• Archives of Plastic Surgery
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• v.36 no.5
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• pp.559-564
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• 2009

Purpose: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially paraplegic patients. Although various muscle, musculocutaneous and fasciocuta - neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still debated which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. Methods: From August 2005 until January 2008, the adductor magnus perforator island flap had been used for resurfacing of the ischial soft tissue defects in a series of 6 patients (4 male and 2 female). Ages ranged from 26 to 67 years (mean, 47.5 years), and follow - up period from 13 to 26 months (mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. Results: The sizes of these flaps ranged from 12 to 18 cm in length and 7 to 9 cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split - thickness skin graft. Average thickness of the flap was 0.94 cm, which was more thicker than other perforator flaps. Long term follow - up showed a good flap durability. Conclusion: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap is a good and suitable option for coverage of the ischial soft tissue defect.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.202-205
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• 2010

Purpose: Male nipple hypertrophy is a rare condition but is a social embarrassment for individual. The currently available techniques of nipple reduction already described in the literature for female patients are discussed, but the goal of treatment is different in male patients. In male patient, the diameter as well as vertical height should be reduced simultaneously to achieve better aesthetic results. Our new technique can reduce the diameter of the hypertrophic nipple as well as the vertical height efficiently and simply. Methods: A 19-years-old man with nipple hypertrophy on the right chest presented. The flap is designed based on the site of left nipple, symmetry, the diameter, and the projection desired. The widths of the V flaps determine projection, whereas the diameter of the C flap determines the diameter of the nipple and top of the new nipple. Unnecessary hypertrophic tissues are extirpated and the V flaps are elevated. The nipple base is reduced by purse-string suture technique. The V flaps are wrapped around, and C flap is used as a cap. Results: No complication including nipple necrosis or sensory loss were found during follow-up period. The normal symmetry of the nipple contour was restored. Conclusion: We describe a simple technique for male nipple reduction using a C-V flap with purse-string suture. In our experience, this technique has provided good aesthetic result and patient satisfaction.

• Archives of Plastic Surgery
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• v.47 no.6
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• pp.535-541
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• 2020

The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.62-67
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• 2000

Recently, the incidence of pressure sore has been increased, due to increased number of patients with central nervous system injuries after traffic and industrial accidents or with long term loss of consciousness due to drug intoxication. The management of sacral pressure sore has been improved through the development of myocutaneous flap. However, sacrifice of the deep muscle cause some problems such as intraoperative bleeding, functional disabilities of donor site and further limitation of reconstruction for recurrent pressure sores in paraplegic patients. The development of perforator-based island skin flap introduce a new treatment modality for sacral pressure sores. We used perforator-based island skin flap in 15 cases with reasonable result from January 1998 to February 2000. This flap has a many advantages such as no significant sacrifice of the gluteus maximus muscle, wide rotation arc, reliable blood flow of the perforator, short elevation time for the flap, and no post-operative hindrance to walking in patients who are not paraplegic. There was no significant complication without significant sequelae and donor sites could be repaired primarily.

• Archives of Plastic Surgery
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• v.40 no.6
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• pp.742-747
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• 2013

Background The medial canthus is an important area in determining the impression of a person's facial appearance. It is composed of various structures, including canthal tendons, lacrimal canaliculi, conjunctiva, the tarsal plate, and skin tissues. Due to its complexity, medial canthal defect reconstruction has been a challenging procedure to perform. The contralateral paramedian forehead flap is usually used for large defects; however, the bulkiness of the glabella and splitting at the distal end of the flap are factors that can reduce the rate of flap survival. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. Methods This study included 10 patients who underwent medial canthal reconstruction using ipsilateral paramedian forehead flaps between 2010 and 2012. To avoid an acute curve of the pedicle, which can cause venous congestion, we attempted to make the arc of the pedicle rounder. Additionally, the pedicle was skeletonized from the nasal root to the glabella to reduce the bulkiness. Results All patients had basal cell carcinoma, and 3 of them had recurrent basal cell carcinoma. All of the flaps were successful without total or partial flap loss. Two patients developed venous congestion of the flap, which was healed using medicinal leeches. Four patients developed epiphora, and 2 patients developed telecanthus. Conclusions Large defects of the medial canthus can be successfully reconstructed using ipsilateral paramedian forehead flaps. In addition, any accompanying venous congestion can be healed using medicinal leeches.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.169-173
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• 2008

Purpose: Sacrococcygeal pilonidal sinus is a chronic inflammatory disease that mostly affects young people, which warrants surgical intervention. Although many surgical methods have been suggested, an optimal surgical method remains controversial because of high recurrence rates and postoperative complications. The objective of this study is to evaluate the results of wide excision and coverage with fasciocutaneous advancement flap for the treatment of sacrococcygeal pilonidal sinus, and to assess the usefulness of this method Methods: From May 1995 to October 2006, the authors treated 19 patients with the use of coverage with fasciocutaneous flap after wide excision. The results were evaluated regarding recurrence rates, complications, and the change in sensitivity of the gluteal region after surgery. The follow-up period was 7 to 142 months (mean, 76 months). All patients were male. Results: Postoperative complications were wound infection at the suction drain insertion site and skin necrosis around the suture margin in one case, respectively. During the follow up period, only one recurrence (5.3%) was seen in fifth postoperative month, which was successfully treated by the same operative procedure. There was no other complications such as seroma, hematoma, wound dehiscence and flap loss. Extensive scarring and anatomic distortion did not occur in the reconstructed area. In addition, sensitivity of the gluteal region did not diminish. The aesthetic results were satisfactory for all patients as well. Conclusion: The authors advocate that fasciocutaneous flap closure be a good alternative method to cover defects after the excision of sacrococcygeal pilonidal sinus.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.24-28
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• 2004

The vascularity of a skin island in fibula osteocutaneous free flap often depends on musculocutaneous perforators that find their origin in the proximal peroneal artery. But a potential drawback has been reported on the unreliability of the skin paddle. The perforating vessels to the skin paddle of the fibula osteocutaneous free flap were rarely derived from a common tibio-fibula trunk, an anterior tibial artery and a posterior tibial artery. Previous studies have emphasized total loss of the overlying skin paddle, if the expected perforating vessels are not present. We report here on our experience that the skin paddle of the fibula osteocutaneous free flap was vascularized not by a peroneal artery but a direct branch of the posterior tibial artery. There were no intraseptal nor intramuscular pedicles in the posterior crural septum which connected to the overlying skin island. Therefore, we performed microsurgical anastomoses between distal peroneal vessels of the fibula and the perforating branches of the posterior tibial vessels of the skin paddle. The anastomosed skin paddle was salvaged with a peroneal flow through vascular anastomosis and was transferred to the bone and intraoral soft tissue defects with the fibula graft. The patient had no evidence of vascular compromise in the postoperative period and showed good healing of the intraoral skin flap.

• Archives of Craniofacial Surgery
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• v.18 no.4
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• pp.243-248
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• 2017

Background: To evaluate the versatility and reach of modified nasolabial flap used in reconstruction of defects created in and around the oral cavity. Methods: A total number of 20 cases were selected. Out of which 13 were males and 7 females. The age of these patients ranged from 24-63 years. 29 modified nasolabial flaps were raised in twenty patients. Based on clinical and histopathological examination, out of 20 patients, 14 patients were diagnosed with oral submucous fibrosis, 3 with verrucous carcinoma, 1 with squamous papilloma, 1 with oro-antral fistula and 1 with traumatic loss of lower lip. Results: Minimum preoperative interincisal distance (IID) was 0 mm and maximum was 15 mm with mean of $6.00{\pm}4.76mm$ in patients with oral submucous fibrosis and 12 months postoperatively minimum IID was 16 mm and maximum was 41 mm with mean of $28.00{\pm}8.96mm$. In one case, dehiscence (3.4%) was noted on the anterior tip for which tip revision was done. Bulky appearance of the flap intraorally was observed in 2 cases (6.9%). Five (17.2%) among the 29 flaps had visible scar at the donor site postoperatively up to 3 months. Conclusion: Numerous reconstructive techniques have been employed in the reconstruction of small to intermediate sized defects of oral cavity. Modified nasolabial flap is a versatile flap which has robust vascularity and can be successfully used with minimal complications. It can be rotated intraorally to extend from the soft palate to the lip. Thus, it can be used efficiently to treat the small defects of the oral cavity as well as recreating lost lip structure.

• Archives of Plastic Surgery
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• v.46 no.5
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• pp.426-432
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• 2019

Background The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma. Methods This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved. Results Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years. Conclusions Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.

• Journal of Periodontal and Implant Science
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• v.12 no.1
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• pp.56.2-56.2
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• 1982