• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제35권4호
• /
• pp.248-255
• /
• 2013

Reconstruction techniques of orofacial defects caused by wide excision of the intraoral malignant lesions are various. Although radial forearm free flap is a common donor site on reconstruction of soft tissue defect, anterolateral thigh (ALT) free flap also has an established site in orofacial soft tissue reconstruction as the favored donor flap with recent progress of the microsurgical technique. A 59-year-old female complained of hyperplastic mass on the right retromolar and buccal cheek, which was diagnosed as a squamous cell carcinoma (SCC) by an incisional biopsy. Before the operation, we planned a wide excision of the SCC lesion, supraomohyoid neck dissection, reconstruction with radial forearm free flap (RFFF), and split thickness skin graft. We accidentally found an arterial variation of the forearm area during elevation of RFFF, and changed the plan of reconstruction operation to reconstruction with ALT free flap. Operative sites was healed well during the post-operative period, and we referred to the department of radiation oncology for post-operative radiotherapy.

• Archives of Plastic Surgery
• /
• 제40권6호
• /
• pp.748-753
• /
• 2013

Background Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction. Methods Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia. Results Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary. Conclusions This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제11권1호
• /
• pp.283-286
• /
• 1989

The buccal mucosa is an effevtive and versatile intraoral grafting material. For adequate reconst ruction of avulsed lip, restoration of natural appearance and adequate lip function should be done. We treated avulsed upper lip defect which had been affected underlying orbicularis oris muscle as well as vermilion border. We chose cheek mucosa for upper lip reconstruction and performed surgical correction of avulsed upper lip with pedicled buccal mucosal flap. The result was very good because of its superior color and texture matching to remaining yermilion tissue.

• 대한치과의사협회지
• /
• 제48권8호
• /
• pp.587-593
• /
• 2010

The management of malignant tumors of the oral cavity requires that the resection should be performed with adequate negative margins. To this end, the surgeon is sometimes required to increase the access to the oral cavity to resect with clear margins although most of our resections can be carried via the transoral route. This article highlights some of the most common surgical accesses to the oral cavity: Peroral approach, mandibulotomy and mandibular swing approach, visor flap approach, upper & lower cheek flap approach, pull-through technique. Also, various modes of management are grossly described according to primary site, size, and stage of the tumors.

• 대한두경부종양학회지
• /
• 제38권1호
• /
• pp.53-57
• /
• 2022

Reconstruction of subtotal maxillectomy defects with columella deficit is challenging. We report a unique case of facial reconstruction using a free radial forearm flap and a free preauricular flap for the maxillectomy and columella deficit. A 73-year-old woman was diagnosed with recurrent sebaceous carcinoma of the nose. We performed wide excision, including areas of the right cheek, nose, upper lip, maxilla, and columella. The resultant subtotal maxillectomy defect was reconstructed using a three-dimensional flap. First, a free radial forearm flap was transfered to resurface the nasal, oral, and external facial side. Second, a preauricular flap was positioned into the columella defect and anastomosed with the distal portion of the radial forearm flap pedicle. The two flaps survived, and the patient recovered uneventfully. We believe the radial forearm and preauricular double free flaps with the pedicle connection method were effective in reconstructing the present case of subtotal maxillectomy defect.

• Archives of Plastic Surgery
• /
• 제39권3호
• /
• pp.244-248
• /
• 2012

Many types of upper lip reconstruction have been introduced to treat defects after a tumor excision or trauma. The authors treated two cases of upper lip defects. A 35-year-old woman presented with a squamous cell carcinoma of the left upper lip that had invaded the corner of the mouth. After resecting the tumor, the defect was $3.7{\times}3.5cm$ in size. A 52-year-old woman presented with a dog bite of the right upper lip. The defect measured $4.0{\times}2.2cm$ in size. The two cases were reconstructed by combined rotation and advancement of a cheek flap. This technique produced a good functional outcome that allowed for oral competence and created an opening of adequate size. A combination of rotation and an advancement flap can be used to treat upper lip defects in a single-stage procedure. This approach produces a good functional and cosmetic outcome.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제12권1호
• /
• pp.210-214
• /
• 1990

외상에 의한 안면부의 반흔 및 안면 종양에 의한 결손은, 사회적 적응면에서 고찰할 때, 환자 자신에 대한 심리적 부담 및 타인에 대한 혐오감을 유발시킨다. 그러므로 안면부의 반흔 구축 및 결선 수복은 환자의 사회적 적응을 쉽게 유도해야 하며 방법적인 면을 고려할 때, 보다 심미적인 결과를 추구해야 한다. 일반적으로 안면 반흔의 구축 및 결손의 수복 방법에는 피부 이식 또는 피판 이식이 이용되고 있으나, 원거리 피부 의식의 결과, 안면부의 피부와 상이한 양태를 나타내고 있어 심미적이지 못하며, 안면부에서의 피판 이식은 수복할 수 있는 반흔 및 결손의 범위가 제한되어 있는 결점이 있다. 경안 피판에 의한 반흔 구축 및 결손 수복은 와반증을 동반할 수 있는 단점이 있으나, 혈류 공급이 우수하고, 봉합후 반흔이 적으며, 보다 광범위한 반흔 및 결손을 수복할 수 있고, 안면부 피부와 성상이 유사하여 보다 심미적이다. 본 교실에서는 화상에 의한 안면부 반흔과 혈관종 절제술에 의한 결손 수복에 경안 피판을 이용하여 심미적으로 우수한 결과를 얻었기에 저자등은 문헌 고찰과 함께 증례 보고를 하는 바이다.

• 대한두경부종양학회지
• /
• 제39권1호
• /
• pp.45-48
• /
• 2023

Angiosarcoma is a very rare subtype of sarcoma. It mainly occurs in the head and neck, and cutaneous angiosarcoma in this region seems to be a distinctive neoplasm with characteristic clinicopathologic features that differ from those of angiosarcoma in other anatomical locations. The prognosis of angiosarcoma in the head and neck region is poor, and the risk of local recurrence and metastasis is high. We reconstructed an atypical angiosarcoma that presented as a solitary nodule with a shape suggestive of hemangioma on the cheek using a modified bilobed local flap. At a 12-month follow-up visit, the patient in this case showed successful recovery after radiation therapy.

• Archives of Plastic Surgery
• /
• 제37권4호
• /
• pp.465-468
• /
• 2010

Purpose: Soft tissue deformity and skin defect after tumor resection in the periorbital area can cause trouble in the function of eyelid as well as in the aspect of external appearance. Therefore, as cosidering reconstruction in periorbital area, detailed assessment of both functional and aesthetic property are required. thus, the purpose of this study is to examine an appropriate reconstruction through clinical cases. Methods: A 14-year-old girl with congenital giant hairy nevus on right periorbital area was selected. Her first visit to our plastic surgery outpatient clinic was on July 2006. Since then, she has undergone staged removal of lesions and reconstruction by various flap technique such as pedicled island flap, forehead galeal flap, paramedian forehead flap, cheek rotation & advancement flap. Results: In the case of this girl, most lesions were removed and replaced by normal skins. Although there was the difference of skin color after skin graft, such difference was not noticeable and section scar by skin flaps was slight. There was no obvious dysfunction in the eyelids and the girl and her parents were satisfied with results after the surgery. Conclusions: In the reconstruction of soft tissue defect or soft tissue deformity and contracture, it is required to choose appropriate reconstruction method, considering aesthetic and functional aspects depending on aesthetic unit sufficiently.

• 대한두개안면성형외과학회지
• /
• 제14권1호
• /
• pp.46-49
• /
• 2013

Facial deformity after nerve injury changes ones' social life. We experienced a few patients with healthy early recovery of muscle contraction after the operation with soft tissue wraparound splint. Under general anesthesia, exploration to find as many injured nerve stumps with ${\times}2.5$ loopes was undertaken at first. Interfascicular repair was done with minimal tension by 10-0 nylon under a microscope, and the suture site was sealed by approximating the surrounding fat flaps. This conjoined adipose tissue flap was a splint as a wraparound environment to reduce the tension in the coaptation site, and to increase the relative concentration of releasing neurotrophic factors by surrounding it. A 45-year-old man fell down in a drunken state and had deep laceration by broken flowerpot fragments with facial muscle weakness on the right cheek. His injured mandibular branches of the facial nerve were found. A 31-year-old female suffered from motionlessnesss of frontalis muscle after a traffic accident. She had four frontal branches injured. The man had his cheek with motion after seven days, and the woman two months after the operation. The nerve conduction test of the woman showed normalized values. Facial nerve repair surrounded by adipose tissue wraparound splint can make the recovery time relatively short.