• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.75-79
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• 2000

The foot plays a vital role in standing and gait. This function results from harmonious interaction of bones, joints, and soft tissue. An imbalance or a defect in such structures can lead to impaired function of the foot. The mid foot, composed of cunieforms, navicular and cuboid bone, plays a vital role in maintaining longitudinal and transverse arches and injury or defects to this region can cause instability of the foot. This paper reports a case of complex foot injury; soft tissue defect of dorsum of foot, and medial and intermediate cuneiform bone defect, reconstructed in a single stage using vascularized osteocutaneous fibular free flap. Segmented to fit the defects of medial and intermediate cuneiform bones and a skin paddle providing adequate coverage, restored the stability to the arches and function of the midfoot. The fibula osteocutaneous free flap has appealing characteristics for reconstruction of the foot and the complex mid foot injuries can be considered to the long list of indications.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.1-10
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• 2002

Purpose : To analyze the clinical results of free vascularized osteocutaneous fibula graft to tibial defect combined with soft tissue defect and infection. Materials and Methods : In the retrospective study of 51 consecutive cases of vascularized osteocutaneous fibular graft, the length of the grafted fibula, size of the skin flap, anastomosed vessels, ischemic time of the flap, time for union, hypertrophy of fibula and the complications were evaluated. Results : Initial bony union of the grafted fibula was obtained at 3.74 months after operation, except 4 cases of nonunion and delayed union. The weight bearing without external supports was possible at 18 months after operation in average. The fracture of grafted fibula was most common complication(16 cases). Conclusion : The vascularized osteocutaneous fibula graft provided satisfactory bony union and functional results in the cases not responsible for conventional treatment methods.

• Journal of Periodontal and Implant Science
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• v.38 no.2
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• pp.207-214
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• 2008

Purpose: The aim of augmentation of the alveolar ridge is to restore absorbed alveolar ridges for future implant site or esthetic prosthodontic restoration. The present clinical report describes the anterior maxillary augmentation cases using a soft tissue rotated palatal flap, and considers various problems of before and after surgery. Method: First & second patients were treated by vascularized interpositional periosteal-connective tissue(VIP-CT) flap for horizontal soft tissue augmentation. Especially second patient was progressed with bone grafting at the same time. Third patient was treated by the same flap with bone graft and implant placement in single tooth missing premaxillary area. Result: The obtained horizontal augmentation width measured $0.5{\sim}2.7\;mm$. Conclusion: This technique constitutes a viable approach for augmentation the anterior sector of alveolar ridge with the placement of dental implants. But it needs correct diagnosis preparation and careful surgery skill.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.44-48
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• 2000

The advent of free bone flaps has made successful replacement of extensive areas of bone loss in the upper and lower extremities. The microvascular free bone flaps have faster healing without bony absorption or atrophy and can heal in the hostile environment of scarred bed or infection. Since the fibula free flap introduced by Taylor and colleague in 1975, it has been used extensively for skeletal reconstruction of extremities. In 1988, the folded vascularized fibula free flap was first described as a technique to reconstruct significant long bone defect of upper and lower extremities. During the same time, the fibular free flap has evolved to become most preferred choice of mandibular reconstruction. Up to present day, few reports have been made on the fibular free flap used for reconstruction of injured hand containing metacarpal bone and soft tissue defect. We present here our new and unique experiences with vascularized fibular osteocutaneous free flap as useful and satisfactory one for reconstruction of hand with composite defects.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.788-791
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• 2009

Purpose: Reconstruction of full - thickness defects of the nasal ala has always been a challenge. Local flaps can be used easily, and good result can be achieved when it is indicated. But local flaps often result in facial scars and bulky ala that require secondary revisions. Composite auricular chondrocutaneous graft may matches nasal alae well in terms of contour, color and texture, however, the size of composite graft is limited. We performed free vascularized helical root flaps for reconstruction of nasal ala. Methods: Bilateral ala were excised and the defects were reconstructed with a chondrocutaneous free helical root flap. Each side of ala was reconstructed in 3 months interval. Superficial temporal vessels of vascularized helical root flap were anastomosed to facial vessels. Great saphenous vein was used for interpositional vascular graft. Results: Flaps were survived successfully. The contour, texture and color match were satisfactory. Functional problem of nasal obstruction caused by scar stenosis of nostrils was also resolved. Conclusion: The free vascularized helical root flap is a reliable method in reconstruction of nasal alar defects. The donor deformity was minimal.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.86-92
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• 2007

Failure of reattachment of finger is inevitable in replantation surgery and that failure rate is about 10 % are reported in many authors. Management of the failed finger replantation is challenge to microsurgeons. We report 7 cases of thumb reconstruction after failure of replantation. The reconstructive surgery composed with early debridement of soft tissue that are under gangrenous processing, extract the phalangeal bone without any soft tissues. Osteosynthesis of the extracted phalangeal bone with host phalangeal bone. The exposed bony portion covered with vascularized flaps such as reverse radial forearm pedicled flap, free radial forearm flap and neurovascular island finger flap. This procedure underwent within a week after vascular insufficiency developed. All of the flaps are survived, bone union achieved within 3 months. The function and external appearance of the reconstructed thumb were encouraging; pinch power was average 1.2 pounds. Early removal of necrotizing soft tissue followed by covering none vascular phalangeal bone which extracted from the dead phalanx with vascularized flap is one of the useful alterative solutions in failed replantation surgery in hand.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.1
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• pp.85-90
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• 2012

The odontogenic myxoma is a relatively rare, benign tumor that occurs on the jaw. A 41 year-old man visited Seoul National University Dental Hospital because of swelling of the mandible. Clinical and radiographic evaluation showed a huge mass invading most of the mandible. After biopsy, he was diagnosed with odontogenic myxoma. For resection of the lesion, partial mandibulectomy and reconstruction with a vascularized fibular free flap was done. The result showed successful removal of the lesion. Reconstruction resulted in satisfactory functional and esthetic outcomes. We conclude that huge benign neoplasms such as odontogenic myxomas can be successfully treated by using a wide margin of resection followed by vascularized fibular free flap reconstruction.

• Korean Journal of Head & Neck Oncology
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• v.1 no.1
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• pp.35-61
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• 1985

The surgical treatment of advanced carcinomas and some benign tumors having clinically malignant behaviors of the head and neck region often require extensive resection, necessitating large flaps for reconstruction. Since the original upper arm flap was described by Tagliacozzi in 1597, a variety of technique such as random pattern local flap, axial flap, distant flap, scalping flap, myocutaneous flap, free flap etc. have been proposed for reconstruction of head, face and neck defects. Reconstruction of the facial defects usually require the use of distant tissue. Traditionally, nasal reconstruction has been carried out with a variety of forehead flaps. In recent years, there has been more acceptance of immediate repairs following the removal of these tumors. As a result, patients are more willing to undergo these extensive resections to improve their chances of cure, with the reasonable expectation that an immediate reconstruction will provide an adequate cosmetic result. Authors experienced 13 cases of head and neck tumor during last three and half years that required wide excision and immediate reconstruction with various flaps, not with primary closure or simple skin graft. We present our experience with varied flaps for reconstruction after wide resection of head and neck tumors 3 cases of defect of dorsum of nose or medial canthus with island forehead flaps, lower eyelid defect with cheek flap, cheek defect with Limberg flap, orbital floor defect with Temporalis muscle flap, lateral neck defects with Pectoralis major myocutaneous flap or Latissimus dorsi myocutaneous free flap, subtotal nose defect with scalping flap, wide forehead defect with Dorsalis pedis free flap and 3 cases of mandibular defect or mandibular defect combined with lower lip defect were reconstructed with free vascularized iliac bone graft or free vascularized iliac bone graft concomitantly combined with free groin flap pedicled on deep circumflex iliac vessels We obtained satisfactory results coincided wi th goal of treatment of head and neck tumors, MAXIMAL CURE RATE with MINIMAL MORBIDITY, OPTIMAL FUNCTION, and an APPEARANCE as close to normal as possible.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.5
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• pp.277-283
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• 2013

Purpose: Well vascularized pectoralis major myocutaneous flap (PMMF) had been a commonly used versatile flap in reconstructive oromaxillofacial surgery since the 1970s. However, after the advent of microvascular surgery in the 1980s, the PMMF was used less frequently. But, to date, PMMF has been useful and has some advantages such as covering wide defects, covering vital structures, back-up procedure in cases of free flap failure, and reconstruction for radiotherapy patients. The purpose of this study is to evaluate the role, indication, complications, functional, and aesthetic results of this flap in the era of free flap with a literature and chart review. Methods: A retrospective study was conducted of 16 oral cancer patients undergoing reconstructive surgery with PMMF for reconstruction of defects from 2001 to 2012 at Kyungpook National University Hospital. The male to female ratio was 10:6, with a mean age of 63 years (16~79 years). Basic demographic data, previous treatment history, indications, dimension of the flap, site of reconstruction, postoperative complications, and patients' final status were systemically analyzed from chart review. Results: The pathology of the disease included squamous cell carcinoma in the majority of cases (n=14). The remaining cases were fibrosarcoma and mucoepidermoid carcinoma. Of the 16 PMMF reconstructions, 13 flaps were applied as primary reconstructive procedures, whereas three flaps were; salvage; procedures (vascularized free flap failure). Twelve patients had complications such as wound dehiscence, infection, hematoma, fistula, flap bulkiness, and partial flap necrosis. The higher complication rates showed an association with utilization of the flap in preoperative radiotherapy cases. However, all patients were discharged without failure. Conclusion: In reconstructive oromaxillofacial surgery, the PMMF is still a useful flap for huge defects. In addition, the PMMF can be used as a salvage procedure after vascularized free flap failure and reconstruction for patients with a history of preoperative radiotherapy.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.275-279
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• 2018

Chronic lymphedema is caused by an impairment of the lymphatic system due to primary or secondary causes. Vascularized lymph node transplantation (VLNT) is currently the most promising and frequently used technique besides lymphaticovenous anastomosis. However, the vessel anatomy in the lateral thoracic region is sometimes quite variable. Based on our experiences with vascular anatomical inconstancy in the lateral thoracic region, we planned a lateral intercostal artery perforator flap for VLNT in a female patient with chronic stage II lymphedema of both legs after cervical cancer treatment. After surgery, the patient reported significant improvement in limb volume and the accompanying symptoms. The limb circumference was reduced by an average of 19.2% at 6 months postoperatively. Despite having a short pedicle and small vessel caliber, the lateral intercostal artery perforator flap can safely be used for VLNT in lymphedema patients with anatomical variants.