• 대한한의학회지
• /
• 제36권4호
• /
• pp.69-73
• /
• 2015

Objectives: This study was carried out to analyse the skin of the Hand lesser yang in human. Methods: The Hand lesser yang meridian was labeled with latex in the body surface of the cadaver, subsequently dissecting a body among superficial fascia and muscular layer in order to observe internal structures. Results: This study has come to the conclusion that a depth of the skin has encompassed a common integument and a immediately below superficial fascia, and this study established the skin boundary with adjacent structures such as relative muscle, tendon as compass. The skin area of the Hand lesser yang in human is as follows: The skin close to the ulnar root angle of 4th finger nail, above between 4th and 5th metacarpal bone, between extensor digit. minimi tendon(t.) and extensor digit. t., extensor digit. m(muscle). at 2, 4, 7 cun above dorsal carpal striation, triceps brachii m. t., deltoid m., trapezius m., just around the ear, upper orbicularis oculi m. Conclusions: The skin area of the Hand lesser yang from anatomical viewpoint seems to be the skin area outside the superficial fascia or the muscle involved in the pathway of the Hand lesser yang meridian, the collateral meridian, the meridian muscle, with the condition that we consider adjacent skins.

• 동의생리병리학회지
• /
• 제25권6호
• /
• pp.1050-1055
• /
• 2011

This paper presents a novel diagnostic method to determine Sasang Consitution (SC) by elasticity coefficient of hand dorsal skin of elderly people. For this purpose, we carried out a clinical test, in which Our SC diagnostic tool and one Oriental medical doctor with SC medicine expertise participated to categorize 458 healthy subjects into four constitutions. After excluding heavy-noise, we extracted 295 subjects' elasticity coefficient feature data and statistically analyzed their SC relevance with ANOVA test. It resulted in that, Taeum-in has high elasticity coefficient compared to Soeum-in in a significance level of 0.05. There are no differences of elasticity coefficient in genders. This result is supported by the theory of Longevity and Life Preservation in Eastern Medicine(Donguisusebowon, 동의수세보원) which suggested that Taeum-in's flesh is solid and Soeum-in's one is tender. This is the first work which reports the relatedness of skin elasticity coefficient and SC by an objective clinical test.

• Archives of Reconstructive Microsurgery
• /
• 제22권2호
• /
• pp.78-81
• /
• 2013

Neurofibroma may present as a solitary lesion or as multiple lesions. Although there is no site of predilection for solitary lesions, occurrence on the hand is rare. Plexiform neurofibroma can develop in isolation or more commonly as a part of neurofibromatosis type 1. In those that apper in isolation, trauma has been suggested as a precipitating factor. A 68-year-old male farmer had experienced repetitive prior episodes of trauma in the involved finger. He presented with a painless mass on the dorsal aspect of the fifth finger. Physical examination showed a protruding mass measuring approximately $15{\times}20mm$ which was not tenderness to palpation and any skin changes or pigmentation. Ultrasonography showed a cystic mass on the dorsal aspect of the middle phalanx. Microsurgical dissection was applied in order to seperated the lesion from the ulnar side of the dorsal branch of the digital nerve. Pathologic examination of the specimens revealed neurofibroma. At three-month follow-up, motor and sensory function were intact, and range of motion was fully recovered. Traumatic solitary neurofibroma is a rare tumor of the hand, especially in the finger. Hand surgeons should be aware of the diagnostic possibilities of this tumor based on examination, history taking and imaging studies.

• 대한간호학회지
• /
• 제43권1호
• /
• pp.30-38
• /
• 2013

Purpose: The study was done to explore variations in physiologic parameters of the stratum corneum (SC) of the dorsal hand and cord area during early days of life in high-risk newborns. Methods: In this longitudinal study, a total of 77 high-risk newborns were assessed for pH, temperature and hydration of the SC of the dorsal hand and the cord area on the $1^{st}$, $2^{nd}$, $3^{rd}$, $5^{th}$ and $7^{th}$ days of life. Results: Results showed that an acid mantle (AM) was formed in 57.1% for dorsal hand and 35.1% for cord area, implying significant delay regardless of decrease in pH (F=103.60, p<.001), and hydration (F=4.00, p=.003) across days in both areas. Peripheral hypothermia with low hydration level was also observed in both areas. There was a positive relation between hydration and temperature (.14

• Archives of Reconstructive Microsurgery
• /
• 제25권1호
• /
• pp.12-14
• /
• 2016

In cases of replantation, accurate closure of all structures, including bone, tendons, arteries, nerves, and veins is essential. Among these, the vein is a weaker structure and is damaged severely in most amputation cases. After fixation of bone, repair of tendons, nerves, and arteries, surgeons often experience difficulty in performing venous anastomoses. We found that in such cases, venous anastomosis is easy to perform using an additional incision after closure of the original wound. In a 33-year-old male patient with amputation of all four fingers at the metacarpophalangeal joint level, venous anastomoses were performed with dorsal veins using additional incisions after completion of the fixation of bones and repair of all other structures and closure of the skin due to surgical site tension.

• Archives of Reconstructive Microsurgery
• /
• 제19권2호
• /
• pp.108-111
• /
• 2010

Purpose: In reconstructing a defect on the dorsum of the hand, there are many cases of extensor tendons exposed or even missing. The repaired or reconstructed tendons need relevant gliding environment for good functional recovery. The anterolateral thigh flap offers a vascular fascial component with large amounts that can be used for covering exposed tendons and we report a unique case of single-stage hand dorsum and gliding surface reconstruction. Methods: A 35-year-old man had severe post-traumatic scarring in his left dorsal hand and coverage of the flap with split-thickness skin graft has been done before. After scarred skin excision and extensor tendon graft for missed part, a free anterolateral thigh adipofascial flap was used to resurface the hand dorsum and to reconstruct a two-layer gliding surface of the extensor tendons. The extensor tendons were wrapped in the fascial component with the fat layer inside. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. Good overall functional recovery and tendon excursion were observed. He was also satisfied with postoperative appearance. Conclusion: A free anterolateral thigh adipofascial flap was used successfully for reconstruction of a two-layer tendon gliding surface to treat a patient with severe scarring in the dorsal hand.

• Archives of Reconstructive Microsurgery
• /
• 제8권1호
• /
• pp.77-83
• /
• 1999

전북대학교병원 정형외과에서 1993년 8월부터 1997년 8월까지 족부 및 수부 손상 5례에 대하여 족 배 유리 피부판 이식술을 시행하고, 1999년 3월까지 최소 19개월부터 최장 67개월간 추시하여 다음과 같은 결과를 얻었다. 1. 나이별로는 9세부터 35세까지로 평균 23세 이었으며, 성별로는 전례가 남자이었으며, 족부에서 시행하였던 예가 4례, 수부에서 1례이었다. 2. 족부의 손상 원인은 교통사고 2례, 기계 사고 1례, 자전거 바퀴 사고 1례 이었으며, 수부에서는 교통사고에 의하여 전완부 요골의 개방성 골절이 동반되고 수부 배부의 다발성 신전 건 파열 및 피부 괴사에 의한 신전 건 노출 1례이었다. 3. 수여 동맥은 족 배 동맥 2례, 전 경골 동맥 1례, 후 경골 동맥 1례 그리고 척골 동맥이었으며, 수여 정맥은 족부 4례에서 2개 정맥을 문합하였으며, 5례(100%) 전례에서 성공하였다. 4. 추시 결과 유리 피판 이식술 후 외양(exterior)과 일상생활시 피부판이 손상되는 분쇄(maceration) 정도는 우수하였으나, 감각 회복 정토는 불량하였다. 5. 제공 부위인 족 배부는 유리 피판 이식술 3주 후 전층 식피술을 시행하여 완전 접착되었으며, 추시상 유병율없이 우수한 결과를 보였다.

• Archives of Reconstructive Microsurgery
• /
• 제17권2호
• /
• pp.115-119
• /
• 2008

Purpose: We reconstructed the skin defect of hands exposing tendons and/or bone with distally based ulnar artery flap and report our cases. Materials and Methods: Between March 2005 and September 2007, 6 cases of skin defect were reconstructed with distally based ulnar artery flap. Defect site were 5 cases of hand dorsal side and 1 case of hand volar side. The average defect size was $3{\times}3\;cm^2$. There were 4 men and 2 women and mean age was 55.5 years. We evaluated the viability of flap, postoperaive complication, healing time, patient's satisfaction. Results: There was no flap failure in 6 cases. But 1 case with recurrent discharge was healed with several times adequate debridement and delayed suture. 1 case with flap edema which might be due to venous congestion was healed with hand elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence was found in follow up period. Cosmetic results as judged by patients were that 3 cases are good and 3 cases are fair. Conclusion: Distally based ulnar artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Distally based ulnar artery flap is useful method for the skin defect of hands because it is simple procedure, has constant blood supply and relatively good cosmetic effect.

• Archives of Reconstructive Microsurgery
• /
• 제22권1호
• /
• pp.24-28
• /
• 2013

Purpose: Soft tissue defect of the hand, which cannot be covered with skin graft or local flap, is usually reconstructed using a free flap. Temporoparietal fascial free flap is one of the best alternatives for functional reconstruction of the hand with exposed tendons, bones, and joints. Materials and Methods: We have experienced four cases of reconstruction using a temporoparietal fascial flap with a skin graft and followed up for 20 years. We conducted a retrospective review of the patients' clinical charts and photos. Results: At the time of initial injury, the average age of patients was 50.3 (39~62) years. The radial artery was used for reconstruction of the dorsal side of the hand, whereas the ulnar artery was used for that of the volar side of the wrist. Short term complication such as skin graft loss and donor site alopecia occurred. However, during the long term follow-up period, no change of flap volume was noted, and full range of motion in the adjacent joint was maintained. In addition, hyperpigmentation of the grafted skin on the flap disappeared gradually. Conclusion: Selection of the optimal flap is important for reconstruction of the hand without functional limitation. We obtained satisfactory soft tissue coverage and functional outcomes using a temporoparietal fascial free flap and followed up for 20 years.

• Archives of Plastic Surgery
• /
• 제37권4호
• /
• pp.396-399
• /
• 2010

Purpose: In hand injury, pedicle is usually damaged by avulsion injury or crushing injury. Because of postoperative pedicle obliteration, it is often hard to save the injured hand and fingers, even after successful replantation. The author introduces three cases of extensive hand injury, and successful results after applicatoin of multiple venous grafts to these patients. Methods: In all cases there was no circulation in any finger. In the first case, some vessels were extracted, so venous graft was applied to two sites of severely damaged venous sites. In the second case, venous grafts were applied to all four digital arteries of all fingers except thumb which got severely crushed, and two sites of dorsal veins. In the third case, venous graft was applied to all four digital arteries of all five fingers, and two sites of dorsal veins and palmar veins each. Results: In all cases, survival of hands and fingers was successful. In the second case, however, amputation in thumb and little finger at DIP joint level was inevitable, because of its severe damage, and the large dorsal defect on index finger was filled with DIEP free flap. Thumb was reconstructed with toe-to-thumb free flap, and additional debulking procedures and contracture release is furtherly needed. In the first case, additional surgery was done, as FDP tendon got re-ruptured, but in long term follow-up, satisfactory range of motion was attained. In the third case, FTSG on dorsal skin region was planned. as flap on dorsal area got partial necrosis. Conclusion: In hand injury, there are many structures to be repaired, but sometimes venous graft is avoided for its long operating time. Even though the length of damaged vessel is enough for anastomosis, the endothelium is often damaged (zone of injury). In extensive hand injury, successful reconstruction would be possible with active venous graft to all vessels suspicious for damage.