• Journal of Korean Neurosurgical Society
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• v.48 no.2
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• pp.105-108
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• 2010

Objective : Some neurosurgeons intentionally ligate the branches of the superficial temporal artery (STA) that are not used in standard STA-to-middle cerebral artery (MCA) anastomosis for the purpose of improving the flow rate in the bypass graft. We investigated changes in bypass flow during temporary occlusion of such unused branches of the STA. Methods : Bypass blood flow was measured by a quantitative microvascular ultrasonic flow probe before and after temporary occlusion of branches of the STA that were not used for anastomosis. We performed measurements on twelve subjects and statistically assessed changes in flow. We also examined all the patients with digital subtraction angiography in order to observe any post-operative changes in STA diameter. Results : Initial STA flow ranged from 15 mL/min to 85 mL/min, and the flow did not change significantly during occlusion as compared with preocclusion flow. The occlusion time was extended by 30 minutes in all cases, but this did not contribute to any significant flow change. Conclusion : The amount of bypass flow in the STA seems to be influenced not by donor vessel status but by recipient vessel demand. Ligation of the unused STA branch after completion of anastomosis does not contribute to improvement in bypass flow immediately after surgery, and furthermore, carries some risk of skin necrosis. It is better to leave the unused branch of the STA intact for use in secondary operation and to prevent donor vessel occlusion.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.46-55
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• 1996

The purpose of this study is to investigate if there is a higher rate of free flap failure in cases of vein grafts compared to non-vein graft, and to analyze the clinical usefulness and necessity in elective free flap surgery. We have used 24 vein grafts in 208 free flaps from May, 1986 until August, 1995. Vein grafts were from 2cm to 50cm in length between the recipient and donor vessels. Reconstructed sites were 10 lower extremities, 8 head and neck, 4 hand, and 2 trunk. Vein grafts were used 14 for arterial, 6 venous, 4 in both arterial and venous anastomoses. We intentionally used long vein grafts longer than 5cm for improved blood flow in cases of peripheral vascular disease, radionecrotic wounds, lower leg trauma. Short vein grafts of about 3cm in length were used to overcome the shortage of vascular length in cases of unexpected vessel anomaly, short donor vessel, and difficult access to recipient vessels after radical neck dissection. All veins were carefully handled with ligation of very small branches and were transferred to the recipient site without irrigation. 8 flaps were failed out of a total of 208 free flaps, however there was no failure among the 24 cases that needed vein grafts between the donor and recipient vessels. Success rates between non-vein grafts free flaps and vein graft free flaps were 95.6%(8/184) and 100%(0/24). Even though the vein grafts increase the operation time and the number of anastomoses, they do not result in any increased failure rate of free flap surgery(4.4% versus 0%). In addition to the reducing tension between recipient and donor vessels, the surgeon can select better recipient vessels with excellent blood flow so that vein grfats in microsurgery can provide a high success rate of free flaps.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.3
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• pp.227-232
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• 2007

The radial forearm fasciocutaneous flap(RFFF) is a well-known flap for the reconstruction of oral and maxillofacial defects. It was first described by Yang et al. in 1981 and Soutar et al. developed it for the reconstruction of intraoral defect. RFFF provides a reliable, thin, and pliable soft tissue/skin paddle that is amenable to sensate reconstruction. It also has a long vascular pedicle that can be anastomosed to any vessel in either the ipsilateral or contralateral neck. However, split thickness skin graft(STSG) is most commonly used to cover the donor site, and a variety of donor site complications have been reported, including delayed healing, swelling of the hand, persistent wrist stiffness, reduced hand strength, and partial loss of the graft with exposure of the forearm flexor tendon. Various methods for donor site repair in addition to STSG have been developed and practiced to minimize both functional and esthetic morbidity, such as direct closure, V-Y closure, full thickness skin graft, tissue expansion, acellular dermal graft. We got a good result of using artificial dermis($Terudermis^{(R)}$) and secondary STSG for the repair of RFFF donor site defect esthetically and report with a review of literature.

• Archives of Reconstructive Microsurgery
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• v.1 no.1
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• pp.51-55
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• 1992

Problems of composite tissue transfer commonly arise when a single indispensable recipient vessel receives the graft vssel, and the graft vessel must be sutured in end-to-side fashion so as not todisturb the vascularity of the recipient vessel. The triangular flap in the recipient vessel wall gives an intact endothelial surface when the flow of blood stream is presented and may reduce the chance of anastomosis. We selected mature Wistar rats weighing over 450 grams to compare the conventional longitudinal slit from the triangular flap in the recipient carotid artery over bloood pressure and blood flow when the donor carotid artery was anastomosed in end-to-side fashion. In 30 minutes after anastomosis, maximum blood pressure measured in the donor carotid arterial side when the recipient arterial wall was fasioned with the longitudinal slit was recorded 114 mmHg and with the triangular flap 100mmHg. Minimum blood pressure with the longitudinal slit was 98mmHg and with the triangular flap 88mmHg. The amount of blood collected for 30 seconds in the conventional longitudinal slit was 1.18mg and in the triangular flap 0.78mg. Histology study in 30 minutes, the conventional longitudinal slit demonstrated the more hemorrhagic features around the suture material compared to that of the triangular. flap and, in the 7th day, the conventional longitudinal slit demonstrated the more prominent granulomatous reactions and vascular proliferations around the suture material compared to that of the triangular flap.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.507-513
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• 2023

Background Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg. This study evaluated the use of a cross-leg free latissimus dorsi muscle flap for the reconstruction of defects in single-vessel legs, using end-to-side anastomosis to recipient vessels in the contralateral leg without sacrificing any vessel in the uninjured leg. Methods This is a retrospective study that included 22 consecutive patients with soft tissue defects over the lower leg. All the reconstructed legs had a single artery as documented by CT angiography. All patients underwent cross-leg free latissimus dorsi muscle flap using end-to-side anastomosis to the posterior tibial vessels of the contralateral leg. Results The age at surgery ranged from 12 to 31 years and the mean defect size was 86 cm². Complete flap survival occurred in 20 cases (91%). One patient had total flap ischemia. Another patient had distal flap ischemia. Conclusion Cross-leg free latissimus dorsi muscle flap is a reliable and safe technique for the reconstruction and salvage of mutilating leg injuries, especially in cases of leg injuries with a single artery. As far as preservation of the donor limb circulation is concerned, end-to-side anastomosis is a reasonable option as it maintains the continuity of the donor leg vessels.

• Archives of Plastic Surgery
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• v.50 no.2
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• pp.194-199
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• 2023

Moderate soft-tissue defects need stable coverage, ideally with tissue of similar characteristics and low donor site morbidity. We propose a simple technique for the coverage of moderate skin defects in the limbs. It allows intraoperative transformation of a propeller perforator flap (PPF) into a keystone design perforator flap (KDPF) in cases of unsatisfying perforator vessel or in cases of unpredictable intraoperative events. Between March 2013 and July 2019, nine patients with moderate soft-tissue defects (mean defect size 4.5 × 7.6 cm) in the limbs (two on the upper limbs and seven on the lower limbs) were covered using this technique. We performed four PPFs and five KDPFs. The mean follow-up was 5 months. There was one complication, partial distal tip necrosis in a PPF located in the leg, which healed by secondary intention within 3 weeks. The donor site was closed directly in all cases. No functional impairments were noted regardless of the perforator flap utilized. This technique enables us to employ flexible surgical strategies and allows us to make adjustments based on the patient's vascular anatomy.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.275-279
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• 2018

Chronic lymphedema is caused by an impairment of the lymphatic system due to primary or secondary causes. Vascularized lymph node transplantation (VLNT) is currently the most promising and frequently used technique besides lymphaticovenous anastomosis. However, the vessel anatomy in the lateral thoracic region is sometimes quite variable. Based on our experiences with vascular anatomical inconstancy in the lateral thoracic region, we planned a lateral intercostal artery perforator flap for VLNT in a female patient with chronic stage II lymphedema of both legs after cervical cancer treatment. After surgery, the patient reported significant improvement in limb volume and the accompanying symptoms. The limb circumference was reduced by an average of 19.2% at 6 months postoperatively. Despite having a short pedicle and small vessel caliber, the lateral intercostal artery perforator flap can safely be used for VLNT in lymphedema patients with anatomical variants.

• Archives of Craniofacial Surgery
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• v.24 no.3
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• pp.129-132
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• 2023

Scalp defects necessitate diverse approaches for successful reconstruction, taking into account factors such as defect size, surrounding tissue, and recipient vessel quality. This case report presents a challenging scenario involving a temporal scalp defect where ipsilateral recipient vessels were unavailable. The defect was effectively reconstructed utilizing a transposition flap and a latissimus dorsi free flap, which was anastomosed to the contralateral recipient vessels. Our report underscores the successful reconstruction of a scalp defect in the absence of ipsilateral recipient vessels, emphasizing the importance of employing appropriate surgical interventions without necessitating vessel grafts.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.106-111
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• 1996

Purpose : Propose a surgical technique in donor harvesting method in free vascularized proximal fibular epiphysis. Methodology : Concerned about growth potentials of the transplanted epiphysis in our long term results of the epiphyseal transplanted 13 cases more than 4 years follow-up, anterior tibial artery which contains anterior tibial recurrent artery is most reliable vessel to proximal fibular epiphysis which is the best donor of the free vascularized epiphyseal transplantation. In vascular anatomical aspect proximal fibular epiphysis norished by latearl inferior genicular artery from popliteal, posterior tibial recurrent artery and anterior tibial recurrent artery from anterior tibial artery and peroneal artery through metaphysis. The lateral inferior genicular artery is very small and difficult to isolate, peroneal artery from metaphysis through epiphyseal plate can not give enough blood supply to epiphysis itself. The anterior tibial artery which include anterior tibial recurrent and posterior tibial recurrent artery is the best choice in this procedure. But anterior tibial recurrent artery merge from within one inch from bifucating point of the anterior and posterior tibial arteries from popliteal artery. So it is very difficult to get enough vascular pedicle length to anastomose in recipient vessel without vein graft even harvested from bifucating point from popliteal artery. Authors took recipient artery from distal direction of anterior tibial artery after ligation of the proximal popliteal side vessel, which can get unlimited pedicle length and safer dissection of the harvesting proximal fibular epiphysis. Results : This harvesting procedure can performed supine position, direct anterolateral approach to proximal tibiofibular joint. Dissect and isolate the biceps muscle insertion from fibular head, micro-dissection is needed to identify the anterior tibial recurrent arteries to proximal epiphysis, soft tissue release down to distal and deeper plane to find main anterior tibial artery which overlying on interosseous membrane. Special care is needed to protect peroneal nerve damage which across the surgical field. Conclusions : Proximal fibular epiphyseal transplantation with distally directed anterior tibial artery harvesting technique is effective and easier dissect and versatile application with much longer arterial pedicle.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.154-157
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• 2000

Author report a case of double metatarso-phalangeal joint transplantation to the elbow joint in the 31 years old female patient who have large bone defect associated with skin and soft tissue defect. The donor joints were second and third metatarso-phalangeal joint as double joint transfer fashion to enhance stability of graft. The graft based on dorsalis pedis vessel to anastomosed with radial artery of recipient site. The result is unsatisfactory because of long lasting lateral instability of reconstructed elbow joint in spite of 40 degree flexion motion and fair axial stability. We can conclude that joints from foot can not be an effective donor for biologic joint arthroplasty of elbow joint even though double metatarso-phalangeal joint were harvested.