• Archives of Plastic Surgery
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• 제49권5호
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• pp.652-655
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• 2022

Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.

• Archives of Plastic Surgery
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• 제50권6호
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• pp.593-600
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• 2023

Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee jointmobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.

• Archives of Plastic Surgery
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• 제36권2호
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• pp.127-134
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• 2009

Purpose: Adipose tissue injection as a free graft for the correction of soft - tissue deficiency or depression deformity is a widespread procedure in plastic surgery. This study is to analyze the changes and viability of cryopreserved adipose tissue and to find out efficient long - term storage period. Methods: After centrifugation of aspirated abdominal tissues, $10m{\ell}$ of packed Adipose tissue were freezed at $-20^{\circ}C$. For 2, 4, 6, 8 months, each frozen samples were taken and injected into scalp of SCID mice. After 15 weeks, injected Adipose tissue were sampled and analyzed at 2 months interval. We compared and analyzed each group about the weight of the injected fat, histologic impressions, activity of mitochondria, size of a fat cell and rate of survival. Results: Significant weight changes were observed in cryopreservation for 2 months(p<0.05). Histologic changes were observed, independent of the freezing period with H - E stain. Among cryopreservations for 2, 4, 6 months, no significant change were observed. The reduction of mitochondrial enzymatic activity was observed independent of time interval but activity of mitochondrial dehydrogenase was reduced less than 50% in MTT assay. Conclusion: Freezing in $-20^{\circ}C$ for 6 months has no adverse effect to Adipose tissue, but fragile adipocytes, damaged cell membrane during harvesting procedure, were disrupted within 1 - 2 month and the maximum volume reduction were followed less than 2 months. These results demonstrate that tissue preparation cells without membrane damage have the greatest viability level and cryopreservation less than 2 months has great volume effect and cryopreservation for 6 months has stable volume effect.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.124-130
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• 2001

Both of latissimus dorsi and rectus abdominis muscles are workhorse for various reconstructive surgeries. These muscle flaps have been used widely for soft tissue coverage, tissue augmentation, and functional muscle transfer. However, the traditional method for muscle harvest requires a long incision that often results in an unsightly scar and becomes the main concern of the patient. The purpose of this study is to introduce our clinical experience of endoscopic harvest of latissimus dorsi muscle and rectus abdominis muscle, and to make comparison with traditional harvest of these two muscle flaps. Of the 13 rectus abdominis muscles free flaps, 6 muscles were harvested traditionally and 7 muscles were harvested with endoscopic assistance. Of the 21 latissimus dorsi muscle free flaps, 12 muscles were harvested traditionally and 9 muscles were harvested with endoscopic assistence. Follow up period was between 6 months and 24 months. The patients age ranged from 7 to 70 years old. The result revealed no statistically significant differences in the amount of intraoperative bleeding, incidence of postoperative hematoma and seroma, and the incidence of donor-site wound infection. However, patients feel less pain and start earlier and better movement after the operation with endoscopically assisted harvest. This technique is easy to learn, is safe, and can reduce substantially the donor site morbidity comparing traditional harvesting technique.

• Fisheries and Aquatic Sciences
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• 제18권2호
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• pp.165-171
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• 2015

Abalone containing phlorotannins is produced by feeding the phlorotannin-rich brown seaweed Eisenia bicyclis after 4 days of starvation. Reverse-phase high-performance liquid chromatography (RP-HPLC) was used to isolate and quantify phlorotannins, which were identified by mass spectrometry and [$^1H$]-nuclear magnetic resonance to be the P1 compound, 7-phloroeckol, and eckol. When E. bicyclis was used as feed, P1 compound accumulated to an average of 1.60 mg/g dry weight of abalone muscle tissue after 18 d, 7-phloroeckolol to 0.21 mg/g after 16 d, and eckol to 0.22 mg/g after 12 d. Saccharina japonica was used as a control feed, and the abalone showed little or no accumulation of phlorotannins in muscle tissue. Feed consumption and growth rate were very similar when either E. bicyclis or S. japonica was fed for 20 d. Half-maximal reductions in the levels of P1 compound, 7-phloroeckol, and eckol accumulation were attained in 1.5, 1.9, and 3.4 days, respectively, after the feed was switched from E. bicyclis to S. japonica. Value-added abalone containing bioactive phlorotannins can be produced by simply changing the feed to the phlorotannin-rich E. bicyclis 18 d prior to harvesting.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.685-690
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• 2009

Purpose: Autologous fat graft is a widely accepted technique used for soft tissue augmentation. Nonetheless, the use of fat graft is limited by unpredictable survival rates and repeated grafting. To avoid repeated grafting, cryopreserved fat graft technique has recently been widely used. On the other hand, the number of patients with chronic infection(who received cryopreserved fat injection) has currently been increasing. Therefore, this study was focused on the safety of cryopreserved fat injection from the infection. Methods: We collected 150 samples from local aesthetic clinics to examine the safety of cryopreserved autologous fat. To test for microbacterial contaminations of the cryopreserved fat specimens, microbacterial cultures & antibiotics sensitivity tests were performed. Then, we examined possible correlation between the preservation period and donor sites, focused on the results of microbacterial culture. Results: Cultures were positive for Staphylococcus epidermidis in 5 samples(methicillin - resistant Staphylococcus epidermidis in 4 samples), Micrococcus species in 3 samples. An average duration of preservation was 191 days and there was no significant correlation between the duration of preservation and microbacterial growth. Conclusion: Staphylococcus epidermidis was the leading cause of cryopreserved fat contamination, and the resistance to methicillin is common. Based on the above results, aseptic handling of fat during harvesting and preservation appeared to be most important.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.25.1-25.4
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• 2018

Background: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. Case presentation: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. Conclusion: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.571-576
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• 2010

Purpose: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. Methods: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. Results: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. Conclusion: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.

• Archives of Plastic Surgery
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• 제48권4호
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• pp.395-403
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• 2021

Background Groin wounds occurring after vascular surgical site infection, oncologic resection, or occasionally orthopedic surgery and trauma may represent a surgical challenge. Reconstruction of these defects by the usual workhorse flaps may be contraindicated following previous surgery and in patients with lower limb lymphedema or extreme morbidity. Methods This study included 15 consecutive patients presenting with inguinal wounds after vascular or general surgery that required debridement and soft tissue coverage. All cases had absolute or relative contraindications to conventional reconstructive techniques, including a compromised deep femoral artery network, limb lymphedema, scarring of potential flap harvesting sites, or poor overall condition. Abdominal adipocutaneous excess enabled the performance of adipocutaneous advancement flaps in an abdominoplasty-like fashion. Immediate and long-term outcomes were analyzed. Results Soft tissue coverage was effective in all cases. Two patients required re-intervention due to flap-related complications (venous congestion and partial flap necrosis). All patients fully recovered over a mean±standard deviation follow-up of 2.4±1.5 years. Conclusions Abdominal flaps can be an effective and simple alternative technique for inguinal coverage with reproducible outcomes. In our experience, the main indications are a compromised deep femoral artery network and poor thigh tissue quality. Relative contraindications, such as previous open abdominal surgery, should be considered.

• Archives of Plastic Surgery
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• 제41권2호
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• pp.174-180
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• 2014

It is well known that patients with severe facial injuries accompanied by facial disfiguration are vulnerable to a poor quality of life. With the help of facial transplantation, it has become possible to achieve an optimal anatomical reconstruction. As compared to conventional methods, it can provide more desirable functional, aesthetic, and psychosocial outcomes. Face transplantation surgeons need to consider many problems associated with the criteria for selecting patients, techniques for harvesting the donor tissue, prediction of the expected functional outcomes, limitations in obtaining written informed consent for conducting the procedure, evaluation of the post-transplant immunological response and postoperative immunosuppressant requirements, psychological and social outcomes for the patients, and other concerns about funding and ethical issues.