• Archives of Plastic Surgery
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• v.33 no.5
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• pp.655-658
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• 2006

Purpose: The main goals of correcting syndactyly of the hand are to form normal web appearance and to prevent motor dysfunction. We modified the original three-square-flap to improve interdigital web space and to reduce the wound healing problem due to tension. Methods: From July 2005 to February 2006, three cases of moderate to minor syndactyly were treated using modified three-square-flap. These flaps were made in such as way that the A flap from dorsal side, the B flap from the interdigital surface, and the C flap from the volar side. We modified the design of dorsal A flap as a hourglass shape instead of square shape to make normal hourglass shaped interdigital web and to reduce the tension of closure with other two flaps(B and C flap). The B and C flap were made as square shape. Results: During 4 to 10 months follow-up period, acceptable esthetic results were obtained without any specific complication, using our modification of the three-square-flap. Conclusion: Our method showed more satisfactory web appearance and was safe to use even in the cases of syndactyly secondary to burns and post-traumatic scars because of excellent blood circulation.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.57-62
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• 2007

Non-vascularized free composite graft is one of the simple and effective reconstructive options, but its clinical use has been limited due to questionable survival rate. Early vascularization is essential for graft survival and is mainly carried out via recipient bed or repaired sites. This study was designed to investigate the effect of the lateral marginal approximations on the survival of the free composite flap using a model of skin-subcutaneous composite graft in rats. Thirty 1.5 ${\times}$ 1.5 $cm^2$ sized square shape composite flaps were elevated freely and reposed in place immediately on the dorsum of five Sprague-Dawley rats, and divided into five groups of six flaps. In all groups, graft bed was isolated with silastic sheet. In the group I, all sides of flap were repaired with blockage of silastic sheet insertion. Three, two, and one sides of flap were treated with same method in the group II, III, and IV respectively. Other sides of flaps were repaired without blockage, so all sides of flap were repaired in the group V. At 14 days later, the survived rate of each flap was evaluated according to the numbers of the repair sites. Histological examination was done for the evaluation of new vessel development quantitatively. Overall survived rates were increased with the number of repaired sites, but the group V only showed increased survival rate up to more than fifty percentile of the flap size with a significant difference statistically. New vessels were also increased in proportion with the number of repaired sites, and the repair site more than two had significant effect on the increased number of new vessels. In conclusion, at least more than three-fourth of flap circumference should be repaired in order to increase flap survival effectively under the condition of bed isolation.

• Archives of Plastic Surgery
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• v.42 no.6
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• pp.716-720
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• 2015

Background This study has been conducted with the aim of evaluating modified T-plate interpositional arthroplasty. Methods A prospective comparative study in patients admitted with temporomandibular joint ankylosis. Ankylotic temporomandibular joint arthroplasty included condylectomy gap arthroplasty in 7, temporalis muscle flap interpositional arthroplasty in 8, and modified T-plate interpositional arthroplasty in 13 cases. The patients were followed for three years. Collected data were tabulated and subjected to Fisher's exact test, chi-square test and probability estimation. Results A significant increase in interincisal distance of 32 mm was seen in 12 (92.31%) patients in the T-plate interposition group, in 2 (25%) cases of the temporalis muscle flap interposition group, and in 1 case (14.28%) of the condylectomy group at 12, 24, and 36 months. Re-ankylosis was observed in 1 case (9.69%) of the T-plate interposition group, while as it was observed in 4 (50%) cases in the temporalis muscle flap interposition group and 4 (57.14%) cases in the condylectomy group, and these differences were statistically significant. Conclusions Our clinical experience with the use of the T-plate over the past 5 years has been encouraging, and our physiotherapy technique is quite simple. Even illiterate parents can assess it easily. Hence, we recommend this easy technique that does not damage the temporalis muscle for the management of temporomandibular joint ankylosis.