• Archives of Craniofacial Surgery
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• v.14 no.2
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• pp.107-110
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• 2013

Background: Basal cell carcinoma (BCC) is the most common skin cancer. About 74% cases of basal cell cancer occur on the head and neck. Basal cell carcinoma on the face may have a higher degree of subclinical spread than tumors arising elsewhere. And incompletely excised BCCs become more aggressive when they recur. So the surgical removal and reconstruction of BCC located on the face are important to make perfect curing and cosmetic results. Methods: A retrospective study was done with 128 patients (137 cancers) who were treated with BCC on the face since 1987 to 2011. General data of these cases such as the primary site of cancer, age and sex of the patients, operative methods, and recurrence rate were reviewed. Results: The ratio of men to women was 1:1.4. And 86.9% of the patients with BCC were older than the age of 50 years with the mean age of 65.8 years. The distribution of facial basal cell carcinoma was on the nose, eyelids, cheek, and nasolabial fold. Surgical methods for treatment were local flap, full thickness skin graft, primary closure, and split thickness skin graft. Specifically, local flap consists of V-Y advancement flap, cheek advancement flap, limberg flap, forehead flap, nasolabial flap, rotation flap, transposition flap, bilobed flap, and island flap. Six cases recurred and all of them were treated with reoperation. Conclusion: The authors reviewed facial basal cell carcinoma cases in our hospital. This study might be helpful to choose appropriate operation method to manage BCC on face in Korea.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.36-40
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• 2002

Purpose : Our clinical experiences in distally based sural artery island flap is presented to show the usefulness and the reliability as an alternative to flaps currently used for defect in lower extremity. Materials and Methods : From February 1998 to September 2001, nine cases of soft tissue defects in the lower leg, the foot, and around the ankle were treated with distally based sural artery island flap. The cause of the wound was trauma in 6 cases, and osteomyelitis in 3 cases. Defects were located at the lower leg in 2 cases, at the foot in 3 cases and around the ankle in 4 cases. The results were retrospectively analyzed. Results : The defect size ranged from $3{\times}3cm\;to\;20{\times}3cm$. Among 9 cases, 7 cases survived and 2 cases were failed. Flap failure was due to not including the deep fascia in one case and due to extensive soft tissue damage in the other case. Both failed cases were reoperated with the split thickness skin graft. Conclusion : The advantages of distally based sural artery island flap follows (1) reliable blood supply, (2) ease of flap elevation, (3) preservation of the major arteries, (4) less donor site morbidity. Owing to the advantages of this flap, we think it is useful for the soft tissue coverage of the lower leg, the foot and around the ankle. Also we believe it will continue to gain acceptance and use in the majority of lower leg reconstruction.

• Archives of Craniofacial Surgery
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• v.15 no.3
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• pp.133-137
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• 2014

Reconstruction of a full-thickness alar defect requires independent blood supplies to the inner and outer surfaces. Because of this, secondary operations are commonly needed for the division of skin flap from its origin. Here, we report a single-stage reconstruction of full-thickness alar defect, which was made possible by the use of a nasolabial island flap and septal mucosal hinge flap. A 49-year-old female had presented with a squamous cell carcinoma of the right ala which was invading through the mucosa. The lesion was excised with a 5-mm free margin through the full-thickness of ala. The lining and cartilage was restored using a septal mucosa hinge flap and a conchal cartilage from the ipsilateral ear. The superficial surface was covered with a nasolabial island flap based on a perforator from the angular artery. The three separate tissue layers were reconstructed as a single subunit, and no secondary operations were necessary. Single-stage reconstruction of the alar subunit was made possible by the use of a nasolabial island flap and septal mucosal hinge flap. Further studies are needed to compare long-term outcomes following single-stage and multi-stage reconstructions.

• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.146-152
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• 2002

As the defects of the penis caused by trauma, surgical amputation, or congenital abnormality give the patients both psychological trauma and functional impairment, reconstruction of the penis is mandatory. Radial forearm free flap is reliable one-stage procedure, which can reconstruct both the phallus and the urethra. Chang and Whang's adaptation of the "tube-in-a-tube" concept and its incorporation into a free flap design represented a major advance in microsurgical phallic construction. Biemer described a modification of the radial forearm flap design in which the neourethra was centered over the radial artery, but the phallic shaft was separated into two paraurethral swatches. The authors have performed one-stage penile reconstruction in two patients since 1998, using a radial forearm free flap. Our present design incorporates the original Biemer triple skin island and includes a fourth distal island for neoglans. One case was the amputation of the penis from felonious assault and the other case was the iatrogenic penile amputation from repetitive urologic surgery for congenital hypospadia. All patients showed aesthetically acceptable results and good tactile sensory recovery. Severe complications such as necrosis, fistula, or urethral stricture were not occurred. Biemer's method modified by the authors is reliable one-stage penile reconstruction providing good aesthetic and functional results.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.894-898
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• 2011

Purpose: Coverage of full-thickness large flank defect is a challenging procedure for plastic surgeons. Some authors have reported external oblique turnover muscle flap with skin grafting, inferiorly based rectus abdominis musculocutaneous flap, and two independent pedicled perforator flaps for flank reconstruction. But these flaps can cover only certain portions of the flank and may not be helpful for larger or more lateral defects. We report a case of large flank defect after resection of extraskeletal Ewing's sarcoma which is successfully reconstructed with reverse latissimus dorsi myocutaneous flap. Methods: A 24-year-old male patient had $13.0{\times}7.0{\times}14.0$ cm sized Ewing's sarcoma on his right flank area. Department of chest surgery and general surgery operation team resected the mass with 5.0 cm safety margin. Tenth, eleventh and twelfth ribs, latissimus dorsi muscle, internal and external oblique muscles and peritoneum were partially resected. The peritoneal defect was repaired with double layer of Prolene mesh by general surgeons. $24{\times}25$ cm sized soft tissue defect was noted and the authors designed reverse latissimus dorsi myocutaneous flap with $21{\times}10$ cm sized skin island on right back area. To achieve sufficient arc of rotation, the cephalic border of the origin of latissimus dorsi muscle was divided, and during this procedure, ninth intercostal vessels were also divided. The thoracodorsal vessels were ligated for 15 minutes before divided to validate sufficient vascular supply of the flap by intercostal arteries. Results: Mild congestion was found on distal portion of the skin island on the next day of operation but improved in two days with conservative management. Stitches were removed in postoperative 3 weeks. The flap was totally viable. Conclusion: The authors reconstructed large soft tissue defect on right flank area successfully with reverse latissimus dorsi myocutaneous flap even though ninth intercostal vessel that partially nourishes the flap was divided. The reverse latissimus dorsi myocutaneous flap can be used for coverage of large soft tissue defects on flank area as well as lower back area.

• Archives of Plastic Surgery
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• v.42 no.1
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• pp.40-45
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• 2015

Background The eyelid and canthal areas are common locations for cutaneous tumors. The medial canthus includes, among many other apparatuses, the canthal tendon and lacrimal canaliculi, and its characteristic thin and supple skin is hard to mimic and restore using tissue from other regions. Accordingly, reconstruction of the canthal area can prove challenging for surgeons. Although various methods, such as skin grafts and local flaps from adjacent regions, have been utilized for reconstructive purposes, they present known disadvantages. However, we were able to successfully reconstruct both lateral and medial canthal area defects by using orbicularis oculi myocutaneous island flaps. Methods Our study included seven patients who underwent medial or lateral canthal region reconstruction, using orbicularis oculi myocutaneous island flaps, between 2011 and 2014, following either cutaneous tumor excision or traumatic avulsion injury. Results Five patients had basal cell carcinoma, one had squamous cell carcinoma of the eyelid, and one had sustained a traumatic avulsion injury of the eyelid and canthal area. Entire flap loss was not observed in any patient, but one-a heavy smoker-showed partial flap loss, which healed with secondary intention and yielded acceptable results. Donor site morbidity was not observed, and all patients were satisfied with their surgical outcomes. Conclusions The canthal regions can be successfully reconstructed with orbicularis oculi myocutaneous island flaps. These flaps offer several key advantages, including similarity in texture, color, and thickness to the recipient site and a negligible incidence of donor site morbidity.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.669-674
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• 2008

Purpose: Although there are many ways to perform midface reconstruction, several difficulties exist for selecting the appropriate method, because of its anatomical and functional complexities, donor site morbidities, and poor aesthetic results. Various flaps based on the angular artery can overcome these limitations of the traditional reconstruction methods. The purpose of this study is to suggest an alternative reconstructive method for the midface using various flaps based on the angular artery. Methods: We investigated the relationship between the angular artery and its surrounding structures through cadaveric studies and then applied the findings clinically. As a result, we were able to perform reconstruction with a retroangular flap for defects of the lower half of the nose and the lower eyelid. In addition, defects of the upper half of the nose and the medial canthal area were reconstructed by using island composite glabellar flap. Results: The angular artery was reliable as a pedicle, whether it was used antegrade or retrograde. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The aesthetic outcomes for the donor and recipient sites were satisfactory. Conclusion: The angular artery has diverse relationships with its surrounding structures according to its course of travel, and if a surgeon has a precise understanding of its anatomical location, we believe that retroangular flap and island composite glabellar flap may improve the treatment of midface defects.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.129-136
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• 2010

Purpose: Anatomically, the foot is provided with insufficient blood supply and is relatively vulnerable to venous congestion compared to other parts of the body. Soft tissue defects are more difficult to manage and palliative treatments can cause hyperkeratosis or ulcer formation, which subsequently requires repeated surgeries. For weight bearing area such as the heel, not only is it important to provide wound coverage but also to restore the protective senses. In these cases, application of flaps for hind foot reconstruction is widely recognized as an effective treatment. In this study, we report the cases of soft tissue reconstruction for which various types of flaps were used to produce good results in both functional and cosmetic aspects. Methods: Data from 37 cases of hind foot operation utilizing flaps performed between from June 2000 to June 2008 were analyzed. Results: Burn related factors were the most common cause of defects, accounting for 19 cases. In addition, chronic ulceration was responsible for 8 cases and so forth. Types of flaps used for the operations, listed in descending order are radial forearm free flap (18), medial plantar island flap (6), rotation flap (5), sural island flap (3), anterolateral thigh free flap (2), lattisimus dorsi muscular flap (2), and contra lateral medial plantar free flap (1). 37 cases were successful, but 8 cases required skin graft due to partial necrosis in small areas. Conclusion : Hind foot reconstruction surgeries that utilize flaps are advantageous in protecting the internal structure, restoring functions, and achieving proper contour aesthetically. Generally, medial plantar skin is preferred because of the anatomical characteristics of the foot (e.g. fibrous septa, soft tissue for cushion). However alternative methods must be applied for defects larger than medial plantar skin and cases in which injuries exist in the flap donor / recipient site (scars in the vicinity of the wound, combined vascular injury). We used various types of flaps including radial forearm neurosensory free flap in order to reconstruct hind foot defects, and report good results in both functional and cosmetic aspects.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.112-116
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• 2017

The ideal scalp reconstruction involves closure of the defect with similar hair-bearing local tissue in a single step. Various reconstructions can be used including primary closure, secondary healing, skin grafts, local flaps, and microvascular tissue transfer. A 53-year-old female patient suffered glioblastoma, which had recurred for the second time. The neuro-surgeons performed radial debridement and an additional resection of the tumor, followed by reconstruction using a serratus anterior muscle flap with a split-thickness skin graft. Unfortunately, the flap became completely useless and a bilateral rotation flap was used to cover the defect. Two month later, seroma with infection was found due to recurrence of the tumor. Additional surgery was performed using multiple perforator based island flap. The patient was discharged two weeks after surgery without any complications, but two months later, the patient died. Radical surgical resection of tumor is the most important curative option, followed by functional and aesthetic reconstruction. We describe a patient with a highly malignant tumor that required multiple resections and subsequent reconstruction. Repeated recurrences of the tumor led to the failure of reconstruction and our strategy inevitably changed, from reconstruction to palliative treatment involving fast and stable wound closure for the patient's comfort.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.13-18
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• 2010

Purpose: Nasal defect can be caused by excision of tumor, trauma, inflammation from foreign body reaction. Nose is located in the middle of face and protruded, reconstruction should be done in harmony with size, shape, color, and textures. We report various methods of nasal reconstruction using local flaps. Methods: From March 1998 to July 2008, 36 patients were operated to reconstruct the nasal defects. Causes of the nasal defects were tumor (18 cases), trauma (11 cases), inflammation from foreign body reaction (5 cases) and congenital malformation (2 cases). The sites of the defects were ala (22 cases), nasal tip (8 cases) and dorsum (6 cases). The thickness of the defects was skin only (5 cases), dermis and cartilagenous layer (7 cases) and full-thickness (24 cases). According to the sites and thickness of the defects, various local flaps were used. Most of alar defects were covered by nasolabial flaps or bilobed flaps and the majority of dorsal and tip defects were covered by paramedian forehead flaps. Small defects below $0.25 cm^2$ were covered with composite graft or full-thickness skin graft. Results: The follow-up period was 14 months. Partial flap necrosis was observed in a case, and one case of infection was reported, it was improved by wound revision and antibiotics. Nasal reconstruction with various local flaps could provide satisfactory results in terms of color and texture match. Conclusion: The important factors of nasal reconstruction are the shape of reconstructed nose, color, and texture. Nasolabial flap is appropriate method for alar or columellar reconstruction and nasolabial island flap is suitable for tip defect. The defect located lateral wall could be reconstructed with bilobed flap for natural color and texture. Skin graft should be considered when the defect could not afford to be covered by adjacent local flap. And entire nasal defect or large defect could be reconstructed by paramedian forehead flap.