• Archives of Plastic Surgery
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• v.35 no.5
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• pp.527-532
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• 2008

Purpose: Transverse type or volar oblique type of defect of thumb tip can be covered by Moberg flap or second toe pulp free flap. We compared these two methods in functional result, patients' satisfaction, and sensation, etc. to find a better way to cover the defect of the thumb tip. Methods: From 2003 to 2006, we chose the patients randomly with preoperative pictures. The patients had the defect of the thumb tip which is either transverse or volar oblique type. The 6 patients were treated with Moberg flap and other 6 patients were treated with second toe pulp free flap. We have analyzed the results by 2 point discrimination, side pinching power test, pulp to pulp pinching power test, pain scales (visual analogue scale), satisfaction scales of the patients (functional and aesthetic), the degree of the range of motion, etc. Results: All flaps survived without any complications. In the cases of Moberg flaps, the value of static 2 point discrimination test was 5.6 mm, and the value of moving 2 point discrimination test was 4.8 mm. In the cases of second toe pulp free flaps, the values were 9.6 mm and 9.3 mm. In the cases of Moberg flaps, the value of the Side pinch power test was 6.6 kg, 4.4 kg. In the case of second toe pulp free flaps, the values were 4.8 kg and 2.5 kg. The value of aesthetic satisfaction scale of the patients in Moberg flaps was 5.6, the value of functional satisfaction scale of the patients was 3.6. In cases of second toe pulp free flaps, the values were 5.6 and 3.6. The active range of motion of Interphalangeal joint in the cases of Moberg flaps was 46.6 degree, and the active range of motion of metacarpophalangeal joint was 55 degree, in the cases of second toe pulp free flaps, the values were 36.6 degree and 59 degree. Conclusion: As a result, when the defect of the thumb tip is transverse or volar oblique type, we suggest that the operators choose Moberg flap to cover the defect of the thumb tip.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.34-37
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• 2001

The injury on the dorsum of foot is usually manifested in the defect of bone and soft tissue, so its reconstruction requires composite tissue. Free flap satisfies this defect but its indication is determined by the defect size, recipient status and so on. Iliac crest bone and fibular bone are useful bone flap but in more than 8cm defect, fibular flap is more useful. The drawback of fibular free flap is the absence of soft-tissue coverage, so another local flap and myocutaneous flap must be added. Fibula-hemisoleus ostemusculocutaneous free flap has been used for the reconstruction of upper and lower extremity. Its advantages are one stage operation, one donor site and the flexibility of the reconstruction with the use of muscle, bone, and skin. This flap has never been reported for the reconstruction of dorsum of foot. In our case, 20-year-old woman was referred with the 17 cm defect of 1st metatarsal bone and $16{\times}8cm$ sized soft tissue loss on the dorsum of the right foot. We reconstructed successfully the dorsum of foot with fibula-hemisoleus osteomusculocutaneous free flap and the patient can walk without crutches after 6 monthes.

• Archives of Reconstructive Microsurgery
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• v.25 no.1
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• pp.7-11
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• 2016

Purpose: In recent decades, amputation is still recommended for patients with extensive lower extremity wounds requiring coverage. Although the feet contribute relatively little to total body surface area, they are essential organ for ambulation, and a high mortality rate after amputation has been reported. We report on 10 challenging cases of a mangled foot which was reconstructed using an anterolateral thigh (ALT) free flap, and analyze the advantages and disadvantages of this technique. Materials and Methods: This retrospective study was conducted on 10 patients who underwent reconstructive surgery on a foot. Patients' charts were reviewed for age, sex, causes, defect size and site, flap size and type, flap type, and complications. Cases with a defect size of > $100cm^2$ were included. Results: Seven of the 10 patients were male, and overall mean age was 38.5 years (range, 22 to 61 years). Mean defect size was $179.6cm^2$ (range, 104 to $330cm^2$), and mean flap size was $193cm^2$ (range, 120 to $408cm^2$). Three cases were reconstructed with a musculocutaneous free flap and seven cases were reconstructed with a fasciocutaneous free flap. There were two occurrences of local wound complication. All ten flaps survived well, however five patients underwent a debulking procedure to reduce flap volume. Conclusion: Reconstruction of a near completely degloved soft tissue defect or a wide defect containing two or more surfaces of extremity with an ALT free flap was performed. The purpose of this case study is to report on free tissue transfer using the ALT flap for salvage of the lower extremity.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.769-774
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• 2010

Purpose: As the soft tissue defect around the knee is difficult to reconstruct, local flap or free flap is used. Distally based anterolateral thigh pedicled flap introduced by Zhang uses sufficient reverse flow supplied from the vascular network around the knee. We report successful reconstruction of defect around knee by this method. Methods: Four patients with skin & soft tissue defect around knee have been treated for reconstruction using the distally based anterolateral thigh pedicled flap. First, the doppler was used to check the perforator flap of the descending branch of the lateral circumflex femoral artery and to draw and dissect the perforator flap as much as needed. After the dissection, the proximal of the descending branch was clamped and checked for sufficient supply of blood flow from the reverse flow and then ligated. It was dissected along the descending branch and in order to prevent damage to the joined parts of the descending branch and the lateral superior geniculate artery, a more careful ligation was done starting from 10 cm superior to the knee. The defect was reconstructed after securing enough vascular pedicle to cover all the damaged parts. Results: Not all patients suffered from flap necrosis. In case of the patient with chronic osteomyelitis, slight venous congestion was observed right after the surgery but it disappeared the following day. All three patients had no occurences of additional complications. Conclusion: Distally based anterolateral thigh pedicled flap was enough to provide large flap for knee reconstruction. It had sufficient blood flow and vascular pedicle. It also had taken short operation time compared to the free flap operation. The distally based anterolateral thigh pedicled flap used by the authors is a very useful way of reconstructing the area around knee.

• Archives of Craniofacial Surgery
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• v.19 no.4
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• pp.254-259
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• 2018

Background: The esthetic and functional outcomes of periorbital defect reconstruction are very important because of the complex anatomy and specialized functions of this region. The orbicularis oculi myocutaneous (OOMC) flap is useful for the reconstruction of periorbital defects. But, according to the location and depth of the defects, the reconstruction using OMC flaps with various techniques is rare. The authors have used various kinds of OOMC flaps in various situations and we present an analysis of our experiences. Methods: From November 2001 to July 2017, we used 36 OOMC flaps to reconstruct 30 periorbital defects in 25 patients. We analyzed the cause of the defect, its location, the type of concomitant surgery, the method of flap movement, and complications. Results: Of the 30 defects, basal cell carcinoma was the most common cause, accounting for 20 cases. When the used OOMC flap was classified according to the location of the defects, the switch flap was used in nine cases among 15 defects of lower eyelid, and the V-Y advancement flap was mainly used for other parts. As surgical methods according to the depth of defect were classified, all cases involving the tarsal plate were reconstructed with a composite graft. In case of skin and muscles, they were reconstructed only with OOMC flap or with full-thickness skin graft. Conclusion: The OOMC flap provides good skin quality that is very similar to that of the defect tissue. Depending on the location and depth of the defect, the OOMC flap may be used properly in a variety of ways to achieve good results.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.474-479
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• 2006

Purpose: To report of a series of successful reconstruction of soft tissue defect on distal leg with extensor digitorum brevis myo-cutaneous flap. Methods: Between April 2002 to December 2004, 7 patients with soft tissue defect on distal leg were operated with Extensor Digiotorum Brevis myocutaneous flap. 6 of these patients had osteomyelitis. Results: Extensor Digiotorum Brevis myocutaneous flap were used in 6 patients and reverse flow flap was used in one patient. Average follow up was 19 months. All flap were survived 100% without any complication and osteomyelitis were controled in all cases. Aesthetic and functional out come were excellent on both recipient and donor sites. Conclusion: The advantages of this flap are effectively control of local wound infection, constant and reliable anatomical structures, adequately thin flap. Technical easiness for raising flap and wide arch of rotation. Extensor Digitorum Brevis myo-cutaneous flap is one of ideal option for the reconstruction of distal leg and foot defects.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.487-490
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• 2008

Purpose: The latissimus dorsi flap and the serratus anterior flap have been used as combined flaps to reconstruct extensive defects. Because these two muscles are usually supplied by the subscapular-thoracodorsal vessels, the two flaps can be based on vascular pedicle that is long and anatomically reliable. In this case, we reported that serratus anterior possessed an anomalous arterial supply totally independent from the subscapular pedicle while raising combined latissimus dorsi and serratus anterior flap. Methods: A 35-year-old male with extensive soft tissue defect in the left perineum and thigh visited. Muscle defects of the medial thigh were observed, and femoral nerve and vessels were exposed. Combined latissimus dorsi and serratus anterior free flap was raised to reconstruct defect. On raising flaps, artery supplying the serratus anterior muscle originated from the axillary artery directly, was lying on the undersurface of the serratus anterior muscle. Results: Because two flap pedicles had no communication and latissimus dorsi muscle was large enough to cover soft tissue defect, we transferred only latissimus dorsi free flap with 1 : 3 meshed skin graft. Patient had limb salvage and satisfactory functional outcome. Conclusion: There are many variations of arterial pedicles of flaps. However, most of these variations remain within known anatomical consistence, thus is an indicator in planning the dissection of the vessels. According to documents, arterial pedicle to the serratus muscle not originated from the thoracodorsal artery is rarely reported, and in most of these cases, the arteries are originated from the subscapular artery. Thus pedicle directly originated from the axillary artery to serratus muscle is a very rare variation in its vascular anatomy.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.663-668
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• 2011

Purpose: A modified free thenar flap was designed for coverage of volar finger defect with constant innervation using the palmar cutaneous branch of the median nerve. After clinical application of this flap, sensory results were evaluated in 6 cases. Methods: Patients were selected who have volar soft tissue defect with or without fingertip defect. The six cases of the innervated free thenar flap were performed since September 2009, and sensory outcomes were evaluated by the Semmes-Weinstein monofilament and two-point discriminator at four and half month after the surgery. Results: The Semmes-Weinstein Monofilament test revealed 3 cases showed 2.83, 1 case showed 3.61, 1 case showed 4.31 and 1 case showed 4.56. The static two-point discrimination test revealed 1 case showed 4 mm, 1 case showed 6 mm, 2 cases showed 9 mm, and 2 cases showed over 15 mm. The moving two-point discrimination test revealed 1 case showed 3 mm, 1 case showed 4 mm, 1 case showed 5 mm, 1 case showed 7 mm, and 2 cases showed over 15 mm. The donor sites showed no significant limitation of the thumb and neuroma formation. Conclusion: The innervated free thenar flap showed good sensory outcomes as a sensate free flap in a short time after surgery. It can be an option for coverage of volar finger defects that requires sensation.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.451-457
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• 2011

Purpose: As a central feature of the face, the nose has considerable significance in appearance and expression. Reconstruction of full thickness defects of the nasal ala has always been a challenge because of the 3-dimensional structure. For reconstruction of post burn defects of ala, skin graft, local or pedicled flap and composite graft are optionally available. We have reconstructed the ala defects using adiposocutaneous graft and observed the outcome. Methods: From March 2003 to December 2010, 19 cases in 11 patients with scar contracture and defect on ala portion were performed operation using adiposocutaneous graft. As a donor site, we used the inguinal crease and posterior auricular area and the donor site was primarily closed. We made incision through the superior rim of ala and released fully. A graft is applied to recipient site with larger size than recipient volume. Results: The mean age of the patient was 38.6 years (16~51), males are seven patients and females are four patients. The operation was performed bilaterally in 5 patients and unilaterally in 6 patients. Composite grafts were harvested from inguinal area in 13 cases and posterior auricular area in 6 cases. In one case, we did 4 times of operation to get enough volume. All the grafts were well taken. The mean size of the graft was 3.63 $cm^2$. Conclusion: For reconstruction of post burn defects of ala, it's not easy to use local flap or pedicled flap because of hardness and fibrosis of surrounding tissue. So, we choose adiposocutaneous graft for ala deformity reconstruction, got satisfactory outcome in color matching and texture.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.69-72
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• 2020

Hemangioma is a benign vascular tumor that grows by endothelial cell hyperplasia. It occurs most frequently in the head and neck region. Nose reconstruction is tricky because of its unique three-dimensional structure and different tissue components. We report a case of successful reconstruction of near-total nose defect using the paramedian forehead flap combined with a nasolabial flap, immediately after excision of nasal hemangioma. A 49-year-old male patient was presented with a huge mass at the nose. Preoperative magnetic resonance imaging showed prominent vascular channels extending to the forehead and cheek. Complete resection of the mass was performed, which resulted in an eccentric defect. The right paramedian forehead flap and the left nasolabial flap were designed and transferred to the defect. Flap division was performed 1 month later. The patient is satisfied with the overall appearance and did not develop any functional deficit.