• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.94-101
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• 2018

Background: Atrophy of muscle and fat often contributes to temporal hollowing after pterional craniotomy. However, the main cause is from the bony defect. Several methods to prevent temporal hollowing have been introduced, all with specific limitations. Autologous bone grafts are most ideal for cranial defect reconstruction. The authors investigated the effectiveness of bony defect coverage and temporal augmentation using pterional craniotomy bone flap. Methods: This study was conducted in 100 patients who underwent brain tumor excision through pterional approach from 2015 to 2016. Group 1 underwent pterional craniotomy with temporal augmentation and group 2 without temporal augmentation. In group 1, after splitting the calvarial bone at the diploic space, the inner table was used for covering the bone defect and as an onlay graft for temporal augmentation. The outcome is evaluated by computed tomography at 1-year follow-up. Results: The mean operative time for temporal augmentation was 45 minutes. The mean follow-up was 12 months. The ratio of temporal thickness of operated side to non-operated side was 0.99 in group 1 and 0.44 in group 2, which was statistically different. The mean visual analogue scale score was 1.77 in group 1 and 6.85 in group 2. Conclusion: This study demonstrated a surgical technique using autologous bone graft for successfully preventing the temporal hollowing and improved patient satisfaction.

• Animal cells and systems
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• v.16 no.6
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• pp.431-437
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• 2012

Calpains are a class of proteins that belong to the calcium-dependent, non-lysosomal cysteine proteases. There are three major types of calpains expressed in the skeletal muscle, namely, ${\mu}$-calpain, m-calpain, and calpain 3, which show proteolytic activities. Skeletal muscle fibers possess all three calpains, and they are $Ca^{2+}$-dependent proteases. The functional role of calpains was found to be associated with apoptosis and myogenesis. However, calpain 3 is likely to be involved in sarcomeric remodeling. A defect in the expression of calpain 3 leads to limb-girdle muscular dystrophy type 2A. Calpain 3 is found in skeletal muscle fibers at the N2A line of the large elastic protein, titin. A substantial proportion of calpain 3 is activated 24 h following a single bout of eccentric exercise. In vitro studies indicated that calpain 3 can be activated 2-4 fold higher than normal resting cytoplasmic [$Ca^{2+}$]. Characterization of the calpain system in the developing muscle is essential to explain which calpain isoforms are present and whether both ${\mu}$-calpain and m-calpain exist in differentiating myoblasts. Information from such studies is needed to clarify the role of the calpain system in skeletal muscle growth. It has been demonstrated that the activation of ubiquitous calpains and calpain 3 in skeletal muscle is very well regulated in the presence of huge and rapid changes in intracellular [$Ca^{2+}$].

• Korean Journal of Head & Neck Oncology
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• v.7 no.2
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• pp.92-98
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• 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.

• Korean Journal of Head & Neck Oncology
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• v.1 no.1
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• pp.35-61
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• 1985

The surgical treatment of advanced carcinomas and some benign tumors having clinically malignant behaviors of the head and neck region often require extensive resection, necessitating large flaps for reconstruction. Since the original upper arm flap was described by Tagliacozzi in 1597, a variety of technique such as random pattern local flap, axial flap, distant flap, scalping flap, myocutaneous flap, free flap etc. have been proposed for reconstruction of head, face and neck defects. Reconstruction of the facial defects usually require the use of distant tissue. Traditionally, nasal reconstruction has been carried out with a variety of forehead flaps. In recent years, there has been more acceptance of immediate repairs following the removal of these tumors. As a result, patients are more willing to undergo these extensive resections to improve their chances of cure, with the reasonable expectation that an immediate reconstruction will provide an adequate cosmetic result. Authors experienced 13 cases of head and neck tumor during last three and half years that required wide excision and immediate reconstruction with various flaps, not with primary closure or simple skin graft. We present our experience with varied flaps for reconstruction after wide resection of head and neck tumors 3 cases of defect of dorsum of nose or medial canthus with island forehead flaps, lower eyelid defect with cheek flap, cheek defect with Limberg flap, orbital floor defect with Temporalis muscle flap, lateral neck defects with Pectoralis major myocutaneous flap or Latissimus dorsi myocutaneous free flap, subtotal nose defect with scalping flap, wide forehead defect with Dorsalis pedis free flap and 3 cases of mandibular defect or mandibular defect combined with lower lip defect were reconstructed with free vascularized iliac bone graft or free vascularized iliac bone graft concomitantly combined with free groin flap pedicled on deep circumflex iliac vessels We obtained satisfactory results coincided wi th goal of treatment of head and neck tumors, MAXIMAL CURE RATE with MINIMAL MORBIDITY, OPTIMAL FUNCTION, and an APPEARANCE as close to normal as possible.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.82-86
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• 2008

Purpose: Soft tissue defect can occur on the posterior aspect of the elbow after trauma or fracture fixation. To cover the defect and maintain elbow functions, various flap surgeries including latissimus dorsi muscle flap, lateral arm flap and radial forearm flap can be performed. We present the clinical results of transposition lateral arm flap for coverage of the elbow defect and discuss the cause of posterior soft tissue necrosis after fracture fixation. Materials and Methods: Two patients who had posterior soft tissue defect of the elbow after open reduction of the fractures around the elbow were treated with transposition lateral arm flap. The mean size of skin defect was 20 $cm^2$. The flap was elevated with posterior radial collateral artery pedicle and transposed to the defect area. Donor defect was covered with split thickness skin graft. The elbow was immobilized for 1 week in extended position and active range of motion was permitted. Results: All two cases of transposition lateral arm flap survived without marginal necrosis. The average range of motion of the elbow was 10~115 degrees. Mayo elbow performance score was 72 and Korean DASH score was 23. Conclusion: When elbow fractures are fixed with three simultaneous plates and screws, skin necrosis can occur on the posterior aspect of the elbow around olecranon area. If the size of skin defect is relatively small, transposition lateral arm flap is very useful option for orthopaedic surgeons without microsurgical technique.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.241-249
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• 1985

Twenty-one patients with Double Chambered Right Ventricle [DCRV] associated with Ventricular Septal Defect [VSD] were treated by open heart surgery under cardiopulmonary bypass with moderate hypothermia in the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital between June 1982 and October 1984. The following results were obtained 1. The symptoms and physical signs, specific for DCRV, could not be identified. 2. The radiologic findings on simple chest X-ray, specific for DCRV, could not be identified. 3. Electrocardiographic findings, specific for DCRV, could not be identified. 4. Cardiac catheterization was found to be the most important diagnostic method, revealing pressure gradient between proximal chamber and distal chamber in the right ventricle. The average pressure gradient between two chambers showed 48.1523.29 mmHg[varying from 15mmHg to 94mmHg]. 5. Cardiac angiography was found to visualize the anomalous muscle bundles in right ventricle [in 17 cases, 81%] but the evidence of pressure gradient between two chambers within right ventricle is considered necessary for the diagnosis of DCRV. 6. Via surgical observation, anatomical and pathologic findings of the anomalous muscle bundles, associated DCRV were identified. 7. As the direct pressure was measured on the operating table before and after surgery, the average pressure gradient across the muscle bundles showed 40.5219.75mmHg [varying from 16 to 89mmHg] preoperatively and 8.909.72mmHg [varying from 0 to 32mmHg] postoperatively, indicating significant surgical correction of the obstruction present. 8. The presence of anomalous muscle bundles, dividing the right ventricle into two separated chambers, and the presence of the pressure gradient over 15mmHg are considered necessary for the diagnosis of DCRV.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.20-27
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• 1998

Among many kinds of introduced free flaps, scapular freeflap is one of the most popularly using modalities in fasciocutaneous defect coverage with minimal donor defect and easier procedure and constant vascular patterns of the donor. Many surgeons who had experience of this flap pointed out deficit of the reliable sensation of the transplanted flap is the main shortcoming of the scapular free flap. If we can subjugate that point, scapular free flap is the most excellent procedure in such a cases as heel pad reconstruction and hand reconstruction which are relatively important to have skin with protective sensation. Author performed anatomical literature review, 10 cadaveric dissections and 12 clinical dissections. In surgical anatomical aspect, the upper six dorsal rami of the thoracic nerves have medial branches which pierce Longissimus thoracis and Multifidus muscle with small cutaneous twigs which pierce Latissimus dorsi and Trapezius muscle. Among that cutaneous twigs, several twigs distribute to the skin of the back from midline to lateral aspect which territory is identical to scapular free flap. We analysed clinical experiences of that sensory bearing scapular free flap surgical anatomy and one year follow-up studies with several results. 1) Two to three cutaneous twigs which pierced from the Trapezius muscle over the scapular free flap region. 2) Each twigs has two to four nerve fascicles with small artery. 3) The nerve distributed to the ordinary scapular free flap and large enough size and pedicle length to neurorrhapy with various recipient site nerves. 4) The inconvenience of this procedure is the vascular pedicle and nerve pedicle have opposite directions, vascular pedicle of that comes from lateral direction from subscapular vessels, but nerve pedicle comes from medial direction from trapezius muscle. Author can found constant cutaneous nerve branches which come from piercing the Trapezius. This nerves are helpful for protective sensation in transplanted scapular free flap. We can't had enough follow-up and evaluation of the nerve function of this procedure, we need continuous research works to application of this procedure. The in conveniences come from directional differences of pedicle can solve with longer harvest neural pedicle and change direction of the neural pedicle.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.3
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• pp.248-253
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• 2001

Main disadvantages of conventional pectorails major myocutaneous flap is bulkness of muscular pedicle. It makes difficult to use this flap in a case of supraomohyoid neck dissection. Pectoralis major myocutaneous island flap is a modification to overcome this shortcoming. And bilobular design of skin portion of this flap could be used for reconstruction of a through and through defect. We report a case of reconstruction of full-thickness defect of cheek with bilobular pectoralis major myocutaneous island flap and compare it with conventional pectoralis myocutaneous flap.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.319-323
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• 2022

Total eyelid defect comprises full-thickness loss of both upper and lower eyelids in a patient. It is a rare and devastating condition with serious implications related to vision, which mandates early and functional reconstruction when associated with intact globe. The primary goal is to give a stable coverage for orbital protection but at the same time provide a functional reconstruction of the defect, to allow for adequate mobility of the eyelids so that the patient's vision is restored to normal with minimal disability. When the defect is massive, and in the absence of loco-regional flaps, microvascular tissue transfer is needed. In this report we describe a radial-artery-based microvascular tissue transfer with a unique innovation utilizing the contralateral frontalis muscle to reconstruct a case of unilateral total upper and lower eyelid loss.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.1
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• pp.1-6
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• 1993

The maxillary squamous cell carcinoma is major part of maxillary malignant tumor. The treatment of maxillary malignancy tumor is the maxillectomy in combination with radiation therapy and chemorherapy. When tumor invasion is occured to the orbit, orbital exenteration is required. But if the periosteum of the orbital floor is intact, the orbit can be preserved. There are many orbital floor reconstruction materials for the prevention of ptosis of the orbital content. The patients on this paper were diagnosised as squamous cell carcinoma on maxilla, we performed the partial maxillectomy including the orbital floor, and we used temporalis muscle-coronoid process flap for the reconstruction of the orbital floor after partial maxillectomy and obtained good esthetic and functional results, as followed. 1. We obtained sufficient flap width for defect of orbital floor. 2. It permits good blood supply and no necessary other donor site. 3. It gives a solid base for the support the globe and the orbital floor. 4. It gives minimal postoperative morphorogical defect and functional disturbance.