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수부손상 후 발생한 Intrinsic contracture의 치험례
정전은,주훈성,박승하,김우경 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.4
A fine balance of the intrinsic and extrinsic muscles of the fingers provides the hand with its normal strength and exquisite versatility. When this balance is upset by contracture of the interossei, lumbricals, or hypothenar muscles, the fingers stiffen and the hand becomes disabled. Ischemic contracture of the intrinsic muscles of the hand is the result of ischemia and secondary intrinsic muscular retraction localized at the intrinsic muscles of the intermetacarpal compartments. Severe involvement of the interossei causes the hand to take up the characteristic "intrinsic plus deformity' with the metacarpophalangeal joints held flexed and the proximal interphalangeal joints extended. This results in a crippling loss of such vital functions of the hand as pinch and grasp. There is the importance of preventing severe and persisting edema of the hand. After injury the limb is elevated, and early fasciotomy of the different compartments of the hand is indicated when the surgeon believes that the intrinsic muscles are ischemic. The surgical procedures of preference to correct the estabilished deformity depend on the severity of the muscular retraction and deformity and the localization of the pathology. We report one case of post-traumatic intrinsic contracture with metacarpophalangeal flexion contracture after crushing injury of right wrist. In our cases, we performed surgical release of the intrinsic contracture by proximal intrinsic release, palmar metacarpophalangeal joint release, and collateral ligament release. By these methods, we were able to achieve sufficient release of the metacarpophalangeal flexion contracture, which increased range of motion about 40 to 60 degree, and good functional results of the hand.
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Distraction divice를 이용한 수지연장술 치험례
김수신,주훈성,김우경,정전은 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.2
The goal of reconstructive hand surgery is to maintain the normal mobile and sensory function of the hand while aesthetically be acceptable. In cases of congenital or post-traumatic shortening and loss of the digit, it is very important to achieve sufficient length of the digit with regard to functional and aesthetic aspect. The initial application of the distaction bone lengthening technique to the upper extremity reconstruction was performed by Matev(1967) for the correction of post-traumatic thumb deformities with first metacarpal lengthening. Matev and others have subsequently applied this method to congenital hand malformations and dislocations. The advantages of this method are; first, there is minimal bone resorption to the interpositional bone graft due to “bipolar nutrition”. second, normal sensibility is maintained. third, minimal sacrifice of other tissues as a donor. The authors used the Matev distraction divice to lengthen digits in 2 cases of post-traumatic shortening due to bone resorption and secondary scar contracture. By this method, we were able to maintain sufficient length of the digit so that the results were functionally and aesthetically accertable.
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