• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권1호
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• pp.11-20
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• 1993

Bony ankylosis is an intraarticular condition where there is fusion of the bony surfaces of the joint : The condyle and the glenoid fossa. It occurs in both children and adults, unfortunately more frequently in the former, in whom early recognition and correction is particularly critical. Trauma is well proven to be the predominant cause of TMJ ankylosis. Infection, rheumatoid arthritis and neoplasm are another, significant cases of TMJ ankylosis. The necessity for using an interpositional material to prevent TMJ reankylosis has been widely discussed and many interpositional materials have been used, including temporal muscle and fascia, dermis, auricular cartilage, fascia lata, fat, Lyo-dura, Silastic and various metals. The temporal muscle and fascia have been widely used pedicled flap for head and neck reconstruction. The use of a temporal muscle and fascia for reconstruction of the TMJ, particularly in cases of ankylosis is a very reasonable option. Its principle advantages are its autogenous nature, resilience, and proximity to the joint, allowing for a pedicled transfer of vascularized tissue into the joint area. However, the viability of temporal muscle and fascia is a critical question. We treated 2 cases of TMJ ankylosis with temporal muscle and fascia transfer and one case with temporal fascia. We obtained satisfactory results as to functional aspects.

• Clinics in Shoulder and Elbow
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• 제21권2호
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• pp.59-66
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• 2018

Background: Massive, irreparable rotator cuff tears (RCTs) are a challenging clinical problem in young patients. In recent years, arthroscopic superior capsular reconstruction (ASCR) is a popular treatment in the massive, irreparable RCTs. However, studies reporting clinical results of ASCR are rare in the literature. Methods: Between 2013 and 2015, six patients underwent ASCR. One patient treated with dermal allograft, while five patients with autogenous fascia lata graft. Demographic data, as well as preoperative and last follow-up clinical data including pain, range of motion (ROM), strength, American Shoulder and Elbow Surgeons system, the Constant system, the University of California at Los Angeles system, the Simple Shoulder Test, and the Shoulder Pain and Disability Index system were obtained. Acromiohumeral distances and Hamada classification were measured on standard anteroposterior x-ray. Results: All patients were men, and the average age was $59.5{\pm}4.18years$ (range, 53-65 years).The minimum follow-up was 18 months with a mean follow-up was $27.33{\pm}7.58months$ (range, 18-36). All patients had postoperative improvement in pain scores and functional scores. The ROM and strength did not improve after surgery. The Hamada score progressed of radiographic stage in 2 patients. In the case of dermal allograft, there was graft failure 6 weeks after ASCR. Conclusions: Our results support the ASCR as a viable treatment for surgical salvage in massive, irreparable RCTs. This treatment option may provide patients with decreased pain and increased function. And studying our case of dermal allograft failure provides opportunities to decrease graft failure in ASCR using dermal allograft.

• Journal of Korean Neurosurgical Society
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• 제50권6호
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• pp.503-506
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• 2011

Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at $-70^{\circ}C$. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.348-352
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• 2013

Background Temporalis muscle transfer produces prompt surgical results with a one-stage operation in facial palsy patients. The orthodromic method is surgically simple, and the vector of muscle action is similar to the temporalis muscle action direction. This article describes transferring temporalis muscle insertion to reconstruct incomplete facial nerve palsy patients. Methods Between August 2009 and November 2011, 6 unilateral incomplete facial nerve palsy patients underwent surgery for orthodromic temporalis muscle transfer. A preauricular incision was performed to expose the mandibular coronoid process. Using a saw, the coronoid process was transected. Three strips of the fascia lata were anchored to the muscle of the nasolabial fold through subcutaneous tunneling. The tension of the strips was adjusted by observing the shape of the nasolabial fold. When optimal tension was achieved, the temporalis muscle was sutured to the strips. The surgical results were assessed by comparing pre- and postoperative photographs. Three independent observers evaluated the photographs. Results The symmetry of the mouth corner was improved in the resting state, and movement of the oral commissure was enhanced in facial animation after surgery. Conclusions The orthodromic transfer of temporalis muscle technique can produce prompt results by applying the natural temporalis muscle vector. This technique preserves residual facial nerve function in incomplete facial nerve palsy patients and produces satisfying cosmetic outcomes without malar muscle bulging, which often occurs in the turn-over technique.

• Archives of Plastic Surgery
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• 제35권2호
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• pp.205-207
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• 2008

Purpose: Although muscle hernia has been well described in the lower-extremity, muscle hernias in the upper extremity are extremely rare. As with lower extremity muscle hernias, the forearm muscle hernia may result from forced exertion of strenuous activity or following blunt trauma. The objective of this paper is to report an extraordinary case of forearm muscle hernia after radial forearm sensory tendocutaneous free flap with references. Methods: A 58-year-old male patient received wide excision and radical neck dissection and lower lip reconstruction with radial forearm sensory tendocutaneous free flap for squamous cell cancer on the lower lip. 16 weeks after the operation, he complained of protruding mass on the forearm and the size was increasing. In postoperative 18 weeks, MRI showed herniation of flexor digitorum superficialis. For unaesthetic cause and preventing progress, the authors performed direct fascial closure and Mesh graft. Results: In 12 months after the surgery there was no recurrence and the patient remained symptom-free. Conclusion: Pain on extremity exertion and unaesthetic buldge of forearm due to forearm muscle hernia were the primary indications for surgery which consist of direct closure, fasciotomy, fascia lata onlay graft, fascia lata inlay graft, etc. The authors experienced uncommon forearm muscle hernia after radial forearm free flap and satisfying result of treatment.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.72-74
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• 2016

The keystone flap is a fascia-based island flap with two conjoined V-Y flaps. Here, we report a case of successful treatment of a trochanter pressure sore patient with the traditional keystone flap. A 50-year-old male patient visited our department with a $3{\times}5cm$ pressure sore (grade III) to the left of the greater trochanter that was covered with eschar. Debridement was done and the defect size increased to $5{\times}8cm$ in an elliptical shape. Doppler ultrasound was then used to locate the inferior gluteal artery perforator near the wound. The keystone flap was designed to the medial side. The perforator based keystone island flap covered the defect without resistance. The site remained clean, and no dehiscence, infection, hematoma, or seroma developed. In general, greater trochanter pressure sores are covered with a perforator based propeller flap or fascia lata flap. However, these flaps have the risk of pedicle kinking and require a large operation site. For the first time, we successfully applied the keystone flap to treat a greater trochanter pressure sore patient. Our design was also favorable with the relaxation skin tension lines. We conclude that the keystone flap including a perforator is a reliable option to reconstruct trochanteric pressure sores.

• Journal of Chest Surgery
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• 제16권1호
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• pp.176-182
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• 1983

Malignant lymphoma in chest wall is a rare form of extranodal variety as occasionally localized tumor. The primary site is suggested from rib or soft tissue, but the incidence in rib is higher than soft tissue. The patient, a male, aged 32, noted a swelling and pain over the left lower posterior chest from 3 months prior to admission. Roentgenograms revealed bony destruction in left 9, & 19th ribs posteriorly and associated chest wall mass which was ill defined uncleared margination. Under diagnosis of malignant tumor, the operation was performed and the tumor mass resected widely with en bloc technique than the fascia lata was grafted at chest wall defect. The histology of specimen was disclosed as malignant lymphoma, non-Hodgkin`s diffuse lymphocytic poorly differentiated form. The radio-and chemotherapy were combined post-operatively and the complete remission is acquired.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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• pp.47-55
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• 1997

One hundred and thirty-seven patients had reconstructive surgery of injured feet with microsurgical technique in the Department of Orthopaedic Surgery at Yonsei University College of Medicine from 1983 to 1997. The results were as follows: 1. There were 89 cases in men and 48 cases in women, who together had a mean age of 21.3 years. 2. The causes of injuries were 97 cases from traffic accidents, 15 cases from burns, 11 cases from machinery injury, 5 cases from infection, 2 cases from falling, 2 cases from glass injury, 2 cases from snake bite, 2 cases from explosive injury, and 1 case from ulceration. 3. There were 47 cases with inguinal flaps, 36 cases with scapular flaps, 36 cases with parascapular flaps, 7 cases with deltoid flaps, 4 cases with lateral thigh flaps, 3 cases with latissimus dorsi flaps, 2 cases with tensor fascia lata flaps, and 2 cases with dorsalis pedis flaps. 4. One hundred and twenty-seven(92.7%) cases were successful in reconstructive surgery with microsurgical technique. 5. Functionally, the thick skin flap or sensory flap has less ulceration and good protective sensation. We considered that the function and cosmetic appearance were excellent after reconstructive surgery of the injured feet with microsurgical reconstructive technique and that the thick skin flap or sensory flap has less ulceration and good protective sensation.

• Archives of Plastic Surgery
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• 제41권3호
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• pp.285-289
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• 2014

The composite anterolateral thigh flap with vascularized fascia lata has emerged as a workhorse at our institution for complex Achilles defects requiring both tendon and soft tissue reconstruction. Safe elevation of this flap, however, is occasionally challenged by absent or inadequate perforators supplying the anterolateral thigh. When discovered intraoperatively, alternative options derived from the same vascular network can be pursued. We present the case of a 74-year-old male who underwent composite Achilles defect reconstruction using a segmental rectus femoris myofascial free flap. Following graduated rehabilitation, postoperatively, the patient resumed full activity and was able to ambulate on his tip-toes. At 1-year follow-up, active total range of motion of the reconstructed ankle exceeded 85% of the unaffected side, and donor site morbidity was negligible. American Orthopaedic Foot and Ankle Society and Short Form-36 scores improved by 78.8% and 28.8%, respectively, compared to preoperative baseline assessments. Based on our findings, we advocate for use of the combined rectus femoris myofascial free flap as a rescue option for reconstructing composite Achilles tendon/posterior leg defects in the setting of inadequate anterolateral thigh perforators. To our knowledge, this is the first report to describe use of this flap for such an indication.

• Archives of Reconstructive Microsurgery
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• 제24권1호
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• pp.32-36
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• 2015

The reconstruction of recurrent pressure sores is challenging due to a limited set of treatment options and a high risk of flap loss. Successful treatment requires scrupulous surgical planning and a multidisciplinary approach. Although the tensor fascia lata flap is regarded as the standard treatment of choice-it provides sufficient tissue bulk for a deep trochanteric sore defect-plastic surgeons must always consider the potential of recurrence and accordingly save the second-best tissues. With the various applications of anterolateral thigh (ALT) flaps in the reconstructive field, we report two cases wherein an alternative technique was applied, whereby pedicled ALT fasciocutaneous island flaps were used to cover recurrent trochanteric pressure sores. The postoperative course was uneventful without any complications. The flap provided a sound aesthetic result without causing a dog-ear formation or damaging the lower-leg contour. This flap was used as an alternative to myocutaneous flaps, as it can cover a large trochanteric defect, recurrence is minimized, and the local musculature and lower-leg contour are preserved.