Does Low-Dose Heparin Have a Significant Role in Free Flap Surgery?

BACKGROUND: It is controversial issue that heparin decreases thrombosis for microsurgical anastomosis, and its effective role is under discussion. This study is for proving whether low-dose heparin is preventing thrombosis in free flap reconstruction. METHODS: Through chart reviews of 134 patients, using low-dose heparin for free tissue transfer from 2011 to 2016, retrospective analysis was performed. 33 patients received low-dose heparin therapy after surgery. And 101 patients received no-heparin therapy. Complications included flap necrosis, hematoma formation, dehiscence and infection. RESULTS: In no-heparin therapy group, comparing the flap necrosis revealed 16 cases (15.84%). And, flap necrosis was 6 cases (18.18%) in low-dose heparin therapy group. The statistical analysis of flap necrosis rate showed no significant difference (p=0.75). The results showed that there was no significant difference of flap necrosis rate between two groups. CONCLUSION: In this study, patients in the low-dose heparin group had no significantly lower rates of flap failure compared with no-heparin group. This suggests that low-dose heparin may not prevent thrombosis and subsequent flap failure to a significant extent.

Comparison of Intramedullary K-Wire Nailing versus Plate for Fixation in Metacarpal Midshaft Fracture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical and radiological results of patients with metacarpal midshaft fracture following surgery using either intramedullary K-wire nailing or internal fixation of plates. MATERIALS AND METHODS: This study was conducted with 39 metacarpal midshaft fracture patients between October 2008 and September 2012. Of these 39 patients, 15 patients underwent intramedullary K-wire nailing and 24 patients underwent internal fixation of metal plates. We analyzed bone union time and final posterior angulation radiologically and the range of motion, grip power, and quick-disabilities of the arm, shoulder and hand (DASH) scores, visual analogue scale (VAS) score clinically. RESULTS: Bone union was observed in all cases and bone union times were not significantly different between the two surgical methods. The final follow-up radiographs showed statistically significant differences in posterior angulation, which was 14°, on average, among the patients who underwent intramedullary K-wire nailing and 5°, on average, among the patients who underwent internal fixation of plates. No significant differences were found for the range of joint motion, power, and quick-DASH scores and VAS score were not significantly different between the two groups. CONCLUSION: Intramedullary K-wire nailing showed significant differences in posterior angulations, but both intramedullary K-wire nailing and internal fixation of plates produced good clinical outcomes in the treatment of metacarpal midshaft fracture. Therefore both techniques are considered good treatment methods.

Arthroscopically assisted Cancellous Bone Grafting and Percutaneous K-Wires Fixation for the Treatment of Scaphoid Nonunions

PURPOSE: The purpose of this study was to analyze the clinical results of patients with scaphoid nonunions treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation. METHODS: We retrospectively reviewed 20 patients with a scaphoid nonunions which was treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation from November 2008 to July 2012. Time from injury to treatment was 74 months (range, 3-480 months) in average. Functional outcome was evaluated using the modified Mayo wrist score and visual analogue scale (VAS) for pain, which were measured before operation and at the last follow up. RESULTS: All nonunions were healed successfully. The average radiologic union time was 9.7 weeks (range, 7-14 weeks). The average VAS score improved from 6.3 (range, 4-8) preoperatively to 1.6 (range, 0-3) at the last follow up. The average modified Mayo wrist score increased from 62.5 preoperatively to 85.7 at the last follow-up. CONCLUSION: Arthroscopically assisted bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion. It may provide more biological environment than open surgery as a minimally invasive procedure.

Surgical Treatment of Sucidal Laceration in the Wrist

PURPOSE: To report clinical appearances and the outcomes of patients treated for wrist laceration with suicidal intent. MATERIALS AND METHODS: Between March 2005 and February 2008, patients with wrist laceration were treated at our center. Among them, 14 patients with suicidal intent were reviewed retrospectively. They were 8 females and 6 males with a mean age of 33 years at the time of treatment. The side of injured wrist, injured structures, suicidal instrument, the time of injury, a suicidal motive, drug or alcohol abuse or not, indication of combined psychiatric disease, the duration of postoperative treatment, and the results of treatment were analyzed. RESULTS: The injured wrist was the left one in 13 cases (93%), and knife wounds in 11 cases (79%) was the most frequent mechanism of injury. An average of 4.6 structures were injured including 3.5 tendons, 0.57 nerves and 0.5 arteries. The most frequently injured structures were the palmaris longus (71%), FCU (50%), FCR (43%), FDS 3 (36%), FDS 2, median nerve, and ulnar artery (each 29%). Simultaneous injury of both median and ulnar nerves occurred in 3 cases (21%), and simultaneous injury of both radial and ulnar artery occurred in 1 case (7%). The injury time was the night in 12 cases (86%), and the most frequent suicidal motive was human relations such as lover or spouse in 12 cases (86%). In 9 cases (64%), the injured were in a drunken state, 3 cases (21%) had been treated for a psychiatric disease at the time of the injury. The durations of postoperative treatment were an average of 5 days of admission and 1 day follow up. Only 1 case results could be evaluated. CONCLUSIONS: Patient's poor compliance in wrist laceration with suicidal intent should be expected and these characteristics may affect the management plan.

Replantation for Amputation of the Finger by a Dog Bite

We present the case of a 49-year-old man with a dog bite on his right index finger at the mid-phalanx level. The finger was severely contaminated by the dog bite but, the amputation margin was clean. We replantated the stump. His finger was recovered very successfully 12 months later. It is recommended that in these types of cases, replantation of the severed finger should proceed even if the amputated finger was contaminated by the dog bite, unless there are other factors that prevent replantation.

Arterialized Venous Free Flap at the Insufficient Vascular Recipient Bed in Finger Reconstruction

PURPOSE: Arterialized venous flap is useful for reconstruction of the traumatic soft tissue defect in fingers, but insufficient circulation of the traumatic fingers makes surgeons annoying to use the flap. We have grafted flaps in 7 fingers with insufficient vascular bed hoping to expanded the category of the flap. MATERIALS AND METHODS: Arterialized venous flap have transplanted in 7 fingers from March 2008 through February 2010 and followed up for 4 to 16 months(average 7.2 months). They were all male with a mean age at the time of surgery was 33. The main injury was crushing in 4 degloving, contact burn and saw injury was I respectively. Time interval from injury to flap transplantation was average 3.1. weeks(3 days to 6 weeks). Designed flap size ranges from 8 cm x 3.5 cm to 4 cm x 3 cm. Vessel type of flap was one artery with two veins were 5 cases and one artey with one vein 2. Flap type was cutaneous in 3, tendocutaneous 2, neurotendocutaneous 1 and neurocutaneous 1. The circulation state of recipient site was avascular in 2 cases, insufficiency 3 and tip avascular 2. RESULTS: Arterialized venous flap was complete survived in 2 cases, partial necrosis(less than 10%) 3 and failed in 2. CONCLUSION: An arterialized venous free flap could be a useful procedure for reconstruction in soft tissue or combined defect of the finger despite an avascular or insufficient vascular beds if the recipient beds were free from infection.

Autogenous Iliac Bone Grafting for the Treatment of Nonunion in the Hand Fracture

PURPOSE: To evaluate autogenous iliac bone graft for nonunion after hand fracture. MATERIALS AND METHODS: From October 2006 through September 2008, we analyzed 35 patients, 37 cases of autogenous iliac bone graft for nonunion after hand fracture that have followed up for more than 12 months. We analyzed about etiology, fracture site, initial treatment, time to bone graft, grafted bone size, grafted bone fixation method, radiologic time of bony healing and bone union rate retrospectively. Also we evaluated VAS and range of motion of each joints (MCP, PIP, DIP) at final follow-up assessment. RESULTS: Etiology was open fracture 23 cases (62.2%), crushing injury 12 cases (32.4%), direct trauma 2 cases (5.4%). Fracture site was metacarpal bone 7 cases, proximal phalanx 17 cases, middle phalanx 8 cases, distal phalanx 5 cases. Time to bone graft was average 20.7 weeks. Grafted bone fixation method was fixation with K-wire 27 cases (73.0%), fixation with only plate 6 cases (16.2%), fixation with K-wire plus plate 2 cases (5.4%), fixation with K-wire plus cerclage wiring 2 cases (5.4%). Grafted bone size was average 0.93 cm3 and bony union time was average 11.1 weeks and we had bone union in all cases. CONCLUSION: Autogenous iliac bone graft is the useful method in the reconstruction of non-union as complication after hand fracture.

Thumb Tip Reconstruction with Subcutaneous Pocket Graft: 2 Cases Report

PURPOSE: The subcutaneous pocket graft of the thumb tip amputation across or proximal to the lunula is chosen in case of impossible microvascular anastomosis and in patient who strongly desired to preserve the thumb tip after failed replantation. MATERIALS AND METHODS: Two patients who underwent a subcutaneous pocket graft for a thumb tip reconstruction between August 2008 and November 2009 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 48 years and had sustained complete thumb tip amputations across or proximal to the lunula. In one case, the microsurgical replantation was not feasible and the other one revealed arterial insufficiency at the 7th day after microsurgical replantation. RESULTS: Authors had experienced 2 cases of flaps which survived completely. The results of sensibility was good, the range of motion at interphalangeal joint and tip to tip pinch was acceptable and color mismatch and loss of thumb finger nail was unacceptable after more than 1 year follow up with conventional successful thumb tip replantation. CONCLUSION: The subcutaneous pocket graft could be chosen in thumb tip amputation in case of impossible microvascular anastomosis as well as who strongly desires to preserve thumb tip after failed replantation.

Arthroscopic Bone Grafting and Percutaneous K-Wires Fixation for the Treatment of Scaphoid Nonunion: Surgical Technique

Various bone grafting techniques have been reported for scaphoid nonunions. We describe surgical technique of osteosynthesis with bone graft using arthroscopic technique and percutaneous fixation as a minimal invasive procedure. Nine patients with scaphoid nonunion were treated with this technique, resulting in successful union at a mean of 10 weeks.

Reconstruction of Soft Tissue Defects in the Finger using Arterialized Venous Free Flaps

PURPOSE: To report the clinical results of the use of arterialized venous free flaps in reconstruction in soft tissue defects of the finger and to extend indications for the use of such flaps based on the clinical experiences of the authors. Materials and METHODS: Eighteen patients who underwent arterialized venous free flaps for finger reconstruction, between May 2007 and July 2009 were reviewed retrospectively. The mean flap size was 4.7x3.2 cm. The donor site was the ipsilateral volar aspect of the distal forearm in all cases. There were 8 cases of venous skin flaps, 5 cases of neurocutaneous flaps, 4 cases of tendocutaneous flaps, 1 case of innervated tendocutaneous flap. The vascuality of recipient beds was good except in 4 cases (partial devascuality in 2, more than 50% avascuality (bone cement) in 2). RESULTS: All flaps were survived. The mean number of included veins was 2.27 per flap. Mean static two-point discrimination was 10.5 mm in neurocutaneous flaps. In 3 of 5 cases where tendocutaneous flaps were used, active ROM at the PIP joint was 60 degrees, 30 degrees at the DIP joint and 40 degrees at the IP joint of thumb. There were no specific complications except partial necrosis in 3 cases. CONCLUSIONS: An arterialized venous free flap is a useful procedure for single-stage reconstruction in soft tissue or combined defect of the finger; we consider that this technique could be applied to fingers despite avascular recipient beds if the periphery of recipient bed vascularity is good.

Reversed Osteocutaneous Radial Forearm Island Flap for Crushing Injury and Open Fracture of the Thumb in Hand / 대한정형외과학회잡지

PURPOSE: To report the outcome of a reversed osteocutaneous radial forearm flap for a thumb reconstruction. MATERIALS AND METHODS: Five patients who underwent a reversed osteocutaneous radial forearm island flap for a thumb reconstruction between 2001 and 2005 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 45 years. The types of thumb defects, size of the flap, length of the radius harvested, time to union, the range of motion of the thumb, grip and pinch strengths, and complications were analyzed. RESULTS: The mean size of the transferred radial forearm flap was 58.4 cm2. The mean length of the harvested radius was 4.4 cm. All flaps survived completely. The mean interval required to obtain bone union was 2.8 months. The mean ROM of the thumb was 47degrees. The postoperative mean grip strength was 94 lbs and the mean pinch power was 14.6 lbs. Mean moving two-point discrimination on the flap was 13 mm. There were no complications. All 5 patients were satisfied with the reconstructed new thumb. CONCLUSION: A reversed osteocutaneous radial forearm island flap is a useful procedure for reconstructing of a combined defect of the thumb.

Versatile Applications of Anterolateral Thigh Perforator Flap in the Reconstruction of Upper Extremity Defects: Retrospective Analysis of 119 Cases

PURPOSE: The perforator flaps have established their role in the reconstruction of various soft tissue defects. For the last five years, we have extensively used anterolateral thigh (ALT) flap for the reconstruction of the complex tissue defects of the hand and upper extremity and report the clinical results and our experiences with the versatile applications of this flap. MATERIALS AND METHODS: From March 2003 through May 2008, 119 free ALT perforator flaps were transferred for reconstruction of the complex tissue defects of the elbow, forearm, wrist and hand after crushing or degloving injuries as well as severe scar contractures. There were 95 females and 24 males. The mean age of the patients was 37 years and mean size of the flap was 170 cm(2). In 20 cases, the flap was vascularized by septocutaneous and in 99 cases by musculocutaneous perforators. Intra-muscular dissection length averaged 3.4 cm. The total length of pedicle averaged 8.4 cm and the average arterial diameter was 0.84 mm. End-to-end arterial anastomosis was performed in 103 cases and end-to-side in 16 cases. RESULTS: Flap survival rate was 98.3%(117/119) and there were 6 cases of partial necrosis. Donor site was closed primarily in 41 cases and skin grafts were applied in 78 cases. CONCLUSION: The reliability and versatility of ALT flap makes it one of the foremost choices for the reconstruction of complex tissue defects of the upper extremity.

Current Trends of Reconstructive Surgery for the 173 Cases of Korean Duplicated Thumbs Based on the Iowa System

PURPOSE: To report the current trends of Korean duplicated thumbs and their reconstructive surgery based on Iowa system performed during the last five years. MATERIALS AND METHODS: We performed retrospective review of all (164) patients who had performed operations between 2003 and 2007. Out of all, 109 were male and 55 were female. The age at the time of surgery ranged from six months to 46 years. Data analysis was done by using information from preoperative radiographs and patients'chart including operative records, etc. RESULTS: Wassel type IV was the most common one, and type II was the next. The thumbs were involved as follows: bilateral in nine patients; right, 100; left, 55. In right duplicated thumb, males had about 2.45 more times than females. Eighty five percent of all were 24 months or less: their average body weight was 2.72 kg; average body weight at surgery, 9.07 kg (7.7~10.3 kg); average age at surgery, 9.98months (6~19months). In age distribution of their parents, each average age of fathers and mothers was 34.3 and 32.5 years old. And 10.1 percent of all had combined anomalies. Though there could be some discrimination between radiological types and intraoperative findings on cartilaginous epiphyseal portions, surgical procedures were simple ablation, central resection followed by reconstruction, and combination with radial remnant tissue portions after resection of radial extradigital bone through preoperative findings including radiographs based on Iowa system. CONCLUSIONS: Surgical procedures for duplicated thumb are not ablation but reconstruction. At the appropriate time and optimal procedures are needed for satisfactory postoperative results.

Flexor Tendon Entrapment at the Malunited Base Fracture of the Proximal Phalanx of the Finger in Child : A Case Report

The proximal phalangeal base is the most commonly fractured hand bone in children. Such fractures are rarely reported to be irreducible as a consequence of flexor tendon entrapment. A 12-year-old male sustained a malunited base fracture of the proximal phalanx of the small finger on the right hand and was unable to flex the finger. 6 weeks ago he was treated with closed reduction and percutaneous K-wire fixation, at another hospital. In a subsequent operation, it was found that the flexor tendon was entrapped at the fracture site. Flexor tenolysis and realignment of the fracture and internal fixation with K-wires were performed. The patient could perform his work without discomfort in his hand and a normal range of motion was possible in the small finger 12 months after the operation.

Comparative Analysis of Short-term Efficacy and Complication of Photoselective Vaporization for Benign Prostatic Hyperplasia which was Classified by Prostate Size / 대한비뇨기과학회지

PURPOSE: This study was conducted to compare the short term clinical efficacy and complications of photoselective vaporization for benign prostatic hyperplasia(BPH), which was classified by the prostate size. MATERIALS AND METHODS: The clinical data of 309 men with BPH, who had undergone photoselective vaporization for prostate(PVP) using potassium-titanyl-phosphate(KTP) laser, between January 2005 and December 2006, were retrospectively analyzed. All patients were classified into three groups by their prostate size(60cc; group III). The clinical efficacy of each group was compared in terms of the International Prostate Symptom Score(IPSS), quality of life(QoL) index, changes in the maximum urinary flow rate(Qmax), postvoid residual urine(PVR), complications and postoperative outcomes. The mean follow-up period was 6.4 months. RESULTS: The postoperative parameters were significantly improved in all patients(p<0.05). With respect to each of the three classified groups, the postoperative parameters of each group were also significantly improved (p<0.05). However, in group III, the postoperative IPSS and QoL index were lower than the average value. Especially, the items for frequency, nocturia and urgency of the IPSS resulted in bad grades. The rate of complications in group III were higher than those in groups I and II, such as urinary retention, delayed hematuria, urethral stricture and bladder neck contracture. CONCLUSIONS: Despite the excellence of KTP, careful consideration must be given when the operation is performed on patients with a large prostate size.

The Fate of Neglected Vascular Injury of the Hand in Acute Hand Injuries

In acute hand injury, there are sometimes hattened neglected or overlooked vascular injury by primary operators. The authors evaluated the final results and prognosis after secondary revascularization. In eight cases, the authors performed secondary revascularization after prolonged warm ischemia. Five fingers in five cases among them were successfully survived and three cases finally necrosed. The mean warm ischemic time was 56.1 hours. In revascularization procedures, end-toend artery anastomosis was possible in six cases. In two cases, vein graft was needed to anastomose digital artery, which resulted in complete survival of the fingers. In all three cases, revision amputation of the fingers was done. In acute complex hand injury, the importance of evaluation of the vascular injury can not be overemphasized. The necessity of the early secondary revascularization as well as serious consequence caused by misdiagnosis of vascular injury should be aware.

Ten Trigger Fingers in an Adult Man: A Case Report

Trigger finger is a common disease particularly in the middle aged women. A very rare case in which an adult man had 10 trigger fingers was experienced. He was treated with local steroid injections in both thumbs, but trigger finger disease has been aggravated in every digit of both hands. We performed an early operative treatment. Three months after the operation, the patient could perform his work without discomfort in his hands and showed normal range of motion in all fingers.

Effect of Posterior Femoral Clearance on Knee Flexion in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To analyze the effect of clearing the protruding posterior femoral condyle from the femoral component (PFC: Posterior femoral clearance) on knee flexion in patients who underwent LCS(R) rotating platform TKA. MATERIALS AND METHODS: Twelve patients were male and one hundred seventy-eight patients were female. The patients were divided into the following two groups: Group A (62 patients 84 knees), TKA without PFC; and Group B (128 patients 182 knees), TKA with PFC. The clinical and radiology follow-up were carried out using the HSS score and tibiofemoral angle, and the possibility of squatting was evaluated in each group, respectively. RESULTS: The mean flexion contracture improved 10.8degrees in group A, and 10.3degrees in group B. The mean further flexion improved 13degrees in group A, and 24degrees in group B. The improvement of knee flexion with PFC showed statistical significance. The mean HSS knee scores improved 30.5 points in group A, and 36.3 points in group B. The improvement in the HSS knee score with PFC showed statistical significance. Squatting was possible 50.0% of group A, and 67.4% of group B. CONCLUSION: PFC is effective in increasing the level of knee flexion and improving the HSS score. PFC can be a good solution for high demand patients, particularly those from Asian countries.

Surgical Outcome of Degenerative Lumbar Spinal Stenosis in Patients over 70 years old: A Comparative Analysis according to Surgical Method / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze and compare the clinical results of different surgical methods for spinal stenosis, without lumbar instability, in patients over 70 years-old. SUMMARY OF LITERATURE REVIEW: Much controversy exists as to the best operative method for spinal stenosis. MATERIALS AND METHODS: Thirty eight patients that had undergone surgical treatment for spinal stenosis, without lumbar spinal instability, with a mean age of 75.1 years(70 to 91 years) and follow up period was 44 months(24 to 52 months), were retrospectively reviewed. The patients were divided into two groups: * Group A (n=23): posterior decompression alone * Group B (n=15): posterior decompression and posterolateral fusion Clinical outcome and satisfaction were assessed using Bohlman's measurements, on a 10 point pain rating scale, and the clinical outcomes were further analyzed according to the co-morbidity and postoperative complications. RESULTS: Clinically excellent and good outcomes were achieved in 86.9 and 80.0% in groups A and B, respectively. The 10-points pain scale for low back pain showed improvements in both groups. The co-morbidity did not influence the clinical outcome in either group. There were no serious postoperative complications in either group. CONCLUSIONS: Posterior decompression alone was an effective surgical method, and was found to be equivalent to posterior decompression and posterolateral fusion in patients over 70 years-old with degenerative lumbar spinal stenosis and without lumbar spinal instability.

A Study on Sodium and Potassium Balance of College Women in Seoul / 대한지역사회영양학회지

The purpose of this study was to investigate Na and K balances in healthy adult women. Anthropometric assessments, biochemical analysis of blood, 3-day dietary flood records and collections of 3-day food, 24-hr urine and faces were performed to evaluate intakes and excretions of Na and K in 20 college women living in Seoul. The mean BMI and blood pressure of the subjects were 21.08 and 110.25/67.50mmHg, respectively. Mean daily intake of energy was 1578.84 kcal, 79% of Korean RDA. Also, daily intakes of Na and K ware 120.86mEq and 44.20mEq. The urinary and fecal excretions of Na were 99.88 and 4.45mEq/day, and those of K were 30.41 and 8.66mEq/day, respectively. The body retention, retention rate, and apparent absorption of Na were 17.11mEq, 13.23%, and 96.31%, and those of K were 5.82mEq, 8.69%, and 80.12%, respectively. The urinary and fecal Na/K ratio were 3.48 and 0.52. There were significantly positive correlations between 1) urinary Na, K excretions and intakes of Na or K, 2) urinary K and BMI, 3) serum K and serum globulin, and 4) urinary Na excretion and serum haptoglobin level, respectively. The results of this study show that Na intake was higher and K intake was lower than those of other advanced nations. Therefore, nutrition education show instruct people to reduce Na intake and to increase K intake.