• Korean Journal of Head & Neck Oncology
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• v.1 no.1
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• pp.63-74
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• 1985

Although regional and myocutaneous flaps are still the standard in head and neck reconstruction. The capacity to transfer distant tissues by microsurgical technique expands the reconstructive surgeon's ability to restore severe deformities of the head and neck. From 1981 to 1985, thirteen patients with extensive defects of the head and neck after extirpative surgery of tumor have been reconstructed utilizing the technique of microsurgical composite tissue transplantation. In this series of patients, six presented with reconstructions in the different region of the head and neck with review of literatures. The results of case analysis are summarized as follows: 1) Transplantation was successful in twelve among thirteen patients (92%). 2) Seven patients presented with malignancy and six with benign tumor. 3) Frequent sites of reconstruction were face and mandible. 4) Fourteen free composite tissue transplantations for reconstruction of thirteen patients were obtained six different tissue compositions from eight different donor sites. 5) The recipient artery and vein was most often superficial temporal or facial vessels. 6) The average time of operation was ten hours.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.129-134
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• 1998

The ability for tissue transfer based on microvascular anastomosis has created a revolution in microsurgical free tissue transplantation. The advantages of cutaneous flaps are that they are soft, durable and provide a good cosmetic reconstruction and muscle flaps have a more vigorous blood supply and a longer, larger vascular pedicle than cutaneous flaps. From June 1992 through May 1997, 68 patients had received reconstructive microsurgery in the lower extremity at Department of Orthopedic Surgery, Chonbuk National University Hospital. The results were as follows. 1. The age distribution was from 15 years of age to 67 and male were 59 cases and female 9 cases. 2. The most common cause was traffic accident(54 cases, 79.4%) and followed chronic osteomyelitis(9 cases, 13.2%), industrial accident(3 cases, 4.4%), burn(1 case, 1.5%) and farm injury(1 case, 1.5%). 3. Latissimus dorsi myocutaneous flap were 25 cases(36.8%), rectus abdominis muscle flap 21 cases(30.9%), gracilis muscle flap 10 cases(14.7%), dorsalis pedis flap 9 cases(13.2%), groin 2(2.9%) and vascularized iliac osteocutaneous flap 1(1.5%). 4. 61 cases(89.7%) of 68 cases were survived and the exposed vital tissues and bones were covered and revealed good cosmetic results.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.14-17
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• 2005

Purpose: Authors have performed free tissue transplantation in the upper and lower extremities with sensory flaps and evaluated the sensory function recovery. Materials and methods: Between 1992 through 2004, sensory free flap articles published in the journal of the Korean microsurgical society, were reviewed and recovery of sensory function was assessed by static two-point discrimination test. Results: Static two point discrimination test showed average 6.7 mm in the thumb, average 12 mm in the hand and 7 cm of the dorsalis pedis flap, 20.5 mm of the lateral arm flap and over 8 cm of the forearm flap in the foot. Conclusion: Sensory flaps provide the protective and useful coverage in the upper and lower extremities and have benefit for activities for daily life in free tissue transferred patients.

• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.167-172
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• 2002

The only treatment method for crushed soft tissue injuries in the proximal leg involving the knee joint is the microsurgical free flap transplantation, especially latissimus dorsi myocutaneous free flap is useful to cover the extensive soft tissue defects, therefore prevents iatrogenic below knee amputation and facilitates early wound healing, early ambulation and shortens hospital stay. Authors have treated the open amputation with crushed soft tissue and bone injuries in the proximal leg, and the repeated abrasion and infectious wound with traumatic neuroma in the below knee with myocutaneous free flap and succeeded to wear below knee amputation prosthesis and return to normal activities of the daily living in the relatively shorter period than usual.

• Archives of Plastic Surgery
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• v.40 no.3
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• pp.214-219
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• 2013

Background We established the Microvascular Research Center Training Program (MRCP) to help trainee surgeons acquire and develop microsurgical skills. Medical students were recruited to undergo the MRCP to assess the effectiveness of the MRCP for trainee surgeons. Methods Twenty-two medical students with no prior microsurgical experience, who completed the course from 2005 to 2012, were included. The MRCP comprises 5 stages of training, each with specific passing requirements. Stages 1 and 2 involve anastomosing silicone tubes and blood vessels of chicken carcasses, respectively, within 20 minutes. Stage 3 involves anastomosing the femoral artery and vein of live rats with a 1-day patency rate of >80%. Stage 4 requires replantation of free superficial inferior epigastric artery flaps in rats with a 7-day success rate of >80%. Stage 5 involves successful completion of one case of rat replantation/transplantation. We calculated the passing rate for each stage and recorded the number of anastomoses required to pass stages 3 and 4. Results The passing rates were 100% (22/22) for stages 1 and 2, 86.4% (19/22) for stage 3, 59.1% (13/22) for stage 4, and 55.0% (11/20) for stage 5. The number of anastomoses performed was $17.2{\pm}12.2$ in stage 3 and $11.3{\pm}8.1$ in stage 4. Conclusions Majority of the medical students who undertook the MRCP acquired basic microsurgical skills. Thus, we conclude that the MRCP is an effective microsurgery training program for trainee surgeons.

• 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 Reconstructive Microsurgery
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• v.1 no.1
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• pp.9-16
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• 1992

Volkmann's ischemic contracture is the end result of an untreated, delayed or Inadequately decompressed compartment syndrome in which muscle ischemia and necrosis have occurred. Once the muscle necrosis have happened, the involved muscle undergo permanent change into fibrous tissue. So secondary shortening and distal joint contracture will be a final outcome, which results in marked functional impairment of hand and forearm. Even though several procedures, such as muscle sliding operation has been attempted, overall results were far from satisfaction, compare to healthy opposite hand. The management of these unfavorable condition of the forearm and hand was regarded as one of challenging area in orthopedics. Recently new approach, using microsurgical technique which transfers functioning muscle unit, has been developed and its result was much better than any other methods in the aspect of an active motion. Among these musculocutaneous free flaps, gracilis has obtained special reputation due to its easiness to handle such as elevation of flap and reliable neurovascular pedicle. Other advantages are flexibility of flap size to adjust variable size of the defect in the forearm and minor morbidity of the donor site. Authors have performed 7 cases of functioning gracilis musulocutaneous free flap transplantation for the functional loss of forearm and hand due to Volkmann's ischemic contracture or muscle and skin defect due to severe trauma since November, 1981 till May, 1991. The results in most cases were satisfactory and acceptable.

• Archives of Reconstructive Microsurgery
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• v.4 no.1
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• pp.9-15
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• 1995

Free vascularized composite tissue transfer is more frequently underwent for reconstruction of complicated tissue defects with the recent advance of microsurgery. But postoperative result was not satifactory because of donor site morbidity, flap bulkiness and cosmetic problem. So would no longer be a problem if we can obtain the exact donor tissue required for the recipient site as allotransplantation and designing the flap. Allotransplantation has been resolved with the recent development of immunosuppressive agents, while reconstruction has made great progress with the refinement of microsurgical techniques in the last 20 years. The final sucess or failure of the operative procedure in transplantation is so utterly dependent no the availability of strategies that can control the immune system effectively, selectively, safely to allow allotransplantation of a nonvital body part. 1 used 2 strains of rats, BUF and LEW, for the limb allotransplantation as a composite tissue transfer. The primary goal of this program is to improve results in clinical transplantation by accelerating the transformation of new immunological knowledge into useful medicine. Two of the most promising new immunosuppressive compounds are FK-t06(FK) and rapamycin(RPM). Both drugs are antibiotic macrolide fungal fermentation products that presumably suppress the immune system in ways similar to cyclosporin(CyA). This study shows that two new immunosuppressive drugs compare the immunosuppressive activity and effectiveness of FK-506 and RPM for prevention of the limb allograft rejection in the rat. Additional experiments investigate the dose, route of administration and histologic findings. These data demonstrates that rapamycin is far more potent and effective than FK-506 when both compounds are administered by the intraperitoneal route, as well as prolonged graft survival significantly in a dose-route dependent manner. These results lead to the view that vascularized allograft composite tissue transfer can become a reality with the expectation of possible future application in reconstructive surgery of humans.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.2
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• pp.269-278
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• 1996

To overcome the limitations of conventional microsurgical tissue transfer, experimental creation of various neo-flaps using the vessel implantation technique has been reported. We have performed some experiments of fabrication of neo-osseous flap with local vessels and iliac bone slabs to know that the flap vascularity and neo-angiogenesis are achieved enough to microtransfer. As a next step of our previous experiments, the flap viability and the histologic change between the recipient bone and neo-oseous flap was assessed after microsurgical transplantation. The flap was created on the rabbit femoral region(n=25) using femoral vessel and the iliac bone segments($2.5{\times}1.5cm$ in size). Three weeks after neovascularization, the newly formed flap was harvested and microtransferred to the mandibular defect. As a control, contralateral mandibular defect was created and reconstructed with conventional free iliac bone graft. Scintigrams of experimental group performed 3 days after microtransfer showed hot uptake, while that of control poor uptake. Histologic and vital stain labeling study revealed good bone viability and vascularity of neo-osseous flap. In conclusion, prefabricated neo-osseous flap of our model could be transferred to the recipient site with retaining the flap viability and showed advantages over the conventional bone graft in that it was living bone graft.