• Archives of Plastic Surgery
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• 제38권4호
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• pp.415-420
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• 2011

Purpose: The reconstruction of a soft tissue defect of the heel pad can be challenging. One vital issue is the restoration of the ability of the heel to bear the load of the body weight. Many surgeons prefer to use local flaps or free tissue transfer rather than a skin graft. In this study, we evaluated the criteria for choosing a proper flap for heel pad reconstruction. Methods: In this study, 23 cases of heel pad reconstruction were performed by using the flap technique. The etiologies of the heel defects included pressure sores, trauma, or wide excision of a malignant tumor. During the operation, the location, size and depth of the heel pad defect determined which flap was chosen. When the defect size was relatively small and the defect depth was limited to the subcutaneous layer, a local flap was used. A free flap was selected when the defect was so large and deep that almost entire heel pad had to be replaced. Results: There was only one complication of poor graft acceptance, involving partial flap necrosis. This patient experienced complete recovery after debridement of the necrotic tissue and a split thickness skin graft. None of the other transferred tissues had complications. During the follow-up period, the patients were reported satisfactory with both aesthetic and functional results. Conclusion: The heel pad reconstructive method is determined by the size and soft-tissue requirements of the defect. The proper choice of the donor flap allows to achieve satisfactory surgical outcomes in aesthetic and functional viewpoints with fewer complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권2호
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• pp.138-141
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• 2006

Introduction : In recent years, vascularized, i.e., living bone grafts, have been widely applied in the field of oral and maxillofacial surgery, as a method of treatment of congenital or acquired non-unions, and a large defects in mandible. The vascularized fibular graft has been especially used for this purpose because of its shape and mechanical strength. The postoperative hypertrophy of grafted fibula is of particular interest to us. Material and methods : This study was undertaken to determine the volume change(indirect methods) and radiographic appearance of a free vascularized fibular graft as it responds to the mechanical and physiologic features of its new environment. In order to elucidate the long term effect on fibular mass after mandibular reconstruction, change in various method of volume change was utilized as indirect measure of change in long-term. Results : The younger the patient, the more prominent and rapid the hypertrophy of the graft. the hypertrophy of the graft never exceeded the diameter of the recipient bone, except for callus enlargement after stress fracture of the grafted bone. Conclusion : Etiologic explanations for this phenomenon have not been clarified in the previeous literature. some of the factors implicated include a periosteal reaction or new bone formation, as seen at the onset of bone union after a fracture in a child, a reaction to the mechanical loading on the graft and a reaction to the circulatory changes resulting from the grafting procedure.

• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.60-63
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• 2001

The reconstruction of the suborbital area followed by resection of skin cancer has been used many methods including skin graft, local flaps, free flaps, and skin expansion. The radial forearm free flap has become a workhorse flap in this area because of its lack of bulk, ease of dissection, malleability, and hairlessness. When the suborbital defect especially including full-thickness defect of lower lid was reconstructed with many free flaps, the ectropion and the deformity of medial and lateral canthal area were common problems encountered as late complication due to gravitational descent. To improve the final aesthetic result in patients with suborbital defect, the radial forearm free flap was elevated as a composite radial forearm - palmaris longus free flap, in which the vascularized palmaris longus london was included and anchored to the periorbital bone with $mitek^{(R)}$ as sling, to suspend the flap against gravity and inferior descent, and thereby creating a more natural cheek contour. Two clinical cases were presented as an example of this procedure. Postoperative results emphasize the importance of suspension sling with palmaris longus tendon using $mitek^{(R)}$ in reconstruction of the suborbital defect with radial forearm free flap.

• 대한기관식도과학회지
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• 제6권1호
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• pp.118-126
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• 2000

A radical maxillectomy causes a defect of the alveolar bone, gingiva, palate, and orbital floor and causes cosmetical problems and masticatory and phonatory functions. Defect after a radical maxillectomy was reconstructed with skin or dermis graft was introduced, but recently wide resection of the tumor and functional reconstruction with free flap was introduced by several methods. The defect due to radical maxillectomy was reconstructed with scapula, iliac crest, radius. But reconstruction with a fibular osteocutaneous free flap was rarely introduced to defect of radical maxillectomy. The fibular osteocutaneous free flap was firstly introduced by Taylor. The fibular osteocutaneous free flap has several advantages. We experienced the first case of radical maxillectomy and reconstruction with the fibular osteocutaneous free flap, so we reported that case with literatures. The patient has a right maxillary sinus squamous carcinoma (T2N0M0), and performed a radical maxillectomy with right supraomohyoid neck dissection, and reconstruction with fibular osteocutaneous free flap. Donor site morbidity was little, and phonatory and masticatory function were nearly normalized. And cosmetical result was very acceptable.

• 한국잠사곤충학회지
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• 제34권2호
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• pp.32-40
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• 1992

반응개시제로 potassium persulfate를 사용한 MAA 가공견섬유에 대하여 열분석, IR spectrum, 아미노산 분석, 전자현미경 등의 기기분석을 통하여 반응 mechanism에 대하여 구명하고자 하였다. IR spectroscopy 분석에서 가공견섬유의 peak은 미가공견섬유와 MAA polymer의 peak을 모두 가지고 있으며, 특이한 peak의 변화는 관찰할 수 없었다. 아미노산 분석에서는 vinyl monomer가 graft된다는 종래의 특정 아미노산의 함량에 있어서, 가공률의 증가에 따른 변화를 관찰할 수 없었으며, MAA 가공견섬유의 중합 mechanism은 styrene 및 MMA의 graft 가공에서와는 일치하지 않는 것으로 나타났는데, 이는 monomer, 개시제, 반응조건에 따라 반응에 관여하는 아미노산이 다른 것으로 추정된다. SEM 관찰에서는 가공률이 낮은 경우의 섬유표면은 미가공견섬유의 표면과 그 차이를 인정할 수 없었으나, 가공률이 증가함에 따라 섬유표면에 섬유축방향으로 줄무늬가 형성되는 것을 관찰할 수 있었다. 이상의 관찰과 앞서 발표한 열분석 결과를 종합하면, potassium persulfate를 반응개시제로한 MAA 가공견의 중합기구에 대해서는 DSC나 IR spectroscopy에 의한 관찰로는 중합기구를 정성정량적으로 분석하기는 힘든 것으로 나타났으며, 아미노산 분석결과로부터 이미 styrene이나 MMA 가공견의 grafting site로 알려 져 있는 Gly, Ala, Ser, Tyr, Thr, Met 및 염기성 아미노산 등의 특정 아미노산에 선택적으로 graft되는 경향을 인정할 수 없으므로 이는 graft 중합에 의해 결합되는 것이라기보다 단지 섬유내부중합에 의해 polymer가 섬유내부에 형성되는 것으로 추정된다. 현미경관찰에서도 polymer는 주로 섬유내에 형성되며, 무게증가율이 큰 경우에는 섬유의 표면에 MAA에 의한 특징적인 줄무늬의 형성을 관찰할 수 있었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권3호
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• pp.267-272
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• 2009

Bone grafting the alveolar cleft allows for stability and continuity of the dental arch, provides bone for eruption of permanent teeth or placement of dental implants, and gives support to the lateral ala of the nose. Closure of residual oronasal fistula can occur simultaneously. Repair of alveolar clefts can occur at a variety of stages defined as primary, early secondary, secondary, and late. Most centers perform this surgery as secondary bone grafting. Autogenous bone provides osteogenesis, osteoinduction and conduction and is recommended for grafting to the cleft alveolus and several donor sites are available. The surgeon should select the best flap design considering the amount of mucosa available, blood supply and tension-free closure, and the extent of the oronasal communication. The authors provide a comprehensive understanding of alveolar clefts and their repair by reviewing the historical perspective, objectives for treatment, timing, source of graft, presurgical orthodontics, surgical techniques, postoperative care, and complications.

• 대한족부족관절학회지
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• 제9권2호
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• pp.224-226
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• 2005

In diabetic foot with arterial occlusive disease, skin defect on heel was tried to treat with free flap or local flap, but couldn't be treated well. Therefore below knee amputation was perfomed mostly. But we treated a patient of large heel defect with using of artificial bypass graft and antero-lateral thigh perforator flap.

• 대한골관절종양학회지
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• 제9권1호
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• pp.110-114
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• 2003

연골 유점액 섬유종은 젊은 층에서 발생하며 비교적 드문 양성종양이나 재발률이 높은 것으로 알려져 있다. 경골의 근위 1/3의 골간단에 대부분 발생하며 족부에도 20%에서 발생한다고 보고하였다. 저자는 족부에 발생한 연골 유점액 섬유종 1례에 대하여 1차 소파술 및 골 이식술을 시행하였으며 술 후 7개월에 재발하여 전절제술 및 장골 이식술을 시행하여 24개월간 추시 후 만족스러운 결과를 얻었다.

• Macromolecular Research
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• 제13권6호
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• pp.483-490
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• 2005

A novel, polysaccharide-based, superabsorbent hydrogel was synthesized through crosslinking graft copolymerization of methacrylic acid (MAA) onto kappa-carrageenan ($_{k}C$), using ammonium persulfate (APS) as a free radical initiator in the presence of methylenebisacrylamide (MBA) as a crosslinker. A proposed mechanism for $_{k}C$­g-polymethacrylic acid ($_{k}C$-g-PMAA) formation was suggested and the hydrogel structure was confirmed using FTIR spectroscopy. The effect of grafting variables, including MBA, MAA, and APS concentration, was systematically optimized to achieve a hydrogel with the maximum possible swelling capacity. The swelling kinetics in distilled water and various salt solutions were preliminarily investigated. Absorbency in aqueous salt solutions of lithium chloride, sodium chloride, potassium chloride, calcium chloride, and aluminum chloride indicated that the swelling capacity decreased with increased ionic strength of the swelling medium. This behavior can be attributed to the charge screening effect for monovalent cations, as well as ionic crosslinking for multivalent cations. The swelling of super absorbing hydrogels was measured in solutions with pH ranging from 1 to 13. In addition, the pH reversibility and on-off switching behavior, at pH levels of 3.0 and 8.0, give the synthesized hydrogels great potential as an excellent candidate for the controlled delivery of bioactive agents.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.97-101
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• 2020

Although the success rate of deep inferior epigastric perforator (DIEP) flaps has increased, late flap failures still occur and have a low salvage rate. The present article describes a case of salvage of a case of late flap failure using the pedicle vein as a vein graft source. A 50-yearold woman underwent a bilateral DIEP free flap procedure. On postoperative day 6, she experienced flap compromise and underwent emergency flap revision. In the flap revision, flap venous drainage and the superficial inferior epigastric vein were completely obstructed. A Fogarty catheter was used to remove a thrombus from the completely obstructed pedicle vein, and this pedicle vein was used as a graft source and was ligated in retrograde fashion to the flap vein stump. After injection of urokinase into the arterial branch, venous flow to the flap was restored. At a 6-month follow-up visit in the outpatient clinic, only partial fat necrosis at the flap was noted. By dissecting various perforators in the initial operation, decisions regarding immediate revision can be made with more confidence. Additionally, the combined procedures performed in this case may be helpful even for practitioners treating cases of late flap compromise.