• Journal of Chest Surgery
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• v.28 no.4
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• pp.376-380
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• 1995

We experienced 17 skeletal muscle transpositions in chest surgery during the past 8 years. There were 3 female and 14 male patients with ranging from 5 to 71 years of age [ average 47.3 Seventeen patients underwent 27 musele flaps : 11 latissimus dorsi, 6 pectoralis major, 6 serratus anterior and 4 other muscles. An average of 2.0 previous operations was performed. Hospitalization averaged 24 days.Follow up ranged from 7 days to 45 months;There were two postoperative deaths; one, 20 days after from operation due to pneumonia and the other, 130 days after from operation due to cor pulmonale.Fifteen patients who were alive after operation had good results at the time of last follow up.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.960-963
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• 2001

Huge chondrosarcoma is a rare form of primary malignant tumor of the chest wall. We operated on a 60 year old female patient who had a huge anterior chest wall mass with local invasion into the pericardium and satellite tumors on the visceral pericardium of the heart. En-bloc resection of the huge tumor including both upper 3 ribs, both clavicles, manubrium of the sternum, pleura, and pericarium, was followed by complex chest wall reconstruction using a Gore-tex soft tissue patch and latissimus dorsi musculocutaneous free flap.

• Archives of Plastic Surgery
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• v.43 no.6
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• pp.586-589
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• 2016

A pressure sore wound is often extensive or complicated by local infection involving adjacent soft tissue and bone. In this case, a regional flap after simple debridement is not adequate. Here, we present a case of an extensive pressure sore in the sacral area with deep tissue infection. A 43-year-old female patient with a complicated sore with deep tissue infection had a presacral abscess, an iliopsoas abscess, and an epidural abscess in the lumbar spine. After a multidisciplinary approach performed in stages, the infection had subsided and removal of the devitalized tissue was possible. The large soft tissue defect with significant depth was reconstructed with a free latissimus dorsi musculocutaneous flap, which was expected to act as a local barrier from vertical infection and provide tensionless skin coverage upon hip flexion. The extensive sacral sore was treated effectively without complication, and the deep tissue infection completely resolved. There was no evidence of donor site morbidity, and wheelchair ambulation was possible by a month after surgery.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.539-544
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• 2008

Purpose: There have been limited reports on breast reconstruction after excision of phyllodes tumor. This paper reports four patients who had immediate reconstruction of the breast following excision of phyllodes tumor. Methods: We retrospectively reviewed the medical records of 14 patients from March 2000 to March 2008. Clinical data were analyzed including age, presenting symptoms and signs, type of surgery and metastasis. Results: The mean age was 38.6 years. The mean follow-up period was 40.6 months. Reconstruction was performed with latissimus dorsi musculocutaneous flap in 3 patients and transverse rectus abdominis musculocutaneous flap in 1 patient. Other cases were covered with skin graft or primary repair. 2 local recurrent cases were noted. Conclusion: The breast affected by phyllodes tumor must undergo complete excision. Followed by mastectomy, immediate reconstruction of breast improved cosmetic results, and allowed a wider surgical excision margin of tumor.

• Archives of Plastic Surgery
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• v.50 no.1
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• pp.10-16
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• 2023

Background The chest wall defects can be caused by various reasons. In the case of malignant tumor resection of the chest wall, it is essential to reconstruct the chest wall to cover the vital tissue and restore the pulmonary function with prevention of paradoxical motion. With our experience, we analyzed and evaluated the results and complications of the chest wall reconstructions followed by malignant tumor resection. Methods From 2013 to 2022, we reviewed a medical record of patients who received chest reconstruction due to chest wall malignant tumor resection. The following data were retrieved: patients' demographic data, tumor type, type of operation, method of chest wall reconstruction of the soft and skeletal tissue and complications. Results There were seven males and six female patients. The causes of reconstruction were 12 primary tumors and one metastatic carcinoma. The pathological types were seven sarcomas, three invasive breast carcinoma, and three squamous cell carcinomas. The skeletal reconstruction was performed in six patients. The series of the flap were eight pedicled latissimus dorsi (LD) myocutaneous flaps, two pectoralis major myocutaneous flap, two vertical rectus abdominis myocutaneous free flap, and one LD free flap. Among all the cases, only one staged reconstruction and successful reconstruction without flail chest. Most of the complications were atelectasis. Conclusion In the case of accompanying multiple ribs and sternal defect, skeletal reconstruction would need skeletal reconstruction to prevent paradoxical chest wall motion. The flap for soft tissue defect be selected according to defect size and location of chest wall. With our experience, we recommend the reconstruction algorithm for chest wall defect due to malignant tumor resection.

• Archives of Plastic Surgery
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• v.41 no.2
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• pp.158-162
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• 2014

Background Loss of nipple projection is a common problem following nipple reconstruction. The aim of this study was to demonstrate that the use of a tightly rolled dermal graft is effective in the long-term maintenance of nipple projection. Methods Nipple reconstruction was performed using the C-V flap technique. A dermal graft was harvested from the dog-ear portion of previous scars. The graft was rolled tightly into a compact cylinder and used to augment the nipple reconstruction. Postoperatively, stacked Allevyn dressing was used for protecting the nipple from compression for a minimum of two months. Nipple projection was measured at the time of surgery and at 12 months postoperatively. Results Forty nipple reconstructions were performed using this technique. There were 19 transverse rectus abdominis musculocutaneous (TRAM) flaps, 10 latissimus dorsi (LD) flaps, and 11 tissue-expanded breast mounds. At one year, the mean projection was 0.80 cm (range, 0.62-1.22 cm). The twelve-month average maintenance of nipple projection was 70.2% for the TRAM flap group, 76.3% for the LD flap group, and 61.8% for the tissue-expanded group. In two patients with previous irradiation of the reconstructed breasts, relatively poor maintenance of nipple projection was noted (45.7%). No complications were noted, and all of the donor sites healed well primarily. Conclusions Our results demonstrated that the use of a C-V flap with a tightly rolled dermal graft for nipple reconstruction improves the long-term maintenance of nipple projection. Its advantages include reproducibility, technical simplicity, cost-effectiveness, and minimal donor site morbidity.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.1-7
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• 2011

The aim of extremity reconstruction has focused on early wound coverage and functional recovery but rarely aesthetics. As the quality of life improves, however, the request for aesthetics has been growing. The authors has conducted retrospective reviews on the 86 cases that had extremity reconstruction using free flap, considering the characteristics of parts that had been assessed in primary operation between May 1996 and December 2010. Aesthetic grading was performed in four categories; color, texture, contour and marginal scar. Recipient sites were 42 hands, 19 feet, 14 lower extremities excluding feet and 10 upper extremities apart from the hand. Types of free flap were 16 latissimus dorsi free flaps, 13 anterolateral thigh free flaps, 12 dorsalis pedis free flaps, 8 transvers rectus abdominis free flaps, 7 gracillis free flaps, and 5 superficial temporal fascia free flaps. Total flap necrosis was seen in 8 cases(9.3%) and partial necrosis in 5 cases(5.8%). Secondary revision was done in 24 cases(27.9%) and the most common revision, debulking was done in 14 cases(16.3%). The authors has considered cosmetic aspects along with wound coverage and functional recovery in primary reconstruction. The results of aesthetic grading was 16.2 out of 20, and the secondary revision rate was reduced.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.6
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• pp.478-482
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• 2011

Purpose: Free flap reconstruction is performed on defects including benign and malignant tumors as well as trauma in the department of oral and maxillofacial surgery, but there are few reports of free flap reconstruction cases for oral cancer in patients in Korea. Methods: This study was designed to retrospectively analyze surgical outcomes and complications of 164 free-flap reconstructions performed at the Oral Oncology Clinic, National Cancer Center, during 2002~2011. A total of 164 free flaps were performed for reconstruction of oral and maxillofacial defects which were caused by oral cancer and osteoradionecrosis in 155 patients. Results: The present study had 162 successful cases and 2 failed cases for a total of 164 cases. The study had a success rate of 98.8% for free-flap reconstructions. Flap donor sites included radial forearm free flap (n=93), fibula osteocutaneous free flap (n=25), anterolateral thigh flap (n=18), latissimus dorsi myocutaneous flap (n=16) and other locations (n=12). Postoperative medical complications were generally pneumonia and delirium. Postoperative local complications occurred including partial flap necrosis, delayed wound healing of the donor site, infection of the recipient site and salivary fistula. The incidence of postoperative complications and patient-related characteristics including age, sex, smoking, history of radiotherapy, hypertension (HTN) and diabetes Mellitus (DM) were retrospectively analyzed. Patient age ($P$=0.003) and DM ($P$=0.000) and HTN ($P$=0.021) were significant risk factors for complications overall. Conclusion: The present study had no mortality and confirms that free-flap reconstructions are extremely reliable in achieving successful results.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.29-35
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• 2002

Free flap reconstruction of the foot has become one of the standard procedures at the present time, but choice of a free flap for the soft tissue defect of the foot according to location and size remains controversial. We evaluated the results of free flap reconstruction for the soft tissue defects of the foot. Twenty seven free flaps to the foot were performed between May 1986 and December 2000 in the department of Orthopedic Surgery. Patient age ranged from 3 to 60 years. Male to female distribution was 20:7. Mean follow-up period was 30.5 months which ranged from 12 months to 60 months. The indications for a specific flap depended on the location and extension of the foot defect. In weight-bearing area and amputation stump, the authors chose the sensate (reinnervated) dorsalis pedis flaps (n=7) and sensate radial forearm flaps (n=2). In nonweight-bearing area including dorsum of the foot and area around Achilles tendon, we performed nonsensate (non-reinnervated) free flap reconstructions which included dorsalis pedis flaps (n=5), groin flap (n=1), radial forearm flaps (n=6), scapular flaps (n=4), latissimus dorsi flaps (n=2). Twenty-six flaps transferred successfully (96.3%). The sensate flaps which were performed in weight-bearing area and amputation stumps survived in all cases and recovered protective sensation. Mean two-point discrimination was 26 mm at the last follow up. As a conclusion, the selection of a proper flap depends on the location and extension of the foot defect and patient's age. Fasciocutaneous flap including radial forearm flaps and dorsalis pedis flaps were the best choice in nonweight-bearing area. The sensate free flaps which are performed in the weight-bearing area and amputation stumps can produce better outcome than nonsensate free flap.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.27-34
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• 2011

Purpose: Anterolateral thigh (ALT) perforator free flap is commonly used because of its various benefits. The author reports important factors of preoperative and perioperative ALT perforator free flap and causes of failure. Methods: 84 patients who were treated with ALT perforator free flap from December 2004 to 2008, and February 2010 to April 2010 were studied. 61 patients were male and 23 were female. The mean age of patients was 51.1. The main cause was neoplasm and the main reconstructive areas were head and neck area. The size of flap was various from $3{\times}4$ to $12{\times}18$ cm. 6 patients received split thickness skin graft at donor site. Preoperative angiography was checked to all patients. Results: Among the 84 patients, partial necrosis of flaps occurred in 4 patients because of atherosclerosis, varicose vein, or inattention of patient, etc. And total flap necrosis in 5 patients because of abnormal vessels of recipient area or delay of operation, etc. One case of serous cyst was found as the complication of donor area. Two cases of skin graft on donor site were done because of suspected muscle compartment syndrome, 4 cases of that because of large flap. Septocutaneous perforators were found in 7 cases. The author couldn't find reliable perforator in 3 cases, ipsilateral anteromedial thigh perforator and contralateral ALT perforator and latissimus dorsi musculocutaneous free flap were done instead of ALT. There was no case which needed reoperation because of the impairment of blood supply, and 3 cases were revised by leech because of the burn injury by a lamp or venous congestion. Conclusion: Although ALT perforator free flap is widely used with its various merits, many factors such as preoperative condition of donor or recipient area, morphology of defect and operating time need to consider to prevent flap necrosis. And operators should need careful technique because septocutaneous perforator is uncommon, and musculocutaneous perforator is common but difficult to dissect.