• Korean Journal of Head & Neck Oncology
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• v.11 no.1
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• pp.47-55
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• 1995

A large lateral facial defects especially a through and through defect of the cheek remains as challenging field of reconstruction for the head and neck surgeons. Closure of these wounds is technically troublesome due to the magnitude and location of the soft tissue and skin defect, functional and aesthetic consideration. optimal cancer surveillance, and desire for good nourishment. Most traditional methods dealing with these defects, including split-thickness skin graft, local and regional flaps as well as musculocutaneous flaps have their limitations. We applied four different methods for these reconstruction in four cases. We utilized temporal muscle flap, forearm free flap and secondary healing for repair of mucosal defects, and medial base cervicopectoral flap, pectoralis major myocutaneous flap and cervicofacial flap for the reconstruction of external skin defects. In one case, both sides were reconstructed with single forearm free flap. In our experiences, secondary healing could be one of the useful method for mucosal repair in the defect between upper and lower gingivobuccal sulcus. However, forearm free flap was thought to be more ideal for the cases with mandibulectomy. For the external repair, the regional skin flap was considered to be superior to pectoralis major myocutaneous flap or forearm free flap especially on color matching.

• Korean Journal of Head & Neck Oncology
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• v.1 no.1
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• pp.35-61
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• 1985

The surgical treatment of advanced carcinomas and some benign tumors having clinically malignant behaviors of the head and neck region often require extensive resection, necessitating large flaps for reconstruction. Since the original upper arm flap was described by Tagliacozzi in 1597, a variety of technique such as random pattern local flap, axial flap, distant flap, scalping flap, myocutaneous flap, free flap etc. have been proposed for reconstruction of head, face and neck defects. Reconstruction of the facial defects usually require the use of distant tissue. Traditionally, nasal reconstruction has been carried out with a variety of forehead flaps. In recent years, there has been more acceptance of immediate repairs following the removal of these tumors. As a result, patients are more willing to undergo these extensive resections to improve their chances of cure, with the reasonable expectation that an immediate reconstruction will provide an adequate cosmetic result. Authors experienced 13 cases of head and neck tumor during last three and half years that required wide excision and immediate reconstruction with various flaps, not with primary closure or simple skin graft. We present our experience with varied flaps for reconstruction after wide resection of head and neck tumors 3 cases of defect of dorsum of nose or medial canthus with island forehead flaps, lower eyelid defect with cheek flap, cheek defect with Limberg flap, orbital floor defect with Temporalis muscle flap, lateral neck defects with Pectoralis major myocutaneous flap or Latissimus dorsi myocutaneous free flap, subtotal nose defect with scalping flap, wide forehead defect with Dorsalis pedis free flap and 3 cases of mandibular defect or mandibular defect combined with lower lip defect were reconstructed with free vascularized iliac bone graft or free vascularized iliac bone graft concomitantly combined with free groin flap pedicled on deep circumflex iliac vessels We obtained satisfactory results coincided wi th goal of treatment of head and neck tumors, MAXIMAL CURE RATE with MINIMAL MORBIDITY, OPTIMAL FUNCTION, and an APPEARANCE as close to normal as possible.

• Archives of Plastic Surgery
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• v.33 no.3
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• pp.294-297
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• 2006

Lymphedema is one of the most common complications of mastectomy. It decreases quality of life and causes functional or aesthetical problems in post-mastectomy patients. Axillary lymph needs dissection (ALND), and radiation therapy(RTx) is known as the representative factor of lymphedema. Authors discovered that breast reconstructions using latissimus dorsi(LD) myocutaneous flap decrease the incidence of lymphedema in spite of these risk factors. Therefore we compared the incidence of lymphedema between the patients who underwent breast reconstructoins by LD pedicled flap, and the patients who did not undergo breast reconstructions from January 2002 to December 2004. Lymphedema was diagnosed when difference of arm circumference was over 2cm or limitation of joint movement was greater than 20 degrees. Overall incidence of lymphedema was 14.0%, and it was 18.9% in case of ALND, and 21.1% in case of RTx, respectively. But the incidence of breast-reconstructed patients using LD pedicled flap was 3.3%. This result reveals that LD pedicled flap decreases incidence of lymphedema significantly. In the future, it is recommended to identify the causes of decrease in the incidence of lymphedema in case of breast reconstructed by LD myocutaneous pedicled flap, for example lymphoscintigraphy and so on.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.305-318
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• 1991

Reconstructive techniques of orofacial defects are very varied. In recent years, myocutaneous flaps, in particular the pectoralis major or latissimus doris myocutaneous flap have achieved popularity. In 1983, Soutar et. al. used the forearm free flap that had been developed in in China and popularised the radial forearm fasciocutaneous flap to reconstruct defects in the orofacial region. This paper presents the authors experience with 10 consecutive patients in which 12 flaps were used either as a fascioncutaneous flap or as a composite flap incorporating part of the radius. Some literatures were reviewed and the clinical results were discussed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.1
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• pp.83-91
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• 2008

The goal of reconstruction following ablative therapy for intraoral cancer is the restoration of form and function to permit a return to activities of daily life. Traditional reconstruction includes split thickness skin grafts, myocutaneous flaps and, more recently, various free flaps. Free flaps provide higher level of functional recovery relative to that seen with other techniques but require the complexity of the technique and microvascular anastomosis and thus, extended surgical time and occasionally a second team for harvesting. The platysma myocutaneous cervical flap is a possible alternative for intraoral reconstruction. It is thin and pliable like the tissue provided by the radial forearm free flap. It can be harvested with enough tissue to close most head and neck ablative defects. There is virtually no donor site morbidity involved. This study evaluated 7 patients affected by intraoral squamous cell carcinoma (SCC). All patients underwent the resection of intraoral SCC with neck dissection and subsequent intraoral reconstruction with the superiorly based platysma myocutaneous cervical flap. Flap-related complications occurred in 3 patients. Adjuvant radiation therapy was performed in 3 patients. Average follow-up was 24.1 months after surgery, with a range of 8 to 42 months. All patients presented self assessment of discomfort associated with intraoral recipient sites and cervical donor sites. However, the neck function measured by two-inclinometer technique was within the normal range during relatively long term follow-up period. Our study concluded that superiorly based platysma myocutaneous cervical flap is good alternative to free flaps, especially for relatively smaller defects and for the defects appropriate for the rotation arc of the flap.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.92-98
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• 1996

The rectus abdominis myocutaneous flap is frequently used in the field of plastic and reconstructive surgery such as breast reconstruction and as a donor of free tissue transfer. Major problems with this flap is bulkiness, the possibility of postoperative abdominal herniation and muscle weakness following the removal of the rectus abdominis muscle. We used paraumbilical perforator based skin flap fed by a muscle perforator from the deep inferior epigastric artery, with no or little muscle and fatty tissue, in three patients for the resurfacing of relatively wide and thin defects. This technique has all of the advantages of the conventional rectus abdominis myocutaneous flap with decreased possibility of postoperative abdominal herniation or muscle weakness. Another challenging merit is possibility of skin flap thinning.

• Medical Lasers
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• v.10 no.2
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• pp.115-119
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• 2021

A giant thyroid mass can be associated with severe compressive symptoms, requiring surgery for treatment. This paper reports the case of an 82-year-old man who presented with a giant thyroid mass that was suspected of being a metastatic papillary thyroid carcinoma on fine-needle aspiration cytology. A harmonic scalpel was used to excise the giant thyroid mass. A pectoralis major myocutaneous flap was used for reconstruction. The histopathology assessment confirmed the metastases in the lymph node and papillary thyroid carcinoma in the resected gland.

• Archives of Plastic Surgery
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• v.45 no.5
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• pp.484-489
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• 2018

Large and ptotic breast reconstruction in patients who are not candidates for a transverse rectus abdominalis myocutaneous flap and revision surgery for the contralateral breast remains challenging. We developed a novel breast reconstruction technique using a latissimus dorsi myocutaneous (LD m-c) flap set at the posterior aspect of the reconstructed breast, combined with an anatomical silicone breast implant (SBI), following tissue expander surgery. We performed the proposed technique in four patients, in whom the weight of the resected tissue during mastectomy was >500 g and the depth of the inframammary fold (IMF) was >3 cm. After over-expansion of the lower portion of the skin envelope by a tissue expander, the LD m-c flap was transferred to cover the lower portion of the breast defect and to achieve a ptotic contour, with the skin paddle set at the posterior aspect of the reconstructed breast. An SBI was then placed in the rest of the breast defect after setting the LD m-c flap. No major complications were observed during the follow-up period. The proposed technique resulted in symmetrical and aesthetically satisfactory breasts with deep IMFs, which allowed proper fitting of the brassiere, following large and ptotic breast reconstruction.

• Archives of Craniofacial Surgery
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• v.12 no.2
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• pp.107-110
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• 2011

Purpose: There have been few case reports regarding treatment plans for long-term, neglected scalp defects and calvarial defects with subdural abscess. The purpose of this case report is to present our experience with a free latissimus dorsi musculocutaneous flap for scalp and calvarial defects and to discuss flap options in comparison with a literature review. Methods: A 60-year-old man who fell down from a four-story-height that resulted in a craniotomy in 1979; he visited our outpatient clinic for a chronic, purulent scalp and calvarial defects with unidentified artificial bone. The artificial bone was removed by a neurosurgeon and reconstructed with a free latissimus dorsi musculocutaneous flap. The deep temporal artery was used as a recipient artery. The postoperative flap status was excellent until the 6th day post-operation when the patient experienced a seizure, and an arterial insufficiency occurred at the flap probably due to an arterial spasm. Emergency exploration with arterial re-anastomosis was performed and the flap status was stabilized. Results: Complete wound healing was achieved after 3 weeks without infectious and systemic postoperative complications. During the 6 month follow-up period, there were no complications. Conclusion: We suggest the latissimus dorsi myocutaneous free flap as a good treatment option for a chronic, purulent, complicated scalp with calvarial defect, as a well as treatment for an acute traumatic defect.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.803-807
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• 2011

Purpose: The safety of radiation therapy after breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap is still being debated, and few studies exist on the outcome of irradiation after immediate TRAM breast reconstruction. Some authors presented satisfactory outcomes after adjuvant radiation therapy on reconstructed breast with pedicled TRAM flap, while others reported significant post radiation changes of the flap. Effect of radiation therapy on TRAM flap was evaluated to see whether adjuvant radiation therapy was tolerable. Methods: 1000 immediate TRAM breast reconstruction was done by a single surgeon from July, 2001 to December, 2009. Among them 105 patients required adjuvant radiation therapy because of advanced disease or locoregional recurrence. Fat necrosis, radiation fibrosis, mastectomy skin flap necrosis, need for secondary touch up procedures, patient satisfaction were evaluated. Results: The incidence of fat necrosis was 10.5% and significant radiation fibrosis occurred in only one patient. Delayed wound problem did not occur during or after irradiation. Secondary touch-up procedures were performed in 12.3%, the most common being fat graft (8.6%). Average patient satisfaction score was 8.62/10, which was not significantly different from the authors' previous report involving all the TRAM patients (8.50). Conclusion: Radiation therapy did not increase the complication rate significantly. Aesthetic result was affected but was tolerated in most cases. The fear of adjuvant radiation is not a negative factor in selecting immediate breast reconstruction with TRAM flap.