• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.82-85
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• 2013

If the replantation on the original position is not possible, the amputated tissue of a hand may be used as a donor for recovering hand functions at other positions. This procedure is termed 'heterodigital replantation'. An 63-year-old male patient who was in press machine accident came to Our Hospital. He had large dorsal soft-tissue defects ($5{\times}3cm$) on his left long finger and complete amputation on his left index finger through the proximal interpharyngeal joint. Replantation was not indicated because crushing injury of index finger was severe. So we decided to use index finger soft tissue as heterodigital free flap for the coverage of the long finger defect. The ulnar digital artery and dorsal subcutaneous vein of the free flap were anastomosed with the radial digital artery and dorsal subcutaneous vein of the long finger. The heterodigital free flap provided satisfactory apperance and functional capability of the long finger. The best way to treat amputation is replantation. But sometimes surgeon confront severely crushed or multi-segmental injured amputee which is not possible to replant. In this situation, reconstructive surgeons should consider heterodigital free flap from amputee as an option.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.78-81
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• 2013

Neurofibroma may present as a solitary lesion or as multiple lesions. Although there is no site of predilection for solitary lesions, occurrence on the hand is rare. Plexiform neurofibroma can develop in isolation or more commonly as a part of neurofibromatosis type 1. In those that apper in isolation, trauma has been suggested as a precipitating factor. A 68-year-old male farmer had experienced repetitive prior episodes of trauma in the involved finger. He presented with a painless mass on the dorsal aspect of the fifth finger. Physical examination showed a protruding mass measuring approximately $15{\times}20mm$ which was not tenderness to palpation and any skin changes or pigmentation. Ultrasonography showed a cystic mass on the dorsal aspect of the middle phalanx. Microsurgical dissection was applied in order to seperated the lesion from the ulnar side of the dorsal branch of the digital nerve. Pathologic examination of the specimens revealed neurofibroma. At three-month follow-up, motor and sensory function were intact, and range of motion was fully recovered. Traumatic solitary neurofibroma is a rare tumor of the hand, especially in the finger. Hand surgeons should be aware of the diagnostic possibilities of this tumor based on examination, history taking and imaging studies.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.63-68
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• 2013

Purpose: In case of the failed replantation, if the patients want to preserve the length of amputated stump, toe transfer is the ideal choice. However, reconstruction of these amputated stump with a free flap can be a useful method when the patients refuse sacrificing their toe. Our purpose of this study is to evaluate availability of functional results and patient satisfaction after this procedure. Materials and Methods: From March 2008 to February 2012, we reconstructed the amputated stump with free flap by patients demand. Eleven patients were included, medial plantar artery perforator flap in seven cases and great toe pulp flap in five cases. Follow-up range 12 to 24 months and we evaluate patient satisfaction by using a visual analogue scale (VAS; 1=unsatisfied, 5=excellent) and functional recovery by measuring the range of motion of remaining joint at 12 months after operation. Results: During follow-up period, all transferred free flaps survived and no major complications were noted. Range of motion of remaining joint appeared satisfactory result ($15^{\circ}$ to $100^{\circ}$). The VAS patient satisfaction score for aesthetic were five in six patients, four in four patients, and three in one patient. Conclusion: In case of the failed digital replantation, if patient refuse toe transfer, it could be useful method to reconstruction with the free flap to preserving maximal length of amputated stump.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.57-62
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• 2013

Purpose: The aim of this study is to report on the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of large bone and soft tissue defect combined with infection by open tibia fracture. Materials and Methods: During the research period, lasting from December 2002 to June 2008 (Kyung Hee University Medical Center), data were collected from three patients who underwent IVFT after free flap. We analyzed the successiveness and persistency of the infection using free flapping, bone union, and hypertrophy between transposed fibula and tibia. Results: Regarding free flap, successive results were observed in all examples. In the final follow-up results, transposed fibulas all survived, having hypertrophy similar to that of adjacent tibia. Conclusion: Reconstruction of tibia defect with free flap followed by IVTF is a useful and safe method for avoidance of the potential risk of infection for patients with a large tibial bone defect and soft tissue defect associated with infection.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.52-56
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• 2013

Purpose: We had proceeded seven iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defects and followed-up average for 5 years and 9 months to evaluate the survival rate, neurosensory function and cosmesis in final results. Materials and Methods: From January 1999 through October 2012, we have performed iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defect (average around $3.6{\times}2.4cm$) in 7 cases and average age was 41.6 years (21.5 to 59.0 years). Lesion site was posterior heel in 4 cases, distal anterior leg in 3 cases. Donor structure was the dorsalis pedis artery and the first dorsal metatarsal vessel and deep peroneal nerve in 3 cases and the dorsalis pedis artery and the first dorsal metatarsal vessel in 4 cases. Results: Seven cases (100%) were survived and defect area was healed with continuous dressing without skin graft. The sensory function in the neurovascular flap was restored to normal in 3 cases. Cosmesis was good and fair in 7 cases (85.7%). Conclusion: Ipsilateral dorsalis pedis vascularized pedicle flap in the distal leg and foot is one of the choice to cover the exposed bone and soft tissues without microsurgical procedure.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.43-47
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• 2013

Purpose: Un-healing and centrally located defect on back area, it is sometimes a challenge for the reconstructive surgeon. Although skin grafts are considered as the first choice for reconstruction of large skin defect on the back region, it is not always helpful but vascularized flaps provide a superior functional and aesthetic outcome. The present study was designed to investigate the clinical anatomy of the lumbar artery perforator flap to reconstruct back ulcer. Materials and Methods: Clinical anatomy study was undertaken using computed tomographic angiographic analysis. We identified the courses of lumbar arteries and its perforators, measured pedicle length by layers. The location of the perforator vessel was charted against anatomical landmarks. Results: The pedicle lengths of the third and fourth lumbar artery perforator reached a mean of 27.8 mm and 37.1 mm respectively from superficial fascia to deep fascia. The fourth perforator was more laterally located than the third perforator and less than 1 cm above the iliac crest. A case in which the fourth lumbar artery perforator was used as flap pedicle is described. Conclusion: For the reconstruction of central defect on the back area, the lumbar artery perforator flap coverage may be a good alternative option. Computed tomographic angiography can easily identify the course and location of lumbar artery perforators and can be helpful to elevate the flap successfully.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.77-84
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• 2006

Purpose: We present clinical usefulness of saphenous neurocutaneous island flap for reconstruction of soft tissue defect of the lower leg, especially anteromedial aspect, including foot and ankle. Materials and Methods: Thirteen cases of soft tissue defects in the lower leg including foot and ankle which were 6 cases of pretibial area, 2 cases of anteromedial aspect of distal two third, 2 cases of ankle, and 3 cases of foot were treated saphenous neurocutaneous island flap. They were proximally based flap 3 cases and distally based flap 10 cases. Clinically the flaps ranged in size from $4{\times}5\;cm$ to $6{\times}12\;cm$. Results: All of the flaps except 1 case survived completely. Three cases, however, had marginal necrosis. One case of flap failure was proximal tibia fracture accompanied with injury of the flap pedicle which was difficult in flap elevation, subsequently. Conclusion: The saphenous neurocutaneous island flap is a simple, reliable procedure with a versatility for soft tissue coverage of the lower leg, especially anteomedial aspect, including foot and ankle. In case of another injuries accompanied near the saphenous nerve, careful attention should be made.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.51-57
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• 2006

Free flap having been used for reconstruction of skin and soft tissue defect in various areas in a body is spreading up its application for not only functional reconstruction but also aesthetic reconstruction. Authors met with good results minimizing the demerits of anastomosis using suture through microvascular anastomotic device, hereupon, we intend to report this. We worked with 27 cases that used microvascular anastomotic device for venous anastomoses among patients who were processed free flap in our hospital. Age ranged from 12 to 63 (average 43.2), and there were 12 females and 15 males. As a result of a follow-up by 3 months - 5years (average 11.3 months), there was no particular complication in the anastomosed vein except 1 cases among 27 cases that sutured their veins through microvascular anastomotic device. Use of microvascular anastomotic device at free flap shortened the time required for vascular anastomoses to reduce ischemic time of tissue, and minimized the damage of intima during anastomoses and made easy anastomoses possible even in case the difference of diameters of blood vessels being sutured is wide. As well, even for survival rate of flap, satisfactory results were obtained compared with using suture. Consequently, it is concluded that use of microvascular anastomotic device in free flap is a useful way that can substitute existing anastomosis using suture.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.117-122
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• 2006

The function of the thumb is critical to overall hand function. The thumb enables motions such as pinch, grip, fine manipulation and allows to circumduction and opposition. It's loss is a serious problem not only from cosmetic point of view but also functional. Therefore, we should make every effort on thumb reconstruction. Many methods of thumb reconstruction from simple osteoplasty to complex microsurgical reconstruction have been reported. We should understand merits and demerits of each method and choose proper method on case by case. When both hands are injured and there is no option but to amputate one hand and the thumb of another hand is lost, spare part flap from the thumb of the amputated hand to another hand can solve cosmetic problem, functional problem and donor morbidity. We report a case of amputated thumb which has been reconstructed with amputated ring finger of the contralateral hand using spare part flap concept.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.85-91
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• 2006

With advances in techniques and instrumentation, the primary concern of microsurgeons has shifted from flap anatomy and survival toward flap refinement and donor-site function and aesthetics because flap survival rates have risen 96 percent. However, the problem still remains on regard that most flap has disadvantages that flap itself is too bulky or leaves unaesthetic scar to the donor site. These problems can be solved by using adipofascial flap instead of fasciocutaneous flap. The adipofascial flap not only has minimal donor site morbidity, but also can be retained thin. It seems that its advantages can be applied on soft tissue defect of exposed body part.