• Archives of Plastic Surgery
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• 제50권2호
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• pp.166-170
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• 2023

Diaphragmatic reconstruction is required for extensive diaphragmatic defects associated with tumor resection. Methods using artificial mesh and autologous tissues, such as pedicled flaps, have been reported predominantly for diaphragmatic reconstruction. We present the case of a 61-year-old woman who presented with a 14×13×12 cm tumor in the abdominal cavity of the upper left abdomen on computed tomography. The diaphragm defect measuring 12×7 cm that occurred during excision of the malignant tumor was reconstructed using the rectus abdominis muscle and fascial flap. The flap has vertical and horizontal vascular axes; therefore, blood flow is stable. It also has the advantage of increasing the range of motion and reducing twisting of the vascular pedicles. Fascial flap does not require processing such as thinning and can be used during suture fixation. This procedure, which has rarely been reported so far, has many advantages and may be a useful option for diaphragm reconstruction.

• Archives of Plastic Surgery
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• 제40권2호
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• pp.91-96
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• 2013

Background A thinned anterolateral thigh (ALT) flap is often harvested to achieve optimal skin resurfacing. Several techniques have been described to thin an ALT flap including an adipocutaneous flap, an adipofascial flap and delayed debulking. Methods By systematically reviewing all of the available literature in English and French, the present manuscript attempts to identify the common surgical indications, complications and donor site morbidity of the adipofascial variant of the ALT flap. The studies were identified by performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database of Systematic Reviews, Current Contents, PubMed, Google, and Google Scholar. Results The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and 15 articles were identified using the study inclusion criteria. These articles were then reviewed for author name(s), year of publication, flap dimensions and thickness following defatting, perforator type, type of transfer, complications, thinning technique, number of cases with a particular area of application and donor site morbidity. Conclusions The adipofascial variant of the ALT flap provides tissue to fill large defects and improve pliability. Its strong and safe blood supply permits adequate immediate or delayed debulking without vascular complications. The presence of the deep fascia makes it possible to prevent sagging by suspending and fixing the flap for functional reconstructive purposes (e.g., the intraoral cavity). Donor site morbidity is minimal, and thigh deformities can be reduced through immediate direct closure or liposuction and direct closure. A safe blood supply was confirmed by the rate of secondary flap debulking.

• Archives of Plastic Surgery
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• 제48권4호
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• pp.410-416
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• 2021

Background This systematic review compared free anterolateral thigh (ALT) flaps versus pedicled distally based sural artery (DBSA) flaps for reconstruction of soft tissue defects of dorsal foot and ankle in children. Methods A systematic literature search was performed to identify cases where an ALT or DBSA was used to reconstruct the dorsal foot in children. A total of 19 articles were included in the systematic review. Results Eighty-three patients underwent an ALT reconstruction and 138 patients underwent a DBSA reconstruction. Patients who had a DBSA were more likely to require grafting of the donor site (P<0.001). The size of ALT flaps was significantly larger than DBSA flaps (P=0.002). Subsequent flap thinning was required in 30% of patients after ALT and 12% of patients after DBSA reconstruction (P<0.001). Complications occurred in 11.6% of DBSA and 8.4% of ALT flaps (8.4%). Conclusions Both flaps are valid options in reconstructing pediatric foot and ankle defects. Each flap has advantages and disadvantages as discussed in this review article. In general for larger defects, an ALT flap was used. Flap choice should be based on the size of the defect.

• 대한두개안면성형외과학회지
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• 제12권1호
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• pp.43-47
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• 2011

Purpose: Romberg's disease manifests as progressive hemifacial atrophy of the skin, soft tissue and bone, which usually begins in the first or second decade of life. When present, atrophy may originate from the cutaneous stigmata and may become so sharply delimited by the midline. Methods: A 10-year-old girl, who had suffered from right mandibular area atrophy for 3 years, visited us and was diagnosed with Romberg's disease. The depressed lesion of the face was augmented successfully using a deepithelialized groin free flap. The superficial circumflex iliac vessels were used as the donor pedicle and the facial artery and vein were used as the recipient vessels. Results: After surgery, the flap survived well and she was satisfied with the result. Although there are various methods of facial augmentation using free flaps, this flap has some advantages. First, there is a considerable amount of fat tissue components for augmentation. Second, flap elevation with thinning is possible. Third, the donor site can be hidden. Conclusion: The groin dermo-fat free flap is a good method for the facial augmentation of Romberg's disease.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.749-754
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• 2017

Objective : To quantitatively measure the degree of bone flap resorption (BFR) following autologous bone cranioplasty and to investigate factors associated with BFR. Methods : We retrospectively reviewed 29 patients who underwent decompressive craniectomy and subsequent autologous bone cranioplasty between April 2005 and October 2014. BFR was defined as : 1) decrement ratio ([the ratio of initial BF size/craniectomy size]-[the ratio of last BF/craniectomy size]) >0.1; and 2) bone flap thinning or geometrical irregularity of bone flap shape on computed tomographic scan or skull plain X-ray. The minimal interval between craniectomy and cranioplasty was one month and the minimal follow-up period was one year. Clinical factors were compared between the BFR and no-BFR groups. Results : The time interval between craniectomy and cranioplasty was $175.7{\pm}258.2$ days and the mean period of follow up was $1364{\pm}886.8$ days. Among the 29 patients (mean age 48.1 years, male : female ratio 20 : 9), BFR occurred in 8 patients (27.6%). In one patient, removal of the bone flap was carried out due to severe BFR. The overall rate of BFR was $0.10{\pm}0.11$ over 3.7 years. Following univariate analysis, younger age ($30.5{\pm}23.2$ vs. $54.9{\pm}13.4$) and longer follow-up period ($2204.5{\pm}897.3$ vs. $1044.1{\pm}655.1$) were significantly associated with BFR (p=0.008 and 0.003, respectively). Conclusion : The degree of BFR following autologous bone cranioplasty was 2.7%/year and was associated with younger age and longer follow-up period.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.303-307
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• 2006

No one technique provides an optimal outcome for all body contouring patients. There are many surgical options for abdominoplasty. Among these, this abdominoplasty without undermining consists of liposuction around abdominal subcutaneous fatty tissue, excision of lower abdominal flap. The procedure allows aggressive thinning and sculpting of abdominal flap. This operation minimizes the dead space, which often leads to postoperative complications, and preserves neurovascular supply to the abdominal skin. From 1999 to 2004, 18 patients underwent the abdominoplasty without undermining, resulting in high satisfaction rates with no significant complications, such as, pulmonary embolism and deep vein thrombosis. Patients could return to normal activity within a week. This abdominoplasty without undermining is an effective and safe alternative with low complication rate and enhances aesthetic results compared to traditional abdominal surgery.

• 대한심미치과학회지
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• 제4권1호
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• pp.1-5
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• 1995

A mucogingival grafting procedure has been developed to cover denuded root surfaces. This procedures need to connective tissue, so many clinician open the trap door to palatal side of the patient. In this study, where palatal pocketing was present, pocket elimination was performed, and the tissue normally discarded after thinning of the palatal flap was used as a grafting material. The esthetics in recipient site, both color match and tissue contour were acceptable to the patient in this case.

• Archives of Plastic Surgery
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• 제45권4호
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• pp.319-324
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• 2018

Perforator flaps are becoming increasingly common, and as primary thinning techniques are being developed, the need for secondary contouring of flaps is decreasing. However, many reconstructive flap procedures still incorporate secondary debulking to improve the functional and aesthetic outcomes. Direct excision, liposuction, tissue shaving with an arthroscopic cartilage shaver, and skin grafting are the four major methods used for secondary debulking. Direct excision is primarily applied in flaps where the skin is redundant, even though the volume is not excessive. However, due to the limited range of excision, performing a staged excision is recommended. Liposuction can reduce the amount of subcutaneous tissue of the flap and protect the vascular pedicles. However, the main drawback of this method is its limited ability to remove fibrotic tissues, for which the use of a shaver may be more convenient. The main drawback of using a shaver is that it is difficult to simultaneously remove excess skin. Skin grafting enables the removal of sufficient excess tissue to recover the contour of the normal limb and to improve the color match, facilitating excellent aesthetic results.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권6호
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• pp.421-429
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• 2003

총 24 마리의 백서를 선택하여 종양화학요법제의 하나인 5-FU를 복강내 투여한후 24 시간이 지난후 8마리에서는 하복부 동맥 및 정맥을 근간으로 한 하복부 피부 도상피판($2{\times}3cm^2$)울 좌, 우 2 개씩 형성하고 피판을 허혈상태를 유도하여 유리피판상태를 만들었다. 허혈상태를 1 시간정도유지한후 다시 혈류를 재개시켜 피판으로의 혈류를 재개시키고 상처부를 층별봉합 하였다. 그 후 3 일, 5 일, 7 일째 각각 2마리씩 희생하여 H-E staining하였다. 또한 술후 1 일, 3 일, 5 일, 7 일째 피판생존을 육안으로서 확인하고 피판의 survival rate를 비교하기 위하여 사진촬영하여 digital image를 얻은후 adobe software program을 이용하여 Image, Histogram기능을 써서 60,000 pixels(가로${\times}200$, 세로${\times}300$)상태에서 피판의 Luminosity(광도)정도를 수치화하였다. 마찬가지의 술식으로 5-FU를 투여후 3일이 경과된후 8마리를 동일한 부위에 동일한 피판을 써서 3 일, 5 일째 각각 2 마리에 대해 피판을 채취하여 H-E staining 하여 조직현미경상의 치유과정을 관찰하였다. 대조군으로서 복강내 5-FU를 투여받지않은 백서 8마리에서 동일한 도상 피부피판을 형성하고 3 일, 5 일, 7 일째되는 2마리씩 피판부위를 채취하여 H-E염색하여 조직치유반응을 광학현미경으로 관찰하였고 상기와 동일한 방식으로 피판의 생존율을 계산하여 다음의 결과를 얻었다. 1. 육안적 소견으로 치유의 순은 대조군, 항암 24 시간째군, 항암 3 일군순으로 빨리 치유되었다. 2. 피판생존율을 비교하기 위한 광도(Luminosity)의 차는 3군끼리 모두 유의한 차를 보였으며 평균치 비교에서는 대조군, 항암 24 시간째군, 항암 3 일군순으로 높았다. 3. 광학현미경상 조직치유의 정도는 5개 항목으로 나누어 관찰하였다. 전체적으로 대조군과 항암 24 시간군은 시일이 지날수록 치유가 되는 양상을 보였으나 항암 3 일군은 조직의 염증반응이 더 심해지는 양상을 보였다. epidermis necrosis관찰항목에서는 대조군에 비해 항암제투여군이 경도의 반응을 보였고 항암3 일군에서 가장 심하였다. Inflammation state는 3일째는 대조군에서 가장 높게 나타났으나 시일이 지남에 따라 감소한 반면 항암 3 일군은 시일이 지날수록 심해졌다. dermis fibrosis면에서는 항암 24 시간군에서 가장 크게 나타났다. vessel change는 대조군과 항암 24군에서는 거의 관찰되지 않았고 항암 3 일군에서는 중등도로 관찰되었다.fatty tissue layer thinning은 3 군모두에서 관찰되었고 항암 3 일군이 가장 심하게 나타났다. 이상의 실험결과를 보면 술전 항암제투여가 초기에 시행한 경우에는 조직의 치유에 초기 5 일정도까지는 영향을 미치나 7 일이 지나면 정상범주로 회복함을 알수 있었고 실험결과 항암제 투여후 3 일째 피판 형성한 군에서 피판치유가 늦어진 것으로 관찰되어 인체에서 항암 투여후 수술시기는 인체면역계가 회복하는 시기를 3주이상 경과후 적어도 4주째 수술시기를 정하는 것이 유리하리라 생각되었다.

• 대한소아치과학회지
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• 제25권3호
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• pp.499-505
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• 1998

Idiopathic gingival hyperplasia is a rare condition of undetermined etiology. The enlargement is usually associated with the emergence of the teeth into the oral cavity and may regress after extraction. The enlarged gingiva may be primarily attributed to hyperplasia of the subepithelial layer that is relatively avascular and consists of densely arranged collagen bundles and numerous fibroblasts. The recommended time for treatment is after completion of eruption of permanent teeth. But the most important thing is the patient's psychological and esthetic needs. Lately, Schluger has proposed modified gingivectomy procedure with horizontal, internal beveled incision for thinning of the flap resulting in less pain and bleeding after treatment, minimal opportunity of infection. The purpose of this report is to document a case of 8-year-old girl who had registered in Dept. of Pediatric Dentistry of Seoul National University dental hospital for treatment of her gingival hyperplasia and delayed tooth eruption