• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권6호
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• pp.527-537
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• 2007

To evaluate criteria, indications, and prognosis of the various reconstructive methods on the patients with intraoral soft tissue defect who had been treated at Dept. of Oral and Maxillofacial Surgery, Pusan National University Hospital from 2003 to 2005, we have reviewed the clinical data of the patients and analysed. The results were as follows: 1. Tongue flaps have been mainly applied on anterior portion of palate and maxilla. The survival rate was high percent, but the cooperation of patient was inevitable for the success. 2. Palatal mucosa rotational flaps were available on relative large defect on palate, oroantral fistula site. The side effect was a scaring band from secondary healing on denuded donor palate site. Sometimes the band came to be a hinderance to swallowing, phonation. 3. Forearm free flap was a workhorse flap for everywhere in intraoral defects. We had used the flap on cheek, floor of mouth, tongue without any significant complications. But the application of the flap was required for long operation time, which was disadvantageous to the old, weak patients. 4. Cervical platysmal flap could be easily applicable for buccal cheek, floor of mouth after excision of the cancer lesion. The design of the flap could be made simultaneously on neck dissection, but the danger of cancer remnants on the flap always might be remained. 5. Buccal fat pad pedicled flap must have been a primary flap for repair of oroantral fistula especially on posterior maxilla. The flap survival will be expected if the considerations for above reconstructive methods on site, size, condition of defects primarily could be made.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.163-168
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• 2007

Purpose: The flap delay is a widely used technique to increase the flap survival. Dexamethasone is a well-known drug to have a positive impact on the flap survival. The objective of this study is to investigate the dual synergic effect of epinephrine as a chemical delay agent plus dexamethasone on the TRAM flap survival in rat model. Methods: Forty Sparague-Dawley rats were divided into 4 groups evenly and a right inferior epigastic vessel pedicled TRAM flap, sized $5.0{\times}3.0cm$, was elevated on each upper abdomen. In the control group(N=10), 2 ml saline was injected on transverse abdominis muscle for a week before the flap elevation. In surgical delay group(N=10) all superior pedicles and left inferior pedicle were ligated a week before the flap elevation. In epinephrine group (N=10), 1 : 50000 epinephrine mixed saline was injected to transverse abdominis muscle every day for a week before flap elevation. In epinephrine plus dexamethasone group (N=10), the same procedure as that of epinephrine group was conducted for a week and 2.5 ml/kg dexamethasone was injected transverse abdominis muscle 2 hours before the flap elevation. On the seventh day after flap elevation, the survival area of flaps were measured and the vessel numbers in upper dermis of flap were counted through histologic slides. Results: The results were as follows: the mean percentage of the flap survival area of surgical delay group ($60.5{\pm}2.44%$), epinephrine group ($75{\pm}4.43%$), and epinephrine plus dexamethasone group ($87{\pm}1.94%$) were higher than that of the control group ($35{\pm}6.06%$) significantly(p<0.05). In case of the vessel number though histologic slides, epinephrine group ($79.3{\pm}5.57$) and epinephrine plus dexamethasone group ($96.3{\pm}14.05$) were higher than that of the control group ($44.8{\pm}8.82$) significantly(p<0.05), but the surgical delay group ($54{\pm}4.23$) showed no significant difference (p>0.05) compared to that of the control group. Conclusion: The results indicated that epinephrine plus dexamethasone injection before the flap elevation could be used to increase the TRAM flap survival area in rat model.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.605-610
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• 2009

Purpose: Substantial tissue necrosis after snake bites requiring coverage with flap surgery is extremely rare. In this article, we report 7 cases of soft tissue defects in the upper and the lower extremities caused by snake bites, which needed to be covered with flaps. Among the vast mass of publications on snake bites there has been no report that focuses on flap coverage of soft tissue defects due to snake bite sequelae. Methods: Seven cases of soft tissue defects with tendon, ligament, or bone exposure after snake bites were included. All patients were males without comorbidities, the average age was 35 years. All of them required coverage with a flap. In 6 cases, the defect was localized on the upper extremity, in one case the lesion was on the lower extremity. Local flaps were used in 6 cases, one case was covered with a free flap. The surgical procedures included one kite flap, one cross finger flap and digital nerve reconstruction with a sural nerve graft, one reverse proximal phalanx island flap, one groin flap, one adipofascial flap, one neurovascular island flap, and one anterolateral thigh free flap. The average interval from injury to flap surgery was 23.7 days. Results: All flaps survived without complication. All patients regained a good range of motion in the affected extremity. Donor site morbidities were not observed. The case with digital nerve reconstruction recovered a static two point discrimination of 7 mm. The patient with foot reconstruction can wear normal shoes without a debulking procedure. Conclusion: The majority of soft tissue affection after snake bites can be treated conservatively. Some severe cases, however, may require the coverage with flap surgery after radical debridement, especially, if there is exposure of tendon, bone or neurovascular structures. There is no doubt that definite coverage should be performed as soon as possible. But we also want to point out that this principle must not lead to a premature coverage. If the surgeon is not certain that the wound is free of necrotic tissue or remnants of venom, it is better to take enough time to get a proper wound before flap surgery in order to obtain a good functional and cosmetic result.

• Archives of Plastic Surgery
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• 제44권3호
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• pp.217-222
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• 2017

Background The prevalence of flap necrosis after palatoplasty in patients with cleft palate. The prevalence of mucoperiosteal flap necrosis after palatoplasty remains unknown, and this complication is rare. This event is highly undesirable for both the patient and the surgeon. We present here a new scale to evaluate the degree of hypoplasia of the palate and identify patients with cleft palate at high risk for the development of this complication. Methods In this case series, a 20-year retrospective analysis (1994-2014) identified patients from our records (medical records and screening day registries) with nonsyndromic cleft palate who underwent operations at 3 centers. All of these patients underwent operations using 2-flap palatoplasty and also underwent a physical examination with photographs and documentation of the presence of palatal flap necrosis after primary palatoplasty. Results Palatal flap necrosis was observed in 4 cases out of 1,174 palatoplasties performed at these centers. The observed prevalence of palatal flap necrosis in these groups was 0.34%. Conclusions The prevalence of flap necrosis can be reduced by careful preoperative planning, and prevention is possible. The scale proposed here may help to prevent this complication; however, further studies are necessary to validate its utility.

• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.60-63
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• 2001

The reconstruction of the suborbital area followed by resection of skin cancer has been used many methods including skin graft, local flaps, free flaps, and skin expansion. The radial forearm free flap has become a workhorse flap in this area because of its lack of bulk, ease of dissection, malleability, and hairlessness. When the suborbital defect especially including full-thickness defect of lower lid was reconstructed with many free flaps, the ectropion and the deformity of medial and lateral canthal area were common problems encountered as late complication due to gravitational descent. To improve the final aesthetic result in patients with suborbital defect, the radial forearm free flap was elevated as a composite radial forearm - palmaris longus free flap, in which the vascularized palmaris longus london was included and anchored to the periorbital bone with $mitek^{(R)}$ as sling, to suspend the flap against gravity and inferior descent, and thereby creating a more natural cheek contour. Two clinical cases were presented as an example of this procedure. Postoperative results emphasize the importance of suspension sling with palmaris longus tendon using $mitek^{(R)}$ in reconstruction of the suborbital defect with radial forearm free flap.

• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.55-59
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• 2001

The hand is a frequently affected area in high voltage electrical burn injury as an input or output sites. Therefore, early debridement and synchronous flap coverage are generally accepted as a primary treatment of several electrical burns complicated by exposure of tendons, neurovascular structures, and bones. So, in order to establish convenient, promising methods for the reconstruction of hand defects in electrical burn patients, we performed various reverse forearm flaps. From March 1997 to February 2000, we reconstructed 12 cases of hand defects in high voltage electrical burn wounds with reverse forearm flaps. Reverse radial fasciocutaneous flap were 3 cases, reverse ulnar fasciocutaneous flap were 3 cases, reverse ulnar fasciocutaneous flap and STSG were 4 cases, reverse ulnar fascial flap and STSG were 2 cases. We successfully reconstructed hand defects in all 12 cases, and obtained following conclusions. 1 Various reverse forearm flaps provide well vascularized, profitable tissues and they require short operative time with relatively easy procedures. 2. Reverse fascial flap and STSG, reverse fasciocutaneous flap and STSG provide thin flaps with good aesthetics and minor donor site morbidity.

• Archives of Reconstructive Microsurgery
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• 제22권2호
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• pp.63-68
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• 2013

Purpose: In case of the failed replantation, if the patients want to preserve the length of amputated stump, toe transfer is the ideal choice. However, reconstruction of these amputated stump with a free flap can be a useful method when the patients refuse sacrificing their toe. Our purpose of this study is to evaluate availability of functional results and patient satisfaction after this procedure. Materials and Methods: From March 2008 to February 2012, we reconstructed the amputated stump with free flap by patients demand. Eleven patients were included, medial plantar artery perforator flap in seven cases and great toe pulp flap in five cases. Follow-up range 12 to 24 months and we evaluate patient satisfaction by using a visual analogue scale (VAS; 1=unsatisfied, 5=excellent) and functional recovery by measuring the range of motion of remaining joint at 12 months after operation. Results: During follow-up period, all transferred free flaps survived and no major complications were noted. Range of motion of remaining joint appeared satisfactory result ($15^{\circ}$ to $100^{\circ}$). The VAS patient satisfaction score for aesthetic were five in six patients, four in four patients, and three in one patient. Conclusion: In case of the failed digital replantation, if patient refuse toe transfer, it could be useful method to reconstruction with the free flap to preserving maximal length of amputated stump.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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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.

• 대한두개안면성형외과학회지
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• 제9권2호
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• pp.110-113
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• 2008

Purpose: The jejunal free flap is the most standard and reliable procedure of reconstruction of the circumferential pharyngoesophageal defect because it provides pliable, elastic, secreting mucosa and posses reliable vascular anatomy. In this report, the authors introduce the modification of jejunal free flap for decreasing the complications in fatty complicated patients. Method: After harvesting the jejunum with mesentery and mesenteric vessels, both ends of jejunum were excised remaining the mesenteric portion. The jejunal portion of this composite flap was placed to reconstruct esophagopharyngeal defect area and the mesenteric portion was used to obliterate the dead space at paratracheal region and to cover the vital structure and the vascular anastomotic region. Result: A 72 year-old man with recurrent hypopharyngeal cancer who had about 15 cm sized circumferential pharyngoesophageal defect after total pharyngectomy was reconstructed with jejunomesenteric composite free flap without any complications. Conclusion: The mesenteric flaps at both side of jejunomesenteric composite free flap provide the advantages that could obliterate dead space, that could provide cover for the vital cervical vascular structure in case of vascularity was compromised due to previous radiation therapy, and that could preserve as much vascularity at both ends of jejunal flap as possible.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2000년도 추계학술대회논문집B
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• pp.568-572
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• 2000

A numerical investigation was performed to determine the effect of airfoil thickness on the optimum Gurney flap height using NACA 00XX series airfoils. Seven airfoils which have 3% chord thickness difference were used. These were NACA 0006, 0009, 0012, 0015, 0018, 0021, and 0024. A Navier-Stokes code, FLUENT, was used to calculate the flow field about airfoil. The fully turbulent results were obtained using the standard $k-{\varepsilon}$ two-equation turbulence model. To provide a check case fur our computational method, numerical studies for NACA 4412 airfoil were made and compared with already existing experimental data for this airfoil by Wadcock. For every NACA 00XX airfoil, Gurney flap heights ranging from 0.5% to 2.0% chord were changed by 0.5% chord interval and their effects were studied. With the numerical solutions, the relationship between $(L/D)_{max}$ and airfoil thickness as a function of flap height and the relationship between $(L/D)_{max}$ and flap height as a function of airfoil thickness were investigated. The same relationship for $(C_l)_{max}$ also were shown. From these results, the optimum flap size for each airfoil thickness can be determined and vice versa.