• Archives of Reconstructive Microsurgery
• /
• 제7권1호
• /
• pp.20-27
• /
• 1998

Among many kinds of introduced free flaps, scapular freeflap is one of the most popularly using modalities in fasciocutaneous defect coverage with minimal donor defect and easier procedure and constant vascular patterns of the donor. Many surgeons who had experience of this flap pointed out deficit of the reliable sensation of the transplanted flap is the main shortcoming of the scapular free flap. If we can subjugate that point, scapular free flap is the most excellent procedure in such a cases as heel pad reconstruction and hand reconstruction which are relatively important to have skin with protective sensation. Author performed anatomical literature review, 10 cadaveric dissections and 12 clinical dissections. In surgical anatomical aspect, the upper six dorsal rami of the thoracic nerves have medial branches which pierce Longissimus thoracis and Multifidus muscle with small cutaneous twigs which pierce Latissimus dorsi and Trapezius muscle. Among that cutaneous twigs, several twigs distribute to the skin of the back from midline to lateral aspect which territory is identical to scapular free flap. We analysed clinical experiences of that sensory bearing scapular free flap surgical anatomy and one year follow-up studies with several results. 1) Two to three cutaneous twigs which pierced from the Trapezius muscle over the scapular free flap region. 2) Each twigs has two to four nerve fascicles with small artery. 3) The nerve distributed to the ordinary scapular free flap and large enough size and pedicle length to neurorrhapy with various recipient site nerves. 4) The inconvenience of this procedure is the vascular pedicle and nerve pedicle have opposite directions, vascular pedicle of that comes from lateral direction from subscapular vessels, but nerve pedicle comes from medial direction from trapezius muscle. Author can found constant cutaneous nerve branches which come from piercing the Trapezius. This nerves are helpful for protective sensation in transplanted scapular free flap. We can't had enough follow-up and evaluation of the nerve function of this procedure, we need continuous research works to application of this procedure. The in conveniences come from directional differences of pedicle can solve with longer harvest neural pedicle and change direction of the neural pedicle.

• Archives of Reconstructive Microsurgery
• /
• 제20권2호
• /
• 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 Reconstructive Microsurgery
• /
• 제13권1호
• /
• pp.58-62
• /
• 2004

Purpose: To cover the exposed tendons and bones after trauma and cure the concomitant osteomyelitis in the lower extremities, gracilis muscle free flaps are frequently preferred. 32 cases of gracilis muscle free flap we had done were analysed according to the indications, specification of flap length and width, pedicle length, vessels used in the anastomosis and final healing after at least over 1 year follow up. Materials and methods: From August 1995 through November 2002, we have performed 32 cases of gracilis muscle free flap transplantation with the general microsurgical procedures in the lower extremities. Open fracture of the middle and distal tibia were 12, exposed heel 6, crushing injury in the foot 5 cases, open fracture of the ankle 4, chronic osteomyelitis of the tibia 3 and osteomyelitis of the tarsal bones 2. Tailored flap length were ranged from 16 cm to 4 cm, width were from 5cm to 4cm. Pedicle length averaged around 4 cm. Anastomosis of one artery and two veins in both of donor and recipient were performed in 17 cases and one artery and one vein in 15 cases. Results: All flaps were survived, except 2 cases. Final flap healing was satisfactory to both of the patients and microsurgeon. Conclusion: Gracilis muscle free flaps are frequently chosen to cover the exposed components and cure the osteomyelitis in the lower extremities.

• Archives of Plastic Surgery
• /
• 제39권4호
• /
• pp.345-351
• /
• 2012

Background Cranial base defects are challenging to reconstruct without serious complications. Although free tissue transfer has been used widely and efficiently, it still has the limitation of requiring a long operation time along with the burden of microanastomosis and donor site morbidity. We propose using a reverse temporalis muscle flap and calvarial bone graft as an alternative option to a free flap for anterior cranial base reconstruction. Methods Between April 2009 and February 2012, cranial base reconstructions using an autologous calvarial split bone graft combined with a reverse temporalis muscle flap were performed in five patients. Medical records were retrospectively analyzed and postoperative computed tomography scans, magnetic resonance imaging, and angiography findings were examined to evaluate graft survival and flap viability. Results The mean follow-up period was 11.8 months and the mean operation time for reconstruction was $8.4{\pm}3.36$ hours. The defects involved the anterior cranial base, including the orbital roof and the frontal and ethmoidal sinus. All reconstructions were successful. Viable flap vascularity and bone survival were observed. There were no serious complications except for acceptable donor site depressions, which were easily corrected with minor procedures. Conclusions The reverse temporalis muscle flap could provide sufficient bulkiness to fill dead space and sufficient vascularity to endure infection. The calvarial bone graft provides a rigid framework, which is critical for maintaining the cranial base structure. Combined anterior cranial base reconstruction with a reverse temporalis muscle flap and calvarial bone graft could be a viable alternative to free tissue transfer.

• Archives of Plastic Surgery
• /
• 제32권4호
• /
• pp.421-427
• /
• 2005

Although the incidence of mediastinal wound infection in patient undergoing median sternotomy for cardiovascular surgery is relatively low(less than 1%), it is not only a devastating and potentially life-threatening complication but also associated morbidity, mortality and cost are unacceptably high. During the past few decades various methods had been applied for the treatment of postoperative mediastinitis. Currently, chest wall reconstruction by using muscle flaps-especially pectoralis major muscle and rectus abdominis muscle are commonly selected for the reconstruction after wide debridement has become widely accepted. We performed bilateral pectoralis major-rectus abdominis muscles in-continuity bipedicle flap to overcome the limit of each flap for reconstruction of sternal defects in 17 patients. We analyzed the results of the surgery. Recurrent infection developed in 17.6% of cases and abdominal herniation was observed in one patient. There was no postoperative hematoma or death. We conclude that this flap is very valuable in reconstruction of the anterior chest wall defect caused by post-sternotomy infection because it provides sufficient volume to fill the entire mediastinum, and the complication rate compares favorably to that of other methods.

• Archives of Plastic Surgery
• /
• 제33권5호
• /
• pp.643-647
• /
• 2006

Purpose: The transverse rectus abdominis myocutaneous(TRAM) flap has become a mainstay of breast reconstruction. The chief disadvantage of the TRAM flap is its potential to create a weakness in the abdominal wall. Nowadays true hernia is less frequent, but bulging that appears at the muscle donor site, or at the contralateral side, or at the epigastric area is still remained as a problem. To prevent this complications, we have used synthetic mesh as well as abdominal muscle plication. Now we report the result of our methods. Methods: We started to use synthetic mesh and muscle plication as supplementary reinforcement for entire abdominal wall, after TRAM flap harvesting, in an attempt to stabilize it and achieve a superior aesthetic result since 2002. We observed complications of TRAM flap donor site, and compared our results (from January, 2002 to January, 2006) with other operator's result (before 2001) at the same hospital in aspect of incidence of abdominal complications. Results: 42 consecutive patients have been performed routine reinforcement with the extended mesh technique and muscle plication from January, 2002 to January, 2006. Mean patient follow up was 25.2 months. No hernia or mesh related infection were encountered and only one patient had a mild abdominal bulging. Nevertheless the our good results, there were no significant statistical differences were observed between two groups. Conclusion: We recommend the using of synthetic mesh and muscle plication for donor site reconstruction after TRAM flap breast reconstruction to improve strength as well as aesthetic quality of the abdominal wall.

• Archives of Plastic Surgery
• /
• 제35권4호
• /
• 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.

• Archives of Reconstructive Microsurgery
• /
• 제18권2호
• /
• pp.49-54
• /
• 2009

Purpose: To evaluate the result of muscle free flap transplantation in chronic osteomyelitis of the tibia and calcaneus occurred from open fractures and exposed bones and internal fixatives. Materials and Methods: The free muscle flap were transferred in the tibia and calcaneus and followed up average 7.3 years at the department of orthopedic surgery from March 1997 to September 2009. Six patients were male and 1 case female averaged 50.3 years of age. Two latissimus dorsi myocutaneous free flaps were transplanted to the exposed 2/3 of the tibia with soft tissue defect, one rectus abdominis muscle free flap to the mid 1/3 of the tibia and four gracilis muscle free flaps to the distal 1/3 of the tibia and calcaneus. Results: At average 7.2 years follow-up, all of the 7 cases obtained solid bone union in the X-ray and kept sound soft tissues without pus discharges. The overall result of bone union, healed soft tissues defect and normal knee and ankle joint range of motion were excellent. Conclusion: The free muscle flap transferred to the chronic osteomyelitis of the tibia and calcaneus showed excellent results in bone union and eradication of the pus forming bacteria by its abundant blood flow.

• Archives of Reconstructive Microsurgery
• /
• 제13권1호
• /
• pp.29-35
• /
• 2004

Materials and Methods: Total number of peroneal perforator flap is 14 cases, which 10 cases were man, 4 cases were woman. The range of age was 12 years old minimally and until 63 years old. The trauma was most common etiology, which was like traffic accidents, 9 cases. We confirmed tibialis anterior artery patency by doppler flow meter, angiography as preoperative evaluation. Results: 1. The success rate was 91%, that in 14 cases, 13 cases were succeded. 2. To obtain successful result of peroneal flap, one must have the anatomic concept for vascular pattern, 8 cases were between peroneus muscle and soleus muscle branch type but, 3 cases were through soleus muscle branch type, so we treated these cases by using soleus muscle including peroneal perforating branch not to injury perforating artery directly. 3. The pedicle size was between minimally $2{\times}2.5cm$ and maximally $6.5{\times}8.5cm$ so we could treat large recipient site. 4. The pedicle length was between minimally 3.2 cm and maximally 11.5cm, average 7.5 cm. 5. The diameter of perforating artery was estimated by inspection, that was about 0.2-0.5 cm Conclusion: The peroneal perforating artery flap has merits that we can approach in avascular zone and has wide movable range from foot to distal femur and little donor site mobidity and can harvest osteocutaneous flap. The weak point was the irregular anatomy of nutrient artery and not to contain sensory nerve.

• Archives of Plastic Surgery
• /
• 제34권2호
• /
• pp.217-221
• /
• 2007

Purpose: Reconstruction of the soft tissue defect exposing Achilles tendon is a formidable challenge because of the paucity of soft tissue and relatively poor blood supply. This article describes the reconstruction of soft tissue defect exposing Achilles tendon using gracilis muscle free flap and split-thickness skin graft. Methods: From 2000 to 2005, four patients with soft tissue defect exposing Achilles tendon and infection were operated using gracilis muscle free flap and split-thickness skin graft. The defect size ranged from 3.5 to 5cm wide and 6.5 to 8cm long. The mean postoperative follow-up was twenty months. Results: All the flaps were survived without necrosis and infection. We obtained the satisfactory results with good functional and aesthetical outcomes. All cases showed good results with the characteristics of a relatively thin flap without additional debulking procedure. Conclusion: Gracilis muscle free flap with split thickness skin graft could be a good option for reconstruction of soft tissue defect of posterior ankle, exposing Achilles tendon with minimal morbidity of the donor site.