• Archives of Plastic Surgery
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• 제44권5호
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• pp.420-427
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• 2017

Background It can be difficult to select an appropriate flap for various defects on the hand. Although defects of the hand usually must be covered with a skin flap, some defects require a flap with rich blood supply and adequate additive soft tissue volume. The authors present their experience with the anconeus muscle free flap in the reconstruction of various defects and the release of scar contractures of the hand. Methods Ten patients underwent reconstruction of the finger or release of the first web space using the anconeus muscle free flap from May 1998 to October 2013. Adequate bed preparations with thorough debridement or contracture release were performed. The entire anconeus muscle, located at the elbow superficially, was harvested, with the posterior recurrent interosseous artery as a pedicle. The defects were covered with a uniformly trimmed anconeus muscle free flap. Additional debulking of the flap and skin coverage using a split-thickness skin graft were performed 3 weeks after the first operation. Results The average flap size was $18.7cm^2$ (range, $13.5-30cm^2$). All flaps survived without significant complications. Vein grafts for overcoming a short pedicle were necessary in 4 cases. Conclusions The anconeus muscle free flap can be considered a reliable reconstructive option for small defects on the hand or contracture release of the web space, because it has relatively consistent anatomy, provides robust blood supply within the same operative field, and leads to no functional loss at the donor site.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권3호
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• pp.305-318
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• 1991

Reconstructive techniques of orofacial defects are very varied. In recent years, myocutaneous flaps, in particular the pectoralis major or latissimus doris myocutaneous flap have achieved popularity. In 1983, Soutar et. al. used the forearm free flap that had been developed in in China and popularised the radial forearm fasciocutaneous flap to reconstruct defects in the orofacial region. This paper presents the authors experience with 10 consecutive patients in which 12 flaps were used either as a fascioncutaneous flap or as a composite flap incorporating part of the radius. Some literatures were reviewed and the clinical results were discussed.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권5호
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• pp.454-458
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• 2010

Velopharyngeal insufficiency is defined as a status in which nasal cavity and oral cavity can not be sepa-rated when speaking, swallowing by any reason. It has been treated by palatorrhaphy, pharyn-geal flap, local flap, free flap etc. When the size of the defect is small, it can be restored by palatorrhaphy, pharyngeal flap etc. But they are not proper for treatment of the large size of defect. In that case, local flap and free flap are more beneficial. Although large defect can be restored by free flap technique, but it is very complex, time-consuming and may bring about esthetical, functional complications of donor site. Buccinator myomucosal flap is a kind of local flap and reported for the first time by Bozola et al in 1989 and it has become a useful way for reconstruction of large intraoral defect. Authors experienced the use of buccinators myomucosal flap for treating secondary velopharyngeal insufficiency with large soft palate defect and obtained good result. So we report the case with literature reviews.

• 대한기관식도과학회지
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• 제6권2호
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• pp.185-188
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• 2000

The goals of lip reconstruction are to provide oral competence, adequate support for the lower lip, contour restoration, adequate lip sulcus, and adequate oral aperture. The composite radial forearm palmaris longus free flap is thin enough that it can be folded onto itself without a significant increase in bulk. The flap is easy to dissect, the pedicle contains long vessels of large diameter, and the skin is a good color and texture match for the perioral region. Moreover, the vascularized tendon can be used for lower lip reconstruction. This makes the flap ideally suited for total lower lip reconstruction. We experienced the case of total lower lip excision and reconstruction with the radial forearm free flap including palmaris longus tendon, so we reported that case with literature. The patient has a lower lip squamous carcinoma(T3NIM0), and performed a total lower lip excision with right modified radical neck dissection and left extended supraomohyoid neck dissection, and a reconstruction with radial forearm free flap includng palmaris longus tendon. The oral competence and masticatory function were nearly normalized and cosmetical result was very acceptable.

• 대한화상학회지
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• 제24권2호
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• pp.74-76
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• 2021

Postburn scar contracture of sole can cause musculoskeletal deformity, restricted range of motion, and decreased quality of life. It is very important to exhibit similar characteristics of the sole when reconstructing the sole because it has to resist shearing force and weight bearing. In this case, we performed medialis pedis free flap for the postburn scar contracture of the sole and the flap survived without complication. The patient satisfied with functional and aesthetic outcomes. Medialis pedis free flap, which is harvested adjacent to the sole, can show similar characteristic of the sole and maintain adequate contour. Moreover, this flap can be harvested without sacrifice of major vessel or nerve. Due to these advantages, medialis pedis free flap can be an ideal option for the reconstruction of the sole.

• Archives of Reconstructive Microsurgery
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• 제23권1호
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• pp.8-12
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• 2014

Purpose: The success rate of free flap operation has shown a recent increase. Especially for breast reconstructive patients, aesthetic results are considered a necessity. However, for patients who underwent reconstruction in parts of the body other than breast, for example, head and neck, lower and upper extremities, aesthetic considerations are underscored. Nowadays, however, aesthetic standpoint toward these patients is changing. Materials and Methods: We conducted a retrospective review of 8 patients who underwent secondary procedures after free flap surgery from March of 2011 to April of 2014. Results: Secondary refinement was a safe and less time-consuming technique for maximizing the function and aesthetic appearance for the patient. Conclusion: Appearance has become increasingly important with regard to function and quality of life. Therefore, for free flap reconstructive patients, secondary refinements may be considered in order to change the shape and contour. The secondary refinements are critical to the final result and must be a planned part of the entire reconstructive sequence.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.81-87
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• 1998

We have investigated the clinical results of 33 cases of free flap transfer performed for the soft tissue defects of heel and sole. In donor sites, tensor fascia lata flaps were 4, dorsalis pedis flaps were 10, forearm flaps were 9, and latissimus dorsi flaps were 10. The recipient sites were heel in 22 cases, sole in 7 cases, and heel and sole in 4 cases. In these cases, the postoperative complications, morbidity of donor sites, recovery of sensation, and cosmetic results were evaluated in each flap. All the flaps survived successfully. The free flaps provided excellent functional and cosmetic results. The tensor fascia lata flap was more reliable free flap for the reconstruction of heel and sole defects.

• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.167-172
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• 2002

The only treatment method for crushed soft tissue injuries in the proximal leg involving the knee joint is the microsurgical free flap transplantation, especially latissimus dorsi myocutaneous free flap is useful to cover the extensive soft tissue defects, therefore prevents iatrogenic below knee amputation and facilitates early wound healing, early ambulation and shortens hospital stay. Authors have treated the open amputation with crushed soft tissue and bone injuries in the proximal leg, and the repeated abrasion and infectious wound with traumatic neuroma in the below knee with myocutaneous free flap and succeeded to wear below knee amputation prosthesis and return to normal activities of the daily living in the relatively shorter period than usual.

• 대한두경부종양학회지
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• 제16권1호
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• pp.26-32
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• 2000

Background and Objectives: Various flaps are using for reconstruction of hypopharyngeal and esophageal defect. However, complication and indication of each flap are not fully analyzed. Patient and Methods: Records of 52 hypopharyngeal cancer patients who had surgical treatment and 13 other head and neck cancer patients who underwent hypopharyngeal and/or esophageal reconstruction with flap were retrospectively analyzed. Eighty three percent(54 cases) of patients needed reconstruction other than primary pharyngeal closure. Five split thickness skin graft, 1 pectoralis major myocutaneous flap, 20 forearm free flap, 13 jejunal free flap, 15 gastric pull up were used. Result: Flap failure was noted in 2 cases who had subsequent gastric transposition. Wound dehiscence and fistula were most common problem of forearm free flap. Most fistulas were developed in patients with conduit type reconstruction of forearm flap while there wasn't any fistula in patient with patch type reconstruction. Stenosis of lower anastomosis was the frequent problem of jejunal transfer. Gastric pull-up has frequent com-plication of stomal stenosis. All but three patients had reached oral feeding postoperatively. Conclusion: Based on this study, forearm flap is effective in partial hypopharyngeal defect while jejunum is the choice for circumferential defect. Gastric pull-up is for combined esophageal defect.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.46.1-46.7
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• 2016

Background: Osteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better reconstruction. Methods: A total of eight consecutive patients who underwent fibula reconstruction due to jaw necrosis from March 2008 to December 2015 were included in this study. Patients were classified according to stages, primary sites, radiation dose, survival, and quality of life. Results: Five male and three female patients underwent operation. The mean age of the patients was 60.1 years old. Two male patients died of recurred disease of oral squamous cell carcinoma. The mean dose of radiation was 70.5 Gy. All fibular free flaps were survived. Five patients could eat normal diet after operation; however, three patients could eat only soft diet due to loss of teeth. Five patients reported no change of speech after operation, two reported worse speech ability, and one patient reported improved speech after operation. The ipsilateral side of the fibular flap was used when intraoral soft tissue defect with proximal side of the vascular pedicle is required. The contralateral side of the fibular flap was used when extraoral skin defect with proximal side of the vascular pedicle is required. Conclusions: Osteonecrosis of the jaw is hard to treat because of poor healing process and lack of vascularity. Free fibular flap is the choice of the surgery for jaw bone reconstruction and soft tissue fistula repair. The design and selection of the right or left fibular is dependent on the available vascular pedicle and soft tissue defect sites.