• 대한족부족관절학회지
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• 제6권1호
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• pp.46-53
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• 2002

Purpose: We would introduce the reverse superficial sural artery flap to reconstruct soft tissue defect on lower leg, ankle, and hind-foot. Materials and Method: From October 1998 to December 2001, we reconstructed 12cases (l2patients) of soft tissue defect around the hind - foot, ankle, and distal lower extremity with the reverse sural artery flap. Results: The time for flap dissection was 28 minutes in average. The size of the flap was from $4\times3cm$ to $14\times10cm$. All flaps survived. Conclusion: The reverse superficial sural artery flap is the useful technique for the soft tissue defect in the lower leg and the foot.

• Archives of Plastic Surgery
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• 제39권2호
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• pp.150-153
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• 2012

Hemophilia B is a rare blood coagulation disorder. Complications such as bleeding and hematoma can cause necrosis of flaps, wound disruption, and the disturbance of wound healing. In particular, guidelines for flap operations in hemophilia B patients have still not been defined, and case reports are rare. We reconstructed the heel of a 41-year-old male hemophilia B patient using a reverse sural artery flap operation. The patient presented with mild hemophilia, having 27% of the normal value of coagulation factor IX. Coagulation and the changing value of the coagulation factor were regularly measured, and 70% of the normal value of coagulation factor IX was maintained through the injection of recombinant coagulation factors and antihemorrhagics. Hematoma developed twice (postoperative day [POD] 5 and POD 7) and in each case the hematoma was removed. Injections of recombinant coagulation factors and antihemorrhagics were continuously administered until postoperative week 2. When the coagulation factors were within normal ranges. In this article, a hemophilia B patient underwent reverse sural artery flap surgery and the healing progress was analyzed. We conclude that higher than baseline levels of coagulation factors are needed for successful healing in reverse sural artery flap surgery.

• Archives of Reconstructive Microsurgery
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• 제21권2호
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• pp.159-164
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• 2012

Purpose: Soft tissue defect on posterior side of heel exposing Achilles tendon is vulnerable and require thin flap to improve aesthetic and functional results. Reverse superficial sural artery flap is simple and fast procedure, and it can preserves major arteries, supplies reliable constant blood, causes less donor site complication. Authors reviewed our cases and report the clinical results. Materials and Methods: Nine cases of soft tissue defects on the posterior side of heel exposing Achilles tendon were treated with distally based superficial sural artery flap. There were 6 male and 3 female and mean age was 48.4 years. The size of flap was from $4{\times}4cm$ to $10{\times}15cm$ and mean follow-up period was 23 months. Flap survival, postoperative complications were evaluated. Results: All flaps were survived completely without necrosis. There was one case of partial wound dehiscence that needed debridement and repair, and other one case had recurrent discharge that was healed after removal of calcaneal plate. All patient showed acceptable range of ankle motion. Conclusion: Authors suggest that the reverse superficial sural artery flap could be one of the useful treatment options for the soft tissue defect on posterior side of heel exposing Achilles tendon.

• Archives of Plastic Surgery
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• 제48권6호
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• pp.691-698
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• 2021

Background The reverse sural artery (RSA) flap is widely used for lower extremity reconstruction. However, patients sometimes suffer from donor site complications such as scar contracture and paresthesia, resulting in dissatisfaction with the aesthetic outcomes. This study investigated the characteristics of donor site morbidity associated with RSA flaps and described our experiences of dealing with complications by performing resurfacing surgery using thoracodorsal artery perforator (TDAP) flaps. Methods From April 2008 to August 2018, a total of 11 patients underwent contracture release and resurfacing surgery using TDAP flaps due to donor morbidity associated with RSA flaps. All affected donor sites were covered with a skin graft, the most common of which was a meshed split-thickness skin graft (six cases). Results Eight of the 11 patients (72.7%) suffered from pain and discomfort due to scar contracture, and seven (63.6%) complained of a depression scar. The donor sites were located 6.3±4.1 cm below the knee joint, and their average size was 140.1 cm². After resurfacing using TDAP flaps, significant improvements were found in the Lower Extremity Functional Scale (LEFS) scores and the active and passive ranges of motion (AROM and PROM) of the knee joint. The LEFS scores increased from 45.1 to 56.7 postoperatively (P=0.003), AROM increased from 108.2° to 118.6° (P=0.003), and PROM from 121.4° to 126.4° (P=0.021). Conclusions Planning of RSA flaps should take into account donor site morbidity. If complications occur at the donor site, resurfacing surgery using TDAP flaps achieves aesthetic and functional improvements.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.75-81
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• 2008

Purpose: The aim of this study was to evaluate the outcome and the effectiveness of local flaps in lower extremity reconstruction. Materials and Methods: We have performed lower extremity reconstruction with local flap in 14 cases (10 males and 4 females) from May 2006 to February 2008. The mean age was 40.1 years (range, 16~67). The defect site was the tibia in 5 cases, the ankle in 1 case and the foot in 8 cases. The local flaps were reverse flow sural artery flap in 7 cases, gastrocnemius flap in 3 cases, lateral supramalleolar flap in 2 cases, dorsalis pedis flap in 1 case and medial hemisoleus flap in 1 case. Results: All flaps were survived. Venous congestion was developed in 1 case of the rerverse flow sural artery flap but healed with secondary rotational flap. Other flaps were good without any complications. Conclusion: If we choose precisely indicated local flap in lower extremity reconstruction, the resultant coverage of defect would be excellent.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.217-223
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• 2023

Purpose: Defects involving the ankle and foot are often the result of road traffic accidents. Many such defects are composite and require a flap for coverage, which is a significant challenge for reconstructive surgeons. Various locoregional options, such as reverse sural artery, reverse peroneal artery, peroneus brevis muscle, perforator-based, and fasciocutaneous flaps, have been used, but each flap type has limitations. In this study, we used the distally based lateral supramalleolar flap to reconstruct distal dorsal defects of the foot. The aim of this study was to analyze the efficacy of the flap in reconstructing distal dorsal defects of the foot. The specific objectives were to study the adequacy, reach, and utility of the lateral supramalleolar flap for distal defects of the dorsum of the foot; to observe various complications encountered with the flap; and to study the functional outcomes of reconstruction. Methods: The distal dorsal foot defects of 10 patients were reconstructed with distal lateral supramalleolar flaps over a period of 6 months at a tertiary care center, and the results were analyzed. Results: We were able to effectively cover distal foot defects in all 10 cases. Flap congestion was observed in two cases, and minor graft loss was seen in two cases. Conclusions: The distally based lateral supramalleolar flap is a good pedicled locoregional flap for the coverage of distal dorsal foot and ankle defects of moderate size, with relatively few complications and little morbidity. It can be used as a lifeboat or even substitute for a free flap.

• 대한정형외과학회지
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• 제55권3호
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• pp.253-260
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• 2020

목적: 하지, 특히 정강이 앞 부분이나 발, 발목에서의 연부조직 결손은 피복에 어려움이 있다. 저자들은 하지의 개방성 골절 또는 폐쇄적 골절 후 수상부위에 발생한 다양한 연부조직 결손에 대하여 역행성 표재 비복동맥 피판술을 사용하여 피복을 시행한 예들을 수집, 분석하여 그 임상적 결과를 보고하고자 한다. 대상 및 방법: 2003년 8월부터 2018년 4월까지 하지의 골절 후 수상 부위에 발생한 연부조직 결손에 대하여 역행성 비복동맥 피판술을 시행받은 환자를 대상으로 하였다. 수술 후 최소 6개월 추시가 가능했던 16명의 환자를 대상으로 하였으며, 평균 추시기간은 18개월이었다. 8예는 개방성, 다른 8예는 폐쇄적 골절 후 발생한 합병증으로 연부조직 결손이 발생했다. 피판의 평균크기는 51.9 cm²였으며, 가장 큰 피판의 크기는 10×15 cm²였다. 결과 분석을 위해 수술 후 피판의 생존 여부와 추가 술식, 합병증 등을 조사하였다. 결과: 최종 추시 시 이식 피판은 모두 생존하였으며, 공여부에 별다른 합병증도 발생하지 않았다. 수술 후 단기 추시 당시 1예에서 경계부의 부분 괴사 소견이 발견되었으나 변연절제술과 1차 봉합을 통해 회복되었다. 다른 1예에서는 혈종이 발생하여 추가로 혈종제거술을 시행하였으며, 추시기간 내 피판은 성공적으로 생존하였다. 이식부의 미용적 목적으로 피판 축소수술이 3예에서 시행되었고, 피판부를 절개하고 접근하여 내고정물을 제거하거나 추가적 내고정술을 시행한 건이 3예였었다. 결론: 역행성 표재 비복동맥 피판술은 하지 골절과 동반된 연부조직 결손의 치료에 있어 적극적 적용을 고려할 만한 유용한 술기의 하나가 될 수 있을 것으로 생각된다.

• 대한골관절종양학회지
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• 제14권1호
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• pp.33-43
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• 2008

목적: 족관절 및 족부에 발생한 악성 연부 조직 종양의 광범위 절제술 후 시행한 재건술의 임상적 효용성에 대하여 알아보고자 한다. 대상 및 방법: 2000년 3월에서 2007년 3월까지 족관절 및 족부에 악성 연부 조직 종양이 발생하여 광범위 절제술을 시행한 후 재건술을 시행한 15례(14명)을 대상으로 하였다. 폐 전이로 사망한 1례를 제외하고 평균 36.4개월(7~72개월)의 추시기간을 가졌고, 평균 연령은 56.8세(26~77세), 남자가 11명, 여자가 3명이었다. 원발병소는 악성 흑색종 12례, 편평상피 세포암 3례이었다. 최종 추시점에서 종양학적, 수술적 그리고 기능적인 결과를 비교하였다. 결과: 재건술의 방법은 전외측 대퇴부 천공지 피판 5례, 역행성 표재 비복동맥 피판 4례, 족배 동맥 피판 3례와 국소 피판 3례였다. 결손의 크기는 평균 $5.5{\times}5.7\;cm$, 피판의 크기는 평균 $5.9{\times}6.0\;cm$이었다. 회전 피판술 결손의 크기는 평균 $4.6{\times}4.7\;cm$, 피판의 크기는 평균 $4.9{\times}4.8\;cm$이었고 유리 피판술 결손의 크기는 평균 $7.2{\times}7.8\;cm$, 피판의 크기는 평균 $8.2{\times}8.8\;cm$이었다. 평균 수술 시간은 310분(120~540분)이었고, 회전 피판술은 256분, 유리 피판술은 420분이었다. 1례가 폐전이로 사망하였고 국소 재발한 4례와 원격 전이가 발견된 4례를 제외한 7례에서는 최종 추시상 병변이 발견되지 않았다. 피판의 국소적인 울혈외에 수술적 합병증은 없었고, 술 후 MSTS 점수는 평균 68.8%였다. 결론: 족관절 및 족부에 발생한 악성 연부 조직 종양의 광범위 절제술 후 결손의 크기가 비교적 작을 경우($5{\times}5\;cm$ 이하)인 경우 족배 동맥 피판술, 역행성 표재 비복 동맥 피판술과 같은 회전 피판술을 일차적으로 고려해 볼 수 있다. 결손이 더 크거나 복합 조직이 필요한 경우 전외측 대퇴부 천공지 피판술을 포함한 유리 피판술이 더 유용할 것으로 사료된다. 그리고 악성 흑색종의 경우 재건 방법은 종양학적인 결과에 영향을 미치지 않는 것으로 보인다.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.137-142
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• 2010

Purpose: Tumor ablation and traumatic intractable ulceration of the plantar surface of the foot results in skin and soft tissue defects of the weight-bearing sole. Simple skin grafting is not sufficient for reconstruction of the weight-bearing areas. Instead, the island medial plantar flap (instep flap) and distally-based island medial plantar flap was used for proper reconstruction of the weight bearing area. However, there are some disadvantages. In particular, an island medial plantar flap has a short pedicle limiting the mobility of the flap and the distally-based island medial plantar flap is based on a very small vessel. We investigated whether good results could be obtained using a reverse island medial plantar flap based on the lateral plantar vessel as a solution to the above limitations. Methods: Three patients with malignant melanoma were cared for in our tertiary hospital. The tumors involved the lateral forefoot, the postero-lateral heel, and the medial forefoot area. We designed and harvested the flap from the medial plantar area, dissected the lateral and medial plantar artery and vena comitans, and clamped and cut the vessel 1 cm proximal to the branch from the posterior tibial artery and vena comitans. The medial plantar nerve fascicles of these flaps anastomosed to the sural nerve, the 5th interdigital nerve, and the 1st interdigital nerve of each lesion. The donor sites were covered with skin grafting. Results: The mean age of the 3 subjects was 64.7 years (range, 57 - 70 years). Histologically, all cases were lentiginous malignant melanomas. The average size of the lesion was $5.3\;cm^2$. The average size of the flap was $33.1\;cm^2$. The flap color and circulation were intact during the early postoperative period. There was no evidence of flap necrosis, hematomas or infection. All patients had a normal gait after the surgery. Sensory return progressively improved. Conclusion: Use of an island medial plantar flap based on the lateral plantar vessel to the variable weight-bearing sole is a simple but useful procedure for the reconstruction of any difficult lesion of the weight-bearing sole.