• Archives of Plastic Surgery
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• 제34권3호
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• pp.346-351
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• 2007

Purpose: As a rare congenital anomaly, Poland's syndrome has been known to show hypoplasia in breast and nipple, absence of pectoralis major muscle, and aplasia or deformity of rib or costal cartilage which has been reported to be more common in male. However, most patients who are seeking operation are female patients having one-side deformity. In the field of plastic surgery, the major surgical indications could be asymmetric chest wall depression in man or breast hypoplasia in woman. There are many reconstruction options according to the degree of patient's deformity: a prosthetic implant, breast implant with or without tissue expander, latissimus dorsi musculocutaneous pedicled flap with or without implant and/or tissue expander, and free tissue transfer with or without tissue expander. Methods: The authors have treated 4 patients(2 male, 2 female) who had a diagnosis of Poland's syndrome. According to the degree of patient's deformity, all patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with one-staged or two-staged reconstruction. Results: All patents were satisfied with the results and there occurred no specific complications. Conclusion: The authors propose the treatment plan for patient with Poland's syndrome, according to the degree of patient's deformity. In case of male patient with mild deformity, the prosthetic implant or latissimus dorsi musculocutaneous pedicled flap will simulate the missing pectoralis and improve the contour deformity. In case of female patient with moderate to severe breast asymmetry and upward displaced nipple areolar complex (NAC), NAC can be lowered with tissue expander, breast can be enlarged with autologous free flaps or latissimus dorsi musculocutaneous pedicled flap with implant.

• Archives of Plastic Surgery
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• 제41권3호
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• pp.253-257
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• 2014

Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to $33.6kg/m^2$ (mean, $23.1{\pm}3.74kg/m^2$). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.

• 대한기관식도과학회지
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• 제3권2호
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• pp.270-276
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• 1997

The records of 18 patients with squamous cell carcinoma of the tongue and floor of mouth treated surgically were reviewed. Surgical approaches, staging, treatment modalities, recurrence and vital status were evaluated. The distrubutions of involved sites were tongue(9 cases) and mouth floor(9 cases). Patients were treated by surgery primarily, combined chemotherapy and radiation, and by surgical salvage in the failure cases of radiation and chemotherapy. All ipsilateral necks of mouth floor cancer and advanced tongue cancer were treated with neck dissection. Cases of early tongue cancer could be excised with transoral route, and advanced cases needed transmandibular approach. Whereas, majorites of mouth floor cancer needed transmandibular approach, and other cases could be excised transoral and pull-through approaches. In the recontructions, we used primary closure, pectoralis major myocutaneous flap, forearm free flap, fibular osteocutaneous flap and skin graft. One year survival rate was 93% and 2 year survival rate was 60%.

• 대한두경부종양학회지
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• 제2권1호
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• pp.49-59
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• 1986

대흉근근피판은 혈액공급이 왕성하며 회전호가 크고 조직량이 층충해 안면부 결손을 기능적 및 미용적으로 잘 재건해 줄 수 있을뿐 아니라 용도에 따라 다양하게 사용할 수 있다. 저자들은 안면 부에 발생한 거대한 기저세포암 l 예와 보존요법으로서는 치료가 불가능한 만성상악골 골수염을 동반한 거대한 섬유성종괴 1 예를 절제하고 이로써 생긴 안면부의 광범한 조직결손을 도서형대흉근근피판으로 대치하여 좋은결과를 얻을 수 있었다.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.228-234
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• 2011

Purpose: Reconstruction of chest wall has always been a challenging problem. Muscle flaps for chest wall reconstruction have been helpful in controling infection, filling dead space and covering the prosthetic material in this challenge. However, when we use muscle flaps, functional and cosmetic donor site morbidities could occur. The authors applied and revised various partial muscle flaps and combination use of them to cover the prosthetic material for the chest wall reconstruction and evaluated the usefulness of partial muscle flaps. Methods: This study included 7 patients who underwent chest wall reconstruction using partial muscle flap to cover prosthetic material from 2004 to 2008. The pectoralis major muscle was used in anterior 2/3 parts of it leaving lateral 1/3 parts of it. The anterior 2/3 parts of the pectoralis major muscle were used while lateral 1/3 parts were left. In case of the rectus abdominis muscle flap, we used upper half of it, or we dissected it around its origin and then advanced to cover the site. The latissimus dorsi muscle flap was elevated with lateral portion of it along the descending branch of the thoracodorsal artery. If single partial muscle flap could not cover whole prosthetic material, it would be covered with combination of various partial muscle flaps adjacent to the coverage site. Results: Flap coverage of the prosthetic material and chest wall reconstructions were successfully done. There occurred no immediate and delayed post operative complications such as surgical site infection, seroma, deformity of donor site and functional impairment. Conclusion: When we use the muscle flaps to cover prosthetic material for chest wall reconstruction, use of the partial muscle flaps could be a good way to reduce donor site morbidity. Combination of multiple partial flaps could be a valuable and good alternative way to overcome the disadvantages of partial muscle flaps such as limitation of volume and size as well as flap mobility.

• 대한두경부종양학회지
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• 제1권1호
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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.

• 대한두경부종양학회지
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• 제16권1호
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• pp.26-32
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• 2000

Background and Objectives: Various flaps are using for reconstruction of hypopharyngeal and esophageal defect. However, complication and indication of each flap are not fully analyzed. Patient and Methods: Records of 52 hypopharyngeal cancer patients who had surgical treatment and 13 other head and neck cancer patients who underwent hypopharyngeal and/or esophageal reconstruction with flap were retrospectively analyzed. Eighty three percent(54 cases) of patients needed reconstruction other than primary pharyngeal closure. Five split thickness skin graft, 1 pectoralis major myocutaneous flap, 20 forearm free flap, 13 jejunal free flap, 15 gastric pull up were used. Result: Flap failure was noted in 2 cases who had subsequent gastric transposition. Wound dehiscence and fistula were most common problem of forearm free flap. Most fistulas were developed in patients with conduit type reconstruction of forearm flap while there wasn't any fistula in patient with patch type reconstruction. Stenosis of lower anastomosis was the frequent problem of jejunal transfer. Gastric pull-up has frequent com-plication of stomal stenosis. All but three patients had reached oral feeding postoperatively. Conclusion: Based on this study, forearm flap is effective in partial hypopharyngeal defect while jejunum is the choice for circumferential defect. Gastric pull-up is for combined esophageal defect.

• Journal of Chest Surgery
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• 제41권6호
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• pp.799-802
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• 2008

흉쇄골관절은 전신의 골관절염 중 매우 드물게 이환되는 부위로 주로 마약 중독자, 당뇨병, 만성 신부전, 폐혈증 환자, 및 중심 정맥 혈관 삽입 후에 주로 나타난다. 초기에는 항생제 치료, 단순 절제 및 배농술 등의 방법으로 치유될 수 있으나, 치료 시기를 놓치면 골수염으로 진행되어 광범위 절제가 필요하다. 그러나 재발할 가능성이 있으므로, 본원 흉부외과에서는 혈류를 유지한 대흉근판을 빈공간에 메워 넣어 재발 가능성을 줄여보고자 하였다. 골수염을 동반한 흉쇄골 관절염 환자를 성공적으로 치료하였기에 이에 보고하는 바이다.

• Journal of Chest Surgery
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• 제27권10호
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• pp.888-892
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• 1994

Acquired, traumatic tracheoesophageal fistula [TEF] is rare and difficult problem to manage. This 55 years old man met with a roller accident of a tractor. During accident, he received a penetrating injury on the left upper sternal border. At local clinic, he received closed thoracotomy drainage [CTD]for relief of pneumothorax[left]. Three days after CTD, he complained abdominal pain and hematemesis. The endoscopy revealed large ulcer at the stomach, so he received subtotal gastrectomy. On 10th day post subtotal gastrectomy, he developed aspiration and coughing from a TEF. The esophagogram showed large TEF at the mid-trachea level. So he transfered to our hospital for operation. This patient was operated on for late TEF three weeks after injury. We have used absorble 4-0 Vicryl sutures to repair trachea. We repair all esophageal injuries with two layers of nonabsorbable silk suture. Where suture line on the esophagus, the strap muscle was interposed for reinforcement. And for feeding, the feeding jejunostomy was performed. Postoperatively the osteomyelitis of the manubrium site was developed, so on the 30th postoperative day, an ostectomy of manubrium, both clavicle and fight 1st, 2nd ribs, and the pectoralis major musculo-cutaneous flap coverage were performed.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.530-538
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• 2017

Background A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula. Methods Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation. Results A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation. Conclusions Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.