• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.75-78
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• 2016

The method of lower limb reconstruction surgery is selected based on a patient's underlying conditions, general conditions, and wound status, and it usually varies from direct closure to skin graft and flap coverage. Herein, we describe a patient with Duchenne muscular dystrophy who developed critical limb ischemia after femoral cannulation for extracorporeal membrane oxygenation was used during knee disarticulation, which was followed by reconstruction of the defect around the knee using a pedicled anterolateral thigh flap and skin graft.

• Journal of Chest Surgery
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• 제35권1호
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• pp.20-26
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• 2002

배경: 관상동맥수술에서 동맥도관의 장점이 확인되면서, 우위망동맥(right gastroepiploic artery)의 사용이 점차 늘고 있다. 우위망동맥을 근위부 협착이 심하지 않은 관상동맥에 유근이식편(pedicled uaft)으로 사용할 경우 역행성 혈류가 발생할 수 있다는 보고들이 많아지면서, 수술 전에 역행성 혈류를 예측하려는 시도가 계속되고 있다. 본 연구는 정상 관상동맥과 우위망동맥 사이에 생리적으로 존재하는 혈압차(Vessure difference: PD)를 증명하고 협착 관상동맥의 경협착 맥압차(trans-stenosis pressure gradient: TSPG)와의 상관관계를 분석함으로써, 우위대망동맥을 유근이식편으로 사용할 때 역행성 혈류가 발생할 수 있는 근위부 협착의 정도를 예측하기 위해 고안되었다. 대상 및 방법,. 1998년 7월부터 1999년 2월까지 관상동맥 조영술에서 정상으로 판정된 12명의 환자에서 우관상동맥과 우위망동맥(혹은 복강동맥; celiac uef)의 압력을 측정하여 혈관 사이의 혈압차(PD)를 측정하였다. 관상동맥협착이 확인된 29명의 환자에서는 경협착 맥압차(TSPG)를 측정하였다. 결과:정상 환자군에서 우관상동맥과 우위망동맥의 수축기혈압은 143$\pm$23 : 134$\pm$17 mmHg(p<0.005), 이완기혈압은 74$\pm$13 : 73$\pm$14 mmHg(p=NS), 평균혈압은 100$\pm$16 : 97$\pm$15mmHg이었다(p<0.05). 동맥 사이의 압력차(PD)는 수축기혈압 -8~25 mmHg, 이완기혈압 -4~7 mmHg, 평균혈압 -1 ~ 10mmHg이었다(p<0.05). 관상동맥협착 환자군에서 경협착맥압차(TSPG)는 75% 미만의 협착의 경우 -4~l9(7$\pm$5.8) mmHg이고, 75% 이상의 협착의 경우 7~74(27$\pm$18.3) mmHg이었다(p<0.005). 75% 이상의 협착에서는 관상동맥의 경협착 맥압차(TSPG)가 우위망동맥과의 생리적 혈압차(PD) 보다 크고, 협착 원위부 관상동맥의 혈압도 우위망동맥 혈압보다 유의하게 낮았다(p<0.001). 결론: 관상동맥우회술 후 역행성 혈류의 발생원인이 우위대망동맥과 협착하부 원위부 관상동맥 사이의 압력차이라고 가정할 때, 본 연구의 결과는 우위대망동맥을 75%이상 협착병소에 유근이식편으로 사용할 경우 역행성 혈류가 발생할 가능성이 적어진다는 것을 시사할 수 있다.

• Journal of Chest Surgery
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• 제26권7호
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• pp.526-531
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• 1993

Sixty-one consecutive patients with coronary artery bypass graft for myocardial revascularization were retrospectively reviewed to analyze various pattern of postoperative complication and death during hospital stay from Nov. 1988 to Oct. 1992. Fortytwo of the patients were male and nineteen female. The mean age was 56 and 51 years in male and female. Preoperative diagnosises were unstable angina in 14 of patients, stable angina in 28, postmyocardial infarction state in 15, and state of failed percutaneous transluminal coronary angioplasty in 4. 141 stenosed coronary arteries were bypassed with use of 20 pedicled internal mammary artery and 124 reversed saphenous vein grafts. Postoperative complications and perioperative death were as follows: 1. Of 61 patients undergoing operation, peri and postoperative over all complication occured in 15 patients [ 25% ]; newly developed myocardial infarction in 4, intractable cardiac arrhythmia including atrial fibrillation and frequent ventricular premature contraction in 3, bleeding from gastrointestinal tract in 2, persistent vegetative state as a sequele of brain hypoxia in 1, wound necrosis in 1, left hemidiaphragmatic palsy in 3 and poor blood flow through graft in 2. 2. Operative mortality was 8%[5 patients]. 3 out of these died in operating room; 1 patient by bleeding from rupture of calcified aortic wall, 1 by air embolism through left atrial vent catheter, 1 by low cardiac output syndrome. 2 patients died during hospital stay; 1 by acute respiratory distress syndrome with multiuple organ failure, 1 by brain death after delayed diagnosis of pericardial tamponade.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권2호
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• pp.153-159
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• 1991

외상성, 혹은 선천적 결손으로 인한 함몰부에 사용한 자가 유리지방 이식은 잘 알려진 방법이다. 이를 위해 사용되는 주된 공여부는 복부나 둔부의 피하지방이었다. 그러나, 1977 년 Egyedi는 협지방대를 유경피판으로 처음 사용하였다. 협지방대는 안면골 절단술시, 협측 피판을 들어올릴 때, 혹은 이하선관 수술 같은 구강내 수술시 항상 귀찮은 구조물로써, 수술 시야를 방해한다. 협지방대는 매우 세밀한 막으로 둘러싸인 소엽형태의 볼록한 물질로, body와 네 개의 prccess들로 구성된다. 이 돌기들은 여러 근육층 사이의 충전물로 작용하며, 유아에서는 sucking시 보조작용으로, 성인에서는 윤활재로 사용되기도 한다. 본 교실에서는 협지방대를 사용하여 세 증례의 협골 함몰부에, 그리고 한 증례의 비순구 재건을 위해 사용한 바, 양호한 결과를 얻었기에 문헌고찰과 함께 증례보고를 하는 바이다.

• 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.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.217-223
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• 2023

Purpose: Defects involving the ankle and foot are often the result of road traffic accidents. Many such defects are composite and require a flap for coverage, which is a significant challenge for reconstructive surgeons. Various locoregional options, such as reverse sural artery, reverse peroneal artery, peroneus brevis muscle, perforator-based, and fasciocutaneous flaps, have been used, but each flap type has limitations. In this study, we used the distally based lateral supramalleolar flap to reconstruct distal dorsal defects of the foot. The aim of this study was to analyze the efficacy of the flap in reconstructing distal dorsal defects of the foot. The specific objectives were to study the adequacy, reach, and utility of the lateral supramalleolar flap for distal defects of the dorsum of the foot; to observe various complications encountered with the flap; and to study the functional outcomes of reconstruction. Methods: The distal dorsal foot defects of 10 patients were reconstructed with distal lateral supramalleolar flaps over a period of 6 months at a tertiary care center, and the results were analyzed. Results: We were able to effectively cover distal foot defects in all 10 cases. Flap congestion was observed in two cases, and minor graft loss was seen in two cases. Conclusions: The distally based lateral supramalleolar flap is a good pedicled locoregional flap for the coverage of distal dorsal foot and ankle defects of moderate size, with relatively few complications and little morbidity. It can be used as a lifeboat or even substitute for a free flap.

• 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.

• Journal of Chest Surgery
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• 제32권2호
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• pp.206-210
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• 1999

기관재건술 후 발생한 심부 종격염 2례에 대해 흉골절제, 대위망 자유이식 혹은 전치술, 근피성형술을 병행하여 좋은 결과를 얻었기에 보고한다. 증례 I은 8세된 남아에서 흉골 정중절개로 전방기관성형술을 실시한 후 심부 종격염과 흉골 골수염이 발생한 경우였으며, 증례 II는 50세된 여자에서 상부 흉골의 부분 정중절개로 기관절제 및 단단문합을 실시한 후 종격농양과 흉골 골수염이 발생한 경우였다. 치료는 두례 모두 배농을 시키고 일정기간 세척한 다음, 골수염이 생긴 흉골을 광범위 절제하고 대위망으로 종격을 덮은 후 양측 대흉근을 피부와 함께 박리하여 전흉벽을 재건하였다. 이때 증례 I의 경우는 대위망을 분리한 뒤 횡격막을 통해 종격부위에 위치시켰으며 (in-situ pedicled grafting), 증례 II의 경우는 대위망을 자유이식편으로 만들어 우횡경동맥과 외경정맥에 연결한 후 피하출구을 통해 상부종격에 위치시켰다 (free grafting). 양례 모두 술후 쾌회복하였으며 외래를 통해 추적관찰 중이다.

• Archives of Reconstructive Microsurgery
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• 제19권2호
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• pp.97-100
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• 2010

Purpose: Epidermolysis bullosa is a rare genetic disease, characterized by the presence of extremely fragile skin and formation of recurrent blister resulting from even a minor mechanical injury. Squamous cell carcinoma (SCC) is recognized as a complication of the chronic scarring associated with dystrophic epidermolysis bullosa (DEB). When a soft tissue defect happens in a patient with epidermolysis bullosa, it is difficult to cover it with a skin graft or a flap. We describe the successful use of a pedicled deep inferior epigastric perforator flap for the reconstruction of SCC associated with DEB in the groin. Methods: A 29-year-old man diagnosed with DEB at birth sustained an ulcer increasing in the right groin for the last 7 months. Under general anesthesia, the mass lesion and lymph nodes were removed and the resulting defect was covered with a pedicled deep inferior epigastric perforator flap. Results: The flap survived completely and his postoperative course was uneventful. Histopathological examination revealed a SCC in the right groin and malignant tumor cells in the removed lymph nodes as well. Additional positron emission tomogram showed a malignant lesion in the ileocecal area with regional lymph node metastasis. The patient was referred to an oncologist for chemotheraphy, but the patient refused to take it. During a 4-month follow-up period, there was no recurrence in the right groin. Conclusion: We suggest that perforator flaps can be considered as a reliable alternative for the reconstruction of soft tissue defects in a patient with DEB.

• Journal of Korean Dental Science
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• 제7권1호
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• pp.38-42
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• 2014

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as exposed necrotic bone without evidence of healing for at least 8 weeks in the maxillofacial area in a patient with history of bisphosphonate use. Obtaining complete coverage of the hard tissue by soft tissue in BRONJ patients is especially important. Therefore, managing the mucosa is one of the key factors in a successful outcome, but this is especially hard to achieve in BRONJ patients. Various applications of buccal fat pad in oral reconstruction-including the closure of surgical defects following tumor excision, repair of surgical defects following the excision of leukoplakia and submucous fibrosis, closure of primary and secondary palatal clefts, coverage of maxillary and mandibular bone grafts, and lining of sinus surface of maxillary sinus bone graft in sinus lift procedures for maxillary augmentation-have been studied. Eliminating all potential sites of infection and post-operative infection control is crucial in BRONJ. We present a case using the buccal fat pad pedicle for a stage 3 BRONJ defect. Uneventful total epithelialization of the buccal fat pad regardless of size was noted. In summary, the buccal fat pad has versatile application and various recipient sites for surgical utilization. It is an easy technique, with promising overall success rates. With careful selection and handling, buccal fat graft can resolve problems with soft tissue coverage in stage 2 or 3 BRONJ patients.