• Maxillofacial Plastic and Reconstructive Surgery
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• 제20권3호
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• pp.246-249
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• 1998

본 증례는 우측 하악 후구치부위에 생긴 편평상피세포암종의 절제후 생긴 결손부를 미세혈관수술을 이용한 유리전완피부피판으로 재건한 증례로서 병소가 발생한 해부학적 위치 및 절제 후 생긴 결손부의 크기를 고려할 때, 전완피부피판을 이용하여 재건하였으며 현재까지 양호한 결과를 보이고 있다. 이와 같이 전완피부피판은 특성을 잘 이용하는 적절한 적응증에 사용된다면 어떤 다른 재건방법 보다도 성공적인 결과를 가져올 수 있으며 특히 구강악안면영역의 재건에서 그 효용성이 크다고 할 수 있다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.45.1-45.8
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• 2015

Background: Radial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. The purpose of this study was to report the clinical results of double-layered collagen graft to the donor site of the forearm free flap without skin graft. Methods: Twenty-two consecutive patients who underwent oral cancer ablation and forearm reconstruction between April 2010 and November 2013 were included in this study. Male to female ratio was 12:10, and average age was 61.0 years old (27-84). Double-layered collagen was grafted to the donor site of the forearm free flap and healed for secondary intention. Upper silicone had been trimmed at the periphery during secondary intention, and dry dressing was used. Postoperative scar healing and esthetic results and function were evaluated. Results: An average follow-up period was 34.9 months. The scar area was decreased to 63.9 % in average. The complete healing was obtained between 1.5 and 3 months according to the defect size. There was no functional defect or impairment 3 months after operation. All patients were satisfied with the esthetic results. Three patients died of recurred cancer. Conclusions: Double-layered collagen graft was successfully performed in this study. Without the thigh skin graft, patients had experienced less painful postoperative healing periods and discomfort.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.86-92
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• 2007

Failure of reattachment of finger is inevitable in replantation surgery and that failure rate is about 10 % are reported in many authors. Management of the failed finger replantation is challenge to microsurgeons. We report 7 cases of thumb reconstruction after failure of replantation. The reconstructive surgery composed with early debridement of soft tissue that are under gangrenous processing, extract the phalangeal bone without any soft tissues. Osteosynthesis of the extracted phalangeal bone with host phalangeal bone. The exposed bony portion covered with vascularized flaps such as reverse radial forearm pedicled flap, free radial forearm flap and neurovascular island finger flap. This procedure underwent within a week after vascular insufficiency developed. All of the flaps are survived, bone union achieved within 3 months. The function and external appearance of the reconstructed thumb were encouraging; pinch power was average 1.2 pounds. Early removal of necrotizing soft tissue followed by covering none vascular phalangeal bone which extracted from the dead phalanx with vascularized flap is one of the useful alterative solutions in failed replantation surgery in hand.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.330-335
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• 2007

Purpose: The purpose of this study is to evaluate the functional outcome and donor site morbidity of anterolateral thigh free flap(ALT) compared to Radial forearm free flap(RFFF) for the reconstruction of partial glossectomy defect. Methods: 5 ALT free flap (group I) were attempted for partial glossectomy patients. We compared patients undergone ALT flap with those(n=11) of similar size defect reconstructed with RFFF (Group II). Rating scales for articulation and swallowing function were applied and donor site morbidity have been evaluated. Results: The scales for speech function showed no difference between the two groups (average score; group I - 6.4, group II - 6.45). Swallowing function also showed no difference between the two groups(average score; Group I - 6.6, Group II - 6.27). ALT group had one patient with donor site morbidity(numbness). All of the RFFF patients(11/11) complained and suffered from hypertrophic scar, retraction, numbness or hyperpigmentation on forearm donor site. Based on our study, ALT free flap is comparable to that of RFFF in terms of functional assessment in tongue reconstruction. Conclusion: Considering the donor site morbidity, ALT flap is to be valuable to reconstruct partial glossectomy defect.

• 대한두경부종양학회:학술대회논문집
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• 대한두경부종양학회 1993년도 제10차 학술대회 연제순서 및 초록집
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• pp.261.2-261.2
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• 1993

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권6호
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• pp.427-431
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• 2021

Objectives: The aim of this study was to describe a simple, convenient, and reliable new technique using local full-thickness skin graft (FTSG) for skin coverage of a donor-site defect of the radial forearm free flap (RFFF). Patients and Methods: Between April 2016 and April 2021, five patients with oral squamous cell carcinoma underwent mass resection combined with RFFF reconstruction. After RFFF harvesting, donor-site defects were restored by proportional local FTSG. Results: The donor-site defects ranged in size from 24 to 41.25 cm², with a mean of 33.05 cm². Good or acceptable esthetic outcomes were obtained in all five patients. There was no dehiscence, skin necrosis, wound infection, or severe scarring at the graft site through the end of the postoperative follow-up period, and no patient had any specific functional complaint. Conclusion: The proportional local FTSG showed promising results for skin coverage of the donor-site defect of the RFFF. This technique could decrease the need for skin grafts from other sites.

• Archives of Reconstructive Microsurgery
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• 제4권1호
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• pp.58-64
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• 1995

사지의 연부조직 결손으로 고려대학교 의과대학 정형외과학 교실에서 입원했던 12명의 환자 13례에 대하여 전완부 유리 피판술을 시행 후 최저 3개월에서 최고 37개월간 평균 14.3개월간 추시하여 다음과 같은 결론을 얻었다. 1. 13례 전례에서 연부조직 결손의 치료로 만족할만한 결과를 얻었다. 2. 이식피판의 크기는 평균 $54cm^2$였으며 유리피판의 평균 혈류 차단시간은 74분 이었다. 3. 술후 3례에서 합병증이 발생하였으며 3례중 2례는 동맥 문합부위에 혈전이 발생하였으나 술후 제 2일에 혈전 재거술을 시행하여 해결하였으며, 1례는 이식 정막내의 혈전으로 이식피판의 표층괴사가 발생하여 고식적인 피부이식술로 치료하였다. 4. 체중 부하를 받는 족저부의 재건에는 감각신경을 포함한 전완부 유리피판술이 좋은 방법의 하나이다. 5. 전완부 피판술은 비교적 넓은 연부조직 결손을 치료할 수 있고 이식 혈관의 내경이 커서 문합이 비교적 쉬워 숙련된 미세수술 수기를 익힌 외과의사에게는 성공률이 높은 유리피판술 중의 하나이다.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.86-92
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• 2001

Failure of replantation is inevitable in finger replantation surgery, around 10% of failure rate are reported in many authors. Management of the failed finger replantation is one of big dilemma to microsurgeons. We report 5 cases of thumb reconstruction after failure of replantation. The reconstructive surgery composed with early debridement of soft tissue that are under gangrenous processing, extract the phalangeal bone without any soft tissues. Osteosynthesis of the extracted phalangeal bone with host phalangeal bone. The exposed bony portion covered with vascularized flaps such as revered radial forearm pedicled flap, free radial forearm flap and neurovascular island finger flap. This procedure underwent within a week after vascular insufficiency developed. All of the flaps are survived, bone union achieved within 3 months. The function and external appearance of the reconstructed thumb were encouraging; Pinch Power was average 1.2 Pounds. Early removal of necrotizing soft tissue followed by covering none vascular phalangeal bone which extracted from the dead phalanx with vascularized flap is one of the useful alterative solutions in failed replantation surgery in hand.

• Archives of Reconstructive Microsurgery
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• 제9권1호
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• pp.56-61
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• 2000

Recommendable reconstructive surgery in the patient with thumb amputation through base of the first metacarpal bone is pollicization. Some patients who do not agree with harvest sound finger as a new thumb, we can consider other options as toe transplantation or osteoplastic thumb reconstruction for creating thumb. Toe transplantation to the thumb is effective procedure in the amputation of distal to metacarpal shaft, it is rarely indicated in the cases of proximal to base of the first metacarpal bone. We performed three cases of modified osteoplastic thumb reconstruction with free vascularized rib that combined with scapular free flap or radial forearm flap. The length of transplanted rib ranged from 7~11cm, the donor vessels are posterior intercostal artery and vein which anastomosed to radial artery. The grafted rib wrapped with additional free flap for creating new thumb. Result of that procedure was not much encouraging, aesthetic appearance and mobility of thumb were not so satisfactory but reconstructed thumb gave improvement of the hand function without sacrificing toe or other digit. That gave reasonable stability for powerful side pinch and three pod pinch and opposable thumb with normal carpo-metacarpal joint motion that can give much function to the thumb absent hand. In spite of those disadvantages, thumb reconstruction with rib transfer can be useful for patients who do not want to lose another part of the body for creating thumb in basal amputation of the thumb metacarpal.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.29.1-29.7
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• 2020

Background: Microvascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery. Methods: This study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed. Results: Four different flap types were used for microvascular reconstruction: radial forearm (n = 65), fibula (n = 34), latissimus dorsi (n = 21), and serratus anterior muscle with rib bone free flap (n = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min. Conclusions: The success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.