• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.3
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• pp.184-194
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• 2011

The dorsalis pedis artery (DPA) was renamed from the anterior tibialis artery after it passed under the extensor retinaculum, and DPA travels between the extensor hallucis longus and extensor digitorum longus muscle along the dorsum of the foot. After giving off the proximal and distal tarsal, arcuate and medial tarsal branches, DPA enters the proximal first intermetatarsal space via the first dorsal metatarsal artery (FDMA), which courses over the first dorsal interosseous muscle (FDIM). For detailed knowledge of the neurovascular anatomy of a dorsalis pedis artery flap (DPAF) as a routine reconstructive procedure after the resection of oral malignant tumors, the precise neurovascular anatomy of DPAF must be studied along the DPA courses as above. In this first review article in the Korean language, the anatomical basis of DPAF is summarized and discussed after a delicate investigation of more than 35 recent articles and atlas textbooks. Many advantages of DPAF, such as a consistent flap vascular anatomy, acceptable donor site morbidity, and the ability to perform simultaneous flap harvest using oral cancer ablation procedures, and additional important risks with the pitfalls of DPAF were emphasized. This article will be helpful, particularly for young doctors during the special curriculum periods for the Korean National Board of Specialists in the field of oral and maxillofacial surgery, plastic surgery, otolaryngology, orthopedic surgery, etc.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.80-86
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• 1997

The lateral arm flap was reported first by Song et al. in 1982, and Katsaros and colleagues described an anatomic study and clinical cases in 1984. This flap is thin, has relatively constant vascular anatomy, and provides relatively acceptable scar at the donor site. Despite its many advantages its wide application has been limited by its short vascular pedicle with small diameter of lumen, and its small skin paddle. We studied its anatomical structure to get longer length of vascular pedicle, wide diameter and thinner part of flap beyond the lateral condyle through 6 fresh cadaver dissection and dye injection study. We experienced 21 cases of lateral arm free flaps and 26 cases of forearm free flaps from May, 1992 to January, 1996. We compared its usefulness with forearm free flaps in the aspects of donor morbidity, operative factors, quality of flap, and versatility. In conclusion, lateral arm flap can replace the role of forearm flap in most cases so that patient's donor morbidity can be reduced especially in the women.

• Archives of Plastic Surgery
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• v.49 no.2
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• pp.240-252
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• 2022

Rather than just another "review," this is intended to be an "overview" of the entire subject of the medial sural artery perforator (MSAP) flap as has been presented in the reconstructive literature from its inception in 2001 until the present, with any exceptions not purposefully overlooked. Unfortunately, the pertinent anatomy of the MSAP flap is always anomalous like most other perforator flaps, and perhaps even more variable. No schematic exists to facilitate the identification of a dominant musculocutaneous perforator about which to design the flap, so some adjunctive technology may be highly valuable for this task. However, if a relatively thin free flap is desirable for a small or moderate sized defect that requires a long pedicle with larger caliber vessels, the MSAP flap deserves consideration. Indeed, for many, this has replaced the radial forearm flap such as for partial tongue reconstruction. Most consider the donor site deformity, even if only a conspicuous scar on the calf, to be a contraindication. Yet certainly if used as a local flap for the knee, popliteal fossa, or proximal leg, or as a free flap for the ipsilateral lower extremity where a significant recipient site deformity already exists, can anyone really object that this is not a legitimate indication? As with any perforator flap, advantages and disadvantages exist, which must be carefully perused before a decision to use the MSAP flap is made. Perhaps not a "workhorse" flap for general use throughout the body, the MSAP flap in general may often be a valuable alternative.

• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.162-166
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• 2002

The anterolateral thigh free flap was first reported by Song et al. in 1984 as a fasciocutaneous flap based on septocutaneous or musculocutaneous perforators of the lateral femoral circumflex vessel. It only becomes popular recently through confirmation of additional anatomy. For reconstruction of Achilles area defect, a thin flap is required to improve aesthetic and functional results. The anterolateral thigh free flap is relatively thin and can provide large skin area. It can be a useful option for reconstruction of Achilles area defect based on these characters. Since March 2002, we have successfully transferred 4 anterolateral thigh free flaps to reconstruct Achilles area defects and have attained good range of motion in this region. The anterolateral thigh free flap has many advantages and can be used for the reconstruction of Achilles tendon area defect.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.41-46
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• 1998

Microvascular free tissue transfer technique is widely accepted for reconstruction of extensive soft tissue defects on the extremities. The system of flap based on the subscapular artery and vein provides the widest ways of composite free flaps. The possible flaps that can be harvested based on this single vascular pedicle include the scapular and parascapular skin flaps, the serratus anterior and latissimus dorsi muscular flaps, the lateral scapular bone flap, the latissimus dorsi-rib flap, and the serratus anterior-rib flap. This combined flap is available to mutiple tissue defects or complex defects because it can incorporated with skin, muscle and bone flaps. A strikig advantage is the independent vascular pedicles of each components, which allow freedom in orientation of each components. So, it can be freely applied to any forms of three demensional defects on the upper and lower extremities. The combination of scapular cutaneous flap and latissimus dorsi musculocutaneous flap can be resurfaced for massive cutaneous defects on the extremities. We report the use of the combined scapular and latissimus dorsi free flap in seven patients to reconstruct massive deefcts on the extremities. There was no flap failure and little complications and disadvantages. The anatomy of this flap is reviewed and the indication and advantages are discussed.

• Archives of Plastic Surgery
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• v.46 no.1
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• pp.92-94
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• 2019

• 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.41 no.6
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• pp.702-708
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• 2014

Background Lower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery. Methods The vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level. Results SIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (${\pm}12.87$) mm, and -8.14 (${\pm}15.24$) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (${\pm}0.39$) mm and 1.37 (${\pm}0.33$) mm, and they were found at a mean depth of 9.75 (${\pm}2.67$) mm and 8.33 (${\pm}2.65$) mm, respectively. Conclusions The SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.435-443
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• 2020

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes. Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated. Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness. Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.146-156
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• 1998

Microvascular surgery has been widely used clinically for over 30 years. Although many types of free skin and myocutaneous flap are being used at present, surgeons are still looking for new flaps to suit the specific requirements of different recipient sites, to reduce the deformity at the donor site, to ease the management of the flap and to increase the success rate of those operations. The lateral thigh free flap was designed and reported simultaneously with the medial thigh free flap by Baek in 1983. The flap, based on the third perforator of the profunda femoris artery. is designed on the posterolateral aspect of the distal thigh. Clinically, the vascular variations and the locations of perforators of this system can be determined preoperatively with simple angiograms and Dopper audiometry. The lateral thigh free flap is suitable for reconstruction of defects in an oral floor with tongue and esophageal deficits, scalp defects with dural defects, and large full thickness defects of the lip. The advantages of this flap are safe elevation, a long vascular pedicles with a large lumen, skin that is generally thin, and good pliability. Furthermore, the skin territory is very wide and long. The donor site is hidden and therefore more acceptable to the patient. The disadvantage of this flap is that the anatomy of the pedicle vessels has irregular derivation from the main vessel. We had reconstructed lateral thigh free flap to the nine patients from January, 1997 to July, 1998 and got satisfactory results. In this paper we illustrate the arterial anatomy of the thigh and usefulness of this flap for the reconstruction of the head and neck.