• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.163-169
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• 1999

Purpose : To evaluate the efficacy of free musculocutaneous flap in the treatment of chronic osteomyelitis with drain sinus. Materials and Methods : Eighteen patients (sixteen male and two female) whose average age was 42.6 years were followed for an average of 3.5 years after free musculocutaneous flap for chronic osteomyelitis with drain sinus tract. The period of time between the initial injury and this procedure was average 10.6 years. The patients had an average of 4.1 prior surgical procedure before it. Results : Sixteen(88.9%) of the eighteen free musculocutaneous flap survived, including thirteen of latisimus dorsi flap, three of scapular free flap with muscle, two of medial plantar flap with abductor muscle. Sixteen cases had no evidence of recurrence at follow up. Conclusion : Free musculocutaneous flap is an extremely successful and reliable procedure for the treatment of chronic osteomyelitis with drain sinus. This flap with microvascular anastomses is highly vascularized through its own intrinsic blood vessels, which has the advantage of obliterating dead space and providing improved vascularity to the relatively ischemic recipient site and covering the skin defect.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.161-167
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• 2006

After total glossectomy, recovery of swallowing and speech function can greatly improve quality of life. The reconstructed tongue must be thick enough to contact with the hard palate for articulation. If the free flap is denervation, it may procede to have atrophy postoperatively. Therefor it is difficult to maintain the tongue volume for a long period of time. To resolve this problem, we have used a innervated rectus abdominis musculocutaneous flap and maintaining the volume through a neurorrhaphy. 7 patients underwent immediate reconstruction using a reinnervated rectus abdominis musculocutaneous free flap in which included intercostal nerve was anastomosed to the remaining hypoglossal nerve. The reinnervated rectus abdominis musculocutaneous free flap has provided good tongue contour with sufficient bulk and shown no obvious atrophy in all patients even though postoperative 9 months later. Considering swallowing and articulation, we concluded that reinnervated rectus abdominis musculocutaneous flap is a viable method after total glossectomy

• Korean Journal of Head & Neck Oncology
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• v.38 no.1
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• pp.59-63
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• 2022

The latissimus dorsi flap has high vascularity and is helpful for the reconstruction of infected areas. Herein, we present a patient with recurrent infections and soft-tissue defects who underwent cranial reconstruction using a free latissimus dorsi flap. The patient had undergone craniectomy and reconstruction using alloplastic bone 18 years previously. A scalp defect accompanied by infection occurred five years ago, and patient underwent reconstruction using a free flap at another hospital; however, the problem persisted. After debridement and bone flap removal, the right latissimus dorsi musculocutaneous flap was elevated, and the thoracodorsal artery and vein were anastomosed end-to-end to the right superficial temporal artery and vein. Methicillin-resistant Staphylococcus aureus was eradicated, and the flap survived. Cranioplasty was performed eight months later, and one year follow-up proceeded without complications. Effective reconstruction and cranioplasty are possible using the free latissimus dorsi musculocutaneous flap, even on scalp with persistent infections and soft-tissue defects.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.480-482
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• 2008

Purpose: Unexpected vascular anomaly can make the surgeon embarrassing and even affects on the operative results of free flap reconstruction. We experienced one case of abnormal course of deep inferior epigastric vessels during the elevation of rectus abdominis musculocutaneous free flap for breast reconstruction. Methods: A 38-year-old female patient who had modified radical mastectomy on her left breast underwent delayed breast reconstruction with rectus abdominis musculocutaneous free flap. Results: Flap elevation was performed in the traditional manner. During the flap elevation, it was detected that the deep inferior epigastric vessels ran between the rectus abdominis muscle and anterior rectus sheath along the midline after traversing the rectus muscle. The reconstructive surgery was successful and there were no postoperative complications. Conclusion: This is the first case reported in Korea. We should always know about the possibilities of unexpected anomaly that we can encounter.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.526-530
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• 2009

Recently, the anterolateral thigh(ALT) flap, based on the septocutaneous vessels or musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery has gained popularity in head and neck soft-tissue reconstruction. It has some advantages in free-flap surgery with respect to the radial forearm free flap, such as low donor site morbidity, availability of different tissues with large amounts of skin, adaptability as a sensate or flow-through flap (with the possibility of harvesting a long pedicle with a suitable vessel diameter). Moreover, the thickness of the flap is adjustable until the subdermal fat level, allowing it to be used as a thin or ultrathin flap. This clinical cases are ALT free flap reconstructions without functional impairment of the donor limbs (transitory and permanent) based on anastomosis with superficial temporal arteries and veins in patient of huge resection defect on face, lip and tongue.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.103-109
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• 2000

Purpose : We performed this study in order to analyze the clinical results of functioning gracilis musculocutaneous free flap transplantation for reconstructon of hand function in cases of Volkmann's ischemic contracture and massive soft tissue injury of forearm. Materials and methods : 18 cases were reviewed with 5 yeas of mean follow up period. We evaluated total active motion of the finger joints and wrist, pinch and grip strength. Results : The flap were survived in 17 cases and 1 case was failed due to infection. The sum of active motion of finger joints(TAM) was improved from 0 to $173.8^{\circ}$. The average grip and pinch strength was improved from 0 kg to $2.7{\pm}2.1kg$ and from 0 kg to $2.4{\pm}1.6kg$. Conclusion : The results in most cases were acceptable in relatively long term follow-up. It may be an option for reconstruction of hand function in cases of Volkmann's ischemic contracture and traumatic upper extremity injury.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.435-440
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• 2005

The reconstruction of deep soft tissue defects of lower extremities combined with bone exposure has been difficult problems. When it is impossible to raise local skin flap, we have been usually used the gastrocnemius musculocutaneous flap, cross leg flap or free flaps. However, In musculocutaneous flap, aesthetical appearance of the calf is not appropriate because of too bulky flap. Although the success rate of the free flap has improved, still failure of flap occurs in cases of the chronic ischemic state. As the concepts of perforator flap has recently developed and widely used due to its thin flap thickness. Between January 2002 to December 2004, we treated 7 patients with soft tissue defect in leg with chronic ischemic limbs with perforator island flap. Preoperative angiography were done in all case and we used 2 medial sural perforator flaps, 1 anterior tibial artery perforator flap, 1 posterior tibial artery perforator flap, 3 anterolateral thigh perforator flap. Partial necrosis of flap was seen in one patient but no further surgical procedure was required for wound healed spontaneously. Perforator island flaps are thin, reduce donor site morbidity, conceal donor site with primary closure and it is useful for resurfacing soft tissue defect of lower extremities.

• Archives of Reconstructive Microsurgery
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• v.24 no.1
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• pp.7-12
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• 2015

Purpose: The rectus abdominis musculocutaneous (RAM) flap has contributed to the efficient reconstruction of soft tissue defects. The flap has the advantage of easy dissection, minimal donor site morbidity, and the constant vascular anatomy with long pedicle. Authors used the free RAM flap to reconstruct multi-located soft tissue defects while still considering functionality and aesthetics. We present the long-term outcomes and versatility of free RAM flaps. Materials and Methods: From 1994 to 2004, all patients who underwent soft tissue reconstruction with free RAM flap were reviewed retrospectively. The site of the reconstruction, vessels of anastomosis, type of RAM flap, and outcomes, including flap success rate, hospital stay after flap transfer, conduction of secondary procedure, flap complications, and donor-site complications were analyzed. Results: Twenty-one patients underwent 24 free RAM flaps in site of breast, face, upper extremity and lower extremity. Mean follow-up period was 36.1 months (range, 3~156 months). The overall success rate was 92% with only a loss of 2 flaps. Minor complications related to transferred flaps were necrosis of 2 partial flaps, hematoma formation in 3 cases, and a wound infection in 1 case. Donor site morbidity was not observed. Debulking surgery was performed in 4 patients, and scar revision was performed in 3 patients. Conclusion: Free RAM flap is a workhorse flap for general soft-tissue reconstruction with minimal donor site morbidity with aesthetically good results. Thus, the free RAM flaps are versatile, and sturdy for any sites of soft-tissue where reconstruction could be performed.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.607-612
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• 2010

Purpose: Maxillectomy for malignant tumor resection often leads to functional and aesthetic sequalae. Reconstruction following maxillectomy has been a challenging problem in the field of head and neck cancer surgery. In this article, we described three dimensional midface reconstructions using free flaps and their functional and aesthetic outcomes. Methods: We reconstructed 35 cases of maxillectomy defects using 9 radial forearm free flaps, 7 lattisimus dorsi musculocutaneous free flaps, 6 rectus abdominis musculocutaneous free flaps, 4 fibular osteocutaneous free flaps, and 9 anterolateral thigh free flaps, respectively. We classified post-maxillectomy defects by Brown's classification. 1 Articulation clarity was measured with picture consonant articulation test. Swallowing function was evaluated with the University of Washington quality-of-life Head and Neck questionnaire by 4 steps.2 Aesthetic outcomes were checked to compare preoperative with postoperative full face photographs by 5 medical doctors who did not involve in our operation. Results: The average articulation clarity was 92.4% (100-41.9%). 27 (81.9%) patients were able to eat an unrestricted diet. Aesthetic results were considered excellent in 18 patients (51.4%). Functional results were best in the group reconstructed with fibular osteocutaneous free flap. Considering the range of wide excision, aesthetic results is best in the group reconstructed with anterolateral thigh free flap. Conclusion: The free flap is a useful technique for the reconstruction of the midface leading to good results, both functionally and aesthetically. Especially, because osteocutaneous flap such as fibular osteocutaneous free flap offered bone source for osteointegrated implant, It produces the best functional results. And perforator flap like as anterolateral thigh free flap reliably provides the best aesthetic results, because it provides sufficient volume and has no postoperative volume diminution.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.556-561
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• 2014

Background Groin dissections result in large wounds with exposed femoral vessels requiring soft tissue coverage, and the reconstructive options are diverse. In this study we reviewed our experience with the use of the pedicled anterolateral thigh and vertical rectus abdominis musculocutaneous flaps in the reconstruction of large groin wounds. Methods Groin reconstructions performed over a period of 10 years were evaluated, with a mean follow up of two years. We included all cases with large or complex (involving perineum) defects, which were reconstructed with the pedicled anterolateral thigh musculocutaneous or the vertical rectus abdominis musculocutaneous (VRAM) flaps. Smaller wounds which were covered with skin grafts, locally based flaps and pedicled muscle flaps were excluded. Results Twenty-three reconstructions were performed for large or complex groin defects, utilising the anterolateral thigh (n=10) and the vertical rectus abdominis (n=13) pedicled musculocutaneous flaps. Femoral vein reconstruction with a prosthetic graft was required in one patient, and a combination flap (VRAM and gracilis muscle flap) was performed in another. Satisfactory coverage was achieved in all cases without major complications. No free flaps were used in our series. Conclusions The anterolateral thigh and vertical rectus abdominis pedicled musculocutaneous flaps yielded consistent results with little morbidity in the reconstruction of large and complex groin defects. A combination of flaps can be used in cases requiring extensive cover.