• Journal of Periodontal and Implant Science
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• v.37 no.1
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• pp.103-113
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• 2007

The purpose of this study was to measure the thickness of masticatory mucosa in the hard palate as a donor site for mucogingival surgery by using computerized tomography(CT), Thickness measurements were performed in 84 adult patients who took CT on maxilla for implant surgery and 24 standard measurement points were defined in the hard palate according to the gingival margin and mid palatal suture. Radiographic measurements were utilized after calibration for standardization. Data were analyzed to determine the differences in mucosal thickness by gender, age, tooth positions and depth of palatal vault. The results of this study were as follows: 1. Mean thickness of palatal masticatory mucosa was $3.93{\pm}0.6mm$ and females had significantly thinner mean masticatory mucosa($3.76{\pm}0.56mm$) than males($4.04{\pm}0.6mm$)(p<0.05). 2. The thickness of palatal masticatory mucosa increased by aging. 3. Depending on position, masticatory mucosa thickness increased from canine to premeolar, but decreased at the first molar, and increased again in the second molar region(p<0.0001). 4. No significant difference in mean thickness of palatal masticatory mucosa were indentified between low palatal vault group and high palatal vault group(p>0.05). The results suggest that canine and premolar area appears to be the most appropriate donor site for soft tissue grafting procedure. The measurement of the thickness of palatal masticatory mucosa by using computerized tomography can offer useful information clinically but further studies in as-sessing the validity and reliability of the method using computerized tomography is needed.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

• The Journal of Korean Academy of Prosthodontics
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• v.53 no.3
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• pp.262-275
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• 2015

The treatment of areas demanding esthetic requirements, such as maxillary anterior teeth, should take into account the achievement of a healthy, harmonious to the surrounding tissue, and an attractive smile line. In this case report, smile line, soft tissue and hard tissue morphology, and the anatomy and proportion of the tooth, must be considered. In patients with unesthetic maxillary anterior ratio due to inadequate gingival contour and diastema caused by peg lateralis, it would be challenging to achieve an esthetic restoration by orthodontic treatment alone. In such case, after orthodontic treatment, dento-gingivo-facial compositional diagnosis and analysis, followed by gingivectomy and prosthodontic restoration is needed to improve the interdental mesial/distal, width/length ratio to achieve a satisfactory esthetic result. In addition, when improving the tooth proportion of peg lateralis by prosthodontic treatment, Porcelain laminate veneer (PLV), which results in less tooth structure loss, reproduction of similar shade to that of the proximal tooth and high transparency, is recommended. This case report demonstrates esthetic improvements by prosthodontic restoration through systematic diagnosis and treatment procedure in patients with unesthetic maxillary anterior proportion after orthodontic treatment due to peg lateralis by means of two female patients aged twenty years old.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.649-654
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• 2012

Background Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow. Methods A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The patients' data including age, sex, cause of injury, wound dimensions, timing of flap coverage, postoperative elbow motion, and complications were investigated. Results Between 2001 and 2012, 16 patients were treated at our hospital. The mean age was 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral arm flaps, and 4 radial forearm flaps. The average defect size was 183.5 $cm^2$ (range, 28 to 670 cm2). Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days). The mean postoperative active elbow flexion was $98^{\circ}$ (range, $85^{\circ}$ to $115^{\circ}$). Partial flap failure occurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%), hematoma (23.5%), seroma (35.3%), and wound infection (5.9%). Conclusions Flap selection for elbow reconstruction is determined by the defect size and the extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a single-staged, reliable, and relatively simple procedure that permits initiation of early rehabilitation, thereby improving a patient's functional outcome.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.53-57
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• 2010

Purpose: The radial forearm fasciocutaneous free flap is currently considered as the ideal free flap for reconstruction of mucosal and soft tissue defects of the palate. But the availability of stably attached oral and nasal mucosal lining is needed. In addition to this, for better operation field, operating convenience and esthetics, we planned a prelaminated radial forearm free flap. Methods: A 64-year-old male patient was admitted due to a $4{\times}4.5cm$ full through defect in the middle of the hard palate caused by peripheral T cell lymphoma with actinomycosis. In the first stage, the radial forearm flap was elevated, tailored to fit the hard palate defect, and then it positioned up-side down with split thickness skin graft. Two weeks later, the prelaminated radial forearm free flap was re-elevated and transferred to the palatal defect. One side covered with grafted skin was used to line the nasal cavity, and the other side (the cutaneous portion of the radial forearm flap) was used to line the oral cavity. Results: The prelamination procedure was relatively easy and useful. The skin graft was well taken to the flap. After 2nd stage operation, the flap survived uneventfully. There was no prolapse of the inset flap into the oral cavity and the cutaneous portion of the flap was mucosalized. The procedure was very successful and the patient can enjoy normal rigid diet and speech. Conclusion: The use of prelaminated radial forearm free flap for hard palate reconstruction is an excellent method to restore oral function. Based upon the result of this case, microvascular free flap transfer with prelaminated procedure is a valid alternative to the prosthetic obturator for palatal defect that provides an improved quality of life. It should be considered as an integral component of head and neck cancer therapy and rehabilitation.

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.166-170
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• 2007

Purpose: To evaluate the clinical and radiologic results of the Ludloff osteotomy for moderate to severe hallux valgus deformity retrospectively. Materials and Methods: Between January 2003 and October 2006, 33 patients (42 feet) who had undergone with Ludloff osteotomy combined with distal soft tissue procedure were followed up for more than one year. The average follow-up period was 14.6 months and the average age at the time of surgery was 47.7 years (26-70 years). The American Othopeaedic Foot and Ankle Society (AOFAS) score was used for clinical outcome assessments. We analyzed the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA) and the degrees of the tibial sesamoid subluxation in preoperative and the last follow-up radiographs. Results: The AOFAS score improved from a preoperative average of 45.6 points to an average 84.3 points at the last follow-up. HVA and IMA were 34.8 and 14.5 degrees preoperatively, 17.2 and 5.9 degrees at the last follow-up. The tibial sesamoid position improved from a preoperative average of grade 2.5 to the last follow-up average of grade 1.2. Conclusion: Ludloff osteotomy produced satisfactory results for moderate to severe hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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• pp.76-79
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• 2014

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.702-708
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• 2014

Background Lower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery. Methods The vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level. Results SIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (${\pm}12.87$) mm, and -8.14 (${\pm}15.24$) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (${\pm}0.39$) mm and 1.37 (${\pm}0.33$) mm, and they were found at a mean depth of 9.75 (${\pm}2.67$) mm and 8.33 (${\pm}2.65$) mm, respectively. Conclusions The SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps.

• Journal of Korean Foot and Ankle Society
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• v.19 no.3
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• pp.91-96
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• 2015

Purpose: The purpose of this study is to evaluate the sequential changes of clinical and radiographic results after proximal chevron osteotomy in patients with moderate to severe hallux valgus. Materials and Methods: Between January 2008 and December 2009, 93 patients (117 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. The mean age of patients was 51 years (range, 19 to 71) and the mean duration of follow-up was 27.5 months (range, 24 to 35). Clinical results were evaluated using visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively, at 3, 6, and 12 months after surgery, and at the last follow-up. Radiographic parameters including hallux valgus angle, intermetatarsal angle, and sesamoid position were evaluated preoperatively, immediately postoperatively, at 6 weeks, at 3, 6, and 12 months after surgery, and at the last follow-up. Results: VAS and AOFAS score showed significant improvement until 12 months after surgery. Hallux valgus angle and sesamoid position stabilized at 12 months after surgery and intermetatarsal angle stabilized at 6 months after surgery. Conclusion: Clinical and radiographic results were stabilized beyond 12 months after proximal chevron osteotomy in patients with moderate to severe hallux valgus.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1484-1490
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• 2000

Objectives : In spinal metastasis and myeloma, percutaneous vertebroplasty could be an effective treatment method to provide spinal stabilization and to relief pain for early rehabilitation. The authors report twenty-five cases the clinical results of percutaneous vertebroplasty for twenty-five cases of spinal metastasis and myeloma. Materials and Methods : From September 1998 to December 1999, seventy percutaneous vertebroplasties(PVP) were performed for spinal metastases and myeloma in 25 patients, sixteen women and nine men ranging in age from 34 to 74. The primary malignancies were 6 multiple myelomas, and in metastatic tumore from various origin. All patients complained of severe pain and had osteolytic vertebral body destructions without spinal cord compression. To evaluate clinical improvement, suObjective verbal analogue pain score(VAS) and Karnofsky performance scale(KPS) were used. Thin sliced(2mm-thickness) sectional computed tomography(CT) was performed before and after PVP. Plain X-ray film was followed up every 1 month to assess the vertebral column stability. Results : In 25 patients, a total of seventy PVPS were performed successfully : 6 cervical, 33 thoracic and 31 lumbar vertebrae. Most patients had clear improvement of pain after PVP ; mean as score was 8.1 and 2.9 before and after PVP, respectively. Improvement was maintained in most patients. No further collapse of treated vertebrae was observed(mean follow-up, 7 months). Leakage of PMMA was notod in the spinal canal(13 levels), neural foramen (2 levels), adjacent disk(15 levels), paravertebral soft tissue(14 levels) and vein(8 levels). Pulmonary embolism was detected in three patients after the procedure, but was not associated with clinical symptoms. Conclusion : These results indicate that percutaneous vertebroplasty can be valuable treatment method in osteolytic spinal metastasis and myeloma, providing immediate pain relief and spinal stabilization and contributing to early rehabilitation.