• 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 Hand and Microsurgery
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• v.23 no.4
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• pp.306-312
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• 2018

The temporal branch of the facial nerve is particularly vulnerable to traumatic injuries due to its anatomic location, which often causes severe aesthetic and functional loss in the patient. Moreover, a chronic injury with nerve defect is more difficult to treat compared to acute injury, because it usually needs an additional procedure such as a nerve graft surgical procedure. This case shows a male patient who had a divided temporal branch of the facial nerve one month after an injury. We successfully grafted the split sural nerve and showed a good aesthetic, functional recovery for the patient.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.55-58
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• 2012

We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had $4{\times}3cm$ and $6{\times}5cm$ scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a severe injury to the right superficial temporal vessel because of previous neurosurgical operations. A 15 cm long pedicle defect was needed to reach the recipient facial vessels. For the vascular graft, the descending branch of the lateral circumflex femoral artery and two venae comitantes were harvested. The flap survived well and the skin graft was successful with no notable complications. When an interposition graft is needed in the reconstruction of the head and neck region for which mobility is mandatory to a greater extent, a sufficient length of graft from an anterolateral flap pedicle could easily be harvested. Thus, this could contribute to not only resolving the disadvantages of a venous graft but also to successfully performing a vascular anastomosis.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.97-101
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• 2020

Although the success rate of deep inferior epigastric perforator (DIEP) flaps has increased, late flap failures still occur and have a low salvage rate. The present article describes a case of salvage of a case of late flap failure using the pedicle vein as a vein graft source. A 50-yearold woman underwent a bilateral DIEP free flap procedure. On postoperative day 6, she experienced flap compromise and underwent emergency flap revision. In the flap revision, flap venous drainage and the superficial inferior epigastric vein were completely obstructed. A Fogarty catheter was used to remove a thrombus from the completely obstructed pedicle vein, and this pedicle vein was used as a graft source and was ligated in retrograde fashion to the flap vein stump. After injection of urokinase into the arterial branch, venous flow to the flap was restored. At a 6-month follow-up visit in the outpatient clinic, only partial fat necrosis at the flap was noted. By dissecting various perforators in the initial operation, decisions regarding immediate revision can be made with more confidence. Additionally, the combined procedures performed in this case may be helpful even for practitioners treating cases of late flap compromise.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1492-1496
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• 1992

Takayasu`s arteritis is a nonspecific inflammatory vascular disease of unknown origin. It most often cuases stenosis of the aorta or its branch arteries with ischemic changes in the organs supplied, but the vessels inside these organs are not directly involved. From 1983 to 1991, we performed operation on 6 patients with Takayasu`s arteritis. There were 6 female patients ranging in age from 17 years to 36 years. Symptoms included headache, dizzness, visual disturbance, and motor weakness or pain of arm. In 5 cases, bypass graft arised from ascening aorta[ventral aorta] were done, and in one, stenotic segments of left subclavian and vertebral arteries were resected an graft interposition done. Follow-up has been 62.4$\pm$34.8 months[ranging from 11 to 113 months], results of each patient were exellent, except one postoperative death.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1132-1135
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• 1997

We have experienced two cases of coronary revascularization without extracorporeal circulation in a 63 year old female patient and a 75 year old male patient. The first patient had the lesion which was the nearly total occulusion of mid-LAD, about 90% luminal narrowing of second diagonal branch and less than 50% stenosis of proximal RCA. The other male patient had a single vessel disease involving about 95% stenosis of proximal LAD and 1st diagonal branch. PTCA failed in the irst patient because of relatively long sinus pause during procedure In both of the patients, the coronary revascularizations were done at distal LAD and diagonal branch using left internal mammary artery and saphenous vein graft under the beating state, respectively. The postoperative courses were uneventful and the patients were discharged without any complications.

• Archives of Reconstructive Microsurgery
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• v.24 no.2
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• pp.56-61
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• 2015

Purpose: We report on the clinical result after coverage of a soft tissue defect on the medial foot and ankle with an adipofascial flap based on the perforator from the posterior tibia artery. Materials and Methods: Nine patients with soft tissue defects on the medial foot and ankle area from March 2009 to May 2014 underwent the procedure. Average age was 54 years old (range, 8~82 years). There were five male patients and four female patients. The causes of the defect were trauma (4), tumor (3), and infection (2). The pivot point of transposition of this flap is the lower perforator originating from the posterior tibia artery. The fatty tissue side of this flap could be used to resurface the defect. The donor site was closed primarily with the preserved skin, and a small caliber drain tube was used. The split-thickness skin graft was grafted to the flap and the wound. If the wound was still infected, this skin graft could be performed at a later date. Results: All flaps survived and normal soft tissue coverage was obtained for the medial foot and ankle of all patients after the skin graft. Normal footwear was possible for all cases because of thin coverage. There was an extension contracture on the medial ray of the foot, which was resolved by contracture release and skin graft. Conclusion: For the medial foot and ankle soft tissue defect, the medial crural adipofascial flap based on a perforator branch of the posterior tibia artery could be a good option to cover it.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.384-389
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• 2012

Background Numerous procedures are available for nipple reconstruction without a single gold standard. This study presents a method for reducing donor-site morbidity in nipple reconstruction using a composite nipple graft after transverse rectus abdominis musculocutaneous flap breast reconstruction. Methods Thirty-five patients who underwent nipple reconstruction using a composite nipple graft technique between July of 2001 and December of 2009 were enrolled in this study. To reduce the donor site morbidity, the superior or superior-medial half dome harvesting technique was applied preserving the lateral cutaneous branch of the fourth intercostal nerves. The patients were asked to complete a previously validated survey to rate the color and projection of both nipples, along with the sensation and contractility of the donor nipple; and whether, in retrospect, they would undergo the procedure again. To compare projection, we performed a retrospective chart review of all the identifiable patients who underwent nipple reconstruction using the modified top hat flap technique by the same surgeon and during the same period. Results Thirty-five patients were identified who underwent nipple reconstruction using a composite nipple graft. Of those, 29 patients (82.9%) responded to the survey. Overall, we received favorable responses to the donor site morbidity. Projection at postoperative 6 months and 1 year was compared with the immediate postoperative results, as well as with the results of nipples reconstructed using the modified top hat flap. Conclusions The technique used to harvest donor tissue is important. Preserving innervation of the nipple while harvesting can reduce donor site morbidity.

• Korean Journal of Agricultural Science
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• v.40 no.4
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• pp.281-287
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• 2013

In Korea, isolated cultivation has been implemented for 102 genera, including about 250 species, each of which has underwent microscopic inspection, cultivation of bacteria in selective medium, analysis of physiology and biochemistry, enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). The number of isolated microorganisms was 8,307 in the period of 2005-2012, and bulbs and tubers had the greatest diversity of microorganisms, of 5,165 (62.2%), followed by 2,119 (25.0%) sapling, 796 (9.6%) seed, 150 (1.8%) cutting slip, 70 (0.8%) branch graft and 7 (0.1%). The number of cases which were disqualified were 413 (4.97%), after the detection of 47 disease causing species of microorganism. Viruses predominated, with 27 species, followed by 16 fungi, a viroid, a Chromalveolata and 2 further species. Top on the list of detection was Arabis mosaic virus (77 cases), followed by Tobacco rattle virus (70 cases), Lily symptomless virus (46 cases) and Penicillium expansum (46 cases).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.226-229
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• 2006

The interforaminal region is usually considered as a safe region in the chin bone graft without important vital anatomical structures to be damaged. But the accurate anatomy of the interforaminal region, with its potential clinical relationships, is controversial. Moreover some complications suggesting damage of incisive terminal branches after chin bone harvesting are reported such as sensory discomfort and pain etc. In order to verify incisive innervation of symphyseal area, we examined the cross-sectional CT scan images taken for preoperative planning of implant placement with chin bone graft and some parameters were measured; (1) visuality rating of incisive canal (2) vertical and horizontal diameter of canal (3) distance from lower border of the incisive canal to the lower border of the mandible (4) shortest distance from anterior border of the incisive canal to the anterior border of the mandible. We report the positive outcome that decrease the complications related with the damages of incisive branch during bone harvesting from the chin.