• Archives of Plastic Surgery
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• 제50권5호
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• pp.501-506
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• 2023

This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.

• 대한기관식도과학회지
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• 제16권2호
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• pp.131-137
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• 2010

Background: Montgomery T-tube is widely used to maintain airway in many cases. Market-available tubes are not always fit to the trachea of each patient and need some modification such as trimming. Complications do happen in prolonged use like tracheostomy tubes. To overcome above limitations, we designed custom-made T-tube using CT data with the aid of 3D reconstruction software. Material and Method: Boundaries were extracted from neck CT data of normal person and processed by surface rendering methods. Real laryngotracheal model and tracheal inner surface-mimicking tube model were made with plaster and rubber. The main tube was designed by accumulation of circles or simple closed curves made from boundaries. Stomal tube was made by accumulation of squares due to limitation of software. Measurement data of tracheal lumen were used to custom-made T-tubes. Tracheal lumen residing portion (vertical limb) was made like circular cylinder or simple closed curved cylinder. Stomal portion (horizontal limb) was designed like square cylinder. Results: Custom made T-tube with cylindric vertical limb and horizontal limb of square cylinder was designed. Conclusion: CT data was helpful in making custom made T-tube with 3D reconstruction technique. If suitable materials are available, commercial T-tube can be printed out from 3D printers.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.1-15
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• 1996

From Fabuary 1982 to May 1995, 396 patients had undergone reconstructive surgery of the upper and lower limb with microsurgical technique at department of orthopaedic surgery, Yonsei University of Medicine. The results were as follows; 1. Average age at the time of operation was 23.4years(2-64 years), and there were 277 male and 119 female patients. 2. Among 324 patients of soft tissue flap(87 inguinal flap, 132 scapular flap, 38 latissimus dorsi flap, 11 latissimus dorsi and scapular combind flap, 6 gracilis flap, 12 deltoid flap, 3 tensor facia lata flap, 11 dorsalis pedis flap, 6 lateral thigh flap, 12 wrap around flap, 1 lateral arm flap, 5 musculocutaneous flap), 274 cases(85.5%) were succeed. 3. Among 37 patients of vascularized bone graft(18 fibular bone graft, 11 iliac bone graft, 7 toe to finger transplantation,1 vascular pedicle rib graft), 30 cases(80.1%) were succeed. 4. In 26 cases of segmental resection and rotationplasty at lower extremity, 23 cases were succeed. 5. In 7 cases of Tikhoff-Linberg procedure and in 2 case of segmental resection and replantation, all case was succeed. Overall success rate of microscopic reconstructive surgery was 85.6%. In conclusion, microsurgical technigue is valuable for reconstruction of tissue defect or function loss of the limb.

• 대한두개안면성형외과학회지
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• 제24권6호
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• pp.260-265
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• 2023

Background: The traditional nasolabial V-Y advancement flap is widely used for midface reconstruction, particularly for the lower third of the nose and upper lip, as its color and texture are similar to these areas. However, it provides insufficient tissue to cover large defects and cannot restore the nasal convexity, nasal ala, and adjacent tissues. The purpose of this study is to investigate the modified nasolabial V-Y advancement flap with extension limbs the along alar crease for the reconstruction of complex midface defects. Methods: A retrospective analysis of 18 patients, who underwent reconstruction with the modified nasolabial V-Y advancement flap, was performed between September 2014 and December 2022. An extension limb was added along the alar crease, adjacent to the defect area, and was hinged down as a transposition flap at the end of the advancement flap. Results: The extension limb along the alar crease successfully covered large and complicated defects, including those of the ala, the alar rim, the alar base, the nostrils, and the upper lip, with minor complications. Conclusion: The alar crease is a good donor site for the reconstruction of large and complex nasal and upper lip defects.

• Archives of Plastic Surgery
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• 제35권5호
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• pp.533-538
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• 2008

Purpose: Sensory changes in the upper limb are complications of a mastectomy with immediate breast reconstruction with the treatment of breast cancer. The purpose of this study is to clarify whether immediate breast reconstruction worsens the sensory changes. Methods: From March 2004 to December 2005, 20 patients who had a mastectomy with immediate breast reconstruction(reconstruction group) were compared with 23 patients who had a mastectomy alone(control group). All patients had stage I or II breast cancer. The sensory changes were assessed in a blind manner by one examiner that used light touch sensation, static two-point discrimination, pain, vibration, hot and cold temperature perception. The sensory changes were identified along the sensory dermatome for diagnosing the damaged nerves. The following factors and their relationship with the sensory changes were analyzed : age, complications, and the mastectomy method. Results: There was no statistical difference in the static two-point discrimination, pain, vibration, hot and cold temperature perception between the two groups. However, the ability to recognize light touch was significantly better(p=0.045) in the reconstruction group than in the control group. The main site of sensory change was the proximal and medial portion of the upper limb in both groups. At these sites, the mean value of Semmes-Weinstein monofilament was $1.01g/mm^2$(reconstruction group 0.82, control group 1.17) and 2-point discrimination was 51.74(converted to perfect score of 100; reconstruction group 42.50, control group 59.78). The total rate of early complications was found to be significantly lower(p=0.006) in the reconstruction group than in the control group. Conclusion: These findings suggest that an immediate breast reconstructive procedure following a mastectomy is as safe as or safer than a mastectomy alone with respect to postoperative sensory changes of the ipsilateral upper limb.

• Archives of Plastic Surgery
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• 제44권3호
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• pp.243-247
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• 2017

Reconstruction of the lower limb presents a complex problem after skin cancer surgery, as proximity of skin and bone present vascular and technical challenges. Studies on vascular anatomy have confirmed that the vascular plane on the lower limb lies deep to the deep fascia. Yet, many flaps are routinely raised superficial to this plane and therefore flap failure rates in the lower limb are high. Fascio-cutaneous flaps based on perforators offer a better cosmetic alternative to skin grafts. In this paper, we detail use of a thermal imaging camera to identify perforator 'compartments' that can help in designing such flaps.

• 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.

• 대한골관절종양학회지
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• 제3권1호
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• pp.47-55
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• 1997

During the last decade, the use of primary amputation has decreased, and a larger number of patients are being treated with resection and reconstruction with limb preservation. The advantage of chemotherapy, improvements in diagnostic imaging methods and newer techniques for reconstruction have made limb salvage an alternative to amputation for most patients with malignant bone tumor. Clinical results and functional results of the limb salvage operation of bone tumors treated at the Department of Orthopaedic Surgery, Guro Hospital, Korea university was reviewed. Eighteen bone tumors(seven giant cell tumors and eleven malignant bone tumors.) were studied over a period of five years. The limb salvage group included fourteen endoprothesis, two pasteurized autograft, one near total scapulectomy and one rotationplasty. Functional evaluation was performed according to the Enneking's modified system. The results were as followed; 1. At a mean follow-up of thirty two months (15-77 months), fourteen(83%) of the eighteen patients with limb salvage procedures had been continuously disease free. 2. There are no local recurrence but deep infection developed in two patients and three patients with distant metastasis. 3. Thirteen(87%) of the fifteen patients showed above 60% of functional results. 4. Fourteen(93%) of the fifteen patients were satisfied with the limb salvage procedures.

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1992년도 제12차 학술대회
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• pp.86-87
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• 1992

• Archives of Reconstructive Microsurgery
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• 제12권1호
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• pp.38-43
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• 2003

Purpose : Various free flaps and pedicled island flaps are effective for reconstruction of soft tissue defect developed after tumor excision. We want to know the advantage of dorsalis pedis island flap for reconstruction of soft tissue defect caused by soft tissue tumor excision. Materials and Methods : Between 1992 and 2002, we performed 4 dorsalis pedis island flap procedure for reconstruction of soft tissue defect of lower limb developed after soft tissue tumor excision. Average age was 54.7 years old $(40{\sim}68)$, and male 2 cases, female 2 cases. The kinds and number of soft tissue tumors were 2 squamous cell carcinoma and 2 malignant melanoma. The procedures that we performed were all dorsalis pedis island flap. The analysis for the result of treatment was retrospectively accessed by physical examination and questionnaire for whether the change of symptom after operation, range of adjacent joint motion. Also we reviewed associated complication after operative treatment. Results : All dorsalis pedis island flaps were alive. There is no problem for activity of daily living, no skin necrosis and no limitation of motion of adjacent joint. In 1 case of them, the patients died of distant metastasis. Conclusion: Dorsalis pedis island flap procedure as a pedicled island flap procedure is very effective and easy operative procedure for reconstruction of soft tissue defect of lower limb developed after tumor excision compared to free flap procedure because there is no need for microvascular surgery, we can obtain relatively large flap and the lesion and flap donor site locate in the same limb.