• Archives of Plastic Surgery
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• v.37 no.6
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• pp.835-838
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• 2010

Purpose: Reconstruction of soft tissue defects in the distal lower leg, especially in the distal third, largely depends on free tissue transfer and local fasciocutaneous flaps. But several local muscle flaps have also been proposed as useful alternative reconstructive manner. In this report, the authors present the successful use of the flexor digitorum longus muscle flaps in the distal lower leg reconstruction. Methods: Case 1: An 81-year-old woman with a dog bite wound in the left distal lower leg was admitted. She had a $10{\times}8\;cm$ wound with tibial exposure along the medial aspect of the leg. Soft tissue reconstruction with a flexor digitorum longus muscle flap and a split-thickness skin graft was performed. Case 2: A 77-year-old woman had a squamous cell carcinoma in the right distal lower leg. After wide excision, a $5{\times}4\;cm$ wound was developed with exposure of the tibia. The flexor digitorum longus muscle flap was transposed and covered with a split-thickness skin graft. Results: The flexor digitorum longus muscle flaps were shown to be useful to cover tibial defects in the distal lower leg. During the follow-up period, no significant donor site morbidity was found. Conclusion: The flexor digitorum longus muscle flap can be used to cover the exposed distal tibia, especially when a free tissue transfer is not an option. The relative ease of dissection and minimal functional deficits were the major advantages of this flap, while the extent of reach into the lower third has a limitation.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.52-56
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• 2013

Purpose: We had proceeded seven iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defects and followed-up average for 5 years and 9 months to evaluate the survival rate, neurosensory function and cosmesis in final results. Materials and Methods: From January 1999 through October 2012, we have performed iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defect (average around $3.6{\times}2.4cm$) in 7 cases and average age was 41.6 years (21.5 to 59.0 years). Lesion site was posterior heel in 4 cases, distal anterior leg in 3 cases. Donor structure was the dorsalis pedis artery and the first dorsal metatarsal vessel and deep peroneal nerve in 3 cases and the dorsalis pedis artery and the first dorsal metatarsal vessel in 4 cases. Results: Seven cases (100%) were survived and defect area was healed with continuous dressing without skin graft. The sensory function in the neurovascular flap was restored to normal in 3 cases. Cosmesis was good and fair in 7 cases (85.7%). Conclusion: Ipsilateral dorsalis pedis vascularized pedicle flap in the distal leg and foot is one of the choice to cover the exposed bone and soft tissues without microsurgical procedure.

• Archives of Plastic Surgery
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• v.39 no.2
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• pp.94-105
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• 2012

Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described the first applications of such flaps. Perforator flaps, whether free or pedicled, gained a high popularity due to their main advantages: decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforator flaps in lower leg was possible due to a better understanding of the cutaneous circulation, leg vascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design. This review will describe the evolution, anatomy, flap design, and technique of the main distally pedicled propeller perforator flaps used in the reconstruction of defects in the distal third of the lower leg and foot.

• Animal Systematics, Evolution and Diversity
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• v.22 no.1
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• pp.1-11
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• 2006

Three new species of Kelleria are described based on the females from the invertebrate burrows in the Port Seogwipo, Jeju Island, Korea. These species possess in common no process on the inner margin of the free segment of leg 5. Kelleria grandisetiger n. sp. possesses a large seta on lateral sides of the genital double-somite and a small thumb-like process near base of the free segment of leg 5. Kelleria undecidentata n. sp. possesses the elongated free segment of leg 5 which is more than four times as long as wide and 11 teeth on the distal margin of the second maxillary segment. Kelleria portiviva n. sp. possesses one seta and one distinct spine on the distal margin of the free segment of leg 5, ten or 11 teeth on the distal margin of the second maxillary segment, and a tuft of spinules on the convex outer comer of mandible.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.23-29
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• 1995

Recently limb-salvage operation is widely used for the treatment of malignant bone tumor. But distal leg is out of range of limb-salvage operation due to its technical problem. We report satisfactory limb-salvage operation with tumor prosthesis in 3 cases of osteosarcoma of the distal tibia and fibula. Two cases involved in the tibia and 1 case in the fibula. Average age at operation was 23 years. Neoadjuvant and adjuvant chemotherapy were performed in all 3 cases. We used custom made tumor prosthesis which is designed by Seoul National University Orthopaedic Department. Overall Functional Evaluations by Enneking rating system were good in all 3 cases. All cases are CDF(continuosly disease free since the surgical procedure) state at mean follow-up 2 year and 9 months. In conclusion limb-salvage with tumor prosthesis is useful treatment modality for malignant bone tumor of distal tibia and fibula. Good functional results and few complications suggests limb salvage of distal lower leg may be replaceable with B-K amputation.

• Animal Systematics, Evolution and Diversity
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• v.39 no.1
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• pp.34-46
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• 2023

Three species of the genus Centropages(C. calaninus, C. orsinii, and C. sinensis) were newly collected from Korean waters. The Korean specimens were consistent with previous descriptions, but differ in the following characteristics: in C. orsinii male right antennule with spine on dorsoposterior surface of each segment XIII and XIV; distal end of segment XIX with humplike process on dorsal surface; in C. calaninus female long spinelike process on second exopodal segment of leg 5 of reaching 1/2 length of terminal spine on third exopodal segment; in male, first endopodal segment of leg 5 without inner seta; left second exopodal segment serrated on distal margin; and in C. sinensis male distal spine of left second exopodal segment of leg 5 not fused with segment. In this study, key characters for species identification also were provided.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.507-513
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• 2023

Background Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg. This study evaluated the use of a cross-leg free latissimus dorsi muscle flap for the reconstruction of defects in single-vessel legs, using end-to-side anastomosis to recipient vessels in the contralateral leg without sacrificing any vessel in the uninjured leg. Methods This is a retrospective study that included 22 consecutive patients with soft tissue defects over the lower leg. All the reconstructed legs had a single artery as documented by CT angiography. All patients underwent cross-leg free latissimus dorsi muscle flap using end-to-side anastomosis to the posterior tibial vessels of the contralateral leg. Results The age at surgery ranged from 12 to 31 years and the mean defect size was 86 cm². Complete flap survival occurred in 20 cases (91%). One patient had total flap ischemia. Another patient had distal flap ischemia. Conclusion Cross-leg free latissimus dorsi muscle flap is a reliable and safe technique for the reconstruction and salvage of mutilating leg injuries, especially in cases of leg injuries with a single artery. As far as preservation of the donor limb circulation is concerned, end-to-side anastomosis is a reasonable option as it maintains the continuity of the donor leg vessels.

• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.182-185
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• 2007

Acute stroke with isolated monoparesis manifesting as distal weakness of a single lower extremity has rarely been described. We report two patients with small cortical infarction who had distal weakness of a single lower extremity. In both cases, diffusion-weighted image [DWI] was used to detect small lesions in the contralateral cortex. These cases illustrate that small cortical infarction can cause isolated monoparesis limited to distal part of the leg and it may be misdiagnosed as spinal lesions, especially when lower back pain and transient sensory symptoms are accompanied. In case of the abrupt onset of weakness limited to one lower limb, the possibility of stroke should be considered and careful attention to identify cortical lesions using magnetic resonance imaging, especially DWI is required.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.474-479
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• 2006

Purpose: To report of a series of successful reconstruction of soft tissue defect on distal leg with extensor digitorum brevis myo-cutaneous flap. Methods: Between April 2002 to December 2004, 7 patients with soft tissue defect on distal leg were operated with Extensor Digiotorum Brevis myocutaneous flap. 6 of these patients had osteomyelitis. Results: Extensor Digiotorum Brevis myocutaneous flap were used in 6 patients and reverse flow flap was used in one patient. Average follow up was 19 months. All flap were survived 100% without any complication and osteomyelitis were controled in all cases. Aesthetic and functional out come were excellent on both recipient and donor sites. Conclusion: The advantages of this flap are effectively control of local wound infection, constant and reliable anatomical structures, adequately thin flap. Technical easiness for raising flap and wide arch of rotation. Extensor Digitorum Brevis myo-cutaneous flap is one of ideal option for the reconstruction of distal leg and foot defects.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.186-189
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• 2000

A case of distal lower leg replantation, in an elderly patient, was successfully performed after retrieval of the amputated limb from 3 hours of immersion in seawater. Due to the patient's age, bony union was delayed and functional nerve recovery was unsatisfactory. After massive saline irrigation of the amputated part, employing a catheter through the main artery, as well as, prophylactic antibiotics to prevent infection by Aeromonas, there were no postoperative complications. Despite the issue of age, immersion of an amputated part into seawater is not a contraindication of replantation.