Mickey Cho - Academia.edu (original) (raw)

Papers by Mickey Cho

Plastic and Reconstructive Surgery Global Open, 2018

PURPOSE: The medial sural artery perforator (MSAP) flap offers thin, pliable tissue with a relati... more PURPOSE: The medial sural artery perforator (MSAP) flap offers thin, pliable tissue with a relatively long pedicle. Compared to other thin fasciocutaneous flaps, its relatively low donor site morbidity makes the MSAP flap a valuable option for the reconstructive microsurgeon. The purpose of this study is to systematically evaluate the literature on use of MSAP flaps with regards to flap characteristics, indications, recipient site defects, and postoperative outcomes.

Clinical Orthopaedics and Related Research, 2004

The technique of cancellous impaction allografting with cement aims to reconstitute a bone-defici... more The technique of cancellous impaction allografting with cement aims to reconstitute a bone-deficient proximal femur while also gaining stable fixation of the femoral prosthesis. Some reports of this technique imply it is a system, requiring not just an exacting surgical method, but also a particular implant design, the polished, double-tapered stem. Other series consider it a surgical technique, and have varied the femoral component design, the method of graft delivery, and other elements of the procedure. Our review evaluates the current literature, with the goal of beginning to ascertain whether published results suggest impaction grafting must be considered a system, requiring a particular stem design, or simply another means to achieve femoral reconstruction in the revision setting. The conclusive answer will require randomized, controlled clinical trials to evaluate particular elements of the procedure, and these studies have yet to be done. However, investigators have shown similarly good short-term to intermediate-term results with various femoral stems at numerous centers. Currently, femoral impaction allografting, whether as a system using particular implant designs or as a surgical technique, is an accepted alternative for revision of a failed femoral component, particularly when bone-stock deficiency is present.

BMC musculoskeletal disorders, Jan 20, 2018

The objective of this analysis is to evaluate the necessity of large clinical trials using FLOW t... more The objective of this analysis is to evaluate the necessity of large clinical trials using FLOW trial data. The FLOW pilot study and definitive trial were factorial trials evaluating the effect of different irrigation solutions and pressures on re-operation. To explore treatment effects over time, we analyzed data from the pilot and definitive trial in increments of 250 patients until the final sample size of 2447 patients was reached. At each increment we calculated the relative risk (RR) and associated 95% confidence interval (CI) for the treatment effect, and compared the results that would have been reported at the smaller enrolments with those seen in the final, adequately powered study. The pilot study analysis of 89 patients and initial incremental enrolments in the FLOW definitive trial favored low pressure compared to high pressure (RR: 1.50, 95% CI: 0.75-3.04; RR: 1.39, 95% CI: 0.60-3.23, respectively), which is in contradiction to the final enrolment, which found no diffe...

There is a significant need for orthopaedic care in developing countries. For the past 10 years, ... more There is a significant need for orthopaedic care in developing countries. For the past 10 years, the United States Army has supported annual orthopaedic hand surgery humanitarian missions to Honduras. The goal of this article is to compare the premission planning to the realities of mission execution to provide a template for future missions. Premission planning began 1 year before the mission. Based on previous missions, supplies were brought for 50 surgical cases. The mission began with 1 preoperative clinic day followed by 8 operative days and 1 postoperative clinic day. Of the 99 prescreened patients, 65 were indicated for surgery. A total of 58 surgeries were performed using innovative methods to stretch available supplies. A multidisciplinary and multination concerted effort is required for a successful humanitarian medical mission. A premission plan is critical prior to arrival and a contingency plan must be in place for missing mission-critical items.

Journal of surgical orthopaedic advances, 2010

Due to the nature of the wounds and environment, internal fixation in battlefield treatment facil... more Due to the nature of the wounds and environment, internal fixation in battlefield treatment facilities is discouraged despite the lack of data. The purpose of this review is to describe the outcomes of fractures that were internally fixed in the combat environment. The records of patients who had internal fixation performed in the theater of combat operations were reviewed. Demographics, injury characteristics, procedure history, and outcomes were recorded and analyzed. Forty-seven patients had internal fixation performed on 50 fractures in a combat theater hospital. Hip, forearm, and ankle fractures made up the majority of cases with 14 (28%), 14 (28%), and 10 (20%), respectively. Sixteen (32%) fractures were open. The average Injury Severity Score was 11.4 +/- 1.1 (range, 4-34). Thirty-nine fractures (78%) healed without incidence. There was one (2%) infection and one (2%) acute surgical complication. Ten (20%) fractures, including the one infection, required additional procedures...

Microsurgery

Background: Peripheral nerve damage resulting in pain, loss of sensation, or motor function may n... more Background: Peripheral nerve damage resulting in pain, loss of sensation, or motor function may necessitate a reconstruction with a bridging material. The RANGER ® Registry was designed to evaluate outcomes following nerve repair with processed nerve allograft (Avance ® Nerve Graft; Axogen; Alachua, FL). Here we report on the results from the largest peripheral nerve registry to-date. Methods: This multicenter IRB-approved registry study collected data from patients repaired with processed nerve allograft (PNA). Sites followed their own standard of care for patient treatment and follow-up. Data were assessed for meaningful recovery, defined as ≥S3/M3 to remain consistent with previously published results, and comparisons were made to reference literature. Results: The study included 385 subjects and 624 nerve repairs. Overall, 82% meaningful recovery (MR) was achieved across sensory, mixed, and motor nerve repairs up to gaps of 70 mm. No related adverse events were reported. There were no significant differences in MR across the nerve type, age, time-to-repair, and smoking status subgroups in the upper extremity (p > .05). Significant differences were noted by the mechanism of injury subgroups between complex injures (74%) as compared to lacerations (85%) or neuroma resections (94%) (p = .03) and by gap length between the <15 mm and 50-70 mm gap subgroups, 91 and 69% MR, respectively (p = .01). Results were comparable to historical literature for nerve autograft and exceed that of conduit. Conclusions: These findings provide clinical evidence to support the continued use of PNA up to 70 mm in sensory, mixed and motor nerve repair throughout the body and across a broad patient population.

Plastic and Reconstructive Surgery - Global Open

The Journal of Hand Surgery

Injury, Jan 28, 2016

There is limited research to guide physicians and patients in deciding whether it is safe to driv... more There is limited research to guide physicians and patients in deciding whether it is safe to drive while wearing various forms of upper extremity immobilization. The purpose of this study is to evaluate the effect of below-elbow removable splints and fiberglass casts on automobile driving performance. 20 healthy subjects completed 10 runs through a closed, cone-marked driving course while wearing a randomized sequence of four different types of immobilization on each extremity (short arm thumb spica fiberglass cast, short arm fiberglass cast, short arm thumb spica splint, and short arm wrist splint). The first and last driving runs were without immobilization and served as controls. Performance was measured based on evaluation by a certified driving instructor (pass/fail scoring), cones hit, run time, and subject-perceived driving difficulty (1-10 analogue scoring). The greatest number of instructor-scored failures occurred while immobilized in right arm spica casts (n=6; p=0.02) an...

Journal of Orthopaedic Trauma, Apr 1, 2014

Much attention has been given to lower extremity amputations that occur more than 90 days after i... more Much attention has been given to lower extremity amputations that occur more than 90 days after injury, but little focus has been given to analogous upper extremity amputations. The purpose of this study was to determine the reason(s) for desired amputation and the common complications after amputation for those combat-wounded service members who underwent late upper extremity amputation. Retrospective case series. Tertiary trauma center. All US service members who sustained major extremity amputations from September 2001 to July 2011 were analyzed. Late (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;90 days after injury) upper extremity amputations. Amputation level(s), time to amputation, age, number of operations, pre/postoperative complications, reason(s) for desiring amputation, and disability outcomes were analyzed. Seven of 218 (3.2%) upper extremity amputees had a late upper extremity amputation (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;90 days from injury to amputation). The mean and median number of days from injury to amputation was 689 and 678, respectively. The most common preamputation complications were loss of wrist or finger motion (7, 100%), neurogenic pain (4, 57%), and heterotopic ossification (4, 57%). Three (43%) patients (2 persistent and 1 new onset) had neurogenic pain and 2 (29%) had heterotopic ossification after amputation. Only 57% (4 of 7) of amputees used their prostheses regularly. Service members undergoing late upper extremity amputation seem to have different pre- and postoperative complications than those patients undergoing late lower extremity amputations. It was common for the amputee to not wear their prostheses and to experience similar complications after amputation, albeit in a less severe form.

Impaction Bone Grafting in Revision Arthroplasty, 2004

Introduction: Interest in alternatives to nerve autograft exist, however limited clinical data ha... more Introduction: Interest in alternatives to nerve autograft exist, however limited clinical data has been published on their use in mixed and motor nerve injuries. As such, a multicenter study was initiated to evaluate clinical outcomes of processed nerve allografts (Avance® Nerve Graft, AxoGen Inc.). We report a subgroup analysis from the outcomes data of observed safety and efficacy in mixed and motor nerve repairs. Methods: Following IRB approval, utilization from the twelve participating centers and 25 surgeons resulted in 132 nerve injuries being contributed over a two year period. Data was collected on the injury, repair, safety and outcomes using standardized case report forms. A review and analysis of mixed and motor nerve repairs was completed. Quantitative and qualitative measures were reviewed and reported. Quantitative measures included: 2-point discrimination, MRCC scale for sensory and motor nerves, range of motion, strength testing and electromyography (EMG) studies. Qu...

Introduction: Severe trauma often results in complex peripheral nerve injuries that challenge eve... more Introduction: Severe trauma often results in complex peripheral nerve injuries that challenge even the most skilled reconstructive surgeon. As these injuries are highly variable, prospective clinical research on treatment algorithms are limited. In 2008, a multicenter, retrospective study was initiated to capture data on outcomes from the utilization of processed nerve allografts in today’s clinical practice. Analysis yielded a subgroup presenting with complex traumatic injuries requiring extensive soft tissue reconstructions. Here we report our findings on the outcomes of complex peripheral nerve injuries reconstructed using processed nerves allografts. Methods: The IRB approved study enrolled 12 sites with 25 contributing surgeons. Standardized data collection forms were completed for 132 individual nerve injuries. The aggregate data was reviewed to identify the subset of patients with multi-tissue, high energy, and extensive reconstructions. Quantitative assessment included: MRCC...

Journal of surgical orthopaedic advances, 2011

The Journal of Hand Surgery, 2014

Orthopedics, 2014

This study evaluates the exposure of the distal humerus articular surface obtained using a tricep... more This study evaluates the exposure of the distal humerus articular surface obtained using a triceps hemi-peel approach versus the triceps-flexor carpi ulnaris (TRIFCU) approach. Twelve cadaveric upper extremity specimens were dissected using a lateral-to-medial hemipeel modification of the TRIFCU approach to the elbow. After completing the hemi-peel exposure, the visible border of the articular surface was marked with a permanent ink pen. The dissection was continued to complete a standard TRIFCU approach, and the visible border of the exposure was again marked. The elbow was disarticulated, and calibrated digital images were taken to quantify the humeral surface area exposed through each approach. During both approaches, the surgeon's ability to visualize the intertrochlear groove, medial crista anterior crest, medial crista posterior crest, anterior capitulum, and posterior capitulum was recorded. No difference was found in the surgeons' ability to identify the 5 designated anatomic landmarks using the hemi-peel versus the TRIFCU approach. The TRIFCU exposed an average of 6.68 cm 2 of the trochlear articular surface, whereas the hemi-peel approach exposed an average of 5.93 cm 2. The average difference between the exposures was 0.75 cm 2 (P<.001), or 12.5%. The hemi-peel and TRIFCU approaches to the elbow both allow excellent visualization of the distal humerus articular surface. The hemi-peel exposure is a useful approach for the accurate reduction and fixation of displaced intra-articular distal humerus fractures.

The Journal of bone and joint surgery. American volume, Jan 16, 2013

Clinical Orthopaedics and Related Research®, 2014

Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputat... more Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied. We evaluated the effect of TMR on residual limb neuroma pain in upper-extremity amputees. We conducted a retrospective medical record review of all 28 patients treated with TMR from 2002 to 2012 at Northwestern Memorial Hospital/Rehabilitation Institute of Chicago (Chicago, IL, USA) and San Antonio Military Medical Center (San Antonio, TX, USA). Twenty-six of 28 patients had sufficient (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 months) followup for study inclusion. The amputation levels were shoulder disarticulation (10 patients) and transhumeral (16 patients). All patients underwent TMR for the primary purpose of improved myoelectric control. Of the 26 patients included in the study, 15 patients had evidence of postamputation neuroma pain before undergoing TMR. Of the 15 patients presenting with neuroma pain before TMR, 14 experienced complete resolution of pain in the transferred nerves, and the remaining patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s pain improved (though did not resolve). None of the patients who presented without evidence of postamputation neuroma pain developed neuroma pain after the TMR procedure. All 26 patients were fitted with a prosthesis, and 23 of the 26 patients were able to operate a TMR-controlled prosthesis. None of the 26 patients who underwent TMR demonstrated evidence of new neuroma pain after the procedure, and all but one of the 15 patients who presented with preoperative neuroma pain experienced complete relief of pain in the distribution of the transferred nerves. TMR offers a novel and potentially more effective therapy for the management of neuroma pain after limb amputation.

Surgical and Radiologic Anatomy, 2006

Several radiologic measurement methods have been described for determining static carpal alignmen... more Several radiologic measurement methods have been described for determining static carpal alignment of the wrist. These include the scapholunate, radiolunate, and capitolunate angles. The triangulation method is an alternative radiologic measurement which we believe is easier to use and more reproducible and reliable than the above mentioned methods. The purpose of this study is to assess the intraobserver reproducibility and interobserver reliability of the triangulation method, scapholunate, radiolunate, and capitolunate angles. Twenty orthopaedic residents and staff at varying levels of training made four radiologic measurements including the scapholunate, radiolunate and capitolunate angles as well as the triangulation method on five different lateral, digitized radiographs of the wrist and forearm in neutral radioulnar deviation. Thirty days after the initial measurements, the participants repeated the four radiologic measurements using the same radiographs. The triangulation method had the best intra-and-interobserver agreement of the four methods tested. This agreement was significantly better than the capitolunate and radiolunate angles. The scapholunate angle had the next best intraobserver reproducibility and interobserver reliability. The triangulation method has the best overall observer agreement when compared to the scapholunate, radiolunate, and capitolunate angles in determining static carpal alignment. No comment can be made on the validity of the measurements since there is no radiographic gold standard in determining static carpal alignment.