• Archives of Reconstructive Microsurgery
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• 제7권2호
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• pp.157-164
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• 1998

It has been very difficult to managing partial joint defect in any etiologies, especially in children. Unicondylar defect of the tibial condyle in children reconstructed with proximal fibular head with articular cartilage from 1995. Two kinds of transfering methods were used, peroneal artery pedicled ipsilateral fibula head transposition to defective lateral tibial condyle defect that revealed poor prognosis with gradual absorption of transposed fibular epiphysis. Free vascularized fibular head transplantation with microvascular anastomosis underwent in the case with medial condyle defect of tibia which revealed very satisfactory results. Author can conclude with these clinical experiences: 1. Tranposition without epiphyseal vesssels intact is not sufficient in fibular head osteochondral transplantation in reconstruction of tibial condyle defect. That means peroneal arterial vascular pedicle is not enough for transplanted proximal epiphysis maintains its function on articular surface and growth activity in children. 2. The anterior recurrent tibial artery is one of the most important and easy to utilizing vessel in proximal fibular epiphyseal transplantation. 3. Free vascularized fibular head transplantation is hopeful method in reconstruction of the knee joint in the patient with partial joint defect which has no effective solution in conventional methods.

• Archives of Reconstructive Microsurgery
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• 제14권1호
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• pp.42-49
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• 2005

Between June 1989 and may 2004 Ipsilateral vascularized fibular transposition was performed on nine patients with segmental tibial defects combined with infection following trauma. Ipsilateral vascularized fibular graft was performed on two or three stage according to the degree of infection. Initially free vascular pedicled graft was done followed by ipsilateral vascularized fibular graft. Type of free flap used is scapular free flap 3 cases, latissimus dorsi free flap 5 cases and dorsalis pedis flap 1 cases. The patients were followed for an average of 3.4 years. the average time to union was 6.7 months, and in all patients the graft healed in spite of complication. Complication was free flap venous thrombosis in 1 cases, persistent infection in 1 cases, delayed bony union at the distal end of fibular graft in 2 cases. The results showed that more faster bony union was seen in which cases firmly internally fixated and more faster hypertrophy of graft in which cases was permitted to ambulate on early weight bearing and more faster healing in which cases debrided more meticulously. Reconstruction of tibia defect with free flap followed by Ipsilateral fibular transposition is a useful and safe method to avoid the potential risk of infection for patients with tibial large bone defect and soft tissue defect associated with infection.

• Archives of Plastic Surgery
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• 제48권6호
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• pp.699-702
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• 2021

Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. A 38-year-old man sustained a severe crush injury in the right leg with loss of circulation. His left lower leg had a soft tissue defect measuring 20×15 cm with an exposed comminuted fracture and a 17-cm tibial defect, along with a segmental fracture of the fibula. Subsequently, we reconstructed the tibial defect by transferring a 17-cm-long section of the ipsilateral fibula. We covered the soft tissue defect with a bipedicled skin flap. The patient eventually began to ambulate independently after surgery.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.69-71
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• 2016

Reconstruction of the lower extremities is difficult due to a lack of skin laxity and muscular tissues. Here, we present a case of lower extremity reconstruction via the anterior tibial artery perforator based segmental muscle island flap. Our patient was a 75-year-old male with a chronic ulcerative wound on the right lower leg from an old car accident. A $5.0{\times}0.5cm$ size ulcerative wound with tibial bone exposure was noted. We planned to reconstruct the lower extremity defect with a free flap, but the vessel status was severely compromised intraoperatively. Thus, we found the anterior tibial artery perforator using Doppler ultrasound, elevated the tibialis anterior muscle segment flap, and transposed it to cover the defect successfully. The flap presented with a nice contour and the skin graft covering the flap survived completely. There were no complications of the surgical site at three months follow-up and no gait morbidity. This is a meaningful case applying the concept of segmental muscle flap based on a perforator that had advantages including proper bulkiness, vascularization, and preservation of function, which were well applied, leading to great success.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.15-21
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• 1999

Soft tissue defect on heel area of the foot present difficult problems particularly because of anatomic property of plantar surface of the foot. There is a paucity of available local tissue in the foot for coverage. In addition to having little expandable tissue, the foot's plantar surface has a unique structure, making its replacement especially challenging. Plantar skin is attached to the underlying bone by fibrous septa, preventing shear of the soft-tissue surfaces from the underlying skeleton. Plantar surface of foot is in constant contact with the environment. Protective sensibility also would be maintained or restored in the ideal reconstruction. So the ideal flap for reconstruction of the heel should include thin, durable hairless skin with potential for reinnervation. The aim of this article is to present a clinical experience of free lateral arm neurosensory flap for reconstruction of the heel. From March 1995 to December 1997, a total 16 lateral arm free flaps were performed to soft tissue defects on the weight-bearing area of the hindfoot. we used tibial nerve as recepient nerve in 11 and calcaneal branch of tibial nerve in 5 for restoration of sensibility of flap. All cases survived completely. A static two-point discrimination of 14 to 34mm was detected in the flap. Radial nerve palsy which was caused by hematoma in donor site occured in one case, but recorverd in 3 weeks later completely. In conclusion, the lateral arm free flaps are versatile, reliable and sensible cutaneous flap and especially indicated for soft tissue defect on plantar surface of the hindfoot which are not good indications for other better-known flaps.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.435-440
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• 2005

The reconstruction of deep soft tissue defects of lower extremities combined with bone exposure has been difficult problems. When it is impossible to raise local skin flap, we have been usually used the gastrocnemius musculocutaneous flap, cross leg flap or free flaps. However, In musculocutaneous flap, aesthetical appearance of the calf is not appropriate because of too bulky flap. Although the success rate of the free flap has improved, still failure of flap occurs in cases of the chronic ischemic state. As the concepts of perforator flap has recently developed and widely used due to its thin flap thickness. Between January 2002 to December 2004, we treated 7 patients with soft tissue defect in leg with chronic ischemic limbs with perforator island flap. Preoperative angiography were done in all case and we used 2 medial sural perforator flaps, 1 anterior tibial artery perforator flap, 1 posterior tibial artery perforator flap, 3 anterolateral thigh perforator flap. Partial necrosis of flap was seen in one patient but no further surgical procedure was required for wound healed spontaneously. Perforator island flaps are thin, reduce donor site morbidity, conceal donor site with primary closure and it is useful for resurfacing soft tissue defect of lower extremities.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.352-357
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• 2007

Purpose: The coverage of distal soft tissue defects and bony exposure of the lower extremity has long been recognized to be difficult clinical problem. Covering with a local skin flap is usually impractical because of the extensive and deep crush, hence free flap has been used commonly for the coverage of the wound. Although it can provide good results, it has many disadvantages. Designing an adipofascial flap raised on perforating vessels of the posterior tibia artery is a reliable and simple method to perform, and it can solve these problems. Methods: From May 2005 to May 2006, 8 patients underwent reconstruction of lower leg defects utilizing various type of the posterior tibial artery perforator adipofascial flaps. The flap provided a durable and thin coverage for the defect, as well as a well vascularized bed for skin grafting. Results: The flap size ranged $15-80cm^2$, and skin graft was done for the recipient site. The flap were successfully used for the lower extremity reconstruction in most cases. Minor complications occurred in 4 cases. There was no functional disability of the donor site with esthetically pleasing results. Furthermore, these flaps were both easy to raise and insured sufficient arterial blood supply. Conclusion: We believe there are many advantages to this posterior tibial artery perforator adipofascial flap and that it can be highly competitive to the free flaps in the lower extremity reconstruction.

• Archives of Reconstructive Microsurgery
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• 제22권2호
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• pp.57-62
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• 2013

Purpose: The aim of this study is to report on the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of large bone and soft tissue defect combined with infection by open tibia fracture. Materials and Methods: During the research period, lasting from December 2002 to June 2008 (Kyung Hee University Medical Center), data were collected from three patients who underwent IVFT after free flap. We analyzed the successiveness and persistency of the infection using free flapping, bone union, and hypertrophy between transposed fibula and tibia. Results: Regarding free flap, successive results were observed in all examples. In the final follow-up results, transposed fibulas all survived, having hypertrophy similar to that of adjacent tibia. Conclusion: Reconstruction of tibia defect with free flap followed by IVTF is a useful and safe method for avoidance of the potential risk of infection for patients with a large tibial bone defect and soft tissue defect associated with infection.

• Archives of Reconstructive Microsurgery
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• 제14권1호
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• pp.50-56
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• 2005

There are limited treatment options in the reconstruction of the very large defect in the metaphyseal portion of distal femur and proximal tibia. Fibula is one of the most popular donor of the long bone reconstruction in reconstructive microsurgical field. It has many advantages such as very strong strut tubular bone, very reliable vascular anatomy with large vascular diameter and long pedicle. There are limited donor site problems such as transient peroneal nerve dysfunction. In those situations with the huge long bone defects in distal femur or proximal tibia, the defective bony shape and strength of the transplanted fibular bone is not enough if only one strut of the fibula is transferred. We performed 7 cases of "doule barrel" fibular transplantation on the metaphyseal portion of distal femur and proximal tibial large defects in which it is very difficult to fill the bony gap with conventional bone graft or callotasis methods. It takes averaged 8.3 months since that procedure to obtain bony union. After solid union of the transferred double barrelled fibular graft. There were no stress fracture in our series. So we can propose double barrel fibular graft is useful method in those cases with very large bone defect on the metaphysis of large long bone.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.447-453
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• 2005

The coverage of soft tissue defects around the knee joint or upper one third of lower leg presents a difficult challenge to the reconstructive surgeon. Various reconstructive choices are available depending on the location, size and depth of the defect. The authors present their clinical application of a medial sural artery perforator island flap as a useful alternative method for upper one third of lower leg and knee reconstruction. From 2002 to 2004, we operated total 4 patients (total 4 flaps) using the medial sural artey perforator island flap for coverage of the defect on upper one third of lower leg and knee, of 4 patients, 3 patients was men and one was woman. Average patient age was 54.6 years. The largest flap obtained was 10x8cm2. Postoperative follow up of the patients ranged from two to 33 months. In two cases, defects was located on upper one third of lower leg and in other two cases, defects were on the knee. All four cases had bone exposure open wound. In angiography, 2 cases had injured in the anterior tibial artery, 1 case had injured in the posterior tibial artery. There were no diabetes or other vascular disease. All 4 flaps were survived completely, without minor complications such as venous congestion and hematoma. Donor morbidity was restricted substantially to the donor linear scar. There were no functional impairment. As the main advantages of the medial sural perforator island flap, it ensures constant location and reliable blood supply without sacrificing any main source artery or damaging underlying muscle. This procedure is valuable extension of local flap for defect coverage with minimal functional deficit donor site and good aesthetic result on the defect. We consider it as one of the useful methods of the upper one third of lower leg and knee reconstruction.