• Archives of Plastic Surgery
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• v.40 no.3
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• pp.251-255
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• 2013

We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

• Journal of Korean Dental Science
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• v.17 no.2
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• pp.92-104
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• 2024

Managing multiple non-carious cervical lesions (NCCLs) with gingival recession and dentin hypersensitivity can be challenging. Herein, we present two cases of successful treatment procedure for multiple NCCLs with gingival recession and dentin hypersensitivity using an envelope coronally advanced flap with CTG and composite resin restoration. Through the combined approach of restorative and periodontal procedure, both patients showed adequate extent of gingival coverage and esthetic outcome based on the Modified Root Coverage Esthetic Score (MRES) at 6 months postoperatively. Also, dentin hypersensitivity was reduced effectively during the follow up period. Although the pocket depth slightly increased in patient 1, possibly due to the amount of restoration located sub-gingivally, pocket depth remained within 3 mm. This suggest that re-establishing the clinical CEJ and performing partial restoration is advantageous for periodontal tissue and is expected to contribute to maintain gingival height in the long term. These case reports emphasize the efficacy of the combined approach for treating multiple NCCLs with gingival recession and dentin hypersensitivity, highlighting the importance of careful restoration planning for optimal clinical and aesthetic outcomes.

• Korean Journal of Head & Neck Oncology
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• v.6 no.2
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• pp.79-84
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• 1990

This paper is a review of our experience with radical resection for cancer of the oral cavity with particular emphasis upon the value of myocutaneous(i.e., musculocutanous) flaps employed in the surgical reconstruction in patient survival. During the past 15 years, 98 patients underwent resection of cancer arising in the oral cavity and oropharynx. Of these, 14 had composite resections in which the mandible was not sectioned, and 4 underwent en bloc resections without neck dissections in the face of post-radiation recurrence. When these excluded, 84 patients who underwent COMMANDO procedures with or without myocutaneous flaps were suitable for analysis of recurrence and survival according to the various surgical technics employed. 1) According to the surgical technic, there were 24 standard COMMANDO procedures in whom no regional or myocutanous flap was used; 12 patients who underwent reconstruction employing a forehead flap; 19 patients in whom a posterior cervical 'nape' flap was employed; 27 patients who underwent myocutaneous or osteo-myocutaneous flap repair; and two patients who had double flap repair. 2) The uncorrected two-year disease free survival was 41% for standard COMMANDOs, 17% for forehead flap COMMANDOs; 35% for nape flap COMMANDOs; and 35% for myocutaneous flap COMMANDO procedures. 3) The two-year disease-free survival by Stage was 100% in Stage I, 45% in Stage II, 41% in Stage III, and 18% in Stage IV. 4) When myocutanous flaps cases were compared with Group I, comprised of matched historical controls including both Standard COMMANDOs and those who had undergone regional flap repairs(that is, forehead and nape flap COMMANDOs)there was no difference, both groups showing a 40% 2-year disease-free survival. 5) When musculocutanous flap cases were compared with Goup II, which was composed of matched historical controis limited to patients who had undergone regional flap repairs(that is, forehead and nape flap cases only)there was no difference, both groups showing a 27% 2-year desease-free survival. 6) When musculocutanous flap cases were compared with Group III, composed of patients who had undergone classic COMMANDO procedures without any sort of flap repair, there was a striking difference; the patients undergoing MC flap repair showed 50% 2-year disease-free survival, whereas the classic COMMANDO cases showed a 25% survival free of disease. 7) Locoregional recurrence was also evaluated in the four categories; for standard COMMANDO cases it was 25%, for nape flap cases 26% ; for forehead flap cases, 33%, and for the musculocutaneous flap cases, the lowest recurrence rate, 22%. These results are of particular significance in view of the fact that the proportion of advanced cases(Stage III and IV)in each category was 67% of standard cases, 79% of nape flap patients, 100% of forehead flap cases, and 96% of musculocutaneous flap cases.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.425-430
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• 2023

Axillary defects need pliable, vascular tissue to cover the critical structures traversing the axilla and to allow near-normal range of motion in the shoulder. Although local flaps are the first choice, free tissue transfer is a good option when local tissues are injured or scarred. Herein, we report two cases of axillary defects that were reconstructed using anterolateral thigh free flaps. One was a post-electric burn axillary defect for which a thoracoacromial pedicle was used as the recipient, and the other was a posttraumatic axillary defect with the transverse cervical vessels as the recipient. In both patients, the flap survived well with no complications and resulted in adequate functional recovery. In large defects of the axilla with a scarcity of local tissues, free flaps can yield optimal results. The proper selection of recipient vessels and a donor flap with adequate pedicle length impact the outcomes of such reconstruction.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.629-636
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• 2009

Purposes: Wide scars occurring on the lower face and neck are a source of both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. Methods: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil$^{(R)}$ tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule-formed by the tissue expander-was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst$^{(R)}$ facial garment in order to stabilize the operation site at least twelve months. Results: The most prevalent location of the scar was the cheek (15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was $55.7{\pm}39.4cm^2$. Conclusions: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

• Korean Journal of Head & Neck Oncology
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• v.13 no.1
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• pp.62-68
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• 1997

The papillary carcinoma is the most common malignant neoplasm of thyroid gland and the prognosis is better than anyother type of thyroid carcinoma. However, the thyroid is closed to the important organs such as esophagus, trachea and larynx, there are some possibilities to invade these organs. In case of advanced disease, not only surrounding structures but also mediastinum and cervical lymphatic chain can be involved or distant metastasis develops frequently. Therefore in these cases the prognosis is worse and the rate of inoperable case is more than those of non-metastatic group. Generally, the treatment modality for papillary thyroid carcinoma consists of surgery, postoperative thyroid hormone and radioiodine therapy. If the tumor invades surrounding structures, cervical lymph node or mediastinum, total thyroidectomy and wide excision of tumor invaded area including mediastinal dissection and neck dissection is necessary. Recently, the authors have experienced a case of locally invasive and recurred papillary thyroid carcinoma without treatment for 7 years. The patient was performed previously thyroid lobectomy and isthmusectomy 13 years ago. We had determinded surgical therapy for this patient and performed mass excision with overlying skin, completion total thyroidectomy, right type I modified radical neck dissection, left lateral neck dissection, thoracotomy with supramediastinal dissection, shaving of diffusely involved trachea and skin defect reconstruction with pectoralis major myocutaneous flap. After operation 2 cycles of radioiodine therapy were taken. Now the patient is following up at the outpatient base and no evidence of disease state for postoperative 16 months. So we report on this case with a brief review of literature.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.1045-1049
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• 1996

Post-intubation tracheoesophageal fistula is rare, and its management causes a serious problems to surgeons. We have experienced 4 cases in 3 patients. Simple ditcision and closure of the fistulas were done by trans-cervical approach after weaning of ventilator. The tracheal defect was closed by simple suture, and the esophageal defect was closed in two layers before a viable muscle flap was interposed between the two suture lines in order to prevent recurrence. There was one delayed tracheal stenosls and one recurrent fistula, and these complications were also managed success ully.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.287-292
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• 1995

From March 1989 to June 1994, 24 casesof esophageal cancer were treated surgically. Among 24, male was 22 cases, female was 2 cases, and the age ranged from 46 to 75, the mean was 59.8. Symptoms were dysphagia[86.9% , weight loss[65.2% and retrosternal pain or discomfort[47.8% . The tumor was located cervical esophagus in two, upper esophagus in three, middle esophagus in 12 and lower esophagus in 7. Among 24 patients, 22 were curative resection, partial esophagectomy with esophagogastrostomy[18 cases or colon interposition [3 cases , with total esophagectomy with musculocutaneous flap[1 case , with feeding jejunostomy or gastrostomy in two cases.Postoperative complications revealed 10 patients[45.4% , as followed ; pleural effusion and pneumonia in 5, passage disturbance in 4, empyema and wound infection in 3, esophagopleural fistula and sepsis in 2, anastomotic site leakage and respiratory failure in each 1. The operative mortality was 13.6 % [3/22 and causes of death were respiratory failure in 1 case and sepsis in 2 cases.During follow-up work, 8 cases died during follow-up period, mean survival time was 15.2 months in curative resection group. One year survival rate was 55.3% in resected group. Also, cancer recurrence revealed in 1 cases.

• Korean Journal of Bronchoesophagology
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• v.9 no.2
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• pp.69-73
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• 2003

Various flaps are using for reconstruction of esophageal defect. The choice of reconstruction is depended to the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor, then total esophagectomy and gastric pull-up or colon transposition is indicated. But for most hypopharyngeal tumors, laryngopharyngeal tumors, and cervical esophageal tumors, segmental resection of these area and replacement with a jejunal fee or forearm free flap has become the standard technique. The authors have experienced a case of total pharyngo-laryngo-esophago-gastrectomy and colon transposition in a patient of esophageal cancer following partial esophagectomy and gastic pull-up due to corrosive esophageal stricture. We report this case with brief review of the literatures.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.99-105
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• 1996

The reconstruction of esophageal defect after ablative surgery have more difficult than other digestive tract tumor because the restoration of anatomical and physiologic function is difficult, the risk of tumor invasion into the adjacent tissue is large. The reconstruction of cervical esophus was depended on the degree of resection of the esophagus, various reconstruction method was developed to minimize functional deficiency and deformity of cervical region. Recently, the free jejunal transfer or free radial forearm flap was commonly utilized for esophageal reconstruction due to development of technique of the microvascular anastomosis. After the esophageal reconstruction used by free jejunal transfer was reported by Seidenberg in 1951, jejunum is most commonly used for reconstruction of esophgus. Becaue of, it have been tubed anatomical similarity with muscular layer, relative small risk of complication, possible of oral intake within 10 days after operation, and early rehabilitaion. Authors have been treated esophageal defect with free jejunal transfer in 7 patients after resection of lesion in 6 eshageal cancer and 1 esophageal stricture from December 1994 to January 1996. We were transferred jejunum used by intercostal artery as recipient artery in 3 cases, it was satisfied with results. If intercostal artery was utilized as recipient artery for free jejunal transfer, we believe that any site of intrathoracic or intraabdominal esophageal defect is possible to recontruction.