• Archives of Plastic Surgery
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• v.34 no.2
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• pp.217-221
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• 2007

Purpose: Reconstruction of the soft tissue defect exposing Achilles tendon is a formidable challenge because of the paucity of soft tissue and relatively poor blood supply. This article describes the reconstruction of soft tissue defect exposing Achilles tendon using gracilis muscle free flap and split-thickness skin graft. Methods: From 2000 to 2005, four patients with soft tissue defect exposing Achilles tendon and infection were operated using gracilis muscle free flap and split-thickness skin graft. The defect size ranged from 3.5 to 5cm wide and 6.5 to 8cm long. The mean postoperative follow-up was twenty months. Results: All the flaps were survived without necrosis and infection. We obtained the satisfactory results with good functional and aesthetical outcomes. All cases showed good results with the characteristics of a relatively thin flap without additional debulking procedure. Conclusion: Gracilis muscle free flap with split thickness skin graft could be a good option for reconstruction of soft tissue defect of posterior ankle, exposing Achilles tendon with minimal morbidity of the donor site.

• Journal of Periodontal and Implant Science
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• v.44 no.3
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• pp.147-155
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• 2014

Purpose: In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect. Methods: We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture. Results: Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment. Conclusions: The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.

• 대한미세수술학회:학술대회논문집
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• 1998.11a
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• pp.193-193
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• 1998

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.70-79
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• 1996

From January 1980 to May 1995, ninety-six patients had been treated by free-flap transfer for the soft tissue defects of the extremities. Ninety-eight cases of free-tissue transfer were reviewed to evaluate the clinical reliability in terms of survival and quality of long-time function after reconstructive surgery. Among these 98 cases(27 cases in latissimus dorsi myocutaneous flap, 25 in dorsalis pedis flap, 20 in forearm fasciocutaneous flap, 9 in groin flap, 7 in gracilis myocutaneous flap, 6 in 1st web space flap of foot and 4 cases in tensor fascia lata flap), 92 cases of then were survived. 7 cases were performed with vein grafts. We ananalyzed the reconstruction of the extremities on 98 cases with the soft tissue defects which had been reconstructed free-flap transfer and followed for minimum 1 year period at Korea University Hospital. 1. 92 cases(93.9%) of the total 98 cases were successful and can be obtained the excellent results in soft tissue free-flap transfer. 2. While there were no clinically significant differences in survival rate of flaps transferred from different potential flap donor sites,3 cases of 9 groin flaps were showed higher failure rate due to the complications such as arterial thrombosis, infection and anatomical variation of vessels. 3. Postoperative thrombectomy was performed in 30 cases to be occured in the arterial and venous thrombosis. The revision was failed in 2 cases due to persistent arterial thrombosis and infection, then treated with skin graft. 4. Vein graft was frequently required in severely compromised-soft tissue defects resulted from high-energy trauma. The vein graft was not stitistically significant on the frequency of flap failure rate(P<0.04). 5. Meticulous monitoring, careful planning, early revision and technical considerations will provide for a high clinical success of the free-flap transfer.

• Archives of Reconstructive Microsurgery
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• v.13 no.2
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• pp.123-129
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• 2004

Lower extremity injuries are frequently accompanied with large soft-tissue defects. Such Injuries are difficult to manage for its poor vascularity, rigid tissue distensibility, easy infectability and a relatively long healing period. Also, osteomyelitis, and/or non-union of the fractured bones are relatively common in lower extremity injuries and its weight-bearing role should be considered. Therefore, it is important to select appropriate reconstruction method of the lower extremities, which is applicable to a variety of surgical techniques according to these considerations. The goal of flap coverage in the lower extremity should not only be satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. In this article, we have tried to establish a reconstruction method in the lower extremity based on our experiences and clinical analysis of soft tissue reconstruction using free muscle flap transfer in 27 cases from Jan. 2000 to Dec. 2002. The results showed 96% flap survival, and flap failure noted in one of the cases due to vascular insufficiency. In conclusion, we believe that in cases of lower extremity soft-tissue defects especially with open comminuted fractures and infections, muscle free flaps should be considered as the first line of treatment.

• Archives of Reconstructive Microsurgery
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• v.17 no.1
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• pp.28-35
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• 2008

The purpose of this study was to present the clinical analysis of the results of lateral arm free flap for small sized and infected diabetic foot ulcer around toes. From May 2006 to December 2007, Seven patients were included in our study. Average age was 52.8 years, six were males and one was female. All had infected diabetic foot ulcer and had exposures of bone or tendon structures. Ulcers were located around great toe in four patients, 4th toe in one and 5th toe in two. Three patients had osteomyelitis of metatarsal or phalanx. After appropriate control of infection by serial wound debridement and intravenous antibiotics, lateral arm flap was applied to cover remained soft tissue defects. Posterior radial collateral artery of lateral arm flap was reanastomosed to dorsalis pedis artery of recipient foot by end to side technique in all cases in order to preserve already compromised artery of diabetic foot. All flaps were designed over lateral epicondyle to get longer pedicle and averaged pedicle length was 8 cm. Two cases were used as a sensate flap to achieve protective sensation of foot. All flaps survived and provided satisfactory coverage of soft tissue defects on diabetc foot ulcers. All patients could achieve full weight-bearing ambulation. No patients has had recurrence of infection, ulceration and further toe amputations. There were three complications, a delayed wound healing of flap with surrounding tissue, a partial peripheral loss of flap and a numbness of forearm below donor site. All patients were satisfied with their clinical results, especially preserving their toes and could return to the previous activity levels. Lateral arm free flap could be recommend for infected diabetic foot ulcers around toes, to preserve toes, coverage of soft tissue defect and control of infection with low donor site morbidity.

• Archives of Reconstructive Microsurgery
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• v.18 no.1
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• pp.16-22
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• 2009

The purpose of this study was to present the clinical result of anterolateral thigh free flap for pretibial soft tissue lesion after chronic tibia osteomyelitis. From December 2006 to September 2008, Five patients were included in our study. 4 of 5 were superficial or localized types of chronic tibia osteomyelitis, based on the classification of Cierny and Mader. Average age at the surgery was 45 years, three were males and two were females. All had a history of chronic tibia osteomyelitis and subsequent pretbial soft tissue lesions coming from previous operations or pus drainage. Pretibial soft tissue defects included small ulcers, fibrotic, bruisable soft tissue and small bony exposures, but not large-sized bony exposures nor active pus discharge. After complete debridement of large sized pretibial soft tissue lesions and decortication of anterior tibial cortical dead bone, anterolateral thigh free flap was applied to cover remained large pretibial soft tissue defect and to prevent the recurrence of infection. All flaps survived and provided satisfactory coverage of soft tissue defect on pretibial region for 16 months' mean follow up period. No patients has had recurrence of osteomyelitis. Anterolateral thigh free flap could be recommend for large sized pretibial soft tissue defect of supreficial or localized types of chronic tibia osteomyelitis after through debridement.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.18-23
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• 2005

Purpose: To report the results and the efficacy of the sensory bearing scapular free flap which is known as non-sensible flap. Materials and Methods: Authors underwent 24 cases of sensory bearing scapular free flap to the hands and feet from March 1995 to November 2002. average follow-up period was six year three months. The used flaps were a ordinary scapular flap in fifteen cases, and a parascapular flap in nine. Sensibility of the flaps were checked every one month. Actual sensory evaluation was mostly depends on objective feeling of the patients. Two point discrimination test was performed in all cases. Results: 23 flaps had good skin circulation after microvascular anastomosis among 24. Objective deep touch sensation were observed about three months later after the operation in three cases, between three and six months in nine. In three case whose results were excellent than others, two point discrimination was 2.7 cm at last follow-up. Most of the sensory recovery is confined in deep touch, temperature and light touch sensation was recovered limitedly in 3 cases during our follow-up period. Conclusion: Authors can propose that sensory bearing free scapular flap was considered as one of useful methods for the reconstruction to hand with soft tissue defect and mutilating hand.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.340-346
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• 2020

Background Adipofascial flaps covered with a skin graft address the challenges involved in reconstructing dorsal foot defects. The purpose of this study was to describe a large adipofascial flap based on the perforators of the dorsalis pedis artery for large foot defects. Methods Twelve patients aged 5-18 years with large soft tissue defects of the dorsal foot due to trauma were treated with an extended dorsalis pedis adipofascial flap from May 2016 to December 2018. The flap was elevated from the non-injured half of the dorsum of the foot. Its length was increased by fascial extension from the medial or lateral foot fascia to the plantar fascia to cover the defect. All perforators of the dorsalis pedis artery were preserved to increase flap viability. The dorsalis pedis artery and its branches were kept intact. Results The right foot was affected in 10 patients, and the left foot in two patients. All flaps survived, providing an adequate contour and durable coverage with a thin flap. Follow-up lasted up to 2 years, and patients were satisfied with the results. They were able to wear shoes. Donor-site morbidity was negligible. Two cases each of partial skin graft loss and superficial necrosis at the tip of the donor cutaneous flap occurred and were healed by a dressing. Conclusions The hinged multiperforator-based extended dorsalis pedis adipofascial flap described herein is a suitable method for reconstructing dorsal foot defects, as it provides optimal functional and aesthetic outcomes with minimal donor site morbidity.

• Archives of Reconstructive Microsurgery
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• v.20 no.2
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• pp.108-112
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• 2011

Purpose: Gracilis muscle free flap transplantation is chosen in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity. We set a study to search for gracilis free flaps to know whether symptoms were cured or recurred in patients that have passed over 10 years from flap transplantation. Materials and Methods: From August 1995 through September 2010, we have performed 28 cases of gracilis muscle free flap in the lower extremities. Ever since no case visited to demand any discomfort, breakdown or recurrence in the flap site on outpatient basis. We made a telephone call to patients or relatives documented in the medical record and only 2 cases visited outpatient department and 9 cases postponed the visit who satisfied with the final result but 17 cases had wrong telephone numbers. Causes, area of lower extremity, recipient vessels in the lower extremity, condition of the donor thigh and overall satisfaction of the flap transplantation in activities of daily living were investigated and written down in the medical record. Results: 11 cases were reviewed after average postoperative 13.7 years. Gracilis muscle flaps were not break down at the recipient site in all cases. The wound of donor thigh wound healed good and overall activities of daily living was satisfied in all cases. Conclusion: Gracilis muscle flaps which had performed and followed up average 13.7 years revealed confident in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity.