• 대한두경부종양학회지
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• 제6권2호
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• pp.71-78
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• 1990

The reconstruction of huge surgical defect is one of the major problems in the surgical treatment of the cancer of the head and neck. The latissimus dorsi myocutaneous flap, which is one of the most versatile myocutaneous flap, is a reliable method of reconstruction for extensive wounds in the head and neck. Due to the difficult patient positioning, its uses are reserved for the extensive defects or for the cases in which other traditional flaps have failed. The authors successfully reconstructed large surgical defects in the head and neck region using LDMC flap in five patients.

• Journal of Yeungnam Medical Science
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• 제28권2호
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• pp.116-123
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• 2011

The incidence of breast cancer, the second most prevalent cancer type in South Korea, has increased by 6.8% annually in the last six years. The higher number of breast cancer patients has led to an increase in the cases of skin-sparing mastectomies, thereby increasing the need for reconstructive procedures. The reconstruction options include alloplastic techniques such as implant or autologous reconstruction with numerous flaps. The abdominal area is the preferred donor site for the harvest of autologous tissue for breast reconstruction. Breast reconstruction using abdonimal tissue is commonly accomplished using the transverse rectus abdominis myocutaneous (TRAM) flap. The establishment of microvascular surgery led to the development of the free TRAM flap because of its increased vascularity and decreased rectus abdominis sacrifice. The muscle-sparing TRAM, DIEP, and SIEA flap techniques were later developed in an effort to decrease the abdominal-donar-site morbidity by decreasing the injury to the rectus abdominis muscle and fascia. This article summarizes the various abdominal flaps for breast reconstruction.

• 대한두경부종양학회지
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• 제9권1호
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• pp.3-9
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• 1993

저자들은 뉴질랜드산 흰 가토의 대퇴부에 총 대퇴동맥의 분지를 영양혈관으로 하는 비복근을 이용한 유경 근피판을 만든 후에 영양혈관을 차단 직전과 12시간 동안의 허혈 기간을 가진 후 이 영양혈관으로 생리 식염수로 관류하여 씻어낸 대조군과 urokinase로 관류한 비교군 I, 최근 개발된 인체의 장기 이식시 사용되는 장기(organ) 보존용제인 UW용액을 이용한 비교군 II, UW용액과 pentoxifylline용액으로 관류한 비교군 III에서 재관류 12시간 후에 허혈 및 괴사 정도를 육안적인 관찰과 근육의 전기 자극 검사, TTC 염색, Wet/Dry 무게비 등으로 비교 분석하여 다음과 같은 결과를 얻었다. 육안적 소견상 대조군과 urokinase 사용군에 비해 비교군 II와 III에서 괴사가 적었으며(p<0.05) 근육 조직의 전기 자극 심사에서도 대조군과 비교군 I 은 각각 $1.76{\pm}1.01,\;2.36{\pm}\1.02$로 차이가 없었으나 비교군 II와 III에서 각각 $3.54{\pm}0.93,\;3.49{\pm}1.37gm/mm^2$으로서 대조군에 비해 근육의 강직도가 의의있게 강하게 나타났다(p<0.05). 그리고 TTC 염색에서 대조군의 7례에서 허혈성 괴사 소견이 보였고 비교군 I도 3례에서 허혈성 괴사 소견이 있었으나 비교군 II과 III에서는 허혈성 괴사가 없었으며(p<0.05) 근피판의 wet/dry 무게비에서 대조군과 비교군 I은 각각 $4.55{\pm}0.37,\;4.33{\pm}0.36$으로 차이가 없었으나 비교군 II와 III는 각각 $3.84{\pm}0.29,\;3.75{\pm}0.48$로 대조군과 비교군 I에 비해 부종이 적음을 나타내었다(p<0.05).

• Archives of Plastic Surgery
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• 제40권3호
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• pp.187-191
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• 2013

Background Our objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group. Methods All patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999 to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared. Results Complications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001). Conclusions Based on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap.

• 대한두경부종양학회지
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• 제27권1호
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• pp.12-16
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• 2011

Background and Objectives : The pectoralis major myocutaneous flap(PMMCF) has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Even with the worldwide use of free flaps, the PMMCF is still considered the mainstay in head and neck reconstruction. The aim of the study is to evaluate the application and reliability of the PMMCF in selected cases of head and neck complication. Materials and Methods : We conducted a retrospective review of 14 patients who underwent the surgical reconstruction using the PMMCF due to the complications after head and neck ablative surgery between 1997 and 2007. Outcome measures included the indications of PMMCF, complications and post-operative functional result. Results : PMMCFs were used to reconstruct defects in the following series; wound dehiscence(7 patients), flap failure(4 patients), pharyngocutaneous fistula(3 patients). Flap survival was 100 percent and mean flap size was $67.2cm^2$. Five patients had complications such as pharyngocutaneous fistula, marginal necrosis, carotid blowout. Conclusions : The PMMCF is a safe and convenient method for reconstruction of the surgical complications after resection of advanced tumors and can be still used as a salvage procedure after free flaps failure.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.448-454
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• 2007

Purpose: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. Methods: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. Results: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. Conclusion: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.

• Archives of Plastic Surgery
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• 제38권6호
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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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• 제33권2호
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• pp.181-186
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• 2006

Myocutaneous flaps have improved the management of soft tissue defects on buttocks and lower extremity. However, there are several inherent disadvantages of muscle flaps such as functional deficits of the donor sites and the bulkiness at the recipient site. To overcome these disadvantages, we have used perforator-based fasciocutaneous rotation flaps for reconstruction of the buttock and lower extremity defects. From March 2003 to February 2005, we have treated 14 patients using perforator-based fasciocutaneous rotation flaps. 10 flaps were based on perforators of the gluteus maximus muscle, and 4 flaps were nourished by perforators from the tibialis anterior and posterior system. The mean postoperative follow-up period was about 1 year. The technique involves localization of the flap perforators preoperatively with a Doppler. The flaps were elevated superficial to the fascia with preservation of one to three perforators. The donor site is then closed primarily. All flaps completely survived and there was no perioperative complications. There was no functional disability of the donor area with esthetically pleasing results. Perforator-based fasciocutaneous rotation flaps for the reconstruction of buttock and lower extremity defects are excellent alternatives to musculocutaeous flaps. The vascularity of the flaps is robust and dissection is technically easy. Perforator flaps do not require sacrificing muscles, but provide sufficient volume and are durable Furthermore, these flaps result in less scar formation and allow more liberal dissection with safety. We conclude that perforator-based fasciocutaneous rotation flaps are very useful for reconstruction of the buttock and lower extremity.

• Archives of Reconstructive Microsurgery
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• 제11권2호
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• pp.135-140
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• 2002

It has been known that latissimus dorsi(LD) myocutaneous flap based on thoracodorsal artery is one of most useful method for microreconstructive surgery and the thoracodorsal artery of this flap has constant vascular anatomy. The retrospective study for anatomy of the thoracodorsal arterial system was performed at operative cases. The aim of this study was to document the anatomical variation of this pedicle clinically. 167 LD flaps were carried out from 1983 to 2002 in our clinic. We found unusual 7(4.2%) cases compared to standard textbooks of anatomy. One case was no vascular supply to LD muscle. In 2(1.2%) cases thoracodorsal artery was a typical branch of the subscapular artery but didn't branch to LD muscle, passed to lower serratus anterior muscle, and at this point, supplied vessel to LD muscle and it's vascular diameter was about 1mm diameter. The thoracodorsal artery arose from the axillary artery in 1.8% of cases(3 cases). One case had less than 1mm vascular diameter but a branch of subscapluar artery. It should be emphasized that we must elevate the latissimus dorsi flap after accurate cognition for the anatomy of thoracodorsal artery because the thoracodorsal arterial system is almost reliable but not uniform in rare cases.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.714-719
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• 2009

Purpose: Recurrent ischial pressure sore is troublesome for adequate soft tissue coverage, because usually its pocket has a very large deep space and adjacent donor tissue have been scarred in the previous surgery. However, the conventional reconstructive methods are very difficult to overcome them. Modified gluteus maximus myocutaneous V - Y advancement flap from buttock can be successfully used in these circumstances. Methods: From February 2007 to October 2008, modified gluteus maximus myocutaneous V - Y advancement flaps were perfomed in 10 paraplegic patients with recurrent ischial pressure sore. The myocutaneous flap based on the inferior gluteal artery was designed in V - shaped pattern toward the superolateral aspect of buttock and was elevated from adjacent tissue. Furthermore, when additional muscular bulk was required to obliterate dead space, the flap dissection was extended to the inferolateral aspect which can included the adequate amount of the gluteal muscle. After the advanced flap was located in sore pocket, donor defect was repaired primarily. Results: The patients' mean age was 46.9 and the average follow - up period was 12.4 months. The immediate postoperative course was uneventful. But, two patients were treated through readvancement of previous flap due to wound dehiscence or recurrence after 6 months. The long - term results were satisfied in proper soft tissue bulk and low recurrence rate. Conclusions: The modified gluteus maximus myocutaneous V - Y advancement flap may be a reliable method in reconstruction of recurrent ischial pressure sore, which were surrounded by scarred tissue because of its repetitive surgeries and were required to provide sufficient volume of soft tissue to fill the large pocket.