• Archives of Plastic Surgery
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• v.40 no.5
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• pp.575-583
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• 2013

Background The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction. Methods We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremity reconstruction at our institution during a 10-year period. In these patients, we evaluated causes and sites of defects, types of flaps, recipient vessels, types of anastomosis, survival rate, and complications. Results There were 42 men and 10 women with a mean age of 32.7 years (range, 3-72 years). The sites of defects included the dorsum of the foot (19), pretibial area (17), ankle (7), heel (5) and other sites (4). The types of free flap included latissimus dorsi muscle flap (10), scapular fascial flap (6), anterolateral thigh flap (6), and other flaps (30). There were four cases of vascular complications, out of which two flaps survived after intervention. The overall survival of the flaps was 96.2% (50/52). There were 19 cases of other complications at recipient sites such as partial graft loss (8), partial flap necrosis (6) and infection (5). However, these complications were not notable and were resolved with skin grafts. Conclusions The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site.

• Archives of Plastic Surgery
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• v.44 no.6
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• pp.550-553
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• 2017

Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury. We performed a jejunal free flap repair of the 8-cm defect in the esophagus. End-to-side microvascular anastomoses were created between the right external carotid artery and the jejunal branches of the superior mesenteric artery, and end-to-end anastomosis was performed between the external jugular vein and the jejunal vein. The right recurrent laryngeal nerve injury was repaired with a 4-cm nerve graft from the right ansa cervicalis. Esophagography at 1 year after surgery confirmed that there were no leaks or structures, endoscopy at 1 year confirmed the resolution of vocal cord paralysis, and there were no residual problems with swallowing or speech at a 5-year follow-up examination. RAT requires experienced surgeons with a thorough knowledge of anatomy, as well as adequate resources to quickly and competently address potentially severe complications such as esophageal rupture.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.75-81
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• 2007

Introduction: Microsurgical replantation of amputated digit have become common procedure in recent years. However replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. So, fingertip amputation was covered by volar V-Y flap, composite graft, cross finger flap and groin flap. But patients who have been treated by these methods experience shortening of digit, nail deformity, excessive tenderness and persistent pain. Replantation could solve most of these problems. Material & Methods: In our department, from March 2004 to August 2007, 36 digits in 32 patients with complete amputation at distal to nail base were replanted using a microsurgical technique. Results: The overall survival rate of the replanted finger was 75%. Venous anastomosis was possible in 8 cases and impossible in 28 cases. In latter cases external bleeding technique was applied with medical leech. Conclusion: After replantation, a few patient complained decreased sensibility, nail deformity and cold intolerance. But most of patients were satisfied with the functional and cosmetic appearance of the viable replanted digits. We believe the replantation should be the first choice in fingertip amputation.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.119-124
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• 2007

Purpose: We reconstructed the skin defect of lower legs exposing muscles, tendons and bone with fasciocutaneous sural artery flap and report our cases. Materials and Methods: Between March 2005 and September 2006, 8 cases of skin defect were reconstructed with fasciocutaneous sural artery flap. Defect site were 4 case of ankle and foot and 4 cases of lower leg. The average defect size was $4{\times}4\;cm^2$. There were 5 men and 3 women and mean age was 52.2 years. We evaluated the viability of flap, postoperative complication, healing time, patient's satisfaction. Results: There was no flap failure in 8 cases. But recurrent discharge in 2 cases was healed through several times adequate debridement and delayed suture without complication. Flap edema may be due to venous congestion was healed through leg elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence in follow up period. Cosmetic results as judged by patients were that 5 cases are good and 3 cases are fair. Conclusion: Sural artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Sural artery flap is useful method for the skin defect of lower legs because it is simple procedure, has constant blood supply and relatively good cosmetic effect.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.24-28
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• 2004

The vascularity of a skin island in fibula osteocutaneous free flap often depends on musculocutaneous perforators that find their origin in the proximal peroneal artery. But a potential drawback has been reported on the unreliability of the skin paddle. The perforating vessels to the skin paddle of the fibula osteocutaneous free flap were rarely derived from a common tibio-fibula trunk, an anterior tibial artery and a posterior tibial artery. Previous studies have emphasized total loss of the overlying skin paddle, if the expected perforating vessels are not present. We report here on our experience that the skin paddle of the fibula osteocutaneous free flap was vascularized not by a peroneal artery but a direct branch of the posterior tibial artery. There were no intraseptal nor intramuscular pedicles in the posterior crural septum which connected to the overlying skin island. Therefore, we performed microsurgical anastomoses between distal peroneal vessels of the fibula and the perforating branches of the posterior tibial vessels of the skin paddle. The anastomosed skin paddle was salvaged with a peroneal flow through vascular anastomosis and was transferred to the bone and intraoral soft tissue defects with the fibula graft. The patient had no evidence of vascular compromise in the postoperative period and showed good healing of the intraoral skin flap.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.115-119
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• 2008

Purpose: We reconstructed the skin defect of hands exposing tendons and/or bone with distally based ulnar artery flap and report our cases. Materials and Methods: Between March 2005 and September 2007, 6 cases of skin defect were reconstructed with distally based ulnar artery flap. Defect site were 5 cases of hand dorsal side and 1 case of hand volar side. The average defect size was $3{\times}3\;cm^2$. There were 4 men and 2 women and mean age was 55.5 years. We evaluated the viability of flap, postoperaive complication, healing time, patient's satisfaction. Results: There was no flap failure in 6 cases. But 1 case with recurrent discharge was healed with several times adequate debridement and delayed suture. 1 case with flap edema which might be due to venous congestion was healed with hand elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence was found in follow up period. Cosmetic results as judged by patients were that 3 cases are good and 3 cases are fair. Conclusion: Distally based ulnar artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Distally based ulnar artery flap is useful method for the skin defect of hands because it is simple procedure, has constant blood supply and relatively good cosmetic effect.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.68-74
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• 2008

Segmental defects of the tibia after open fractures, sepsis and a tumor surgery are among the most difficult and challenging clinical problems. Tibia defects in these situations are complicated with infection and are resistant to conventional bone grafting techniques. The aim of this study is to report the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of tibia defects. Ten patients had free flap followed by IVFT in the period 1989~2007. Mean age was 25.3 years. The patients were followed for an average of 3.4 years. All flaps were survived including 1 case with venous thrombosis requiring additional surgery. The average time to union of proximal and distal end was 5.2 months, 8.2 months, each other. All transposed fibula were viable at last follow-up. IVFT offers the advantages of a vascularized graft. In patients with large bone and soft tissue defects combined with infection, free flap followed by IVFT is an useful and reliable method without microvascular anastomosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.3
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• pp.188-195
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• 2002

The purpose of this investigation was to evaluate the relationship between the hydration time of demineralized freeze-dried bone (DFDB) and early new bone formation in rat calvarial defects filled with DFDB. Rats (n = 43) were divided into 4 experimental groups. Standard, transosseous circular defects of the calvaria were made midparietally. In experimental group 1, the defect was grafted immediately after soaking the DFDB. In experimental group 2, the defects were grafted with DFDB after soaking the DFDB for 10 minutes. In experimental groups 3 and 4, the defects were filled after soaking the DFDB for 30 and 60 minutes, respectively. Graft sites were analyzed histologically after healing periods of 1, 2, or 4 weeks. Each group showed similar bone regeneration at each time point by histological analysis. The results of this study were as follows: 1. After 1 week, a significant amount of inflammation, granulation tissue, and edema were found. A small amount of bone was seen, but the amount of bone did not differ between groups. 2. After 2 weeks, a small amount of new bone formation and DFDB resorption were observed. 3. After 4 weeks, a greater amount of new bone formation was observed. The greatest amount of bone formation occurred in experimental group 4 after 4 weeks. We conclude that the hydration time of DFDB does not affect new bone formation and that it is very important to control inflammation in bone grafting.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.3
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• pp.228-233
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• 2004

Summary: The malignant peripheral nerve sheath tumor(MPNST) is an aggressive neoplasm and can either arise independently or result from malignant change in preexisting neurofibromatosis (von Recklinghausen's disease). Its histologic characteristics remain controversial, but currently it is believed that the schwann cell is the origin of the peripheral nerve sheath tumors. MPNST is an uncommon neoplasm of the head and neck region, and its presentation in the oral cavity is quite rare. In this study, we report a patient with a rare case of a MPNST involving the maxilla. A case report: A 29-year-old female presented with a chief complaint of painless swelling with bleeding tendency on the left maxillary tuberosity area 2 months ago. Clinical examination showed a $5.0{\times}3.0cm^2$ sized, indurative swelling on the site. Conventional radiographs showed a relatively well-defined soft tissue mass involving the left maxillary sinus, and destruction of the anterior, posterolateral walls of the left maxillary sinus. Subtotal maxillectomy and split-thickness skin graft from thigh were undertaken. In histochemical and immunohistochemical studies, the specimen revealed positive reactivities to Vimentin and S-100 protein. Final diagnosis was made as MPNST.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.1
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• pp.19-27
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• 2008

Thirty-six sinus grafts were performed in 34 patients with an alveolar crest bone height in the posterior maxilla of 3 to 5 mm before grafting. The sinuses were grafted using Bio-Oss alone or mixed with fibrin glue. Group 1 was the control group and included 25 patients who received a xenograft mixed in saline. Group 2 comprised 9 patients who received a xenograft and fibrin glue. The study was further subdivided at the time of 9 months. This histologic study evaluated by hematoxylin-eosin (H&E) and histomorphometric analysis whether fibrin glue in combination with Bio-Oss enhances bone regeneration in sinus floor elevation in humans. The new bone formation was better in Group 2 than in Group 1, but the difference was not significant. The absorption of the graft material was faster in Group 2 than in Group 1, in the short term, but better in Group 1 over the long term, although the difference was not significant. Lamellar bone was formed earlier in Group 1 compared to Group 2, but the difference was not significant. Overall, the surgery site stabilized earlier with new bone formation in Group 2 than in Group 1, but the difference was not significant. Combining a fibrin sealant and Bio-Oss could lead to improved scaffolds for bone tissue engineering based on the synergistic effects of the biomaterials. Therefore, Bio-Oss or Bio-Oss plus Tisseel may be used depending on the situation.