• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.28-34
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• 1999

The need for reconstruction of large bone, soft tissue defect of mandible has greater emphasis due to development of industry, traumatic accident and increase of tumor. The mandibular reconstruction had greatly progressed through the first and the second World Wars. The Fibular free flap by using microscope was reported in 1970 and many maxillofacial reconstructive surgeons had used. In 1988, Dr. Hidalgo first reported mandibular reconstruction by using fibular free flap. Mandibular reconstruction by using fibular free flap has several advantages. First, it provides up to 25 cm of bone, enough to reconstruct any length of mandible defect. Second, a skin island, based on a septocutaneous blood supply, is available in a size large enough to simultaneously reconstruct internal and external soft tissue defect. Third, The fibular donor site morbidity is low, fourth, it provides a esthetic effect of mandible line. And finally bone viability is good. The Fibular osteocutaneous free flap was performed after COMMANDO operation due to squamous cell cancer in oral cavity (15 cases). Therefore we report out successful operation of the mandible reconstruction by using fibular osteocutaneous free flap.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.653-658
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• 2008

Purpose: Skin and soft tissue defect is one of the major challenges faced by plastic surgeons. Adipose derived stromal cells, which can be harvested in large quantities with low morbidity, display multilineage mesodermal potential. Therefore, adipose derived stromal cells have been met with a great deal of excitement by the field of tissue engineering. Recently, Adipose derived stromal cells have been isolated and cultured to use soft tissue restoration. In order to apply cultured cells for clinical purpose, however, FDA approved facilities and techniques are required, which may be difficult for a clinician who cultures cells in a laboratory dedicated to research to utilize this treatment for patients. In addition, long culture period is needed. Fortunately, adipose derived stromal cells are easy to obtain in large quantities without cell culture. The purpose of this study is to present a possibility of using uncultured adipose derived stromal cells for wound coverage. Methods: Seven patients who needed skin and soft tissue restoration were included. Five patients had diabetic foot ulcers, 1 patient got thumb amputation, and 1 patient had tissue defect caused by resection of squamous cell carcinoma. The patients' abdominal adipose tissues were obtained by liposuction. The samples were digested with type I collagenase and centrifuged to obtain adipose derived stromal cells. The isolated adipose derived stromal cells were applied over the wounds immediately after the wound debridement. Fibrin was used as adipose derived stromal cells carrier. Occlusive dressing was applied with films and foams and the wounds were kept moist until complete healing. Results: One hundred to one hundred sixty thousand adipose derived stromal cells were isolated per ml aspirated adipose tissue. All patients' wounds were successfully covered with the grafted adipose derived stromal cells in a 17 to 27 day period. No adverse events related to this treatment occurred. Conclusion: The use of uncultured adipose derived stromal cells was found to be safe and effective treatment for wound coverage without donor site morbidity.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.655-662
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• 2011

Purpose: The anterolateral thigh flap is versatile flap for soft-tissue reconstruction for defects located at various sites of the body. This useful flap offers a thick and vascular fascia lata component with large amounts that can be soft tissue coverage for different reconstructive purposes. We present our clinical experience with the use of vascular fascia lata, combined with anterolateral thigh flap for various reconstructive goals. Methods: From April 2008 to February 2011, we transferred anterolateral thigh flaps with fascia lata component to reconstruct soft-tissue defects for different purposes in 11 patients. The fascia lata component of the flap was used for tendon gliding surface in hand/forearm reconstruction in 4 patients, for reconstruction medial and lateral patellar synovial membrane and retinaculum in 2 patients, for reconstruction of plantar aponeurosis in the foot in 2 patients, for reconstruction of fascial and peritoneal defect in the abdominal wall in 2 patient, and for dural defect reconstruction in the scalp in the remaining one. Results: Complete loss of the flap was not seen in all cases. Partial flap necrosis occurred in 2 patients. These complications were treated successfully with minimal surgical debridement and dressing. Infection occurred in 1 patient. In this case, intravenous antibiotics treatment was effective. Conclusion: Anterolateral thigh flap has thick vascular fascia with large amounts. This fascial component of the flap is useful for different reconstructive aims, such as for tendon, ligament, aponeurosis defects, abdominal wall or dura reconstruction. It should be considerated as an important advantage of the flap, together with other well-known advantages.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.58-64
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• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.28-34
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• 1998

The traditionally useful coverage methods of the wrist and hand soft tissue defect are the chinese forearm flap, the ulnar forearm flap. But, this flaps are inevitably sacrifice major vessel to the hand. Advantages of the posterior interosseous artery island flap(PIA Flap) is no need to sacrifice blood supply to the hand and supply relatively large thin, good quality flap and more cosmetic than other forearm flaps. But, it is difficult to dissect and raise because of deep seat, close relation with the posterior interosseous nerve and anatomic variation. Authors evaluated 8 cases of 7 patients in the department of orthopaedic surgery, college of medicine, Hallym University from January, 1993 to December, 1995. The results are as follows: 1. The satisfactory coverage was achieved 7 cases and 1 case failed because of anatomic variation. 2 The pedicle length is average 9cm and the flap size is variable from 3cm by 4cm to 5cm by 8cm. 3. The donor site defect was repaired by direct closure in 5 cases, remained 3 cases combined with skin graft. From our experience we conclude that the PIA flap is one of the useful coverage methods of the wrist and hand soft tissue defect.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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• pp.103-110
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• 1997

Since R.Y. Song(1982) has reported anatomic studies about septocutaneous perforator flap, various experiences especially on thigh flaps pedicled on septocutaneous artery were reported. Baek(1983) reported an anatomic study through the cadavers dissections on medial, lateral thigh area and provided the first new cutaneous free flap of thigh for clinical use. Song, et a1.(1984) reported anterolateral thigh free flap, Koshima, et al.(1989) reported pedicle variations and its versatile clinical usages. According to their reports, accessory branches of lateral femoral circumflex artery are placed in comparatively constant location and proved to be the effective pedicle of this flap. The advantages of anterolateral thigh free flap are 1) comparatively thin 2) can obtain sufficiently large flap 3) can contain cutaneous nerve 4) can be easy to approach anatomically because pedicle is located in comparatively constant position 5) minimal donor site morbidity. We report the experience of 10 cases of anterolateral thigh free flap coverage for soft tissue defects: 4 cases of soft tissue defects on foot area, 2 cases of soft tissue defects on hand, 3 cases of partial tongue defects owing to tongue cancer ablation, and 1 case of soft tissue defect on nasal alar.

• 대한두개안면성형외과학회지
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• 제20권3호
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• pp.212-216
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• 2019

Zygomaticomaxillary complex (ZMC) fractures account for a substantial proportion of trauma cases. The most frequent complications of maxillofacial fracture treatment are infections and soft tissue flap dehiscence. Postoperative infections nearly always resolve in response to oral antibiotics and local wound care. However, a significant infection can cause a permanent fistula. A 52-year-old man visited our clinic to treat an oroantral fistula (OAF), which was a late complication of a ZMC fracture. Postoperatively, the oral suture site dehisced, exposing the absorbable plate. However, he did not seek treatment. After 5 years, an OAF formed with a $2.0{\times}2.0cm$ bony defect on the left maxilla. We completely excised the OAF, harvested a piece of corticocancellous bone from the iliac crest, inserted the harvested bone into the defect, and covered the soft tissue defect with a buccal mucosal transposition flap. Although it is necessary to excise OAFs, the failure rate is higher for large OAFs (> 5 mm in diameter) because of the extensive defect in the underlying bone that supports the overlying flap. Inappropriate management of postoperative wounds after a ZMC fracture can lead to disastrous outcomes, as in this case. Therefore, proper postoperative treatment and follow-up are essential.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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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.

• 대한심미치과학회지
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• 제28권2호
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• pp.74-85
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• 2019

상악전치부에서 치아 임플란트의 심미적 회복은 경조직, 연조직, 심미적 보철물이 조화를 이루어야 하며 임상의에게 도전적인 과제이다. VIP-CT graft와 같은 새로운 기법이 많은 볼륨의 연조직 이식을 위해서 소개되어졌다. VIP-CT graft의 장점은 많은 연조직의 결손부위를 회복할 수 있고 술후 수축이 적다는 것이다. 게다가 그것은 부가적인 혈행공급을 통해 경조직의 증대도 촉진실킬 수 있다. 이 기법은 환자분의 불편감을 줄여주고 치료시간을 단축시킨다. 이 논문에서는 순면 결손부위가 있는 상악전치부에서 즉시 임플란트 식립을 할때 골이식과 VIP-CT graft 술식을 하는 과정에 대해 설명드리고자 한다.

• Archives of Plastic Surgery
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• 제50권6호
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• pp.586-592
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• 2023

Background One-stage reconstruction with "thin perforator flaps" has been attempted to salvage limbs and restore function. The deep inferior epigastric perforator (DIEP) flap is a commonly utilized flap in breast reconstruction (BR). The purpose of this study is to present the versatility of DIEP flaps for the reconstruction of large defects of the extremities. Methods Patients with large tissue defects on extremities who were treated with thin DIEP flaps from January 2016 to January 2018 were included. They were minimally followed up for 36 months. We analyzed the etiology and location of the soft tissue defect, flap design, anastomosis type, outcome, and complications. We also considered the technical differences in the DIEP flap between breast and extremity reconstruction. Results Overall, six free DIEP flaps were included in the study. The flap size ranged from 15 × 12 to 30 × 16 cm². All flaps were transversely designed similar to a traditional BR design. Three flaps were elevated with two perforators. Primary closure of the donor site was possible in all cases. Five flaps survived with no complications. However, partial necrosis occurred in one flap. Conclusion A DIEP flap is not the first choice for soft tissue defects, but it should be considered for one-stage reconstruction of large defects when the circulation zone of the DIEP flap is considered. In addition, this flap has many advantages over other flaps such as provision of the largest skin paddle, low donor site morbidity with a concealed scar, versatile supercharging technique, and a long pedicle.