• Archives of Reconstructive Microsurgery
• /
• 제1권1호
• /
• pp.9-16
• /
• 1992

Volkmann's ischemic contracture is the end result of an untreated, delayed or Inadequately decompressed compartment syndrome in which muscle ischemia and necrosis have occurred. Once the muscle necrosis have happened, the involved muscle undergo permanent change into fibrous tissue. So secondary shortening and distal joint contracture will be a final outcome, which results in marked functional impairment of hand and forearm. Even though several procedures, such as muscle sliding operation has been attempted, overall results were far from satisfaction, compare to healthy opposite hand. The management of these unfavorable condition of the forearm and hand was regarded as one of challenging area in orthopedics. Recently new approach, using microsurgical technique which transfers functioning muscle unit, has been developed and its result was much better than any other methods in the aspect of an active motion. Among these musculocutaneous free flaps, gracilis has obtained special reputation due to its easiness to handle such as elevation of flap and reliable neurovascular pedicle. Other advantages are flexibility of flap size to adjust variable size of the defect in the forearm and minor morbidity of the donor site. Authors have performed 7 cases of functioning gracilis musulocutaneous free flap transplantation for the functional loss of forearm and hand due to Volkmann's ischemic contracture or muscle and skin defect due to severe trauma since November, 1981 till May, 1991. The results in most cases were satisfactory and acceptable.

• Archives of Plastic Surgery
• /
• 제39권6호
• /
• pp.637-642
• /
• 2012

Background Fingertip injuries involving subtotal or total loss of the digital pulp are common types of hand injuries and require reconstruction that is able to provide stable padding and sensory recovery. There are various techniques used for reconstruction of fingertip injuries, but the most effective method is functionally and aesthetically controversial. Despite some disadvantages, cross-finger pulp flap is a relatively simple procedure without significant complications or requiring special techniques. Methods This study included 90 patients with fingertip defects who underwent cross-finger pulp flap between September 1998 and March 2010. In 69 cases, neurorrhaphy was performed between the pulp branch from the proper digital nerve and the recipient's sensory nerve for good sensibility of the injured fingertip. In order to evaluate the outcome of our surgical method, we observed two-point discrimination in the early (3 months) and late (12 to 40 months) postoperative periods. Results Most of the cases had cosmetically and functionally acceptable outcomes. The average defect size was $1.7{\times}1.5$ cm. Sensory return began 3 months after flap application. The two-point discrimination was measured at 4.6 mm (range, 3 to 6 mm) in our method and 7.2 mm (range, 4 to 9 mm) in non-innervated cross-finger pulp flaps. Conclusions The innervated cross-finger pulp flap is a safe and reliable procedure for lateral oblique, volar oblique, and transverse fingertip amputations. Our procedure is simple to perform under local anesthesia, and is able to provide both mechanical stability and sensory recovery. We recommend this method for reconstruction of fingertip injuries.

• Archives of Plastic Surgery
• /
• 제32권6호
• /
• pp.777-781
• /
• 2005

Syndactyly and polysyndactyly are one of the most common congenital anomalies of upper limb. Although there are many surgical approaches, most of them require skin graft for covering the raw surfaces. Therefore these methods involve many disadvantages such as grafted skin contracture, web recurrence, skin graft loss and long operation time, and the grafted hyperpigmented skin and donor site of skin graft, which lead to poor results aesthetically. The authors treated seven cases with a Hayashi's new method in four patients. In this method, tissue of interdigital space are regarded as forming 4 facets of a two piled cube. A dorsal rectangular flap on dorsum of interdigital web makes a new interdigital space. One side of divided digit is coverd with lateral based plantar flap and the other side of divided digit is covered with subcutaneous pedicled flap and remnant web skin. The authors could obtain natural deep interdigital space without web recurrence and scar contracture in 7 cases. Moreover this method does not require skin grafting, accordingly produces better aesthetic results without hyperpigmentation and donor site scaring. Therefore we report this operation technique, which might be used as one of the standard in surgical correction of syndactyly and polysyndactyly.

• 대한두경부종양학회지
• /
• 제25권1호
• /
• pp.39-42
• /
• 2009

Wide excision for curative treatment of malignant tumor on periauricular area often leads to loss of the external ear. But the auricle has rich vascular supply, Conservation of auricular contour is possible through salvage and engineering of remained auricular tissue. We experienced two cases of auricular salvage after wide excision of malignant tumor. In the first case, we performed two-staged technique. In first step, we covered soft tissue defect on periauricualr area with the anterolateral thigh free flap and remained auricle was floating over the flap after split-thickness skin graft was applied on it's posterior raw surface because it's survival was not confirmed. Second step was reposition of remained auricule on the anterolateral thigh flap. In the second case, we packed in periauricular dead space and external auditory canal with temoporalis muscle and temporoparietal fascial flap and then covered the flap with split thickness skin graft. In these two cases, there were no recurrence of tumors and we obtained cosmetically & functionally satisfactory results.

• Archives of Reconstructive Microsurgery
• /
• 제22권1호
• /
• pp.18-23
• /
• 2013

Purpose: For reconstruction of lower extremity defects, various flaps can be used and the appropriate flap must be selected and applied according to the size of the defect. In particular, in cases where the defect size is small to moderate, thinner or smaller volume flaps are useful. The authors performed reconstruction of small to moderate defects on the lower extremities using superficial circumflex iliac artery perforator free flaps and are reporting the results. Materials and Methods: Fifteen patients underwent reconstruction of defects on lower extremity areas using superficial circumflex iliac artery perforator free flaps from July 2011 to July 2012 at this hospital. The flaps were elevated from above the deep fat layer, and, in all cases, the vessel diameter of the flaps was less than 1mm, with the exception of superficial vein that accompanied it. Results: The mean follow up period was 4.46 months, and, despite a partial loss in the flap in two cases, there were no total losses. All donor sites were closed with primary closure, and there was no occurrence of complications, such as hematomas, seromas, or lymphorrheas. The patients were highly satisfied with the donor site scar since it could be masked by underwear. Conclusion: Compared to other flaps, superficial circumflex iliac artery perforator free flaps are thinner in thickness and smaller in volume, which results in a more natural contour of the recipient site after the operation. In addition, since the flap can be elevated from supra-deep fat layer, the operation time can be shortened, and lymphorrhea can be prevented, which in turn lessens donor-site morbidity.

• Journal of Periodontal and Implant Science
• /
• 제31권4호
• /
• pp.765-775
• /
• 2001

The aim of the study was to investigate the effect of surgical therapy combined with the usage of metronidazole gel in the treatment of juvenile periodontitis by comparing clinical indices of flap operation along with application of metronidazole gel and flap operation only. Comparing clinical indices of the baseline, 3 months after surgery, 6 months after surgery statistically, the results are as follows; 1. Bleeding on probing (BOP) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p<0.05). BOP increased 0.9% in the control group 6 months after surgery, while in the experimental group, decreased 4.7% (p>0.05). However, there was no statistically significant difference in these groups (p>0.05). 2. Pocket probing depth (PPD) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p<0.05). PPD increased 0.lmm in the control group 6 months after surgery, while in the experimental group, no increase of the depth could be observed (p>0.05). However, there was no statistically significant and difference in these groups (p>0.05). 3. Loss of attachment level(LOA) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p<0.05). LOA increased 0.2mm in the control group 6 months after surgery, while in the experimental group, increased 0.3mm However, there was no statistically significant difference in these groups (p>0.05). In conclusion, flap operation was effective on the treatment of juvenile periodontitis. However, combined therapy of metronidazole gel could not give rise to any significant adjunctive effect on the treatment outcome.

• Archives of Plastic Surgery
• /
• 제47권2호
• /
• pp.187-193
• /
• 2020

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.

• Archives of Plastic Surgery
• /
• 제46권2호
• /
• pp.140-146
• /
• 2019

Background Thoracodorsal vessels (TDVs) and internal mammary vessels (IMVs) have both been widely employed as recipient vessels for use in free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps. However, whether TDVs or IMVs are preferable as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap remains controversial. The purpose of this study was to compare the clinical outcomes when TDVs were used as recipient vessels to those obtained when IMVs were used as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap. Methods A retrospective matched-cohort study was performed. We retrospectively reviewed data collected from patients who underwent a free MS-TRAM flap for autologous breast reconstructions after mastectomy between March 2003 and June 2013. After a one-to-one matching using age, 100 autologous breast reconstructions were selected in this study. Of the 100 breast reconstructions, 50 flaps were anastomosed to TDVs and 50 to IMVs. Patient demographics and clinical outcomes including operation time, length of hospital stay, postoperative complications, and aesthetic score were compared between the two groups. Results No statistically significant differences were found between the two groups in patient demographics and clinical outcomes, including the complication rates and aesthetic scores. There were no major complications such as total or partial flap loss in either group. Conclusions The results of our study demonstrate that both TDVs and IMVs were safe and efficient as recipient vessels in terms of the complication rates and aesthetic outcomes.

• Archives of Plastic Surgery
• /
• 제42권1호
• /
• pp.40-45
• /
• 2015

Background The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps. Methods Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury. Results Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes. Conclusions The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity.

• Archives of Plastic Surgery
• /
• 제49권2호
• /
• pp.227-239
• /
• 2022

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.