• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.46-49
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• 2002

Background: Free flaps have become a very important role in the ablative head and neck surgery with functional preservation of defect sites. The forearm free flap has many advantage of lack of bulk, ease of dissection, vascularity, and malleability. Patients and Methods: A review of 51 radial forearm free flaps performed between may 1990 and feburary 2001 at the Korea University was undertaken to determine outcome. Patient age ranged 27 to 72 years (mean 56). There were 44 men and 7 women. The most prevalent neoplasm was squamous cell carcinoma. Results: The tans verse cervical artery and the external jugular vein were the most frequent receipient sites for microvascular anastomosis. Total flap loss occurred in 2 cases (4%) and other complications were seen in 42%. Fifteen patients received preoperative irradiation and the complication was higher than non-irradiation patients, but statistically not significant. Conclusion: The radial forearm free flap offers a variety of reconstructive options for head and neck. Its low flap loss and complication rates offer the best choice for reconstruction of defect of head and neck malignancy.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.499-503
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• 2008

Berry syndrome (a distal aortopulmonary window and a right pulmonary artery originating from the ascending aorta, an intact ventricular septum, a patent ductus arteriosus and an interrupted aortic arch) is a rare complex congenital cardiac malformation. We describe a case of one stage repair with using an autologous arterial flap in a 19-day-old neonate who was suffering with this malformation, and we report on the development of postoperative right pulmonary artery stenosis and its successful management with performing multiple balloon angioplasties.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.336-341
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• 2007

Purpose: The most accepted method for the reanimation of a paralyzed face is the two-stage method that combines cross-face nerve grafting with free-muscle transfer. Although the results of reconstruction with this method are satisfactory, there is an excessive delay between the stages, which prolongs the period of rehabilitation. In order to overcome this drawback, a one- stage, neurovascular free-flap reconstruction method using free neurovascular muscle flaps is introduced. Methods: From 1994 to 2004, 35 patients with longstanding facial palsy were treated. Fifteen patients underwent the single-stage reconstruction with the latissimus dorsi muscle, and 20 patients underwent the two-stage reconstruction method with the gracilis muscle. We compared the long-term results of the two methods of reconstruction. The mean follow-up period was 28.7 months for one-stage reconstruction, and 35.2 months for the two-stage, respectively. Results: In the patient group of the single stage reconstruction, both mouth corner excursion and animation grade were markedly improved at the final postoperative visit. Moreover, the first muscle contraction occurred earlier in this group, than in the two-stage reconstruction group. However, four patients in the single stage group never achieved a first muscle contraction or mouth corner excursion. Conclusion: Facial palsy is a very challenging condition for cosmetic surgeons to deal with. Traditional methods for treatment of chronic facial palsy use a two-stage muscle flap which is time-consuming and burdensome to patients, many of whom are averse to waiting 8 to 12 months to complete the two stages. The one-stage reconstruction method described herein uses a latissimus dorsi free-flap and has demonstrated consistent positive outcomes in clinical assessments.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.75-79
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• 2009

Purpose: The transverse rectus abdominis musculocutaneous(TRAM) flap is the most commonly used autogenous tissue flap for breast reconstruction. Postoperatively, partial flap loss or fat necrosis are relatively common and it may result in a smaller breast volume with marked contour irregularities. These defects are not easy to reconstruct with local tissue rearrangement or with breast implants. The current authors present the results of 2 patients who underwent Latissimus dorsi(LD) flap reconstruction to correct partial flap or fat necrosis that developed after TRAM flap breast reconstruction. Method: Case1: A 50 - year - old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively partial flap necrosis was developed. Secondary breast reconstruction using LD flap was done. Case2: A 51 - year - old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively fat necrosis was developed. Secondary breast reconstruction using LD flap was done. Results: Secondary breast reconstruction using LD flap survived completely and produce successful reconstruction. There was no significant complication in both patients. Conclusion: LD flap provides sufficient, vascularized skin and soft tissue. The flap can be molded easily to replace deficient tissue in all areas of the breast. These attributes make it an ideal candidate for salvage of the partially failed TRAM flap breast reconstructio.

• Korean Journal of Head & Neck Oncology
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• v.21 no.2
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• pp.190-195
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• 2005

Background and Objectives: Fibula is the flap of choice for reconstruction of wide mandible defects after tumor ablation surgery. In mandible reconstruction, restoring the mandible frame to provide mandibular contour and dental arch while restoring masticatory function are important. Even though vascularized fibula can be osteotomized freely, proper design and flap insetting is not easy because of its three dimensional structure and difference in design according to the defect sites. We reviewed patients who underwent mandible reconstruction with fibular flaps according to the defect sites and suggest proper modification methods of fibular flap according to the various defects sites after tumor ablation surgery. Materials and Methods: Twelve consecutive mandible reconstruction with fibular free flaps were performed for defects after tumor ablation surgery. Patients were classified into 4 groups according to the type of mandibular defect(Group 1 : defect on central segment including symphysis, Group 2 : defect on lateral segment(with or without central segment) confined to body, Group 3 : defect on body and ascending ramus that does not include the condyle, Group 4 : defect including the condyle). Results: We suggest different modification methods of fibular free flap for each patient group. Group 1, 3 ; contour by using multiple closing wedge osteotomy. Group 2 ; single or double barrel reconstruction without wedge osteotomy. Group 4 ; contour using single or multiple wedge osteotomy and condylar reconstruction with costochondral graft. Conclusion: Fibular free flaps can be contoured to any desired shape after multiple osteotomies to restore various mandibular defects. It is a reliable and versatile method for reconstruction of mandibular defects after tumor ablation surgery.

• Korean Journal of Head & Neck Oncology
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• v.25 no.2
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• pp.119-122
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• 2009

Objectives : Ablation of carcinoma of the tongue leads to deficits in speech and swallowing, but none to date has provided all of the qualities of mobility and sensation to simulate the complex function of the tongue. The authors evaluated postoperative swallowing and pronouncing function in patients who underwent tongue reconstruction using free flap. Material and Methods : This is a retrospective review documenting the outcome of 42 patients between January of 1991 and August of 2008. We classified patients according to the size of resection of the tongue like as 7 partial glossectomy, 25 hemiglossectomy, 2 subtotal glossectomy, and 8 total glossectomy. Swallowing function was graded into 4 point scale and pronouncing function was analyzed using picture consonant articulation test. Aspiration was evaluated with videofluoroscopic swallowing study. Results : The average points for swallowing function were 3.43 in partial glossectomy, 3.52 in hemiglossectomy, 3 in subtotal glossectomy, and 2.63 in total glossectomy. The percentage of consonants correct showed 76.5% in partial glossectomy, 72.29% in hemiglossectomy, 47.69% in subtotal glossectomy, and 29.94% in total glossectomy. Aspiration was noted in 3 patients(1 hemiglossectomy and 2 total glossectomy) and 2 total glossectomy patients were taken permanent feeding gastrostomy. Conclusion : Free flap gave us proper volume in tongue reconstruction and showed good result in preserving swallowing function. Swallowing function difference according to the size of defect showed no statistical significance, whereas articulation function was shown to decrease in accuracy as the size of defect was larger.

• Korean Journal of Head & Neck Oncology
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• v.2 no.1
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• pp.49-59
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• 1986

The surgical reconstruction of major defects of the head and neck such as those following accidental injuries or resection of tumors has been facilitated and advanced by the development of myocutaneous flaps which provide both muscle bulk and skin coverage. Of the many available myocutaneous flaps, the pectoralis major myocutaneous flap has many advantages such as abundant tissue with an excellent vascularity, anatomic proximity, long arc of rotation, reliability and versatility, so it is used most frequently in head and neck reconstruction. It is the purpose of this paper to present our experiences with two cases of pectoralis major myocutaneous island flaps used in reconstruction of major defects of face; one is after resection of very large basal cell carcinoma of the left oral commissure and the other is after resection of a huge fibrous mass and destructed facial bones caused by chronic osteomyelitis.

• Korean Journal of Head & Neck Oncology
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• v.29 no.2
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• pp.41-47
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• 2013

Background : The purpose of this study is to review our experience with the variable applications of the facial artery muscolomucosal(FAMM) flap for oral cavity reconstruction following treatment for head and neck malignancies. Methods : We performed retrospect medical record review from January 2012 to June 2013. This flap technique was applied in 3 patients to reconstruct the defects of oral cavity induced by treatment for head and neck malignancies. Results : The defects and fibrosis occurred due to variable causes related to previous treatment for head and neck malignancies such as tumor resection and chemoradiation. Two patient suffered from defect on hard and soft palate and one patient suffered from trismus related to fibrotic scar band. We performed oral cavity reconstruction using FAMM flap even though these all patients had history of neck dissection surgery or radiation therapy. Conclusion : FAMM flap is an ideal option for reconstruction following treatment not only for primary tumor resection but also for defects induced by variable causes. Preoperative radiation and neck dissection surgery, which are previously considered as some challenges, are no longer contraindication in our cases.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.87-93
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• 2008

Purpose: Because of good blood supply of the pedicled perforator flap and its advantage of not requiring vessel anastomosis compared to pedicled flap, it is widely used recently. The authors intended to report the results of various pedicled perforator flaps which have been performed to reconstruct the soft tissue defects and the utility of the flap. Methods: The study was conducted for 12 cases of pedicled perforator flap which were performed at the plastic surgery department of the current hospital from the period of June, 2005 to August, 2008. Four patients were male and eight patients were female and their age was ranged from 22 to 74 years old with mean age of 42.6 years old. The sites were 1 case on face, 3 cases on chest, 3 cases on back, 4 cases on coccyx, and 1 case on foot. Results: The defect sites of all patients were successfully reconstructed by using the pedicled perforator flap. Although most of the flaps revealed congestion at the early stage after the surgery, they were recuperated within few days. One case of skin flap was reported to be partially necrotized in old age woman who has no reliable perforator. Other than that, all defects were covered successfully and acceptable aethetically. Conclusion: As stated in above, the pedicled perforator flap has many useful advantages than the conventional pedicled flap and various free flap. Unless free flap must be required, the use of pedicled perforator flap is recommended by first choice for soft tissue coverage.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.46-49
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• 2012

Purpose: The forehead flap is the workhorse in nasal reconstruction, which provides a similar skin color, texture, structure, and reliability. There are some disadvantages, including donor site morbidities, 2- or 3-stage operations, and postoperative management after initial flap transfer. Furthermore, there has been little attention to the exposed raw surface wound, after the first stage of an operation. This article describes the authors' modification to overcome this problem, using artificial collagen membrane. Methods: An Artificial collagen membrane is composed of an outer silicone membrane and an inner collagen layer. After a forehead flap elevation, the expected raw surface was covered by an artificial collagen membrane with 5-0 nylon suture. A simple dressing, which had been applied to the site, was changed every 2 or 3 days in an outpatient unit. At 3 weeks postprocedure, a second stage operation was performed. Results: With biosynthetic protection of the raw surface, there were no wound problems, such as infection or flap loss. Thus, the patient was satisfied due to an effortless management of the wound and a reduction in pain. Conclusion: The application of an artificial collagen membrane to the raw under-surface of the flap could be a comfortable and a protective choice for this procedure.