• Title/Summary/Keyword: Plastic Defect

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Lower Extremity Reconstruction by Perforator Based Flap (천공지 기저 피판을 이용한 다양한 하지 재건)

  • Oh, Chang Hyun;Shim, Jeong Su;Park, Dae Hwan
    • Archives of Plastic Surgery
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    • v.36 no.6
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    • pp.720-726
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    • 2009
  • Purpose: Fasciocutaneous flap with random pattern flap has limitation in mobility and length - width ratio. This characteristic is more pronounced in lower extremity which has relatively poor vascularity. Perforator based flap in lower extremity reconstruction has various advantages as a axial flap, allowing abundant blood supply and widening of mobility range. So if it is not a case of wide defect, free flap can be replaced by perforator based flap. Methods: From April 2007 to March 2009, 18 cases of perforator flap were performed. 8 had defect in upper 1/3 of calf, 6 in middle 1/3, and 4 in lower 1/3. In 10 cases island flap were used, 3 case had transposition flap, 2 cases used advancement flap, 2 case had propeller flap and 1 case had rotation flap. Results: 17 cases survived without flap necrosis. Partial flap necrosis occurred in 1 case, so secondary split thickness skin graft was done. Chronic wound with pseudomonas infection occurred in 1 case, but it was completely cured with conservative treatment. Conclusion: Perforator based flap is useful in lower extremity reconstruction because of relative freedom in changing the size and thickness of the flap depending on the recipient site, good mobility, and abundant vascularity. And donor site morbidity can be minimized. Lower extremity reconstruction using perforator based flap is a good method because it can minimize the complication and obtain effective result.

Soft Tissue Reconstruction Using Anterolateral Thigh Flap with Fascia Lata Component (대퇴 근막이 포함된 전외측대퇴피판을 이용한 다양한 연부조직 결손의 재건)

  • Lee, Sin-Chul;Eun, Seok-Chan;Baek, Rong-Min
    • Archives of Plastic Surgery
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    • v.38 no.5
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    • pp.655-662
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    • 2011
  • Purpose: The anterolateral thigh flap is versatile flap for soft-tissue reconstruction for defects located at various sites of the body. This useful flap offers a thick and vascular fascia lata component with large amounts that can be soft tissue coverage for different reconstructive purposes. We present our clinical experience with the use of vascular fascia lata, combined with anterolateral thigh flap for various reconstructive goals. Methods: From April 2008 to February 2011, we transferred anterolateral thigh flaps with fascia lata component to reconstruct soft-tissue defects for different purposes in 11 patients. The fascia lata component of the flap was used for tendon gliding surface in hand/forearm reconstruction in 4 patients, for reconstruction medial and lateral patellar synovial membrane and retinaculum in 2 patients, for reconstruction of plantar aponeurosis in the foot in 2 patients, for reconstruction of fascial and peritoneal defect in the abdominal wall in 2 patient, and for dural defect reconstruction in the scalp in the remaining one. Results: Complete loss of the flap was not seen in all cases. Partial flap necrosis occurred in 2 patients. These complications were treated successfully with minimal surgical debridement and dressing. Infection occurred in 1 patient. In this case, intravenous antibiotics treatment was effective. Conclusion: Anterolateral thigh flap has thick vascular fascia with large amounts. This fascial component of the flap is useful for different reconstructive aims, such as for tendon, ligament, aponeurosis defects, abdominal wall or dura reconstruction. It should be considerated as an important advantage of the flap, together with other well-known advantages.

Usefulness of using Tissue Expander in Pediatric Patient (소아 환자에서 조직확장기 사용의 유용성)

  • Lee, Jun-Woo;Park, Chul-Gyoo;Park, Jong-Lim;Kim, Yong-Kyu
    • Archives of Plastic Surgery
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    • v.37 no.6
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    • pp.763-768
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    • 2010
  • Purpose: Reconstruction of soft tissue defect using tissue expander can provide better flap which is more similar to surrounding tissue in color, skin texture and hair compared to other methods. Many pediatric patients need reconstruction of soft tissue defect because of giant congenital nevi, congenital or acquired malformations and burn scars. Reconstruction using tissue expander is adequate to minimize dysmorphism in these patients. We intended to assess outcomes of using tissue expander in pediatric patients by retrospective study. Methods: Total cases were 168 of pediatric patients who received soft tissue reconstruction using tissue expander by the same surgeon from February, 1982 to May, 2009. All patients who received soft tissue reconstruction were under 10 years old. Mean age was 4.3 years old, the youngest 13 months, the oldest 8 years. Eightynine cases were male and 79 cases were female. Most common cause was giant hairy nevi (67 cases, 39.9%), secondary cause was burn scar/scar contracture (61 cases, 36.3%). Trunk (38 cases, 22.6%) was most common anatomical location. Results: Soft tissue defects were successfully covered using tissue expander in 149 cases (88.7%) without major complications. There was infection on 8 cases (4.7%) and we treated by adequate antibiotics in these cases. There were tissue expander folding or valve displacement on 5 cases (3%). Conclusion: Usage of tissue expander is useful on pediatric patients because tissue expansion is rapid on children and there are less secondary contractures on operation site than full thickness skin graft. Because of psychological stress due to tissue expander, operation should be performed before school age.

Repair of Large Spinal Soft Tissue Defect Resulting from Spinal Tuberculosis Using Bilateral Latissimus Dorsi Musculocutaneous Advancement Flap: A Case Report (척추결핵으로 인한 광범위한 결손에 대해 양측 넓은등근전진피판술을 이용한 치험례)

  • Kim, Yeon-Soo;Kim, Jae-Keun
    • Archives of Plastic Surgery
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    • v.38 no.5
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    • pp.695-698
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    • 2011
  • Purpose: Since spinal tuberculosis is increasing in prevalence, it appears that a repair of spinal soft tissue defect as a complication of spinal tuberculosis can be a meaningful work. We report this convenient and practical reconstructive surgery which use bilateral latissimus dorsi musculocutaneous advancement flap. Methods: Before the operation, $13{\times}9.5$ cm sized skin and soft tissue defect was located on the dorsal part of a patient from T11 to L3. And dura was exposed on L2. Under the general endotrachel anesthesia, the patient was placed in prone position. After massive saline irrigation, dissection of the bilateral latissimus dorsi musculocutaneous flaps was begun just upper to the paraspinous muscles (at T11 level) by seperating the paraspinous muscles from overlying latissimus dorsi muscles. The plane between the paraspinous muscles fascia and the posterior edge of the latissimus dorsi muscle was ill-defined in the area of deformity, but it could be identified to find attachment of thoracolumbar fascia. The seperation between latissimus dorsi and external oblique muscle was identified, and submuscular plane of dissection was developed between the two muscles. The detachment from thoracolumbar fascia was done. These dissections was facilitated to advance the flap. The posterior perforating vasculature of the latissimus dorsi muscle was divided when encountered approximately 6 cm lateral to midline. Seperating the origin of the latissimus dorsi muscle from rib was done. The dissection was continued on the deep surface of the latissimus dorsi muscle until bilateral latissimus dorsi musculocutaneous flaps were enough to advance for closure. Once this dissection was completely bilateraly, the bipedicled erector spinae muscle was advanced to the midline and was repaired 3-0 nylon to cover the exposed vertebrae. And two musculocutaneous units were advanced to the midline for closure. Three 400 cc hemovacs were inserted beneath bilateral latissimus dorsi musculocutaneous flaps and above exposed vertebra. The flap was sutured with 3-0 & 4-0 nylon & 4-0 vicryl. Results: The patient was kept in prone and lateral position. Suture site was stitched out on POD14 without wound dehiscence. According to observative findings, suture site was stable on POD55 without wound problem. Conclusion: Bilateral latissimus dorsi musculocutaneous advancement flap was one of the useful methods in repairing of large spinal soft tissue defect resulting from spinal tuberculosis.

Application of F.E.M to the Forming Process of Valve-Spring Retainer (유한요소법을 이용한 Valve-Spring Retainer의 공정해석)

  • 오현석;박성호;황병복
    • Proceedings of the Korean Society for Technology of Plasticity Conference
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    • 1995.10a
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    • pp.57-68
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    • 1995
  • A design methodology is applied for manufacturing the valve-spring retainer component. The design criterion is the forging load within the available press limit. Also, the final product should not have any geometrical defect. The rigid-plastic TEM has been applied to simulate the conventional five-stage manufacturing processes, which include mainly backward extrusion and heading process. Simulations of one step process from selected stocks to the final product shape are performed for a possibly better process than the conventional one.

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Paraffinoma induced bilateral preauricular cheek skin defects

  • Heo, Jae-Woo;Kim, Baek Kyu
    • Archives of Craniofacial Surgery
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    • v.19 no.3
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    • pp.227-230
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    • 2018
  • "Paraffinoma" is a well-recognized complication of paraffin oil injection into various body parts for an aesthetic purpose. After a variable latency phase, paraffinoma can present as a wide range of clinical symptoms. This paper is a case report of surgical excision of the paraffinoma and subsequent reconstruction of the associated skin defect on bilateral preauricular cheeks, manifesting 50 years after a primary injection.

Recycling of flap pedicle in complex lower extremity reconstruction: A proof of free muscle flap neovascularization

  • Pafitanis, Georgios;Vris, Alexandros;Reissis, Dimitris;Sadri, Amir;Alamouti, Reza;Myers, Simon;Sadigh, Parviz
    • Archives of Plastic Surgery
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    • v.47 no.6
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    • pp.619-621
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    • 2020
  • This article portrays the authors' clinical experience of a complex case of lower extremity reconstruction using a recycled pedicle from 10 years old free latissimus dorsi musculocutaneous flap to supply a new free anterolateral thigh flap for proximal tibia wound defect reconstruction. It provides clinical evidence that muscle neovascularization occurs and supports the dogma peripheral tissue neovascularization. This case stipulates that recycling of pedicle is feasible, when used with appropriate strategy and safety and also provides evidence for the long-term survival of greater saphenous vein grafts in lower extremity reconstruction.

Free Flap Salvage in the Ischemic Foot: A Case Report

  • Seo, Dongkyung;Dannnoura, Yutaka;Ishii, Riku;Tada, Keisuke;Kawashima, Kunihiro;Yoshida, Tetsunori;Horiuchi, Katsumi
    • Archives of Plastic Surgery
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    • v.49 no.5
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    • pp.696-700
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    • 2022
  • We performed distal bypass and free flap transfer in a single-stage operation to repair an extensive soft tissue defect in an ischemic foot of an 84-year-old woman. The nutrient artery of the free flap was anastomosed to the bypass graft in an end-to-side manner. Subsequently, the bypass graft became occluded on several occasions. Although intravascular and surgical interventions were performed each time, the bypass graft eventually became completely occluded. However, despite late occlusion of the nutrient artery, the free flap has remained viable and the patient is ambulatory. The time required for a transplanted free flap to become completely viable without a nutrient artery is likely longer for an ischemic foot compared with a healthy foot. However, the exact period of time required is not known. A period of month was required in our patient. We report this case to help clarify the process by which a free flap becomes viable when applied to an ischemic foot.

How to Transform a Perforator Propeller Flap into a Keystone Flap in Case of Unsatisfying Perforator Vessel Local Perforator Flap Coverage in Limbs

  • Elena Ciucur;Hadj Boukhenouna;Benjamin Guena;I. Garrido-Stowhas;Christian Herlin;Benoit Chaput
    • Archives of Plastic Surgery
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    • v.50 no.2
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    • pp.194-199
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    • 2023
  • Moderate soft-tissue defects need stable coverage, ideally with tissue of similar characteristics and low donor site morbidity. We propose a simple technique for the coverage of moderate skin defects in the limbs. It allows intraoperative transformation of a propeller perforator flap (PPF) into a keystone design perforator flap (KDPF) in cases of unsatisfying perforator vessel or in cases of unpredictable intraoperative events. Between March 2013 and July 2019, nine patients with moderate soft-tissue defects (mean defect size 4.5 × 7.6 cm) in the limbs (two on the upper limbs and seven on the lower limbs) were covered using this technique. We performed four PPFs and five KDPFs. The mean follow-up was 5 months. There was one complication, partial distal tip necrosis in a PPF located in the leg, which healed by secondary intention within 3 weeks. The donor site was closed directly in all cases. No functional impairments were noted regardless of the perforator flap utilized. This technique enables us to employ flexible surgical strategies and allows us to make adjustments based on the patient's vascular anatomy.

USE OF AUTOGENOUS DERMIS-FAT GRAFT FOR RECONSTRUCTION OF ORAL AND MAXILLOFACIAL SOFT TISSUE DEFECT;A CASE REPORT (구강 악안면 연조직 결손 재건을 위한 진피 지방 이식의 이용;증례보고)

  • Park, No-Seung;Yeo, Hwan-Ho;Kim, Young-Kyun;Kim, Su-Gwan;Lee, Byung-Joon;Hwang, Kyung-Kon
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.18 no.3
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    • pp.348-352
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    • 1996
  • Soft tissue defects in oral & maxillofacial region caused by tumor resection, trauma, congenital deformities have been treated in autogenous soft tissue flap, allogenic material, free dermal graft, fascia graft. Of these methods, autogenous dermis graft had initially been applied in hernia treatment at the beginning of nineteenth century and have been applied in soft tissue augmentation coverage of vital structure, dead space removal and reconstruction of fascia. A fat graft is used in reconstruction of orbit at the enucleation, restoration of facial contours, etc. In this case, patient with chin soft tissue defect in traffic accident was treated in autogenous dermis-fat graft from patient's abdominal and gluteal region. Chin defect was reconstructed favorably. There was no severe atrophy of grafted area 12 months postoperatively. We will report the result that is favorable esthetically with literature review.

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