• Archives of Plastic Surgery
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• v.35 no.4
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• pp.480-482
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• 2008

Purpose: Unexpected vascular anomaly can make the surgeon embarrassing and even affects on the operative results of free flap reconstruction. We experienced one case of abnormal course of deep inferior epigastric vessels during the elevation of rectus abdominis musculocutaneous free flap for breast reconstruction. Methods: A 38-year-old female patient who had modified radical mastectomy on her left breast underwent delayed breast reconstruction with rectus abdominis musculocutaneous free flap. Results: Flap elevation was performed in the traditional manner. During the flap elevation, it was detected that the deep inferior epigastric vessels ran between the rectus abdominis muscle and anterior rectus sheath along the midline after traversing the rectus muscle. The reconstructive surgery was successful and there were no postoperative complications. Conclusion: This is the first case reported in Korea. We should always know about the possibilities of unexpected anomaly that we can encounter.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.435-440
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• 2005

The reconstruction of deep soft tissue defects of lower extremities combined with bone exposure has been difficult problems. When it is impossible to raise local skin flap, we have been usually used the gastrocnemius musculocutaneous flap, cross leg flap or free flaps. However, In musculocutaneous flap, aesthetical appearance of the calf is not appropriate because of too bulky flap. Although the success rate of the free flap has improved, still failure of flap occurs in cases of the chronic ischemic state. As the concepts of perforator flap has recently developed and widely used due to its thin flap thickness. Between January 2002 to December 2004, we treated 7 patients with soft tissue defect in leg with chronic ischemic limbs with perforator island flap. Preoperative angiography were done in all case and we used 2 medial sural perforator flaps, 1 anterior tibial artery perforator flap, 1 posterior tibial artery perforator flap, 3 anterolateral thigh perforator flap. Partial necrosis of flap was seen in one patient but no further surgical procedure was required for wound healed spontaneously. Perforator island flaps are thin, reduce donor site morbidity, conceal donor site with primary closure and it is useful for resurfacing soft tissue defect of lower extremities.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.695-698
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• 2011

Purpose: Since spinal tuberculosis is increasing in prevalence, it appears that a repair of spinal soft tissue defect as a complication of spinal tuberculosis can be a meaningful work. We report this convenient and practical reconstructive surgery which use bilateral latissimus dorsi musculocutaneous advancement flap. Methods: Before the operation, $13{\times}9.5$ cm sized skin and soft tissue defect was located on the dorsal part of a patient from T11 to L3. And dura was exposed on L2. Under the general endotrachel anesthesia, the patient was placed in prone position. After massive saline irrigation, dissection of the bilateral latissimus dorsi musculocutaneous flaps was begun just upper to the paraspinous muscles (at T11 level) by seperating the paraspinous muscles from overlying latissimus dorsi muscles. The plane between the paraspinous muscles fascia and the posterior edge of the latissimus dorsi muscle was ill-defined in the area of deformity, but it could be identified to find attachment of thoracolumbar fascia. The seperation between latissimus dorsi and external oblique muscle was identified, and submuscular plane of dissection was developed between the two muscles. The detachment from thoracolumbar fascia was done. These dissections was facilitated to advance the flap. The posterior perforating vasculature of the latissimus dorsi muscle was divided when encountered approximately 6 cm lateral to midline. Seperating the origin of the latissimus dorsi muscle from rib was done. The dissection was continued on the deep surface of the latissimus dorsi muscle until bilateral latissimus dorsi musculocutaneous flaps were enough to advance for closure. Once this dissection was completely bilateraly, the bipedicled erector spinae muscle was advanced to the midline and was repaired 3-0 nylon to cover the exposed vertebrae. And two musculocutaneous units were advanced to the midline for closure. Three 400 cc hemovacs were inserted beneath bilateral latissimus dorsi musculocutaneous flaps and above exposed vertebra. The flap was sutured with 3-0 & 4-0 nylon & 4-0 vicryl. Results: The patient was kept in prone and lateral position. Suture site was stitched out on POD14 without wound dehiscence. According to observative findings, suture site was stable on POD55 without wound problem. Conclusion: Bilateral latissimus dorsi musculocutaneous advancement flap was one of the useful methods in repairing of large spinal soft tissue defect resulting from spinal tuberculosis.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.103-109
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• 2000

Purpose : We performed this study in order to analyze the clinical results of functioning gracilis musculocutaneous free flap transplantation for reconstructon of hand function in cases of Volkmann's ischemic contracture and massive soft tissue injury of forearm. Materials and methods : 18 cases were reviewed with 5 yeas of mean follow up period. We evaluated total active motion of the finger joints and wrist, pinch and grip strength. Results : The flap were survived in 17 cases and 1 case was failed due to infection. The sum of active motion of finger joints(TAM) was improved from 0 to $173.8^{\circ}$. The average grip and pinch strength was improved from 0 kg to $2.7{\pm}2.1kg$ and from 0 kg to $2.4{\pm}1.6kg$. Conclusion : The results in most cases were acceptable in relatively long term follow-up. It may be an option for reconstruction of hand function in cases of Volkmann's ischemic contracture and traumatic upper extremity injury.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.526-530
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• 2009

Recently, the anterolateral thigh(ALT) flap, based on the septocutaneous vessels or musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery has gained popularity in head and neck soft-tissue reconstruction. It has some advantages in free-flap surgery with respect to the radial forearm free flap, such as low donor site morbidity, availability of different tissues with large amounts of skin, adaptability as a sensate or flow-through flap (with the possibility of harvesting a long pedicle with a suitable vessel diameter). Moreover, the thickness of the flap is adjustable until the subdermal fat level, allowing it to be used as a thin or ultrathin flap. This clinical cases are ALT free flap reconstructions without functional impairment of the donor limbs (transitory and permanent) based on anastomosis with superficial temporal arteries and veins in patient of huge resection defect on face, lip and tongue.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.722-727
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• 2014

Background Perineal reconstruction following pelvic exenteration is a challenging area in plastic surgery. Its advantages include preventing complications by obliterating the pelvic dead space and minimizing the scar by using the previous abdominal incision and a vertical rectus abdominis musculocutaneous (VRAM) flap. However, only a few studies have compared the complications and the outcomes following pelvic exenteration between cases with and without a VRAM flap. In this study, we aimed to compare the complications and the outcomes following pelvic exenteration with or without VRAM flap coverage. Methods We retrospectively reviewed the cases of nine patients for whom transpelvic VRAM flaps were created following pelvic exenteration due to pelvic malignancy. The complications and outcomes in these patients were compared with those of another nine patients who did not undergo such reconstruction. Results Flap reconstruction was successful in eight cases, with minor complications such as wound infection and dehiscence. In all cases in the reconstructed group (n=9), structural integrity was maintained and major complications including bowel obstruction and infection were prevented by obliterating the pelvic dead space. In contrast, in the control group (n=9), peritonitis and bowel obstruction occurred in 1 case (11%). Conclusions Despite the possibility of flap failure and minor complications, a VRAM flap can result in adequate perineal reconstruction to prevent major complications of pelvic exenteration.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.482-487
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• 2022

In lower abdominal flap representing transverse rectus abdominis musculocutaneous (TRAM) flap or deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric vein (SIEV) exists as superficial and independent venous system from deep system. The superficial venous drainage is dominant despite a dominant deep arterial supply in anterior abdominal wall. As TRAM or DIEP flaps began to be widely used for breast reconstruction, venous congestion issue has been arisen. Many clinical series in regard to venous congestion despite patent microvascular anastomosis site were reported. Venous congestion could be divided in two conditions by the area of venous congestion and each condition is from different anatomical causes. First, if venous congestion was shown in whole flap, it is due to the connection between SIEV and vena comitantes of DIEP. Second, if venous congestion is limited in above midline (Hartrampf zone II), it is due to problem in venous midline crossover. In this article, the authors reviewed the role of SIEV in lower abdominal flap based on the various anatomic and clinical studies. The contents are mainly categorized into four main issues; basic anatomy of SIEV, the two cause of venous congestion, connection between SIEV and vena comitantes of DIEP, and midline crossover of SIEV.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.12-18
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• 2005

The Transverse rectus abdominis musculocutaneous (TRAM) flap has been commonly used for autologous breast reconstruction. Despite these clinical usefulness, the TRAM flap is prone to partial flap or fat necrosis in especially pedicled flap. To improve flap survival, the surgical delay procedures and pharmacological treatments have been developed. In many studies for the pharmacological treatment, Lipo-$PGE_1$ has demonstrated a marked ability to improve flap survival and it's effect has been proved similar to surgical delay procedure. The purpose of this study is to determine the most effective route of Lipo-$PGE_1$ administration as a pharmacological treatment in TRAM flap of the rat. Fifty male Sprague-Dawley rats weighing 300-350 gm were divided into five groups, One week before flap elevation, Lipo-$PGE_1$($2{\mu}g/kg$) was injected three times in a week and than the left inferior epigastric vessel based TRAM flap ($5.0{\times}3.0cm$) elevated; group I: no procedure before flap elevation; group II: intraperitoneal injection; group III: intravenous injection; group IV: subcutaneous injection; group V: topical application. A flap was assessed at postoperative 7 days by comparison of flap survival rate, vessel counts(H-E stain), and vascular endothelial growth factor(VEGF) protein expressed by Western blot. The results demonstrated that the mean percentages of the flap survival area in group III were significantly higher than that of any other group(p<0.05). The vessel counts of all experimental groups were statistically higher than that of control group(p<0.05). Only in group III, the VEGF protein expression was increased significantly than control group and there are no difference in other experimental groups. In conclusion, the intravenous administration of the Lipo-$PGE_1$ is the most effective on flap survival, and the VEGF induced by Lipo-$PGE_1$ has some positive effects on new vessel formation and flap survival.

• Archives of Reconstructive Microsurgery
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• v.1 no.1
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• pp.9-16
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• 1992

Volkmann's ischemic contracture is the end result of an untreated, delayed or Inadequately decompressed compartment syndrome in which muscle ischemia and necrosis have occurred. Once the muscle necrosis have happened, the involved muscle undergo permanent change into fibrous tissue. So secondary shortening and distal joint contracture will be a final outcome, which results in marked functional impairment of hand and forearm. Even though several procedures, such as muscle sliding operation has been attempted, overall results were far from satisfaction, compare to healthy opposite hand. The management of these unfavorable condition of the forearm and hand was regarded as one of challenging area in orthopedics. Recently new approach, using microsurgical technique which transfers functioning muscle unit, has been developed and its result was much better than any other methods in the aspect of an active motion. Among these musculocutaneous free flaps, gracilis has obtained special reputation due to its easiness to handle such as elevation of flap and reliable neurovascular pedicle. Other advantages are flexibility of flap size to adjust variable size of the defect in the forearm and minor morbidity of the donor site. Authors have performed 7 cases of functioning gracilis musulocutaneous free flap transplantation for the functional loss of forearm and hand due to Volkmann's ischemic contracture or muscle and skin defect due to severe trauma since November, 1981 till May, 1991. The results in most cases were satisfactory and acceptable.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.13 no.1
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• pp.237-252
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• 2000

Pressure sore is an area of ulceration and necrosis of the skin and underlying tissues usually occuring over the bony prominences of the body after prolonged or often repeated pressure. We reviewed and summarized the published articles and treatise on the treatment of pressure sore. The results were as follows : 1. Pressure sore occur due to prolonged or often repeated pressure. So it is better than decubitus ulcer that is called pressure sore. 2. The most common lesions of pressure sore are sacrum, ischial tuberosity, greater trochanter. 3. The cause of pressure sore are change of comprehension. urine, moisture, change of the ability of activity and exercise, shearing force. 4. The elements to influence on wound healing are collagen accumulation velocity, nutrition condition, Vitamine C, copper, iron. oxygen pressure, steroids, cell-toxic drug, radiation. 5. Non-operative treatments are managements of skin such as avoiding consistant pressure, dressing, preventing moisture, understanding patient and protecter, preventing spasm, improvement of systemic nutrition condition. 6. Operative treatements are debridement, suture, skin transplantation, muscle flap and musculaocutaneous flap surgery. Recently V-${\Gammer}$ advancement surgery in use of muscle and musculocutaneous flap is generally maded. 7. Complications of post-operation are wound rupture, infection, disappearance of transmitted skin, necrosis of flaps.