sacral pressure sores and reconstructing breasts. To establish the ideal fasciocutaneous flap design for use in the gluteal area, the soft tissue thickness distribution was measured. METHODS: Twenty-one buttocks of adult Korean cadavers were analyzed through rectangular subfascial dissection. Each buttock was divided horizontally into 10 sections and vertically into 10 sections, and then, the thickness at the corners of the sections was measured. For the sake of comparison and statistical verification with living bodies, computed tomography (CT) images of 120 buttocks of patients were randomly selected. Five horizontal sections and 4 vertical sections were made, and the thickness at each corner was recorded. RESULTS: According to the dissection and the CT images, the area with the thinnest soft tissues in the buttock was around the posterior superior iliac spine, close to the sacral area. The thickest area was the superolateral area of the buttock, which was 3.24 times and 2.15 times thicker than the thinnest area in the studies on cadaver anatomy and the CT images, respectively. CONCLUSIONS: The thickness of the soft tissues in the buttocks differed by area. The superolateral area had the thickest soft tissues, and the superomedial area had the thinnest. This study includes information on the distribution of the thickness of the gluteal soft tissues of Koreans. The outcome of this study may contribute to the design of effective local flaps for pressure sore reconstruction and free flaps for breast reconstruction.

The Effect of a Topical Selective Cyclooxygenase-2 Inhibitor on Skin-Wound Scarring of the Rabbit Ear

PURPOSE: The inflammatory phase is considered an integral part of adult wound healing, but fetal wound healing studies have shown scarless healing results in the absence of the inflammation process. The COX-2 pathway is an essential component of inflammation. The purpose of this study is to identify the effect of a topical selective COX-2 inhibitor on inflammation in rabbit skin wound healing and scarring. METHODS: Full-thickness wounds were made on 6 New Zealand rabbits' ears. Topical 5% celecoxib + vehicle (experimental tissue) and vehicle only (controlled tissue) were applied daily for 14d on each side of the ears. Scar samples were harvested at 2 wks, 4 wks, and 8 wks after the wounding. Each sample was stained with hematoxylin and eosin and the Masson's trichrome stain to evaluate inflammation and scar formation. RESULTS: Histological analysis demonstrated a significant reduction of inflammation, neovascularization, and scar elevation in the experimental tissue as compared to the control. Additionally, experimental tissue exhibited faster improvement of collagen organization similar to that of normal tissue. CONCLUSION: This study suggests that the topical application of a selective COX-2 inhibitor on a rabbit ear wound resulted in decreased inflammation and had a positive effect on the reduction of scar formation.

The Surgical Results of Balloon Catheter Dacryocystoplasty in Both Children and Adults

PURPOSE: The purpose of this study was to evaluate the surgical results of balloon catheter dacryocystoplasty (DCP) for congenital nasolacrimal duct (NLD) obstruction in children and partial NLD obstruction in adults. METHODS: The authors performed balloon catheter DCP as a secondary treatment of eight children (nine lacrimal systems) over 12 months of age who had been failed by probing, and as a primary treatment of five adults (five lacrimal systems) whose lacrimal system was partially obstructed. In children, Lacricath was inflated at the level of the valve of Hasner and 5 mm proximal to that level, three times with eight atm (bars) for 90 seconds at each level. In adults, the procedure was the same for children, but if there is any doubt of common canalicular stenosis, inflation at that level was included. RESULTS: Seven of eight children (eight of nine lacrimal systems) and three of five adults (three of five lacrimal systems) showed objective and subjective improvement at the mean follow-up period of 5.3 months and 5.0 months, respectively. CONCLUSIONS: Balloon catheter DCP was thought to be an alternative to silicone tube intubation in children with NLD obstruction who had been failed by probing and also a useful primary treatment in adults with partial NLD obstruction in the office setting.

Clinical Types of Glaucoma and Comparison Between Diffuse and Focal Nerve Fiber Layer Defects

PURPOSE: To evaluate and compare the characteristics of patients whose nerve fiber layer (NFL) photographs showing diffuse or focal nerve fiber layer defects. METHODS: Patients with diffuse NFL defect were selected by comparing upper and lower half of a NFL photo, and we included the patients only when one part of it showed NFL defect. Patients with focal NFL defect were selected only when one eye had a wedge-shape NFL defect. RESULTS: There were no significant differences between the two groups in visual field index, nor in the results of glaucoma hemifield test. However, patients with diffuse NFL defect (13 eyes, 13 patients) mostly had primary open-angle glaucoma (POAG) (62%), and patients with focal NFL defect (13 eyes, 13 patients) mostly had normal- tension glaucoma (NTG) (62%) (p=0.048, chi-square test). CONCLUSIONS: We found significant differences in the diagnosis of glaucoma between the diffuse and focal NFL loss groups. Our results suggest that the characteristics of NFL loss in POAG and NTG may be different.