• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.7.1-7.5
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• 2018

Background: Oroantral communicating defects, characterized by a connection between the maxillary sinus and the oral cavity, are often induced by tooth extraction, removal of cysts and benign tumors, and resection of malignant tumors. The surgical defect may develop into an oroantral fistula, with resultant patient discomfort and chronic maxillary sinusitis. Small defects may close spontaneously; however, large oroantral defects generally require reconstruction. These large defects can be reconstructed with skin grafts and vascularized free flaps with or without bone graft. However, such surgical techniques are complex and technically difficult. A buccal fat pad is an effective, reliable, and straightforward material for reconstruction. Case presentation: This report describes three cases of reconstruction of large oroantral defects, all of which were covered by a pedicled buccal fat pad. Follow-up photography and radiologic imaging showed successful closure of the oroantral defects. Furthermore, there were no operative site complications, and no patient reported postsurgical discomfort. Conclusion: In conclusion, the use of the pedicled buccal fat pad is a reliable, safe, and successful method for the reconstruction of large oroantral defects.

• 대한족부족관절학회지
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• 제22권3호
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• pp.91-94
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• 2018

Ankle sprain is one of the most common musculoskeletal injuries. Although most ankle sprains respond well to conservative measures, chronic instability following an acute sprain has been reported to occur in 20% to 40% of patients. Some individuals are eventually indicated for a lateral ankle ligament reconstruction due to persistent ankle instability. More than 80 surgical procedures have been described to address lateral ankle stability. These range from direct repair of the anterior talofibular ligament (ATFL) and of the calcaneofibular ligament (CFL) to reconstructions based on the use of autograft or allograft tissues. However, the best surgical option remains debatable. The modified $Brostr{\ddot{o}}m$ procedure is most widely used for direct ligament repair, but not always possible because of the poor ATFL or CFL quality or deficiency of these ligaments, which prevents effective shortening imbrication. Furthermore, the importance of a CFL reconstruction has been emphasized recently. On the other hand, it is difficult to achieve an efficient CFL reconstruction during the $Brostr{\ddot{o}}m$ procedure. Others have reported that an anatomic reconstruction of injured ligaments restores the normal resistance to anterior translation and inversion without restricting subtalar or ankle motion, and as a result, anatomic reconstructions for lateral ankle instability utilizing an autograft or allograft tendon have gained popularity.

• Archives of Plastic Surgery
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• 제43권3호
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• pp.229-236
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• 2016

Recently, diagnoses of and operations for medial orbital blowout fracture have increased because of the development of imaging technology. In this article, the authors review the literature, and overview the accumulated knowledge about the orbital anatomy, fracture mechanisms, surgical approaches, reconstruction materials, and surgical methods. In terms of surgical approaches, transcaruncular, transcutaneous, and transnasal endoscopic approaches are discussed. Reconstruction methods including onlay covering, inlay implantation, and repositioning methods are also discussed. Consideration and understanding of these should lead to more optimal outcomes.

• 대한족부족관절학회지
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• 제14권2호
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• pp.109-114
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• 2010

Purpose: The purpose of this study was to report the surgical outcome of reconstruction of neglected chronic Achilles tendon ruptures with various methods including Achilles tendon allograft. Materials and Methods: Between October 2003 and November 2008, 8 consecutive neglected chronic Achilles tendon ruptures with the defect gap of more than 4 cm underwent surgical reconstruction including V-Y advancement, gastrocnemius fascial turn-down flap, flexor hallucis longus transfer and Achilles tendon allograft. There were 7 males and 1 female who were evaluated at more than 18 months after surgery. At the time of followup, all patients were assessed with regard to postoperative complications, their self-reported level of satisfaction, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, 10 repetitive single heel rise, single leg hopping test, and ankle range of motion. Results: The AOFAS score increased from average 71.4 (50-87) to 96.4 (86-100). All patients were able to perform 10-repetitive single heel raise and single leg hopping at the latest follow up. No patient experienced wound complications and deep infection. Six patients were rated as 'excellent' and the other two as 'good'. Conclusion: Neglected chronic Achilles tendon ruptures could be successfully treated with careful selection of the reconstruction method according to the amount of defect gap. With an extensive defect, Achilles tendon allograft can be a good option when the reconstruction is not feasible otherwise.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.379-386
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• 2014

Background Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction. Methods From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps. Results The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis. Conclusions We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권5호
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• pp.337-342
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• 2012

The osseous or osteocutaneous free fibula flap has become the gold standard for most mandibular reconstructions because of its favorable osseous characteristics. However, disadvantages, such as the time-consuming reconstructive step, difficulty in performing the osteotomies to precisely recreate the shape of the missing segment of mandible and poor bone-to-bone contact play a role in making the surgeons look for alternative flaps. With the advent of computerized design software, which accurately plans complex 3-dimensional reconstructions, has become a process that is more efficient and precise. However, the ability to transfer the computerized plan into the surgical field with stereolithographic models and guides has been a significant development in advancing reconstruction in the maxillofacial regions. The ability to "pre-plan" the case, mirror and superimpose natural structures into diseased and deformed areas, as well as the ability to reproduce these plans with good surgical precision has decreased overall operative time, and has helped facilitate functional and esthetic reconstruction. We describe a complex case treated with this technique, showing the power and elegance of computer assisted maxillofacial reconstruction from the University of Michigan, Oral and Maxillofacial Surgery.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.564-569
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• 2013

Background Scalp defects may be caused by various etiological factors, and they represent a significant surgical and aesthetic concern. Various surgical techniques can be applied for reconstructive work such as primary closure, skin grafting, pedicled or free flaps. In this article, the authors share their clinical experience with scalp operations using the technique of local flaps and discuss the application of this method from the perspective of not only the size of the defect, but also in relation to the anatomical area, quality of surrounding tissue, and patient's condition. Methods During the period from December 2007 to December 2012, 13 patients with various scalp defects, aged 11 to 86 years, underwent reconstruction with local pedicle flaps. The indications were based on the patients' condition (age, sex, quality of surrounding tissue, and comorbidities) and wound parameters. Depending on the size of the defects, they were classified into three groups as follows: large, 20 to 50 $cm^2$; very large, 50 to 100 $cm^2$; extremely large, 100 $cm^2$. The location was defined as peripheral (frontal, temporal, occipital), central, or combined (more than one area). We performed reconstruction with 11 single transposition flaps and 1 bipedicle with a skin graft on the donor area, and 2 advancement flaps in 1 patient. Results In all of the patients, complete tissue coverage was achieved. The recovery was relatively quick, without hematoma, seroma, or infections. The flaps survived entirely. Conclusions Local flaps are widely used in scalp reconstruction since they provide healthy, stable, hair-bearing tissue and require a short healing time for the patients.

• 대한두개안면성형외과학회지
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• 제22권6호
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• pp.296-302
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• 2021

Background: The reconstruction of large full-thickness alar defects requires complex surgical procedures that are usually performed in two stages, with concomitant disadvantages in terms of patient trauma, surgical risk, and cost. This study presents a functional folded nasolabial island flap (FNIF) that can be used to repair large-sized full-thickness alar defects in a straightforward manner. Methods: This retrospective study included seven patients who received a FNIF for a full-thickness alar defect between January 2007 and December 2020. The FNIF is different from the conventional nasolabial flap in that it is folded and twisted to achieve nostril reconstruction with a satisfactory three-dimensional mucosal lining in a single stage. The cosmetic and functional results of FNIF were evaluated by both patients and physicians. Results: The age ranged from 51 to 82 years (mean, 65.6 years). The causes of the defects were squamous cell carcinoma, basal cell carcinoma, and trigeminal trophic syndrome. The nostril lining did not collapse, there was no hypertrophic scarring, and air movement through the nostrils on the flap side was normal. Overall, FNIF produced excellent aesthetic and functional outcomes, with minimal patient discomfort. There were no postoperative complications. Conclusion: Compared with existing reconstruction methods for large full-thickness alar defects, FNIF can easily achieve aesthetic and functional success in a single-stage procedure. It provides satisfactory results for both the patient and the surgeon.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권2호
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• pp.112-119
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• 2021

Objectives: Myxomatous odontogenic tumors (MOTs) are the third most common odontogenic tumors in the oral and maxillofacial region. Due to its slow-growing, but locally invasive nature, the tumor is usually detected by accident or only when it becomes a large mass, which causes facial deformity. Materials and Methods: Current study reports three unusual cases of MOT including huge myxoma involve the mandible in middle-aged man, MOT with ossifying fibroma pattern in mandible, and MOT in maxilla of young female patient. The diagnosis and treatment strategy of MOTs was also summarized and updated. Results: In reported three cases of patients with large MOTs, surgical treatment was indicated with fibular free flap reconstruction in the mandible and plate reconstruction in the maxilla. The tumors were successfully treated with radical resection and did not show signs of recurrence during the follow-up period. Conclusion: Surgical treatment indication depends on size, the position of the lesion, patient systemic condition and surgeon individual experience. In the case of a large tumor, radical resection and reconstruction is the standard surgical strategy. The conservative surgical treatment including enucleation with wide curettage is still under controversy. The recurrence rate for MOTs is significantly high, up to 30%, therefore long-term follow-up is essential.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.240-247
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• 2023

More than 40 years have passed since the description of the first "free abdominoplasty flap" for breast reconstruction by Holmström. In the meantime, surgical advances and technological innovations have resulted in the widespread adoption of autologous breast reconstruction to recreate the female breast after mastectomy. While concepts and techniques are continuing to evolve, maintaining an overview is challenging. This article provides a review of current trends and recent innovations in autologous breast reconstruction.