• Archives of Plastic Surgery
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• v.32 no.1
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• pp.100-104
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• 2005

A soft tissue defect of the lower leg or foot presents a challenging problem. Reconstructive surgeon should be armed at all points of wound site, tendon and bone exposure, injury of major vessel and so on in the lower limb. We reconstructed the defects of lower legs and feet of 25 patients between February, 1997 and December, 2003. Applying reversed adipofascial flap with skin graft on a soft tissue defect of the lower leg or foot is challenging. We did a comparative study of 25 reversed adipofascial flaps with 51 free flaps. All 25 cases of reverse adpofascial flap reconstruction were successful except for a partial loss of skin graft in 3 occasions. The reversed adipofascial flap had a merit of a short operation time and hositalization, a high success rate and minimum complications. Besides major vessels in the lower leg are better preserved and donor morbidity is minimal. However, the flap is unmerited in reconstructing a hug hallowed defect and in the leg with poor blood circulation and once previous surgery. The operators may consider the feasible substitution of reversed adipofascial flap for free flap before applying in the lower leg.

• Archives of Reconstructive Microsurgery
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• v.13 no.2
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• pp.117-122
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• 2004

Purpose : The aim of this study was to evaluate the efficacy of arterialized venous flap in finger flexion contracture correction. Materials and methods : From 2002 to 2004, we have performed 10 arteriaized venous flap for treatment of severe flexion contracture in digit. The duration of flexion contracture was from 1 year to 50 years. The cause of contracture were bum scar(7 cases), postoperative contracture(2 cases) and other(l case). We evaluated the survival of flap, flap size, recovery of flexion contracture and subjective satisfaction. Results : All arterialized venous flap survived. The marginal minimal skin necrosis developed in 2 cases. The flap size was average $5.2{\times}3.5cm$. The recovery of flexion contracture was 87% compared with non affected side. 9 patients(90%) satisfied the results of operation. Conclusion : Arterialized venous flap is one of the useful procedure in treatment of finger flexion contracture because it has many advantages such as thin and good quality, variable length of pedicle, preservation of major vascular pedicle, less operation time and in addition possibility of various modifications.

• Archives of Reconstructive Microsurgery
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• v.17 no.1
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• pp.14-18
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• 2008

Purpose: Evaluation of results of free flap as a method of reconstruction in soft tissue defect after wide excision of soft tissue tumor of extremity. Materials and Methods: From 2000 through 2007, 11 patients received free flap surgery for soft tissue defect after wide excision operation for soft tissue tumor of limbs. Four cases were upper extremities and seven were lower extremities. Four subjects were diagnosed as squamous cell carcinoma, three as malignant melanoma, two as synovial sarcoma and one as malignant fibrous histiocytoma and alveolar soft part sarcoma. Donor sites of free flap varied with anterolateral thigh flaps in six cases, latissimus dorsi flaps in four, reverse forearm flap in one. By the method of doppler ultrasound, venous circulation was evaluated for the survival of each flap on the third, fifth and seventh day respectively after the operation. Results: 10 of 11 free flaps were successfully survived. Necrosis of free flaps in 1 cases occurred in case of anterolateral thigh flap. Conclusion: Free flap can be a useful method for reconstruction of soft tissue defect after wide excision of soft tissue sarcoma of extremity.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.811-813
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• 2009

Purpose: Congenital cleft earlobe is relatively rare malformation and defective type congenital cleft earlobes are reconstructed with mainly local flap methods rather than primary closure or z - plasty. Various methods are introduced but many of these remain visible scars or require complex operative techniques. We designed a new and simple method of reconstruction for defective type cleft earlobe. Methods: On the posterior surface of the auricle and mastoid area, S - shaped line was drawn continuously. One arc is for turnover hinge flap to make the anterolateral surface of the earlobe, and the other is for transposition flap to reconstruct the posterolateral surface. The donor site of the transposition flap was closed primarily. Results: Four patients were operated by S - shaped flap design method. They were all female and two were right side and others were left. We obtained aesthetically satisfactory postoperative results with inconspicuous scars at the posterior side of the auricle. In one case, minor revision was performed because of insufficient blood supply of the hinge flap. Conclusion: We can reconstruct defective type cleft earlobe with new, simple S - shaped design for hinge flap and transposition flap.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.69-71
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• 2016

Reconstruction of the lower extremities is difficult due to a lack of skin laxity and muscular tissues. Here, we present a case of lower extremity reconstruction via the anterior tibial artery perforator based segmental muscle island flap. Our patient was a 75-year-old male with a chronic ulcerative wound on the right lower leg from an old car accident. A $5.0{\times}0.5cm$ size ulcerative wound with tibial bone exposure was noted. We planned to reconstruct the lower extremity defect with a free flap, but the vessel status was severely compromised intraoperatively. Thus, we found the anterior tibial artery perforator using Doppler ultrasound, elevated the tibialis anterior muscle segment flap, and transposed it to cover the defect successfully. The flap presented with a nice contour and the skin graft covering the flap survived completely. There were no complications of the surgical site at three months follow-up and no gait morbidity. This is a meaningful case applying the concept of segmental muscle flap based on a perforator that had advantages including proper bulkiness, vascularization, and preservation of function, which were well applied, leading to great success.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.3
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• pp.209-213
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• 1995

Various cutaneous as well as myocutaneous flaps have been designed for the reconstruction of tissue defects caused by the excision of oral cancer. Among these flaps, cervical island skin flap have been introduced by Farr et al and more have developed by Tashiro et al. This flap has many advantages. The flap minimizes donor size by use of cervical operation wound, flap size available is adequate for most oral defects and the procedure is relatively simple and time saving. However, this flap is not applicable in patients where there are large tissue defects and metastasis is suspected. We used this flap for it's rapid, simple, and effective, primary closure of oral defects after cancer ablation and we have found this flap very useful for the reconstruction of relatively small oral defects.

• Archives of Plastic Surgery
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• v.45 no.1
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• pp.85-88
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• 2018

Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19-80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

• Archives of Plastic Surgery
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• v.46 no.5
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• pp.480-483
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• 2019

Repairing surgical defects of the nose is still challenging due to its tridimensional shape and its aesthetic concern. Difficulty in reconstructing nasal subunits lies in their contour, skin texture and limited availability of adjacent skin. For lower nasal dorsum and supra-tip regions, we design a new combined local flap as existing local flaps may give disappointing results. This combination flap was performed on two patients for reconstruction of the lower nasal dorsum area after basal cell carcinoma excision. Size of the excision ranged from 20 to 25 mm diameter and safe margins were obtained. The defects were reconstructed with a local flap that combined a rotation nasal flank flap and a V-Y advancement nasolabial flap. Excision and reconstruction were performed in a one-stage surgery under intravenous sedation and local anesthesia. There were no postoperative complications and no flap loss occurred. Aesthetic and functional results after 6 months postoperatively were satisfying without modification of nasal shape. This flap is reliable and offers interesting functional and aesthetic outcomes. It can be considered as a new reconstruction alternative for supra-tip and lower nasal dorsum skin defects performed in a one-stage procedure under local anesthesia.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.235-240
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• 2019

Background The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. Methods A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. Results Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 ($107.7{\pm}60.3cm^2$ vs. $61.4{\pm}33.8cm^2$, respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. Conclusions Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.448-452
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• 2022

Total reconstruction of the penis (TPR) represents a challenge for urologists and plastic surgeons, especially when urethral length is severely reduced. We here describe, for the first time in an oncologic scenario, a double flap phalloplasty using a pedicled anterolateral thigh (ALT) flap for penile reconstruction and a radial forearm free flap (RFFF) for complete neourethra and glans reconstruction following penile amputation. A 48-year-old patient came to our department following a total penectomy with inferior urethral derivation. The indication for a double flap phalloplasty was posed as only way to fully reconstruct the urethra on its length avoiding possible complications of single flap reconstruction using tube-into-tube technique. Both flaps healed uneventfully with no neourethral strictures or fistulas described. At 18 months follow-up, the patient was extremely satisfied with the aesthetic result and was able to void in standing position. We think that a double free tissue transfer for TPR should be considered, particularly when a urethral length > 14 cm needs to be reconstructed. While the pedicled ALT can be used to reconstruct a proper penile shaft with an easily concealed scar, the RFFF can provide adequate neourethra length with satisfactory sensory recovery at the neoglans.