• Archives of Plastic Surgery
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• 제45권1호
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• pp.29-36
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• 2018

Background The emergence of breast-conserving surgery combined with radiotherapy as the treatment of choice for early stage breast cancer has resulted in greater focus on oncoplastic breast surgery. The use of perforator flaps has particularly gained in reputation for its effectiveness in the reconstruction of partial breast defects in Korean women. Herein, we present our experience with the use of thoracodorsal artery perforator (TDAP) and lateral intercostal artery perforator (LICAP) flaps. Methods This study included 33 patients who underwent breast reconstruction using TDAP or LICAP flaps at our hospital from January 2011 to December 2014. Data from patient medical records, and patient satisfaction surveys, which were conducted 12 months postoperatively, were retrospectively evaluated. Results TDAP and LICAP flap-based reconstructions were performed in 14 and 19 patients, respectively. Five patients developed complications that required additional intervention. Overall patient satisfaction was observed to be excellent in 15 (46%) patients, and good in 12 (36%). Conclusions Based on our experience, oncoplastic breast surgery using TDAP or LICAP flap is an effective remodeling technique for small-to-moderate breast defects in Korean women with smaller breasts.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.748-753
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• 2013

Background Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction. Methods Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia. Results Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary. Conclusions This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.187-191
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• 2013

Background Our objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group. Methods All patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999 to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared. Results Complications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001). Conclusions Based on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap.

• Archives of Aesthetic Plastic Surgery
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• 제23권1호
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• pp.1-10
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• 2017

Background Creating a natural-looking umbilicus during closure of the donor-site in abdominally based free flap breast reconstruction is a factor of satisfaction for both the patient and surgeon. We present a simple method of umbilical transposition that results in an aesthetic, natural-looking umbilicus. Methods From March 2011 to November 2014, fifty three consecutive female patients received abdominal flap breast reconstruction. Twenty patients (from March 2011 to February 2013) underwent umbilical transposition through a cross like incision in the abdominal flap, with fascial fixation sutures but no dermal flaps. Thirty three patients (March 2013 to November 2014) received umbilical transposition in the following method. An oval-shaped incision is made at the location of the new umbilicus on the abdominal flap. This oval is deepithelialized, and full-thickness incisions are made at the 2, 6, and 10 o'clock directions to create three triangular dermal flaps. These are pulled down to the abdominal fascia using sutures that pass through the umbilical stalk and the abdominal fascia at the 3, 9, and 12 o'clock directions. This results in an umbilical stalk lined with dermal flaps, creates a natural periumbilical concavity, and anchors the abdominal flap inward to minimize tension. The cranial flap enhances superior hooding. Results Patient and surgeon satisfaction, surveyed 2 months after surgery with a satisfaction scoring system, were higher in the dermal flap group. Conclusions The technique using three dermal flaps in an oval skin incision is simple, relatively easy to learn, and results in an aesthetic, natural-looking umbilicus.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.163-168
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• 2007

Purpose: The flap delay is a widely used technique to increase the flap survival. Dexamethasone is a well-known drug to have a positive impact on the flap survival. The objective of this study is to investigate the dual synergic effect of epinephrine as a chemical delay agent plus dexamethasone on the TRAM flap survival in rat model. Methods: Forty Sparague-Dawley rats were divided into 4 groups evenly and a right inferior epigastic vessel pedicled TRAM flap, sized $5.0{\times}3.0cm$, was elevated on each upper abdomen. In the control group(N=10), 2 ml saline was injected on transverse abdominis muscle for a week before the flap elevation. In surgical delay group(N=10) all superior pedicles and left inferior pedicle were ligated a week before the flap elevation. In epinephrine group (N=10), 1 : 50000 epinephrine mixed saline was injected to transverse abdominis muscle every day for a week before flap elevation. In epinephrine plus dexamethasone group (N=10), the same procedure as that of epinephrine group was conducted for a week and 2.5 ml/kg dexamethasone was injected transverse abdominis muscle 2 hours before the flap elevation. On the seventh day after flap elevation, the survival area of flaps were measured and the vessel numbers in upper dermis of flap were counted through histologic slides. Results: The results were as follows: the mean percentage of the flap survival area of surgical delay group ($60.5{\pm}2.44%$), epinephrine group ($75{\pm}4.43%$), and epinephrine plus dexamethasone group ($87{\pm}1.94%$) were higher than that of the control group ($35{\pm}6.06%$) significantly(p<0.05). In case of the vessel number though histologic slides, epinephrine group ($79.3{\pm}5.57$) and epinephrine plus dexamethasone group ($96.3{\pm}14.05$) were higher than that of the control group ($44.8{\pm}8.82$) significantly(p<0.05), but the surgical delay group ($54{\pm}4.23$) showed no significant difference (p>0.05) compared to that of the control group. Conclusion: The results indicated that epinephrine plus dexamethasone injection before the flap elevation could be used to increase the TRAM flap survival area in rat model.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권5호
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• pp.454-458
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• 2010

Velopharyngeal insufficiency is defined as a status in which nasal cavity and oral cavity can not be sepa-rated when speaking, swallowing by any reason. It has been treated by palatorrhaphy, pharyn-geal flap, local flap, free flap etc. When the size of the defect is small, it can be restored by palatorrhaphy, pharyngeal flap etc. But they are not proper for treatment of the large size of defect. In that case, local flap and free flap are more beneficial. Although large defect can be restored by free flap technique, but it is very complex, time-consuming and may bring about esthetical, functional complications of donor site. Buccinator myomucosal flap is a kind of local flap and reported for the first time by Bozola et al in 1989 and it has become a useful way for reconstruction of large intraoral defect. Authors experienced the use of buccinators myomucosal flap for treating secondary velopharyngeal insufficiency with large soft palate defect and obtained good result. So we report the case with literature reviews.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권1호
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• pp.71-78
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• 2007

The nasolabial flap has been used for reconstruction of moderate size intraoral defects. The nasolabial fold area provides an ample supply of tissue with a good color and texture match. The nasolabial flap classified advancement flap, inferiorly-based flap, superiorly-based flap. The flap is based inferiorly, so that it can easily be rotated to the intraoral defects. The nasolabial flap is chosen for the repair of various intraoral defects because of its simple elevation, proximity to the defect and its rich subcutaneous blood supply of a island flap. The subjects were 6 patients with nasolabial flap, who had reconstruction of moderate size intraoral defects. We have found the inferiorly-based nasolabial flap with a subcutaneous pedicle useful in the primary repair of surgical defects of the buccal mucosa, edentulous mandibular ridge, maxillary alveolus area and soft palate in these patients. There was no complication except one case. Intraoral hair growth was a minor problem of this patient. We thought that the inferiorly-based nasolabial flap is a useful technique for reconstruction of various intraoral defects.

• Archives of Reconstructive Microsurgery
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• 제7권1호
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• pp.10-14
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• 1998

When covering a skin defect of the finger with a local flap is difficult, a vascular island flap is often used. For a palmar skin defect, it is desirable to add a sensory supply to the flap. This report describes a neurovascular island flap that was used to repair a palmar skin defect, the donor skin coming from the dorsal region of the middle phalanx. This flap is elevated with a vascular pedicle of the palmar digital artery and its dorsal skin branch, including the dorsal digital veins, palmar digital nerve and its cutaneous branches. The advantage of this flap are that it can be transferred with ease and without any tension. No special manipulation is required under a microscope and operation can be performed under a simple nerve-block. There if little possibility that the flap itself undergoes ischemic change or congestion. The disadvantage of this flap are that a skin graft is required at the donor skin site and one palmar digital aretery is lost. We think that this neurovascular island flap is one of the useful methods for skin defects that are difficult to cover with a local flap.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.53-62
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• 2002

Several investigators have reported clinical experience of medial plantar septo-cutaneous flap for reconstruction for soft tissue defect of the hand and digits. Jayme and Hamilton first described the anatomy of superficial branch of medial division of the medial plantar artery used in this flap through cadavaric study in 1997. But, they had a few cases for this flap and there was no anatomic study in Korean. We experienced the reliability of medial plantar septo-cutaneous flap for reconstruction for soft tissue defect of hand and digits through an anatomic study (20 fresh specimens dissected) and clinical application (17 patients). An anatomic study revealed that there were differences in diameter and length of the vessels between Korean and Caucasian. The diameter of vessels in Korean is larger than Caucasian one in each area. Based on this anatomic knowledge, we could harvest this flap safely, and have performed reconstruction on 17 patients with soft tissue defects of hand and digits using a thin, flexible medial plantar septo-cutaneous flap similar to the volar aspect of the hand and digits in anatomical characteristics of the skin and subcutaneous tissue covering. The vessels used for this flap were superficial branches of medial division of the medial plantar artery and vena comitants, or the subcutaneous veins. The mean size of the flap was $2.82cm{\times}4.15cm$. All the flaps survived without significant complications. A medial plantar septo-cutaneous flap possesses several advantages : (1) It is very thin in comparison with other standard free flap; (2) it has two draining venous pathways; (3) it provides a good color and texture match for hand and finger; (4) a good recovery of protective sensation is achievable.

• Archives of Plastic Surgery
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• 제48권5호
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• pp.511-517
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• 2021

The use of free flaps is an essential and reliable method of reconstruction in complex head and neck defects. Flap failure remains the most feared complication, the most common cause being pedicle thrombosis. Among other measures, thrombolysis is useful when manual thrombectomy has failed to restore flap perfusion, in the setting of late or established thrombosis, or in arterial thrombosis with distal clot propagation. We report a case of pedicle arterial thrombosis with distal clot propagation which occurred during reconstruction of a maxillectomy defect, and was successfully treated with thrombolysis using recombinant tissue plasminogen activator. We also review the literature regarding the use of thrombolysis in free flap surgery, and propose an algorithm for the salvage of free flaps in head and neck reconstruction.