• Archives of Reconstructive Microsurgery
• /
• v.7 no.1
• /
• pp.20-27
• /
• 1998

Among many kinds of introduced free flaps, scapular freeflap is one of the most popularly using modalities in fasciocutaneous defect coverage with minimal donor defect and easier procedure and constant vascular patterns of the donor. Many surgeons who had experience of this flap pointed out deficit of the reliable sensation of the transplanted flap is the main shortcoming of the scapular free flap. If we can subjugate that point, scapular free flap is the most excellent procedure in such a cases as heel pad reconstruction and hand reconstruction which are relatively important to have skin with protective sensation. Author performed anatomical literature review, 10 cadaveric dissections and 12 clinical dissections. In surgical anatomical aspect, the upper six dorsal rami of the thoracic nerves have medial branches which pierce Longissimus thoracis and Multifidus muscle with small cutaneous twigs which pierce Latissimus dorsi and Trapezius muscle. Among that cutaneous twigs, several twigs distribute to the skin of the back from midline to lateral aspect which territory is identical to scapular free flap. We analysed clinical experiences of that sensory bearing scapular free flap surgical anatomy and one year follow-up studies with several results. 1) Two to three cutaneous twigs which pierced from the Trapezius muscle over the scapular free flap region. 2) Each twigs has two to four nerve fascicles with small artery. 3) The nerve distributed to the ordinary scapular free flap and large enough size and pedicle length to neurorrhapy with various recipient site nerves. 4) The inconvenience of this procedure is the vascular pedicle and nerve pedicle have opposite directions, vascular pedicle of that comes from lateral direction from subscapular vessels, but nerve pedicle comes from medial direction from trapezius muscle. Author can found constant cutaneous nerve branches which come from piercing the Trapezius. This nerves are helpful for protective sensation in transplanted scapular free flap. We can't had enough follow-up and evaluation of the nerve function of this procedure, we need continuous research works to application of this procedure. The in conveniences come from directional differences of pedicle can solve with longer harvest neural pedicle and change direction of the neural pedicle.

• Archives of Plastic Surgery
• /
• v.48 no.4
• /
• pp.417-426
• /
• 2021

Background Soft tissue coverage plays a vital role in replacing the vascularity of the underlying bone in Gustilo type IIIB fractures. The aim of this article was to evaluate the feasibility of local pedicled flaps in type IIIB fractures at a tertiary care center. Methods We included all cases of open Gustilo-Anderson type IIIB fractures of the tibia treated with local flap coverage from January 2017 to February 2019. We carried out a retrospective analysis to investigate the relationships of complications, hospital stay, and cost-effectiveness with the choice of flap, infective foci, site and size of the defect, and type of fixation. Results Out of 138 Gustilo type IIIB fractures analyzed in our study, 27 cases had complications, of which 19 (13.76%) involved flap necrosis, four (2.89%) were infections, three (2.17%) involved partial necrosis, and one (0.72%) was related to bone spur development. Flap complications showed a statistically significant association with the perforator flap category (propeller flaps in particular) (P=0.001). Flap necrosis showed a significant positive correlation with cases treated within 3 weeks after trauma (P=0.046). A significant positive correlation was also found between defect size and the duration of hospital stay (P=0.03). Conclusions Although local flaps are harvested from the same leg that underwent trauma, their success rate is at least as high as microvascular flaps as reported from other centers. Amidst the local flaps, complications were predominantly associated with perforator flaps.

• Archives of Reconstructive Microsurgery
• /
• v.21 no.2
• /
• pp.111-117
• /
• 2012

Purpose: To report the clinical results of the perforated-based propeller flap for lower extremity soft tissue reconstruction. Materials and Methods: Between January 2010 and June 2012, a total of 16 defects in the lower extremities were covered with perforator-based propeller flaps. Retrospective data for location and size of the defect, flap dimension, pedicle artery, pedicle rotation, complications were obtained. Results: Peroneal artery-based perforator flap were used in eleven cases, posterior tibial artery-based perforator flap in two cases, anterior tibial artery-based perforator flap in one case and medial plantar artery-based perforator flap in two cases. The average size of the flaps was $63cm^2$. The marginal skin necrosis of the flaps as a complication was developed in two cases, one of which was covered with split-thickness skin graft. There were no functional deficits from the donor site. Conclusion: For the reconstruction of lower extremities, the perforator-based propeller flap could be a reasonable alternative as it is a simple, safe and versatile technique.

• Archives of Reconstructive Microsurgery
• /
• v.10 no.2
• /
• pp.99-104
• /
• 2001

Purpose : Loss of sensibility over the finger tip resents a grave deficit and is an indication for sensible soft tissue reconstruction. This paper was performed to assess the long term results obtained by nerovascular island flap. Material and Methods : We performed neurovascular island graft for defective sensibility of finger tip loss in 94 cases since 1979 to 2000. The recipient sites were the thumb pulp defect in 79 cases, the amputated thumb in 9 cases, the amputated index in 4 cases, and the velar aspect of interphalangeal joint of thumb in 2 cases. The donor flaps were obtained from the radial side of ring finger in 63 cases, the ulnar side of the ring finger in 21 cases, and the ulnar side of the middle finger in 10 cases. A mean follow-up period was 5.7 years. Results : The flap quality was well vascularized and survived in 89 cases. The two-point discrimination was average 8.7mm. Because of scar contracture, the range of motion of the donor finger was decreased 3.5% of the normal finger in the distal interphalangeal joint, 8,2% in the proximal interphalangeal joint. A phenomenon of double sensibility occurred in 66 cases. Conclusion : This technique was excellent both aesthetically and functionally as a reconstruction of the Loss of fingertip.

• Archives of Reconstructive Microsurgery
• /
• v.16 no.1
• /
• pp.23-29
• /
• 2007

The reconstruction of deep soft tissue defect such as pressure sore has difficult problems. Myocutaneous flaps have been used commonly as the best coverage method for pressure sore. But, they have several drawbacks such as sacrifice of functional muscle, high morbidity of the donor sites and bulkiness at the recipient site. The concepts of perforator flap has recently developed and widely used to overcome these disadvantages. Between March 2005 to July 2006, we have treated 9 patients who had pressure sore using perforator based fasciocutaneous island rotation flap. Preoperative unidirectional Doppler was used in all cases. Mean number of perforator vessels was 3.8 and flap sizes were from $7{\times}5\;cm$ to $14{\times}13\;cm$. Rotation angles of flap were from 90 degree to 180 degree. In all cases, donor sites were closed primarily. All flap survived completely and postoperative complications were wound dehiscence in 1 case, wound infection in 3 cases. The mean postoperative follow up period was 15.7 months and recurrence was not reported. We could decrease donor site morbidity and cover wound sites easily by using flap rotation and get robust blood supply without sacrifice of functional muscle. Fasciocutaneous perforator island rotation flap would be very useful for various pressure sore treatment.

• Archives of Plastic Surgery
• /
• v.45 no.5
• /
• pp.479-483
• /
• 2018

Malignant peripheral nerve sheath tumor (MPNST) is a very rare type of sarcoma, with an incidence of 0.001%. MPNST has a 5-year survival rate near 80%, so successful reconstruction techniques are important to ensure the patient's quality of life. Sarcoma of the forearm is known for its poor prognosis, which leads to wider excision, making reconstruction even more challenging due to the unique anatomical structure and delicate function of the forearm. A 44-year-old male presented with a large mass that had two aspects, measuring $9{\times}6cm$ and $7{\times}5cm$, on the dorsal aspect of the right forearm. The extensor compartment muscles (EDM, EDC, EIP, EPB, EPL, ECRB, ECRL, APL) and invaded radius were resected with the mass. Tendon transfer of the entire extensor compartment with skin defect coverage using a $24{\times}8cm$ anterolateral thigh (ALT) perforator free flap was performed. The patient was discharged after 18 days without wound complications, and has not complained of discomfort during supination, pronation, or wrist extension/flexion through 3 years of follow-up. To our knowledge, this is the first report of successful reconstruction of the entire forearm extensor compartment with ALT free flap coverage after resection of MPNST.

• The Journal of Advanced Prosthodontics
• /
• v.8 no.5
• /
• pp.411-416
• /
• 2016

Patients who underwent resection of maxilla due to benign or malignant tumor, or accident will have defect in palatal area. They get retention, support and stability from remaining tissues which are hardly optimal. The advantage of swing-lock attachment design is having multiple contacts on labial and lingual side of the abutment teeth by retentive strut and palatal bracing component. Because the force is distributed equally to abutment teeth, abutment teeth of poor prognosis can be benefited from it. It is also more advantageous to cover soft tissue defects which are hard to reach with conventional prosthesis. A 56-year-old female patient who had undergone a maxillectomy due to malignant melanoma complaining of loose and unstable surgical obturator. Surveyed crowns were placed on #12, 26, and 27. Teeth #11, 21, 22, and 23 had lingual rest seat and #24 had mesial rest seat to improve stability and support of the obturator. This clinical report presents the prosthetic management of a patient treated with obturator on the maxilla using swing-lock attachment to the remaining teeth.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.31 no.6
• /
• pp.526-530
• /
• 2009

Recently, the anterolateral thigh(ALT) flap, based on the septocutaneous vessels or musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery has gained popularity in head and neck soft-tissue reconstruction. It has some advantages in free-flap surgery with respect to the radial forearm free flap, such as low donor site morbidity, availability of different tissues with large amounts of skin, adaptability as a sensate or flow-through flap (with the possibility of harvesting a long pedicle with a suitable vessel diameter). Moreover, the thickness of the flap is adjustable until the subdermal fat level, allowing it to be used as a thin or ultrathin flap. This clinical cases are ALT free flap reconstructions without functional impairment of the donor limbs (transitory and permanent) based on anastomosis with superficial temporal arteries and veins in patient of huge resection defect on face, lip and tongue.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.23 no.2
• /
• pp.145-155
• /
• 2007

The advent of osseointegration and advances in biomaterials and techniques have contributed to increased application of dental implants in the restoration of maxillary partial edentulous patients. Often, in these patients, soft and hard tissue defects result from a variety of causes, such as infection, trauma, and tooth loss. These create an anatomically less favorable foundation for ideal implant placement. Reconstruction of the atrophic maxillary alveolar bone through a variety of regenerative surgical procedures has become predictable; it may be necessary prior to implant placement or simultaneously at the time of implant surgery to provide a restoration with a good long-term prognosis. Regenerative procedures are used for horizontal and vertical ridge augmentation. Many different techniques exist for effective bone augmentation. The approach is largely dependent on the extent of the defect and specific procedures to be performed for the implant reconstruction. It is most appropriate to use an evidenced-based approach when a treatment plan is being developed for bone augmentation cases. The cases presented in this article clinically demonstrate the efficacy of using a autogenous block graft, guided bone regeneration, ridge split, immediated implant placement technique on the atrophic maxillary area.

• Journal of Chest Surgery
• /
• v.31 no.2
• /
• pp.190-193
• /
• 1998

We experienced a case of primary sternal tuberculosis with destroyed midsternum and bony defect. An 22-year-old female was admitted to our hospital two times for severe sternal pain and spontaneous fracture without history of trauma. On hospital admission, chest X-ray and chest CT showed destruction of midsternum and soft tissue swelling. Fine needle aspiration cytology revealed tuberculous osteomyelitis with cold abscess. And the patient was treated with usual anti-tubeculosis medication for preoperative preparation. At operation, we confirmed midsternal destruction with cold abscess and multiple sinus tracts. After removal of diseased sternal segment and cold abscess, we performed sternal reconstruction with autologus iliac bone graft. The pathologic report was compatible with tuberculous osteomyelitis and caseous necrosis The postoperative course was smooth and uneventful, and she remains well without sternal instability two months later.