• Archives of Craniofacial Surgery
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• v.21 no.4
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• pp.237-243
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• 2020

Background: The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons. Methods: This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors. Results: Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p=0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R=0.479, p<0.001) and depth (p<0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis. Conclusion: There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.

• Archives of Plastic Surgery
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• v.40 no.3
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• pp.181-186
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• 2013

Background Partial or complete necrosis of a skin flap is a common problem. Polydeoxyribonucleotide (PDRN) can be extracted from trout sperm and used as a tissue repair agent. The aim of this study was to investigate whether PDRN could improve the survival of random pattern skin flaps in rats. Methods Twenty-two male Sprague-Dawley rats were randomly divided into two groups: the PDRN treatment group (n=11) and the control group (n=11). Caudally pedicled random pattern skin flaps were elevated on their dorsal skin and resutured. The treatment group received daily intraperitoneal administration of PDRN (8 mg/kg/day), and the control group received fluid vehicle (NaCl 0.9%, 8 mg/kg/day) from day 0 to day 6. On day 7, the flap survival was evaluated and the harvested tissue surrounding the demarcation line of the necrotic area was stained with H&E, anti-rat vascular endothelial cell growth factor (VEGF) antibody, and PECAM-1/CD31 antibody. Results The average necrotic area of the flap in the PDRN group was significantly smaller when compared with that of the control group. Histologic and immunohistochemical evaluation showed that granulation thickness score and VEGF-positive staining cells were marked higher in the PDRN group than in the control group. PECAM-1/CD31-positive microvascular densities were significantly higher in the PDRN group when compared with the control group. Conclusions This study confirms that PDRN improves the survival of random pattern skin flaps in rats. These results may represent a new therapeutic approach to enhancing flap viability and achieving faster wound repair.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.376-383
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• 2012

Background No consensus has been reached regarding the outcome of management of local recurrence after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. This study demonstrated the presentation, management, and outcomes of local recurrence after immediate TRAM breast reconstruction. Methods A comparison was conducted among 1,000 consecutive patients who underwent immediate breast reconstruction with a pedicled TRAM flap (TRAM group) and 3,183 consecutive patients who underwent only modified radical mastectomy without reconstruction (MRM group) from January 2001 to December 2009. The presentation, treatment, and outcome including aesthetics and overall survival rate were analyzed. Results Local recurrences occurred in 18 (1.8%) patients (TRAM-LR group) who underwent TRAM breast reconstruction and 38 (1.2%) patients (MRM-LR group) who underwent MRM only (P=0.1712). Wide excision was indicated in almost all the local recurrence cases. Skin graft was required in 4 patients in the MRM-LR group, whereas only one patient required a skin graft to preserve the mound shape in the TRAM-LR group. The breast mound was maintained in all 17 patients that survived in the TRAM-LR group even after wide excision. The overall survival rate was 94.4% in the TRAM-LR group and 65.8% in the MRM-LR group (P=0.276). Conclusions Local recurrence after immediate TRAM flap breast reconstruction could be detected without delay and managed effectively by multiple modalities without reducing overall survival rates. Breast mound reconstruction with soft autologous tissue allowed for primary closure in most of the cases. In all of the patients who survived, the contour of their reconstructed breast remained.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.436-440
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• 2007

Purpose: TRAM flap surgery has settled down as a common method for breast reconstruction after mastectomy. We investigated how TRAM flap surgery influences on the patients' physical movement capability by observing their capability of sit-ups as well as exercises they usually enjoy. Methods: A total of consecutive 375 patients were investigated who had breast reconstruction with unilateral pedicled TRAM flap surgery at Asan Medical Center from July 2001 to August 2005. The patients were asked to sit up right before the surgery and do it again 6 months later and 1 year later. 221 patients were followed up 6 month after the surgery. And 132 patients were followed up 1 year after the surgery. In addition, 155 patients who used to exercise before the surgery were also asked to show us the change in their physical movement capability one year after their surgery. Results: 139 patients showed decrease in the counted number of sit-ups, 48 increase, and 34 showed no change between 6 months in the first group of 221 patients. Among the second group of 132 patients, 64 showed decrease, 39 increase, and 29 no change a year later. There was a statistical significant decrease in the number of sit-ups between pre-operation and six months later and between pre-operation and one year later. According to the research on the exercise that 155 patients participated, 3 of them showed improvement in athletic ability, 7 showed decrease, while the rest, 145 patients, showed no change at all. Conclusion: Considering no difference in usual exercise ability, some patients' increase in the number of sit-ups and the effect of anticancer treatment, we found that the loss of abdominal wall function on this research is not too serious to exclude TRAM flap surgery in the field of breast reconstruction

• Journal of Chest Surgery
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• v.32 no.2
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• pp.206-210
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• 1999

We report here 2 cases of deep-seated mediastinitis combined with sternal osteomyelitis after tracheal reconstruction which were successfully treated with sternectomy, in-situ or free omental transfer, and pectoralis major myocutaneous flap. In case I, an 8 year-old boy with deep seated mediastinitis and sternal osteomyelitis that developed after anterior tracheoplasty through a standard midline sternotomy. In case II, a 50 year-old female patient with mediastinal abcess and sternal osteomyelitis that developed after resection and end-to-end anastomosis of the trachea through an upper midline sternotomy. Treatments consisted of drainage and irrigation followed by wide resection of the infected sternum, placement of the viable omentum into the anterior mediastinal space, and chest wall reconstruction with a pectoralis major myocutaneous flap. The omentum was transferred as an in-situ pedicled graft in case I and a free graft in case II. Both patients have recovered smoothly wit out any events and have been doing well postoperatively.

• Archives of Craniofacial Surgery
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• v.21 no.2
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• pp.127-131
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• 2020

A 60-year-old woman with a history of diabetes mellitus and chronic renal failure was admitted to the hospital with severe pain in the upper lip, which began 4 days prior to admission, accompanied by a bullous lesion and suspected cellulitis in the upper lip. Immediately after admission, as the patient's general condition worsened, tests revealed a non-ST elevated myocardial infarction, septic embolism of the lung, as well as septic shock. Her upper lip suddenly presented a gangrenous and necrotic change, which the tissue and blood culture confirmed to be a Klebsiella pneumoniae infection. After a quick response, the patient's general condition improved. Subsequently, serial debridement was performed to effectively clear away the purulent discharge. While under general anesthesia, the process confirmed full-layer necrosis of the upper lip including the orbicularis oris muscle. Almost half of the entire upper lip sustained a full-layer skin and soft tissue defect, with scar contracture. Six months later, to correct the drooling and lip sealing following the defects, a scar release and an Abbe flap coverage were performed considering both functional and aesthetic aspects. The follow-up revealed a favorable corrective result of the upper lip drooling, and the patient was satisfied from a functional perspective.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.420-427
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• 2007

Background: Postpneumonectomy empyema (PPE) due to bronchopleural fistula (BPF) can be a surgical challenge for surgeons. We analyzed the follow-up outcomes after performing omentopexy and thoracoplasty for the treatment of PPE with BPF after pneumonectomy. Material and Mehod: Between December 1991 and January 2006, 9 patients underwent BPF closure using an omental pedicled flap for the treatment of PPE with BPF after pneumonectomy. There were 7 males and 2 females (mean age: $45.9{\pm}9$ years). The patients were followed up for a mean of 58 months (median: 28 months, range: $6{\sim}169$). When we performed omentopexy, the surgical procedures for empyema were thoracoplasy for 8 patients and the Clagett procedure for 1 patient. Thoracoplasty was performed for the latter patient due to recurrence of empyema, Result: For the 8 patients who were treated by omentopexy and thoracoplasty, there was 1 operation-related death due to sepsis. During follow up, 1 patient, who was treated by omentopexy and a Clagett procedure, died of acute hepatitis 40 months postoperatively. The early mortality was 11.1% (8/9). Of the 8 patients, including the 1 late death patient, successful closure of the BPF were achieved in all patients (8/9) and the empyema was cured in 7 patients (7/8). Conclusion: The BPF closure using an omental pedicled flap was an effective method for treating PPE with BPF due to 75-destroyed lung, and thoracoplasty with simultaneous omentopexy was effective and safe for removing dead space if the patient was young and in a good general condition.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.627-635
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• 2011

Purpose: Advanced breast cancer traditionally has been perceived as a contraindication to immediate breast reconstruction, because of concerns regarding adjuvant treatment delays and the cosmetic effects of radiotherapy to breast reconstruction, so delayed reconstruction is usually preferred in advanced breast cancer patients undergoing mastectomy. However, with the improved outcome using multimodality therapy, consisting of perioperative chemotherapy and radiotherapy, immediate breast reconstruction is now being performed as surgical option for selected advanced breast cancer patients. Additionally, advanced breast cancer patients may be needed soft tissue coverage of an extensive skin and soft tussue defect after mastectomy. Current authors have experienced several types of immediate breast and chest wall reconstruction for advanced breast cancer. Methods: From December of 2007 to June of 2009, 14 women performed for immediate breast and chest wall reconstruction for advanced breast cancer. They had been treated with neoadjuvant chemotherapy or chemoradiotherapy followed by modified radical mastectomy or radical mastectomy. Four different techniques were used immediate breast and chest wall reconstruction, which are pedicled TRAM flap (4 cases), extended LD flap with STSG (3 cases), thoracoabdominal flap (4 cases) and thoracoepigastric flap (3 cases). Results: The mean age was 53 years and mean follow up period was 9 months. Patients' oncologic status ranged stage IIIa to stage IV. Two patients had major complications: partial flap necrosis of TRAM flap and one distal necrosis of thoracoabdominal flap. Three patients with stage IV disease died from metastases. Conclusion: The result of this study suggests that immediate breast and chest wall reconstruction can be considered as surgical option for advanced breast cancer. But we need long term follow up and large prospective studies for recurrence and survival.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.945-949
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• 1991

The treatment of acute and chronic empyema with bronchopleural fistula is remained as serious postoperative complication in thoracic surgery. Although several operative procedures for the treatment of postpneumonectomy empyema have been reported, the method of treating empyema, and in particular empyema associated with fistula, remains controversial. Recently some successful results have been reported by use of the omentum in the patients with thoracic empyema resulting from bronchial fistula. We have performed one-stage operations using the omentum and chest wall muscles in 2 patients, one was acute, and the other was chronic case. Their postoperative courses were uneventful

• Oral Biology Research
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• v.42 no.4
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• pp.254-261
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• 2018

Reports have it that horizontal and vertical loss of the ridge happens during 6 months after tooth extraction. So valuable ridge preservation techniques are often necessary in the maxillary anterior areas. Maintaining and/or increasing blood supply and stability is essential to graft survival. The objective of this study was to determine the effect on extraction socket seal of pedicle subepithelial connective tissue graft with tunneling on maxillary esthetic zone through healing state for 8 weeks.