Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap

BACKGROUND: Severe forefoot deformities, particularly those involving the dorsum of the foot, cause inconvenience in daily activities of living including moderate pain on the dorsal aspect of the contracted foot while walking and difficulty in wearing nonsupportive shoes due to toe contractures. This paper presents clinical results of reconstruction of severe forefoot deformity using the anterolateral thigh (ALT) free flap. METHODS: Severe forefoot deformities were reconstructed using ALT flaps in 7 patients (8 cases) between March 2012 and December 2015. The mean contracture duration was 28.6 years. RESULTS: All the flaps survived completely. The size of the flaps ranged from 8 cm × 5 cm to 19 cm × 8 cm. The mean follow-up period was 10 months (range, 7 to 15 months). There was no specific complication at both the recipient and donor sites. There was one case where the toe contracture could not be completely treated after surgery. All of the patients were able to wear shoes and walk without pain. Also, the patients were highly satisfied with cosmetic results. CONCLUSIONS: The ALT flap may be considered ideal for the treatment of severe forefoot deformity.

Replantation for Segmental Amputation of the Digits and Hand: A Case Report

Segmental amputation of the digits and hand has been described as a contraindication for replantation because of poor results. We report the results of replantation for a patient who experienced multi-segment amputation of the hand. A 39-year-old man presented six hours after an accident, while using a straw cutter, that caused a multi-segment amputation of the entire palm and digits. The replantation surgery took 18 hours. We observed the patient gain satisfactory function of the hand. For replantation of a multi-segment amputation, connecting as many blood vessels as possible without tension is most important.

Analysis of Predictors of Results after Surgical Treatment of Acetabular Fractures / 대한고관절학회지

PURPOSE: The aim of this study was to analyze the factors affecting the outcomes after surgical treatment of acetabular fractures. MATERIALS AND METHODS: Between January 2000 and December 2012, 106 patients with acetabular fractures were treated with open reduction and internal fixation. We performed a retrospective cohort study to analyze the factors which may influence a patient's prognosis after surgical treatment of an acetabular fracture. The factors examined included age, femoral head injury, fracture type, dislocation, initial displacement, delay to injury-related surgery (in days), and quality of reduction. Additionally, we investigated clinical and radiological outcomes, as well as the development of osteoarthritis. RESULTS: Patients included 85 males (80.2%) and 21 females (18.8%) with a mean age of 50.4 (17-78) years. The mean follow-up period was 2.6 (1-10) years. In a univariable regression analysis, quality of reduction, age, and initial displacement were significantly associated with radiological and clinical outcomes. In a multivariable regression analysis, quality of reduction (P<0.001) and initial displacement (P=0.001) were found to be factors predictive of clinical and radiological outcomes. Additionally, the quality of reduction (P=0.005) was found to be predictive of osteoarthritis development. CONCLUSION: Study results indicated that the quality of reduction was the most important factor influencing the prognosis of patients with acetabular fractures.

Age-Related Changes of Catalase Immunoreactivity in the Main Olfactory Bulbs of Wistar and Spontaneously Hypertensive Rats / 대한해부학회지

The reactive oxygen species (ROS) is well-known for the causative factors inducing ischemia, Parkinson's disease, Alzheimer, amylotrophic lateral sclerosis, hypertension and aging. Catalase (CAT) is an important endogenous antioxidant enzyme against ROS because it removes H2O2 during metabolic processes. Hence, we examined the age-related changes of CAT-immunoreactivity in the main olfactory bulbs (MOB) of the Wistar and spontaneous hypertensive rat (SHR) at various aging stages over 2 years periods; postnatal month 6 (PM 6), PM 12, PM 18 and PM 24. CAT immunoreactive (IR) neurons in Wistar rats were located in the glomerular layer (GL), external plexiform layer (EPL), internal plexiform layer (IPL) and granule cell layer (GCL). The number of CAT-IR neurons slightly decreased agedependently and nearly disappeared at PM 24. At PM 6 and PM 12, the CAT-IR neurons located in the EPL were morphologically identified as granule cells. However, at PM 18 and PM 24, CAT-IR neurons located in the EPL and mitral cell layer (MCL) were morphologically identified as tufted and mitral cells, respectively. CAT-IR neurons in the SHR were located in all layers of the MOB. The number of CAT-IR neurons and CAT immunoreactivity decreased agedependently and nearly disappeared especially in the GL and EPL at PM 24. These findings indicate that the decrease of CAT immunoreactivity may be one of the causative factors for increase of oxidative stress, and these damages may underlie age-related changes in the olfactory process. The early decrease of CAT immunoreactivity in the SHR than in the Wistar rat suggests that the early decreae of CAT may be associated with the cause of hypertensive neuronal damage.

Seizure Induced Alteration of Microtubule Associated Proteins Immunoreactivities in the Mongolian Gerbil Striatum / 대한해부학회지

The present study involves a chronological and comparative analysis of both microtubule-associated protein 1A (MAP1A) and microtubule-associated protein 2 (MAP2) immunoreactivities in the striatum of both seizure resistant (SR) and seizure sensitive (SS) gerbil. The MAP1A immunoreactivity is weakly detected in perikarya of SR gerbils. However, MAP1A immunoreactivity is more accumulated in perikarya and dendrites in the pre-seizure group. At 30 min postictal, MAP1A immunoreactivity in the perikarya is decreased. At 3 hr postictal, MAP1A immunoreactivity in perikarya and dendrites is similarly decreased to the level of SR gerbils. The MAP2 immunoreactivity is weakly detected in the perikarya and dendrites of SR gerbils. However, MAP2 immunoreactivity is more accumulated in perikarya and dendrites. In particular, the neuropil between unstained fiber tracts obviously contains strong MAP2 immunoreactivity. At 30 min postictal, MAP2 immunoreactivity isn't almost observed in striatum. At 3 hr postictal, the MAP2 immunoreactivity is not different in the 30 min post -seizure groups but is only observed in the neuropil. However, at 12 hr postictal, the decrease of both MAP1A and MAP2 immunoreactivities had recovered to the pre -seizure level of SS gerbils. These results suggest that MAPs immunoreactivity in the striatum is different in SR and SS gerbils, and that this difference may be the results of seizure activity in this animal.

Chronological Alteration of Calbindin D-28k and Calretinin Immunoreactivity in the Gerbil Trigeminal Ganglion After Ischemia-Reperfusion / 대한해부학회지

Many researches have focused upon temporal changes of neurotransmitters and/or neuromodulators in the central nervous system after ischemic insult. In sensory neurons, the spatial and temporal alterations of neurotransmitters have been little studied. Calbindin D-28k (CB) and calretinin (CR) have been suggested to play a role in the transmission of neurotransmitters. Therefore, in the present study we investigated the chronological alteration of CB and CR immunoreactivity in the trigeminal ganglion cells of the Mongolian gerbil after ischemic insult. In the sham operated group, CB and CR immunoreactivities were found in small -, medium -and large -sized neurons. One and two days after ischemia-reperfusion, small and large-sized CB immunoreactive neurons increased significantly. Thereafter, number of the CB immunoreactive neurons decreased markedly. Furthermore, five days after ischemia -reperfusion, CB immunoreactivity was detected in a few neurons, and its immunoreactivity was also very weak in the cytoplasm. Number of the large -sized CR immunoreactive neurons increased significantly one day after ischemia -reperfusion. Thereafter, the number of the large -sized CR immunoreactive neurons decreased. Especially, the number of the medium-sized CR immunoreactive neurons increased dramatically 4 days after ischemia-reperfusion. These results suggest that an increase of CB and CR may play an important role in modulating the mechanoception 1 day after ischemia-reperfusion, because the immunoreactivities increased in large -sized neurons which have the myenlinated A fibers. These results also suggest that significant increase of CR expression in medium -sized neurons 4 and 5 days after ischemia-reperfusion may provoke CR in modulating the nociception or thermoception because the medium-sized neurons which have the myenlinated A sigma or C fibers.