• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.129-134
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• 1998

The ability for tissue transfer based on microvascular anastomosis has created a revolution in microsurgical free tissue transplantation. The advantages of cutaneous flaps are that they are soft, durable and provide a good cosmetic reconstruction and muscle flaps have a more vigorous blood supply and a longer, larger vascular pedicle than cutaneous flaps. From June 1992 through May 1997, 68 patients had received reconstructive microsurgery in the lower extremity at Department of Orthopedic Surgery, Chonbuk National University Hospital. The results were as follows. 1. The age distribution was from 15 years of age to 67 and male were 59 cases and female 9 cases. 2. The most common cause was traffic accident(54 cases, 79.4%) and followed chronic osteomyelitis(9 cases, 13.2%), industrial accident(3 cases, 4.4%), burn(1 case, 1.5%) and farm injury(1 case, 1.5%). 3. Latissimus dorsi myocutaneous flap were 25 cases(36.8%), rectus abdominis muscle flap 21 cases(30.9%), gracilis muscle flap 10 cases(14.7%), dorsalis pedis flap 9 cases(13.2%), groin 2(2.9%) and vascularized iliac osteocutaneous flap 1(1.5%). 4. 61 cases(89.7%) of 68 cases were survived and the exposed vital tissues and bones were covered and revealed good cosmetic results.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.157-164
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• 1998

It has been very difficult to managing partial joint defect in any etiologies, especially in children. Unicondylar defect of the tibial condyle in children reconstructed with proximal fibular head with articular cartilage from 1995. Two kinds of transfering methods were used, peroneal artery pedicled ipsilateral fibula head transposition to defective lateral tibial condyle defect that revealed poor prognosis with gradual absorption of transposed fibular epiphysis. Free vascularized fibular head transplantation with microvascular anastomosis underwent in the case with medial condyle defect of tibia which revealed very satisfactory results. Author can conclude with these clinical experiences: 1. Tranposition without epiphyseal vesssels intact is not sufficient in fibular head osteochondral transplantation in reconstruction of tibial condyle defect. That means peroneal arterial vascular pedicle is not enough for transplanted proximal epiphysis maintains its function on articular surface and growth activity in children. 2. The anterior recurrent tibial artery is one of the most important and easy to utilizing vessel in proximal fibular epiphyseal transplantation. 3. Free vascularized fibular head transplantation is hopeful method in reconstruction of the knee joint in the patient with partial joint defect which has no effective solution in conventional methods.

• Archives of Reconstructive Microsurgery
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• v.15 no.1
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• pp.33-37
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• 2006

Purpose: The aim of this study was to evaluate the efficacy of lateral middle phalangeal finger flap for pulp and palmar defect of the finger. Materials and methods: We performed the lateral middle phalangeal finger flap in thumb pulp defect 4 cases and the palmar defect of other finger 3 cases. Mean age was 38(25-53) years old and there were male 6 cases and female 1 case. Sensate flap was performed in 4 cases of thumb pulp defects. Mean follow-up period was 14(7-22) months. Results: All flaps were survived. Mean static two-pint discrimination of sensate flap 4 cases was 8(6-10) mm. The sensation of donor finger tip was normal in all cases. Limitation of range of motion of the donor fingers was absent. Patients complained of transient cold intolerance 1 month after surgery but didn't complain of that in all cases at last follow-up. Conclusions: The advantages of the lateral middle phalangeal finger flap are the preservation of the ipsilateral palmar digital nerve, good sensory reconstruction of the fingertip, well maintained donor finger mobility with minimal exposure of the extensor tendon, cosmetically good appearances of donor finger, and easy raising as a large flap. So we suggest that this flap is versatile for reconstructing of relatively large pulp defect of the thumb and the palmar defects involving the joint of finger.

• Archives of Reconstructive Microsurgery
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• v.15 no.1
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• pp.38-41
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• 2006

A 57-year-old male suffered from tingling and paraesthesia on radial side of right hand. We carried out exploration, the process being done, a radial artery passing between the two branches of bifurcated superficial radial nerve was found by accident. Then we performed dissection of the radial artrery a little more distally. It was passing above the extensors of thumb to anstomical snuff box. We treated it with ligating the radial artery, which was done a little above the bifurcated site of superficial radial nerve after angiography of upper extremity. While we were following this procedure, we noticed that symptoms had improved a lot. To our knowlege, neuropathy, by itself of superficial radial nerve by the radial artery with anatomical variation has never been reported and therefore we report this case.

• Archives of Reconstructive Microsurgery
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• v.15 no.1
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• pp.26-32
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• 2006

Purpose: The purpose of this study was to evaluate the effectiveness of limb reconstruction and functional recovery using vascularized fibular graft in the treatment of extensive bone defect of long bone caused by various diseases. Materials and Methods: From september 1995 to March 2005, 21 patients with segmental bone defects were managed with vascularized fibular graft: 13 males and 8 females, aged 39 years on average (range, $8{\sim}65\;years$). The reconstructed site was the humerus in 9 patients, the femur in 5, the tibia in 4 and the forearm bone in 3. The length of bone defect ranged from $8{\sim}17\;cm$. Results: Twenty grafts were successful. The mean period to obtain radiographic bone union was 5.7 months on average. Conclusion: Fibular grafts allow the use of a segment of diaphyseal bone and of sufficient length to reconstruct most skeletal defects of the long bone. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects.

• Archives of Reconstructive Microsurgery
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• v.12 no.2
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• pp.112-118
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• 2003

Purpose : Soft tissue defect and exposed tendons and bones with concomitant infection in the foot and lower leg have to be covered with vascularized flap as the one stage treatment. Authors have performed 6 cases of pedicled dorsalis pedis island flaps under the loupes magnification and evaluated the benefits. Materials and methods : From 1994 through 2003, we have performed 6 pedicled dorsalis pedis island flaps for reconstruction of soft tissue defects in the foot and lower leg. The causes were trauma in 3 cases, skin necrosis and secondary infection after Achilles tendon repair in 2 cases and acute osteomyelitis in 1 case. Average age was 38 years and 5 cases were male and 1 female. The results of the procedure was evaluated by survival of the island flap, comfort in putting on shoes and walking, comfort in the donor site, comfort in the recipient site and range of motion of the ankle joint. Results : All pedicled dorsalis pedis island flaps survived except 1. Three cases felt discomfort in the dorsum of foot as the donor site and 1 case of the Achilles tendon ruptured and repaired showed limited dorsiflexion of ankle joint. Conclusion : Nonmicrosurgical pedicled dorsalis pedis island flaps under the loupes magnification are one of the useful treatment methods because procedure is rapid, survival is confident and overall reconstructive results are good.

• Archives of Reconstructive Microsurgery
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• v.12 no.1
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• pp.30-37
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• 2003

We used bipedicled scapular osteocutaneous free flap for total maxillectomy defect reconstruction in 3 cases of malignant maxillary tumor. We elevated two flaps of the skin paddle and the bone flap with one common pedicle - the subscapular artery - which was devided to the angular branch of the thoracodorsal artery and the circumflex scapular artery to reconstruct the nasal cavity, the palate and the zygoma. The angle between the two flaps was free enough so that we could transfer the two flaps through a single microanastomosis. After the operation, patients could swallow and pronounce well, and the wound contracture was minimal so that we could get aesthetically good result.

• Archives of Reconstructive Microsurgery
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• v.12 no.2
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• pp.119-124
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• 2003

Introduction : The purpose is a retrospective evaluation of the clinical results of the radial forearm flap transfer for foot reconstruction. Materials and methods : We evaluated 21 cases with medical records including etiology, wound dimension, presence of infection, associated fracture, ischemic time of free flap, complication of donor and recipient site. The final results were evaluated with our clinical score (walking, shoe-in, cosmetic). Results : Defects were located on the heel (12 cases), dorsum of foot (4 cases) and sole (5 cases). Mean wound dimension was $7.56{\times}6.0cm$, and mean ischemic time of free flap was 94.5minute. There were superficial skin necrosis (1 case), recurrent ulceration (2 cases) in recipient site, and no complication in donor site but complaint about cosmetic problem (3 cases). The clinical score showed excellent in 14 cases, good in 4 cases, fair in 1 case and poor in 2 cases. Conclusion : We consider the radial forearm flap could provid the stable and durable restoration of normal foot contour without debulking in the foot reconstruction and achieved normal ambulation and cosmetic satisfaction.

• Archives of Reconstructive Microsurgery
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• v.12 no.1
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• pp.13-18
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• 2003

Fournier's gangrene is a synergistic necrotizing fasciitis of the perineal, perirectal and urogenital area and can be fatal unless treated in early stage. Perianal and urogenital infections are common causes of the disease but it can occur after artificial procedure on perineal area using by surgical instruments. It is mixed aerobic and anaerobic infection and E. coli is the most common causative bacteria. Untill now many investigators have focused on early diagnosis, preserving hemodynamic stability, broad-spectrum systemic antibiotics and treatment of underlying disease in management of Fournier's gangrene. The authors have experienced five patients of chronic liver disease whose necrotizing perineal infections developed spontaneously and treated them aggressively as described above and reconstructed perineal soft tissue defects using by various surgical methods, then we got good results both functionary and cosmetically. From now on, we would better reconstruct soft tissue defect of perineum with skin graft or pedicled flap in early stage when treat Fournier's gangrene, thereafter we can get an ultimate increase in patient's life quality.

• Archives of Reconstructive Microsurgery
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• v.12 no.2
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• pp.93-98
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• 2003

Purpose : The purpose of this study is to investigate an occurrence of valgus deformity of ankle joint after vascularized fibular graft in children. Materials and Methods : Four children under 15 years who were surgically treated with vascularized fibular graft were studied. The age of the patients was from 4 years to 13 years, the follow-up period was from 24 months to 108 months. The causes of vascularized fibular graft were open fracture (1 case), congenital psuedarthrosis (2 cases), hypoplastic ulna (1 case). The tibiofibular synostosis was done in 3 cases and not in 1 case. We measured the tibiotalar angle and bimalleolar angle at immediately postoperative and final radiography, and checked ankle motion, pain, and instability of ankle joint. Results : The A-P mortise angle was not different between initial and final radiography in all cases. The intermalleolar angle increased in all cases at the final radiography. There were no pain, instability and limitation of ankle motion. Conclusion: We consider the tibiofibular synostosis can prevent from ankle valgus deformity after vascularized fibular graft in children.