• Archives of Reconstructive Microsurgery
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• v.19 no.2
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• pp.88-92
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• 2010

The forefoot reconstruction is a challenging field for plastic surgeons. Weight bearing tolerability and stability are important factor of choosing reconstruction methods, but cosmetic aspect has to be considered. 51 year old man visited our clinic with extensive degloving injury on right forefoot by roller. The soft tissue defect started from metatarsal area to the toe tip including nails. We harvested the anterolateral thigh flap and transferred it to the forefoot defect area with nerve coaptation. The flap was successful without skin necrosis or other complications. Secondary flap debulking surgery was performed after ten months from initial operation. Patient was satisfied with functional and cosmetic outcomes. The patient was able to wear shoes and walk with adequate sensory recovery. As there is few report about reconstruction of forefoot soft tissue defects, we report a unique case of the anterolateral thigh innervated free flap reconstruction in degloving injury.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.130-138
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• 1999

The lower extremity injuries are extremely increasing with the development of industrial & transportational technology. For the lower extremity injuries that result from high-energy forces, particularly those in which soft tissue and large segments of bone have been destroyed and there is some degree of vascular compromise, the problems in reconstruction are major and more complex. In such cases local muscle coverage is probably unsuccessful, because adjacent muscles are destroyed much more than one can initially expect. Reconstruction of the lower extremity has been planned by dividing the lower leg into three parts traditionally The flaps available in each of the three parts are gastrocnemius flap for proximal one third, soleus flap for middle one third and free flap transfer for lower one third. Microvascular surgery can provide the necessary soft tissue coverage from the remote donnor area by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde flow flaps are well established in island flaps. Retrograde flow anastomosis could not interrupt the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. During 5 years, from March 1993 to Feb. 1998, we have done 68 free flap transfers in 61 patients to reconstruct the lower extremity. From analysis of the cases, we concluded that for the reconstruction of the lower extremity, free flap transfer yields a more esthetic and functional results.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.8-13
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• 2011

Purpose: A palatal defect following maxillectomy can cause multiple problems like the rhinolalia, leakage of foods into the nasal cavity, and hypernasality. Use of a prosthetic is the preferred method for obturating a palate defect, but for rehabilitating palatal function, prosthetics have many shortcomings. In a small defect, local flap is a useful method, however, the size of flap which can be elevated is limited. In 12 cases of palatomaxillary defect, we used various microvascular free flaps in reconstructing the palate and obtained good functional results. Method: Between 1990 and 2004, 12 patients underwent free flap operation after head and neck cancer ablation, and were reviewed retrospectively. Among the 12 free flaps, 6 were latissimus dorsi myocutaneous flaps, 3 rectus abdominis myocutaneous flaps, and 3 radial forearm flaps. Result: All microvascular flap surgery was successful. Mean follow up time was 8 months and after the follow up time all patients reported satisfactory speech and swallowing. Wound dehiscence was observed in 4 cases, ptosis was in 1 case and fistula was in 1 case, however, rhinolalia, leakage of food, or swallowing difficultly was not reported in the 12 cases. Conclusion: We used various microvascular flaps for palatomaxillary reconstruction. For 3-dimensional flap needs, we used the latissimus dorsi myocutaneous flap to obtain enough volume for filling the defect. Two-dimensional flaps were designed with latissimus dorsi myocutaneous flap, rectus abdominis flap and radial forearm flap. For cases with palatal defect only, we used the radial forearm flap. In palatomaxillary reconstruction, we can choose various free flap techniques according to the number of skin paddles and flap volume needed.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.154-162
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• 1999

The laryngopharyngectomy for tumor ablation is the most common indication for pharyngoesophageal reconstruction in our country. Most of these cases are advanced laryngeal cancer that has spread beyond the larynx, pharynx and cervical esophagus. Such patients are obviously unable to breathe, swallow, or speak in the normal manner. The ideal reconstruction would restore normal anatomy, permitting patients to breathe and swallow without aspiration, and would not require a permanent tracheostomy. Reconstruction of the pharyngoesophageal defect traditionally been carried out with tubed local random flap, deltopectoral or musculocutaneous flap. Another approach is the pedicled enteric flap. But microsurgical reconstruction of the pharyngoesophagus, using either the free jejunal or the tubed radial forearm flap, have now become the preferred technique. Among them, we used jejunal free flap in 39 cases, tubed radial forearm free flap in 5 cases, patched radial forearm free flap in 2 cases and pectoralis major myocutaneous island flap in 2 cases from December 1990 to Febrary 1999. In this paper we illustrated that both forearm and jejunal free flap is a usful alternative in reconstruction of hypopharynx and cervical esophagus.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.122-128
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• 1998

Radial forearm flap is one of the most useful skin flap in hand reconstructuion with distally based reverse pedicled or free vascularized fashion. Athors modified that flap into reverse pedicled and free vascularized flap which has advantages of both methods. The modification composed with harvesting flap on recipient side distal forearm just as free flap, than apply it as reverse distal pedicled flap fashion with microvascular anastomosis with distal vascular stump of donor radial vessels. We underwent this method in 5 cases in finger reconstruction from 1996, all of the cases had sucessful results. The advantages of this method are: 1. Thin flap which is compatible to finger skin can harvest from distal forearm with very long vascular pedicle that can be passed under the subcutaneous tunnel which avoid additional skin incisions on the hand. 2. The vessels of donor site and recipient site are same vessel in effected side of forearm, which can preserve contralateral side forearm and hand keep intact. 3. The flap can cover the defects on distal portion of the fingers which is difficult in conventional reversed radial forearm pedicled flap because of limited mobilization of flap due to limitation of pedicle length reach to tip of the fingers.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.56-62
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• 1997

Latissimus dorsi(LD) muscle is the largest transplantable block of vascularized tissue. Since LD free flap was introduced in 1970's, this flap has been widely used for the reconstruction of large soft tissue defect of the limb. From 1981 to 1996, we had experienced 37 cases of LD free flap. Serratus anterior muscle was combined with LD in three of them whose defects were very large. The average age of the patients was 31 years(range : 4-74 years), and thirty one patients were male. Trauma was cause of the defect in every case. For the recipient sites, the foot and ankle was the most common(22 cases); and the knee and lower leg(11 cases), the elbow and forearm(2 cases), the hand(2 cases) were the next. The duration of follow-up was averaged as 16 months(range: 6 months-12 years). Thirty one cases(84%) out of 37 were successful transplantations. In one case the failure of the flap was due to heart attack and subsequent death of the patient. One failure was caused by sudden violent seizure of the patient who had organic brain damage. Immediate reexploration of the flap was performed in 4 patients, and the flap survived in three of them. There was one necrosis of the grafted split-thickness skin on the survived LD flap. LD free flap was considered as one of the good methods, for the reconstruction of the large soft tissue defect of the limb.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.692-697
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• 2008

Purpose: Gluteal perforator flap has evolved to one of the standard tools for coverage of pressure sore. We used this flap to cover the defect adjacent to the buttock. Methods: From September 2004 to August 2006, gluteal perforator flaps were performed in 3 patients with sore and 9 patients with tumor. We made the rule for free style design of the flap. First, the defect should be covered fully regardless of the shape or area. Second, the location of perforators was decided to maximize flap mobility. Third, the donor-site should be closed directly. Results: Successful reconstruction was fulfilled. In 2 cases, initial flap congestion was observed but medical leech was applied and it was resolved. Partial flap loss occurred in one case. Infection was observed in one case. But there were no major complications. Conclusion: Gluteal perforator flap is very good option for the reconstruction of the defects adjacent to the buttock.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.56-61
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• 1996

The nasal ala and columella represent a difficult location for reconstruction, especially when defect area is covered with scar. Local flap, such as forehead flap or nasolabial flap, may result in additional facial scarring and bulkiness that require multiple thinning revisions. Recent delineation of vascular territories of the ear has allowed the use of vascularized auricular free flap in the reconstruction of large ala and columella defects. Authors reconstructed two cases of full thickiness defect of the ala and columella with auricular free flap. The pedicle of this flap is the superficial temporal artery and vein. The donor vessels were anastomosed to the facial artery and vein. The results were satisfactory cosmetically and functionally.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.457-460
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• 2010

Purpose: The great toe presents a reconstructive challenge for plastic surgeons. The big toe has much importance not only for the gait and the stability, but also for appearance aspects. Few reports have documented the reconstruction of big toe defects and we report a unique case of free flap reconstruction technique. Methods: A 41-year-old man with right great toe open fracture with soft tissue necrosis was referred from the orthopedic surgery department. On physical examination, there was the skin necrosis circumferentially and the fratured bone was severely fragmented. The metatarsophalangeal (MTP) joint of the big toe was intact. After the wound debridement, we harvested the innervated anterolateral thigh flap and transposed to the defected area. After five months, we finally retouched the flap by the dorsal defatting and distal debulking. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. He has remained asymptomatic for eight months without any recurrence such as the osteomyelitis. Finally, he kept the normal gait and posture with weight bearing on the reconstructed great toe and foot. Conclusion: The anterolateral thigh flap is described for the reconstruction of the great toe. It involves two stage procedure with the minimal donor site morbidity and provides a good cosmetic result.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.539-542
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• 2005

Reconstructions of soft tissue defect of the posterior ankle including Achilles the tendon should take into account not only coverage but functional outcome. Various methods of tendon transfer and tendon graft have been reported as a single-stage procedure. With advances and refinements in microsurgical techniques, several free composite flaps including tendon, fascia, or nerve have been used in single-stage reconstructions of large defects in this area minimizing further damage to the traumatized leg. However, when free flap is not feasible for some reasons, this cannot be accomplished successfully. Here we present a patient with Achilles tendon and circumferential large soft tissue defect. Because of circulatory compromise of the lower extremity, free flap reconstruction could not be applied. Instead, cross-leg composite flap of the dorsalis pedis flap including the extensor hallucis brevis musle and tendon, and tendon strips of the Second, third and fourth extensor digitorum logus were employed, Functional reconstruction of the tendon and resurfacing were obtained at the same time. The flap was detached 3 weeks postoperatively, and the transplanted flap has survived without any complications. By 3 months after surgery, full weight bearing, tip-toe standing and even walking without crutch assistance was possible. When functional reconstruction with the free flap is unattainable in the large defect of the posterior ankle including the Achilles tendon, cross-leg composite island flap of dorsalis pedis flap and tendon strips of the extensor digitorum longus tendon is a viable alternative.