• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.63-67
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• 2004

Because traumatic tissue damage on hands and feet often lead to loss of function, permanent deformity, prompt and adequate reconstruction is essential. For children, future growth, as well as function and esthetics, must be taken into account. Several techniques have been employed to reconstruct hand and foot dorsum defects of children. However, skin graft and muscle free flap with skin graft cannot prevent contracture and will interfere with normal growth. Fasciocutaneous free flap reduces contracture and enables early physical therapy, decreasing the need for additional surgical intervention. Parascapular flap is particularly suitable because it has reliable pedicle and is relatively thin. There is little functional loss in the donor site, and also simultaneous extensor tendon reconstruction of hand and foot is possible. The disadvantage of this technique is that postoperative defatting is needed to adjust volume. Our department has achieved satisfactory results using this approach, and would like to report 13 cases of hand and foot reconstruction using parascapular flap in patients under the age of 15 (from March, 1998 to May, 2003).

• Archives of Reconstructive Microsurgery
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• 제23권2호
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• pp.70-75
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• 2014

Purpose: Soft-tissue reconstruction in the knee area requires thin, pliable, and tough skin. The range of motion of the knee also acts as a limitation in using only local flaps for coverage. The author has successfully used various perforator flaps for soft tissue reconstruction around the knee while preserving its functional and cosmetic characteristics. Materials and Methods: Out of the twenty patients assessed from April 2009 to March 2011, seven received anterolateral thigh perforator flaps, four received medial sural perforator island flaps, four received lateral supragenicular perforaor perforator flaps, and five received medial genicular artery flaps. The age of the patients ranged from 44 to 79 and the size of the defects ranged from $4{\times}5cm$ to $17{\times}11cm$. Fifteen of the twenty patients had histories of total knee replacement (TKR) surgery. Results: There were no flap losses in any of the twenty patients assessed. Two patients showed partial losses in the distal area of the flap, but were treated through careful wound care. One patient presented with pedicle adhesion at the drainage site from a past TKR, but it did not hinder the flap survival. Primary closure at the donor site was possible in nine patients, while split skin graft was necessary for the other 13. Conclusion: In soft tissue reconstruction of the knee, various perforator flaps can be used depending on the condition of the preoperation scar, wound site, and size. It also proved to provide better functional and cosmetic results than in primary wound closure or skin grafts.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.754-760
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• 2013

Background Classical flaps for perinasal defect reconstruction, such as forehead or nasolabial flaps, have some disadvantages involving limitations of the arc of rotation and two stages of surgery. However, a perforator-based flap is more versatile and allows freedom in flap design. We introduced our experience with reconstruction using a facial artery perforator-based propeller flap on the perinasal area. We describe the surgical differences between different defect subtypes. Methods Between December 2005 and August 2013, 10 patients underwent perinasal reconstruction in which a facial artery perforator-based flap was used. We divided the perinasal defects into types A and B, according to location. The operative results, including flap size, arc of rotation, complications, and characteristics of the perforator were evaluated by retrospective chart review and photographic evaluation. Results Eight patients were male and 2 patients were female. Their mean age was 61 years (range, 35-75 years). The size of the flap ranged from $1cm{\times}1.5cm$ to $3cm{\times}6cm$. Eight patients healed uneventfully, but 2 patients presented with mild flap congestion. However, these 2 patients healed by conservative management without any additional surgery. All of the flaps survived completely with aesthetically pleasing results. Conclusions The facial artery perforator-based flap allowed for versatile customized flaps, and the donor site scar was concealed using the natural nasolabial fold.

• Archives of Reconstructive Microsurgery
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• 제18권1호
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• pp.1-8
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• 2009

Purpose: The perforator flaps have established their role in the reconstruction of various soft tissue defects. For the last five years, we have extensively used anterolateral thigh (ALT) flap for the reconstruction of the complex tissue defects of the hand and upper extremity and report the clinical results and our experiences with the versatile applications of this flap. Materials and Methods: From March 2003 through May 2008, 119 free ALT perforator flaps were transferred for reconstruction of the complex tissue defects of the elbow, forearm, wrist and hand after crushing or degloving injuries as well as severe scar contractures. There were 95 females and 24 males. The mean age of the patients was 37 years and mean size of the flap was 170 $cm^2$. In 20 cases, the flap was vascularized by septocutaneous and in 99 cases by musculocutaneous perforators. Intra-muscular dissection length averaged 3.4 cm. The total length of pedicle averaged 8.4 cm and the average arterial diameter was 0.84 mm. End-to-end arterial anastomosis was performed in 103 cases and end-to-side in 16 cases. Results: Flap survival rate was 98.3%(117/119) and there were 6 cases of partial necrosis. Donor site was closed primarily in 41 cases and skin grafts were applied in 78 cases. Conclusion: The reliability and versatility of ALT flap makes it one of the foremost choices for the reconstruction of complex tissue defects of the upper extremity.

• 한국수산과학회지
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• 제3권1호
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• pp.19-26
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• 1970

1969년 여름 부산수산대학 양어장에서 1963년 일본으로부터 도입하여 길러온 초어와 백련을 사용 채란과 부화실험을 하였는 바, 그 결과는 좋지 못하였지만, 다음과 같은 점을 지적한다. 1. 부산지방의 못에서 양식한 초어가 백련의 성숙 채란 적기는 6월 말부터 8원 초까지의 사이에 있다고 인정된다. 2. 산란 촉진용 뇌하수체는 동종 또는 근연종의 친어로부터 그들의 산란기이 진에 적출 보관하였다가 사용하는 것이 좋다고 인정된다. 3. 백련은 체장 40cm(전장 48cm) 가량의 작은 개체도 6년생은 모두 채란 가능하였으며, 포란수는 체장 $40\~44.5cm$ 되는 것에서 $23\~26$ 만개로 추산되었다. 4. 부화 시설로서는 원추형 망부화기를 급수 파이프에 병렬하고, 각 부화기에는 수량 조절용 발브를 달아서 수중에 설치하는 것이 좋은 동작을 하였다. 5. 알의 발생 중, 분할된 할구(세포)가 배체 밖으로 방출되는 것이 생기면, 그 알은 예외없이 괴사하였다. 6. 친어의 사전 관리를 보다 철저히 하는 것이 긴요함을 느꼈으며, 좋은 먹이와 적절한 수심 및 수온을 유지시키도록 해야 할 것이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.11.1-11.5
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• 2018

Background: Squamous cell carcinoma (SCC) is the most commonly occurring malignant tumor in the oral cavity. In South Korea, it occurs most frequently in the mandible, tongue, maxilla, buccal mucosa, other areas of the oral cavity, and lips. Radial forearm free flap (RFFF) is the most widely used reconstruction method for the buccal mucosal defect. The scar of the forearm donor, however, is highly visible and unsightly, and a secondary surgical site is needed when such technique is applied. For these reasons, buccal fat pad (BFP) flap has been commonly used for closing post-surgical excision sites since the recent decades because of its reliability, ease of harvest, and low complication rate. Case presentation: In the case reported herein, BFP flap was used to reconstruct a cheek mucosal defect after excision. The defect was completely covered by the BFP flap, without any complications. Conclusion: Discussed herein is the usefulness of BFP flap for the repair of the cheek mucosal defect. Also, further studies are needed to determine the possibility of using BFP flap when the defect is deep, and the maximum volume that can be harvested considering the changes in volume with age.

• Archives of Reconstructive Microsurgery
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• 제21권2호
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• pp.159-164
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• 2012

Purpose: Soft tissue defect on posterior side of heel exposing Achilles tendon is vulnerable and require thin flap to improve aesthetic and functional results. Reverse superficial sural artery flap is simple and fast procedure, and it can preserves major arteries, supplies reliable constant blood, causes less donor site complication. Authors reviewed our cases and report the clinical results. Materials and Methods: Nine cases of soft tissue defects on the posterior side of heel exposing Achilles tendon were treated with distally based superficial sural artery flap. There were 6 male and 3 female and mean age was 48.4 years. The size of flap was from $4{\times}4cm$ to $10{\times}15cm$ and mean follow-up period was 23 months. Flap survival, postoperative complications were evaluated. Results: All flaps were survived completely without necrosis. There was one case of partial wound dehiscence that needed debridement and repair, and other one case had recurrent discharge that was healed after removal of calcaneal plate. All patient showed acceptable range of ankle motion. Conclusion: Authors suggest that the reverse superficial sural artery flap could be one of the useful treatment options for the soft tissue defect on posterior side of heel exposing Achilles tendon.

• Archives of Plastic Surgery
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• 제43권6호
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• pp.570-574
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• 2016

Background Fractional $CO_2$ laser is an effective treatment for scars, but most patients complain about sharp burning pain, even after the application of lidocaine ointment. This study analyzed the impact of a vibrating device to nonpharmacologically reduce the acute pain of laser treatment, in accordance with the gate control theory of pain management. Methods This is a prospective study performed from May 2013 through March 2014. Fifty-three patients (mean age, 26.7 years; range, 16-44 years) who had donated livers for liver transplantation were treated with a fractional $CO_2$ laser (10,600 nm; model $eCO_2$, Lutronic Corp) for their abdomen scars. Laser treatment was applied 4 months after surgery. A commercially available, locally applied vibrating device (model UM-30M, Unix Electronics Co. Ltd.) was used, in an on-and-off pattern, together with the $CO_2$ laser. A visual analogue scale (VAS; 0, no pain; 10, most severe pain) of pain sensation was assessed and statistically analyzed using a paired t-test. Results The average VAS score for pain with the vibrating device was 4.60 and the average VAS score without the vibrating device was 6.11. The average difference between scores was 1.51 (P=0.001). Conclusions A locally applied vibrating device was demonstrated to be effective in reducing pain when treating with a fractional $CO_2$ laser. Vibration treatment could be helpful when treating scars with fractional $CO_2$ laser in pain-sensitive patients, particularly children.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.56-61
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• 2015

Purpose: We report on the clinical result after coverage of a soft tissue defect on the medial foot and ankle with an adipofascial flap based on the perforator from the posterior tibia artery. Materials and Methods: Nine patients with soft tissue defects on the medial foot and ankle area from March 2009 to May 2014 underwent the procedure. Average age was 54 years old (range, 8~82 years). There were five male patients and four female patients. The causes of the defect were trauma (4), tumor (3), and infection (2). The pivot point of transposition of this flap is the lower perforator originating from the posterior tibia artery. The fatty tissue side of this flap could be used to resurface the defect. The donor site was closed primarily with the preserved skin, and a small caliber drain tube was used. The split-thickness skin graft was grafted to the flap and the wound. If the wound was still infected, this skin graft could be performed at a later date. Results: All flaps survived and normal soft tissue coverage was obtained for the medial foot and ankle of all patients after the skin graft. Normal footwear was possible for all cases because of thin coverage. There was an extension contracture on the medial ray of the foot, which was resolved by contracture release and skin graft. Conclusion: For the medial foot and ankle soft tissue defect, the medial crural adipofascial flap based on a perforator branch of the posterior tibia artery could be a good option to cover it.

• Journal of Chest Surgery
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• 제46권2호
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• pp.111-116
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• 2013

Background: Heart transplantation in elderly patients has raised concerns because of co-morbidities and limited life expectancy in the era of donor shortage. We examined the outcomes after heart transplantation in elderly patients. Materials and Methods: From March 1994 to December 2011, 81 patients (male:female=64:17, $49.1{\pm}14.0$ years) underwent heart transplantation. The outcomes after heart transplantation in the younger patients (<60 years; group Y, n=60) were compared with those in the elderly patients (${\geq}60$ years; group O, n=21). The follow-up duration was $51.8{\pm}62.7$ months. Results: Early mortality (${\leq}30$ days) occurred in 5.0% (3/60) and 4.8% (1/21) of groups Y and O, respectively (p>0.999). There were no differences in overall survival between the two groups (p=0.201). Freedom from rejection was higher in group O than in group Y (p=0.026). Multivariable analysis revealed that age ${\geq}60$ years was not a significant risk factor for long-term survival; postoperative renal failure was the only significant risk factor for long-term survival (p=0.011). Conclusion: Early and mid-term results of heart transplantation in elderly patients were similar to those in younger patients.