• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권6호
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• pp.427-431
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• 2021

Objectives: The aim of this study was to describe a simple, convenient, and reliable new technique using local full-thickness skin graft (FTSG) for skin coverage of a donor-site defect of the radial forearm free flap (RFFF). Patients and Methods: Between April 2016 and April 2021, five patients with oral squamous cell carcinoma underwent mass resection combined with RFFF reconstruction. After RFFF harvesting, donor-site defects were restored by proportional local FTSG. Results: The donor-site defects ranged in size from 24 to 41.25 cm², with a mean of 33.05 cm². Good or acceptable esthetic outcomes were obtained in all five patients. There was no dehiscence, skin necrosis, wound infection, or severe scarring at the graft site through the end of the postoperative follow-up period, and no patient had any specific functional complaint. Conclusion: The proportional local FTSG showed promising results for skin coverage of the donor-site defect of the RFFF. This technique could decrease the need for skin grafts from other sites.

• 대한치과의사협회지
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• 제54권4호
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• pp.296-305
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• 2016

Narrow zone of attached gingiva and shallow vestibule around the implants might contribute to difficulty of cleasing, periimplant mucositis caused by incomplete cleansing and further peri-implantitis. The aim of this case report is to present modification of soft tissue biotype around the implants by free gingival grafts according to timing of surgical intervention and shape of free gingiva. A 44 year-old male patient had a missing area on lower right second molar area with 1 to 2 mm of narrow attached gingiva zone and wanted to be treated by implant placement. In radiographic analysis, there was enough alveolar bone to install an implant, free gingiva from hard palate was grafted following implant placement using double layer flap. The width of attached gingival was increased to 4 to 5mm and well maintained during 5 months of follow up. A 69 year-old female patient also had a missing area on lower right first and second molar area with 1 to 2 mm narrow attached gingiva. Since she had systematically angina pectoris and dental phobia, minimal invasive free gingival graft after implants placement was planned. After 2 months of implant surgery, free gingival graft surgery was performed with healing abutments connection. The grafted gingiva was composed of two strip shaped free gingiva, and they were immobilized by periodontal pack. The width of attached gingival was increased to 4 to 5mm and well maintained during 10 months of follow up. With prosthesis delivery, the patients recovered ideal periodontal environment around implants and masticatory function. In conclusion, periodontal health and masticatory function could be achieved through implant placement and free gingival graft.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.345-351
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• 2012

Background Cranial base defects are challenging to reconstruct without serious complications. Although free tissue transfer has been used widely and efficiently, it still has the limitation of requiring a long operation time along with the burden of microanastomosis and donor site morbidity. We propose using a reverse temporalis muscle flap and calvarial bone graft as an alternative option to a free flap for anterior cranial base reconstruction. Methods Between April 2009 and February 2012, cranial base reconstructions using an autologous calvarial split bone graft combined with a reverse temporalis muscle flap were performed in five patients. Medical records were retrospectively analyzed and postoperative computed tomography scans, magnetic resonance imaging, and angiography findings were examined to evaluate graft survival and flap viability. Results The mean follow-up period was 11.8 months and the mean operation time for reconstruction was $8.4{\pm}3.36$ hours. The defects involved the anterior cranial base, including the orbital roof and the frontal and ethmoidal sinus. All reconstructions were successful. Viable flap vascularity and bone survival were observed. There were no serious complications except for acceptable donor site depressions, which were easily corrected with minor procedures. Conclusions The reverse temporalis muscle flap could provide sufficient bulkiness to fill dead space and sufficient vascularity to endure infection. The calvarial bone graft provides a rigid framework, which is critical for maintaining the cranial base structure. Combined anterior cranial base reconstruction with a reverse temporalis muscle flap and calvarial bone graft could be a viable alternative to free tissue transfer.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권2호
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• pp.140-147
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• 2012

Microvascular reconstruction, in the oral and maxillofacial regions, is a widely accepted as the best way to overcome the complex oral cavity defects. Many patients requiring composite reconstructions have been treated previously with radiation therapy, chemotherapy, selective and/or functional neck dissection or any of these combinations. In many cases of these patients, inadequate neck vessels for the microanastomosis of free flap are available, due to a lack of recipient vessels in the neck, poor vessel quality or vessel caliber mismatch. To achieve a tension-free anastomosis, vein grafting must be considered to span the vessel gap between the free flap pedicle and the recipient neck vessels. Although most microsurgeons believed that interpositional grafts are to be avoided due to vessel thrombosis and increased number of necessary microanastomosis, we, authors have some confidence of equivalency between reconstruction with and without interpositional saphenous vein graft. The great saphenous vein, also known as the long saphenous vein, is the large subcutaneous superficial vein of the leg and thigh. It joins with the femoral vein in the region of femoral triangle at the saphenofemoral junction, and coursed medially to lie on the anterior surface of the thigh before entering an opening in the fascia lata, called the saphenous opening. For a better understanding of the great saphenous vein graft for the interpositional vessel graft in the oral cavity reconstructions, and an avoidance of any uneventful complications during these procedures, the related surgical anatomies with their harvesting tips are summarized in this review article in the Korean language.

• Archives of Reconstructive Microsurgery
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• 제9권1호
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• pp.27-36
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• 2000

February 1995 to September 1999, authors have experienced seven cases of infected nonunion of tibial fractures with associated soft tissue injury and skin defect, and have accomplished union in all cases by free vascularized fibular graft. All grafts healed with no radiographic evidence of bone necrosis or resorption and have been able to treat large bony defect and skin defect simultaneously. In this study, five cases of vascularized free fibular osteocutaneous flap transfer and two cases of free fibular graft are reported. All of seven cases were infected nonunion of tibia. The results were obtained as follows 1) The mean duration of the radiologic bone union was average 5.3months. 2) Grafted fibular has been hypertrophied, average 10.6 months. 3) In five cases of preservation of posterior cortex of tibia, bony union and hypertrophy of grafted bone were earlier than that two cases of complete segmental resection of tibia. 4) In two cases which only free vascularized fibular graft were performed because achievement of cutaneous flap was failed, authors found that soft tissue defect was filled with granulation tissue and split-thickness skin graft was possible over the granulation tissue after 3 weeks postoperatively.

• Journal of Periodontal and Implant Science
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• 제25권1호
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• pp.121-132
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• 1995

Patients, who have gingival recession and complain of root sensitivity, or esthetic concerns, are candidates for root coverage. When free gingival grafting is used for complete root corverage, the results may not be entirely predictible unless the recession is shallow and narrow because a free gingival graft depends on collateral circulation from the lateral and apical parts of the recipient bed to survive over the avascular root. Various pedicle graft techniques can produce more esthetic results, but these procedures are only indicated when adequate donor tissues are available adjacent to the defect. This case report presents three cases for root coverage using the various connective tissue graft techniques. In the first case(Class III & IV), subepithelial connective tissue grafting was done and resulted in gingival coverage on the two-thirds of exposed root surface and blended with the adjacent tissue in color and texture. In the second case(Class I), connective tissue and partial thickness double pedicle graft resulted in complete coverage of denuded root surface. In the third case(Class I), recession was treated by supraperiosteal envelope technique. The root surface was covered completely and esthetically. Finally, the esthetics in both colors and tissue contours were acceptable to patients in all cases by the connective tissue grafting. However, in the case of the reduced interdental bone, the denuded root surfaces were hardly covered completely.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권3호
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• pp.214-219
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• 1995

Free grafting of oral mucosa for minor oral reconstruction was first described by Propper in ridge extension surgery. Situation calling for mucosal grafting procedures may relate to periodontal surgery, minor and major preprosthetic surgery, implant surgery, reconstruction in deformity cases after trauma, congenital cleft, gross atrophy and ablative tumor surgery. In the cases of 9 patients with mucosal defect of intraoral or orbital cavity after wide excision of tumor, preprosthetic surgery, and orbitoplasty, full-thickness mucosal graft were used to close a large defect. Four patients received buccal mucosal graft for preprosthetic surgery or orbitoplasty, one patient had benign tumor and the others had malignant tumors located on the palate or upper alveolus. Buccal mucosal graft donor site morbidity and trismus were minimal and healing of surgical defect was satisfactory. So we present the case with review of literatures.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.68-74
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• 2015

Purpose: The reconstruction of femur and tibia defects following tumor resection remains a surgical challenge. The clinical outcome of free vascularized fibula graft (VFG) reconstruction with locking plate for massive femur and tibia defects of more than 10 cm that were secondary to skeletal tumor resection is reported. Materials and Methods: Thirteen patients with a mean follow-up of 3.3 years were reviewed. Seven patients received vascularized fibula grafts in the femur and six in the tibia. The mean bony defect of the femur and tibia was more than 10 cm and the length of the grafted fibula was more than 15 cm. All defects were stabilized with long locking plates. Results: All patients were free of disease at final follow-up; All VFGs were transferred successfully. All patients had a successful outcome with bony union. Stress fractures of the grafted fibula had occurred but the locking plate stabilized the fracture and healed until the last follow-up. All patients were able to walk without a brace after a mean of 9 months postoperatively. Conclusion: VFG with locking plate is a reliable reconstructive procedure for massive femur and tibia defects.

• Archives of Plastic Surgery
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• 제43권1호
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• pp.3-9
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• 2016

The reconstruction of the mandible is a complex procedure because various cosmetic as well as functional challenges must be addressed, including mastication and oral competence. Many surgical techniques have been described to address these challenges, including non-vascularized bone grafts, vascularized bone grafts, and approaches related to tissue engineering. This review summarizes different modifications of the free vascularized fibula graft, which, since its introduction by Hidalgo in 1989, has become the first option for mandibular reconstruction. The fibula free flap can undergo various modifications according to the individual requirements of a particular reconstruction. Osteocutaneous flaps can be harvested for reconstruction of composite defects. 'Double-barreling' of the fibula can, for instance, enable enhanced aesthetic and functional results, as well as immediate one-stage osseointegrated dental implantation. Recently described preoperative virtual surgery planning to facilitate neomandible remodeling could guarantee good results. To conclude, the free fibula bone graft can currently be regarded as the "gold standard" for mandibular reconstruction in case of composite (inside and outside) oral cavity defects as well as a way of enabling the performance of one-stage dental implantation.

• 한국의류학회지
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• 제23권7호
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• pp.1064-1072
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• 1999

Nylon fabric was grafted for the purpose of the development of detergency against the hemoglobin as a protein soil. By free-radical producing chemical initiator systems the graft using acrylic acid(AA) as a hydrophilic vinyl monomer was performed to change surface energies in the presence of ammonium persulfate(APS) as an initiator and then acrylic acid grafted Nylon was treated with NaOH solution. The surface morphology for Nylon-g-NaAA with changing graft rate were studied by scanning electron microscopy (SEM) The properties of the Nylon such as diameter tenacity elongation contact angle and the hemoglobin removal were also investigated. The diameter of grafted Nylon fiber increased as the graft ratio increased. The tenacity of grafted Nylon also increased with increasing graft ratio up to 15% The elongation however decreased gradually according to graft, The contact angle decreased after graft and alkaline treatment. The amount of hemoglobin on the grafted Nylon increased in proportion to the graft ratio. Hemoglobin was easily removed from grafted Nylon while it was difficult to be removed from ungrafted Nylon. The detergency of hemoglobin for grafted Nylon decreased when the graft ratio exceeded 15% The removal of hemoglobin increased markedly with increasing hemoglobin content and revolution speed. Therefore the removal of hemoglobin was improved due to graft and alkaline treatment.