• Archives of Craniofacial Surgery
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• v.22 no.2
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• pp.105-109
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• 2021

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

• Archives of Craniofacial Surgery
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• v.22 no.3
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• pp.164-167
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• 2021

Reconstruction of lip defects is important because the lips play an important role in maintaining aesthetic facial balance, facial expressions, and speech. There are various methods of lip reconstruction such as primary repair, skin grafting, and utilization of local and free flaps. It is important to select a proper reconstruction method according to the size and location of lip defect. Failure to select an appropriate method may result in distortion, color mismatch, sensory loss, and aesthetic imbalance. Herein we present a case of successful aesthetic reconstruction of the lower vermilion. We removed a venous malformation, which was limited to the lower vermilion and adjacent to the white roll, and repaired the defect using the modified O-Z flap.

• Journal of Trauma and Injury
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• v.37 no.2
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• pp.151-157
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• 2024

Electrical burn injuries can cause more damage than clinical evaluations initially suggest. The energy waves penetrate from the surface to the deepest layers of tissue, causing extensive harm at every level. The neck is a critical area, both functionally and aesthetically. We present a case involving a young male patient with a severe fourth-degree electrical burn on the neck, who underwent a single-stage debridement and reconstructive surgery. The pectoralis major myocutaneous flap is a versatile option for various head and neck reconstructions. However, if the donor site cannot be closed primarily and requires split-thickness skin grafting, it can result in unsightly scars and deformities. For large flap paddles, it is ideal to reconstruct the secondary defect with locoregional flaps. In this case, we successfully reconstructed the donor site's secondary defect using a contralateral internal mammary artery perforator flap, without resorting to any skin grafts. The early postoperative results demonstrated satisfactory cosmesis, patient satisfaction, and functional outcomes.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.1
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• pp.83-91
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• 2008

The goal of reconstruction following ablative therapy for intraoral cancer is the restoration of form and function to permit a return to activities of daily life. Traditional reconstruction includes split thickness skin grafts, myocutaneous flaps and, more recently, various free flaps. Free flaps provide higher level of functional recovery relative to that seen with other techniques but require the complexity of the technique and microvascular anastomosis and thus, extended surgical time and occasionally a second team for harvesting. The platysma myocutaneous cervical flap is a possible alternative for intraoral reconstruction. It is thin and pliable like the tissue provided by the radial forearm free flap. It can be harvested with enough tissue to close most head and neck ablative defects. There is virtually no donor site morbidity involved. This study evaluated 7 patients affected by intraoral squamous cell carcinoma (SCC). All patients underwent the resection of intraoral SCC with neck dissection and subsequent intraoral reconstruction with the superiorly based platysma myocutaneous cervical flap. Flap-related complications occurred in 3 patients. Adjuvant radiation therapy was performed in 3 patients. Average follow-up was 24.1 months after surgery, with a range of 8 to 42 months. All patients presented self assessment of discomfort associated with intraoral recipient sites and cervical donor sites. However, the neck function measured by two-inclinometer technique was within the normal range during relatively long term follow-up period. Our study concluded that superiorly based platysma myocutaneous cervical flap is good alternative to free flaps, especially for relatively smaller defects and for the defects appropriate for the rotation arc of the flap.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.163-168
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• 2001

The defects of the abdominal wall could be brought about either congenitally, for instances in such cases as omphalocele or gastroschisis, or by various acquired causes-trauma, excision of tumors, excision of burn scar, tissue necrosis caused by infection, hematoma after abdominal surgery, tissue necrosis after radiation therapy and so on. As for the techniques of the reconstruction of the abdominal wall defects, many authors have developed and reported diverse methods. To summarize, primary closure, skin graft, local skin flaps, various myocutaneous flaps, free flap, fascia graft, artificial mesh, tissue expansion, etc could be used in the reconstruction of the abdominal wall defects. The periumbilical perforator-based island skin flap has a many advantages such as no significant sacrifice of the rectus abdominis muscle, wide rotation arc, reliable blood flow of the perforator, short elevation time for flap, and for middle-aged, obese patients, the donor site may be the best from the cosmetic point of view. We used perforator-based island skin flap in 5 cases with reasonable result from March 1999 to May 2001. There were no significant complications and donor sites could be repaired primarily.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.669-674
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• 2008

Purpose: Although there are many ways to perform midface reconstruction, several difficulties exist for selecting the appropriate method, because of its anatomical and functional complexities, donor site morbidities, and poor aesthetic results. Various flaps based on the angular artery can overcome these limitations of the traditional reconstruction methods. The purpose of this study is to suggest an alternative reconstructive method for the midface using various flaps based on the angular artery. Methods: We investigated the relationship between the angular artery and its surrounding structures through cadaveric studies and then applied the findings clinically. As a result, we were able to perform reconstruction with a retroangular flap for defects of the lower half of the nose and the lower eyelid. In addition, defects of the upper half of the nose and the medial canthal area were reconstructed by using island composite glabellar flap. Results: The angular artery was reliable as a pedicle, whether it was used antegrade or retrograde. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The aesthetic outcomes for the donor and recipient sites were satisfactory. Conclusion: The angular artery has diverse relationships with its surrounding structures according to its course of travel, and if a surgeon has a precise understanding of its anatomical location, we believe that retroangular flap and island composite glabellar flap may improve the treatment of midface defects.

• Archives of Plastic Surgery
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• v.44 no.5
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• pp.420-427
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• 2017

Background It can be difficult to select an appropriate flap for various defects on the hand. Although defects of the hand usually must be covered with a skin flap, some defects require a flap with rich blood supply and adequate additive soft tissue volume. The authors present their experience with the anconeus muscle free flap in the reconstruction of various defects and the release of scar contractures of the hand. Methods Ten patients underwent reconstruction of the finger or release of the first web space using the anconeus muscle free flap from May 1998 to October 2013. Adequate bed preparations with thorough debridement or contracture release were performed. The entire anconeus muscle, located at the elbow superficially, was harvested, with the posterior recurrent interosseous artery as a pedicle. The defects were covered with a uniformly trimmed anconeus muscle free flap. Additional debulking of the flap and skin coverage using a split-thickness skin graft were performed 3 weeks after the first operation. Results The average flap size was $18.7cm^2$ (range, $13.5-30cm^2$). All flaps survived without significant complications. Vein grafts for overcoming a short pedicle were necessary in 4 cases. Conclusions The anconeus muscle free flap can be considered a reliable reconstructive option for small defects on the hand or contracture release of the web space, because it has relatively consistent anatomy, provides robust blood supply within the same operative field, and leads to no functional loss at the donor site.

• Archives of Plastic Surgery
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• v.40 no.3
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• pp.220-225
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• 2013

Background A recent advancement in microsurgery, the free flap is widely used in the reconstruction of the lower leg and foot. The simple and effective methods of local flaps, including transposition and advancement flaps, have been considered for patients with chronic debilitation who are unable to endure long surgical procedures or general anesthesia. However, the location and size of the wound may restrict the clinical application of a local flap. Under these circumstances, a sural flap can be an excellent alternative, rendering satisfying clinical outcomes in chronically debilitated patients. Methods Between 2008 and 2012, 39 patients underwent soft tissue defect treatment by sural artery flap as a final method. All of the patients had at least one chronic disease or more (diabetes, hypertension, vascular disease, etc.). Also, all of the patients had a history of chronic lower extremity ulceration, which revealed no response to several months of conservative treatment. Results The results of the 39 cases had a success rate of 100% with 39 complete recoveries. Nine cases suffered complications: partial necrosis (n=4), wound dehiscence without necrosis (n=3), hematoma (n=1), and infection (n=1). Conclusions The sural artery flap is not only useful for the lower leg but also for the heel, and other various parts. Furthermore, it is a relatively simple surgical technique for reconstructing the defect area for patients with various chronic conditions with a high surgical risk or contraindications to surgery.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.217-223
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• 2023

Purpose: Defects involving the ankle and foot are often the result of road traffic accidents. Many such defects are composite and require a flap for coverage, which is a significant challenge for reconstructive surgeons. Various locoregional options, such as reverse sural artery, reverse peroneal artery, peroneus brevis muscle, perforator-based, and fasciocutaneous flaps, have been used, but each flap type has limitations. In this study, we used the distally based lateral supramalleolar flap to reconstruct distal dorsal defects of the foot. The aim of this study was to analyze the efficacy of the flap in reconstructing distal dorsal defects of the foot. The specific objectives were to study the adequacy, reach, and utility of the lateral supramalleolar flap for distal defects of the dorsum of the foot; to observe various complications encountered with the flap; and to study the functional outcomes of reconstruction. Methods: The distal dorsal foot defects of 10 patients were reconstructed with distal lateral supramalleolar flaps over a period of 6 months at a tertiary care center, and the results were analyzed. Results: We were able to effectively cover distal foot defects in all 10 cases. Flap congestion was observed in two cases, and minor graft loss was seen in two cases. Conclusions: The distally based lateral supramalleolar flap is a good pedicled locoregional flap for the coverage of distal dorsal foot and ankle defects of moderate size, with relatively few complications and little morbidity. It can be used as a lifeboat or even substitute for a free flap.

• Journal of Chest Surgery
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• v.24 no.10
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• pp.1033-1038
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• 1991

From August 1988 to August 1991 40 automatic staplers[four TA 30 Premium and 36 TA 55 Premium] were used to close the bronchial stump in 38 patients. There were 8 pneumonectomies, 5 bilobectomies, 23 lobectomies, 1 lobectomy and segmentectomy, and 1 segmentectomy due to various pulmonary diseases. Among 40 bronchial stumps, 15 stumps were covered with the pleural flaps for reinforcing the stump and remained 25 stumps left uncovered. The patients of the 2 groups were selected randomly regardless of disease entities. The duration of follow-up was from 1 month to 38 month-average 16 months, and there were no bronchopleural fistulas in all cases during the follow-up period. Especially in the uncovered bronchial stumps group, 3 preoperative sputum AFB[+] patients and 2 patients of stage IIIa lung cancer underwent pneumonectomy with ipsilateral radical lymph node dissection were included. So, surgical stapling is the safe method and is recommended in closing the bronchial stump in various pulmonary resections.