• Archives of Plastic Surgery
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• 제41권6호
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• pp.716-721
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• 2014

Background The aim of this study was to review the recipient vessels used in our cases of facial reanimation with free functional muscle transfer and to identify patient variables that may predict when the facial vessels are absent. From this we present a protocol for vessel selection in cases when the facial artery and/or vein are absent. Methods Patients were identified from November 2006 to October 2013. Data was collected on patient demographics, facial palsy aetiology, history of previous facial surgery/trauma and flap/recipient vessels used. A standard operative approach was adopted and performed by a single surgeon. Results Eighty-seven eligible patients were identified for inclusion amongst which 98 hemifaces were operated upon. The facial artery and vein were the most commonly used recipient vessels (90% and 83% of patients, respectively). Commonly used alternative vessels were the transverse facial vein and superficial temporal artery. Those with congenital facial palsy were significantly more likely to lack a suitable facial vein (P=0.03) and those with a history of previous facial surgery or trauma were significantly more likely to have an absent facial artery and vein (P<0.05). Conclusions Our algorithm can help to guide vessel selection cases of facial reanimation with free functional muscle transfer. Amongst patients with congenital facial palsy or in those with a previous history of facial surgery or trauma, the facial vessels are more likely to be absent and so the surgeon should then look towards the transverse facial vein and superficial temporal artery as alternative recipient structures.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.702-708
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• 2014

Background Lower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery. Methods The vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level. Results SIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (${\pm}12.87$) mm, and -8.14 (${\pm}15.24$) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (${\pm}0.39$) mm and 1.37 (${\pm}0.33$) mm, and they were found at a mean depth of 9.75 (${\pm}2.67$) mm and 8.33 (${\pm}2.65$) mm, respectively. Conclusions The SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.505-509
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• 2013

Background The aim of this study was to collect important data on the time of oxygen saturation change in relation to skin flap color alteration using non-invasive pulse oximetry to evaluate its ability to provide continuous monitoring of skin flap perfusion. Methods An experimental study on the monitoring of blood perfusion of 20 tube-island groin flaps of 10 male New Zealand rabbits was performed using pulse oximetry. The animals were randomly assigned to one of two groups representing a blockage of either arterial or venous blood flow. The oxygen saturation change and clinical color alteration were monitored from the beginning of vessel clamping until the saturation became undetectable. The result was analyzed by the t-test using SSPS ver. 10.0. Results The mean times from the vessel clamping until the saturation became undetectable were $20.19{\pm}2.13$ seconds and $74.91{\pm}10.57$ seconds for the artery and vein clamping groups, respectively. The mean time of the clinical alteration from the beginning of vein clamping was $34.5{\pm}11.72$ minutes, while the alteration in flaps with artery clamping could not be detected until 2.5 hours after clamping. Conclusions The use of neonate-type reusable flex sensor-pulse oximetry is objective and effective in early detection of arterial and vein blockage. It provides real-time data on vessel occlusion, which in turn will allow for early salvaging. The detection periods of both arterial occlusion and venous congestion are much earlier than the color alteration one may encounter clinically.

• Archives of Plastic Surgery
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• 제49권6호
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• pp.729-739
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• 2022

Cranioplasties are common procedures in plastic surgery. The use of tissue expansion (TE) in staged cranioplasties is less common. We present two cases of cranioplasties with TE and systematically review literature describing the use of TE in staged cranioplasties and postoperative outcomes. A systematic review was performed by querying multiple databases. Eligible articles include published case series, retrospective reviews, and systematic reviews that described use of TE for staged bony cranioplasty. Data regarding study size, patient demographics, preoperative characteristics, staged procedure characteristics, and postoperative outcomes were collected. Of 755 identified publications, 26 met inclusion criteria. 85 patients underwent a staged cranioplasty with TE. Average defect size was 122 cm², and 30.9% of patients received a previous reconstruction. Average expansion period was 14.2 weeks. The most common soft tissue closures were performed with skin expansion only (75.3%), free/pedicled flap (20.1%), and skin graft (4.7%). The mean postoperative follow-up time was 23.9 months. Overall infection and local complication rates were 3.53 and 9.41%, respectively. The most common complications were cerebrospinal fluid leak (7.1%), hematoma (7.1%), implant exposure (3.5%), and infection (3.5%). Factors associated with higher complication rates include the following: use of alloplastic calvarial implants and defects of congenital etiology (p = 0.023 and 0.035, respectively). This is the first comprehensive review to describe current practices and outcomes in staged cranioplasty with TE. Adequate soft tissue coverage contributes to successful cranioplasties and TE can play a safe and effective role in selected cases.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.99-105
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• 1996

The reconstruction of esophageal defect after ablative surgery have more difficult than other digestive tract tumor because the restoration of anatomical and physiologic function is difficult, the risk of tumor invasion into the adjacent tissue is large. The reconstruction of cervical esophus was depended on the degree of resection of the esophagus, various reconstruction method was developed to minimize functional deficiency and deformity of cervical region. Recently, the free jejunal transfer or free radial forearm flap was commonly utilized for esophageal reconstruction due to development of technique of the microvascular anastomosis. After the esophageal reconstruction used by free jejunal transfer was reported by Seidenberg in 1951, jejunum is most commonly used for reconstruction of esophgus. Becaue of, it have been tubed anatomical similarity with muscular layer, relative small risk of complication, possible of oral intake within 10 days after operation, and early rehabilitaion. Authors have been treated esophageal defect with free jejunal transfer in 7 patients after resection of lesion in 6 eshageal cancer and 1 esophageal stricture from December 1994 to January 1996. We were transferred jejunum used by intercostal artery as recipient artery in 3 cases, it was satisfied with results. If intercostal artery was utilized as recipient artery for free jejunal transfer, we believe that any site of intrathoracic or intraabdominal esophageal defect is possible to recontruction.

• Journal of Periodontal and Implant Science
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• 제40권2호
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• pp.96-101
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• 2010

Purpose: The purpose of this study was to evaluate the effect of collagen matrix with apically positioned flap (APF) on the width of keratinized gingiva, comparing to the results of APF only and APF combined with free gingival graft (FGG) at the second implant surgery. Methods: Nine patients were selected from those who had received treatments at the Department of Periodontics, Chosun University Dental Hospital, Gwangju, Korea. We performed APF, APF combined with FGG, and APF combined with collagen matrix coverage respectively. Clinical evaluation of keratinized gingival was performed by measuring the distance from the gingival crest to the mucogingival junction at the mid-buccal point, using a periodontal probe before and after the surgery. Results: The ratio of an increase was 0.3, 0.6, and 0.6 for the three subjects in the APF cases, 3, 5, and 7 for the three in the APF combined with FGG case, and 1.5, 0.5, and 3 for the three in the APF combined with collagen matrix coverage case. Conclusions: This study suggests that the collagen matrix when used as a soft tissue substitute with the aim of increasing the width of keratinized tissue or mucosa, was as effective and predictable as the FGG.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.84-90
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• 2021

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5-6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1992년도 제12차 학술대회
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• pp.66-66
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• 1992

• Archives of Plastic Surgery
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• 제39권2호
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• pp.94-105
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• 2012

Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described the first applications of such flaps. Perforator flaps, whether free or pedicled, gained a high popularity due to their main advantages: decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforator flaps in lower leg was possible due to a better understanding of the cutaneous circulation, leg vascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design. This review will describe the evolution, anatomy, flap design, and technique of the main distally pedicled propeller perforator flaps used in the reconstruction of defects in the distal third of the lower leg and foot.

• Journal of Chest Surgery
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• 제34권12호
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• pp.960-963
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• 2001

거대 연골육종은 흉벽의 원발성 악성종양 중 임상에서 드물게 보는 형태이다. 60세 여자 환자가 전흉부에 발생한 거대 종양과 심막 침범 및 심장의 장측 심막에 위성 종양 등의 진행된 연골육종을 보였다. 수술은 종괴를 포함하여 양측 3개의 늑골, 양측 쇄골, 흉골자루와 흉막, 심막을 광범위 총괄절제하고, 2mm Gore-tex 포편과 광배근 자유 피부 근육판을 이용하여 흉벽을 재건하였다.