Clinical Analysis of Blow-In Orbit Fracture and Its Treatment

Blow-in orbit fracture is relatively rare fracture which is an inward displacement of the orbital rim or wall fragment, resulting in decreased orbital volume. The objective of this article is to analyze blow-in fracture status of orbit and to suggest appropriate management in this unusual fracture. The study included 23 cases who had treatment of blow-in fractures of orbit from July, 1995 to June, 2001. Their ages ranged from 4 years to 63 years. There were 17 males and 6 females. The diagnosis of blow-in fracture was accomplished with physical examination, ophthalmologic examination, plain X-ray, and facial CT scan. According to Antonyshyn's classification, we classified them into 2 large groups which were pure type and impure type. Pure type blow-in fractures are relatively uncommon and 5 cases were documented in a series of 23 patients. Impure type fractures included the orbital rim and 18 cases were documented. Clinical symptoms of blow-in fractures were proptosis, limitation of eyeball movement, diplopia, blepharoptosis, subconjunctival hemorrage and blindness. 2 patients with globe rupture and blindness underwent enucleation due to direct injury by bony segment. We conclude that early and appropriate surgical treatment with complete examination is very important to prevent blepharoptosis, proptosis, limitation of eyeball movement and optic nerve compression. However, when globe rupture and blindness by direct injury of bony segment happened, the operation of enucleation was needed in this particular case.

Strategic Management for Lower Limb Salvage in Diabetic Foot

Diabetic foot is one of the most frequent complications with diabetic nephropathy and diabetic retinopathy in diabetic patient. Ischemia and peripheral neuropathy are the primary pathologic mechanism leading to diabetic foot. Approximately 20% of all diabetic patients admitted for foot problems, and about 80% of these patients need leg amputations. The objective of this article is to analyze the result of strategic treatment for limb salvage and to suggest appropriate surgical management in patients with diabetic foot. This study included 97 cases of treatment of diabetic foot for 6 years since August, 1995. The patients' age ranged from 34 to 83 years. There were 59 males and 38 females. According to the wound grade, extent, and involved site, we classified into 4 groups of diabetic foot. Conservative treatment was accomplished in 53 cases, local flap and/or skin graft in 13 cases, free flaps were in 12 cases, and amputations in 19 cases. The relatively superficial defects were treated with reversed adipofascial flap and split thickness skin graft. The used free flaps were 10 radial forearm free flap, 1 radial forearm osteocutaneous free flap, 1 latissimus dorsi muscle free flap. One flap loss occurred in latissimus dorsi free flap and the patient was treated with below knee amputation. The amputations included 9 toe amputations, 3 Syme amputations, 5 below knee amputations, and 2 above knee amputations. Except one patient, all patients had primary wound healing in operated site without specific complications. We conclude that selection of treatment method is very important for diabetic foot patient. Appropriate surgical treatment for limb salvage consists of infection control, coverage of exposed tendon, joint, and bone, and prevention of recurrence. In case of rapid progression of necrosis, amputations can be considered in order to prevent sepsis and provide early rehabilitation with prosthesis.

Microsurgical Reconstruction in Pediatric Patients

Microsurgical reconstruction is necessary for children to correct severe trauma and congenital or acuqired deformity. The aim of this study was to evaluate whether or not microsurgical reconstruction is a safe and reliable operation in children and to analyze the differences of microsurgical reconstruction in children compared to adults. The study included 12 children who underwent 13 microsurgical reconstructions among a total of 251 cases of microsurgical reconstruction from May, 1986 to August, 1998. Their ages ranged from 24 months to 14 years and 8 months. There were 7 males and 6 females. The involved sites were 9 legs, 3 hands and 1 face. The causes of microsurgical reconstruction were 9 traumas, 2 congenital anomalies, 1 acquired deformity and 1 cancer. The applied flaps were 4 scapular flaps, 2 rectus abdominis muscle flaps, 1 de-epithelized groin flap, 1 lateral arm flap, 1 forearm tendocutaneous flap, 1 forearm tendocutaneous flap, 1 latissimus dorsi muscle flap, 1 fibula flap, 1 second toe transfer, and 1 wrap-around flap. All patients have had normal growth of the donor and recipient sites without specific complications during an average 2 years follow-up. We concluded that microvascular reconstruction is a very useful and reliable procedure in children if it is performed in consideration of each child's specific characteristics and conditions.