• Archives of Plastic Surgery
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• v.45 no.2
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• pp.118-127
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• 2018

Background A variety of island flaps can be based on the superficial temporal artery with variable tissue composition. They can be used for defect reconstruction, cavity resurfacing, facial hair restoration, or contracture release. Methods Seventy-two patients underwent facial reconstruction using a superficial temporal artery island flap from October 2010 to October 2014. The defects had various etiologies, including trauma, burns, tumors, exposed hardware, and congenital causes. We classified the patients by indication into 5 groups: cavity resurfacing, contracture release, facial hair restoration, skin coverage, and combined. The demographic data of the patients, defect characteristics, operative procedures, postoperative results, and complications were retrospectively documented. The follow-up period ranged from 24 to 54 months. Results A total of 24 females and 48 males were included in this study. The mean age of the patients was $33.7{\pm}15.6years$. The flaps were used for contracture release in 13 cases, cavity resurfacing in 10 cases, skin coverage in 17 cases, facial hair restoration in 19 cases, and combined defects in 13 cases. No major complications were reported. Conclusions Based on our experiences with the use of superficial temporal artery island flaps, we have developed a detailed approach for the optimal management of patients with composite facial defects. The aim of this article is to provide the reader with a systematic algorithm to use for such patients.

• Archives of Plastic Surgery
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• v.43 no.1
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• pp.26-31
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• 2016

Background The global prevalence of myelomeningocele has been reported to be 0.8-1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution. Methods Patients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed. Results A total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely. Conclusions Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

• Archives of Plastic Surgery
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• v.34 no.6
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• pp.759-764
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• 2007

Purpose: Various types of flaps, with their own advantages and disadvantages, have been described for reconstruction of soft tissue defect with exposure of tendons, bones, or joints in the hand or foot. Local flaps with random vascularity have a limitation by their length. Free flaps are time-consuming procedure that may require the sacrifice of some major vessels. The ideal flap for covering soft tissue defects of the hand or foot must provide subcutaneous tissue that tendons can glide through which, supply enough subcutaneous tissue for cover of vital neural, bony, vascular and joint structures, and it has to be aesthetically pleasing. The adipofascial flap fulfills these criteria. It allows immediate or early closure of difficult wound of hand and foot in an easy way, and is especially indicated for small to medium-sized defects. Methods: From October 2005 to December 2006, seven cases underwent this procedure to reconstruct soft tissue defect on hand or foot. Results: All flaps survived completely, and no complications were observed. Conclusion: The adipofascial flap is a convenient flap for coverage of soft tissue with exposure of vital structure in the hand or foot, and provide several advantages, as following; easy and safe, short operating time, one stage procedure, thinness and good pliability of the flap, preservation of the major vascular pedicles, skin preservation at the donor site, thus preserve the shape of the limb and minimize donor site scar.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.365-371
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• 2009

Purpose: Good color match holds a key position in facial reconstruction for good aesthetic result. To correct the wide facial soft tissue defect were usually used the tissue expanded cheek flap, deltopectoral flap or radial forearm free flap. This study is aimed to analyse the color difference after flap surgery by using chromameter. Method: From August 1995 to December 2006, 30 patients underwent flap operations were chosen randomly and evaluated color differences between flap site and adjacent skin. Reconstructive procedures included tissue expanded cheek flap(n = 10), deltopectoral flap(n = 10), and radial forearm free flap(n = 10). The measured sites were flap center within a radius of 1 ㎝ and four points of adjacent skin along the flap margin. The color was quantified in a three dimensional coordinate system $L^*$ (brightness), $a^*$ (redness), $b^*$ (yellowness). Results: There was no significant color difference between the pedicled flaps(tissue expanded cheek flap and deltopectoral flap) and adjacent skin area. On the other hand, color values of the radial forearm free flap were statistically different from those of adjacent skin area. Total color difference(${\Delta}E$) of tissue expanded cheek flap and deltopectoral flap were $7.45{\pm}5.78$ versus $9.41{\pm}7.09$, and that of radial forearm free flap was $11.74{\pm}3.85$. They suggest that pedicled flaps have a potential of better color match than radial forearm free flap. Conclusion: Thus, better esthetic result and satisfaction is more likely to be expected in pedicled flaps as long as it could be applied comparing radial forearm free flap.

• Archives of Reconstructive Microsurgery
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• v.18 no.1
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• pp.35-39
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• 2009

Purpose: Various techniques have been attempted for design of the flaps. However, there are some disadvantages. They have thin, pliable, and two dimensional methods. The aim of this study is to report usefulness of polyurethane foam dressing materials for three dimensional design of the digital island flap. Methods: From June of 2007 to september of 2008, 10 patients received digital island flap surgery for soft tissue defect of the finger. After minimal debridement of the wound, size and shape of the defect were measured using polyurethane foam. We used Medifoam-$5^{(R)}$ And then, designed this inset the wound. The flap was designed on the donor site with a arterial pedicle as the central axis according to size and shape. A full thickness skin graft from the groin is applied on the flap donor defect and secured with a tieover bolster dressing. Results: Reviewing sizes of the flaps, the length and width of flaps ranged from 1.5 to 3.3 cm and 1.0 to 2.5 cm. The PACS(Picture Archiving Communication System) program allows identification of the donor depth of finger. The distance for the soft tissue ranged from 4.3 mm to 6.7 mm. Mean depth of donor site was 5.3${\pm}$0.6 mm. Also, the thickness of Medifoam-$5^{(R)}$ ranged nearly 5 mm. On flap insetting, full-thickness skin graft was necessary. We did not experience any problems in the recipient site size either, regardless of the extended flaps. Conclusion: Polyurethane foam has many advantages over the more conventional templates. Refinements in flap design and surgical technique resulted in favorable functional and cosmetic results. Especially, for beginner, Polyurethane foam dressing material is a simple and safe tool and therefore is an excellent choice for design of the island flap.

• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.296-300
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• 2018

Penile shaft reconstruction requires adequate soft tissue characteristics as well as constant vascular pedicles when considering a perforator flap. The free flap technique using various donor sites and regional conventional and perforator flaps have been utilized for penile shaft reconstruction. Still, the free flap techniques include challenging surgical procedures in addition to postoperative management. The regional flap can be applied to limited defects due to the size and shape. We performed the bilateral superficial external pudendal artery (SEPA) perforator flaps in order to reconstruct a circumferential penile shaft defect. The circumferential wound has noted necrotic tissue involving superficial (Dartos) fascia. We underwent debridement, preserving deep (Buck's) fascia and corpus spongiosum. Thereafter, the soft tissue defect was covered with bilateral SEPA perforator flaps. The patient has been observed for 27 months, showing penile resilience without deformity or wound-related problems.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.17-23
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• 2019

Background: The resection of head and neck cancer can result in postoperative defect. Many patients have difficulty swallowing and masticating, and some have difficulty speaking. Various types of flaps are used for palatal reconstruction, but flap selection remains controversial. Therefore, our study will suggest which flap to choose during palatal reconstruction. Methods: Thirteen patients who underwent palatal reconstruction from 30 January, 1989 to 4 October, 2016 at our institution. Size was classified as small when the width was < $4cm^2$, medium when it was $4-6cm^2$, and large when it was ${\geq}6cm^2$. Based on speech evaluation, the subjects were divided into a normal group and an easily understood group. After surgery, we assessed whether flap selection was appropriate through the evaluation of flap success, complications, and speech evaluation. Results: Defect size ranged from $1.5{\times}2.0cm$ to $5.0{\times}6.0cm$. In four cases, the defect was in the anterior third of the palate, in eight cases it was in the middle, and there was one case of whole palatal defect. There were three small defects, two medium-sized defects, and eight large defects. Latissimus dorsi free flaps were used in six of the eight large defects in the study. Conclusion: The key to successful reconstructive surgery is appropriate selection of the flap with reference to the characteristics of the defect. Depending on the size and location of the defect, the profiles of different flaps should be matched with the recipient from the outset.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.3
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• pp.185-190
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• 1998

Various local flaps and distant flaps including tongue flap, palatal island flap, and buccal flap as well as skin grafts have been used for the reconstruction of oral mucosal defect. In the posterior region of oral cavity and the buccal cheek area, buccal fat pad can be used as a pedicled graft. The buccal fat pad is different from other subcutaneous fat tissue and it is easily accessible. There are many advantages in pedicled buccal fat pad graft for the closure of oral mucosal defect. The procedure is easy, there is no visible scar in the donor site, it is capable of reconstruction of various contour, and it has good viability. We had used buccal fat pad as a pedicled graft for the closure of oral mucosal defect after the excision of tumor and the oroantral fistula. From the results of these cases, we concluded that the use of the buccal fat pad flaps was worth of the consideration for the reconstruction of oral mucosal defect in the regions of the buccal cheek, and posterior oral cavity.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.80-91
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• 1996

A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

• Korean Journal of Head & Neck Oncology
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• v.21 no.2
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• pp.190-195
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• 2005

Background and Objectives: Fibula is the flap of choice for reconstruction of wide mandible defects after tumor ablation surgery. In mandible reconstruction, restoring the mandible frame to provide mandibular contour and dental arch while restoring masticatory function are important. Even though vascularized fibula can be osteotomized freely, proper design and flap insetting is not easy because of its three dimensional structure and difference in design according to the defect sites. We reviewed patients who underwent mandible reconstruction with fibular flaps according to the defect sites and suggest proper modification methods of fibular flap according to the various defects sites after tumor ablation surgery. Materials and Methods: Twelve consecutive mandible reconstruction with fibular free flaps were performed for defects after tumor ablation surgery. Patients were classified into 4 groups according to the type of mandibular defect(Group 1 : defect on central segment including symphysis, Group 2 : defect on lateral segment(with or without central segment) confined to body, Group 3 : defect on body and ascending ramus that does not include the condyle, Group 4 : defect including the condyle). Results: We suggest different modification methods of fibular free flap for each patient group. Group 1, 3 ; contour by using multiple closing wedge osteotomy. Group 2 ; single or double barrel reconstruction without wedge osteotomy. Group 4 ; contour using single or multiple wedge osteotomy and condylar reconstruction with costochondral graft. Conclusion: Fibular free flaps can be contoured to any desired shape after multiple osteotomies to restore various mandibular defects. It is a reliable and versatile method for reconstruction of mandibular defects after tumor ablation surgery.