• Archives of Plastic Surgery
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• v.33 no.6
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• pp.748-752
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• 2006

Purpose:Circular skin lesions between 10 and 35 mm in diameter generate problems often. Direct closure of the lesion risks excessive wound tension or wound dehiscence. Skin grafts heal slowly and often remain unsightly. Traditional skin flaps have a limited role. We treated this circular medium-sized skin lesion(10 - 35 mm sized) by reducing opposed multilobed(ROM) flap. Methods: ROM flap involves a series of semicircular lobes extending both cephalic and caudal from the defect. Direction of the semicircular multilobed flap is set parallel to relaxed skin tension line(RSTL) to minimize scar formation. First semicircle is drawn 60% in diameter of the defect. Second semicircles are drawn at the cephalic and caudal aspects of the original semicircles. These semicircles are 60% in diameter of the first semicircle. Additional semicircles are repeatedly drawn until the tension of skin flaps becomes free. ROM flap has a length-to-base ratio of 0.5 resulting in lower theoretical risk of end flap necrosis than a random pattern flap with a large ratio. The technique involves lobes most distant from the primary defect being transposed in turn closer to the defect. Results: The ROM flap reduces skin tension concerns, lowers the risk of flap necrosis and allows for quicker and more aesthetic healing. Results were generally good and major complications, such as dehiscence, infection, or delayed healing, did not occur. Conclusion: ROM flap repair allows the plastic surgeon an additional option when faced with a circular medium-sized skin lesion.

• Archives of Plastic Surgery
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• v.41 no.1
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• pp.45-49
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• 2014

Background Preauricular sinuses are congenital abnormalities caused by a failure of fusion of the primitive tubercles from which the pinna is formed. When persistent or recurring inflammation occurs, surgical excision of the infected tissue should be considered. Preauricular defects inevitably occur as a result of excisions and are often difficult to resolve with a simple suture; a more effective reconstruction technique is required for treating these defects. Methods After total excision of a preauricular sinus, the defect was closed by a plastic surgeon. Based on the depth of the defect and the degree of tension when apposing the wound margins, the surgeon determined whether to use primary closure or a posterior auricular flap. Results A total of 28 cases were examined. In 5 cases, including 2 reoperations for dehiscence after primary repair, reconstruction was performed using posterior auricular transposition flaps. In 16 cases of primary closure, the defects were closed using simple sutures, and in 7 cases, closure was performed after wide undermining. Conclusions If a preauricular defect is limited to the subcutaneous layer and the margins can be easily approximated, primary closure by only simple suturing may be used to perform the repair. If the defect is deep enough to expose the perichondrium or if there is tension when apposing the wound margins, wide undermining should be performed before primary closure. If the extent of the excision exposes cartilage, the procedure follows dehiscence of the primary repair, or the tissue is not sufficiently healthy, the surgeon should use a posterior auricular flap.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.174-180
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• 2008

Purpose: While radiotherapy remains an essential part of the multidisciplinary treatment of cancers, it may cause unwanted consequences such as tissue break down and chronic non-healing wounds as a result of hypoxia, hypovascularity, and hypocellularity. The conservative treatment of osteoradionecrosis was effective only in the early stages or has a limited result. The surgical treatment of osteoradionecrosis includes various local fasciocutaneous flaps, local myocutaneous flaps and different kinds of free flaps with cancellous bone graft or alloplastic material after removal of all devitalized tissue. This study reviews recent cases of osteoradionecrosis in Severance hospital and investigates the use of various flaps for reconstruction of osteoradionecrosis. Methods: From 2000 to 2006, a total of 29 patients, nine men and twenty women with a mean age of 60.4 years were identified and included in the study. Fasciocutaneous flaps were used on 7 patients and myocutaneous flaps were used on the remaining patients. Mean follow-up period was 10.4 months. Results: In the fasciocutaneous flap group, we noted two complications including total flap failure and a partial flap necrosis. In the myocutaneous flap group, four complications were noted including a partial flap necrosis and 3 cases of wound dehiscence. Considering the complications noted in this study, the natural history of progression to flap necrosis appeared to follow the following sequence of events: marginal flap necrosis, infection, wound dehiscence, flap floating and partial flap necrosis, serially. Conclusion: Successful surgical treatment of osteoradionecrosis includes wide radical debridement and reconstruction with a well vascularized flap like myocutaneous flap or fasciocutaneous flap.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.182-188
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• 2011

Purpose: The buttocks region has been associated with allure and sex appeal for centuries. Gluteal implants enable buttocks remodeling in a way that is not possible in other methods. One of the reasons that render gluteal implant surgeries unpopular is the fear of complications, the main problems being seroma, wound dehiscence, extrusion, and a visible or palpable implant. The authors present the XYZ technique, which provides anatomical reference points to guide the intramuscular dissection procedure in a feasible and safe way, resulting in a lower complication rate. Methods: The XYZ procedure was done for buttock augmentation on 8 patients from December 2009 to June 2010. Patient's ages ranged from 27 to 44 with a mean age of 36. Seven patients were applied the 250cc sized Elastomer implants with one patient 290cc sized implant. Preoperative marking was done with the patients in the standing position. Bisection of the gluteus maximus muscle was done at the midpoint thickness to create a plane for implant insertion, which is called the sandwich plane. Results: The 8 cases were performed safely without major complications. However one patient had minor wound dehiscence, and was managed with conservative treatment. Another patient had a discomfort on the buttocks for a long time. The patients were followed up for average 6 months. All patients were satisfied with the aesthetic results. Conclusion: In performing the XYZ technique for gluteal augmentation, the surgeon must split the muscle into two equal halves with anatomical reference points to guide the muscle detachment in a symmetrical way at an adequate depth. This method provides a guideline for the surgeon in determining the ideal plane during intramuscular dissection and gives predictable results with low complication rates. Intramuscular gluteoplasty with gluteal implants offers predictable, aesthetically pleasing results without contour irregularities and only a low incidence of major complications.

• Journal of Periodontal and Implant Science
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• v.27 no.1
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• pp.249-262
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• 1997

The present study investigates the effects of calcium sulfate graft on the periodontal healing in intrabony periodontal defects of dogs. Following the general anesthesia with 30mg/kg pentobarbital injected intravenously, the first premolar was extracted and full-thickness periodontal flap was elevated from the second premolar to the fourth premolar. The portion of premolars coronal to the alveolar crest was removed and mesial and distal roots were separated. Exposed root canals were sealed with Caviton and covered completely with flaps sutured. Following the healing period of 12 weeks, the surgical sited were uncovered and $4{\times}4mm$ intrabony defects were surgically created. Those defects with calcium sulfate graft following the root planing was designated as the test sites and those with flap surgery-only were designated as control sites. The animals were sacrificed after 8 weeks and the healing was histologically analyzed. The results were as follows. 1. No foreign body reaction or inflammation were observed in either groups. Calcium sulfate was completely resorbed in the test sites. 2. New cementum was observed coronal to the notch in both groups. Connective tissue fibers were oriented parallel to the root surface in the controls. Connective tissues were formed in large amount in the sites. 3. Test sites showed marked amount of new bone formation while the control sites showed minimal bone gain. 4. Root resorption was observed in coronal portions of th control Sites. The results suggest that calcium sulfate is a biocompatible graft material with a potential for new bone and cementum formation.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.47-52
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• 2002

One of the most common problems in cord injury is pressure sores. In the early stage of pressure sores, the wound can be covered by advancing or transpositioning a local myocutaneous flap. However, it can be a great challenge to treat end-stage paraplegic patient who underwent multiple prior flaps, where continuous treatment is needed to prevent recurrent pressure sore due to infection and metabolic drain. In these patients, a local myocutaneous flap may be very difficult for coverage of the wounds. Therefore, hemipelvectomy may be considered. The authors performed a hemipelvectomy on a 33 year-old male paraplegic patient who presented with multiple, large wounds seen in end-stage pressure sores. He had a compression fracture of the lumber spine 9 years ago during a motor vehicle accident. After a wide exicision of the wound, the anterior flap was used as a fillet-flap for reconstruction. On the sixth day postoperatively, secondary repair was done due to wound dehiscence and the postoperative results have been satisfactory thus far.

• Archives of Reconstructive Microsurgery
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• v.16 no.1
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• pp.23-29
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• 2007

The reconstruction of deep soft tissue defect such as pressure sore has difficult problems. Myocutaneous flaps have been used commonly as the best coverage method for pressure sore. But, they have several drawbacks such as sacrifice of functional muscle, high morbidity of the donor sites and bulkiness at the recipient site. The concepts of perforator flap has recently developed and widely used to overcome these disadvantages. Between March 2005 to July 2006, we have treated 9 patients who had pressure sore using perforator based fasciocutaneous island rotation flap. Preoperative unidirectional Doppler was used in all cases. Mean number of perforator vessels was 3.8 and flap sizes were from $7{\times}5\;cm$ to $14{\times}13\;cm$. Rotation angles of flap were from 90 degree to 180 degree. In all cases, donor sites were closed primarily. All flap survived completely and postoperative complications were wound dehiscence in 1 case, wound infection in 3 cases. The mean postoperative follow up period was 15.7 months and recurrence was not reported. We could decrease donor site morbidity and cover wound sites easily by using flap rotation and get robust blood supply without sacrifice of functional muscle. Fasciocutaneous perforator island rotation flap would be very useful for various pressure sore treatment.

• Journal of Yeungnam Medical Science
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• v.36 no.2
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• pp.136-140
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• 2019

Background: Epidermal cysts are the most common benign epithelial tumors in humans. The curative treatment of epidermal cyst is surgical excision. However, only few studies have investigated the cause and mechanism of postoperative complications of epidermal cysts. Therefore, this study aimed to evaluate the factors affecting complications of epidermal cyst after surgical treatment. Methods: Patients with histologically diagnosed epidermal cysts were selected from among 98 consecutive patients with excised benign cystic tumors from March 2014 to August 2017. Sex, age, size, mobility, site of occurrence, history of infection, history of incision and drainage, complications, history of reoperation, and method of overcoming complications was obtained by analyzing medical records retrospectively. Results: Five of the 98 patients had wound dehiscence due to surgical infection. Three of them underwent wound healing with conservative treatment without a second operation. The other two patients underwent a second operation and showed signs of preoperative infection. None of the factors showed statistical significance in relation to the occurrence of complications. Conclusion: Postoperative complications occurred when the excision of the epidermal cyst was performed at preoperative infection sites or at sites with high tension, so attention should be paid to postoperative care.

• Journal of Periodontal and Implant Science
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• v.28 no.2
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• pp.205-221
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• 1998

The present study invetigates the effects of root planing only(control group), DFDBA alone(test group 1) and combined use of DFDB and Dura mater(test group 2) in dehiscence defects in dogs. The results of 8weeks post-surgery by histological comparison between the three groups are as follows. 1. The contol group showed minimum regeneration of new cementum and new bone with limited migration of epitheilal cells, and healed by connective tissue attachment. 2. The test group 1 showed minimum regeneration of new cementum and new bone with limited migration of epitheilal cells, and healed by connective tissue attachment. 3. The test group 2 showed significant amount of the new cementum and new bone. 4. Both control and test groups healed without any observable root resorption and ankylosis. The above the results suggest that the use of resorbable Dura mater only does not improve the regeneration of new bone and periodontal ligament due to difficulties of space making, but the combined use with DFDB may be more effective.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.1
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• pp.31-34
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• 2009

Purpose: This study compared the frequency of postoperative infections in patients for a closed mandibular fracture with that without the postoperative antibiotic prophylaxis. Patients and Methods: 48 patients without any specific medical history were divided into two groups depending on whether or not antibiotics had been applied after the surgery. The 24 patients in group 1 received only a second-generation cephalosporin ($Cefotetan^{(R)}$) intravenously from admission to immediate after the surgery. Likewise, 24 patients in group 2 received 1.0g of $Cefotetan^{(R)}$ twice daily longer than the third day after surgery. The mean (SD) duration of antibiotics administration after surgery was 6.9 (${\pm}3.56$). The patients were evaluated after surgery for any postoperative infections according to the criteria: purulent drainage from a wound, spontaneous wound dehiscence accompanied by swelling, pain, and fever around the wound. Results: Postoperative infections were encountered in 2 out of 24 patients in group 1, who received antibiotic medication until shortly after surgery, and in 3 out of the 24 patients in group 2, in whom the medication was continued even after the surgery. There was no sig nificant difference in the incidence of postoperative infections between the two groups. Conclusion: From this study, postoperative use of antibiotics seems to be unnecessary with view of the little significance of the factors that could affect the wound infection.