• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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• pp.37-54
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• 1987

The aim of surgery for all parotid masses is directed toward total removal of the tumor with adequate safe margins of adjacent normal tissue and preservation of the facial nerve whenever possible. Reconstructive procedures following parotidectomy for benign or low grade malignant lesions are most commonly necessary if soft tissue deficits appear at the angle of the mandible below the earlobe as a major cosmetic deformity. This is a report of Z4 cases with a diagnosis of parotid tumor who were treated using various surgical procedures at Department of Plastic and Reconstructive Surgery, Hanyang University Hospital over the period of 4 years from January, 1983 to December, 1986. Among 24 cases, 11 cases were reconstructed by Sternocleidomastoid muscle flap at the same time that extirpative surgery is outlined. The advantage of Sternocleidomastoid muscle flap is the coverage of the facial nerve, so adhesion between the facial nerve and skin was prevented. Absorption and loss of bulk was not found such as dermofat graft. It was a simple method. Neither donor site defect nor sternocleidomastoid muscle deformity was developed. Sternocleidomastoid muscle flap have been found satisfactory in maintaining filled-out soft tissue hollows with good result cosmetically and functionally.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.571-577
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• 2009

Purpose: The Provision of thin and pliable tissue and the adequate coverage of tendon - gliding surface is necessary for a soft tissue defect of the hand with exposure of bone, tendon and muscle. This report will discuss our experience with anterolateral thigh fascial free flap for the reconstruction of the soft tissue defect of the hand. Methods: Between February 2004 and August 2008, seven patients with full - thickness soft tissue defects of the hand were reconstructed by means of a composite anterolateral thigh fascial free flap. There were soft tissue defects associated with trauma (n=5), scar contracture (n=1) and necrosis due to ischemia (n=1). Flaps were harvested from the anterolateral thigh as adipofascial flaps with only a small sheet of fascia and fatty tissue above it. The fascia and the skin of the donor site was closed directly and delayed split - thickness skin graft was performed. Result: All flaps survived completely. The size of the transferred flap ranged from $2{\times}4cm$ to $5{\times}8cm$. Thin flap coverage was possible without secondary debulking operations. It left minimal donor site morbidity with a linear scar. In one case, the thigh muscle herniation in the donor site was developed. Conclusion: The anterolateral thigh fascial free flap provided thin and pliable tissue which can establish a tendon - gliding mechanism, minimal bulk, minimal donor site morbidity. The disadvantages of this technique were the need for a skin graft and the muscle herniation of donor site.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.1
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• pp.1-11
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• 1994

The functional deformity following removal of the maxilla is considerable, especially following maxilla cancer excision. Rehabilitation of oral and maxillofacial region used to be very difficult with prosthesis or traditional flaps. Temporal muscle and fascia flaps have been described for immediate reconstruction following hemi-maxillectomy, but not total maxillectomy. The muscle and superficial fascia of the temporal area differ in their physical characteristics, vascular supply and clinical applications. Both can be employed independently or simultaneously as regional flaps in the reconstruction of a variety of complex craniofacial defects. Four case is presented in which 3 case maxilla cancer, one case non-union after maxilla fracture, and all case showed successful use of this flap. Only one patient developed partial necrosis of the flap ; significant necrosis did not occur in any other patient. This present paper reviews the anatomy, surgical technique and utilisation of temporal muscle and fascia flaps.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.277-281
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• 2019

Recto-vaginal fistulas are difficult to treat due to their high recurrence rate. Currently, no single surgical intervention is universally regarded as the best treatment option for recto-vaginal fistulas. We present a case of recurrent recto-vaginal fistula surgically treated with a gracilis pull-through flap. The surgical goals in this patient were complete excision of the recto-vaginal fistula and introduction of fresh, vascularized muscle to seal the fistula. A defunctioning colostomy was performed 1 month prior to the present procedure. The gracilis muscle and tendon were mobilized, pulled through the freshened recto-vaginal fistula, passed through the anus, and anchored externally. Excess muscle and tendon were trimmed 1 week after the procedure. Follow-up at 4 weeks demonstrated complete mucosal coverage over an intact gracilis muscle, and no leakage. At 8 weeks post-procedure, the patient resumed sexual intercourse with no dyspareunia. At 6 months post-procedure, her stoma was closed. The patient reported transient fecal staining of her vagina after stoma reversal, which resolved with conservative treatment. The fistula had not recurred at 20 months post-procedure. The gracilis pull-through flap is a reliable technique for a scarred vagina with an attenuated recto-vaginal septum. It can function as a well-vascularized tissue plug to promote healing.

• 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 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.39 no.4
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• pp.367-375
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• 2012

Background The anterolateral thigh (ALT) perforator flap has become a popular option for treating soft tissue defects of lower extremity reconstruction and can be combined with a segment of the vastus lateralis muscle. We present a comparison of the use of the ALT fasciocutaneous (ALT-FC) and myocutaneous flaps. Methods We retrospectively reviewed patients in whom free-tissue transfer was performed between 2005 and 2011 for the reconstruction of lower extremity soft-tissue defects. Twenty-four patients were divided into two groups: reconstruction using an ALT-FC flap (12 cases) and reconstruction using a vastus lateralis myocutaneous (VL-MC) flap (12 cases). Postoperative complications, functional results, cosmetic results, and donor-site morbidities were studied. Results Complete flap survival was 100% in both groups. A flap complication was noted in one case (marginal dehiscence) of the ALT-FC group, and no complications were noted in the VL-MC group. In both groups, one case of partial skin graft loss occurred at the donor site, and debulking surgeries were needed for two cases. There were no significant differences in the mean scores for either functional or cosmetic outcomes in either group. Conclusions The VL-MC flap is able to fill occasional dead space and has comparable survival rates to ALT-FC with minimal donor-site morbidity. Additionally, the VL-MC flap is easily elevated without myocutaneous perforator injury.

• 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 Chest Surgery
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• v.48 no.4
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• pp.258-264
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• 2015

Background: This study aimed to evaluate the therapeutic results and safety of pectoralis major muscle turnover flaps in the treatment of mediastinitis after coronary artery bypass grafting (CABG) procedures. Methods: Data regarding 33 patients with post-CABG deep sternal wound infections (DSWIs) who underwent pectoralis major muscle turnover flap procedures in the Emam Reza and Ghaem Hospitals of Mashhad, Iran were reviewed in this study. For each patient, age, sex, hospital stay duration, remission, recurrence, and associated morbidity and mortality were evaluated. Results: Of the 2,447 CABG procedures that were carried out during the time period encompassed by our study, DSWIs occurred in 61 patients (2.5%). Of these 61 patients, 33 patients (nine females [27.3%] and 24 males [72.7%]) with an average age of $63{\pm}4.54$ years underwent pectoralis major muscle turnover flap placement. Symptoms of infection mainly occurred within the first 10 days after surgery (mean, $10.24{\pm}13.62days$). The most common risk factor for DSWIs was obesity (n=16, 48.4%) followed by diabetes mellitus (n=13, 39.4%). Bilateral and unilateral pectoralis major muscle turnover flaps were performed in 20 patients (60.6%) and 13 patients (39.4%), respectively. Complete remission was achieved in 25 patients (75.7%), with no recurrence in the follow-up period. Four patients (12.1%) needed reoperation. The mean hospitalization time was $11.69{\pm}6.516days$. Four patients (12.1%) died during the course of the study: three due to the postoperative complication of respiratory failure and one due to pulmonary thromboembolism. Conclusion: Pectoralis major muscle turnover flaps are an optimal technique in the treatment of post-CABG mediastinitis. In addition to leading to favorable therapeutic results, this flap is associated with minimal morbidity and mortality, as well as a short hospitalization time.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.24-30
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• 2005

Thigh perforator flaps are used popularly, because they have a small thickness, a long vascular pedicle and a low rate of donor site morbidity. Among thigh perforator flaps, anterolateral thigh perforator flaps are generally used, but it is not easy to dissect the vastus lateralis muscle to find the vasuclar pedicle. The authors have planed 11 anteromedial thigh perforator flaps that have septocutaneous perforators. We were able to find anteromedial thigh perforators in 8 cases(72.7%). The perforators originated from the medial descending branch of the lateral circumflex femoral artery in 2 cases and a branch to the rectus femoris muscle in 6 cases. Of this type of surgery, 7 flaps survived. However, 1 flap failed because of arterial insufficiency. We believe the anteromedial thigh perforator flap is a good option when the thigh region is decided as a donor site, but surgeons should keep in mind that the perforator of anteromedial thigh flap may be absent.