Latanoprostene Bunod 0.024% w/v Treatment of Open-anlge Glaucoma: Short-term Effects, Safety, and Changes in Ocular Blood

Purpose@#To study the short-term intraocular pressure (IOP)-lowering effect and optic nerve head (ONH) blood flow improvement after switching from latanoprost 0.005% w/v to latanoprostene bunod 0.024% w/v. @*Methods@#This prospective study ran from May 2022 to December 2022 and included 40 patients with open-angle glaucoma who switched from latanoprost 0.005% w/v to latanoprostene bunod 0.024% w/v. The IOP, ONH blood flow, and conjunctival hyperemia, corneal erosion, and eyelid pigmentation status were measured 3 months after switching. We recorded all possible side effects. @*Results@#The baseline IOP significantly dropped from 17.53 ± 6.49 to 16.00 ± 8.06 mmHg at 3 months (p = 0.032). The best-corrected visual acuity did not significantly change (0.24 ± 0.19 to 0.23 ± 0.16); neither did eyelid pigmentation (1.16 ± 0.78 to 1.16 ± 0.82) nor the corneal erosion score (0.58 ± 0.85 to 0.39 ± 0.76). Conjunctival hyperemia significantly decreased from 2.00 ± 0.69 to 1.67 ± 0.63 (p = 0.010). Neither the whole-image vessel density nor the peripapillary vessel density significantly changed. However, pruritus became significantly worse after the change (p = 0.008). @*Conclusions@#In the short term, latanoprostene bunod 0.024% w/v lowered the IOP more effectively than did latanoprost 0.005% w/v. However, there was no significant change in ONH blood flow after the switch.

Effect of Mask Mandates on the Intraocular Pressure Measured via Goldmann Applanation Tonometry

Purpose@#The corona virus disease-19 (COVID-19) pandemic has resulted in mandatory masking of patients and physicians during outpatient visits. This study evaluated the changes in intraocular pressure (IOP) according to mask use. @*Methods@#This prospective study enrolled 30 healthy volunteers (60 eyes). IOP was measured via Goldmann applanation tonometry (GAT) for the subjects wearing one of four commonly used masks: dental, bi-folding Korean Filter (KF)94, tri-folding KF94, and dust masks. Subjects with IOP measurement errors of more than 5 mmHg were rechecked with another GAT type. @*Results@#The mean IOP measured via GAT before mask wearing was 13.7 ± 1.7 mmHg. It was 13.5 ± 2.1, 14.0 ± 2.3, 14.3 ± 2.5, and 13.8 ± 1.6 mmHg with the dental, bi-folding KF94, tri-folding KF94, and dust masks, respectively. There were no significant differences in IOP according to mask type (p = 0.635). IOP errors above 5 mmHg were detected in three subjects who had contact between the GAT feeler arm and tri-folding KF94 mask during IOP measurement. @*Conclusions@#The IOP as measured via GAT is artificially elevated by mechanical interference from the tri-fold KF94 mask. To minimize such mask-induced artifacts in GAT measurements, compress the patient’s mask or change the mask type to prevent any contact during measurement.

Effect and Safety of Travoprost 0.003% in Open Angle Glaucoma

Purpose@#To determine whether travoprost 0.003% has a similar intraocular pressure (IOP) reduction effect to that of travoprost 0.004% while reducing side effects. @*Methods@#This was a prospective study from January 2018 to December 2018 that included 102 patients diagnosed with open angle glaucoma who switched from travoprost 0.004% to travoprost 0.003%. We investigated the changes in IOP, conjunctival hyperemia, corneal erosion, and eyelid pigmentation before and at 3 months after switching to travoprost 0.003%. Additionally, a questionnaire survey of these patients was conducted to determine possible side effects, including hyperemia, stinging, pruritus, irritation, blurred vision, dryness, and foreign body sensation. @*Results@#IOP readings before and after switching to travoprost 0.003% were 12.95 ± 4.25 and 12.94 ± 3.89 mmHg, respectively, showing no significant change (p = 0.974). No changes were observed in corneal erosion or eyelid pigmentation; however, conjunctival hyperemia was reduced significantly from 1.60 ± 0.88 to 1.36 ± 0.84 (p = 0.001). No significant changes in hyperemia, stinging, pruritus, irritation, or foreign body sensation were reported; however, a significant improvement was noted for blurred vision and dryness (p = 0.008, p = 0.007, respectively). @*Conclusions@#We were able to show the effectiveness and safety of travoprost 0.003% as being as effective as travoprost 0.004% in reducing IOP and injections while improving blurred vision and dryness.

Effect and Safety of Travoprost 0.003% in Open Angle Glaucoma

Purpose@#To determine whether travoprost 0.003% has a similar intraocular pressure (IOP) reduction effect to that of travoprost 0.004% while reducing side effects. @*Methods@#This was a prospective study from January 2018 to December 2018 that included 102 patients diagnosed with open angle glaucoma who switched from travoprost 0.004% to travoprost 0.003%. We investigated the changes in IOP, conjunctival hyperemia, corneal erosion, and eyelid pigmentation before and at 3 months after switching to travoprost 0.003%. Additionally, a questionnaire survey of these patients was conducted to determine possible side effects, including hyperemia, stinging, pruritus, irritation, blurred vision, dryness, and foreign body sensation. @*Results@#IOP readings before and after switching to travoprost 0.003% were 12.95 ± 4.25 and 12.94 ± 3.89 mmHg, respectively, showing no significant change (p = 0.974). No changes were observed in corneal erosion or eyelid pigmentation; however, conjunctival hyperemia was reduced significantly from 1.60 ± 0.88 to 1.36 ± 0.84 (p = 0.001). No significant changes in hyperemia, stinging, pruritus, irritation, or foreign body sensation were reported; however, a significant improvement was noted for blurred vision and dryness (p = 0.008, p = 0.007, respectively). @*Conclusions@#We were able to show the effectiveness and safety of travoprost 0.003% as being as effective as travoprost 0.004% in reducing IOP and injections while improving blurred vision and dryness.

Comparison of Videofluoroscopic Swallowing Study in Patients with Stroke-Associated Pneumonia / 대한연하장애학회지

Objective@#To compare the findings of videofluoroscopic swallowing study (VFSS) in patients with stroke-associated pneumonia (SAP). @*Methods@#Between January 2015 and June 2019, 1245 patients diagnosed with pneumonia underwent VFSS examination. Data were collected through retrospective chart reviews. Depending on the diagnosis, 378 post-stroke patients identified were classified into two groups: 327 non-aspiration pneumonia (non-AP) and 51 aspiration pneumonia (AP). Aspiration pneumonia was diagnosed both clinically and radiologically. VFSS results included 11 items of functional dysphagia scoring (FDS) and 8 points of penetration-aspiration scale (PAS) that analyze the swallowing function by anatomical site. @*Results@#Based on the FDS score, the AP group showed significantly higher values in residue in pyriform sinuses (P= 0.01), as compared to the non-AP group. There was a significant difference in the PAS score between both groups (P＜0.001). @*Conclusion@#Based on the FDS results, AP in SAP is associated with residue in piriform sinuses. VFSS tests therefore have the potential to be clinically applied to predict the occurrence of aspiration pneumonia in stroke patients.

Adherence Improvement in Glaucoma Patients: Effects of Educational Intervention Using an Eye Drop Chart

Purpose@#To evaluate the effects of an educational intervention using an eye drop chart and supplementary education on glaucoma patients’ adherence. @*Methods@#In this multicenter prospective study, medically treated glaucoma patients were educated on the administration of eye drops using an eye drop chart. At the time of recruitment, all of the patients completed a questionnaire on demographic characteristics and adherence. Three months after the initial educational intervention, the patients were randomly divided into two groups: an education group and a control group. The education group received supplementary education. Immediately thereafter and at 6 months, all of the patients completed the questionnaire on adherence again. Changes in instillation behavior, the relationship between the adherence score and demographic characteristics, and factors contributing to an improvement in adherence and intraocular pressure were then analyzed. @*Results@#The adherence scores were significantly higher in patients with fewer medications, a higher annual income and higher educational level, and an urban residence (p = 0.038, p = 0.033, p = 0.041 and p = 0.047, respectively). Education on the administration of eye drops and use of the eye drop chart improved adherence scores from 23.05 ± 3.52 to 21.30 ± 3.95 (p = 0.021) and significantly reduced the average intraocular pressure from 14.3 ± 2.9 to 12.4 ± 3.1 mmHg (p < 0.001). Working indoors (odds ratio [OR] = 5.47, p = 0.032) and supplementary education at 3 months (OR = 4.53, p = 0.030) were also correlated with improved adherence. @*Conclusions@#An eye drop chart is an effective tool for improving adherence and intraocular pressure control in glaucoma patients. Improvement in adherence was especially notable in patients whose work predominantly involved indoor activity. The effectiveness of the eye drop chart was improved by supplementary education.

Clinical Features of Delayed Diagnosed Acute Angle Closure Glaucoma in an Emergency Room

Purpose@#To analyze the clinical features of delayed diagnosed acute angle-closure glaucoma (AACG) patients who were misdiagnosed with neurologic disease in an emergency room (ER). @*Methods@#This study was conducted with a total of 77 patients (77 eyes) who had been diagnosed with AACG in the ER. Age, gender, laterality, best-corrected visual acuity (BCVA) of the affected eye at the time of the ER visit and at an outpatient clinic follow-up examination, bilateral intraocular pressure (IOP) at time of visit, previous eye-disease history, previous history of ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, referral source, chief complaint, past history of migraine, residence, and specialty of the initial doctor in charge of the ER were statistically analyzed. @*Results@#Among the 77 patients, 34 received a delayed diagnosis and 43 were diagnosed in a timely manner. Higher cases of delayed diagnosis were observed in patients who had lower BCVA at the time of the ER visit (p = 0.001), nonophthalmologic referral source visiting the ER (p < 0.001), a chief complaint of extra-ocular symptoms (p < 0.001), and a non-ophthalmologist as the initial doctor in charge of the ER (p < 0.001). None of the other factors, including IOP, previous eye-disease history, previous ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, past history of migraine, or residence showed any statistically significant intergroup difference. @*Conclusions@#Among the AACG patients visiting the ER, many were delayed in their diagnosis and thus required much attention afterwards. Careful examination and a detailed recording of a patient’s medical history by an ophthalmologist is important for accurate and timely diagnosis in the ER.

A Case Report of Golf-Swing-Induced T2∼T3 Clay-Shoveler’s Fractures

Clay-shoveler’s fractures are rare stress-type avulsion fractures of the spinous processes especially in sports. There have been two case reports that discussed clay-shoveler’s fractures in golf. A 36-year-old beginner golfer presented with a pain in the back after practicing golf swing. No fractures were detected using cervical radiography; however, computed tomography (CT) and magnetic resonance imaging (MRI) revealed T2∼T3 spinous process fractures. The patient was treated conservatively and his pain subsided. The mechanism of injury is speculated to that of clay-shoveler’s fractures. Therefore, if a golfer suffers persistent pain in the cervicothoracic region, clay-shoveler’s fracture is one possibility to consider.

Clinical Features of Delayed Diagnosed Acute Angle Closure Glaucoma in an Emergency Room

Purpose@#To analyze the clinical features of delayed diagnosed acute angle-closure glaucoma (AACG) patients who were misdiagnosed with neurologic disease in an emergency room (ER). @*Methods@#This study was conducted with a total of 77 patients (77 eyes) who had been diagnosed with AACG in the ER. Age, gender, laterality, best-corrected visual acuity (BCVA) of the affected eye at the time of the ER visit and at an outpatient clinic follow-up examination, bilateral intraocular pressure (IOP) at time of visit, previous eye-disease history, previous history of ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, referral source, chief complaint, past history of migraine, residence, and specialty of the initial doctor in charge of the ER were statistically analyzed. @*Results@#Among the 77 patients, 34 received a delayed diagnosis and 43 were diagnosed in a timely manner. Higher cases of delayed diagnosis were observed in patients who had lower BCVA at the time of the ER visit (p = 0.001), nonophthalmologic referral source visiting the ER (p < 0.001), a chief complaint of extra-ocular symptoms (p < 0.001), and a non-ophthalmologist as the initial doctor in charge of the ER (p < 0.001). None of the other factors, including IOP, previous eye-disease history, previous ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, past history of migraine, or residence showed any statistically significant intergroup difference. @*Conclusions@#Among the AACG patients visiting the ER, many were delayed in their diagnosis and thus required much attention afterwards. Careful examination and a detailed recording of a patient’s medical history by an ophthalmologist is important for accurate and timely diagnosis in the ER.

A Case Report of Golf-Swing-Induced T2∼T3 Clay-Shoveler’s Fractures

Clay-shoveler’s fractures are rare stress-type avulsion fractures of the spinous processes especially in sports. There have been two case reports that discussed clay-shoveler’s fractures in golf. A 36-year-old beginner golfer presented with a pain in the back after practicing golf swing. No fractures were detected using cervical radiography; however, computed tomography (CT) and magnetic resonance imaging (MRI) revealed T2∼T3 spinous process fractures. The patient was treated conservatively and his pain subsided. The mechanism of injury is speculated to that of clay-shoveler’s fractures. Therefore, if a golfer suffers persistent pain in the cervicothoracic region, clay-shoveler’s fracture is one possibility to consider.

Eye Drop Chart for Improvement of Topical Eye Drops Administration and Adherence

PURPOSE: To evaluate the efficacy of an eye drop chart and to determine the factors contributing to adherence enhancement using the eye drop chart. METHODS: In this prospective study, enrolled glaucoma patients were educated on the administration of eye drops and use of the eye drop chart. They were required to complete a questionnaire on demographic characteristics and adherence. After 3 months, they completed a second questionnaire on adherence and satisfaction with the use of the eye drop chart. Changes in instillation behavior, relationships between performance scores and demographic characteristics, as well as factors contributing to the improvement of performance scores were analyzed. RESULTS: Forty-seven patients were enrolled in this study. The performance scores were significantly better for those who administered the eye drops by themselves (p = 0.002), those with an annual income > 60 million won (p = 0.036), and patients with at least a college degree (p = 0.002). After using the eye drop chart for 3 months, the average intraocular pressure was significantly reduced (p = 0.041) and the performance score was improved (p = 0.019). The working area (p = 0.009) and eye drop applicator (p = 0.001) were correlated with performance score enhancement. CONCLUSIONS: The eye drop chart was a cost-effective tool for improving the adherence and instillation practices of glaucoma patients. Adherence was improved among patients with more indoor activity, and those who practiced self-instillation. It is expected that the respective conditions of such patients would be more efficiently improved in a clinical setting.

Predictors of Success of Selective Laser Trabeculoplasty Adjusted for Intraocular Pressure Variations

PURPOSE: To investigate the efficacy, and identify predictors of success of selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG) patients after adjusting for intraocular pressure (IOP) changes in the untreated fellow eye. METHODS: This retrospective chart review included 52 eyes of 52 OAG patients who underwent SLT in one eye and were followed-up for at least 1 year after the procedure. The IOP was measured before the treatment, at 1, 2, and 3 months posttreatment, and every 3 months thereafter. To account for the possible influence of IOP fluctuations on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed, after adjusting for IOP changes in the untreated fellow eye. Success was defined as an IOP decrease ≥20% of the pretreatment IOP. The success rate was determined based on Kaplan-Meier survival analysis and factors predictive of success were analyzed using the Cox proportional hazard model. RESULTS: The mean pretreatment IOP was 23.17 ± 6.96 mmHg. The mean IOP reduction was 5.59 ± 4.78 mmHg (29.7%) and the success rate was 65.4% at 1 year. The adjusted mean IOP reduction was 4.70 ± 4.67 mmHg (23.9%) and the adjusted success rate was 53.9%. Pretreatment IOP was associated with SLT success; the higher the pretreatment IOP, the greater the post-laser IOP reduction (p = 0.025). Age and mean deviation index did not show a significant association with SLT success (p = 0.066 and p = 0.464, respectively). CONCLUSIONS: SLT is a safe and effective alternative method of IOP reduction in OAG patients. Herein, pretreatment IOP was the only factor significantly associated with SLT success. IOP fluctuations of the untreated eye should be considered for a better understanding of the impact of treatment.

Refractive Error Induced by Combined Phacotrabeculectomy

PURPOSE: We evaluated the postoperative accuracy of intraocular lens power prediction for patients undergoing phacotrabeculectomy and identified preoperative factors associated with refractive outcome in those with primary open-angle glaucoma (POAG). METHODS: We retrospectively reviewed the medical records of 27 patients who underwent phacotrabeculectomy to treat POAG. We recorded all discrepancies between predicted and actual postoperative refractions. We compared the data to those of an age- and sex-matched control group that underwent uncomplicated cataract surgery during the same time period. Preoperative factors associated with the mean absolute error (MAE) were identified via multivariate regression analyses. RESULTS: The mean refractive error of the 27 eyes that underwent phacotrabeculectomy was comparable to that of the 27 eyes treated via phacoemulsification (+0.02 vs. −0.01 D, p = 0.802). The phacotrabeculectomy group exhibited a significantly higher MAE (0.65 vs. 0.35 D, p = 0.035) and more postoperative astigmatism (−1.07 vs. −0.66 D, p = 0.020) than the phacoemulsification group. The preoperative anterior chamber depth (ACD) and the changes in the postoperative intraocular pressure (IOP) were significantly associated with a greater MAE after phacotrabeculectomy. CONCLUSIONS: POAG treatment via combined phacoemulsification/trabeculectomy was associated with greater error in terms of final refraction prediction, and more postoperative astigmatism. As both a shallow preoperative ACD and a greater postoperative change in IOP appear to increase the predictive error, these two factors should be considered when planning phacotrabeculectomy.

Extracorporeal Shock Wave Therapy and Quantitative Ultrasonographic Evaluation of the Rheologic Effect in the Patients with Post-stroke Upper Limb Spasticity: A Case Report

Post-stroke spasticity is a common complication that causes limitations of function, pain and decrement of the quality of life. Although botulinum toxin injection and anti-spastic medications are effective and widely used for the management of post-stroke spasticity, clinical applications are often limited in stroke patients because of their invasiveness and systemic side effects. Alternatively, we performed upper limb muscle-belly extracorporeal shock wave therapy (ESWT) to resolve problematic spasticity in two subacute stroke patients. Serial quantitative ultrasonographic measurements of spastic muscle were conducted to investigate the rheological changes in chronological order by echogenicity comparison. After 4 sessions of weekly ESWT, gradual decrements of clinical spasticity parameters and muscle echogenicity were observed and lasted for 1 week after the cessation of the therapy. ESWT may be a useful alternative management for treating post-stroke spasticity.

Utility of the Swept Source Optical Coherence Tomography for Measurements of Central Corneal Thickness

PURPOSE: To evaluate the efficacy of swept source optical coherence tomography (SS-OCT) by comparing the measurement of central corneal thickness (CCT) to the measurement obtained using Orbscan II, anterior segment optical coherence tomography (AS-OCT) and ultrasound pachymetry. METHODS: One examiner measured the CCT in 65 eyes of 65 healthy subjects using Orbscan II, AS-OCT, SS-OCT and ultrasound pachymetry. The mean values and correlations were analyzed. RESULTS: The average CCT measurements obtained using Orbscan II, AS-OCT, SS-OCT and ultrasound pachymetry were 534.83 ± 38.46, 517.80 ± 32.48, 528.22 ± 33.71 and 528.02 ± 34.90 µm, respectively. A significant linear correlation was observed among Orbscan II, AS-OCT, SS-OCT and ultrasound pachymetry (r > 0.894, p < 0.001). There was no significant difference between the SS-OCT and ultrasound pachymetry (p = 0.782). CONCLUSIONS: The results of the 4 methods were significantly correlated and the SS-OCT reached a high level of agreement when CCT was determined using ultrasound pachymetry. The CCT measurements using SS-OCT is a better alternative for ultrasound pachymetry than Orbscan II and AS-OCT.

Morphologic and Functional Evaluation before and after Vitrectomy in Idiopathic Epiretinal Membrane Patients Using Microperimetry

PURPOSE: To investigate the relationship between photoreceptor inner/outer segment (IS/OS) integrity and macular sensitivity after epiretinal membrane (ERM) surgery using spectral-domain optical coherence tomography combined with microperimetry. METHODS: 20 eyes of 20 patients with idiopathic ERM who underwent pars plana vitrectomy for ERM removal were prospectively reviewed. The IS/OS defect diameter, BCVA, macular sensitivity, and fixation stability were measured using spectral-domain optical coherence tomography combined with microperimetry. The correlation of these factors was analyzed. RESULTS: The macular sensitivity improved after successful ERM surgery (p < 0.001), but the IS/OS defect diameter has not improved. The preoperative and postoperative macular sensitivity were negatively correlated with preoperative IS/OS defect diameter (p = 0.035, p = 0.006). The fixation stability was not correlated with preoperative IS/OS defect diameter. CONCLUSIONS: Macular sensitivity showed significant correlation with IS/OS defect diameter. Macular sensitivity is vital functional parameter allows subjective quantification of the retinal function and reflects morphologic changes.

Usefulness of Automated Measurements of Localized Retinal Nerve Fiber Layer Defects Area Using Significance Map

PURPOSE: To evaluate the usefulness of automated measurements of the localized retinal nerve fiber layer (RNFL) defects area in patients with glaucoma. METHODS: Fifty one patients with localized RNFL defects in RNFL red-free photographs and 53 healthy subjects were included. All participants were imaged with 3D spectral-domain optical coherence tomography (OCT). The area of defects was measured with the RNFL significance map (red = p < 1% and yellow = p < 5%) using Image J manually and Matlab software automatically. The area under the receiver operating characteristic curve (AUC) was calculated for the RNFL defect area of the RNFL photograph and RNFL maps, circumpapillary RNFL thickness, optic disc parameter, and macular inner retina thickness. RESULTS: High correlation was observed between manually and automatically measured defect areas in the significance map (red area r = 0.904, red and yellow area r = 0.890). The AUC for manually and automatically measured defects area (0.987, 0.966; p < 5%, p = 0.31, respectively) in the significance map was comparable. The latter demonstrated slightly higher but insignificant difference in AUC for inferior quadrant circumpapillary RNFL thickness (0.936; p = 0.22) and was significantly higher than the inferior ganglion cell layer plus inner plexiform layer thickness (0.894) and vertical cup to disc ratio (0.869) (p = 0.018, p = 0.008, respectively). CONCLUSIONS: The automated measurements of the RNFL defect area in the significance map performed adequately in detecting localized RNFL defects and had a better performance than macular inner retina and optic nerve parameters.

The Changes of Anterior Chamber Depth, Axial Length, Refractive Errors after Combined Vitrectomy

PURPOSE: To evaluate the changes of anterior chamber depth (ACD), Axial length (AXL) after combined vitrectomy and cataract surgery and to analyze the association with refractive errors. METHODS: In 22 eyes who underwent combined vitrectomy and cataract surgery (PPV-Phaco group), 20 eyes who underwent vitrectomy-only (PPV-only group) and 28 eyes who underwent uncomplicated cataract surgery (Phaco-only group), ACD and AXL were measured with IOL master (Carl Zeiss Jena, Germany) preoperatively and 3 months postoperatively. We compared the preoperative desired refraction and postoperative 3 months refraction. RESULTS: ACD were increased in PPV-Phaco group and Phaco-only group (all, p < 0.001) and this change was more prominent in PPV-Phaco group (p = 0.030). In PPV only group, ACD was decreased (p < 0.001). The AXL after surgery was not significant different from the preoperative AXL in PPV-Phaco and PPV only groups (p = 0.612, p = 0.090). But the AXL was decreased in Phaco-only group (p = 0.022). Hyperopic shifting were noticed in PPV-Phaco and phaco-only groups, but myopic shifting was noticed in PPV-only group. However, these changes were not statistically significant (p = 0.292, p = 0.251, p = 0.068). CONCLUSIONS: ACD was increased after combined vitrectomy and cataract surgery. AXL was not changed. The hyperopic shifting was noticed after combined vitrectomy and cataract surgery, but was not statistically significant.

Thigh Perforator Free Flap for Reconstruction of the Soft Tissue Defect of the Lower Extremity / 대한족부족관절학회지

INTRODUCTION: To report the result of the thigh perforator free flap for the reconstruction of the soft tissue defect of the lower extremities and usefulness of this flap. MATERIALS AND METHODS: We have performed 23 cases of thigh perforator free flap to reconstruct the soft tissue defect of the lower extremities between February 2004 and July 2005. The anterior aspect of the legs were 9 cases, the ankle joints were 4 cases, the dorsal aspect of the feet were 6 cases, the sole of the feet were 4 cases as recipient sites. The anterolateral thighs were 13 cases, the anteromedial thighs were 10 cases as donor sites. The size of the flap ranged from 4 x 5 cm to 12 x 18 cm. The mean flap area was 73.2 cm2. The length of the pedicle ranged from 5 cm to 15 cm. Every patient except children was operated under the spinal anesthesia. RESULTS: 21 flaps (91.3%) survived, 2 flaps (8.7%) failed. In the 21 flaps that had survived, there were partial necrosis in 4 cases, which healed without any additional operation. In the 13 anterolateral thigh perforator flaps, 9 cases survived totally, 3 cases had the partial necrosis, 1 case failed. In the 10 anteromedial thigh perforator flaps, 8 cases survived totally, 1 case had the partial necrosis, 1 case failed. CONCLUSION: The authors had a good result with the thigh perforator free flap and believe that this flap is a good option for the reconstruction of the soft tissue defect of the lower extremities, because this flap has a thin thickness and it is easy to dissect the vessels. Moreover the patients can be operated with supine position.

Subtrochanteric Fracture after Cannulatd Screw Fixation of Femoral Neck Fracture in a Child: A Case Report

Though femoral neck fractures in adults are usually treated by fixation with multiple screws, subtrochanteric fracture at the insertion site is an uncommon complication, and in children, there has been a few reports about this complication after treatment of slipped capital femoral epiphysis. We report a subtrochanteric fracture at the insertion site of cannulated screws used in femoral neck fracture of a 9-years old boy.