• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.38-43
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• 2001

Introduction : The goal in the management of soft tissue injuries of the lower extremity is to obtain a closed stable wound as soon as possible. Recently, An anatomic study that has shown the role of the vascular axis that follows the superficial sensory nerves in supplying the skin developed the concept of a neuroskin island flap. It has been suggested that skin island flaps supplied by the vascular network of the saphenous nerve is one of the most reliable treatment to skin defect below the knee joint. Purpose : The aim of this article is to present a clinical experience of neuroskin island flaps based on the saphenous nerve and to estimate the clinical utilities of distally based saphenous neuroskin flap. Materials and Methods : From September 1995 to May 2000, a total 12 distally based neuroskin island flaps supplied by the vascular axis of the saphenous nerve were performed to cover defects in pretibial area below the knee. Result : flap necrosis due to reactivation of existing infection developed in a case that skin defect had been on infected nonunion site of tibia. But other 11 cases survived completely without any specific complications. Conclusion : The distally based neuroskin pedicled island flap using the vascular network of the saphenous nerve are versatile and reliable and especially indicated for limited defects in pretibial area below the knee joint which are not good indications for other better-known flaps.

• Archives of Plastic Surgery
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• 제32권6호
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• pp.777-781
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• 2005

Syndactyly and polysyndactyly are one of the most common congenital anomalies of upper limb. Although there are many surgical approaches, most of them require skin graft for covering the raw surfaces. Therefore these methods involve many disadvantages such as grafted skin contracture, web recurrence, skin graft loss and long operation time, and the grafted hyperpigmented skin and donor site of skin graft, which lead to poor results aesthetically. The authors treated seven cases with a Hayashi's new method in four patients. In this method, tissue of interdigital space are regarded as forming 4 facets of a two piled cube. A dorsal rectangular flap on dorsum of interdigital web makes a new interdigital space. One side of divided digit is coverd with lateral based plantar flap and the other side of divided digit is covered with subcutaneous pedicled flap and remnant web skin. The authors could obtain natural deep interdigital space without web recurrence and scar contracture in 7 cases. Moreover this method does not require skin grafting, accordingly produces better aesthetic results without hyperpigmentation and donor site scaring. Therefore we report this operation technique, which might be used as one of the standard in surgical correction of syndactyly and polysyndactyly.

• Archives of Plastic Surgery
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• 제50권6호
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• pp.593-600
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• 2023

Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee jointmobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.

• Archives of Reconstructive Microsurgery
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• 제24권1호
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• pp.32-36
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• 2015

The reconstruction of recurrent pressure sores is challenging due to a limited set of treatment options and a high risk of flap loss. Successful treatment requires scrupulous surgical planning and a multidisciplinary approach. Although the tensor fascia lata flap is regarded as the standard treatment of choice-it provides sufficient tissue bulk for a deep trochanteric sore defect-plastic surgeons must always consider the potential of recurrence and accordingly save the second-best tissues. With the various applications of anterolateral thigh (ALT) flaps in the reconstructive field, we report two cases wherein an alternative technique was applied, whereby pedicled ALT fasciocutaneous island flaps were used to cover recurrent trochanteric pressure sores. The postoperative course was uneventful without any complications. The flap provided a sound aesthetic result without causing a dog-ear formation or damaging the lower-leg contour. This flap was used as an alternative to myocutaneous flaps, as it can cover a large trochanteric defect, recurrence is minimized, and the local musculature and lower-leg contour are preserved.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.360-366
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• 2012

Background Coverage of defects of the pretibial area remains a challenge for surgeons. The difficulty comes from the limited mobility and availability of the overlying skin and soft tissue. We applied variable pedicled perforator flaps to overcome the disadvantages of local flaps and free flaps on the pretibial area. Methods Eight patients who had the defects in the anterior tibial area were enrolled. Retrospective data were obtained on patient demographics, cause, defect location, defect size, flap dimension, originating artery, pedicle length, pedicle rotation, complication, and postoperative result. The raw surface created following the flap elevation was covered with a split thickness skin graft. Results Posterior tibial artery-based perforator flaps were used in five cases and peroneal artery-based perforator flaps in three cases. The mean age was 54.3 and the mean period of follow-up was 6 months. The average size of the flaps was 63.8 $cm^2$, with a range of 18 to 135 $cm^2$. There were no major complications. No patients had any newly developed functional deficit of the lower leg. Conclusions We suggest that pedicled perforator flaps can be an alternative treatment modality for covering pretibial defects as a simple, safe and versatile procedure.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.15-25
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• 2021

Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.

• 대한두경부종양학회:학술대회논문집
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• 대한두경부종양학회 1996년도 춘계학술대회 초록집
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• pp.103-107
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• 1996

• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.44-48
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• 2001

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wounds. However, in case of complete extremity amputation in eletrical burn patient, the transfer of pedicled flaps from the amputated part is not possible. In such instances, we have designed total arm musculocutaneous free-fillet flaps from the amputated limb to provide wound coverage, when replantation of the amputated part was contraindicated. now we present such a case. This technique allows immediate wound coverage without the morbidity of an additional donor site. The flap provides the ideal combination of large surface area, muscle bulk, and long vascular pedicle. It can be dissected rapidly to minimize ischemic time and could therefore be applicable to traumatic forequarter amputations.

• Archives of Plastic Surgery
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• 제48권4호
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• pp.410-416
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• 2021

Background This systematic review compared free anterolateral thigh (ALT) flaps versus pedicled distally based sural artery (DBSA) flaps for reconstruction of soft tissue defects of dorsal foot and ankle in children. Methods A systematic literature search was performed to identify cases where an ALT or DBSA was used to reconstruct the dorsal foot in children. A total of 19 articles were included in the systematic review. Results Eighty-three patients underwent an ALT reconstruction and 138 patients underwent a DBSA reconstruction. Patients who had a DBSA were more likely to require grafting of the donor site (P<0.001). The size of ALT flaps was significantly larger than DBSA flaps (P=0.002). Subsequent flap thinning was required in 30% of patients after ALT and 12% of patients after DBSA reconstruction (P<0.001). Complications occurred in 11.6% of DBSA and 8.4% of ALT flaps (8.4%). Conclusions Both flaps are valid options in reconstructing pediatric foot and ankle defects. Each flap has advantages and disadvantages as discussed in this review article. In general for larger defects, an ALT flap was used. Flap choice should be based on the size of the defect.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제14권1_2호
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• pp.105-116
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• 1992

저자들은 악안면부에 발생한 종양 절제 후 광배근피판(유정 피판, 5례 : 유리 피판, 1례)으로 재건하여 5례에서 성공하였다. 큰 피판 형성의 잠재성은 두경부에서 충분한 종물제거와 재건을 가능하게 하였으며, 피판 형성이 빠르고 용이하며 긴 혈판경(약 45cm)을 채득할 수 있었다. 공여부 합병증과 기능 상실이 적어 두경부의 커다란 결손부 재건에 매우 유용한 피판으로 판단되었으며, 경부곽청술 후 노출되는 심부 조직에 대해 심미적이며 기능적인 보호를 제공할 수 있었다.