• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.59-64
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• 1997

The aims of free tissue transplantation to the injured foot are to cover the exposed blood vessels, nerves, muscles, tendons and bones, to clear up infection, to lessen the morbidity, to shorten the hospitalization, and to prepare for further surgical procedures when no local or transpositioning flaps are available. Authors have carried out free flap transplantation in 13 cases of crushing injury, osteomyelitis and electrical burn in the foot at Chonbuk National University Hospital from June 1992 through May 1996. The results were as follows : 1. 9 cases of 13 (69%) were sustained from the traffic accident. 2. The dorsalis pedis free flap transplantation has been performed most frequently in 5 cases (38.5%), followed gracilis muscle flap in 4 cases(30.7%), rectus abdominis muscle flap in 2 cases(15.4%), latissimus dorsi muscle flap and upper arm flap in 1 each. 3. 6 muscle flaps were covered with split thickness skin graft 20 days after microsurgical anastomosis. 4. All of 13 cases were survived after microsurgical procedure and showed excellent coverage in the foot.

• Archives of Plastic Surgery
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• v.35 no.1
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• pp.20-27
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• 2008

Purpose: The anterolateral thigh flap has many advantages over other conventional free flaps. But the anterolateral thigh flap has yet to enter widespread use because perforating arteries exhibit a wide range of anatomic variations and are difficult to dissect when small. The aim of this study is to identify the vascular variability of perforating arteries and pedicle in the anterolateral thigh free flap. Methods: We studied 12 cadavers and dissected 23 thighs. An anterolateral thigh flap ($12{\times}12cm$) was designed and centered at the midpoint of the line drawn from anterior superior iliac spine to the superolateral border of the patella. After we identifed the perforating arteries we dissected up to their origin from lateral circumflex femoral artery along descending branch of lateral circumflex femoral artery. We then investigated the number and the position of perforating arteries, length and diameter of vascular pedicle and pattern of lateral circumflex femoral arterial system. Results: On average $2.3{\pm}1.1$ perforating arteries per thigh were identified. The musculocutaneous perforators were 63.1%. In those perforators five perforators were arose from transverse branch of lateral circumflex femoral artery and two were arose from rectus femoral artery. Most of the perforators were near the intermuscular septum between rectus femoris muscle and vastus lateralis muscle. The length and diameter of pedicle were $11.9{\pm}3.5cm$ and $3.1{\pm}0.8mm$ on average. Conclusion: This study will be helpful for the success in anterolateral thigh free flap.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.29.1-29.7
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• 2020

Background: Microvascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery. Methods: This study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed. Results: Four different flap types were used for microvascular reconstruction: radial forearm (n = 65), fibula (n = 34), latissimus dorsi (n = 21), and serratus anterior muscle with rib bone free flap (n = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min. Conclusions: The success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.119-124
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• 2007

Purpose: Management of the soft tissue defect in the lower extremity caused by trauma has always been difficult. Coverage with local and free muscle flaps after complete surgical excision of necrotic soft tissue and bone is a major strategy for treatment. There is no doubt that muscle provides a good blood supply, thus improving bone healing and increasing resistance to bacterial inoculation. However, accompanying problems are seen in cases with shallow dead space. This research was conducted to assess the efficacy of raising anterolateral thigh flaps and transferring them to the defect after complete debridement of non-viable, infected, and scar tissue as an alternative way to use local or free muscle flaps. Methods: From March 2005 to October 2007, 18 cases of soft tissue defect on lower extremities were re-surfaced with an anterolateral thigh perforator free flap. Results: The follow-up period ranged from 1 to 31 months with a mean of 15.9 months. All flaps survived completely. Satisfactory aesthetic and functional results were achieved. Under a two-point discrimination test, 13 patients had sensory recovery from 11 mm to 20 mm after 6 months postoperatively. Conclusion: Reconstruction of the lower extremity with anterolateral thigh perforator free flaps after appropriate debridement is a good alternative way to use local or free muscle flaps.

• Archives of Reconstructive Microsurgery
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• v.3 no.1
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• pp.64-71
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• 1994

The successful treatment of the extensively traumatized foot warrants reconstruction utilizing tissue that will provide adequate coverage, is resistant to infection, thin enough to conform to the contours of the foot as well as durable to constant frictional movement and weight bearing. Currently, free flaps offer the best means in achieving these difficult and sometimes contradictory goals. We treated twenty-one patients suffering from extensive soft tissue loss of the foot due to trauma, electric burn or postburn sequelae with free flaps. A fasciocutaneous, musculocutaneous or muscle flap with skin grafting was used based on the location, volume of tissue required, and the functional anatomical requirement of the injured region. The follow-up duration averaged twenty-nine months. From our group of patients, we believe that the muscle free flap with skin grafting offers the most favorable outcome.

• Korean Journal of Head & Neck Oncology
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• v.1 no.1
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• pp.35-61
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• 1985

The surgical treatment of advanced carcinomas and some benign tumors having clinically malignant behaviors of the head and neck region often require extensive resection, necessitating large flaps for reconstruction. Since the original upper arm flap was described by Tagliacozzi in 1597, a variety of technique such as random pattern local flap, axial flap, distant flap, scalping flap, myocutaneous flap, free flap etc. have been proposed for reconstruction of head, face and neck defects. Reconstruction of the facial defects usually require the use of distant tissue. Traditionally, nasal reconstruction has been carried out with a variety of forehead flaps. In recent years, there has been more acceptance of immediate repairs following the removal of these tumors. As a result, patients are more willing to undergo these extensive resections to improve their chances of cure, with the reasonable expectation that an immediate reconstruction will provide an adequate cosmetic result. Authors experienced 13 cases of head and neck tumor during last three and half years that required wide excision and immediate reconstruction with various flaps, not with primary closure or simple skin graft. We present our experience with varied flaps for reconstruction after wide resection of head and neck tumors 3 cases of defect of dorsum of nose or medial canthus with island forehead flaps, lower eyelid defect with cheek flap, cheek defect with Limberg flap, orbital floor defect with Temporalis muscle flap, lateral neck defects with Pectoralis major myocutaneous flap or Latissimus dorsi myocutaneous free flap, subtotal nose defect with scalping flap, wide forehead defect with Dorsalis pedis free flap and 3 cases of mandibular defect or mandibular defect combined with lower lip defect were reconstructed with free vascularized iliac bone graft or free vascularized iliac bone graft concomitantly combined with free groin flap pedicled on deep circumflex iliac vessels We obtained satisfactory results coincided wi th goal of treatment of head and neck tumors, MAXIMAL CURE RATE with MINIMAL MORBIDITY, OPTIMAL FUNCTION, and an APPEARANCE as close to normal as possible.

• Archives of Reconstructive Microsurgery
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• v.13 no.2
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• pp.123-129
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• 2004

Lower extremity injuries are frequently accompanied with large soft-tissue defects. Such Injuries are difficult to manage for its poor vascularity, rigid tissue distensibility, easy infectability and a relatively long healing period. Also, osteomyelitis, and/or non-union of the fractured bones are relatively common in lower extremity injuries and its weight-bearing role should be considered. Therefore, it is important to select appropriate reconstruction method of the lower extremities, which is applicable to a variety of surgical techniques according to these considerations. The goal of flap coverage in the lower extremity should not only be satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. In this article, we have tried to establish a reconstruction method in the lower extremity based on our experiences and clinical analysis of soft tissue reconstruction using free muscle flap transfer in 27 cases from Jan. 2000 to Dec. 2002. The results showed 96% flap survival, and flap failure noted in one of the cases due to vascular insufficiency. In conclusion, we believe that in cases of lower extremity soft-tissue defects especially with open comminuted fractures and infections, muscle free flaps should be considered as the first line of treatment.

• Archives of Reconstructive Microsurgery
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• v.23 no.1
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• pp.18-20
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• 2014

Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.94-100
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• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.2
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• pp.124-129
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• 2007

Synovial sarcomas of the hand are rare. It should be treated with wide resection. In the cases of soft tissue sarcomas of the hand, functional reconstruction must be considered. We report 46-year-old male patient with synovial sarcoma of the right thenar muscle which was treated with unplanned intralesional resection at outside hospital, that has been treated with wide resection including trapezium and first metacarapl bone then, reconstructed with nonvascularized fibular graft and anterolateral thigh free flap.