전외측 대퇴부 천공지 피판을 이용한 만성 경골 골수염에 동반된 하지 전방 연부조직 병변의 재건

정현균,최동혁,전성훈,김희동,Jung, Heun-Guyn,Choi, Dong-Hyuk,Jeon, Sung-Hoon,Kim, Hee-Dong 대한미세수술학회 2009 Archives of reconstructive microsurgery Vol.18 No.1

The purpose of this study was to present the clinical result of anterolateral thigh free flap for pretibial soft tissue lesion after chronic tibia osteomyelitis. From December 2006 to September 2008, Five patients were included in our study. 4 of 5 were superficial or localized types of chronic tibia osteomyelitis, based on the classification of Cierny and Mader. Average age at the surgery was 45 years, three were males and two were females. All had a history of chronic tibia osteomyelitis and subsequent pretbial soft tissue lesions coming from previous operations or pus drainage. Pretibial soft tissue defects included small ulcers, fibrotic, bruisable soft tissue and small bony exposures, but not large-sized bony exposures nor active pus discharge. After complete debridement of large sized pretibial soft tissue lesions and decortication of anterior tibial cortical dead bone, anterolateral thigh free flap was applied to cover remained large pretibial soft tissue defect and to prevent the recurrence of infection. All flaps survived and provided satisfactory coverage of soft tissue defect on pretibial region for 16 months' mean follow up period. No patients has had recurrence of osteomyelitis. Anterolateral thigh free flap could be recommend for large sized pretibial soft tissue defect of supreficial or localized types of chronic tibia osteomyelitis after through debridement.

족지 주위의 작은 크기의 당뇨 족부 궤양에 대한 외측 상완 유리 피판술

정현균,소광영,국우종,김희동,Jung, Heun-Guyn,So, Gwang-Young,Kuk, Woo-Jong,Kim, Hee-Dong 대한미세수술학회 2008 Archives of reconstructive microsurgery Vol.17 No.1

The purpose of this study was to present the clinical analysis of the results of lateral arm free flap for small sized and infected diabetic foot ulcer around toes. From May 2006 to December 2007, Seven patients were included in our study. Average age was 52.8 years, six were males and one was female. All had infected diabetic foot ulcer and had exposures of bone or tendon structures. Ulcers were located around great toe in four patients, 4th toe in one and 5th toe in two. Three patients had osteomyelitis of metatarsal or phalanx. After appropriate control of infection by serial wound debridement and intravenous antibiotics, lateral arm flap was applied to cover remained soft tissue defects. Posterior radial collateral artery of lateral arm flap was reanastomosed to dorsalis pedis artery of recipient foot by end to side technique in all cases in order to preserve already compromised artery of diabetic foot. All flaps were designed over lateral epicondyle to get longer pedicle and averaged pedicle length was 8 cm. Two cases were used as a sensate flap to achieve protective sensation of foot. All flaps survived and provided satisfactory coverage of soft tissue defects on diabetc foot ulcers. All patients could achieve full weight-bearing ambulation. No patients has had recurrence of infection, ulceration and further toe amputations. There were three complications, a delayed wound healing of flap with surrounding tissue, a partial peripheral loss of flap and a numbness of forearm below donor site. All patients were satisfied with their clinical results, especially preserving their toes and could return to the previous activity levels. Lateral arm free flap could be recommend for infected diabetic foot ulcers around toes, to preserve toes, coverage of soft tissue defect and control of infection with low donor site morbidity.

광범위 당뇨병성 족부 궤양 및 괴사에 대한 복직근 유리 피판술의 임상적 유용성

정현균,전성훈,최동혁,김희동,송준영,Jung, Heun-Guyn,Jeon, Sung-Hoon,Choi, Dong-Hyuk,Kim, Hee-Dong,Song, Jun-Young 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.1

The purpose of this study was to present the clinical significance of rectus abdominis free muscle flap for large sized diabetic ulcer and necrosis of the foot to salvage limb. From June 2000 to February 2006, eleven patients were included in our study. There were seven males and four females with a mean age of 58.3 years (48~65) at the surgery. All had a history of diabetics and subsequent huge soft tissue defect caused by necrotizing abscess formation around the foot and the ankle. After complete debridement of large sized, infected necrotic tissue, susceptible intravenous antibiotics and wound care were done. After control of infection, confirmed by clinical and laboratory findings, the rectus abdominis free muscle flap was applied to cover remained large soft tissue defect and to prevent the recurrence of infection. All flaps survived and it provided satisfactory coverage for the soft tissue defect on the foot and the ankle area for a mean of 41.1 months (24~85) follow up period. All except of one patients did not have any recurrence of infection on the operation site and could salvage their limbs. The rectus abdominis free muscle flap could be recommended for large sized soft tissue defect after necrotizing abscess in diabetic foot to salvage major limb.

Treatment of the Femoral Shaft Nonunion Occurred after Intramedullary Nailing

Heun Guyn Jung(정현균),Dae Joong Kim(김대중),Byung Hak Kim(김병학),Young Yool Chung(정영율) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.5

목적: 골수강 금속정 고정후 발생한 대퇴골 불유합에 대해 여러 가지 방법으로 치료를 실시하고 각 방법들의 치료 효과에 대해 알아보고자 하였다. 대상 및 방법: 1996년 1월부터 2000년 12월까지 교합정 골수정 고정 후 발생한 대퇴골 불유합 31예를 연구대상으로 하였다. 26예는 위축성 불유합이었으며 5예는 비후성 불유합이었다. 31예의 불유합에 대해 총 45회의 수술적 치료를 하였다. 골이식술 14회, 골수강 금속정 교환술 13회, 금속판 보강술 및 골이식술 14회, 역동화 수술 4회이었다. 결과: 31예의 불유합에 대한 1회 수술 성공률은 58%이었다. 4예의 역동화 수술은 전 예에서 실패하였으며, 금속정 교환술은 13예 중 7예(54%)에서 골유합을 얻었다. 14예의 금속판 보강술과 골이식술은 전 예에서 골유합을 얻었다. 골유합은 골절후 평균 20개월에 얻었다. 결론: 본 연구를 통해 확공후 금속정 교환술은 모든 불유합에서 골유합을 얻는 것은 아니었으며, 금속판 보강술과 골이식술은 합병증없이 불유합을 치료할 수 있는 좋은 방법이었다. Purpose: To evaluate of efficacy of the treatment options for a femoral shaft nonunion occurring after intramedullary nailing. Material and Methods: Thirty-one patients with nonunion of a femoral shaft fracture, who had been treated with interlocking intramedullary nailing from January 1996 to December 2000, were examined. Twenty-six had oligotrophic nonunion and five were hypervascular. Forty-five procedures were performed for 31 nonunions; bone grafting for 14, exchange nailing for 13, plate augmentation and bone grafting for 14 and dynamization for 4 cases. Results: The success rate after a single procedure was only 58%. The four dynamization cases failed to unite. Seven of the 13 (54%) nonunion cases treated with nail exchange healed satisfactorily. All cases treated with plate augmentation and bone grafting achieved successful union. The mean period from fracture to union was 20 months. Conclusion: Exchange nailing is not always a reliable procedure for treating nonunion of a femoral shaft fracture. Plate augmentation and bone grafting were found to be a successful mode of therapy for the femoral shaft nonunion without complications.

난치성 창상에 음압치료의 적용

정현균(Heun Guyn Jung),기성찬(Sungchan Ki),김병학(Byunghak Kim),김관우(Kwanwoo Kim),김영경(Yungkyung Kim),조유경(Yungkyung Kim),최용수(Yongsoo Choi) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.1

Vibrio vulnificus에 의하여 발생한 화농성 슬관절염

정현균(Heun Guyn Jung),최진배(Jin Bae Choi),서유석(Yu Seok Seo) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.2

Vibrio vulnificus는 여름철 해수에서 서식하는 그람음성 간균으로 주로 간질환, 당뇨, 면역저하증 등의 기저질환을 가진 환자들에서 패혈증, 괴사성 근막염 등을 일으키는 치명적인 균주이다. 주로 어패류를 날것으로 먹거나 직접 상처를 통해 균이 침투를 함으로서 생기며, 열, 오한, 저혈압 등의 증상과 함께 홍반, 수포로 시작해 피부와 근육의 괴사로 이어지며, 높은 치사율을 보인다. 저자들은 처음에 화농성 관절염으로 임상적 발현을 한 Vibrio vulnificus 패혈증 감염 1예를 치험하였기에 문헌 고찰과 함께 보고하는 바이다. Vibrio vulnificus is a fatal marine Gram-negative bacillus that might cause septicemia, necrotizing cellulites in patients with underlying liver disease or an immunocompromised health status, and is associated with high mortality. It is usually attributed to the ingestion of raw shellfish or traumatic exposure to the marine environment. The clinical manifestation includes fever, chill, hypotension, and skin lesions such as erythematous patch, vesicle, bullae that develop into necrosis and wound infections. We report a case of Vibrio vulnificus septicemia and necrotizing fascitis in a patient who presented with septic arthritis of the knee as the first clinical manifestation.

원위부 요골 골절의 수술적 치료 후 방사선학적 정복소실 -K-강선 단독 고정과 외고정 장치 병행 고정 간의 비교-

정현균 ( Heun Guyn Jung ),최진배 ( Jin Bae Choi ),서승용 ( Seung Yong Seo ),최용수 ( Yong Soo Choi ) 대한골절학회 2006 대한골절학회지 Vol.19 No.4

목적: 원위부 요골 골절의 수술적 치료 중 K-강선 단독 고정과 K-강선과 외고정 장치 병행 고정 후 발생하는 방사선학적인 정복소실을 비교 분석하였다. 대상 및 방법: 원위부 요골 골절로 K-강선 단독 고정 혹은 K-강선과 외고정 장치 병행 고정술을 받은 환자 중 1년 이상 추시가 가능하였던 60예의 환자를 대상으로 수술 직후와 최종 추시상의 요골 길이, 요골 경사각 그리고 수장측 경사각의 정복 소실을 측정하여 수술방법, 골절의 분류, 연령군에 따라 비교 분석하였다. 결과: K-강선 단독 고정군의 수장측 경사각이 K-강선과 외고정을 병행 고정한 군에 비교하였을 때 더 많은 정복 소실을 보였다(p<0.05). K-강선 단독 고정군을 관절내 골절군과 관절외 골절군으로 나누어 비교하였을 때 관절내 골절군이 관절외 골절군보다 요골 길이와 요골 경사각에서 더 많은 정복 소실을 보였다 (p<0.05). K-강선과 외고정 병행 고정군내에서는 관절내 골절군과 관절외 골절군간에 방사선학적인 정복소실 면에서 유의한 차이는 보이지 않았다 (p>0.05). 60세 미만의 군과 60세 이상의 군으로 나누어 방사선학적 정복 소실을 비교하였을 때 통계적으로 유의한 차이를 보이지 않았다. 결론: 원위부 요골 골절 중에서 특히 관절내 골절의 경우 K-강선 단독 고정 시에는 관절외 골절에 비교하였을 때 정복 소실이 가능성이 높으므로 외고정을 추가하는 것이 정복 소실을 줄이는 방법이라 생각된다. Purpose: To compare and analyse radiologic reduction loss between fixation with K-wire only group and fixation with K-wire and external fixator group for surgical treatment of distal radial fracture. Materials and Methods: We analysed 60 patients who received the operative treatment with K-wire fixation only or K-wire and external fixator and also were in regular follow up at least one year. We compared radiologic reduction loss of radial length, radial inclination and volar tilt between immediate post-operative radiograph and latest follow up radiograph according to operative methods, fracture patterns and age groups. Results: Reduction loss of volar tilt was greater in fixation with K-wire only group than fixation with K-wire and external fixator group (p<0.05). Reduction losses of radial length and radial inclination were more in intra-articular subgroup than extra-articular subgroup in fixation with K-wire only group (p<0.05). No significant difference of reduction loss was noted between intra-articular and extra-articular subgroups in fixation with K-wire and external fixator group. Conclusion: More radiologic reduction loss can be expected in fixation with K-wire only group for intra-articular distal radius fracture compared with extra-articular distal radius fracture. Additional external fixation should be added in intra-articular distal radius fracture to reduce radiologic reduction loss.

연부조직 결손을 동반한 감염성 경골 불유합 및 골결손의 치료(유리피판술과 동시에 시행한 Ilizarov기구를 이용한 골연장술의 유용성)

송준영,정현균,서승용,장현호,Song, June-Young,Jung, Heun-Guyn,Seo, Seung-Yong,Jang, Hyun-Ho 대한미세수술학회 2005 Archives of reconstructive microsurgery Vol.14 No.1

Purpose: The purpose of this study was to evaluate the effectiveness of internal transport using Ilizarov apparatus with free flap surgery for infected tibial nonunion. Materials and Methods: We reviewed 8 patients of infected tibial nonunion treated with internal transport using Ilizarov apparatus and free flap surgery. Seven of eight patients were available for at least 1 year follow-up. All patients were male. The mean age at the time of the surgery was All fractures were Gustilo's type III B open fracture. The mean length of the bone defect was 8.5 cm. All used flaps for covering the soft tissue defect were free rectus abdominis muscle flap. We evaluated bone and functional results with use of the Paley and Catagni's classification. And we classified the complication with use of the Paley's classification. Results: Acceptable length and solid union of bone was achieved in all cases. The mean size of the bone length was 7.2 cm. The mean healing index was 69.5 days/cm. All but one case needed bone graft at docking site. All flaps were survived. There was no recurrence of infection. According to Paley and Catagni's classification, all cases showed excellent or good results. Complications were pin tract infection in 3 cases, persistent pain in 2 cases and limitation of joint motion in 2 cases. Conclusion: Simultaneous free-tissue transfer and Ilizarov distraction osteogenesis was thought to be an attractive treatment modality for infected nonunion of the tibia.

역행성 요측 전완부 피판을 이용한 수지 절단부 재건

송준영,정현균,서승용,장현호,Song, June-Young,Jung, Heun-Guyn,Seo, Seung-Yong,Jang, Hyun-Ho 대한미세수술학회 2005 Archives of reconstructive microsurgery Vol.14 No.1

Purpose: We analyzed the result of the radial forearm island flap for the reconstruction of amputated fingers. Materials and Methods: From March 2001 to February 2004, we assessed two patients who could not be able to receive replantation and six patients who had necrosis of the fingers after replantation. There were six men and two women. The mean age was 42 years. The average duration of follow-up was 26months. Results: All flaps were survived. Two patients needed bone graft. Two patients needed curettage due to osteomyelitis. All patients needed fat reduction procedure. No patients needed amputation of reconstructed digit due to complication. Conclusion: Radial forearm island flap seems useful operation procedure for severely amputated digit or necrotized digit after replantation.

불안정 원위부 요골 골절에서 수장 잠김 금속판 고정술 후 방형 회내근의 경과

임채현 ( Chae Hyun Lim ),정현균 ( Heun Guyn Jung ),허주영 ( Ju Yeong Heo ),장영재 ( Young Jae Jang ),최용수 ( Yong Soo Choi ) 대한골절학회 2014 대한골절학회지 Vol.27 No.3

Purpose: The purpose of this study is to evaluate the pronator quadrates muscle in patients who underwent internal fixation with a volar locking plate for unstable distal radius fractures. Materials and Methods: Forty patients who underwent internal fixation with a volar locking plate for unstable distal radius fracture were enrolled. We evaluated the clinical results according to the Mayo wrist score, the wrist range of motion, and the grip strength at the last follow-up. Using ultrasonography, muscle thickness of the pronator quadrates was compared between injured and uninjured arm. Results: Bone union was achieved in all cases. The mean Mayo wrist score was 82.79 points. The grip strength of the injured arm was decreased to 89.1% of the uninjured side. The decrease of pronation range of the injured wrist motions was significant (82.3￠ª, p=0.004). There was significant atrophy of the pronator quadrates muscle on the injured side (injured side: 3.19 mm, uninjured side: 4.72 mm, p=0.001); and the decrement of muscle thickness in pronator quadrates showed an association with the Mayo wrist score (r=-0.35, p=0.042). Conclusion: These results suggest that continuity of the muscle is maintained after use of the volar locking plating for unstable distal radius fractures with repair of pronator quadrates; however, there is atrophy of pronator quadrates muscle and limitation of pronation in the injured wrist.