• Journal of Trauma and Injury
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• 제36권4호
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• pp.404-410
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• 2023

Large scalp defects resulting from high-voltage electrical burns require free flaps, preferably skin, to permit optimal coverage and enable future or simultaneous cranial vault reconstruction. The anterolateral thigh permits the harvest of a large area of skin supplied by a reliable perforator. The superficial temporal vessels offer the proximate choice of recipient vessels to enable adequate reach and coverage. The lack of a second vein at this site implies the inability to perform a second venous anastomosis; however, this obstacle can be overcome by using an interposition vein graft, to the neck veins primarily. This assures adequate venous drainage and complete flap survival.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.324-331
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• 2022

Prior abdominal liposuction can be viewed as a relative or absolute contraindication to abdominally based autologous breast reconstruction given concerns for damaged perforators and scarring complicating intraoperative dissection. This systematic review aims to explore the outcomes of abdominally based breast reconstruction in patients with a history of abdominal liposuction. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature search was conducted using PubMed, Scopus, and Web of Science from the earliest available date through June 2020. Deep inferior epigastric perforator, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), superficial inferior epigastric artery, and pedicled TRAM flaps were included for evaluation. Complications included total or partial flap loss, fat necrosis, seroma, delayed wound healing, and donor site complications. After inclusion criteria were applied, 336 non-duplicate articles were screened, yielding 11 for final review, representing 55 flaps in 43 patients. There was no instance of total flap loss, eight (14.5%) flaps developed partial loss or fat necrosis, three (5.4%) flaps had delayed wound healing, and two (4.6%) patients had donor site complications. Most authors (8/11) utilized some type of preoperative imaging. Doppler ultrasonography was the most used modality, and these patients had the lowest rate of partial flap loss or flap fat necrosis (8%), followed by those without any preoperative imaging (10%). In conclusion, this review supports that patients undergoing abdominally based autologous breast reconstruction with a history of abdominal liposuction are not at an increased risk of flap or donor site complications. Although preoperative imaging was common, it did not reliably decrease complications. Further prospective studies are needed to address the role of imaging in improving outcomes.

• Journal of Trauma and Injury
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• 제37권2호
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• pp.151-157
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• 2024

Electrical burn injuries can cause more damage than clinical evaluations initially suggest. The energy waves penetrate from the surface to the deepest layers of tissue, causing extensive harm at every level. The neck is a critical area, both functionally and aesthetically. We present a case involving a young male patient with a severe fourth-degree electrical burn on the neck, who underwent a single-stage debridement and reconstructive surgery. The pectoralis major myocutaneous flap is a versatile option for various head and neck reconstructions. However, if the donor site cannot be closed primarily and requires split-thickness skin grafting, it can result in unsightly scars and deformities. For large flap paddles, it is ideal to reconstruct the secondary defect with locoregional flaps. In this case, we successfully reconstructed the donor site's secondary defect using a contralateral internal mammary artery perforator flap, without resorting to any skin grafts. The early postoperative results demonstrated satisfactory cosmesis, patient satisfaction, and functional outcomes.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.596-600
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• 2015

Background The uptake of breast reconstruction is ever increasing with procedures ranging from implant-based reconstructions to complex free tissue transfer. Little emphasis is placed on scarring when counseling patients yet they remain a significant source of morbidity and litigation. The aim of this study was to examine the scarring preferences of men and women in breast oncoplastic and reconstructive surgery. Methods Five hundred men and women were asked to fill out a four-page questionnaire in two large Irish centres. They were asked about their opinions on scarring post breast surgery and were also asked to rank the common scarring patterns in wide local excisions, oncoplastic procedures, breast reconstructions as well as donor sites. Results Fifty-eight percent of those surveyed did not feel scars were important post breast cancer surgery. 61% said that their partners' opinion of scars were important. The most preferred wide local excision scar was the lower lateral quadrant scar whilst the scars from the deep inferior epigastric artery perforator (DIEP) flap were most favoured. The superior gluteal artery perforator flap had the most preferred donor site while surprisingly, the DIEP had the least favourite donor site. Conclusions Scars are often overlooked when planning breast surgery yet the extent and position of the scar needs to be outlined to patients and it should play an important role in selecting a breast reconstruction option. This study highlights the need for further evaluation of patients' opinions regarding scar patterns.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.225-232
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• 2023

In retrospect, the irony of this story began with the first meeting of these co-authors-in of all places, Coimbatore, India, in 2008, at the 12th International Perforator Flap Course. Here the junior author [hereafter "jp"] demonstrated his unparalleled skills in networking, and soon thereafter journeyed some 11,073 km to Allentown, U.S. to peruse the operating room and clinics of the senior author [sic. ggh] in action. Within 2 years jp orchestrated the presentation of the 14th International Perforator Flap Course, so ggh with great anticipation flew only 6,830 miles to reach Seoul, Korea for his first time. But four years more elapsed before ggh returned again to Korea to be a visiting professor, all the while not quite sure why any Korean would want anything from a country doctor who resided in nowheresville Allentown, Pennsylvania. Yet, an extraordinary fact then was to be unveiled, about which ggh was totally ignorant. The pioneer of plastic surgery in Korea, the first Korean to have completed an accredited plastic surgery fellowship, by coincidence had accomplished all this in . . . . . Allentown. The collegial relationship that evolved between these co-authors, who met by chance, indeed had a precedent coincidence! Was this "by chance" alone or predestination? Amazingly, in a way similar, the origin of plastic surgery itself in Korea also had Allentown connections. As a tribute to Lew Jae-duk, this important story must be here told, so let us now retrace his past in Allentown so we can find how the future was to be not so far away.

• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.146-156
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• 1998

저자들은 1997년 1월부터 1998년 7월까지 두경부 악성종양 및 반안면왜소증과 같은 선천성 안면기형을 주소로 본원에 내원하였던 환자 9명을 대상으로 하여 9례의 외측대퇴 유리피판술을 시행하여 다음과 같은 결과를 얻을 수 있었다. 첫째, 두경부 재건에 있어서 외측대퇴 유리피판은 다른 유리피판술에 비해 여러 장점을 가지고 있었다. 특히, 공여부 추형이 노출되지 않는 부위이며 동시에 두팀이 수술에 참여할 수 있어서 수술시간이 단축될 수 있었다. 둘째, 술후 방사선치료를 시행하면 피판의 모발은 사라지지만 모공의 과각화증 및 색조 침착이 증가하므로, 외측대퇴부에 모발이 많은 환자는 술후 방사선치료의 여부와 관계없이 미용적인 금기사항에 해당한다. 셋째, 악성종양 절제후에 발생하는 결손의 재건시 피판의 두께가 문제시 되지 않았으며, 피판의 두께는 피판을 도안할 때의 위치, 성(sex), 피하지방층의 제거정도, 근육의 포함 정도, 술 후 피판의 위축정도에 따라 조절 가능하였다. 넷째, 모든 증례에서 정맥이식없이 혈관문합이 가능하였으므로 두경부 재건시 혈관경의 길이는 충분한 것으로 사료된다. 다섯째, 가능한 피판을 장축으로 길게 도안하여 두 번째 또는 네 번째 관통동맥을 포함시켜 수술 후 발생할지도 모르는 혈류부전에 대비하는 것도 피판의 생존률을 높이는 좋은 방법으로 사료된다.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.60-63
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• 2011

Capillary malformation is common vascular malformation. In case of facial capillary malformation, patients' cosmetic and functional deficits are quite significant. The standard treatment which has been applied so far for capillary malformation is pulsed dye laser with 585nm. But in case of advanced capillary malformation, surgical interventions are inevitable. The problem of large size facial capillary malformation is how to cover the remnant defect, which occurs after resection. In this case, authors have experienced surgical treatment of large size facial capillary malformation and covered the large facial defect with free thoracodorsal artery perforator flap. The flap was thick, so facial asymmetry remained after the first surgery. But with the secondary procedure, authors have made more symmetric figures. The patient was satisfied with the result. Using free flap to replace the defect after resection due to capillary malformation is useful for these kinds of cases.

• Archives of Reconstructive Microsurgery
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• 제18권1호
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• pp.16-22
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• 2009

The purpose of this study was to present the clinical result of anterolateral thigh free flap for pretibial soft tissue lesion after chronic tibia osteomyelitis. From December 2006 to September 2008, Five patients were included in our study. 4 of 5 were superficial or localized types of chronic tibia osteomyelitis, based on the classification of Cierny and Mader. Average age at the surgery was 45 years, three were males and two were females. All had a history of chronic tibia osteomyelitis and subsequent pretbial soft tissue lesions coming from previous operations or pus drainage. Pretibial soft tissue defects included small ulcers, fibrotic, bruisable soft tissue and small bony exposures, but not large-sized bony exposures nor active pus discharge. After complete debridement of large sized pretibial soft tissue lesions and decortication of anterior tibial cortical dead bone, anterolateral thigh free flap was applied to cover remained large pretibial soft tissue defect and to prevent the recurrence of infection. All flaps survived and provided satisfactory coverage of soft tissue defect on pretibial region for 16 months' mean follow up period. No patients has had recurrence of osteomyelitis. Anterolateral thigh free flap could be recommend for large sized pretibial soft tissue defect of supreficial or localized types of chronic tibia osteomyelitis after through debridement.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.894-898
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• 2011

Purpose: Coverage of full-thickness large flank defect is a challenging procedure for plastic surgeons. Some authors have reported external oblique turnover muscle flap with skin grafting, inferiorly based rectus abdominis musculocutaneous flap, and two independent pedicled perforator flaps for flank reconstruction. But these flaps can cover only certain portions of the flank and may not be helpful for larger or more lateral defects. We report a case of large flank defect after resection of extraskeletal Ewing's sarcoma which is successfully reconstructed with reverse latissimus dorsi myocutaneous flap. Methods: A 24-year-old male patient had $13.0{\times}7.0{\times}14.0$ cm sized Ewing's sarcoma on his right flank area. Department of chest surgery and general surgery operation team resected the mass with 5.0 cm safety margin. Tenth, eleventh and twelfth ribs, latissimus dorsi muscle, internal and external oblique muscles and peritoneum were partially resected. The peritoneal defect was repaired with double layer of Prolene mesh by general surgeons. $24{\times}25$ cm sized soft tissue defect was noted and the authors designed reverse latissimus dorsi myocutaneous flap with $21{\times}10$ cm sized skin island on right back area. To achieve sufficient arc of rotation, the cephalic border of the origin of latissimus dorsi muscle was divided, and during this procedure, ninth intercostal vessels were also divided. The thoracodorsal vessels were ligated for 15 minutes before divided to validate sufficient vascular supply of the flap by intercostal arteries. Results: Mild congestion was found on distal portion of the skin island on the next day of operation but improved in two days with conservative management. Stitches were removed in postoperative 3 weeks. The flap was totally viable. Conclusion: The authors reconstructed large soft tissue defect on right flank area successfully with reverse latissimus dorsi myocutaneous flap even though ninth intercostal vessel that partially nourishes the flap was divided. The reverse latissimus dorsi myocutaneous flap can be used for coverage of large soft tissue defects on flank area as well as lower back area.

• Archives of Plastic Surgery
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• 제45권6호
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• pp.550-556
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• 2018

Background To achieve improvements in intramuscular injection, autologous fat grafting, and gluteal artery perforator flaps in infants and children, the relationships of computed tomography (CT)-determined gluteal muscle thickness (MT) and subcutaneous tissue thickness (SCT) with age and body mass index (BMI) were analyzed. Methods Gluteal SCT and MT at ventrogluteal (VG) and dorsogluteal (DG) sites were measured in a standardized manner in 350 patients aged 0 to 6 years who had visited a tertiary hospital and had undergone abdominopelvic CT between January 2005 and December 2016. Recorded measurements were analyzed using one-way analysis of variance and stepwise multiple regression to identify the factors that were most closely related to MT and SCT. Results Subcutaneous tissue at VG sites was thinner than at DG sites, but not significantly so in any age group. Muscles tended to be thinner at VG sites in 4 to 7-year-old, but thicker at VG sites in 1 to 3-year-old, though the differences were not significant. MT in the VG and DG regions was found to be related to age, and SCT in these regions to be related to age and BMI. Conclusions The VG and DG sites should be considered as alternatives for intramuscular injection in infants and children when the anterolateral site is problematic. In addition, considering the gluteal MT and SCT of infants and children should help produce good results in autologous fat grafting and gluteal artery perforator flap harvesting.