• Archives of Reconstructive Microsurgery
• /
• 제13권1호
• /
• pp.1-6
• /
• 2004

Advances in microvascular techniques and refinements in microsurgical tissue transfers have enabled surgeons to combine different tissue components and reconstruction into a single-stage operation in extensive or composite defect following injury. Some problems and consideration for extensive or composite defects are form, shape, function, and dimension of the defect sites. Therefore combination of two or more flaps is required to reconstruct extensive or composite defect. This paper presents our clinical experience of four cases of combined free flaps with or without sequential microanastomosis in reconstruction of upper extremity based on peroneal flowthrough, thoracodorsal, and dorsalis pedis vascular system. Satisfactory results were obtained without flap loss and complications. The free flaps were combined in th following fashion; two cases by bridge fashion, one by chimeric microanastomosis and one by simple chimeric fashion. The median follow-up time on all patients was 21.7 months. Donor site morbidity was minimal. Extensive soft tissue or composite defects can be effectively covered by various combined flaps. Even though the risk for complication exists, the options of combination with or without sequential microanastomosis can add a functional or sensory dimension to reconstruction of complex wounds.

• Archives of Reconstructive Microsurgery
• /
• 제16권1호
• /
• pp.1-5
• /
• 2007

The purpose of this article to evaluate the availability of the rectus femoris flap in Korean subjects. Material and Methods is that Cadaveric dissections were done on 51 femoral triangles of 26 cadevers. We measured the length of the direct head of rectus femoris from anterior superior iliac spine to patella upper pole, ASIS to lateral border of femoral nerve, and entry point of femoral nerve and vessel branches to rectus. Usually, there were three terminal branches to rectus femoris from the femoral nerve. The entry point of the first branch was at the proximal $17.5{\sim}31.4%$ portion of the rectus femoris. The second and the third branch entered at the proximal $22.5{\sim}40.7%$ and $26.3{\sim}42.3%$, respectively. The vessel entry was at $20.2{\sim}37.3%$. The length from ASIS to femoral nerve was $3.5{\sim}8.5\;cm$. Among the 51 rectus femoris muscles, 44 had one nutrient artery, and 7 had 2 nutrient arteries. The nutrient artery originated from the descending branch of the lateral femoral circumflex artery in 18(40.9%) cases, directly from the lateral femoral circumflex artery in 8(18.0%) cases, and from proximal(6 cases, 13.6%) and distal(12 cases, 27.3%) portion of the deep femoral artery. The average length of the nutrient artery was 29.8 mm and the width was 2.14 mm. The point where it meets the main feeding artery of the rectus femoris was $9.0{\sim}15.0\;cm$ from the ASIS. In all cases, the main artery's entrance was proximal to the first nerve branch. Conclusion is that rectus femoris has available data for functional flap.

• 대한두개안면성형외과학회지
• /
• 제21권4호
• /
• pp.237-243
• /
• 2020

Background: The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons. Methods: This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors. Results: Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p=0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R=0.479, p<0.001) and depth (p<0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis. Conclusion: There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.

• Archives of Plastic Surgery
• /
• 제42권5호
• /
• pp.619-625
• /
• 2015

Background The reconstruction of ankle and heel defects remains a significant problem for plastic surgeons. The following options exist for reconstructing such defects: local random flaps, reverse flow island flaps, and free flaps. However, each of these methods has certain drawbacks. Peroneal artery perforators have many advantages; in particular, they are predictable and reliable for ankle and heel reconstructions. In this study, we report our clinical experience with peroneal artery perforator-based pedicled flaps in ankle and heel reconstructions. Methods From July 2005 to October 2012, 12 patients underwent the reconstruction of soft tissue defects in the ankle and heel using a peroneal artery perforator-based pedicled flap. These 12 cases were classified according to the anatomical area involved. The cause of the wound, comorbidities, flap size, operative results, and complications were analyzed through retrospective chart review. Results The mean age of the patients was 52.4 years. The size of the flaps ranged from $5{\times}4$ to $20{\times}8cm^2$. The defects were classified into two groups based on whether they occurred in the Achilles tendon (n=9) or heel pad (n=3). In all 12 patients, complete flap survival was achieved without significant complications; however, two patients experienced minor wound dehiscence. Nevertheless, these wounds healed in response to subsequent debridement and conservative management. No patient had any functional deficits of the lower extremities. Conclusions Peroneal artery perforator-based pedicled flaps were found to be a useful option for the reconstruction of soft tissue defects of the ankle and heel.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제34권2호
• /
• pp.140-147
• /
• 2012

Microvascular reconstruction, in the oral and maxillofacial regions, is a widely accepted as the best way to overcome the complex oral cavity defects. Many patients requiring composite reconstructions have been treated previously with radiation therapy, chemotherapy, selective and/or functional neck dissection or any of these combinations. In many cases of these patients, inadequate neck vessels for the microanastomosis of free flap are available, due to a lack of recipient vessels in the neck, poor vessel quality or vessel caliber mismatch. To achieve a tension-free anastomosis, vein grafting must be considered to span the vessel gap between the free flap pedicle and the recipient neck vessels. Although most microsurgeons believed that interpositional grafts are to be avoided due to vessel thrombosis and increased number of necessary microanastomosis, we, authors have some confidence of equivalency between reconstruction with and without interpositional saphenous vein graft. The great saphenous vein, also known as the long saphenous vein, is the large subcutaneous superficial vein of the leg and thigh. It joins with the femoral vein in the region of femoral triangle at the saphenofemoral junction, and coursed medially to lie on the anterior surface of the thigh before entering an opening in the fascia lata, called the saphenous opening. For a better understanding of the great saphenous vein graft for the interpositional vessel graft in the oral cavity reconstructions, and an avoidance of any uneventful complications during these procedures, the related surgical anatomies with their harvesting tips are summarized in this review article in the Korean language.

• 대한두경부종양학회지
• /
• 제7권2호
• /
• pp.92-98
• /
• 1991

Numerous mycoutaneous island flaps or free flaps have been used to reconstruct a defect which resulted from the wide resection of tumor mass in head and neck region. Since the curative resection of tumor usually include muscles and bones as well as skin and mucosa, the anatomical and functional restoration of the defect depend on which and what amount of tissues were provided to cover the defect; good aesthetic appearance subsequently follows the result. Furthermore, a simultaneous neck nodes dissection usually results in exposure of major neck vessels., which should be protected with sufficient padding. The ideal method to reconstruct a defect in the head and neck region requires a sufficient coverage by muscle layer with good vascularity, a wide arc of rotation, and minimization of donor site defect. The pectoralis major myocutaneous flap which was first decribed by Ariyan and lateral trapezius myocutaneous flap by Demergasso meet these criteria. We describe the use of these myocutaneous flaps in reconstruction of mandible and oral cavity.

• Archives of Plastic Surgery
• /
• 제47권5호
• /
• pp.451-459
• /
• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

• 대한치과보철학회지
• /
• 제60권2호
• /
• pp.195-201
• /
• 2022

편평세포암으로 하악골 절제술과 비골 피판 이식을 받은 경우 하악의 기능적 움직임이 저해될 수 있다. 하악골이 절제된 측은 근육부착의 소실로 인해 근기능이 약화되어 중심교합 및 편심교합에서 불안정한 교합접촉을 초래한다. 본 증례는 하악골절제술과 비골이식 재건술을 받은 63세 남성에서 전치부의 상실된 치아를 수복하기 위해 고정성 보철물이 필요했던 경우이다. 중심 및 편심교합에서 교합력의 크기에 따라 교합접촉 양상의 변화가 관찰되었다. Functionally generated path 기법과 디지털 영상기술을 적용하여 환자의 하악운동과 조화되고 적절한 수직고경이 있는 기능적으로 최적화된 고정성 보철물을 제작할 수 있었기에 보고하고자 한다.

• Archives of Plastic Surgery
• /
• 제39권4호
• /
• pp.360-366
• /
• 2012

Background Coverage of defects of the pretibial area remains a challenge for surgeons. The difficulty comes from the limited mobility and availability of the overlying skin and soft tissue. We applied variable pedicled perforator flaps to overcome the disadvantages of local flaps and free flaps on the pretibial area. Methods Eight patients who had the defects in the anterior tibial area were enrolled. Retrospective data were obtained on patient demographics, cause, defect location, defect size, flap dimension, originating artery, pedicle length, pedicle rotation, complication, and postoperative result. The raw surface created following the flap elevation was covered with a split thickness skin graft. Results Posterior tibial artery-based perforator flaps were used in five cases and peroneal artery-based perforator flaps in three cases. The mean age was 54.3 and the mean period of follow-up was 6 months. The average size of the flaps was 63.8 $cm^2$, with a range of 18 to 135 $cm^2$. There were no major complications. No patients had any newly developed functional deficit of the lower leg. Conclusions We suggest that pedicled perforator flaps can be an alternative treatment modality for covering pretibial defects as a simple, safe and versatile procedure.

• Archives of Reconstructive Microsurgery
• /
• 제6권1호
• /
• pp.96-102
• /
• 1997

The gracilis that is frequently used as a donor of free muscle trasfer is appropriate in the muscular shape and vascular position. This muscle is belonged to the second type of muscle group by the classification of the pattern of muscular nutrient vessel. The adductor branch or first perforating branch of deep femoral artery which supplies the proximal 1/3 of this muscle is a dominant one and this is used for the microscopic anastomosis of muscle or musculocutaneous flap. The minor vascular pedicles which enter the distal 1/3 of this of this muscle are branches of the superficial femoral artery and it is 0.5mm in diameter, 2cm in length with two venae comitantes. These minor pedicles supplies distal half of the gracilis muscle. This island musculocutaneous flap using distal vascular pedicle can be used to cover the defect of soft tissue around the distal femoral supra-condylar area, knee joint and proximal tibial condyle area which cause limitation of motion of knee joint, or in the cases that usual skin graft is impossible. The important operative procedure is as follows; The dissection is carried proximally and distally and the entire gracilis muscle including proximal and distal pedicle is completely dissected. After temporary blocking of the proximal vascular pedicle, the adequate muscle perfusion by the distal pedicle is identified and it is rotated to the recipient site around knee joint. The advantages of this procedure are simple, no need of microscopic vascular anastomoses and no significant functional loss of donor site. Especially in the cases of poor condition of the recipient vessel, this procedure can be used effectively. From 1991 to 1996, we performed 4 cases; complete survival of flap in 3 cases and partial survival of flap with partial necrosis in 1 case. This procedure is though to be useful in the small sized soft tissue defect of distal femoral supra-condylar area, knee joint and proximal tibial condylar area, especially in the defect of anterior aspect which expected to cause limitation of motion of knee joint due to scar contracture. But the problems of this procedure are the diameter of distal vascular pedicle is small and the location of distal vascular pedicle is not constant. To reduce the failure rate, identify the muscular perfusion of distal vascular pedicle after blocking the proximal pedicle, or strategic delay will be helpful.