• Archives of Plastic Surgery
• /
• v.34 no.1
• /
• pp.44-51
• /
• 2007

Purpose: Blow-out fracture is one of the most common fractures in facial trauma. It is diagnosed by Computed Tomography(CT) scan, which is considered as the most effective diagnostic tool. Since, the Picture Archiving Communication System(PACS) has been provided recently to many hospitals, doctors are more familiar with imaging software of PACS. Because this software has many useful measuring tools, doctors can measure orbital structure easily and make a plan for treatment with its data. Therefore, authors intended to analyze the data of orbital structure measured with PACS imaging software and evaluate its usefulness. Methods: The charts and CT images of 100 patients, which were 50 patients with medial wall fracture and 50 patients with floor fracture, were reviewed. Patients were selected by pre-determined criteria and their CT images were measured with image software of PACS. 'Extraocular muscle thickness', 'Defect ratio'(ratio of defect area to normal area) and 'Globe position index' were measured and analyzed statistically. Results: The thickness of inferior rectus muscle and medial rectus muscle was simultaneously increased in acute-stage of blow-out fracture. The medial rectus muscle was more thickened in medial wall fracture and inferior rectus was more thickened in floor fracture, respectively. In acute blow-out fracture, globe position is exophthalmic rather than enophthalmic. Especially in floor fracture, numerical value summed up thickness of all extraocular muscle is correlated to the defect ratio and globe position index. Conclusion: Clinicians can decide globe position or presume defect ratio in inferior wall fracture by measurement of CT image in acute blow-out fracture using PACS.

• Journal of Trauma and Injury
• /
• v.20 no.2
• /
• pp.119-124
• /
• 2007

Purpose: Management of the soft tissue defect in the lower extremity caused by trauma has always been difficult. Coverage with local and free muscle flaps after complete surgical excision of necrotic soft tissue and bone is a major strategy for treatment. There is no doubt that muscle provides a good blood supply, thus improving bone healing and increasing resistance to bacterial inoculation. However, accompanying problems are seen in cases with shallow dead space. This research was conducted to assess the efficacy of raising anterolateral thigh flaps and transferring them to the defect after complete debridement of non-viable, infected, and scar tissue as an alternative way to use local or free muscle flaps. Methods: From March 2005 to October 2007, 18 cases of soft tissue defect on lower extremities were re-surfaced with an anterolateral thigh perforator free flap. Results: The follow-up period ranged from 1 to 31 months with a mean of 15.9 months. All flaps survived completely. Satisfactory aesthetic and functional results were achieved. Under a two-point discrimination test, 13 patients had sensory recovery from 11 mm to 20 mm after 6 months postoperatively. Conclusion: Reconstruction of the lower extremity with anterolateral thigh perforator free flaps after appropriate debridement is a good alternative way to use local or free muscle flaps.

• Archives of Plastic Surgery
• /
• v.35 no.4
• /
• pp.487-490
• /
• 2008

Purpose: The latissimus dorsi flap and the serratus anterior flap have been used as combined flaps to reconstruct extensive defects. Because these two muscles are usually supplied by the subscapular-thoracodorsal vessels, the two flaps can be based on vascular pedicle that is long and anatomically reliable. In this case, we reported that serratus anterior possessed an anomalous arterial supply totally independent from the subscapular pedicle while raising combined latissimus dorsi and serratus anterior flap. Methods: A 35-year-old male with extensive soft tissue defect in the left perineum and thigh visited. Muscle defects of the medial thigh were observed, and femoral nerve and vessels were exposed. Combined latissimus dorsi and serratus anterior free flap was raised to reconstruct defect. On raising flaps, artery supplying the serratus anterior muscle originated from the axillary artery directly, was lying on the undersurface of the serratus anterior muscle. Results: Because two flap pedicles had no communication and latissimus dorsi muscle was large enough to cover soft tissue defect, we transferred only latissimus dorsi free flap with 1 : 3 meshed skin graft. Patient had limb salvage and satisfactory functional outcome. Conclusion: There are many variations of arterial pedicles of flaps. However, most of these variations remain within known anatomical consistence, thus is an indicator in planning the dissection of the vessels. According to documents, arterial pedicle to the serratus muscle not originated from the thoracodorsal artery is rarely reported, and in most of these cases, the arteries are originated from the subscapular artery. Thus pedicle directly originated from the axillary artery to serratus muscle is a very rare variation in its vascular anatomy.

• Journal of Trauma and Injury
• /
• v.22 no.1
• /
• pp.119-122
• /
• 2009

Traumatic abdominal wall hernia after blunt abdominal trauma is rare. The prevalence of traumatic abdominal wall hernia in published series is approximately 1%. Recently, by the use of computed tomography has increased the number of occult traumatic abdominal wall hernias (TAWH). A 47-year-old woman presented to the emergency room soon after a traffic accident. She was fully conscious and complained of diffuse, dull, abdominal pain. She had a seat belt on at the time of the accident. Initial computed tomography showed that the lower left abdominal wall had a defect and that a part of the small bowel had herniated through the defect. During the operation, we made an incision at the defect site and confirmed the defect. The defect size was about $15{\times}5cm$. The muscle layers were repaired in layers with absorbable sutures. Prolen mesh was layed down and fixed on the site of the repaired muscle defect. After 6 months, hernia had not recurred, and no weakness of the repaired abdominal wall layers was identified. The patient's postoperative body functions were normal.

• Archives of Plastic Surgery
• /
• v.33 no.2
• /
• pp.213-218
• /
• 2006

As the large defect of peripheral nerve occurs, the autologous nerve graft is the most ideal method but it has many limitations due to donor site morbidities. Various materials have been developed for the nerve defect as the conduits, but none of these materials is satisfactory. Among them, $Gore-Tex^{(R)}$ tube seems to be one of the most ideal nerve conduit materials at peripheral nerve defect. Many researches have focused on finding the neurotrophic factors. It is recently demonstrated that Valproic acid(VPA) has an effect of axonal regeneration as a neurotrophic factor without enzymatic degradation and toxicity problems. The purpose of this study is to evaluate the effect of VPA on the nerve regeneration at the peripheral nerve defect. A 10 mm gap of rat sciatic nerve was made and $Gore-Tex^{(R)}$ tube filled with biceps femoris muscle was placed at the nerve defect site. We let the rat take VPA as drinking water in experimental group and did not give VPA to the control group. We estimated the results as electrophysiologic and histological aspects for 16 weeks after the surgery. The nerve conduction velocity, total myelinated axon count, myelin sheath thickness and mean nerve fiber diameter significantly increased in VPA-treated experimental group when compared to the control (p < 0.05). From the above results, we conclude that VPA promotes the nerve regeneration at the peripheral nerve defect site. It is suggested that $Gore-Tex^{(R)}$ tube filled with skeletal muscle and VPA administration may be a good substitute for autologous nerve graft.

• Archives of Reconstructive Microsurgery
• /
• v.12 no.1
• /
• pp.1-12
• /
• 2003

The bridging of nerve gaps is still one of the major problems in peripheral nerve surgery. To evaluate the role of silicon tube in nerve regeneration, gaps were made by resection of tibial components of sciatic nerves of twenty-five New Zealand rabbits. The gaps were divided into five groups. In group I, the tibial components of sciatic nerves were isolated and the incision immediately closed. In group II, 1-cm segments of the nerve were removed and the silicon tubes filled with autogenous skeletal muscle were sutured in place. In group III, 1-cm segments of the nerve were removed and the silicon tubes filled without muscle were sutured in place. In group IV, 2-cm segments of the nerve were removed and the silicon tubes filled with autogenous skeletal muscle were sutured in place. In group V, 2-cm segments of the nerve were removed and the silicon tubes filled without muscle were sutured in place. At 16th week, the eletromyography, the light and transmission electron microscopy were performed. Nerve conduction study stimulating sciatic nerve proximal to the lesion and recording at gastrocnemius muscle showed that the compound muscle action potentials of the group II with 1 cm nerve defect filled with muscle were higher amplitudes than the group III without muscle. Compound muscle action potentials of the group IV with 2 cm defect filled with muscle showed similar results in comparison with the group V. The light and transmission electron microscpy showed that a good morphological pattern of nerve regeneration in 1 cm gap than 2 cm and in gap with muscle than gap without muscle.

• Archives of Reconstructive Microsurgery
• /
• v.20 no.2
• /
• pp.108-112
• /
• 2011

Purpose: Gracilis muscle free flap transplantation is chosen in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity. We set a study to search for gracilis free flaps to know whether symptoms were cured or recurred in patients that have passed over 10 years from flap transplantation. Materials and Methods: From August 1995 through September 2010, we have performed 28 cases of gracilis muscle free flap in the lower extremities. Ever since no case visited to demand any discomfort, breakdown or recurrence in the flap site on outpatient basis. We made a telephone call to patients or relatives documented in the medical record and only 2 cases visited outpatient department and 9 cases postponed the visit who satisfied with the final result but 17 cases had wrong telephone numbers. Causes, area of lower extremity, recipient vessels in the lower extremity, condition of the donor thigh and overall satisfaction of the flap transplantation in activities of daily living were investigated and written down in the medical record. Results: 11 cases were reviewed after average postoperative 13.7 years. Gracilis muscle flaps were not break down at the recipient site in all cases. The wound of donor thigh wound healed good and overall activities of daily living was satisfied in all cases. Conclusion: Gracilis muscle flaps which had performed and followed up average 13.7 years revealed confident in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity.

• Archives of Plastic Surgery
• /
• v.32 no.2
• /
• pp.183-188
• /
• 2005

Defect on the temporal area caused by, surgical ablation of a tumor or an infection should be reconstructed immediately to prevent potentially life-threatening complications such as meningitis and cerebrospinal fluid leakage. The defect on the temporal area usually presents as a typical 'cone-shape'. Successful reconstruction requires sufficient volume of well-vascularized soft tissue to cover the exposed bone and dura. From 1994 through 2003, the authors applied rectus abdominis free flap for the reconstruction of the temporal defect from 1994 through 2003. There were 10 patients with a mean age of 52.1 years. Of these 10 patients, external auditory canal cancer was present in four patients, temporal bone cancer in two, parotid gland cancer in one and three patients were reconstructed after debridement of infection(destructive chronic otitis media). All the free flaps survived, and flap-related complications did not occur. Compared to a local flap, the rectus abdominis free flap can provide sufficient volume of well-vascularized tissue to cover the large defect and can be well-tolerated during an adjuvant radiation therapy. The long and flat muscle can be easily molded to fit in to the 'cone-shape' temporal defect without dead space. It is also preferred because of the low donor site morbidity, a large skin island and an excellent vascular pedicle. Two-team approach without position change is possible. In conclusion, the authors think that rectus abdominis free flap should be considered as one of the most useful method for the reconstruction of a cone-shaped temporal defect.

• Archives of Reconstructive Microsurgery
• /
• v.15 no.2
• /
• pp.58-64
• /
• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• Journal of Chest Surgery
• /
• v.15 no.2
• /
• pp.230-237
• /
• 1982

Malignant hyperthermia has been reported by many authors since Denborough [1960] first described concerning anesthetic death in a family. Malignant hyperthermia is characterized by a hypermetabolic state [tachycardia, tachypnea, hypercarbia, hypoxia, cyanosis, hypotension, high fever and muscle rigidity] and is related to a hereditary defect of skeletal muscle. In susceptible individuals, it is triggered by potent inhalational anesthetics, depolarizing muscle relaxant [Succinylcholine], amide type local anesthetics [prototype lidocaine] and occasionally by stress due to emotional and environmental factors. Unrecognized and untreated malignant hyperthermia is associated with a very high mortality rate. Recently authors have experienced malignant hyperthermia in 5 year old male child who was diagnosed to have patent ductus arteriosus and interatrial septal defect associated with congenital physical deformities such as short stature, hypotrophic muscles and genu valgus deformity of lower extremity, indirect inguinal hernia and Ramphant caries.