• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.41-48
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• 2009

There are several advantages for groin flap, but its small and unpredictable vessels of pedicle have made it to lose its initial popularity. Although it would be ideal flap when it is focused on its useful advantages such as relative larger size, low donor site morbidity and possible bone graft, there have been few studies for prognostic factors for successful groin flap. Authors intended to determine prognostic factors which are relative with success of free groin flap. From January 1985 to December 2007, 107 patients who underwent groin flap for reconstruction of extremities were selected consecutively. Univariate and multivariate analysis were performed to determine prognostic factors which were related with success of groin flap. Eighty of 107 (74.8%) flaps survived. There was significant difference in success rate according to the recipient site. Nineteen of 20 cases (95%) survived in upper extremities, but 61 of 87 cases (70.1%) survived in lower extremities, which was statistically significant (p=0.022). Univariate analysis showed that mean diameter of donor veins was significantly larger in success group (p=0.021). Groin flap is recommended for reconstruction of upper extremities than lower extremities. It is thought to be critical that surgeons try to match vessel diameters between donor and recipient site.

• Journal of Periodontal and Implant Science
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• v.23 no.1
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• pp.67-76
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• 1993

After periodontal surgery, the potential healing responses were occurred by interaction among junctional epithelium, gingival connective tissue, alveolar bone and periodontal ligament. The only cell that created periodontal regeneration was derived from periodontal ligament. The aim of the study was to evaluate the regenerative effects of the collagen membrane($collacote^{\circ}C$) and autogenous connective tissure graft with periosteum. Experimental periodontitis were created in furcation area of 4 adult dogs with bone removal and gutta percha packing. After 6 weeks later, the gutta percha was removed and experiment was performed divided by 3 groups. 1) Flap operation(control group). 2) Flap operation with collage membrane(Experimental group I). 3) Flap operation with autogenous connective tissue graft with periosteum (Experimental group II). After dogs were sacrificed after two and three weeks, specimens were prepared and stained with hematoxylin-eosin and masson-trichrome stain for light microscopic study. The results were as follows : 1. In all gruoups, connective tissue compartments were increased from two to three weeks especially in experimental group I. 2. Collagen membrane and connective tissue were increased collagen deposits of periodontal ligament. Therefore collagen fiber attached to tooth surface was seen. 3. In al experimental groups, newly forming alveolar bone was seen. 4. Collagen membrane and connective tissue were which prevented proliferation of epithelium, aided connective tissue new attachment and influenced periodontal regeneration.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.3
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• pp.231-238
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• 1995

The scapular flap, described by dos Santos in 1986, has been used successfully for the reconstruction of a variety of defects of oro-mandible. Some have defined the gross and vascular anatomy of the lateral border of the scapula, yet useful anatomical information and a complete description of area and contour of each cut surface of lateral border of scapula, which is very important for esthetic and functional reconstruction using dental implants, are missing. These prompted us to clarify the cross-sectional area of lateral border of scapula. Twenty three scapulas of 15 fixed adult Caucasian cadavers were sectioned in every 1cm interval along the lateral border of scapular, and the metric relations and the shape of cut surface were assessed. The lateral border of the scapula, consisting of cortico-cancellous bone measuring $7.86{\pm}0.97mm$ in width, $19.6{\pm}2.86mm$ in height and $12{\pm}1.78cm$ in length, could be harvested as an osteocutaneous scapular flap or as a single vascularized bone flap. The mean thickness of cortical bone of lateral, medial, dorsal and costal surface was $0.46{\pm}1.48mm$, $1.78{\pm}1.34mm$, $1.54{\pm}1.11mm\;and\;1.35{\pm}0.87mm$, respectively. So we have thought that all scapular transplants could be supported osseointegrated implants for fixation of dental prosthesis.

• Journal of Periodontal and Implant Science
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• v.52 no.4
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• pp.298-311
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• 2022

Purpose: The aim of this study was to evaluate the clinical outcomes of periodontal granulation tissue preservation (PGTP) in access flap periodontal surgery. Methods: Twenty patients (stage III-IV periodontitis) with 42 deep periodontal pockets that did not resolve after non-surgical treatment were consecutively recruited. Access flap periodontal surgery was modified using PGTP. The clinical periodontal parameters were evaluated at 9 months. The differences in the amount of granulation tissue width (GTw) preserved were evaluated and the influence of smoking was analyzed. Results: GTw >1 mm was observed in 97.6% of interproximal defects, and the granulation tissue extended above the bone peak in 71.4% of defects. At 9 months, probing pocket depth reduction (4.33±1.43 mm) and clinical attachment gain (CAG; 4.10±1.75 mm) were statistically significant (P<0.001). The residual probing depth was 3.2±0.89 mm. When GTw extended above the interproximal bone peak (i.e., the interproximal supra-alveolar granulation tissue thickness [iSUPRA-GT] was greater than 0 mm), a significant CAG was recorded in the supra-alveolar component (1.67±1.32 mm, P<0.001). Interproximal gingival recession (iGR) was significant (P<0.05) only in smokers, with a reduction in the interdental papillary tissue height of 0.93±0.76 mm. In non-smokers, there was no increase in the iGR when the iSUPRA-GT was >0 mm. The clinical results in smokers were significantly worse. Conclusions: PGTP was used to modify access flap periodontal surgery by preserving affected tissues with the potential for recovery. The results show that preserving periodontal granulation tissue is an effective and conservative procedure in the surgical treatment of periodontal disease.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.848-853
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• 2001

Background: Sternal infection or dehiscence after cardiac surgery through median sternotomy is rare. If suitable treatment is not performed for the complication, however, the mortality is high. For 12 patients with sternal dehiscence or infection, we performed wide excision of the infected and necrotic tissue and covered with muscle flap(s) to obliterate the mediastinal dead space. Material and method: Sternal infection or dehiscence occurred in 13 of patients who underwent cardiac surgery One patient, who died of cerebral infarction before the sternal complication was treated, was excluded in this study. The sternal wound complication occurred in 6 of patients with valve replacement and 6 of patients with coronary bypass surgery, respectively. Since 1991, 9 patients underwent definite surgical debridement and muscle transposition as soon as fever was controlled with closed irrigation and drainage. The necrotic tissue and bone was widely excised and the sternal dead space was eradicated with the single flap or the combined flaps of right pectoralis flap(turnover flap), left pectoralis flap(turnover flap or rotation-advancement flap), and right rectus muscle flap. Result : There was no mortality in 12 patients with coverage of muscle flap(s) for sternal infection or dehiscence The mean interval between the diagnosis of sternal complication and the myoplasty was 6.6$\pm$3.9 days. In 4 patients, one pectoralis muscle flap was used, and in 8 patients both pectoralis muscle flaps were used. For each 1 patient and 2 patients in each group, right rectus muscle flap was added. For the last 3 patients, a single pectoralis flap was used to eradicate the mediastinal dead space and the longer placement of the mediastinal drain catheter was needed. One patient, who had suffered from necrosis of left pectoralis flap(rotation-advancement flap) with subsequent chest wall abscess after coverage of both pectoralis flaps, was managed with reoperation using right rectum flap. Conclusion : Sternal dehiscence or infection after cardiac operation can be readily managed with wide excision of necrotic infected tissue(including bone) and muscle flap coverage after short-term irrigation of sternal wound. The sternal(mediastinal) dead space may be completely eradicated with right pectoralis major muscle flap alone.

• Archives of Reconstructive Microsurgery
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• v.23 no.1
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• pp.1-7
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• 2014

Purpose: Recent studies have reported on application of fibrin glue composed of fibrinogen and thrombin to nerve anastomosis, which can be another candidate for vessel anastomosis. However, no research regarding the risk and effectiveness of thrombin in microvascular free tissue transfer has been reported. Therefore, the aim of study is to determine the risk and effectiveness of thrombin on microvascular free tissue transfer through clinical cases. Materials and Methods: Twenty-five patients underwent free flap reconstruction for soft tissue defect or bone exposure in our institute from March 2011 to February 2014. In the group using thrombin, dissolved powder thrombin (5,000 IU/amp) was mixed with 10 mL normal saline. Saline mixed with thrombin was applied on the flap, recipient, and around vessel anastomosis. In the control group, free flap was performed using the same method, except using thrombin. We analyzed the results between the two groups. Results: All flaps survived. The group using thrombin included 14 patients and the control group included 11 patients. Hematoma was found in two cases, respectively, in each group. The group using thrombin showed lower incidence of hematoma than the control group. No difference in survival rate of the flap was observed between the thrombin group and the control group. Conclusion: Results of this study showed that use of saline mixed with thrombin in free tissue transfer may be safe and effective for prevention of hematoma formation in the recipient site.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.36-42
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• 2004

Materials and Methods: We studied 50 cases of peroneal perforating branch about branching pattern, course, length of vascular pedicle, and perforating level of the perforating cutaneous branches from Oct. 1985 to November 2003 by doppler flow meter and intraoperative findings. Results: 1) The perforating cutaneous branches were classified into four types, the Straight Branch (27cases), the Proximal Oblique Branch (11cases), the Branch from Muscular Artery (10cases), the Distal Oblique Branch(2 cases) respectively. The most common patten was Straight Branch, that was 54%. 2) There were 3 pathways of these branches, the most common one passed between the Soleus and Peroneus muscles(34 cases, 68%) 3) The length of vascular pedicle in Buoy Flap was variable from from 3 cm to 15 cm, but 32 cases(64%) were distributed between 5 cm and 6 cm. 4) The perforating level of branches were 5.9 cm in average from fibular neck to subcutaneous perforator artery 5) Peroneal Buoy Flap in possible to reconstruct both seperated bone and skin defect in some distance by One-Stage Operation and we can harvest maximal $8{\times}16cm$ sized flap in one perforating artery. If we include more two perforating artery, we get more wide flap which can cover large defect.

• Archives of Craniofacial Surgery
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• v.22 no.2
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• pp.105-109
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• 2021

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

• Journal of Periodontal and Implant Science
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• v.23 no.1
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• pp.16-26
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• 1993

In order to investigate the healing effect on inflammation and bone regeneration of low power density laser radiation in dogs, experimental periodontitis was made in dog mandibular 3rd, 4th premolars. All teeth were classified with four groups of two experimental group and control groups. The second group were irradiated on periodontitis site and the first group were control. The fourth group were irradiated on periodontitis site flap operation and the third group were flap control. Experimental groups were irradiated with GaAs low power density laser of pulse wave and continuous wave of 904nm every day by five days respectively and then control group and experimental groups were evaluated by histo-pathological study. The results were as follows : 1. Experimental periodontits site of dog were irradiated with GaAs low power laser results in reducing of pseudoepitheliomatous proliferation and inflammation at light microscope. 2. After irradiation with low power density laser, experimental groups were revealed that PDL forming activity were increased and newly formed collagen deposition were observed. 3. Low power density lsaer irradiation on experimental periodontits site after flap operation showed that decreasing of inflammation, reducing of osteoclast activity. Capillary proliferation, reduction of pseudoepitheliomatous proliferation. 4. After irradiation with low power density laser on flap experimental site, experimental groups were revealed that newly formed collagen in periodontal ligament and alveolar bone were detected on MT staining.

• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.4
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• pp.512-518
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• 2010

The impaction of the maxillary permanent incisor is a common clinical problem and is mostly found at the "labial to the alveolar process." Surgical exposure and orthodontic treatment with fixed orthodontic appliances can be considered if normal eruption of the labillay impacted tooth is not expected. Surgical exposure of the impacted tooth, that is usually under the attached gingiva or is surrounded by alveolar bone through gingivectomy and removal of alveolar bone, may give a rise to complications such as diminution in the width of the attached gingiva, inflammation of the gingiva, and the loss of marginal alveolar bone. Therefore, closed eruption technique, which includes surgical exposure and orthodontic treatment with fixed orthodontic appliances followed by repositioning of surgical flap, is preferred. However, apically repositioned flap of the impacted tooth, which is beneath the movable submucosal area or is above the alveolar crestal area, can prevent unwanted exposures and facilitate successful tooth eruption. In this report, we described esthetic results of three patients with unerupted maxillary permanent incisor who were performed with an apically positioned flap without the loss of attached gingiva.