• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.36-42
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• 2004

Materials and Methods: We studied 50 cases of peroneal perforating branch about branching pattern, course, length of vascular pedicle, and perforating level of the perforating cutaneous branches from Oct. 1985 to November 2003 by doppler flow meter and intraoperative findings. Results: 1) The perforating cutaneous branches were classified into four types, the Straight Branch (27cases), the Proximal Oblique Branch (11cases), the Branch from Muscular Artery (10cases), the Distal Oblique Branch(2 cases) respectively. The most common patten was Straight Branch, that was 54%. 2) There were 3 pathways of these branches, the most common one passed between the Soleus and Peroneus muscles(34 cases, 68%) 3) The length of vascular pedicle in Buoy Flap was variable from from 3 cm to 15 cm, but 32 cases(64%) were distributed between 5 cm and 6 cm. 4) The perforating level of branches were 5.9 cm in average from fibular neck to subcutaneous perforator artery 5) Peroneal Buoy Flap in possible to reconstruct both seperated bone and skin defect in some distance by One-Stage Operation and we can harvest maximal $8{\times}16cm$ sized flap in one perforating artery. If we include more two perforating artery, we get more wide flap which can cover large defect.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.29-35
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• 2004

Materials and Methods: Total number of peroneal perforator flap is 14 cases, which 10 cases were man, 4 cases were woman. The range of age was 12 years old minimally and until 63 years old. The trauma was most common etiology, which was like traffic accidents, 9 cases. We confirmed tibialis anterior artery patency by doppler flow meter, angiography as preoperative evaluation. Results: 1. The success rate was 91%, that in 14 cases, 13 cases were succeded. 2. To obtain successful result of peroneal flap, one must have the anatomic concept for vascular pattern, 8 cases were between peroneus muscle and soleus muscle branch type but, 3 cases were through soleus muscle branch type, so we treated these cases by using soleus muscle including peroneal perforating branch not to injury perforating artery directly. 3. The pedicle size was between minimally $2{\times}2.5cm$ and maximally $6.5{\times}8.5cm$ so we could treat large recipient site. 4. The pedicle length was between minimally 3.2 cm and maximally 11.5cm, average 7.5 cm. 5. The diameter of perforating artery was estimated by inspection, that was about 0.2-0.5 cm Conclusion: The peroneal perforating artery flap has merits that we can approach in avascular zone and has wide movable range from foot to distal femur and little donor site mobidity and can harvest osteocutaneous flap. The weak point was the irregular anatomy of nutrient artery and not to contain sensory nerve.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.222-226
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• 2014

Four patients with soft tissue defects around the ankle joint were covered with peroneal artery perforator-based propeller flaps. Using color Doppler sonography, the flap was designed by considering the location of the perforator and soft tissue defects. The procedure was then performed by rotating the flap by $180^{\circ}$. Additional skin graft was required in a patient due to partial necrosis, and delayed wound repair was performed in another patient with poor blood circulation at the distal part of the flap. The remaining patients did not have any complications and results were considered excellent. Good outcomes were eventually obtained for all patients.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.56-60
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• 2012

Purpose: Thumb reconstruction plays most important role in hand injuries because total loss of a thumb constitutes about 40% disability in the hand. The reconstruction can be accomplished by pollicization, free toe-to-thumb transfer, wrap around procedure and lengthening extraction. However, we sometimes need consecutive or double free flaps in the reconstruction of mutilating hand injuries. Methods: We reconstructed a mutilating hand injury in a 54-years old man. Because of severe crushing injury of right thumb and index fingers, we reconstructed a thumb with pollicization using nearly amputated middle finger. Although it survived completely, the adjacent soft tissues which had been covered by fillet flap from the space past was necrosed on 1 month. We debrided the necrotic tissues and covered it with anteromedial thigh perforator free flap consecutively because he had an anatomical variation in branches of lateral femoral circumflex artery. Results: He had an uneventful postoperative course without any complication such as infection, dehiscence and flap necrosis. Three months later, he had undergone tenolysis and defatting procedure of flap site. He recovered the some amount of grip function and was happy with the result. Conclusion: In severe hand trauma including thumb amputation, thumb reconstruction using pollicization and perforator free flap could be an alternative option. It provides minimal donor site morbidity and an acceptable functional result.

• Archives of Reconstructive Microsurgery
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• v.16 no.1
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• pp.48-51
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• 2007

There could be several methods for trochanteric reconstruction including local flap, pedicled perforator flaps, free flap, etc. We performed greater trochanteric reconstruction with lumbar artery perforator free flap in some aberrant method. So we report this experience with review of literatures. A 42-year-old man visited our hospital with a large soft tissue defect in his left greater trochanteric area by traffic accident. The patient had wide skin and soft tissue defect combined with open femur fracture. During one month period of admission, he underwent femur open reduction and wound debridement four times. After that we planned thoracodorsal perforator free flap reconstruction. The flap was outlined as large as $20{\times}15\;cm$ and elevated in a suprafascial plane from the lateral border. During intramuscular perforator dissection, we found that two 1.5 mm diametered perforator vessels coursed inferomedially toward second lumbar region. Finally the flap became lumbar artery perforator flap based on second lumbar artery perforator as a main pedicle. After flap transfer, the perforator vessels were connected with inferior gluteal artery and vein microsurgically. The operation was successful without uneventful course. We found no significant postoperative complication and donor site morbidity during six months follow up periods. Lumbar artery perforator flap could be an alternative procedure for thoracodorsal perforator flap in some patients with anatomic variant features.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.715-722
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• 2006

Purpose: The main advantages of the perforator flap are minimal donor site morbidity, preservation of any main source artery and its thin characteristics. Most perforator flaps for hand reconstruction need primary and secondary procedures such as a flap debulkiness and liposuction etc. However, flap thickness of calf area is thinner than any other perforator flaps. Methods: We performed an anatomical study and clinical application of medial sural artery perforator flap. We found that there are two or more medial sural perforators located on a straight line drawn from the mid-point of popliteal crease to the mid-point of medial malleolus. Most pathway of medial sural artery comes along with this line. It is possible to observe the first perforators almost exactly 8 cm from midpoint of popliteal crease in a distal half circle drawn with a radius of 2 cm. Results: We report 12 cases in 11 patients of hand reconstruction with medial sural perforator free flap from Febrary 2003 to Febrary 2006. Complete healing was possible in 11 cases. Total flap loss for venous insufficiency was in 1 patient. During the follow-up, good contour and full range of motion was observed on hand reconstruction with medial sural perforator free flap. Conclusion: In the authors' experience, this anatomical study made it possible to prepare a diagram of the exact location of the medial sural perforators. This flap can be used to achieve acceptable functional and aesthetic results for hand reconstruction because of its thin characteristics.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.447-453
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• 2005

The coverage of soft tissue defects around the knee joint or upper one third of lower leg presents a difficult challenge to the reconstructive surgeon. Various reconstructive choices are available depending on the location, size and depth of the defect. The authors present their clinical application of a medial sural artery perforator island flap as a useful alternative method for upper one third of lower leg and knee reconstruction. From 2002 to 2004, we operated total 4 patients (total 4 flaps) using the medial sural artey perforator island flap for coverage of the defect on upper one third of lower leg and knee, of 4 patients, 3 patients was men and one was woman. Average patient age was 54.6 years. The largest flap obtained was 10x8cm2. Postoperative follow up of the patients ranged from two to 33 months. In two cases, defects was located on upper one third of lower leg and in other two cases, defects were on the knee. All four cases had bone exposure open wound. In angiography, 2 cases had injured in the anterior tibial artery, 1 case had injured in the posterior tibial artery. There were no diabetes or other vascular disease. All 4 flaps were survived completely, without minor complications such as venous congestion and hematoma. Donor morbidity was restricted substantially to the donor linear scar. There were no functional impairment. As the main advantages of the medial sural perforator island flap, it ensures constant location and reliable blood supply without sacrificing any main source artery or damaging underlying muscle. This procedure is valuable extension of local flap for defect coverage with minimal functional deficit donor site and good aesthetic result on the defect. We consider it as one of the useful methods of the upper one third of lower leg and knee reconstruction.

• Archives of Reconstructive Microsurgery
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• v.19 no.1
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• pp.56-60
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• 2010

Purpose: Breast reconstruction with abdominal flap has many advantages. However, it might cause abdominal complications such as bulging or hernia. SIEA (Superficial inferior epigastric artery) flap is the most advanced form of abdominal flap which has no adverse effect on abdominal fascia. We report 2 cases of breast reconstruction with SIEA flap with reference review. Methods: From Jun 2006 to Jan 2009, 110 patients underwent breast reconstruction with free abdominal flap. We tried to find the SIEA in every cases and adopted SIEP flap if the diameter was larger than 1mm and it had visible pulsation. 2 patients underwent breast reconstruction with SIEA flap. After design of abdominal flap SIEA was investigated with portable Doppler. SIEA was usually found 4-5 cm lateral to the midline. Flap was elevated with SIEA and SIEV to their maximal length at hiatus. Results: There were no complications, such as infection, hematoma, and necrosis of flap. In both cases, flaps survived completely with excellent vascularity and breast reconstruction was successful. In one case, there was skin necrosis of mastectomy flap, and it was healed by conservative management. Conclusion: With the SIEA flap, donor site morbidity can be minimized along with reduction of operation time. If there is reliable SIEA, SIEA flap would be the preferred skills. However, the limitation of the SIEA flap is difficulty in identifying the SIEA. The reason for less availability of the flap in Korea might include high prevalence of the Caesarian section scar and relatively higher level of the lower margin of the flap.

• Archives of Reconstructive Microsurgery
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• v.12 no.1
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• pp.19-29
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• 2003

Soft tissue reconstruction of dorsum of the foot and ankle has long presented challenging problems for the reconstructive surgeon. Limitations of available local tissue, the need for specialized tissue, and donor site morbidity restrict the options. In an effort to solve these difficult problems, we have begun to use adipofascial flap based on the perforating branch of the peroneal artery. We present our early experience of 5 patients treated with this flap. Our patients ranged from 6 to 26 years in age and included 3 males and 2 females. The etiologies of the wounds were secondary to traffic accident, and crushing injury. The flaps had reverse flow in all patients. The flap and the adjoining raw area were covered with a full-thickness skin graft, while the donor site at the lateral aspect of the leg was closed primarily without grafting. The skin graft was taken from the inguinal area, which was closed primarily. Compared with other flap, this adipofascial flap is thinner, producing less bulkiness to the recipient site and minor aesthetic sequelae to the donor site. In our opinion, this flap is versatile, effective, and an addition to the armamentarium of the reconstructive surgeon for coverage of difficult wounds of the foot and ankle.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.181-186
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• 2006

Myocutaneous flaps have improved the management of soft tissue defects on buttocks and lower extremity. However, there are several inherent disadvantages of muscle flaps such as functional deficits of the donor sites and the bulkiness at the recipient site. To overcome these disadvantages, we have used perforator-based fasciocutaneous rotation flaps for reconstruction of the buttock and lower extremity defects. From March 2003 to February 2005, we have treated 14 patients using perforator-based fasciocutaneous rotation flaps. 10 flaps were based on perforators of the gluteus maximus muscle, and 4 flaps were nourished by perforators from the tibialis anterior and posterior system. The mean postoperative follow-up period was about 1 year. The technique involves localization of the flap perforators preoperatively with a Doppler. The flaps were elevated superficial to the fascia with preservation of one to three perforators. The donor site is then closed primarily. All flaps completely survived and there was no perioperative complications. There was no functional disability of the donor area with esthetically pleasing results. Perforator-based fasciocutaneous rotation flaps for the reconstruction of buttock and lower extremity defects are excellent alternatives to musculocutaeous flaps. The vascularity of the flaps is robust and dissection is technically easy. Perforator flaps do not require sacrificing muscles, but provide sufficient volume and are durable Furthermore, these flaps result in less scar formation and allow more liberal dissection with safety. We conclude that perforator-based fasciocutaneous rotation flaps are very useful for reconstruction of the buttock and lower extremity.