• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.70-76
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• 2006

This study investigated the clinical application of anterolateral thigh (ALT) perforator flap in reconstruction of soft tissue defect of lower extremity. There were twenty-one patients who had been taken soft tissue reconstruction with anterolateral thigh perforator flap. There were 19 males and 2 females between 3 and 65 years (mean, 36 years). This study included 4 cases of pedatric case of under 10-year-old. All cases were a cutaneous flap. Flap size averaged $160\;cm^2\;(20{\sim}450\;cm^2)$. 19 cases were musculocutaneous perforator flaps and 2 were septocutaneous perforator. T-shaped pedicle were used to reconstruct and to preserve major artery of lower extremity in 2 cases. 19 cases flaps survived completely and 2 cases flap were marginal necrosis partially. There was venous congestion in one case of type of reverse island flap but that was improved after salvage procedure with leech. While the donor sites were closed directly in 5cases, 16 cases underwent skin graft. ALT flap is suitable for coverage of defects in lower extremity where have various condition and reliable in children as in adult.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.111-116
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• 2006

An infection after total knee arthroplasty has many complications such as severe bone defect, skin and soft tissue problems, devastated general condition, so arthrodesis is preferred as treatment option. However, poor bony contact due to severe bone defect and inadequate conditions of the soft tissue often cause nonunion or severe limb shortening after arthrodesis. More over these conditions, it is not easy to choose appropriate fixative devices. In these situations, the arthrodesis using vascularized fibular graft can be the solution. Vascularized fibular graft (VFG) can playa role as a suitable material for the treatment of bone defects. And VFG can overcome poor blood circulation caused by scar tissues, and can be relatively more durable and adequate length. In the long term, VFG can be hypertrophied by weight bearing, and will give mechanical stablility. The purpose of the paper is to report the successful results of arthrodesis using VFG in a patient who got extensive bone defect after failed revision total knee arthroplasty with infection.

• Archives of Reconstructive Microsurgery
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• 제16권1호
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• pp.14-22
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• 2007

Perforator free flap (PFF) is currently a major reconstructive option for soft tissue reconstruction in adults. Although PFFs have been used commonly, most reconstructive surgeons still hesitate to perform PFFs in children. The main cause of concern is the perceived high failure rate related to the small diameter of children's perforator vessels. We present 8 consecutive cases of successful transfer of thoracodorsal artery (TDA) & anterolateral thigh (ALT) perforator flap in children. Between 2003 and 2005, 8 children(4 to 13 years old) with soft tissue defects of the extremities were reconstructed with TDA & ALT PFFs. All flaps completely survived. There were no problems relating to vascular spasm or occlusion. Range of motion of reconstructed extremities were fully recovered. Among 8 patients, only 1 patient was performed an additional flap thinning procedure. 8 cases of TDA & ALT perforator flaps were successfully transferred in children. PFF is an excellent option in reconstruction of children as well as in adults because of its thinness, long pedicle length, least donor site morbidity and acceptable donor site scar.

• Archives of Reconstructive Microsurgery
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• 제16권1호
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• pp.23-29
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• 2007

The reconstruction of deep soft tissue defect such as pressure sore has difficult problems. Myocutaneous flaps have been used commonly as the best coverage method for pressure sore. But, they have several drawbacks such as sacrifice of functional muscle, high morbidity of the donor sites and bulkiness at the recipient site. The concepts of perforator flap has recently developed and widely used to overcome these disadvantages. Between March 2005 to July 2006, we have treated 9 patients who had pressure sore using perforator based fasciocutaneous island rotation flap. Preoperative unidirectional Doppler was used in all cases. Mean number of perforator vessels was 3.8 and flap sizes were from $7{\times}5\;cm$ to $14{\times}13\;cm$. Rotation angles of flap were from 90 degree to 180 degree. In all cases, donor sites were closed primarily. All flap survived completely and postoperative complications were wound dehiscence in 1 case, wound infection in 3 cases. The mean postoperative follow up period was 15.7 months and recurrence was not reported. We could decrease donor site morbidity and cover wound sites easily by using flap rotation and get robust blood supply without sacrifice of functional muscle. Fasciocutaneous perforator island rotation flap would be very useful for various pressure sore treatment.

• Archives of Reconstructive Microsurgery
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• 제16권1호
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• pp.30-38
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• 2007

In acute hand injury, there are sometimes hattened neglected or overlooked vascular injury by primary operators. The authors evaluated the final results and prognosis after secondary revascularization. In eight cases, the authors performed secondary revascularization after prolonged warm ischemia. Five fingers in five cases among them were successfully survived and three cases finally necrosed. The mean warm ischemic time was 56.1 hours. In revascularization procedures, end-to-end artery anastomosis was possible in six cases. In two cases, vein graft was needed to anastomose digital artery, which resulted in complete survival of the fingers. In all three cases, revision amputation of the fingers was done. In acute complex hand injury, the importance of evaluation of the vascular injury can not be overemphasized. The necessity of the early secondary revascularization as well as serious consequence caused by misdiagnosis of vascular injury should be aware.

• Archives of Reconstructive Microsurgery
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• 제2권1호
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• pp.77-81
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• 1993

Free tissue transplantation is commonly performed with the brilliant achievement in microsurgery and anticoagulants and antithrombotic agents have been prescribed in the procedures. However, there is no clean-cut indication as to which agents would be more effective in every steps and final consequences. Low molecular weight heparins inhibiting coagulation in plateletrich plasma and acting on the vascular endothelium have antithrombotic and fibrinolysis action. The experiment with rat groin free flap transplantation after 6-hour ischemia and injection of the low molecular weight heparin was performed and the results between the injection and non-injection group were analysed as follows, 1. Both of the 24-hour groups, vessel patency was not proportional to color change of the groin flap. 2. On the second day after anastomois, heparin-injection group showed intact intima, patent lumen without thrombus, and mild granulomatous inflammation around the suture material and control group with doubtful patency revealed intimal loss and thrombus formation. 3. On the 5th, 7th, and 9th postoperative day, heparin group was patent in anastomosis and showed acute inflammatory cells. 4. The 7th-week period, heparin-injection group showed intact flap color, patent lumen with intact intima and persistent foreign body granuloma.

• Archives of Reconstructive Microsurgery
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• 제2권1호
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• pp.53-61
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• 1993

High level, major limb amputation above the wrist and ankle joint has some characteristic problems because of the large muscle mass and poor potential for nerve regeneration. As an adjunct method to reduce warm ischemic time prior to bony stabilization, temporary vascular shunting by simple catheterization has been performed, which has not been associated with any significant complication and has improved on success rate in replantation surgery. The authors have experienced 198 cases replantation of amputated limbs and digits from September, 1983 at the Korea medical center, Guro hospital, of which, 13 cases of successful replantation of amputated limbs by avulsion injury above the wrist and ankle joint level, which is generally considered as contraindication, were followed up for average 4.5 years(minimum 1.5 to maximum 8.4 years) on terms of survival rate, function and appearance. The clinical analysis upon these cases is to be presented with review of references.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.56-61
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• 1996

The nasal ala and columella represent a difficult location for reconstruction, especially when defect area is covered with scar. Local flap, such as forehead flap or nasolabial flap, may result in additional facial scarring and bulkiness that require multiple thinning revisions. Recent delineation of vascular territories of the ear has allowed the use of vascularized auricular free flap in the reconstruction of large ala and columella defects. Authors reconstructed two cases of full thickiness defect of the ala and columella with auricular free flap. The pedicle of this flap is the superficial temporal artery and vein. The donor vessels were anastomosed to the facial artery and vein. The results were satisfactory cosmetically and functionally.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.16-23
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• 1996

The omental pedicle based on right gastroepiploic vessels is designed new experimental model for prefabrication(revasculirization) of skin flaps in rats. A $2.5{\times}4cm$ pack of omentum with right gastroepiploic vessels was transferred under a bipediceld panniculocutaneous flap which is $2.5{\times}8cm$ size. At day 7, all four margin was divided and the flap was rasied as an secondary island flap connected only by its vascular pedicle, then the composite flap sutured back in place. The flap perfusion was examined by dermofluorometry and flap survival area was measured at day 12. The Secondary island flap demonstrated a dye fluorescence index(DFI%) of $31.38{\pm}12.33$ and survival rate $80.47{\pm}9.61$ The survival rate was increased when DFI% and contact surface between vascular carrier and skin flap was increased. An india ink injection and histologic examination provided visual evidence of revasculization. The omental pedicle is a promising and safe model for revasculirization of other tissues.

• 대한족부족관절학회지
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• 제24권2호
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• pp.48-54
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• 2020

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Various terms are used to describe this clinical entity, including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Several treatment options are available; the choice of treatment is based on the type and size of the defect and the treating clinician's preference. Arthroscopic microfracture (a bone marrow stimulation technique) is a common and effective surgical strategy in patients with small lesions or in those in whom non-operative treatment has failed. This study had the following aims: 1) to review the historical background, etiology, and classification systems of OLT; 2) to describe a systematic approach to arthroscopic bone marrow stimulation for OLT; and 3) to determine the characteristics that are useful for assessing osteochondral lesions, including age, size, type (chondral, subchondral, cystic), stability, displacement, location, and containment of the lesion.