• Archives of Plastic Surgery
• /
• 제48권4호
• /
• pp.417-426
• /
• 2021

Background Soft tissue coverage plays a vital role in replacing the vascularity of the underlying bone in Gustilo type IIIB fractures. The aim of this article was to evaluate the feasibility of local pedicled flaps in type IIIB fractures at a tertiary care center. Methods We included all cases of open Gustilo-Anderson type IIIB fractures of the tibia treated with local flap coverage from January 2017 to February 2019. We carried out a retrospective analysis to investigate the relationships of complications, hospital stay, and cost-effectiveness with the choice of flap, infective foci, site and size of the defect, and type of fixation. Results Out of 138 Gustilo type IIIB fractures analyzed in our study, 27 cases had complications, of which 19 (13.76%) involved flap necrosis, four (2.89%) were infections, three (2.17%) involved partial necrosis, and one (0.72%) was related to bone spur development. Flap complications showed a statistically significant association with the perforator flap category (propeller flaps in particular) (P=0.001). Flap necrosis showed a significant positive correlation with cases treated within 3 weeks after trauma (P=0.046). A significant positive correlation was also found between defect size and the duration of hospital stay (P=0.03). Conclusions Although local flaps are harvested from the same leg that underwent trauma, their success rate is at least as high as microvascular flaps as reported from other centers. Amidst the local flaps, complications were predominantly associated with perforator flaps.

• Archives of Plastic Surgery
• /
• 제50권3호
• /
• pp.225-232
• /
• 2023

In retrospect, the irony of this story began with the first meeting of these co-authors-in of all places, Coimbatore, India, in 2008, at the 12th International Perforator Flap Course. Here the junior author [hereafter "jp"] demonstrated his unparalleled skills in networking, and soon thereafter journeyed some 11,073 km to Allentown, U.S. to peruse the operating room and clinics of the senior author [sic. ggh] in action. Within 2 years jp orchestrated the presentation of the 14th International Perforator Flap Course, so ggh with great anticipation flew only 6,830 miles to reach Seoul, Korea for his first time. But four years more elapsed before ggh returned again to Korea to be a visiting professor, all the while not quite sure why any Korean would want anything from a country doctor who resided in nowheresville Allentown, Pennsylvania. Yet, an extraordinary fact then was to be unveiled, about which ggh was totally ignorant. The pioneer of plastic surgery in Korea, the first Korean to have completed an accredited plastic surgery fellowship, by coincidence had accomplished all this in . . . . . Allentown. The collegial relationship that evolved between these co-authors, who met by chance, indeed had a precedent coincidence! Was this "by chance" alone or predestination? Amazingly, in a way similar, the origin of plastic surgery itself in Korea also had Allentown connections. As a tribute to Lew Jae-duk, this important story must be here told, so let us now retrace his past in Allentown so we can find how the future was to be not so far away.

• Archives of Plastic Surgery
• /
• 제50권3호
• /
• pp.264-273
• /
• 2023

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap, and yet is less commonly utilized than other free flaps in microvascular reconstructions of the head and neck. The aim is to conduct a high-quality Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)- and Assessment of Multiple Systematic Reviews 2 (AMSTAR 2)-compliant systematic review comparing the use of the MSAP flap to other microvascular free flaps in the head and neck. Medline, Embase, and Web of Science databases were searched to identify all original comparative studies comparing patients undergoing head and neck reconstruction with an MSAP flap to the radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap from inception to February 2021. Outcome studied were the recipient-site and donor-site morbidities as well as speech and swallow function. A total of 473 articles were identified from title and abstract review. Four studies met the inclusion criteria. Compared with the RFFF and the ALT flaps, the MSAP flap had more recipient-site complications (6.0 vs 10.4%) but less donor-site complications (20.2 vs 7.8%). The MSAP flap demonstrated better overall donor-site appearance and function than the RFFF and ALT flaps (p = 0.0006) but no statistical difference in speech and swallowing function following reconstruction (p = 0.28). Although higher quality studies reviewing the use of the MSAP flap to other free flaps are needed, the MSAP flap provides a viable and effective reconstructive option and should be strongly considered for reconstruction of head and neck defects.

• 대한영상의학회지
• /
• 제82권5호
• /
• pp.1281-1286
• /
• 2021

척추기저동맥의 혈류공급감소로 인한 뇌간 경색은 매우 드문 전신성 루푸스 환자의 초기 증상으로, 경색의 직접적인 원인으로 매우 작은 기저동맥 분지인 교뇌공급혈관의 박리성 동맥류는 보고된 사례가 없다. 이에 저자들은 디지털감산 혈관조영술과 고해상도 혈관벽 자기공명영상를 이용하여 작은 교뇌공급혈관의 박리성 동맥류의 진단과 추적관찰 중 치유된 20세 여성의 사례를 보고하고자 한다. 전신성 루푸스의 진단은 신경학적장애의 유무와 혈액화학검사 결과를 바탕으로 하였다. 추적 고해상도 혈관벽 자기공명영상에서 환자의 교뇌천공지의 박리성동맥류는 폐색되어 있었고 우측 척추동맥의 박리성동맥류는 치유되어 보이지 않았다. 환자는 퇴원 시 수정랭킨척도 점수가 1점으로 증상 개선을 보였으며 3개월과 12개월 추적관찰에서도 증상이 악화되지 않고 1점을 유지하였다.

• Journal of Korean Neurosurgical Society
• /
• 제48권3호
• /
• pp.259-262
• /
• 2010

Large to giant middle cerebral artery aneurysm is a challenging disease, especially when incorporating important perforating arteries. Surgical risk increases by perforator infarction and anatomical complexity. In this clinical setting, extensive consideration of surgical options is needed. The two cases described here were unruptured and had rather stable wall. Because of their large and giant size, hardness and incorporated arteries, it was not affordable to isolate them by means of clipping or trapping. The procedure as the alternative to conventional treatment modalities, extracranial-intracranial bypass followed by clipping of only the efferent artery successfully treated the aneurysms.

• Archives of Plastic Surgery
• /
• 제39권1호
• /
• pp.3-10
• /
• 2012

The free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) and deep inferior epigastric perforator (DIEP) flaps involve transferring skin and subcutaneous tissue from the lower abdominal area and have many features that make them well suited for breast reconstruction. The robust blood supply of the free flap reduces the risk of fat necrosis and also enables aggressive shaping of the flap for breast reconstruction to optimize the aesthetic outcome. In addition, the free MS-TRAM flap and DIEP flap require minimal donor-site sacrifice in most cases. With proper patient selection and safe surgical technique, the free MS-TRAM flap and DIEP flap can transfer the lower abdominal skin and subcutaneous tissue to provide an aesthetically pleasing breast reconstruction with minimal donor-site morbidity.

• Archives of Reconstructive Microsurgery
• /
• 제24권1호
• /
• pp.20-23
• /
• 2015

Despite increased utilization of microvascular anastomotic coupler (MAC) devices, the consequences have yet to be fully explored in terms of vascular regeneration. Removal of an exposed venous coupler is described herein, documenting normal circulatory flow through the remodeled site of application. A 25-year-old man who underwent open reduction and rigid fixation elsewhere for traumatic calcaneal fracture ultimately presented with a necrotic postoperative wound. The debrided defect was treated by free thigh perforator flap, incorporating a MAC device. Three months later, the flap remained viable, but the MAC itself was exposed. Structural integrity of the vessel and blood flow were sustained as the device was carefully removed, confirming true vascular remodeling in this example of MAC usage.

• Archives of Plastic Surgery
• /
• 제45권1호
• /
• pp.90-92
• /
• 2018

• Archives of Reconstructive Microsurgery
• /
• 제19권2호
• /
• pp.112-119
• /
• 2010

The anterolateral thigh flap is a reliable and versatile flap. It has been extensively used for soft tissue reconstruction because minimal donor site morbidity is attractive feature of this flap. It can be harvested as a cutaneous, fasciocutaneous, muscluocutaneous flap. We can be used to form as desired shape and thickness. But variation of vascular anatomy make difficult for many surgeons. We review of vascular anatomy of the anterolateral thigh to be easier access to surgery. With understanding anatomic variation, it allows you to take advantage of this surgery using little more variable form.

• Journal of Trauma and Injury
• /
• 제36권4호
• /
• pp.404-410
• /
• 2023

Large scalp defects resulting from high-voltage electrical burns require free flaps, preferably skin, to permit optimal coverage and enable future or simultaneous cranial vault reconstruction. The anterolateral thigh permits the harvest of a large area of skin supplied by a reliable perforator. The superficial temporal vessels offer the proximate choice of recipient vessels to enable adequate reach and coverage. The lack of a second vein at this site implies the inability to perform a second venous anastomosis; however, this obstacle can be overcome by using an interposition vein graft, to the neck veins primarily. This assures adequate venous drainage and complete flap survival.