• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.15-21
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• 1999

Soft tissue defect on heel area of the foot present difficult problems particularly because of anatomic property of plantar surface of the foot. There is a paucity of available local tissue in the foot for coverage. In addition to having little expandable tissue, the foot's plantar surface has a unique structure, making its replacement especially challenging. Plantar skin is attached to the underlying bone by fibrous septa, preventing shear of the soft-tissue surfaces from the underlying skeleton. Plantar surface of foot is in constant contact with the environment. Protective sensibility also would be maintained or restored in the ideal reconstruction. So the ideal flap for reconstruction of the heel should include thin, durable hairless skin with potential for reinnervation. The aim of this article is to present a clinical experience of free lateral arm neurosensory flap for reconstruction of the heel. From March 1995 to December 1997, a total 16 lateral arm free flaps were performed to soft tissue defects on the weight-bearing area of the hindfoot. we used tibial nerve as recepient nerve in 11 and calcaneal branch of tibial nerve in 5 for restoration of sensibility of flap. All cases survived completely. A static two-point discrimination of 14 to 34mm was detected in the flap. Radial nerve palsy which was caused by hematoma in donor site occured in one case, but recorverd in 3 weeks later completely. In conclusion, the lateral arm free flaps are versatile, reliable and sensible cutaneous flap and especially indicated for soft tissue defect on plantar surface of the hindfoot which are not good indications for other better-known flaps.

• 대한미세수술학회:학술대회논문집
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• 대한미세수술학회 1993년도 제13차 학술대회
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• pp.101.2-101.2
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• 1993

• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.76-80
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• 2012

Various soft tissue defects can be occurred in the hand. In determining the most suitable means of reconstruction a defect, the benefit of the reconstruction has to outweigh the risk of donor morbidity. Flap selection will be based on the size of the defect, the requirements for sensibility, the surgeon's comfort level, and the patient profile such as gender, age, or systemic disease. The hand is the most important tactile sensory organ, hence sensory restoration is critical. Neurosensory free flaps can provide sensibility, vascularity, and soft tissue coverage to an injured hand. This paper will discuss free flaps which can be used for soft tissue reconstruction of the hand.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.120-126
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• 2000

저자들은 1992년 7월부터 수부에서 연부 조직이 손상되어 결손된 부위를 신경감각 유리 피부판을 이용하여 재건하여 평균 5년 11개월 추시하였다. 수부에서 적절한 신경감각 유리 피부판은, 절개와 문합시 미세 수술이 가능하도록 충분한 직경과 길이를 가진 혈관이 존재하여야 하며, 피부판에 존재하는 신경은 임계 감수성이 가장 중요하며, 때로는 방어 감수성을 향상시키기 위하여 선택되어져야 한다. 포장 주위 유리 피부판은, 족부의 제 1 협부-공간 피부판과 족지-수질 피부판과 함께 임계 감수성을 향상시키기 위한 중요한 피부판이지만, 수부에서 결손 부위, 그리고 결손 부위의 특수한 상황과 결손 부위가 넓은 경우에는, 2차적으로 방어 감수성의 향상을 위하여 족 배유리 피부판이나 외 상완 피부판 등이 선택되어 질수 있다. 저자들이 치험한 수부 무지의 재건에 이용한 포장 주위 피부판 4례는 임계 감수성이 우수하고, 2점 감별 검사에서 양호한 결과를 보였다.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.129-136
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• 2010

Purpose: Anatomically, the foot is provided with insufficient blood supply and is relatively vulnerable to venous congestion compared to other parts of the body. Soft tissue defects are more difficult to manage and palliative treatments can cause hyperkeratosis or ulcer formation, which subsequently requires repeated surgeries. For weight bearing area such as the heel, not only is it important to provide wound coverage but also to restore the protective senses. In these cases, application of flaps for hind foot reconstruction is widely recognized as an effective treatment. In this study, we report the cases of soft tissue reconstruction for which various types of flaps were used to produce good results in both functional and cosmetic aspects. Methods: Data from 37 cases of hind foot operation utilizing flaps performed between from June 2000 to June 2008 were analyzed. Results: Burn related factors were the most common cause of defects, accounting for 19 cases. In addition, chronic ulceration was responsible for 8 cases and so forth. Types of flaps used for the operations, listed in descending order are radial forearm free flap (18), medial plantar island flap (6), rotation flap (5), sural island flap (3), anterolateral thigh free flap (2), lattisimus dorsi muscular flap (2), and contra lateral medial plantar free flap (1). 37 cases were successful, but 8 cases required skin graft due to partial necrosis in small areas. Conclusion : Hind foot reconstruction surgeries that utilize flaps are advantageous in protecting the internal structure, restoring functions, and achieving proper contour aesthetically. Generally, medial plantar skin is preferred because of the anatomical characteristics of the foot (e.g. fibrous septa, soft tissue for cushion). However alternative methods must be applied for defects larger than medial plantar skin and cases in which injuries exist in the flap donor / recipient site (scars in the vicinity of the wound, combined vascular injury). We used various types of flaps including radial forearm neurosensory free flap in order to reconstruct hind foot defects, and report good results in both functional and cosmetic aspects.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.