• 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.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.197-202
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• 2007

Purpose: The gluteal artery perforator flaps earned its popularity in buttock reconstruction due to the lower morbidity of the donor site and the flexibility in the design. Speedy and safe reconstruction is important for the success of buttock reconstruction. If a proper design is selected, satisfactory results can be obtained with more simple method of surgery. Methods: Between April 2005 and April 2006, buttock reconstruction by using gluteal artery perforator flaps were performed on sacral sores(6 cases), ischial sores(2 cases) and malignant melanoma on buttock(1 case). Various designs depending on the location and the size of the defect was made. In those designs, perforator was used as an axis for the minimal dissection of the vessel. Donor site from which sufficient amount of soft tissue can be transferred was selected, and also not causing high tension against the recipient site during the donor site closure. In addition, postoperative aesthetics, and the possibility of another design of a second operation which can be necessary in the future, was considered. Results: Patient follow up was for a mean period of 10.8 months. All flaps survived except for one that had undergone partial necrosis. Wound dehiscence was observed in one patient treated by secondary closure. Most patients presented with cosmetically and functionally satisfying results Conclusion: By designing the flap using the perforator as an axis, depending on the defect size and degree, reconstruction can be performed with only a small tension to the donor and the recipient site. And the minimal perforator dissection allowed easier and faster reconstruction. Selection of a proper design is the key procedure which greatly affects operation time and result success.

• 대한미세수술학회:학술대회논문집
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• 1994.11a
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• pp.110.2-111
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• 1994

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.62-69
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• 1996

Lateral arm flap has been used for the reconstruction of the various defects in hand, head and neck region. This flap is highly dependable as a free flap because of its thin flap thickness, constant vascular anatomy and possibility of osteocutaneous flap and fascial flap. Recently, many authors tried extended approach for vascular pedicle and distal flap extension for bigger defects. In this study, we review previous articles and 14 cases used lateral arm flaps for coverage of the varying defect on head and neck, upper and lower extremities succesfully. In conclusion, lateral arm flap has constant anatomical structure and can overcome the disadvantages such as short pedicle length and limited flap size, then the range of its application can be very widened.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.58-61
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• 2010

Purpose: Sebaceous carcinoma is a rare malignant tumor that occurs mostly in head and neck regions. Early diagnosis and treatment are necessary because it tends to be locally aggressive and goes through distal metastasis with fast progression. This study presents reliable surgical methods for sebaceous carcinoma in head and neck regions. Methods: Three patients were included in this study. First, a 61-year-old woman visited the hospital with a yellow-colored, slowly growing mass on the left ala. A 54-year-old woman had a brown-colored mass on her right preauricle. Last case was a 62-year-old man who had a yellow-colored mass on his scalp. CT scan and punch biopsy were done. All cases were diagnosed as sebaceous carcinoma. The lesions were resected with 10 mm safety margin and various regional flaps were used for reconstruction. Results: Histological examination revealed sebaceous differentiation and local invasions. Postoperatively, all patients did not suffer from complication and no recurrence was found. Conclusion: We recommend early wide excision with an enough safety margin, and a regional flap as a treatment of sebaceous carcinoma.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.35-43
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• 1999

There are lots of reconstructive ways like direct closure, skin graft, local flap, regional flap, distant flap, free flap and so on. Microsurgical reconstruction is regarded as the last step in various reconstructive methods. So the failure of this last step causes the troublesome situation for both of patients and surgeon. The purpose of this paper is to investigate the problems in failed free flap surgery and to introduce the strategy of appropriate management in wound of free flap failure. We performed 252 cases of free flap surgeries from May, 1988 to June, 1998. Among these cases, we failed 9 cases of free flaps. Patients' age ranged from 19 to 63. There were 7 males and 2 females. Site of failure were 3 head and neck areas, 2 hands, and 4 lower extremities. However there was no failure in breast, trunk, buttock, and genitalia. 7 patients who had region of head and neck, and lower extremity underwent the second free flap surgery successfully in postoperative 4 to 16 days following debridement of necrotic tissue. However 2 patients who had region in hand were managed with conventional treatment like skin graft and distant flap. Vein grafts were needed in 3 cases of 7 second free flaps, and 1 patients needed sequentially-linked free flaps with two flaps. The second free flaps were inevitable for head and neck area because the large complex wound may cause the lifethreatening condition without immediate coverage with well vascularized flap. Lower extremity also needed second free flap for limb salvage. Hand could be managed with conventional method, even though healing time was quite delayed. We thought second free flap surgery in free flap failure cases should be performed with more careful preoperative evaluation and refined surgery. Success of second free flap surgery could recover the very difficult situation due to previously failed operation.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.559-564
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• 2009

Purpose: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially paraplegic patients. Although various muscle, musculocutaneous and fasciocuta - neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still debated which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. Methods: From August 2005 until January 2008, the adductor magnus perforator island flap had been used for resurfacing of the ischial soft tissue defects in a series of 6 patients (4 male and 2 female). Ages ranged from 26 to 67 years (mean, 47.5 years), and follow - up period from 13 to 26 months (mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. Results: The sizes of these flaps ranged from 12 to 18 cm in length and 7 to 9 cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split - thickness skin graft. Average thickness of the flap was 0.94 cm, which was more thicker than other perforator flaps. Long term follow - up showed a good flap durability. Conclusion: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap is a good and suitable option for coverage of the ischial soft tissue defect.

• Archives of Plastic Surgery
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• v.41 no.2
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• pp.133-139
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• 2014

Background Various shapes and designs of the gluteal artery perforator flap have been used for treating sacral pressure sores and reconstructing breasts. To establish the ideal fasciocutaneous flap design for use in the gluteal area, the soft tissue thickness distribution was measured. Methods Twenty-one buttocks of adult Korean cadavers were analyzed through rectangular subfascial dissection. Each buttock was divided horizontally into 10 sections and vertically into 10 sections, and then, the thickness at the corners of the sections was measured. For the sake of comparison and statistical verification with living bodies, computed tomography (CT) images of 120 buttocks of patients were randomly selected. Five horizontal sections and 4 vertical sections were made, and the thickness at each corner was recorded. Results According to the dissection and the CT images, the area with the thinnest soft tissues in the buttock was around the posterior superior iliac spine, close to the sacral area. The thickest area was the superolateral area of the buttock, which was 3.24 times and 2.15 times thicker than the thinnest area in the studies on cadaver anatomy and the CT images, respectively. Conclusions The thickness of the soft tissues in the buttocks differed by area. The superolateral area had the thickest soft tissues, and the superomedial area had the thinnest. This study includes information on the distribution of the thickness of the gluteal soft tissues of Koreans. The outcome of this study may contribute to the design of effective local flaps for pressure sore reconstruction and free flaps for breast reconstruction.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.172-178
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• 2000

With esthetic concern in the reconstruction of skin and soft tissue defects of face, the use of local flap has been the method of choice. However, when there is extensive tissue loss in the face, local flaps do not provide satisfactory results. The amazing development of microsurgical technique has decreased the percentage of free flap failure, thus making free flap use in reconstruction of facial soft tissue defects. Many free flaps has been applied for reconstruction of face defects. Especially, the radial forearm flap has numerous advantages with which facial reconstruction is made possible. But, its disadvantages are ; the sacrifice of one major artery supplying the hand and donor site complications. In order to circumvent these disadvantages, we employed posterior interosseous artery(PIA) forearm free flap for the reconstruction of the face defects. The posterior interosseous forearm island flap was first described by Zancolli and Angrigiani(1985). Currently, the PIA island flap and free flap have been used for hand reconstructions. The disadvantages of the PIA flap are ; the small caliber of the pedicle, different locations of the perforating branches, and the proximity of the motor branch of the radial nerve. But, its advantages lies in preserving the major artery of the hand, minimal donor site morbidity, and fairly well matched skin texture and color, and that the flap volume is sufficient, not too bulky with convenient handling. By using this flap, we performed 1 case of tumor resection and 1 case of traumatic defect. From our experiences we conclude that it is one of many useful methods in the reconstruction of the skin and soft tissue defects of the face. We also have discussed advantages and some limitations of various free flaps for reconstruction of the face.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.595-599
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• 2010

Purpose: Trochanteric pressure sores management has been improved through the development of musculocutaneous flaps. But it has many drawbacks such as donor site morbidity and functional muscle sacrifice. With the introduction of perforator flap, it is possible to use in every location where musculocutaneous perforators are present. We have reconstructed trochanteric pressure sores using perforator-based flaps from the ascending branch of lateral circumflex femoral artery. Methods: Between May of 2006 and April of 2008, we performed six cases of perforator-based flap from the ascending branch of lateral circumflex femoral artery for the coverage of trochanteric pressure sores. For identifying perforators, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella as the vertical axis, from the pubis to the trochanteric prominence as the horizontal axis. In the lateral aspect of the intersection of these two axes, various flap were designed according to its defects. The flap was raised in the subcutaneous plane above the fascia and the pedicle was traced by doppler and identified. The pedicle was meticulously dissected not to injure the periadventitial tissues and transposed to the defect. The donor site was closed primarily. Results: The mean age of patients was 56.2 years. Four male and two female patients were studied. Five patients were paraplegic. The mean defect size was $6{\times}4\;cm$. The largest flap dimension was $14{\times}7\;cm$. Donor sites were closed primarily without any complications. All flaps survived completely without necrosis, hematoma or infection. There were no recurrence during the follow-up period. Conclusion: Trochanteric pressure sores using perforator-based flap from the ascending branch of lateral circumflex femoral artery can be performed safely and it would be a reliable option for coverage of trochanteric pressure sores with minimal donor site morbidity.