• Archives of Plastic Surgery
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• v.35 no.3
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• pp.295-302
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• 2008

Purpose: The lower leg often has poor vascularity, proximity to bone, and insufficient soft tissue. The island flaps offer a feasible one stage reconstruction and has a remarkable vascularization and high quality results for soft tissue defect with or without bony problems to occur on regions below the knee. So we reported our experience of island flaps with review of the literatures. Methods: We reconstructed 29 cases of soft tissue and 2 cases of bony defect on regions below the knee by using various island flaps at our hospital from December, 1991 to January, 2006. We used 2 fibular osteocutaneous island flaps, 15 reverse sural island flaps, 6 extensor digitorum brevis muscular island flaps, 2 medial plantar island flaps, 5 saphenous island flaps, and a dorsalis pedis island flap. Results: Partial necrosis was developed in 4 out of 15 reverse sural island flaps and 1 out of 5 saphenous island flaps, but they were healed with secondary skin graft. There was partial loss of skin graft on the donor sites in 2 cases. Conclusion: Island flaps are very useful for reconstruction of regions below the knee because island flaps have good vascularity and less risk of infection. Generous flap size, easy operative technique, lower cost, shorter operative time, and minimal morbidity at the donor site are other advantages. We attained satisfactory results.

• Journal of Embryo Transfer
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• v.32 no.1
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• pp.33-38
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• 2017

A 10-day-old, Holstein calf with facial mass of 10 cm in diameter at the forehead region referred to Veterinary Medical Teaching Hospital in Chungnam National University. The mass was soft and fluctuating swelling. It had normal skin and hair hanging forward from frontal region and was thought to contain cerebrospinal fluid. On the skull radiography, cauliflower like-irregular marginated, soft tissue opacity mass was identified craniodorsal to the frontal bone. The mass appeared as a cyst filled with anechoic fluid on ultrasonography. Soft tissue structures considered brain tissues were observed in the deep area of the mass. On the computed tomography, a large skull defect of left side frontal bone was found, and heterogeneous materials were exposed through the defect but exposure of cerebral meninges and brain tissue were not confirmative. On magnetic resonance imaging, herniated left brain parenchyma showed heterogenous T2 and T1 hyperinsensity. In the intracranium, T2 hyperinstense and T1 hypointense fluid was identified on the left side, instead of left cerebral parenchyma. Also leftward shift of right hemisphere and midline structure, including thalamus and midbrain, were observed. The definitive diagnosis was confirmed as a meningoencephalocele based on computed tomography and magnetic resonance imaging. The calf was euthanized and necropsy was performed. On necropsy, both hemisphere were developed unequally with different size. One side hemisphere was grown in the outside through 10 cm hole on the median plane.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.465-468
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• 2010

Purpose: Soft tissue deformity and skin defect after tumor resection in the periorbital area can cause trouble in the function of eyelid as well as in the aspect of external appearance. Therefore, as cosidering reconstruction in periorbital area, detailed assessment of both functional and aesthetic property are required. thus, the purpose of this study is to examine an appropriate reconstruction through clinical cases. Methods: A 14-year-old girl with congenital giant hairy nevus on right periorbital area was selected. Her first visit to our plastic surgery outpatient clinic was on July 2006. Since then, she has undergone staged removal of lesions and reconstruction by various flap technique such as pedicled island flap, forehead galeal flap, paramedian forehead flap, cheek rotation & advancement flap. Results: In the case of this girl, most lesions were removed and replaced by normal skins. Although there was the difference of skin color after skin graft, such difference was not noticeable and section scar by skin flaps was slight. There was no obvious dysfunction in the eyelids and the girl and her parents were satisfied with results after the surgery. Conclusions: In the reconstruction of soft tissue defect or soft tissue deformity and contracture, it is required to choose appropriate reconstruction method, considering aesthetic and functional aspects depending on aesthetic unit sufficiently.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.85-91
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• 2006

With advances in techniques and instrumentation, the primary concern of microsurgeons has shifted from flap anatomy and survival toward flap refinement and donor-site function and aesthetics because flap survival rates have risen 96 percent. However, the problem still remains on regard that most flap has disadvantages that flap itself is too bulky or leaves unaesthetic scar to the donor site. These problems can be solved by using adipofascial flap instead of fasciocutaneous flap. The adipofascial flap not only has minimal donor site morbidity, but also can be retained thin. It seems that its advantages can be applied on soft tissue defect of exposed body part.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.325-329
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• 2009

Objective : This is to report the effectiveness of intraoral distraction osteogenesis, iliac bone graft for alveolar augmentation in the extremely atrophied alveolar defects after infected allobone grafted area. Subjects and Methods : Anterior segmental osteotomy was performed and the trans-oral alveolar distractors (Martin, Germany) were applied in patient with the severe acquired anterior mandibular and mandibular defect after ameloblastoma enucleation. Iliac bone grafts were performed in defect sites and distraction osteogenesis were treated. After latent period for 1 week, the osteomized alveolar segments were distracted by 0.75 mm a day (0.25 mm/1 turn) for 10 days The consolidation period was about 12 weeks. Thereafter, 2 titanium threaded implants were simultaneously installed with removal of distractor. For oral rehabilitiation, The implants were installed in maxilla, mandible. It was tested with clinically and radiographically. Results : Amounts of acquired alveolar bone were 10 mm with the increased width of the ridge crests and soft tissue expansion. Dental implants installated on the augmented alveolar ridges in 12 weeks after distraction were confirmed as in good osseointegration and in good function without any complications. Conclusion : Intraoral distraction osteogenesis can be a good option for alveolar ridge augmentation of the severely atrophied ridges and soft-tissue defects.

• Archives of Reconstructive Microsurgery
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• v.19 no.2
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• pp.88-92
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• 2010

The forefoot reconstruction is a challenging field for plastic surgeons. Weight bearing tolerability and stability are important factor of choosing reconstruction methods, but cosmetic aspect has to be considered. 51 year old man visited our clinic with extensive degloving injury on right forefoot by roller. The soft tissue defect started from metatarsal area to the toe tip including nails. We harvested the anterolateral thigh flap and transferred it to the forefoot defect area with nerve coaptation. The flap was successful without skin necrosis or other complications. Secondary flap debulking surgery was performed after ten months from initial operation. Patient was satisfied with functional and cosmetic outcomes. The patient was able to wear shoes and walk with adequate sensory recovery. As there is few report about reconstruction of forefoot soft tissue defects, we report a unique case of the anterolateral thigh innervated free flap reconstruction in degloving injury.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.254-260
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• 2021

Background Myelomeningocele is a frequently seen condition at tertiary care hospitals. Its treatment involves a variety of plastic reconstructive techniques. Herein, we present a series of myelomeningocele patients treated using keystone flaps. Methods We gathered information regarding soft tissue reconstruction and the use of bilateral keystone flaps to treat myelomeningocele patients. We obtained data from clinical records and recorded the demographic characteristics of mothers and children with the condition. The size, level of defect, and complications detected during the follow-up were analyzed. Results A series of seven patients who underwent bilateral keystone flaps for myelomeningocele closure was analyzed. There were no cases of midline or major dehiscence, flap loss, necrosis, surgical site infections, or cerebrospinal fluid leakage. No revision procedures were performed. Minor complications included one case with minimal seroma and three cases with areas of peripheral dehiscence that healed easily using conventional measures. Conclusions The use of keystone flaps is an adequate option for closure of dorsal midline soft tissue defects related to myelomeningocele. This technique offers predictable results with an acceptable spectrum of complications. Robust blood flow can be predicted based upon anatomical knowledge.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.75-80
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• 2001

Purpose : We have evaluated the morbidity of donor site after transfer of free fibular osseous and osteocutaneous flap to defect site of bone and soft tissue due to chronic osteomyelitis of long tubular bone, open fracture with bony defect, bone or soft tissue tumor and congenital anomaly. Materials and methods : The 54 cases of 79 cases to be carried out from May, 1982 to May, 2001 which could be followed up were reviewed. There were forty nine in male and five in female. The mean age was 35(4 to 66)years old and mean follow up period is 21.3 month(12 to 72). We have retrospectively analyzed the various postoperative complications such as compartment syndrome, donor site infection, skin defect, hypesthesia, hammer toes, ankle instability and activity of daily living by help of questionnaire, telephone, physical examination, follow up x-ray study and chart. Results : In the total 54 cases the medication period for pain control after operation were classified into three groups under 2 weeks(49 cases), from 2 weeks to 6 weeks(3 cases) and over 6 weeks(2 cases). The postoperative morbidity were occurred in total 12 cases(compartment syndrome: 0, infection : 2, skin defect: 1, hypesthesia: 5, hammer toe: 2 ankle pain: 2 discomfort in activity of daily living: 0), and also the morbidity rates of donor site were 23.5% in osseous flap and 21.6% in osteocutaneous flap were occurred. There was no statistical significonce in morbidity between osseous and osteocutaneous free fibular flap transfer(P>0.05). Discussion : In general the morbidity of free fibular flap transfer was relatively high but it did not have any effect on daily activity of living. We think that the meticulous operation technique, detailed wound care and early range of motion exercise will reduce the morbidity of donor site of flap.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.69-72
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• 2020

Hemangioma is a benign vascular tumor that grows by endothelial cell hyperplasia. It occurs most frequently in the head and neck region. Nose reconstruction is tricky because of its unique three-dimensional structure and different tissue components. We report a case of successful reconstruction of near-total nose defect using the paramedian forehead flap combined with a nasolabial flap, immediately after excision of nasal hemangioma. A 49-year-old male patient was presented with a huge mass at the nose. Preoperative magnetic resonance imaging showed prominent vascular channels extending to the forehead and cheek. Complete resection of the mass was performed, which resulted in an eccentric defect. The right paramedian forehead flap and the left nasolabial flap were designed and transferred to the defect. Flap division was performed 1 month later. The patient is satisfied with the overall appearance and did not develop any functional deficit.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.249-253
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• 2000

Oral and Maxillofacial defects is produced by trauma or cancer surgery. This defects have been shown functional loss such as mastication, swallowing, speech and psychosocial esthetic problem. Oral and Maxillofacial defects is reconstructed by the use of many flaps. However although previous flap surgery was done, additional soft tissue defects can be still remained. In this case, Walk-Up flap that is introduced by Marx RE in 1990 is recommended for successful reconstruction. We report Walk-Up flap for reconstruction of remained soft tissue defects of tongue S.C.C. After induction chemotherapy, tongue S.C.C. is excised surgically and reconstructed by use of PMMC flap. Post-op infection results in surrounding soft tissue defect with oro-facial fistula. We have experienced a case of Walk-up flap by use of PMMC flap for reconstruction with satisfactory result, so we report it with literature reviews.