A 58-year-old man presented with postprandial pain that radiated to the right shoulder and right flank. He had undergone a laparoscopy-assisted distal gastrectomy with Billroth II anastomosis 2 months previously for Borrmann type III advanced gastric cancer. The operation had been uneventful and he had been discharged without any complications. However, about a week after being discharged he developed abdominal discomfort that worsened after eating. Because of the progressive postprandial abdominal pain, which was unrelated to gastric dumping syndrome or blind loop syndrome, his oral intake had reduced and he had lost 6 kg since the time of the operation.
24세의 남자 환자로 동아대학교병원 내원 3주 전 지역 병원에서 전방십자인대 재건술을 시행하였다. 지역 병원에서의 재건술에 는 transtibial technique을 이용하여 대퇴부 터널을 만든 뒤 동종 아킬레스건을 삽입하였고 대퇴골은 cross-pin system인 Rigidfix (Depuy Mitek Inc., Raynham, MA, USA)를 이용하여 고정하였으 며 경골은 생체흡수성 간섭 나사와 4.5 mm 피질골 나사를 워셔와 함께 고정하였다. 술 후 2주경 수동적 관절 운동을 90까지 시행 하였으며 당시 특별한 통증이나 불편감 등의 문제는 없다고 판단 하여 부분 체중 부하를 시행하였다고 하였다. 그러나 환자가 술 후 16일경 관절 운동 도중 무릎에서 ‘뚝’하는 소리가 들리는 것을 인지하여 자기공명영상 촬영을 비롯한 추가적인 검사를 시행한 후 대퇴골 cross-pin의 파열 의심 소견과 후방의 신경혈관의 손상 이 우려되어 본원 응급실로 전원되었다. pISSN : 1226-2102, eISSN : 2005-8918 350
Purpose: If the primary suture is difficult due to the large size of a tendon defect, reconstruction of the defective tendon is attempted through tendon transfer or tendon graft. The Pulvertaft technique is most commonly used, but it increases bulk and friction, and it could cause adhesion formation. In order to overcome these problems, we aimed to introduce a new technique.Methods: We retrospectively reviewed 22 patients who underwent tendon reconstruction using the modified Pulvertaft technique due to tendon defects from January 2016 to December 2021. An abbreviated version of the original DASH (Disabilities of Arm, Shoulder and Hand) outcome measure (QuickDASH) was measured 3 months after surgery. Until the final follow-up observation, tendon rerupture, infection, tendon-related complications (quadriga effect, motion limitation due to bulky size of the suture site), and contracture were measured. QuickDASH was compared according to the cause of the tendon defect and the type of operation using the Mann-Whitney test.Results: The mean QuickDASH score measured 3 months after surgery was 10.42±7.83. No statistically significant difference in the QuickDASH score was found between patients who underwent tendon transfer and those who underwent tendon grafts (p=0.988). Rerupture occurred in 1 case, and there were no cases of infection, tendon-related complications (quadriga effect, motion limitation due to bulky size of the suture site), or contracture.Conclusion: The orthogonal passing-through suture technique could be a new alternative to the tendon reconstruction technique.
This study aimed to determine how the muscle mass of the lower leg affects the preservation of the lower extremities in patients with diabetic foot ulcer. This study analyzed patients with diabetic foot ulcer between January 2014 and June 2018 with a follow-up of at least 2 years. Of these 181 patients whose ulcer is located distal to the metatarsophalangeal joint, which was categorized as grade ≤2 by the Wagner classification were classified into 4 grades: grade 0 (treated without amputation), grade 1 (amputation distal to the metatarsophalangeal joint), grade 2 (Ray, transmetatarsal, Lisfranc, and Chopart amputation), and grade 3 (Syme, below-knee, and above-knee amputation) according to the final amputation degree. The muscles of the lower leg were classified into 4 compartments: anterior, lateral, deep posterior, and superficial posterior. The cross-sectional area and attenuation to estimate the muscle volume and density were measured at the axial image of computed tomography (CT) angiography. No significant differences were observed in the sex ratio and mean age among the grades (P = .966 and .962). The cross-sectional area of the anterior, lateral, and posterior compartments demonstrated no significant differences, but that of the superficial posterior compartment exhibited significant differences among the grades (P < .001). Moreover, the attenuation of the anterior, lateral, and deep posterior compartments showed no significant differences, but that of the posterior compartment showed significant differences among the grades (P = .003). The muscle mass of the superficial posterior compartment of the lower leg could be a good indicator of the preservation of the lower extremity in patients with diabetic foot ulcer. Therefore, a strengthening exercise for the triceps surae and plantaris muscles in the early stage could help preserve as much of the lower extremities as possible.
diabetes and infection is usually accompanied with DFU, therefore antibiotic treatment is often required. 1)Since the need for admission care is inevitable in most patients associated with infection, the economic burden of medical expenses is growing annually. 2)In patients with diabetes, since immunity weakens with decreased function of neutrophil, soft tissue infections can worsen quickly and may be associated with osteomyelitis and sepsis without adequate antibiotic therapy. 3)Recent studies have reported that antibiotic-resistant bacteria in patients with DFU are becoming
Purpose: The prospective study conducted by an independent examiner included an overall series of 104 ligamento-plasties using the fascia lata (Jaeger procedure). Material and methods: All procedures were performed by the same operator and outcome was assessed at least 12 months after operation (mean follow-up 27 months). Results and discussion: The IKDC scores were comparable with other series using autotransplants: 39% A, 45% B, 12% C, 4% D. Mean residual laxity differential (KT 2000) was 1.92 mm (−2 to 6 mm) and showed the anatomic efficacy of this technique. Extra-articular reinforcement was determinant in supporting the intra-articular plasty, calibrated at 6 mm diameter, explaining the good score obtained for residual differential laxity in sub-extension: 54% A, 29%B, 3%C. Laxity measured between +2 and +3 mm in 14% of the patients who could not be classed in the IKDC A and B classes. Mixed plasty with the fascia lata neutralised rotation clicks in 90.4% of the cases. The lateral portion of the mixed plasty did not raise any problem for ligamentisation explaining its efficacy and low rate of rotation clicks at last follow-up. All professional athletes in this series and all athletes participating in high-level competitions were able to resume their former sports activity at the same level; for the entire series 67% resumed their former sports activities at the same level. Thirty-eight competition level athletes (n=63, 60%) resumed competition after surgery, 24 (38%) practised leisure sports. The change to leisure sports in these 24 patients was related to the knee plasty in eight. Irreducible knee flexion (+5°) was related to reflex dystrophy in four patients. Eleven patients presented reflex dystrophy; two had mobilisation under general anaesthesia. None of the patients had a painful harvesting site. Among the four cases with lateral decoaptation, two were related to poor dissection of the posterolateral angle without any pre-existing lesion of the peripheral formations. Section of the lateral intermuscular partition allowed complete closure of the fascia lata in all the difficult cases. We had only one case of proximal muscular herniation at the harvesting site.
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