• Archives of Plastic Surgery
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• v.46 no.6
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• pp.525-534
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• 2019

Background In microtia patients with bilateral hearing impairment, hearing improvement is crucial for language development and performance. External auditory canal reconstruction (EACR) has been performed to improve hearing, but often results in complications. We performed transcutaneous bone conduction implant (TBCI) surgery in these patients. This study aimed to evaluate the safety and efficacy of TBCI surgery. Methods A retrospective review was performed of five patients who underwent auricular reconstruction and TBCI surgery and 12 patients who underwent EACR between March 2007 and August 2018. Hearing improvement was measured based on the air-bone gap values using pure-tone audiometry over a 6-week postoperative period. We reviewed other studies on hearing improvement using EACR and compared the findings with our results. The surgical techniques for TBCI were reviewed through case analyses. Results Postoperative hearing outcomes showed a significant improvement, with a mean gain of 34.1 dB in the TBCI cohort and 14.1 dB in the EACR cohort. Both gains were statistically significant; however, the TBCI cohort showed much larger gains. Only three of the 12 patients who underwent EACR achieved hearing gains of more than 20 dB, which is consistent with previous studies. All patients who underwent TBCI surgery demonstrated hearing gains of more than 20 dB and experienced no device-related complications. Conclusions TBCI is a safe and effective method of promoting hearing gains in microtia patients with bilateral hearing impairment. TBCI surgery provided better hearing outcomes than EACR and could be performed along with various auricular reconstruction techniques using virgin mastoid skin.

• Journal of Yeungnam Medical Science
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• v.9 no.1
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• pp.167-174
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• 1992

Microvascular tissue transfers have facilitated primary closure of various complex defects after radical ablation of head and neck cancers. From Oct 1991 to Feb 1992, we used forearm free flap in two patients and delto-pectoral flap in one patient who had preoperative irradiation for pharyngoesophageal reconstruction. The stricture and fistular formation were most troublesome complication in forearm free flap, so we designed as lazy S shape in distal flap margin to prevent circular contraction and longitudinal margin was deepithelized(5mm) and sutured double layer to withstand fistular formation and this can be considered useful in place of a free jejunal transfer.

• Archives of Plastic Surgery
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• v.48 no.6
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• pp.651-659
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• 2021

Background Many surgical specialties have had pioneering influences from plastic surgeons. However, many of these areas of practice have evolved to include surgeons from diverse training backgrounds. This raises the question as to whether the prominence of other specialties in clinical practice translates to greater research productivity in these areas. The objective of this paper is to investigate the publication volumes of plastic surgeons in selected areas of practice compared to surgeons from other disciplines. Methods PubMed was used to examine publication trends in areas associated with plastic surgery. Searches for the following topics were performed: head and neck reconstruction, hand surgery, breast reconstruction, ventral hernia repair, abdominal component separation, brachial plexus injury, craniofacial surgery, and aesthetic surgery. Affiliation tags were used to examine contributions from nine specialties. Web of Science was used to identify the top cited articles for the last 10 years in each area. Results Articles by non-plastic surgeons comprise the majority of the literature for all areas of practice studied except for breast reconstruction and aesthetic surgery. Despite this, plastic surgeons contributed the greatest number of top cited articles over the last 10 years for five of the areas of practice. Conclusions While plastic surgeons do not contribute the greatest proportion of articles published each year in several of the selected areas of practice, they do publish a larger number of articles that are the most cited. Plastic surgeons remain the dominant academic force in terms of volume and citations for both breast and aesthetic surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.144-152
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• 1991

Various muscular flaps are used in oral and maxillofacial reconstructive surgery for the defects caused by tumor resection and trauma or for the correction of head and neck deformities. The sternocleidomastoid(SCM) muscle may be widely used as a muscular or myocutaneous flap in these lesion. The authors used SCM muscular flap for the expected parotid defect following benign tumor related conservative parotidectomy in three cases. We expected that prevention of post-operative facial deformity, reduction of dead-space and protection of denuded facial nerve etc. is lead by SCM muscular flap. But the total SCM flap can lead to some complications such as "flat neck deformity", limitation of neck movement and overcontouring of parotid defect. Therefore, the authors used split pedicled SCM muscular flap and it lead good favorable results of post-operative functional and esthetic problems.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.41-45
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• 2012

Purpose: Fibular osteocutaneous free flap is the procedure of choice for mandibular reconstruction. However, the anatomic consistency and the reliability of the skin paddle have been considered to be questionable and the utilization of the fibular osteocutaneous free flap can be challenging for the inexperienced surgeon. Preoperative computed tomography (CT) angiography can support revolutionary help with the operator design of the fibular osteocutaneous flap. The purpose of this article is to share the valuable experience of support with preoperative CT angiography. Methods: Three consecutive patients, who needed mandibular reconstruction, were treated with fibular osteocutaneous free flap. Each of the patients had undergone lower extremity CT angiography before the surgery. The CT angiographies were scrupulously investigated to calculate the locations and the tracts of the peroneal artery perforators. We compared the findings of the CT angiography with those of the real operation. Results: The information about the perforators was sufficiently matched with the findings of the operation. With the use of preoperative CT angiography, we were able to achieve confident performance during operation, shortening of operation time, and fine outcomes with a no flap failure. Conclusion: The CT angiography of lower extremity can provide reliable information of the perforators of the fibular osteocutaneous free flap.

• Archives of Craniofacial Surgery
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• v.21 no.4
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• pp.229-236
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• 2020

Background: Oncologic resection of the scalp confers several obstacles to the reconstructive surgeon dependent upon patient-specific and wound-specific factors. We aim to describe our experiences with various reconstructive methods, and delineate risk factors for coverage failure and complications in the setting of scalp reconstruction. Methods: A retrospective chart review was conducted, examining patients who underwent resection of fungating scalp tumors with subsequent soft-tissue reconstruction from 2003 to 2019. Patient demographics, wound and oncologic characteristics, treatment modalities, and outcomes were recorded and analyzed. Results: A total of 189 patients were appropriate for inclusion, undergoing a range of reconstructive methods from skin grafting to free flaps. Thirty-three patients (17.5%) underwent preoperative radiation. In all, 48 patients (25.4%) suffered wound site complications, 25 (13.2%) underwent reoperation, and 47 (24.9%) suffered from mortality. Preoperative radiation therapy was an independent risk factor for wound complications (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.1-7.3; p=0.028) and reoperations (OR, 4.45; 95% CI, 1.5-13.2; p=0.007). Similarly, the presence of an underlying titanium mesh was an independent predictor of wound complications (OR, 2.49; 95% CI, 1.1-5.6; p=0.029) and reoperations (OR, 3.40; 95% CI, 1.2-9.7; p=0.020). Both immunosuppressed status (OR, 2.88; 95% CI, 1.2-7.1; p=0.021) and preoperative radiation therapy (OR, 3.34; 95% CI, 1.2-9.7; p=0.022) were risk factors for mortality. Conclusion: Both preoperative radiation and the presence of underlying titanium mesh are independent risk factors for wound site complications and increased reoperation rates following oncologic resection and reconstruction of the scalp. Additionally, preoperative radiation, along with an immunosuppressed state, may predict patient mortality following scalp resection and reconstruction.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.152-158
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• 2008

Purpose: Mandibulotomy approach and mandible sparing approach are most common methods for oropharyngeal cancer surgery. Good surgical view and convenience of flap inset are advantages of mandibulotomy approach but deformity of mandible contour, postoperative malocclusion and radionecrosis are its limitations. To make up for the limitations, mandible sparing method is commonly performed, but limited surgical view and difficulties of flap inset are the weak points of this approach. The purpose of the study is to compare mandibulotomy and mandible sparing approaches in postoperative complications and progression of the treatment in oropharyngeal cancer operation and reconstruction. Methods: Single reconstructive microsurgeon operated for oropharyngeal cancer patients with different surgeons of head and neck department who prefer mandibulotomy and mandible sparing approach respectively, and we compared the frequency of postoperative complication, operation time, duration of hospitalization and recurrence rate between two different surgical approaches. Results: Mandibulotomy approach was used in 18 patients and mandible sparing approach was used in 15 patients. In mandibulotomy approach, there happened one case of teeth injury and one case of necrosis of skin and gingiva, but there happened no malocclusion and radionecrosis. In mandible sparing approach, there were 3 cases of fistula and 2 cases of infection which are significantly higher than mandibulotomy approach. There were no significant differences between early regional recurrence and duration of hospitalization. Conclusion: In this study we compared two different methods for the surgical approach in oropharyngeal cancer surgery. As mandible sparing approach has difficulties of limited surgical view, it can be used for the limited indications of anterior tongue and mouth floor cancer. Mandibulotomy approach has advantages of good surgical view and convenience of flap inset. In this method preservation of gingival tissue, watertight fashion suture, delicate osteotomy and plate fixation to maintain occlusion are the key points for the successful results.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.6
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• pp.549-558
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• 2011

The latissimus dorsi myocutaneous flap (LDMF) was initially described at the turn of the century by Tansini et al, and latissimus dorsi myocutaneous free flap (LDMFF) was also first described for the coverage of a chronically infected scalp by Maxwell et al. As a pedicled flap, LDMF has been often used for breast reconstruction and for soft tissue replacement near the shoulder and the lower reaches of the head and neck. LDMFF is a flat and broad soft tissue flap with large-caliber thoracodorsal vessels for microvascular anastomosis. A skin paddle of the LDMFF can be more than $20{\times}40$ cm, so very large defects in the oral cavity and outer facial region can be covered by this LDMFF. Other advantages include consistent vascular anatomy, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with tumor resection. For a better understanding of LDMFF as a routine reconstructive procedure in large defects of the oral cavity and facial legion, anatomical findings must be learned and memorized by young doctors during the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article discusses the anatomical basis of LDMFF with Korean language.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.1
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• pp.11-20
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• 1993

Bony ankylosis is an intraarticular condition where there is fusion of the bony surfaces of the joint : The condyle and the glenoid fossa. It occurs in both children and adults, unfortunately more frequently in the former, in whom early recognition and correction is particularly critical. Trauma is well proven to be the predominant cause of TMJ ankylosis. Infection, rheumatoid arthritis and neoplasm are another, significant cases of TMJ ankylosis. The necessity for using an interpositional material to prevent TMJ reankylosis has been widely discussed and many interpositional materials have been used, including temporal muscle and fascia, dermis, auricular cartilage, fascia lata, fat, Lyo-dura, Silastic and various metals. The temporal muscle and fascia have been widely used pedicled flap for head and neck reconstruction. The use of a temporal muscle and fascia for reconstruction of the TMJ, particularly in cases of ankylosis is a very reasonable option. Its principle advantages are its autogenous nature, resilience, and proximity to the joint, allowing for a pedicled transfer of vascularized tissue into the joint area. However, the viability of temporal muscle and fascia is a critical question. We treated 2 cases of TMJ ankylosis with temporal muscle and fascia transfer and one case with temporal fascia. We obtained satisfactory results as to functional aspects.

• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.141-145
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• 2002

Rectus abdominis muscle free flap is widely used for breast reconstruction and soft tissue defect in lower leg but donor-site morbidities such as abdominal wall weakness, hernia, bulging are troublesome. Recently, to minimize donor-site morbidity, there has been a surge in interest in deep inferior epigastric perforator(DIEP) free flap preserving the anatomy of rectus abdominis muscle, fascia, and motor nerve. Between August of 1995 and September of 2002, topographic investigation of DIEP was performed during the elevation of 97 cases of TRAM free flap and 5 cases of DIEP free flap. There were 84 cases of breast reconstructions, 12 cases of lower leg reconstructions, and 6 cases of head and neck reconstruction. We could observe total 10 to 12 perforators on each rectus abdominis muscle below umbilicus. Among these, the numbers of large perforators(>1.5mm of diameter) were mean 2.1 in lateral half of rectus abdominis muscle, mean 1.2 in medial half, and mean 0.5 in linea alba and paramedian. DIEP free flap provides ample amount of well vascularized soft tissue without inclusion of any rectus abdominis muscle and fascia and minimizes donor-site morbidity. One perforator with significant flow can perfuse the whole flap. For large flap, a perforator of the medial row provides better perfusion to zone-4 than one of lateral row and, if diameter of perforator is small, $2{\sim}3$ perforators can be used. According to the condition of recipient-site, thin flap can be harvested. As DIEP free flap has many advantage, perforator topography will be useful in increasing clinical usage of DIEP free flap.