• Archives of Plastic Surgery
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• v.37 no.6
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• pp.847-849
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• 2010

Purpose: Traditional radical surgery for vulvar cancer produces severe skin and soft tissue defects in the vulvar and vaginal area. Vulvoperineal V-Y advancement fasciocutaneous flaps have limitations in advancement and tension at the wound margin and vaginal orifice area, causing wound disruption or vaginal wall exposure. Therefore, we designed the "Butterfly flap" using a vulvoperineal V-Y advancement fasciocutaneous flap and an inguinal rotational skin flap for 3-dimensional reconstruction of vagina and vulvar area. Methods: A 27 year-old female was diagnosed with vulvar intraepithelial neoplasia. Radical vulvectomy and full-thickness-skin-graft was performed. We designed a vulvoperineal V-Y advancement fasciocutaneous flap as the greater wing and inguinal rotational skin as the lesser wing. After flap elevation, the inguinal flap was rotated $180^{\circ}$ to reconstruct the labia major and vaginal orifice. The perineum was reconstructed using V-Y advancement flaps. Results: The flap survived completely, without any complications. After 6 months, the patient was able to perform normal sexual activities and after 18 months, the patient was able to give birth to normal child by caesarean section. Conclusion: The traditional vulvoperineal V-Y advancement fasciocutaneous flap is thin, reliable, easily elevated and matches local skin quality. However, the vaginal wall becomes exposed due to limited advancement and tension of the flap. The "Butterfly flap" using a vulvoperineal V-Y advancement fasciocutaneous flap and an inguinal rotational skin flap is useful for the release of vaginal orifice contracture, reconstruction of the labia major, and 3-dimensional reconstruction of vagina and vulvar area.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.601-609
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• 2023

Background The anterolateral thigh (ALT) flap is a preferred option in the reconstruction of a wide variety of defects, enabling multiple tissue components and thicknesses. Methods This study was conducted to investigate the correlation of the thickness of the traditional subfascial ALT flap and superficial fat flap with age, gender, and body mass index (BMI). A total of 42 patients (28 males and 14 females) were included in the study. Results Mean age was 50.2 (range, 16-75) years and mean BMI was 24.68 ± 4.02 (range, 16.5-34.7) kg/m². The subfascial flap thickness was significantly thinner in male patients (16.07 ± 2.77 mm) than in female patients (24.07 ± 3.93 mm; p < 0.05), whereas no significant difference was found between male (4.28 ± 1.15 mm) and female patients (4.85 ± 1.09 mm) regarding superficial fat flap thickness (p = 0.13). The thickness of both flaps had a positive correlation with BMI, and the strongest correlation was found for subfascial ALT thickness in female patients (r = 0.81). Age had no effect on both flap thickness measurements. The anterior thigh is thicker in women than in men, although it varies according to BMI. This shows that flap elevation is important in the superthin plane, especially if a thin flap is desired in female patients in defect reconstruction with the ALT flap. Thus, a single-stage reconstruction is achieved without the need for a defatting procedure after subfascial dissection or a second defatting procedure 3 to 6 months later. Conclusion The appropriate ALT flap plane should be selected considering the gender and BMI of the patient.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.432-435
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• 2007

Purpose: The jejunal free flap has the shorter ischemic time than other flap and requires a laparotomy to harvest it. As the evaluation of the perfusion the buried flap is very important, the perfusion of the buried jejunal free flap requires monitoring for its salvage. We tried to improve the monitoring flap method in the jejunal free flap and examined its usefulness. Methods: From March 2002 to March 2006, the monitoring flap method was applied to 4 cases in 8 jejunal free flaps for the pharyngeal and cervical esophageal reconstructions. The distal part of the jejunal flap was exposed without suture fixation through cervical wound for monitoring its perfusion. The status of perfusion was judged by the color change of jejunal mucosa and mesentery. If necessary, pin prick test was performed. Doppler sonography was applied to mesenteric pedicle of the monitoring flap in case of suspicious abnormal circulation. Results: The monitoring flap shows no change in 3 cases, but the congestion happened in one case at the 12 hours after the operation. This congestion was caused by the twisting or kinking of the mesenteric pedicle of the monitoring flap. So, we fixed up the monitoring flap close to adjacent cervical skin for prevention of rotation. Finally, the main part of transferred jejunal flap was intact. Conclusion: The success of a jejunal free flap depends on close postoperative monitoring and early detection of vascular compromise. So, various monitoring methods have been tried, for instance, direct visualization using a fiberoptic pharyngoscope, through a Silastic window placed in the neck flap, or external surface monitoring with an Doppler sonography, use of a buried monitoring probe. But, all of the above have their own shortcomings of simplicity, non-invasiveness, reliability and etc. In our experience, monitoring flap can be a accurate and reliable method.

• Speech Sciences
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• v.9 no.3
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• pp.155-168
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• 2002

The intervocalic Korean liquid sound has been recognized as a flap in the studies of the Korean language. But there has been very little experimental data corroborating it. The electropalatographic (EPG) experiment was conducted to test this. The subjects were one Korean speaker and one native English speaker who had a pseudopalate and did the EPG experiment at the UCLA phonetics laboratory. The spectrographic evidence of the flaps in both the English t-flap and the Korean liquid flap was also sought. The English and Korean flaps were between mid/low back vowels so that the vowels themselves would not affect palatal contacts of the tongue. The results confirmed that the Korean liquid is realized as a flap in intervocallical position with many similar properties to English flap in both EPG and spectrographic data. The Korean initial liquid sound in borrowed words such as 'rotary' and 'radio' was also a flap. But the Korean liquid in the word-final and geminate positions was a lateral as in words 'dol ' (stone), 'dollo' (with stone), 'nal' (day) and 'nallara' (carry). The intuitive theory of the Korean liquid flap was proved by the EPG and spectrographic data.

• The Transactions of The Korean Institute of Electrical Engineers
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• v.58 no.4
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• pp.801-805
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• 2009

This paper reports on a flexible flap valve actuated by electromagnetic force under a constant pressure source. The flexible flap valve consists of the three main components: a flexible flap with a steel disk embedded in PDMS, an electromagnetic actuator and two glass plates with inlet and outlet. The flap valve is fabricated by SU-8 mold process, the EDM process and oxygen plasma treatment. The dimension of an assembled flap valve is $12[mm]{\times}20[mm]{\times}28[mm]$. The stroke volume of the flap valve is measured for various pressures. And the time of the applied input voltage is varied to change the open time of the valve. When the input voltage of 30[V] is applied for 0.25[s], the minimum stroke volume of the flap valve is $40[{\mu}L]$ at 70 [kPa].

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.57-59
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• 2011

Tongue reconstruction after oncologic resection with free flap is important to conserve function and shape. Vertical rectus myocutaneous free flap is usually used for total tongue reconstruction, but our patient was thin and primary closure after flap elevation seemed hard. So we used anterolateral thigh free flap to reduce donor site morbidity and to maintain bulk of the tongue as much as possible. Deepithelization of both middle side of flap and folding was done to mimic normal tongue base's shape and volume. Flap survived without complication and patient underwent concurrent chemoradiation therapy three weeks after surgery. Anterolateral thigh free flap can be good candidate for total tongue reconstruction especially in thin patient.

• Archives of Craniofacial Surgery
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• v.10 no.2
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• pp.97-102
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• 2009

Purpose: To close anterior cranial base, various types of pedicle flaps have been developed previously. However, the results of those pedicle flaps were not constant. To solve such problem, the author designed bipedicle temporalis-pericranial (BTP) flap based on various types of existing flaps and this study intends to introduce this flap and present clinical application case. Methods: The pedicle of the proposed temporalis-pericranial flap is temporalis muscle. The point of this BTP flap is that because of both sides of the unilateral temporalis-pericranial flap are connected by midline pericranial tissue connected with dense vascular network communicate one another locally, that BTP flap can be safely elevated. The case is a 14 months old male patient of frontoethmoidal encephalomeningocele. Surgery was done in a way that after elevating BTP flap and removing encephalomeningocele, BTP flap was moved intracranially, and to prevent cerebrospinal fluid leakage, anterior cranial base was closed. Results: During 1 year and 6 month outpatient tracking observation, no particular finding like CSF leakage, meningitis or hydrocephalus was observed. Conclusion: The benchmarked BTP flap, effective in the treatment of frontoethmoidal encephalomeningocele, is one of the methods to close intracranium and extracranium.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.85-91
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• 2006

With advances in techniques and instrumentation, the primary concern of microsurgeons has shifted from flap anatomy and survival toward flap refinement and donor-site function and aesthetics because flap survival rates have risen 96 percent. However, the problem still remains on regard that most flap has disadvantages that flap itself is too bulky or leaves unaesthetic scar to the donor site. These problems can be solved by using adipofascial flap instead of fasciocutaneous flap. The adipofascial flap not only has minimal donor site morbidity, but also can be retained thin. It seems that its advantages can be applied on soft tissue defect of exposed body part.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.692-697
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• 2008

Purpose: Gluteal perforator flap has evolved to one of the standard tools for coverage of pressure sore. We used this flap to cover the defect adjacent to the buttock. Methods: From September 2004 to August 2006, gluteal perforator flaps were performed in 3 patients with sore and 9 patients with tumor. We made the rule for free style design of the flap. First, the defect should be covered fully regardless of the shape or area. Second, the location of perforators was decided to maximize flap mobility. Third, the donor-site should be closed directly. Results: Successful reconstruction was fulfilled. In 2 cases, initial flap congestion was observed but medical leech was applied and it was resolved. Partial flap loss occurred in one case. Infection was observed in one case. But there were no major complications. Conclusion: Gluteal perforator flap is very good option for the reconstruction of the defects adjacent to the buttock.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.157-162
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• 2010

Purpose: Free flap reconstruction in the pediatric population is difficult. However, microsurgery has had remarkable success rates in children. The aim of study is to present our clinical experience using free flap for reconstruction of soft tissue defects in children and to describe long-term follow-up results. Methods: Between June 2002 and July 2010, 30 cases of pediatric reconstruction were performed with free flap. The authors analyzed several items, such as the kind of flap, associated complications, and growth problems. Results: Among the 30 cases, 21 cases were due to traffic accidents, 5 to cancer, and 4 to falls and other soft tissue defects. The lower leg and foot were the most common sites of the lesion. In the free flap operations we have done, 20 cases involved an anterolateral thigh perforator free flap, 6 a superficial circumflex iliac perforator free flap, and 4 an upper medial thigh perforator free flap. In early postoperative complications, partial necrosis was seen in 2 cases, infection in 1 case, and the hematoma in 1 case. A satisfactory success rate and functional results were achieved. Conclusion: Free flap reconstruction in children allows satisfactory function with no significant effect on growth. Free flaps are regarded as the primary choice for selective pediatric reconstructive cases.