• Archives of Plastic Surgery
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• v.37 no.5
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• pp.607-612
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• 2010

Purpose: Maxillectomy for malignant tumor resection often leads to functional and aesthetic sequalae. Reconstruction following maxillectomy has been a challenging problem in the field of head and neck cancer surgery. In this article, we described three dimensional midface reconstructions using free flaps and their functional and aesthetic outcomes. Methods: We reconstructed 35 cases of maxillectomy defects using 9 radial forearm free flaps, 7 lattisimus dorsi musculocutaneous free flaps, 6 rectus abdominis musculocutaneous free flaps, 4 fibular osteocutaneous free flaps, and 9 anterolateral thigh free flaps, respectively. We classified post-maxillectomy defects by Brown's classification. 1 Articulation clarity was measured with picture consonant articulation test. Swallowing function was evaluated with the University of Washington quality-of-life Head and Neck questionnaire by 4 steps.2 Aesthetic outcomes were checked to compare preoperative with postoperative full face photographs by 5 medical doctors who did not involve in our operation. Results: The average articulation clarity was 92.4% (100-41.9%). 27 (81.9%) patients were able to eat an unrestricted diet. Aesthetic results were considered excellent in 18 patients (51.4%). Functional results were best in the group reconstructed with fibular osteocutaneous free flap. Considering the range of wide excision, aesthetic results is best in the group reconstructed with anterolateral thigh free flap. Conclusion: The free flap is a useful technique for the reconstruction of the midface leading to good results, both functionally and aesthetically. Especially, because osteocutaneous flap such as fibular osteocutaneous free flap offered bone source for osteointegrated implant, It produces the best functional results. And perforator flap like as anterolateral thigh free flap reliably provides the best aesthetic results, because it provides sufficient volume and has no postoperative volume diminution.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.130-138
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• 1999

The lower extremity injuries are extremely increasing with the development of industrial & transportational technology. For the lower extremity injuries that result from high-energy forces, particularly those in which soft tissue and large segments of bone have been destroyed and there is some degree of vascular compromise, the problems in reconstruction are major and more complex. In such cases local muscle coverage is probably unsuccessful, because adjacent muscles are destroyed much more than one can initially expect. Reconstruction of the lower extremity has been planned by dividing the lower leg into three parts traditionally The flaps available in each of the three parts are gastrocnemius flap for proximal one third, soleus flap for middle one third and free flap transfer for lower one third. Microvascular surgery can provide the necessary soft tissue coverage from the remote donnor area by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde flow flaps are well established in island flaps. Retrograde flow anastomosis could not interrupt the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. During 5 years, from March 1993 to Feb. 1998, we have done 68 free flap transfers in 61 patients to reconstruct the lower extremity. From analysis of the cases, we concluded that for the reconstruction of the lower extremity, free flap transfer yields a more esthetic and functional results.

• Journal of Periodontal and Implant Science
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• v.29 no.1
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• pp.153-171
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• 1999

The purpose of this study was to evaluate the effect of modified calcium sulfate paste on periodontal regeneration. l-wall intrabony defect(mesio-distal width: 4mm, depth: 4mm) was surgically created on the distal side of P2 and mesial side of p4 in four dogs. The control group(GFS) was treated with conventional flap operation alone, and the experimental group(CS) was treated with conventional flap operation with modified calcium sulfate paste application. Both control and experimental groups were sacrificed after 8weeks of healing period, The results of histological and histometric observations were as follows. 1. The length of the junctional epithelium was 0.41${\pm}$0.01mm in the control groups, 0.47${\pm}$0.01mm in the experimental group. 2. The connective tissue attachment was 0.28${\pm}$0.02mm(6.15${\pm}$0.28%) in the control group, 0.18${\pm}$0.01mm(3.41${\pm}$0.14%) in the experimental group. The control group showed more connective tissue attachment. 3. The new cementum formation was 3.80${\pm}$0.06mm(84.80${\pm}$0.33%) in the control group, 4.49${\pm}$0.06mm(87.57${\pm}$0.15%) in the experimental group. Both groups showed a lot of new cementum formation. 4. The new bone formation was 1.43${\pm}$0.03mm(32.37%) in the control group, 2.04${\pm}$O.09mm(40.94%) in the experimental group. 5. The inflamatory cells were observed partially around resorbed calcium sulfate in the connective tissue of the experimental group. 6. Partially resorbed calcium sulfate were found within the connective tissue, around alveolar bone, and in the newly formed alveolar bone, On the basis of these results, newly formed calcium sulfate paste enhanced new bone formation and new cementum formation. The resorption rate of calcium sulfate seems to be controlled by the add-in compounds. Thus research about biocompatibility and adequate resorptionrate is required to develop a improved material.

• Journal of Periodontal and Implant Science
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• v.24 no.3
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• pp.618-632
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• 1994

The ultimate goal of periodontal therapy is promoting the regeneration of lost periodontal tissue. The purpose of this study is to evaluate the effect of treatment using decalcified freeze dried bone allograft as a bone graft material. 47 intrabony defects from 27 patients with clinical diagnosis of chronic periodontitis were selected among those 24 defects were treated via flap operation only and designated as the control group, the other 23 defects were treated with decalcified freeze dired bone allografting via flap operation and designated as the experimental group. Clinical parameters including probing depth, loss of attachment, probing bone level and gingival recession have been recorded at 6th months, and the significance of the changes has been analyzed. The results are as follows : 1. Probing depths were reduced significantly in both control group($2.75{\pm}0.99mm$) and experimental group($3.69{\pm}0.97mm$) postoperatively(p<0.01). Experimental group showed significantly higher decrease compared to the control group(p]0.01). 2. Loss of attachment showed statistically significant decrease in both control group($1.77{\pm}1.08mm$) and experimental group postoperatively($2.70{\pm}1.55mm$). Experimental group showed significantly higher decrease compared to the control group(p]0.05). 3. Probing bone levels were reduced with statistically significance in both control group($1.08{\pm}0.97mm$) and experimental group($4.00{\pm}1.41mm$) postoperatively(p<0.01). Experimental group showed significantly higher decrease compared to the control group(p<0.01). 4. Gingival recession showed statistically significant increase in the control group($1.21{\pm}0.72mm$) and experimental group($1.00{\pm}1.09mm$) postoperatively(p<0.01). There was no statistical significance between the control group and the experimental group. On the basis of these results, treatment using allogenic decalcified freeze dried bone is effective in reducing probing depth, loss of attachment and probing bone level. Therefore allogenic decalcified freeze dried bone is an effective bone graft material in periodontal regeneration.

• The Journal of the Korean dental association
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• v.51 no.12
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• pp.643-649
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• 2013

The aim of this study was to achieve the healing of peri-implantitis defects and the hard tissue regeneration using the augmentation of a xenograft on defect site. Two patients were treated with the surgical approach. With a full muco-periosteal flap elevation, the implant surfaces were exposed and taken the debridement of granulation tissue around the abutment. Each surface of the abutments was prepared with the air-abrasive device (PerioFlow$^{(R)}$) for decontamination. Bovine-derived bone mineral (Bio-Oss collagen$^{(R)}$) was then used to fill the defects, and no membrane was placed on the grafting site. Radiographs and clinical photo was taken to compare from baseline status. Within the limits of the present case, this case shows the significance of the surgical treatment of peri-implantitis. And this also verifies the stability of bovine-derived bone mineral and effectiveness of Air-abrasive device (PerioFlow$^{(R)}$).

• Archives of Plastic Surgery
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• v.40 no.6
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• pp.779-782
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• 2013

Chondroblastomas are rare entities accounting for approximately 1% of all primary bone tumors. We describe a case of a 7-year-old girl with a giant chondroblastoma of the maxilla, treated with bilateral class III maxillectomy and reconstruction with a double-barreled and double skin paddle fibular free flap. We show evidence of an excellent aesthetic outcome at 6 months' follow up with no evidence of tumor recurrence.

• Journal of Periodontal and Implant Science
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• v.32 no.3
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• pp.565-576
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• 2002

The ultimate goal of periodontal therapy is the regeneration of periodontal tissue which has been lost due to destructive periodontal disease. To achieve periodontal regeneration, various kinds of methods have been investigated and developed, including guided tissue regeneration and bone graft. Bone graft can be catagorized into autografts, allografts, xenografts, bone substitutes. And materials of all types have different biological activity and the capacity for periodontal regeneration, but ideal graft material has not been developed that fits all the requirement of ideal bone graft material. Intensive research is underway to identity, purify, synthesize a variety biologic modulators that may enhance wound healing and regeneration of lost tissues in periodontal therapy. The present study evaluates the effects of ABM/P-15 on the periodontal regeneration in intrabony defects of human. We used thirty four 2-wall or 3-wall osseous defects in premolars and molars of chronic peridontitis patient that have more than 5mm pockets and more than 3mm in intrabony defect. 12 negative control group underwent flap procedure only, 11 positive control group received DFDBA graft with flap procedure, and 11 experimental group received ABM/P-15 graft with flap procedure. The changes of probing pocket depth, loss of attachment and bone probing depth following 6months after treatment revealed the following results: 1. The changes of probing pocket depth showed a statistically significant decrease between after scaling and 6months after treatment in negative control(2.0${\pm}$0.9mm), positive control(3.0${\pm}$0.9mm), and experimental group (3.4${\pm}$1.5mm) (P<0.01). Significantly more reduction was seen in experimental group compared to negative control group (P<0.05). 2. The changes of loss of attachment showed a statistically significant decrease between after scaling and 6months after treatment in positive control(2.0${\pm}$0.6mm), and experimental group (2.2${\pm}$l.0mm) except negative control group(0.1${\pm}$0.7mm) (P<0.01). Significantly more reduction was seen in both experimental and positive control group compared to negative control group(P<0.05). 3. The changes of bone probing depth showed a statistically significant decrease between after scaling and 6months after treatment in positive control(2.7${\pm}$l.0mm), and experimental group (3.4${\pm}$1.3mm) except negative control(0.l${\pm}$0.9mm) (9<0.01). Significantly more reduction was seen in both experimental and positive control group compared to negative control group (P<0.05). The results suggest that the use of ABM/P-15 in the treatment of periodontal intrabony defects can reduce loss of attachment and bone probing depth more than flap operation only. It suggests that ABM/P-15 may be an effective bone graft material for the regeneration of periodontal tissue in intrabony defects.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.62-66
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• 2009

Purpose: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. Materials and methods: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. Results: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. Conclusion: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.84-90
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• 2021

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5-6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.15-21
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• 1999

Soft tissue defect on heel area of the foot present difficult problems particularly because of anatomic property of plantar surface of the foot. There is a paucity of available local tissue in the foot for coverage. In addition to having little expandable tissue, the foot's plantar surface has a unique structure, making its replacement especially challenging. Plantar skin is attached to the underlying bone by fibrous septa, preventing shear of the soft-tissue surfaces from the underlying skeleton. Plantar surface of foot is in constant contact with the environment. Protective sensibility also would be maintained or restored in the ideal reconstruction. So the ideal flap for reconstruction of the heel should include thin, durable hairless skin with potential for reinnervation. The aim of this article is to present a clinical experience of free lateral arm neurosensory flap for reconstruction of the heel. From March 1995 to December 1997, a total 16 lateral arm free flaps were performed to soft tissue defects on the weight-bearing area of the hindfoot. we used tibial nerve as recepient nerve in 11 and calcaneal branch of tibial nerve in 5 for restoration of sensibility of flap. All cases survived completely. A static two-point discrimination of 14 to 34mm was detected in the flap. Radial nerve palsy which was caused by hematoma in donor site occured in one case, but recorverd in 3 weeks later completely. In conclusion, the lateral arm free flaps are versatile, reliable and sensible cutaneous flap and especially indicated for soft tissue defect on plantar surface of the hindfoot which are not good indications for other better-known flaps.