• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.87-93
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• 2008

Purpose: Because of good blood supply of the pedicled perforator flap and its advantage of not requiring vessel anastomosis compared to pedicled flap, it is widely used recently. The authors intended to report the results of various pedicled perforator flaps which have been performed to reconstruct the soft tissue defects and the utility of the flap. Methods: The study was conducted for 12 cases of pedicled perforator flap which were performed at the plastic surgery department of the current hospital from the period of June, 2005 to August, 2008. Four patients were male and eight patients were female and their age was ranged from 22 to 74 years old with mean age of 42.6 years old. The sites were 1 case on face, 3 cases on chest, 3 cases on back, 4 cases on coccyx, and 1 case on foot. Results: The defect sites of all patients were successfully reconstructed by using the pedicled perforator flap. Although most of the flaps revealed congestion at the early stage after the surgery, they were recuperated within few days. One case of skin flap was reported to be partially necrotized in old age woman who has no reliable perforator. Other than that, all defects were covered successfully and acceptable aethetically. Conclusion: As stated in above, the pedicled perforator flap has many useful advantages than the conventional pedicled flap and various free flap. Unless free flap must be required, the use of pedicled perforator flap is recommended by first choice for soft tissue coverage.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.61-67
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• 2008

Introduction: The purpose of this study is to evaluate the necessity of distant pedicled flap in the treatment of soft tissue defects in the hand. Materials and Methods: Distant pedicled flap was performed in the 25 hands of 25 patients from 2000 to 2004. There were 20 males and 5 females and mean age was 34 years. The surgery was done for electrical burns in 13 patients, flame burns in 8 patients and crushing injuies in 4 patients. Results: We have performed 25 distant pedicled flaps for the coverage of soft tissue defects in the hands when local and free flaps were unavailable. Soft tissue coverages by distant pedicled flap were completely successful in all the 25 hands. No complication such as total flap loss, marginal flap loss and infection occurred. Conclusion: Distant pedicled flaps were very useful alternative method in the treatment of soft tissue defect in the hand.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.122-128
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• 1998

Radial forearm flap is one of the most useful skin flap in hand reconstructuion with distally based reverse pedicled or free vascularized fashion. Athors modified that flap into reverse pedicled and free vascularized flap which has advantages of both methods. The modification composed with harvesting flap on recipient side distal forearm just as free flap, than apply it as reverse distal pedicled flap fashion with microvascular anastomosis with distal vascular stump of donor radial vessels. We underwent this method in 5 cases in finger reconstruction from 1996, all of the cases had sucessful results. The advantages of this method are: 1. Thin flap which is compatible to finger skin can harvest from distal forearm with very long vascular pedicle that can be passed under the subcutaneous tunnel which avoid additional skin incisions on the hand. 2. The vessels of donor site and recipient site are same vessel in effected side of forearm, which can preserve contralateral side forearm and hand keep intact. 3. The flap can cover the defects on distal portion of the fingers which is difficult in conventional reversed radial forearm pedicled flap because of limited mobilization of flap due to limitation of pedicle length reach to tip of the fingers.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.114-120
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• 2021

Background The pedicled anterolateral thigh (ALT) flap has become more popular for the reconstruction of soft-tissue defects in neighboring areas. Nonetheless, few studies in the literature have explored the use of this flap for trochanteric ulcer reconstruction. The aim of our study is to present the author's experience of utilizing the ALT flap, with a focus on technical elements regarding the flap design and the tunneling method to maximize the reach of the flap. Methods The medical records of patients who received pedicled ALT flaps for the reconstruction of trochanteric pressure sores were retrospectively reviewed. The patients' demographic data, operative details, and postoperative complications were evaluated. Results Between October 2018 and December 2019, 10 consecutive patients (age range, 13-45 years) underwent 11 pedicled ALT myocutaneous flaps for trochanteric pressure sore reconstruction. Each flap was designed around the most distal cutaneous perforator that was included in the proximal third of the skin paddle. The flaps ranged in size from 11×6 to 14×8 cm. The ALT flap was transposed through a lateral subcutaneous tunnel in five patients, while the open tunnel technique was used in six patients. All flaps survived, and no vascular compromise was observed. Conclusions The pedicled ALT flap is a safe and reliable option for reconstructing trochanteric pressure sores. An appropriate flap design and a good choice of the tunneling method are crucial for successful flap transposition.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.769-774
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• 2010

Purpose: As the soft tissue defect around the knee is difficult to reconstruct, local flap or free flap is used. Distally based anterolateral thigh pedicled flap introduced by Zhang uses sufficient reverse flow supplied from the vascular network around the knee. We report successful reconstruction of defect around knee by this method. Methods: Four patients with skin & soft tissue defect around knee have been treated for reconstruction using the distally based anterolateral thigh pedicled flap. First, the doppler was used to check the perforator flap of the descending branch of the lateral circumflex femoral artery and to draw and dissect the perforator flap as much as needed. After the dissection, the proximal of the descending branch was clamped and checked for sufficient supply of blood flow from the reverse flow and then ligated. It was dissected along the descending branch and in order to prevent damage to the joined parts of the descending branch and the lateral superior geniculate artery, a more careful ligation was done starting from 10 cm superior to the knee. The defect was reconstructed after securing enough vascular pedicle to cover all the damaged parts. Results: Not all patients suffered from flap necrosis. In case of the patient with chronic osteomyelitis, slight venous congestion was observed right after the surgery but it disappeared the following day. All three patients had no occurences of additional complications. Conclusion: Distally based anterolateral thigh pedicled flap was enough to provide large flap for knee reconstruction. It had sufficient blood flow and vascular pedicle. It also had taken short operation time compared to the free flap operation. The distally based anterolateral thigh pedicled flap used by the authors is a very useful way of reconstructing the area around knee.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.325-328
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• 1993

The pedicled omental flap has been used for treatment of various kind of complications in thoraxcic surgery. Its property of promoting neovascularization , immunilogic properties that limiting the spread of infection, providing soft tissue coverage are very effective in treatment esophageal fistulas. Also, congenital broncho-esophageal fistula [ BEF ] is a rare disease entity which was reported about 100 cases around the world. We experienced 27 years old female patient with Braimbridge type I congenital BEF. We performed division of BEF using stapler and pericardial patch coverage of esophageal side with concomittent left lower lobectomy. This patient was complicated with postoperative esophageal leakage with empyema thoracis. We have successfully managed these problems with re-thoracotomy and re-closure of esophageal fistula using Right Gastroepiploic Artery based pedicled omental flap wrapping around the esophageal anastomosis site. It is felt that pedicled omental flap is a very effective method to manage esophageal complication such as postoperative esophageal leakage.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.348-350
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• 2009

Purpose: The objective of this study is to present a reliable method of scrotal reconstruction. Methods: 75 year - old - man visited the out patient department of urology for chronic itching sensation in his scrotal area, diagnosed as Bowen's disease. After the wide resection of scrotal lesion, reconstruction was carried with pedicled anterolateral thigh perforator flap. All operation procedure was done with an usual manner, previously reported. Donor site was closed primarily. Results: In 6th month follow - up period, there was no event, such as flap necrosis, wound dehiscence, tumor recurrence. And tactile sensation was recovered. Conclusion: In the Korean literature, there have not been the report that describes the reconstruction of scrotal defect using pedicled anterolateral thigh perforator flap. Pedicled anterolateral thigh perforator flap is reliable and robust flap for scrotal reconstruction.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.62-66
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• 2009

Purpose: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. Materials and methods: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. Results: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. Conclusion: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.3
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• pp.174-177
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• 2013

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a disease characterized by jaw necrosis and delayed wound healing in patients who had received bisphosphonates. Buccal fat pad (BFP) can be used as a pedicled flap in the posterior region of the oral cavity. BFP pedicle flap needs simple surgical technique and it shows less donor site morbidity and aesthetic problem than other vascularized flap. BFP pedicled flap was fed by 3 arteries-facial, internal maxillary, and transverse facial artery. Osteomyelitis was generally related with poor blood supply. Thus, rich blood supply of BFP pedicle flap can have a potential advantage to BRONJ patients. In this case report, we presented 3 BRONJ patients treated by BFP pedicle flap after sequestrectomy.

• Archives of Reconstructive Microsurgery
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• v.12 no.2
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• pp.112-118
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• 2003

Purpose : Soft tissue defect and exposed tendons and bones with concomitant infection in the foot and lower leg have to be covered with vascularized flap as the one stage treatment. Authors have performed 6 cases of pedicled dorsalis pedis island flaps under the loupes magnification and evaluated the benefits. Materials and methods : From 1994 through 2003, we have performed 6 pedicled dorsalis pedis island flaps for reconstruction of soft tissue defects in the foot and lower leg. The causes were trauma in 3 cases, skin necrosis and secondary infection after Achilles tendon repair in 2 cases and acute osteomyelitis in 1 case. Average age was 38 years and 5 cases were male and 1 female. The results of the procedure was evaluated by survival of the island flap, comfort in putting on shoes and walking, comfort in the donor site, comfort in the recipient site and range of motion of the ankle joint. Results : All pedicled dorsalis pedis island flaps survived except 1. Three cases felt discomfort in the dorsum of foot as the donor site and 1 case of the Achilles tendon ruptured and repaired showed limited dorsiflexion of ankle joint. Conclusion : Nonmicrosurgical pedicled dorsalis pedis island flaps under the loupes magnification are one of the useful treatment methods because procedure is rapid, survival is confident and overall reconstructive results are good.