• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권2호
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• pp.249-253
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• 2000

Oral and Maxillofacial defects is produced by trauma or cancer surgery. This defects have been shown functional loss such as mastication, swallowing, speech and psychosocial esthetic problem. Oral and Maxillofacial defects is reconstructed by the use of many flaps. However although previous flap surgery was done, additional soft tissue defects can be still remained. In this case, Walk-Up flap that is introduced by Marx RE in 1990 is recommended for successful reconstruction. We report Walk-Up flap for reconstruction of remained soft tissue defects of tongue S.C.C. After induction chemotherapy, tongue S.C.C. is excised surgically and reconstructed by use of PMMC flap. Post-op infection results in surrounding soft tissue defect with oro-facial fistula. We have experienced a case of Walk-up flap by use of PMMC flap for reconstruction with satisfactory result, so we report it with literature reviews.

• 대한족부족관절학회지
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• 제12권1호
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• pp.59-65
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• 2008

Purpose: To evaluate the results of anterolateral thigh perforator free flap for reconstruction of foot and ankle in old diabetic patients. Materials and Methods: Fifteen diabetic foot ulcer patients over the age of 55 were operated with anterolateral thigh perforator free flap. Hematological, hemodynamic, diabetic, bacteriologic and radiologic tests were checked with examination of blood vessel state in both the donor site and the recipient site. After surgery, serial check-up was performed at 6 week, 6 month, and 1 year postoperatively on the survival of transplantation tissue, condition of foot, and condition of walking. Results: There are one case of transplantation failure and four cases of partial tissue-necrosis. Delayed wound-healing was observed both recipient and donor tissue sites. At the final follow up, three cases of small ulcer were found at junction of flap and recipient tissue in plantar area. Fourteen out of fifteen patients could walk without any brace or walking aids. Conclusion: Reconstruction of foot and ankle region in old diabetic patients with the anterolateral thigh perforator free flap is a useful method which can prevent the amputation of foot and ankle.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.583-590
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• 2009

Purpose: In the cases of a vascular compromised condition in an injured lower extremity, soft tissue coverage with free tissue transfer presents a challenging problem to the reconstructive surgeon. For this reason, cross - leg flaps are still used in unusual circumstances. Advances in surgical technique has made the cross - leg free flap possible although it may require long operation time along with significant donor site morbidity. Therefore, a pedicled cross - leg muscle flap may be an alternative treatment modality when local flap or free flap is not possible. Methods: Twelve patients(9 males and 3 females) underwent the operation between October of 2001 and December of 2008. The patients' age ranged from 6 to 82 years. The unusual defects included the regions such as the knee, popliteal fossa, distal third of the tibia, dorsal foot, and the heel. Indications for the cross - leg gastrocnemius flap are inadequate recipient vessels for free flap(in eight cases), extensive soft tissue injuries(in three cases) and free flap failure(in one case). The muscle flap was elevated from contralateral leg and transferred to the soft tissue defect on the lower leg while both legs were immobilized with two connected external fixator systems. Delay procedure was performed 2 weeks postoperatively, and detachment was done after the establishment of the adequate circulation. The average period from the initial flap surgery to detachment was 32 days (3 to 6 weeks). Mean follow - up period was 4 years. Results: Stable coverage was achieved in all twelve patients without any flap complications. Donor site had minimal scarring without any functional and cosmetic problems. No severe complications such as deep vein thrombosis or flap necrosis were noted although mild to moderate contracture of the knee and ankle joint developed due to external fixation requiring 3 to 4 weeks of physical treatment. All patients were able to walk without crutches 3 months postoperatively. Conclusion: Although pedicled cross - leg flaps may not substitute free flap surgery, it may be an alternative method of treatment when free flap is not feasible. Using this modification of the gastrocnemius flap we managed to close successfully soft tissue defects in twelve patients without using free tissue transfers.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.

• 대한정형외과학회지
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• 제52권1호
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• pp.40-48
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• 2017

목적: 족부 및 족관절부의 연부조직 결손은 해부학적 한계와 기능적 특성상 선택할 수 있는 재건술의 폭이 비교적 적은 편으로 미용 및 기능적 필요로 인하여 동일 하퇴부의 추가 반흔을 피하고자 하는 경우 그 선택의 폭은 더 줄어들게 된다. 저자들은 이런 경우 전외 측 대퇴 천공지 피판술을 시행하였고 그 임상적 결과를 보고하고자 한다. 대상 및 방법: 총 16예가 대상에 포함되었고 남자 12명, 여자 4명, 평균 나이는 34세였다. 연부조직 결손의 가장 흔한 원인은 외상으로 9예였다. 추시기간은 평균 33개월이었고 피판의 평균 크기는 146 cm²로 피판의 생존 및 합병증, 보행 여부 등을 평가하였다. 결과: 총 16예의 피판 중 15예는 성공적으로 생존하였으며 1예에서는 환자의 조기 보행으로 인한 천층 일부 괴사로 피부이식술을 추가하여 호전되었다. 모든 환자들에게서 보조 기구 없이 독립 보행이 가능하여 피판이 보행에 지장을 준 경우는 없었고 최종 추시까지 잔존하는 특별한 합병증은 없었다. 결론: 족부 및 족관절 연부조직 결손의 재건에 있어 이차 치유나 단순 봉합, 또는 유경 피판술 등의 방법으로 피복이 어려운 경우 전외측 대퇴 천공지 피판술은 안전하면서도 얇게 결손 부위를 피복할 수 있어 유용한 유리 피판술로 생각된다.