• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권1호
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• pp.46-52
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• 2009

The maxillary posterior edentulous region presents unique and challenging conditions in implant dentistry. The height of the posterior maxilla is reduced greatly as a result of dual resorption from the crest of the ridge and pneumatization of the maxillary sinus after the loss of teeth. Materials previously used for sinus floor grafting include autogenous bone, allogeneic bone, xenogenic bone and alloplastic materials. Autogenous bone is the material of choice, but its use is limited by donor-site morbidity, complications, sparse availability, uncontrolled resorption and marked volume loss. One way to overcome this problem would be to use bone substitutes alone as a osteoconductive scaffold for bone regeneration from the residual bone or in combination with allogeneic bone, which also has osteoinductive properties. The purpose of this article is to describe a double layers technique of demineralized and mineralized bone graft materials instead of autogenous bone in sinus floor augmentation of deficient posterior maxillary alveolar process and to report our experience with this technique. Our results show that maxillary sinus augmentation using mineralized and demineralized bone materials, when installed simultaneously with the implant or not, is good results for bone healing.

• 대한기관식도과학회지
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• 제6권1호
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• pp.118-126
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• 2000

A radical maxillectomy causes a defect of the alveolar bone, gingiva, palate, and orbital floor and causes cosmetical problems and masticatory and phonatory functions. Defect after a radical maxillectomy was reconstructed with skin or dermis graft was introduced, but recently wide resection of the tumor and functional reconstruction with free flap was introduced by several methods. The defect due to radical maxillectomy was reconstructed with scapula, iliac crest, radius. But reconstruction with a fibular osteocutaneous free flap was rarely introduced to defect of radical maxillectomy. The fibular osteocutaneous free flap was firstly introduced by Taylor. The fibular osteocutaneous free flap has several advantages. We experienced the first case of radical maxillectomy and reconstruction with the fibular osteocutaneous free flap, so we reported that case with literatures. The patient has a right maxillary sinus squamous carcinoma (T2N0M0), and performed a radical maxillectomy with right supraomohyoid neck dissection, and reconstruction with fibular osteocutaneous free flap. Donor site morbidity was little, and phonatory and masticatory function were nearly normalized. And cosmetical result was very acceptable.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.217-221
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• 2007

Purpose: Reconstruction of the soft tissue defect exposing Achilles tendon is a formidable challenge because of the paucity of soft tissue and relatively poor blood supply. This article describes the reconstruction of soft tissue defect exposing Achilles tendon using gracilis muscle free flap and split-thickness skin graft. Methods: From 2000 to 2005, four patients with soft tissue defect exposing Achilles tendon and infection were operated using gracilis muscle free flap and split-thickness skin graft. The defect size ranged from 3.5 to 5cm wide and 6.5 to 8cm long. The mean postoperative follow-up was twenty months. Results: All the flaps were survived without necrosis and infection. We obtained the satisfactory results with good functional and aesthetical outcomes. All cases showed good results with the characteristics of a relatively thin flap without additional debulking procedure. Conclusion: Gracilis muscle free flap with split thickness skin graft could be a good option for reconstruction of soft tissue defect of posterior ankle, exposing Achilles tendon with minimal morbidity of the donor site.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.457-460
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• 2010

Purpose: The great toe presents a reconstructive challenge for plastic surgeons. The big toe has much importance not only for the gait and the stability, but also for appearance aspects. Few reports have documented the reconstruction of big toe defects and we report a unique case of free flap reconstruction technique. Methods: A 41-year-old man with right great toe open fracture with soft tissue necrosis was referred from the orthopedic surgery department. On physical examination, there was the skin necrosis circumferentially and the fratured bone was severely fragmented. The metatarsophalangeal (MTP) joint of the big toe was intact. After the wound debridement, we harvested the innervated anterolateral thigh flap and transposed to the defected area. After five months, we finally retouched the flap by the dorsal defatting and distal debulking. Results: He had an uneventful postoperative course without infection, dehiscence and flap necrosis. He has remained asymptomatic for eight months without any recurrence such as the osteomyelitis. Finally, he kept the normal gait and posture with weight bearing on the reconstructed great toe and foot. Conclusion: The anterolateral thigh flap is described for the reconstruction of the great toe. It involves two stage procedure with the minimal donor site morbidity and provides a good cosmetic result.

• Archives of Plastic Surgery
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• 제48권2호
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• pp.179-184
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• 2021

Women attach great importance to the presence of a three-dimensional nipple upon completion of the breast reconstruction process. To meet patients' expectations, nipple-areolar complex reconstruction should achieve symmetry in position, size, shape, texture, and color, as well as minimizing donor-site morbidity. However, it is well known that regardless of the reconstructive technique, loss of nipple projection can be reasonably expected. We developed and evaluated a quick, simple, and innovative technique using injectable Integra Flowable Wound Matrix to increase nipple projection after reconstruction. Twenty breast cancer patients who underwent nipple reconstruction resulting in unsatisfactory projection were enrolled in our retrospective study. Nipple projection was measured at the time of surgery and after 6 and 12 months. A visual analogue scale was used to assess patients' satisfaction. Our technique yielded reliable results in terms of the long-lasting maintenance of nipple projection. This method is high-priced, but cost-effective, since one kit may suffice for three patients. Furthermore, our patients were very appreciative of this technique as a single-step, minimally invasive, painless procedure with no reported necessity of re-intervention.

• 대한두개안면성형외과학회지
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• 제21권6호
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• pp.337-344
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• 2020

Facial paralysis is a devastating disease, the treatment of which is challenging. The use of the masseteric nerve in facial reanimation has become increasingly popular and has been applied to an expanded range of clinical scenarios. However, appropriate selection of the motor nerve and reanimation method is vital for successful facial reanimation. In this literature review on facial reanimation and the masseter nerve, we summarize and compare various reanimation methods using the masseter nerve. The masseter nerve can be used for direct coaptation with the paralyzed facial nerve for temporary motor input during cross-facial nerve graft regeneration and for double innervation with the contralateral facial nerve. The masseter nerve is favorable because of its proximity to the facial nerve, limited donor site morbidity, and rapid functional recovery. Masseter nerve transfer usually leads to improved symmetry and oral commissure excursion due to robust motor input. However, the lack of a spontaneous, effortless smile is a significant concern with the use of the masseter nerve. A thorough understanding of the advantages and disadvantages of the use of the masseter nerve, along with careful patient selection, can expand its use in clinical scenarios and improve the outcomes of facial reanimation surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권3호
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• pp.241-248
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• 2008

Tibial bone grafts provide an adequate volume of cancellous bone with cortical bone, high biologic value of bone, minimal gait disturbance and complications, and no special contraindications, and offer a superior clinical results than any other donor sites. Lateral appoach in tibial bone graft was used to gain large bone volume traditionally, but medial approach provides low morbidity associated with the tibial anatomic structure, simple and safety surgical procedure, and better comfortable to patients recently. We have undertaken clinical and retrospective studies on patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from April 2004 to January 2008. 50 patients have maxillofacial bony defect as resection of bening tumor, cyst enucleation, alveolar bone resorption, sinus pneumatization were received the tibial proximal autogenous particulated cancellous bone grafts. They were analyzed sex, age, diagnosis of recipient site, lesion size, dornor site, cortical bone repositioning, complications and we concluded favorable following results. 1. Medial approach for proximal tibia is safer and technically easier than lateral approach, associated with the proximal tibial anatomic structures, and short operative times. 2. Proximal tibia provides an adequate bone volume with predictability for oral and maxillofacial reconstruction. 3. Patients rarely complain of pain, swelling, discomfort and dysfunction such as gait disturbance. In conclusion, medial approach for proximal tibial graft seems to be a valuable tool for oral and maxillofacial reconstruction.

• Journal of Periodontal and Implant Science
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• 제33권2호
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• pp.289-299
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• 2003

The autogenous free gingival graft is the most predictable procedure currently used to increase the width of　the attached gingiva in periodontics. But the major disadvantage of the procedure is to create the multiple surgical wounds at both a donor site and a recipient site. The other problem is the limited amount of available　graft material in oral cavity. Therefore, recent researches have been focused to develop the biomaterial to substitute the autogenous gingival tissue. The purpose of this study was to evaluate the histologic healing after　grafting of bilayer artificial dermis, compared to the free gingival graft. Four non-smoking subjects (mean age, 32.5 years) in systemically healthy state and good oral hygiene were selected according to their particular needs for correction of mucogingival problems as suggested by Nabers(1966). The recipient sites were prepared through the procedure for the free gingival graft and were grouped according to the graft materials: Experimental group(n=5) - bilayer artifcia1 dermis ($Terudermis^{(R)}$; Terumo Co. Japan) and Control group(n=6) - free gingival graft with autogenous palatal mucosa. Biopsies were harvested at 1,2,3 and 6 weeks postsurgery to evaluate histologically. At the third week in the experimental group and at the second week of in the control group, the grafts has been clinically stabilized on the recipient bed and the graft border has been blended into the surrounding tissue. In the experimental group after 1 week of grafting, the epithelial migration from the adjacent tissue to graft material was seen and after 3 weeks of grafting, the : nflmmation decreased, collagen layer of the artificial dermis was lost and the basement membrane of epithelium was formed. After 6 weeks of grafting, both groups demonstrated orthokeratinized epithelium and increased thickness of epithelial tissue and the rete peg formation, similar to the adjacent tissue, Histologic evaluation revealed a biologic acceptance and incorporation of the collagen layers of the graft tissue to the host tissue, without foreign body reaction. In conclusion, a bilayer artificial dermis is essentially similar to autogeneous free gingival graft in the correction of mucogingival problems, and has the advantages of decreased patient morbidity (no donor site) and availability of abundant amounts of graft material when needed.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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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 Plastic Surgery
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• 제40권4호
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• pp.341-347
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• 2013

Background Intractable chronic scalp ulcers with cranial bone exposure can occur along the incision after cranioplasty, posing challenges for clinicians. They occur as a result of severe scarring, poor blood circulation of the scalp, and focal osteomyelitis. We successfully repaired these scalp ulcers using a vascularized bipedicled pericranial flap after complete debridement. Methods Six patients who underwent cranioplasty had chronic ulcers where the cranial bone, with or without the metal plate, was exposed along the incision line. After completely excising the ulcer and the adjacent scar tissue, subgaleal dissection was performed. We removed the osteomyelitic calvarial bone, the exposed metal plate, and granulation tissue. A bipedicled pericranial flap was elevated to cover the defect between the bone graft or prosthesis and the normal cranial bone. It was transposed to the defect site and fixed using an absorbable suture. Scalp flaps were bilaterally advanced after relaxation incisions on the galea, and were closed without tension. Results All the surgical wounds were completely healed with an improved aesthetic outcome, and there were no notable complications during a mean follow-up period of seven months. Conclusions A bipedicled pericranial flap is vascularized, prompting wound healing without donor site morbidity. This may be an effective modality for treating chronic scalp ulcer accompanied by the exposure of the cranial bone after cranioplasty.