• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.1-5
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• 2000

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.114-121
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• 1998

The purpose of this study is to investigate the appropriate management of severe radionecrotic wounds of the anterior chest wall associated with infection of the soft tissues and ribs and exposure of vital structures(heart and lung), and present our strategies for reconstruction of these complicated patients. 9 patients have undergone radical debridement and immediate microsurgical reconstruction for severe radionecrotic wounds of the anterior chest wall over last 7 years. All patients had extensive osteomyelitis of the ribs or sternum, and chronic infection or cutaneous fistulae. 2 patients had pericardial effusions due to longstanding inflammation, and 6 patients had pleural effusions. 2 patients had ipsilateral lung collapse. 10 free flaps were performed for coverage of the huge defects. One patient required 2 free flaps to control the inflammation. 8 free TRAM flaps were used for coverage of the defects and in addition, the rectus abdominis muscle was packed into any deep cavity. 1 patients underwent latissimus dorsi muscle free flap because of previous abdominal surgery. After extensive debridement of the infected, radionecrotic wounds, all 10 free flaps were successful. All the extensive radionecrotic defects of the anterior chest wall were completely healed. Free flaps successfully covered the exposed vital structures of the heart and lungs. Patients with severe radionecrotic defects of the anterior chest wall after ablative breast cancer surgery and radiotherapy were successfully treated by radical debridement and immediate free flap surgery. The TRAM flap together with the rectus muscle is the treatment of choice for these huge defects. The latissimus dorsi muscle flap was the second choice in patients with previous abdominal surgery. The recipient vessel should be carefully selected because of possible radiation damage and inflammation.

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.29.1-29.7
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• 2020

Background: Microvascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery. Methods: This study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed. Results: Four different flap types were used for microvascular reconstruction: radial forearm (n = 65), fibula (n = 34), latissimus dorsi (n = 21), and serratus anterior muscle with rib bone free flap (n = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min. Conclusions: The success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.

• Archives of Reconstructive Microsurgery
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• v.20 no.1
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• pp.1-7
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• 2011

The aim of extremity reconstruction has focused on early wound coverage and functional recovery but rarely aesthetics. As the quality of life improves, however, the request for aesthetics has been growing. The authors has conducted retrospective reviews on the 86 cases that had extremity reconstruction using free flap, considering the characteristics of parts that had been assessed in primary operation between May 1996 and December 2010. Aesthetic grading was performed in four categories; color, texture, contour and marginal scar. Recipient sites were 42 hands, 19 feet, 14 lower extremities excluding feet and 10 upper extremities apart from the hand. Types of free flap were 16 latissimus dorsi free flaps, 13 anterolateral thigh free flaps, 12 dorsalis pedis free flaps, 8 transvers rectus abdominis free flaps, 7 gracillis free flaps, and 5 superficial temporal fascia free flaps. Total flap necrosis was seen in 8 cases(9.3%) and partial necrosis in 5 cases(5.8%). Secondary revision was done in 24 cases(27.9%) and the most common revision, debulking was done in 14 cases(16.3%). The authors has considered cosmetic aspects along with wound coverage and functional recovery in primary reconstruction. The results of aesthetic grading was 16.2 out of 20, and the secondary revision rate was reduced.

• 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.

• Journal of International Society for Simulation Surgery
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• v.3 no.1
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• pp.12-15
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• 2016

Functional and esthetic reconstruction after segmental mandibulectomy is one of the most challenging surgeries in microsurgical reconstruction field. Simulation surgery before free flap reconstruction has been performed for efficient surgery and successful results. Fibula free flap is the flap of the choice for reconstruction of the segmental mandibular defect. Straight nature of the fibula bone requires multiple segmentations to fit into mandible. 3D rapid prototype (RP) model gives a lot of information for mandibular reconstruction. The purpose of this study was to report mandibular reconstruction with free fibular flap using simulation surgery. A total of 30 consecutive patients were included for functional and esthetic evaluation. Among 30 patients, two flaps showed necrosis after radiotherapy. The other flaps were all survived and showed successful reconstruction in both function and esthetics.

• Archives of Plastic Surgery
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• v.45 no.2
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• pp.180-184
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• 2018

Breast deformity, in post-burn patients, is a common problem leading to lower self-esteem and reclusive behavior that impairs quality of life. The authors present the course of treatment of an 18-year-old immigrant girl who suffered second- to third-degree burns over approximately 20% of her total body surface area in her early childhood. The second- to third-degree burns were located on her right trunk and abdomen, as well as her right shoulder, neck, and right groin area. Since it was not offered in her home country, reconstructive surgery, including microsurgical breast reconstruction, was sought abroad. Due to the lack of available skin and soft tissue, a bilateral breast reconstruction with free transverse myocutaneous gracilis flaps was offered. This case illustrates one method of using microsurgery to address post-burn breast deformities in order to alleviate psychological suffering and improve quality of life.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.121-126
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• 2021

Background Despite the wide demand for thin flaps for various types of extremity reconstruction, the thin elevation technique for anterolateral thigh (ALT) flaps is not very popular because of its technical difficulty and safety concerns. This study proposes a novel perforator-centralizing technique for super-thin ALT flaps and analyzes its effects in comparison with a skewed-perforator group. Methods From June 2018 to January 2020, 41 patients who required coverage of various types of defects with a single perforator-based super-thin ALT free flap were enrolled. The incidence of partial necrosis and proportion of the necrotic area were analyzed on postoperative day 20 according to the location of superficial penetrating perforators along the flap. The centralized-perforator group was defined as having a perforator anchored to the middle third of the x- and y-axes of the flap, while the skewed-perforator group was defined as having a perforator anchored outside of the middle third of the x- and y-axes of the flap. Results No statistically significant difference in flap thickness and dimension was found between the two groups. The arterial and venous anastomosis patterns of patients in both groups were not significantly different. Only the mean partial necrotic area showed a statistically significant difference between the two groups (centralized-perforator group, 3.4%±2.2%; skewed-perforator group, 15.8%±8.6%; P=0.022). Conclusions The present study demonstrated that super-thin ALT perforator flaps can be elevated safely, with minimal partial necrosis, using the perforator-centralizing technique.

• 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.