• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.4
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• pp.161-167
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• 2014

Purpose: The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results. Methods: Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes. Results: This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour. Conclusion: Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap.

• Transactions of the Korean Society of Mechanical Engineers A
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• v.37 no.11
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• pp.1379-1386
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• 2013

The present work reports the mismatch limit loads for a V-groove welded pipe for a circumferential crack using finite element (FE) analyses. To integrate the effect of groove angles on mismatch limit loads, one geometry-related slenderness parameter was modified by relevant geometric parameters including the groove angle, crack depth, and root opening based on plastic deformation patterns in the theory of plasticity. Circumferential through-wall cracks are located at the centre of the weldments with two different groove angles ($45^{\circ}$, $90^{\circ}$). With regard to the loading conditions, axial (longitudinal) tension and bending are applied for all cases. For the parent and weld metal, elastic-perfectly plastic materials are considered to simulate and analyze under- and over-matching conditions in plasticity. The overall results from the proposed solutions are found to be similar to the FE results.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.29-36
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• 2016

Purpose: Skin grafting is used for the transfer of cutaneous tissue from one site of the body to another. To improve graft survival, close contact between the graft and the wound bed is essential for vessels to grow across the gap. Here, we introduce an easy and efficient dressing method to improve graft survival. Materials and Methods: A retrospective chart review was performed to identify patients who underwent split thickness skin graft and negative pressure wound therapy (NPWT) or conventional treatment between January 2007 and April 2015. Overall, 25 consecutive patients were included in the NPWT group and 49 were included in the conventional dressing group to compare the outcome of the procedure. The data were obtained from medical records, including age, sex, cause of the skin defect, size of graft, time for healing, wound preparation time, and complications. Results: Of the NPWT group, the average wound size was $147.04{\pm}146.74cm^2$ (range, $9{\sim}900cm^2$). With the exception of one patient, all wounds healed without the need for further procedure. The average duration of time required for the NPWT group, which was defined as removal of stitches (or staples) and no need for additional active dressing, was $6.4{\pm}1.97days$ (range, 5~15 days). The average time for the conventional dressing group was $10.78{\pm}2.38days$ (range, 5~15 days). Conclusion: NPWT can be used to cover regions in which wound healing does not occur fully or when neither tie-over nor compressive dressings are applicable. This treatment also reduced wound healing time and allowed earlier patient mobilization and hospital discharge.

• Archives of Plastic Surgery
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• v.47 no.2
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• pp.187-193
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• 2020

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.401-406
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• 1999

Secondary deformities of the lip and nose in individuals with repaired unilateral and bilateral clefts may vary in severity, depending on the state of the original defect, the care taken in the initial surgical procedure, the pattern of the patient's facial growth, and the effectiveness of interceptive orthodontic technique. Because each patient has a unique combination of deformities, their surgical reconstruction usually requires the modification and combination of several surgical techniques. Residual lip deformities after primary repair may be esthetic or functional and include scars, skin shortage or excess(vertical and transverse), orbicularis oris muscle malposition or diastasis. The key to accurate repair of secondary cleft lip deformities is a precise diagnosis. This requires observation of the patient in animation and repose. The quality of the scar is not the only factor determining the overall appearance of the lip. Observing the patient in the animated position is critical to assess muscular function. Factors that require precise analysis include lip length, the appearance of the Cupid's bow and philtrum, and nasal symmetry. Only after this detailed analysis can a decision be made as to wether a major or minor deformity exists. We report successful cases using various techniques for the secondary lip deformities.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.338-345
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• 1991

Velopharyngeal incompetence (VPI) is a condition of inadequate functional valving between the oral and nasal cavities that results in hypernasal speech and nasal air escape. VPI is caused by the following factors ; cleft palate, soft palate defect, pharyngomegaly, velopharyngeal sphincter muscle anomaly and maxillary advancement surgery, etc. Velopharyngeal function is assessed by a variety of measures that include speech evaluation, cephalogram, airflow study, videofluoroscopy and nasoendoscopy. The management of VPI is classified into four main groups ; prosthesis, insertion of implant, palatoplasty and pharyngoplasty. Pharyngeal flap is the most common surgical procedure for correcting VPI since Schoenborn's report in 1875. We report seven cases of VPI which were treated by modified modified superiorly based pharyngeal flap with good results.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.2
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• pp.183-187
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• 2005

The coronal approach has been used for over a century by neurosurgeons to access to the anterior cranium. Indications for the coronal approach expanded from use in the correction of congenital skeletal anomalies to applications in acute maxillofacial trauma and secondary deformity correction, oncologic surgery and reconstruction, and esthetic surgery. Complications were such as injury to frontal branch of the facial nerve, motor nerve paralysis, hematoma under flap, trismus, ptosis, epiphora, infection and anterior temporal depression. $Medpor^{(R)}$ is made up of dense polyethylene connected in porous structures. It is easily shapable without collapsing the pores due to it's hardness and tissue growth takes place at the porosities. Based on these advantages, $Medpor^{(R)}$ has been used in augmentation and restoration in craniofacial defect. A temporal depression after the coronal approach for treatment of Le Fort III fracture was successfully reconstruction with $Medpor^{(R)}$ and we report this case with review of literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.9-15
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• 1991

The cleft alveolus occurs about 75% of cleft lip and palate patients. The purpose of bone grafting is improve the maxillary growth, rehabilitation of continuty of maxillary arch and providing bone for periodontal support for unerupted teeth. The bone grafting for alveolar cleft defect repair are classsified; primary bone grafting, early secondary bone grafting secondary bone grafting and late secondary bone grafting. In this article, we reported the cases of PMCB grafts for repair of the alveolar clefts showed potential benifit to the patient to induce a normal maxillary growth and providing bone foor periodontal support of unerupted teeth.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.2
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• pp.113-121
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• 1994

Large oral defects following tumor resection pose formidable challenge for the reconstructive surgeon. Ideally, wound closure should utilize like tissue in providing expedient, single-stage closure, returning maximum function while minimizing deformity. Recent methods have reported and utilize variable mucocutaneous flaps. However, the ideal reconstruction has yet to defined. The small bowel serves as a readily available donor site for satisfying reconstructive needs in oropharyngeoesophageal defects. Segments of jejunum may be opened along the antimesenteric border and transferred to oral defect as free tissue transfers. Some of the benefits of this technique have included a one-stage procedure, abundant donor tissue with characteristics similar to oral mucosa, near normal facial appearance, preservation of maximum tongue function and relief of annoying xerostomia by jejunal mucous secretion. Three cases re presented in which two cases show successful use of this flap. The other one patient developed total necrosis of this flap. We report cases of reconstruction using free jejunal flap transfer in oral reconstruction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.5
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• pp.429-438
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• 2007

Transport distraction osteogenesis has been introduced recently to correct skeletal malformations and discrepancies in the maxillofacial area. To reconstruct 3-dimensitonal mandibular shape, this transport distraction can be considered with the use of reconstruction plate. A 23-years-old male having unilateral mandibular body and angle defects, who had been operated of partial mandibular resection due to unicystic ameloblastoma, was treated by transport distraction procedures with ThreadLock transport $distractor^{(R)}$ (KLS Martin Co., Germany) through the rail of reconstruction plate (Osteomed Co., USA). After being distracted 35 mm defect from mandibular angle to body, and consolidated for 16 weeks, allogenic bone graft on docking site was performed with removal of transgingival pin. For more than 13 weeks follow up period after consolidation period, gradual increase of radiopacity in the radiographic examination was shown, and the curved mandibular continuity according to the reconstruction plate was made firmly. These transport distraction osteogenesis in the mandible was able to be considered as the good and minimally invasive technique for the reconstruction of mandibular discontinuity. Young patient was also very satisfactory for these results.