• Archives of Plastic Surgery
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• 제49권4호
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• pp.543-548
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• 2022

Microvascular reconstruction frequently requires anastomosis outside of the zone of injury for successful reconstruction. Multiple options exist for pedicle lengthening including vein grafts, arteriovenous loops, and arteriovenous bundle interposition grafts. The authors performed a systematic review of arteriovenous bundle interposition grafts to elucidate indications and outcomes of arteriovenous grafts in microvascular reconstruction. A systematic review of the literature was performed using targeted keywords. Data extraction was performed by two independent authors, and descriptive statistics were used to analyze pooled data. Forty-four patients underwent pedicle lengthening with an arteriovenous graft from the descending branch of the lateral circumflex femoral artery. Most common indications for flap reconstruction were malignancy (n = 12), trauma (n = 7), and diabetic ulceration (n = 4). The most commonly used free flap was the anterolateral thigh flap (n = 18). There were five complications, with one resulting in flap loss. Arteriovenous bundle interposition grafts are a viable option for pedicle lengthening when free flap distant anastomosis is required. The descending branch of the lateral circumflex femoral artery may be used for a variety of defects and can be used in conjunction with fasciocutaneous, osteocutaneous, muscle, and chimeric free flaps.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권3호
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• pp.200-209
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• 2013

Over the past few years, a large number of perforator flaps have been revised by several microsurgeons in the USA, France, Canada and Japan. A perforator flap is a flap of skin or subcutaneous tissue that is based on the dissection of a perforating vessel, which is a perforator. In short, a perforator is a vessel that has its origin in one of the axial vessels of the human body. By reducing any muscle harvesting and trauma to a minimum, perforator flaps aim to minimize donor site morbidity, and by avoiding the transfer of dennervated muscle, the long-term bulk of the free tissue transfer becomes more predictable. There are a finite number of potential perforator flaps in the body, which are based on the named source arteries. The most commonly used perforator flaps are deep inferior epigastric perforator, superior gluteal artery perforator, thoraco dorsal artery perforator, medial sural artery perforator, and anterolateral thigh perforator flap. For a better understanding of perforators as a routine reconstructive procedure in oral and maxillofacial surgery, the definition with nomenclature, classifications with special characteristics, and review points for their individual applications must be learned and memorized by the young doctors in the course regarding the special curriculum periods for the Korean national board of oral and maxillofacial surgery. Perforator flaps have been known to have many advantages, so this review article summarized their applications to the maxillofacial reconstruction in the Korean language.

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1997년도 제17차 학술대회
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• pp.121.2-122
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• 1997

• Archives of Plastic Surgery
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• 제36권5호
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• pp.591-596
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• 2009

Purpose: To reconstruct soft tissue defect on lower extremity especially combined with osteomyelitis, free flap with enough blood supplies is required. There are some instance when patients have inadequate recipient vessels for microanastomosis. Anastomosis with harvested vein graft can solve the problem. It may be more problematic or even increase recipient site complication. Cross leg free flaps using contra - lateral vessel can be a solution. Methods: From 2005 to 2008, 12 cases of cross leg free flap were done for 12 patients(male = 9, female = 3). External fixators used in all cases. Free flaps used were laissmus dorsi muscle flap(n=5), anterolateral thigh flap(n=4), gracilis muscle flap(n=2) and medial plantar artery fasciotaneous flap(n=1). In all cases, contralateral posterior tibial artery and vein were used as recipient pedicle. Results: All flaps survived without additional operative procedures. There were no complications such as hematoma or Infection. Sometimes patients needs further therapeutic exercise for fast movement recovery. Conclusion: Although cross leg free flaps require long period of bed resting and rehabilitation after pedicle cutting, It can be practical alternative for soft tissue defect on lower distal extremity with inadequate recipient vessels for free flap on affected leg.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.575-583
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• 2013

Background The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction. Methods We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremity reconstruction at our institution during a 10-year period. In these patients, we evaluated causes and sites of defects, types of flaps, recipient vessels, types of anastomosis, survival rate, and complications. Results There were 42 men and 10 women with a mean age of 32.7 years (range, 3-72 years). The sites of defects included the dorsum of the foot (19), pretibial area (17), ankle (7), heel (5) and other sites (4). The types of free flap included latissimus dorsi muscle flap (10), scapular fascial flap (6), anterolateral thigh flap (6), and other flaps (30). There were four cases of vascular complications, out of which two flaps survived after intervention. The overall survival of the flaps was 96.2% (50/52). There were 19 cases of other complications at recipient sites such as partial graft loss (8), partial flap necrosis (6) and infection (5). However, these complications were not notable and were resolved with skin grafts. Conclusions The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.315-324
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• 2023

Hemoglobinopathies such as sickle cell disease (SCD) are traditionally considered a relative contraindication to free tissue transfer, due to concerns that erythrocyte sickling will increase the risk of microvascular thrombosis and flap failure. This article describes a case report with the successful use of free tissue transfer in a patient with SCD and provides a systematic literature review on free tissue transfer in SCD. A retrospective chart review was performed of a patient with SCD who underwent free tissue transfer at the authors' institution. A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the keywords "free tissue transfer," "free flap," or "microsurgery" and "sickle cell" on PubMed, Ovid/Medline, and Scopus. A 29-year-old male with delayed presentation of an electrical burn to the face and scalp underwent wound closure with a free anterolateral thigh flap. Key management principles included red blood cell transfusion to keep hemoglobin S under 30% and hemoglobin greater than 10 g/dL, maintenance of hydration, normothermia, adequate analgesia, and postoperative anticoagulation. Systematic literature review identified 7 articles describing 13 cases of free tissue transfer in 10 patients with SCD, with combined complete free flap success in 10 of the 13 flaps. Free tissue transfer can be successfully performed in patients with SCD. However, evidence on the optimal management of this unique patient population in the perioperative period after free tissue transfer is limited to case reports in the literature.

• 대한골관절종양학회지
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• 제14권1호
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• pp.33-43
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• 2008

목적: 족관절 및 족부에 발생한 악성 연부 조직 종양의 광범위 절제술 후 시행한 재건술의 임상적 효용성에 대하여 알아보고자 한다. 대상 및 방법: 2000년 3월에서 2007년 3월까지 족관절 및 족부에 악성 연부 조직 종양이 발생하여 광범위 절제술을 시행한 후 재건술을 시행한 15례(14명)을 대상으로 하였다. 폐 전이로 사망한 1례를 제외하고 평균 36.4개월(7~72개월)의 추시기간을 가졌고, 평균 연령은 56.8세(26~77세), 남자가 11명, 여자가 3명이었다. 원발병소는 악성 흑색종 12례, 편평상피 세포암 3례이었다. 최종 추시점에서 종양학적, 수술적 그리고 기능적인 결과를 비교하였다. 결과: 재건술의 방법은 전외측 대퇴부 천공지 피판 5례, 역행성 표재 비복동맥 피판 4례, 족배 동맥 피판 3례와 국소 피판 3례였다. 결손의 크기는 평균 $5.5{\times}5.7\;cm$, 피판의 크기는 평균 $5.9{\times}6.0\;cm$이었다. 회전 피판술 결손의 크기는 평균 $4.6{\times}4.7\;cm$, 피판의 크기는 평균 $4.9{\times}4.8\;cm$이었고 유리 피판술 결손의 크기는 평균 $7.2{\times}7.8\;cm$, 피판의 크기는 평균 $8.2{\times}8.8\;cm$이었다. 평균 수술 시간은 310분(120~540분)이었고, 회전 피판술은 256분, 유리 피판술은 420분이었다. 1례가 폐전이로 사망하였고 국소 재발한 4례와 원격 전이가 발견된 4례를 제외한 7례에서는 최종 추시상 병변이 발견되지 않았다. 피판의 국소적인 울혈외에 수술적 합병증은 없었고, 술 후 MSTS 점수는 평균 68.8%였다. 결론: 족관절 및 족부에 발생한 악성 연부 조직 종양의 광범위 절제술 후 결손의 크기가 비교적 작을 경우($5{\times}5\;cm$ 이하)인 경우 족배 동맥 피판술, 역행성 표재 비복 동맥 피판술과 같은 회전 피판술을 일차적으로 고려해 볼 수 있다. 결손이 더 크거나 복합 조직이 필요한 경우 전외측 대퇴부 천공지 피판술을 포함한 유리 피판술이 더 유용할 것으로 사료된다. 그리고 악성 흑색종의 경우 재건 방법은 종양학적인 결과에 영향을 미치지 않는 것으로 보인다.

• 대한두경부종양학회지
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• 제23권1호
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• pp.26-31
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• 2007

Background and Objectives：Microvascular free flap reconstruction has been revolutionized in last two decades, and became a standard option in the reconstruction of head and neck defects. We intended to review our experiences of 51 microvascular free flap for head and neck defects during 5-year period and to analyze the types of flaps according to primary sites, success and complication rates. Subjects and Methods：From Oct. 2001 through Dec. 2005, fifty one free flap reconstructions were performed in forty nine patients at ENT department of Soonchunhyang university bucheon hospital. Primary sites, pathology, T-stage, operative time, time interval of oral feeding, and various reconstructive factors such as recipient and donor vessels, free flap related complications, failure rates and salvage rates were retrospectively analyzed. The relation between complication rates and preoperative risk factors were statistically analyzed. Results：Methods of reconstruction were radial forearm free flap(RFFF)(n=28, 54.9%), anterolateral thigh free flaps(n=9, ALTFF)(17.6%), rectus abdominis free flap(n=7, RAFF)(13.7%), jejunal free flap(n=5, JFF)(9.8%), and miscellanous(n=2, 4.0%) in order. In free flap related complications, failure of free flap occurred in seven cases(13.7%) and pharyngocutaneous fistula occurred in five cases(9.8%) among fifty one free flaps. The overall success rate of free flaps was 86.3%. Salvage of free flaps was possible only one among eight cases(12.5%). In positive preoperative risk factor groups, failure of free flap was higher than in negative risk factor group. However, it was not statistically significant. Conclusion：We confirmed that free flap reconstructions are highly versatile and reliable options for use in the reconstruction of various soft tissue defects of the head and neck. Free flaps have gained great popularity given its versatility, ability for a two-team approach, and minimal donor site morbidity. However, complications related to microvascular surgery may be overcome by increased surgical experience and by intensive flap monitoring in early postoperative period.

• Journal of Trauma and Injury
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• 제32권3호
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• pp.187-193
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• 2019

Many techniques have been developed for reconstruction of the hand; however, less attention has been paid to foot reconstruction techniques. In particular, reconstruction of the forefoot and big toe has been considered a minor procedure despite the importance of these body parts for standing and walking. Most of the weight load on the foot is concentrated on the forefoot and big toe, whereas the other toes have a minor role in weight bearing. Moreover, the forefoot and big toe are important for maintaining balance and supporting the body when changing directions. Recently, attention has been focused on the aesthetic appearance and functional aspects of the body, which are important considerations in the field of reconstructive surgery. In patients for whom flap reconstruction in the forefoot and big toe is planned, clinicians should pay close attention to flap survival as well as functional and cosmetic outcomes of surgery. In particular, it is important to assess the ability of the flap to withstand functional weight bearing and maintain sufficient durability under shearing force. Recovery of protective sensation in the forefoot area can reduce the risk of flap loss and promote rapid rehabilitation and functional recovery. Here, we report our experience with two cases of successful reconstruction of the forefoot and big toe with a sensate anterolateral thigh flap, with a review of the relevant literature.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.425-430
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• 2023

Axillary defects need pliable, vascular tissue to cover the critical structures traversing the axilla and to allow near-normal range of motion in the shoulder. Although local flaps are the first choice, free tissue transfer is a good option when local tissues are injured or scarred. Herein, we report two cases of axillary defects that were reconstructed using anterolateral thigh free flaps. One was a post-electric burn axillary defect for which a thoracoacromial pedicle was used as the recipient, and the other was a posttraumatic axillary defect with the transverse cervical vessels as the recipient. In both patients, the flap survived well with no complications and resulted in adequate functional recovery. In large defects of the axilla with a scarcity of local tissues, free flaps can yield optimal results. The proper selection of recipient vessels and a donor flap with adequate pedicle length impact the outcomes of such reconstruction.