• Archives of Plastic Surgery
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• v.47 no.5
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• pp.382-391
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• 2020

Facial palsy has a broad clinical presentation and the effects on psychosocial interaction and facial functions can be devastating. Pediatric facial palsy, in particular, introduces unique familial and technical considerations as anatomy, future growth potential, and patient participation influence treatment planning. Though some etiologies of pediatric facial palsy are self-limiting, congenital and long-standing facial palsies pose difficult challenges that require a combination of surgical, adjunctive, and rehabilitative techniques to achieve facial reanimation. Given the spectrum of ages and symptom severity, as well as the various surgical options available for facial palsy, a tailored approach needs to be developed for each child to restore facial balance and function. Here, we review the etiologies, workup, and treatment of pediatric facial palsy and present our novel algorithmic approach to treatment.

• Proceedings of the Korean Society for Food Science of Animal Resources Conference
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• 2006.05a
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• pp.192-195
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• 2006

Current study was conducted to investigate the effect of different hanging techniques (achilles tendon, aitch bone and pelvic ligament) on variations in sarcomere length and palatability within and between muscles using thirty-four Angus steer sides. Results showed that tenderstretch(by either suspension method) resulted in longer sarcomeres for most positions within the major leg muscle than did conventional hanging method, but in some minor muscles(eg., mm. gluteus profundus, gastronemius, and gracilis) tenderstetch allowed the muscles fibres to shorten. Some tenderstretched muscles(e.g., m. gluteus profundus, 1.5 ${\mu}m$) appeared not to toughen even at very low sarcomere lengths, while others toughened at higher sarcomere lengths. The current data demonstrated that the effect of tenderstretch on the length of sarcomeres and its influence on palatability varied between muscles, Overall the difference between the two tenderstretch methods was for the aitch method to produce meat that was 3.2 units more palatable than the ligament hanging method.

• Archives of Plastic Surgery
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• v.41 no.4
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• pp.387-393
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• 2014

Background Reconstruction of ischial pressure sore defects is challenging due to extensive bursas and high recurrence rates. In this study, we simultaneously applied a muscle flap that covered the exposed ischium and large bursa with sufficient muscular volume and a profunda femoris artery perforator fasciocutaneous flap for the management of ischial pressure sores. Methods We retrospectively analyzed data from 14 patients (16 ischial sores) whose ischial defects had been reconstructed using both a profunda femoris artery perforator flap and a muscle flap between January 2006 and February 2014. We compared patient characteristics, operative procedure, and clinical course. Results All flaps survived the entire follow-up period. Seven patients (50%) had a history of surgery at the site of the ischial pressure sore. The mean age of the patients included was 52.8 years (range, 18-85 years). The mean follow-up period was 27.9 months (range, 3-57 months). In two patients, a biceps femoris muscle flap was used, while a gracilis muscle flap was used in the remaining patients. In four cases (25%), wound dehiscence occurred, but healed without further complication after resuturing. Additionally, congestion occurred in one case (6%), but resolved with conservative treatment. Among 16 cases, there was only one (6%) recurrence at 34 months. Conclusions The combination of a profunda femoris artery perforator fasciocutaneous flap and muscle flap for the treatment of ischial pressure sores provided pliability, adequate bulkiness and few long-term complications. Therefore, this may be used as an alternative treatment method for ischial pressure sores.

• 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.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.591-596
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• 2009

Purpose: To reconstruct soft tissue defect on lower extremity especially combined with osteomyelitis, free flap with enough blood supplies is required. There are some instance when patients have inadequate recipient vessels for microanastomosis. Anastomosis with harvested vein graft can solve the problem. It may be more problematic or even increase recipient site complication. Cross leg free flaps using contra - lateral vessel can be a solution. Methods: From 2005 to 2008, 12 cases of cross leg free flap were done for 12 patients(male = 9, female = 3). External fixators used in all cases. Free flaps used were laissmus dorsi muscle flap(n=5), anterolateral thigh flap(n=4), gracilis muscle flap(n=2) and medial plantar artery fasciotaneous flap(n=1). In all cases, contralateral posterior tibial artery and vein were used as recipient pedicle. Results: All flaps survived without additional operative procedures. There were no complications such as hematoma or Infection. Sometimes patients needs further therapeutic exercise for fast movement recovery. Conclusion: Although cross leg free flaps require long period of bed resting and rehabilitation after pedicle cutting, It can be practical alternative for soft tissue defect on lower distal extremity with inadequate recipient vessels for free flap on affected leg.

• Journal of Yeungnam Medical Science
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• v.14 no.1
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• pp.227-236
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• 1997

발꿈치는 신체의 다른부위에 비하여 엄청난 하중을 지탱하고 있으며, 주행시에는 막대한 전단력을 받으므로 그 재건에 있어서 어려운 점이 있다. 그 동안 발꿈치의 연부조직 결손을 재건하기 위한 많은 방법들이 개발되어 왔지만, 비교적 큰 발꿈치의 연부조직 결손을 재건하는 것은 아직도 쉬운 일이 아니다. 이처럼 큰 결손의 재건에는 주로 유리 피판술을 이용한 재건술을 사용하는데, 그 중에서도 광배근, 복직근, 대퇴박근 등의 근육을 이용하는 방법이 최근에 많이 이용되고 있다. 이와 같은 유리 근 피판에 피부이식을 이용하는 발꿈치 재건술은 표재성 감각기능을 재건하지 못하는 것이 단점으로 지적되고 있으나, 보행 또는 주행시 발꿈치에 가해지는 압력과 전단력을 효과적으로 견디어 낼 뿐아니라, 외관상으로도 정상에 가까운 발꿈치를 재건할 수가 있어서 좋은 방법으로 인정되고 있다. 특히, 대퇴박근은 피판을 비교적 쉽게 채취할 수 있고, 공여부에 기능적인 장애나 심한 변형을 남기지 않아서 좋은 방법이라 생각된다. 다만 크기가 비교적 작아서, 발등이나 족관절 상부에까지 이르는 광범위한 연부조직 결손에서는 사용할 수 없는 점이 아쉽다. 저자는 비교적 가늘고 긴, 대퇴박근의 형태적 특징을 최대한 이용하여, 결손부의 다양한 형태 및 크기에 따라 대퇴박근을 말발굽형, 나선형, S-자형 등으로 적절히 형상화하여 발꿈치 결손을 효과적으로 재건하는 방법을 고안하였다. 또한, 공여부에 긴 선상 반흔이 남는 것을 피하기 위하여 두 개의 작은 절개를 통해서 대퇴박근을 채취하였다. 이 방법을 이용하여 영남대학교 의과대학 성형외과학 교실에서는 1993년 이후부터 7명의 비교적 큰 발꿈치의 연부조직 결손 환자를 대상으로 유리 대퇴박근 피판술을 이용한 재건술로 성공적인 결과를 얻을 수 있었다.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.1-6
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• 2001

Free flap transplantation demands meticulous microsurgical technique to cover the exposed vital structures which is important to restore and maintain functions of the extremities. From July 1992 through December 2000, 99 patients were received reconstructive microsurgery in the upper and lower extremity at Department of Orthopedic Surgery, Chonbuk National University Hospital. The most common cause in the upper extremity was industrial accident, 8 cases of total 15 cases and in the lower extremity was traffic accident, 66 cases of total 84 cases. The most commonly involved site was thumb and finger, 8 cases of total 15 cases and in the lower extremity was leg, 65 cases of total 84 cases. In upper extremity, the wrap around free flap was carried out in 4 cases(4.0%), first dorsal metatarsal artery flap and lateral arm flap were 3 cases(3.0%) each in 15 cases and in lower extremity, latissimus dorsi myocutaneous flap were 23 cases(23.2%), gracilis 20cases(20.2%), and rectus abdominis muscle flap 18(18.2%) in 84 cases. Overall 89 cases(89.9%) of 99 cases were survived and maintained and revealed good cosmetic results.

• 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 Reconstructive Microsurgery
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• v.8 no.2
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• pp.176-183
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• 1999

Chronic osteomyelitis have been treated with wound dressing and antibiotics therapy often results in healing but foul odor pus discharges from the fibrotic soft tissues reactivates and requires appropriate control of the infection. Debridement of the wound, curettage and sequestrectomy, bone graft and immediate free flap transplantation is the curative protocol for the chronic osteomyelitis in the lower extremity. Authors have treated 7 cases of chronic osteomyelitis in the lower extremity with microsurgical free tissue transplantation at Department of Orthopedic Surgery, Chonbuk National University Hospital from December 1993 through February 1998. The results are as follows. 1. The chronic osteomyelitis occurred in tibial shaft in 4 cases, in calcaneus 2 cases and in femur 1 case. 2. Duration of the chronic osteomyelitis was at average 31.6 years. 3. Squamous cell carcinoma in the surrounding fibrotic tissue was biopsied in 1 case. 4. 4 cases had no trauma and occurred through hematogenous infection and 3 cases had fracture trauma. 5. Wound debridement and immediate free muscle transplantation had done in 5 cases and wound debridement, sequestrectomy and immediate free muscle transplantation in 2 cases. 6. Rectus abdominis muscle transplantation had peformed in 4 cases(57.1%), latissimus dorsi mucle 1 case(14.3%), latissimus dorsi myocutaneous 1 case(14.3%) and gracilis 1 case (14.3%). 6 cases of 7 were success(85.7%). 7. 1 case of failed latissimus dorsi musculocutaneous flap in thigh had done above knee amputation and 1 case of chronic posttraumatic osteoarthritis of the ankle joint had done below knee amputation at other hospital.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.327-334
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• 2005

This study was designed to investigate the effect of the surgical delay in the prefabricated cutaneous flap. Abdominal skin flaps (n=40), $4.5{\times}6.0cm$ in size, were created by the subcutaneous implantation of a saphenous vascular tissue in the male Sprague-Dawley rats. In the groups 1 and 2, the pedicle was skeletonized. In the groups 3 and 4, perivascular muscle cuff or gracilis fascia was retained, respectively. Six weeks later, each flap was elevated as an island flap and reposed in place. All flaps of the group 2 had a 72-hours of delay period. Five days after the flap repositioning, estimation of flap viability, microangiographies, and histological evaluation of vessel development were performed. The groups 2 and 3 showed higher viability in flap survival. The dilated choke vessels and fully developed vascular network were observed in the flap of the group 2, but not typically seen in the other groups. New vessels around the implanted pedicle were more developed in the group 2. Amount of the vessels in the mid-portion of the flap was significantly increased in the groups 2 and 4. In conclusion, the delay procedure enhanced the viability, and its effect was dependent on the new vessel formation around the implanted pedicle.